HIV/AIDS and the Stall in Fertility Decline in Rural South Africa

Jill Williams, University of Colorado at Boulder
Christie Sennott, University of Colorado at Boulder
Casey Blalock, University of Colorado at Boulder
Mildred Shabangu, Bubhezi Healthcare Clinic
Jane Menken, University of Colorado at Boulder
Mark Collinson, University of the Witwatersrand
Kathleen Kahn, University of the Witwatersrand
Stephen Tollman, University of the Witwatersrand

In an era of fertility decline in South Africa, high HIV prevalence and increasing AIDS mortality was expected to result in further declines in fertility and negative population growth. However, fertility decline actually stalled in rural black areas with high HIV prevalence. We use prospective data from the Agincourt Health and Demographic Surveillance Site from 1993-2010 to investigate whether HIV/AIDS put upward pressure on fertility through insurance effects or replacement effects. Due to differences in fertility and mortality regimes we examine South African and former Mozambican refugees separately. We find no evidence of insurance effects in either population and strong evidence of replacement effects for both populations. Mozambican women accomplish a decline in fertility through reductions in first birth rates at all ages and significant reductions in unplanned fertility. Fertility decline for South Africans stalled during the time of HIV/AIDS due to a lack of decline in unplanned fertility.