Uncertain Child Survival and Fertility: The Effects of Child Morbidity and Mortality

This paper analyzes the response of fertility and human capital investment to changes in childhood disease burden. Unlike previous child mortality-fertility studies, it focuses on disease-related mortality and distinguishes between disease morbidity and mortality. When child survival is uncertain, a fall in childhood disease burden may lower or raise total fertility in contrast to the unambiguously positive relationship in other studies. The fertility response depends on the type of disease (the severity of its long-term effects), the level of disease burden, and whether the disease burden falls due to lower infection or case fatality rates. Fertility rates follow mortality and morbidity, but mortality and morbidity do not always move in the same direction in response to a change in disease burden, dampening the fertility response. Evidence from panel data on malaria spanning 1985-2005 for 44 countries in sub-Saharan Africa supports a stronger, more positive response of fertility to child mortality when disease morbidity moves in the direction of mortality.