Research Questions
What are the patterns of fertility transition in South Africa? What have been the causes of the stalling of fertility decline in South Africa? Do we expect a resumption of fertility decline in the recent future? What is the impact of HIV on fertility in populations which are highly affected by HIV?
Rationale
We have shown in the analyses done by Moultrie et al (2008) that after a stalling of the decline in fertility seen during the nineties and the early part of this decade, there now seems to be a resumption of falling overall fertility rates after 2005. Birth interval spacing in this community as in other places in South Africa is unusually long, and we are exploring the role of length of pregnancy interval in overall fertility and determining its contribution to the overall decline. Further, we plan to address the relationship between fertility and HIV, and the possible impact of HIV treatment on fertility and desire for children (with collaborators at the University of Cape Town), using data collected within the household surveillance.
Findings
South Africa has recorded one of the lowest fertility levels in Africa. However, fertility transition in South Africa has an ethnic dimension, with variance noted between fertility levels of whites, Asians, colored and blacks. Ethnic black people experienced very high fertility levels of over 5.5 children per woman in the past but declines to almost 2.5 children per woman have been noted. Although the black population in South Africa lagged behind other ethnic groups in fertility transition, they have now experienced phenomenal and sustained fertility decline, which is now approaching replacement level fertility. In the surveillance area, which is predominantly rural and more than half the households are poor, fertility has declined to about 2.8 births per woman recorded in 2008. The data from the surveillance area confirms that fertility has declined even among rural and poor rural populations.
However, teenage fertility has not changed declined. The data also show that although there has been an overall decline in fertility rates by age group, the drop in the age-specific fertility rates in the age group 15-19 seems to have stagnated at about 0.1 children per woman during the past 10 years. Thus, the issue of teenage fertility remains an important issue in South Africa.
Policy Implications
1. The high rate of teenage pregnancies has far-reaching consequences, especially for Africans who are among the poorest and most disadvantaged groups in the country. The majority of these pregnancies are neither planned nor wanted. Specific focus needs to be placed on empowerment programmes for teenagers as well as vulnerable rural South African women in order for them to take control of their reproductive choices.
2. The failure to have fertility changes at older ages might be a reflection of the failure of the family planning program to cater for women who would want to stop childbearing. Terminal methods like sterilization might be the appropriate for older women.
Further work
Studies on the impact of HIV on fertility are producing contradictory evidence on whether HIV has a depressing effect at the population level. According to Forston (2009) based on DHS from 12 countries “results suggest that HIV had very little impact on fertility, both overall and in a sample of HIV-negative women”. However, Kongnyuy and Wiysonge (2008) argue that in Cameroon “fertility rates are lower in HIV-positive than HIV-negative women”. It is biologically plausible that HIV could depress a woman’s ability to carry a pregnancy to full term, it is also plausible that people in advanced stages of HIV infection may be less frequently exposed to the risk of becoming pregnant. Most studies are based on survey data, and it is not possible to establish causality, since it is unclear when HIV infection would have taken place. The second limitation relates to selectivity bias in HIV test data. According to Magadi and Agwanda “High fertility HIV sero-positive women are more likely to develop AIDS symptoms and die earlier, since pregnancy may hasten AIDS progression”. HIV-positive women interviewed may represent a select sub-group with low fertility, distorting the observed relationship between HIV and fertility. However, whether pregnancy hastens HIV progression is also a moot point. The availability of longitudinal data in the ACDIS allows for the measurement of causality to an extent since data on individual HIV acquisition and fertility histories of each woman are available, and in 2010-1011 we plan to address the question of the relationship between HIV and fertility with ACDIS data.