Sanford School of Public Policy, Duke University, 302 Towerview Road, Rubenstein Hall, Office 262, Durham, NC, 27708, USA.
Bureau for Research and Economic Analysis of Development (BREAD), London, UK.
Demography. 2020 Oct;57(5):1647-1680. doi: 10.1007/s13524-020-00900-9.
Zika virus epidemics have potential large-scale population effects. Controlled studies of mice and nonhuman primates indicate that Zika affects fecundity, raising concerns about miscarriage in human populations. In regions of Brazil, Zika risk peaked months before residents learned about the epidemic and its relation to congenital anomalies. This spatiotemporal variation supports analysis of both biological effects of Zika infection on fertility and the effects of learning about Zika risk on reproductive behavior. Causal inference techniques used with vital statistics indicate that the epidemic caused reductions in birth cohort size of approximately one-quarter 18 months after Zika infection risk peaked but 10 months after public health messages advocated childbearing delay. The evidence is consistent with small but not statistically detectable biological reductions in fecundity, as well as large strategic changes in reproductive behavior to temporally align childbearing with reduced risk to infant health. The behavioral effects are larger for more-educated and older women, which may reflect facilitated access to information and to family planning services within high-risk, mosquito-infested urban locations as well as perceptions about the opportunity costs of risks to pregnancy and infant survival.
寨卡病毒流行可能对人口产生大规模影响。对小鼠和非人类灵长类动物的对照研究表明，寨卡病毒会影响生育能力，引发对人类流产的担忧。在巴西的一些地区，寨卡病毒的风险在居民了解疫情及其与先天畸形的关系之前的数月就达到了高峰。这种时空变化支持对寨卡病毒感染对生育力的生物学影响以及对了解寨卡病毒风险对生殖行为的影响进行分析。利用生命统计数据使用的因果推理技术表明，寨卡病毒感染风险达到高峰后 18 个月，出生队列规模减少了约四分之一，但在公共卫生部门建议推迟生育 10 个月后。这一证据与生育能力的微小但在统计学上无法检测到的降低一致，以及为使生育时间与婴儿健康风险降低相吻合而对生殖行为进行的重大战略调整一致。对于受教育程度更高和年龄更大的女性来说，这种行为影响更大，这可能反映了在高风险、蚊虫滋生的城市地区更容易获得信息和计划生育服务，以及对怀孕和婴儿生存风险的机会成本的认识。
