School of Economics, University of Johannesburg, Auckland Park, South Africa.
Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
PLoS One. 2023 Apr 4;18(4):e0284032. doi: 10.1371/journal.pone.0284032. eCollection 2023.
This paper investigates the effect of under-five mortality, child support grant (CSG) coverage and the rollout of antiretroviral therapy (ART) on fertility in South Africa. The study employs the quality-quantity trade-off framework to analyse the direct and indirect factors affecting fertility using the two stage least squares fixed effects instrumental variable approach. The analysis uses balanced panel data covering nine provinces from 2001-2016. This period was characterised by significant increases in the child support grant coverage and ART coverage. Furthermore, this period was characterised by a significant decline in the under-five mortality rate. We find no evidence to support the hypothesis that increases in the CSG coverage are associated with an increase in fertility. This finding aligns with previous literature suggesting that there are no perverse incentives for childbearing associated with the child support grant. On the other hand, results indicate that an increase in ART coverage is associated with an increase in fertility. Results also show that a decrease in under-five mortality is associated with a decline in fertility over the sample period. HIV prevalence, education, real GDP per capita, marriage prevalence and contraceptive prevalence are also important determinants of fertility in South Africa. Although the scale up of ART has improved health outcomes, it also appears to have increased fertility in HIV-positive women. The ART programme should therefore be linked with further family planning initiatives to minimise unintended pregnancies.
本文研究了五岁以下儿童死亡率、儿童抚养补助金（CSG）覆盖范围以及抗逆转录病毒疗法（ART）的推出对南非生育率的影响。本研究采用质量-数量权衡框架，利用两阶段最小二乘固定效应工具变量法，分析了影响生育率的直接和间接因素。该分析使用了 2001 年至 2016 年涵盖 9 个省份的平衡面板数据。这一时期的特点是儿童抚养补助金覆盖范围和 ART 覆盖范围显著增加。此外，这一时期五岁以下儿童死亡率显著下降。我们没有证据支持这样一种假设，即 CSG 覆盖范围的增加与生育率的增加有关。这一发现与先前的文献一致，即儿童抚养补助金没有与生育相关的不良激励。另一方面，结果表明，ART 覆盖范围的增加与生育率的增加有关。结果还表明，在样本期内，五岁以下儿童死亡率的下降与生育率的下降有关。艾滋病毒流行率、教育、人均实际 GDP、婚姻流行率和避孕普及率也是南非生育率的重要决定因素。尽管抗逆转录病毒疗法的推广改善了健康结果，但它似乎也增加了艾滋病毒阳性妇女的生育率。因此，ART 方案应与进一步的计划生育倡议相结合，以尽量减少意外怀孕。
