The central aim of this dissertation research is to expand understanding of fertility preferences in times of social and economic crisis, particularly during a disease epidemic. Using the case of the severe AIDS epidemic in rural Malawi, a country with high fertility and high HIV prevalence, the investigator employs mixed methods to test economic and socio-cultural theories of fertility through exploring how "or if" thinking about childbearing changes in unsettled times. Specifically, the research studies the social mechanisms through which HIV influences fertility preferences. While there is an existing literature on the biological effect of HIV infection on fertility, little is known about how behavioural changes associated with the epidemic affect fertility. However, as HIV testing spreads and the consequences of earlier infections are felt in rural sub-Saharan African communities, the effect of the epidemic on fertility preferences becomes increasingly important for understanding how such preferences are shaped and how behavioural changes will alter the demographic future of the region. The quantitative component of the current project will utilize high quality longitudinal data collected between 2001 and 2006 from the Malawi Diffusion and Ideational Change Project (MDICP) to compare fertility preferences before and after HIV testing, and following an AIDS-related compositional change in the household such as an AIDS-related death or the fostering of orphans. The qualitative component of the project will consist of in-depth interviews with a subsample of MDICP respondents and with women at prevention of mother to child transmission clinics. These data will be used to investigate the specific pathways through which the heightened insecurity surrounding the AIDS epidemic influences thinking about fertility. The broader impacts of the research are threefold. Through wide dissemination of the results in publication and at scientific conferences in the United States and sub-Saharan Africa, the project will advance theoretical understanding of African fertility and the nature of stalled fertility transitions in sub-Saharan Africa. Second, the findings will help local and international policymakers to anticipate social, demographic and epidemiological changes associated with fertility as the AIDS epidemic progresses. Finally, the research will serve to identify the specific reproductive goals and needs of HIV positive women, a largely underserved yet growing population.
