Childbearing in an AIDS epidemic

The consequences of the African AIDS epidemic are growing--not just in size--but in complexity. These consequences are no longer just biological; increasingly, they are also social, cultural, economic, and psychological. In this dissertation, I consider one overlooked consequence of the epidemic by asking how HIV infection affects the desire to have children in a context where reproduction is so highly valued. Taking advantage of a unique situation in rural Malawi, where no one knew their HIV status prior to testing being introduced as part of an ongoing longitudinal survey, I use a quasiexperimental design and in‐depth interviews to examine the evidence for an intentional relationship between HIV/AIDS and fertility. Rural Malawians adjust their childbearing desires in response to information about their HIV status. The relationship--both in magnitude and in motivation--is highly gendered. HIV positive women fear that a pregnancy will worsen their disease. Despite this widely shared belief, there remains a lot of ambivalence: women who are positive, or who fear they are positive, want to live normal lives. For some, that means avoiding childbearing as a strategy to delay the symptoms of HIV. For others, it means having children as they would have had despite what they think it might mean for their health. Male fertility preferences are more volatile to information about HIV status. Men see childbearing as futile if they are HIV positive because they anticipate their own death and the death of their future offspring. However, men may be less likely to translate their preferences into action because--after learning they are infected--they are less motivated to stop having children than they are unmotivated to have children. This dissertation shows that rural Malawians adapt their childbearing preferences to information about their HIV status. There are strategies in these adaptations, as well as hope for a future where the conditions of childbearing in an AIDS epidemic might have changed. I conclude by discussing what the findings mean for fertility, fertility theory, and policy.