The Impact of Childhood Mortality on Fertility in Rural Tanzania: Evidence From the Ifakara and Rufiji Health and Demographic Surveillance Systems

This manuscript examines the relationship between child mortality and subsequent fertility using longitudinal data on births and childhood deaths occurring among 15,291 Tanzanian mothers between 2000 and 2015. Generalized hazardreg ression analyse sassess the effect of child loss on the hazard of conception, adjusting for child-level, mother-level, and contextual covariates. Results show that time to conception is most reduced if an index child dies during the subsequent birthinterval, representing the combined effect of biological and volitional replacement. Deaths occurring during prior birth intervals were associated with accelerated time to conception during future intervals, consistent with hypothesized insurance effects of anticipating future child loss, but this effect is smaller than replacement effects. The analys is reveals that residence in areas of relatively high child mortality is associated with hastened parity progression, again consistent with the insurance hypothes is. Investigation of high-order interactions suggests that insurance effects tend to begreater in low-mortality communities, replacement effects tend to be stronger in high mortality community contexts, and wealthier familie stend to exhibit a weaker insurance response but a stronger replacement response to childhood mortality relative to poorer families.