Childhood disease and the precautionary demand for children

The childhood disease burden depends on the prevalence of infectious diseases, their case fatalities, and long-term morbidity. We propose a quantity–quality model of fertility choice under uncertainty that emphasizes morbidity and mortality from infectious disease. The fertility response to a decline in child mortality depends on the morbidity effect of the disease, the prevalence rate, and whether the prevalence or case fatality rate declines. Fertility follows mortality and morbidity, but since mortality and morbidity do not always move in the same direction, the fertility response may be dampened or nonmonotonic. Disease-specific evidence from sub-Saharan Africa supports these theoretical predictions.