Bucking social norms: Examining anomalous fertility aspirations in the face of HIV in Lusaka, Zambia
Section snippets
Background
The effect of HIV on fertility behavior as well as pregnancy preferences complicates reproductive decision-making, negotiation and behavior (Trinitapoli and Yeatman, 2011). Previous individual-based research from sub-Saharan Africa examining HIV status and fertility preferences has generally found HIV to have a depressing effect on fertility desires (Johnson et al., 2009, Kaida et al., 2011). Qualitative work by Baylies in Zambia with respondents in households where long-term AIDS illness had
Anomalous Case Analysis
While survey research provides the power to identify patterns across large groups, qualitative methods are better at revealing new information and the richness of complex dynamics. Anomalous Case Analysis (ACA) is a methodology that tries to employ the strengths of each where anomalous cases identified through logistic regression of survey data can identify individuals that do not adhere to predicted patterns. Qualitative follow-up interviews with these individuals can reveal additional factors
Desired number of children
In the community-based sample, most right-tail respondents ended up having more children than initially desired, ranging from one to five children above their original figure. Right-tail respondents mentioned that economic hardship made it difficult to have many children, but they were not motivated to reduce their fertility desires based on that. Other considerations such as perceptions of what are socially or religiously acceptable, or personal experiences that were highly influential,
Discussion
This application of Anomalous Case Analysis in Lusaka found revealing differences in the relevant structures and schema in place governing fertility decision-making in this high HIV-prevalence context. Among both HIV-positive and community-based respondents in the right-tail of the distribution, higher fertility desires seemed less affected by adverse economic or health conditions. They seemed less in control of their fertility desires than left-tail respondents based on the fact that even
Conclusion
Using survey findings to help draw our sample for the in-depth interviews serves two purposes. It allowed us to: 1) examine in greater depth the perspectives of individuals who hold non-typical fertility preferences in a context of high HIV to understand how these individuals differed in their responses to their social environments; and 2) test the application of the Anomalous Case Analysis methodology in Lusaka, Zambia to learn more about fertility-related behavior in this high HIV-prevalence
Acknowledgments
Thanks to Kumbutso Dzekedzeke who was the in-country principle investigator in Zambia. Tsuyoshi Onda provided assistance with locating literature, formatting citations and administrative responsibilities. We appreciate the guidance provided by the project's Advisory Panel. We would like to thank Sara Yeatman for her comments on this paper as well as John Casterline for his input, particularly around uncertainty and childbearing, and Jennifer Johnson-Hanks, Christine Bachrach, Phil Morgan and
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