The Impact of Population Policies, Non-Governmental Organizations and HIV/AIDS Policies on Fertility and HIV Prevalence in Sub-Saharan Africa

Rachel S. Robinson, American University

This paper considers the impact of macro-level forces, including policies and organizations, on micro-level behaviors in sub-Saharan Africa. Policies, programs, and organizations shape the context in which people make decisions about sex and childbearing – decisions which then drive fertility and reproductive health outcomes, including HIV prevalence. I find evidence for two types of impacts of such institutional factors on individuals: 1) countries that adopted national population policies had greater declines in their total fertility rates between 1987 and 2002 than did countries that did not adopt such policies, and 2) countries that adopted national HIV/AIDS policies, and that had many HIV/AIDS non-governmental organizations (NGOs), experienced greater declines in HIV prevalence between 2001 and 2007. Other factors, such as wealth, degree of donor investment, and extent of international NGO involvement, do a relatively poor job of explaining differential resource availability.