The Effect of Antimalarial Campaigns on Child Mortality and Fertility in Sub-Saharan Africa

Joshua K. Wilde, Max Planck Institute for Demographic Research (MPIDR)
Benedicte Apouey, Paris School of Economics - CNRS
Gabriel Picone, University of South Florida
Joseph Coleman, University of South Florida

We examine the extent to which recent declines in mortality and fertility in Sub-Saharan Africa can be attributed to insecticide-treated bed nets (ITNs). Exploiting the rapid increase in ITNs during the mid-2000s, we employ a difference-in-differences estimation strategy to identify the causal effect of ITNs on mortality and fertility. We show that ITNs reduced all-cause child mortality, but surprisingly increased total fertility rates in spite of reduced desire for children and increased contraceptive use. We explain this paradox by showing evidence for an unexpected increase in fecundity and sexual activity due to the better health environment after the ITN distribution.