title: Fertility among orphans in rural Malawi: challenging common assumptions about risk and mechanisms.
abstract: BACKGROUND
  Although a substantial literature suggests that orphans suffer disadvantage relative to nonorphaned peers, the nature of this disadvantage and the mechanisms driving it are poorly understood. Some evidence suggests that orphans experience elevated fertility, perhaps because structural disadvantage leads them to engage in sexual risk-taking. An alternative explanation is that orphans intentionally become pregnant to achieve a sense of normality, acceptance and love.
  
  
  METHODS
  Data from the 2006 wave of the Malawi Longitudinal Study of Families and Health on 1,033 young adults aged 15-25 were used to examine the relationship of maternal and paternal orphanhood with sexual risk indicators and desired and actual fertility. Regression analyses were used to adjust for covariates, including social and demographic characteristics and elapsed time since parental death.
  
  
  RESULTS
  Twenty-six percent of respondents had lost their father and 15% their mother. Orphanhood was not associated with sexual risk-taking. However, respondents whose mother had died in the past five years desired more children than did those whose mother was still alive (risk differences, 0.52 among women and 0.97 among men). Actual fertility was elevated among women whose father had died more than five years earlier (0.31) and among men whose mother had died in the past five years (1.06) or more than five years earlier (0.47).
  
  
  CONCLUSIONS
  The elevations in desired and actual fertility among orphans are consistent with the hypothesis that orphans intentionally become pregnant. Strategies that address personal desires for parenthood may need to be part of prevention programs aimed at orphaned youth.
authors.affiliation: Assistant professor, Program in Public Health and Department of Preventive Medicine, Stony Brook University, Stony Brook, NY, USA, rachel.kidman@stonybrook.edu.
authors.forename: Rachel
authors.initials: R
authors.lastname: Kidman
authors.forename: Philip
authors.initials: P
authors.lastname: Anglewicz
mesh_terms: D000293:Adolescent; D000328:Adult; D054540:Child, Orphaned / Q000523:psychology* / Q000706:statistics & numerical data*; D005191:Family Characteristics; D005220:Fathers / Q000706:statistics & numerical data; D005260:Female; D005298:Fertility / Q000502:physiology*; D006801:Humans; D008137:Longitudinal Studies; D008295:Malawi; D008297:Male; D009035:Mothers / Q000706:statistics & numerical data; D011247:Pregnancy / Q000523:psychology* / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012307:Risk Factors; D012309:Risk-Taking; D012424:Rural Population; D017678:Sex Distribution; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult