title: Social patterns and differentials in the fertility transition in the context of HIV/AIDS: evidence from population surveillance, rural South Africa, 1993 - 2013.
abstract: BACKGROUND
  Literature is limited on the effects of high prevalence HIV on fertility in the absence of treatment, and the effects of the introduction of sustained access to antiretroviral therapy (ART) on fertility. We summarize fertility patterns in rural northeast South Africa over 21 years during dynamic social and epidemiological change.
  
  
  METHODS
  We use data for females aged 15-49 from the Agincourt health and socio-demographic surveillance system (1993-2013). We use discrete time event history analysis to summarize patterns in the probability of any birth.
  
  
  RESULTS
  Overall fertility declined in 2001-2003, increased in 2004-2011, and then declined in 2012-2013. South Africans showed a similar pattern. Mozambicans showed a different pattern, with strong declines prior to 2003 before stalling during 2004-2007, and then continued fertility decline afterwards. There was an inverse gradient between fertility levels and household socioeconomic status. The gradient did not vary by time or nationality.
  
  
  CONCLUSIONS
  The fertility transition in rural South Africa shows a pattern of decline until the height of the HIV/AIDS pandemic, with a resulting stall until further decline in the context of ART rollout. Fertility patterns are not homogenous among groups.
authors.affiliation: School of Demography, The Australian National University, #9 Fellows Road, Acton, ACT Australia, Canberra, Australia ; Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO USA ; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Brian
authors.initials: B
authors.lastname: Houle
authors.affiliation: Department of Sociology, University of Washington, Seattle, WA USA.
authors.forename: Athena
authors.initials: A
authors.lastname: Pantazis
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; INDEPTH Network, Accra, Ghana ; Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Chodziwadziwa
authors.initials: C
authors.lastname: Kabudula
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; INDEPTH Network, Accra, Ghana ; Centre for Global Health Research, Umeå University, Umeå, Sweden.
authors.forename: Stephen
authors.initials: S
authors.lastname: Tollman
authors.affiliation: Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO USA ; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; Department of Sociology, University of Washington, Seattle, WA USA ; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; INDEPTH Network, Accra, Ghana.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Clark
keywords: Discrete time event history analysis; Fertility; Mozambican refugee; Socio-economic status; South Africa