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Working Paper

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In communities where early age of childbearing is common and HIV prevalence is high, adolescent boys and girls may place themselves at risk of HIV to realize their childbearing preferences. In this paper, we analyze survey data from Kwa-Zulu-Natal province that explores whether an association exists between pregnancy preferences and behavioral and perceptual measures of HIV risk among adolescents in South Africa. Our analysis is based on data from 1,426 sexually active respondents aged 14-22 who participated in wave 1 of the “Transitions to Adulthood in the Context of AIDS in South Africa” study. We use logistic regression to model the probability of reporting that pregnancy would be a problem, using measures of HIV risk together with controls for individual and community measures that are also likely to affect pregnancy preferences. We find that educational and employment opportunities affect fertility preferences but also that the HIV pandemic, specifically adults’ perception of HIV risk for the young in the community and peer opinions about HIV risk, affect fertility preferences. Some significant differences by sex emerge concerning the influence of the perceptions of HIV risk. The analysis suggests that although individual and structural factors remain important, for some adolescents-and for girls more than for boys-the danger of HIV infection is becoming part of their calculus of the desirability of pregnancy. For both boys and girls, the unprotected sex required for conception puts them at danger of HIV transmission. For girls, the environment of risk may be particularly influential because the double threat of pregnancy and HIV infection carries an additional risk of HIV transmission to the infant, as well as the possibility of learning one’s serostatus at an antenatal clinic during pregnancy.