Community/Rural/Urban Development, Consumer/Household Economics, Downloads November 2008 - July 2007: 6,

Bailey, Linda

Chapoto, Antony

Donovan, Cynthia

Jayne, Thomas S.

Mather, David

Mazhangara, Edward

Mghenyi, Elliot W.

Weber, Michael T.

Yamano, Takashi

Yoo, Kyeongwon

English

Research Papers in Economics

Office of
Sustainable
Development
POLICY SYNTHESIS
for Cooperating USAID Offices and 
Country Missions
( http://www.aec.msu.edu/agecon/fs2/psynindx.htm )
     Number 71                     June 2004
 
A CROSS-COUNTRY ANALYSIS OF HOUSEHOLD RESPONSE TO ADULT MORTALITY
 IN RURAL SUB-SAHARAN AFRICA: IMPLICATIONS FOR HIV/AIDS 
MITIGATION AND RURAL DEVELOPMENT POLICIES
by
David Mather, Cynthia Donovan, T.S. Jayne, Michael Weber, Antony Chapoto, Edward Mazhangara,
Elliot Mghenyi, Linda Bailey, Kyeongwon Yoo, and Takashi Yamano *
Food Security III Cooperative Agreement between U.S. Agency for International Development, Bureau for
 Economic Growth, Agriculture, and  Trade, Office of Agriculture and Food Security and 
Department of Agricultural Economics, Michigan State University  **
BACKGROUND: A general assumption in some of the
literature and in popular discussion is that AIDS-related
mortality results in severe labor constraints and
increased poverty rates and land scarcity among affected
households.  The subsequent implication of these
assumptions is that HIV/AIDS mitigation policy should
prioritize technology and assistance targeted to affected
households: agricultural labor-saving technologies and
food aid. 
 
Yet there is surprisingly little empirical research to date
which can confirm whether this scenario is generally
representative of affected households, and how affected
household behavior and welfare compare with the
non-affected household population.  It is not clear that
these suggested mitigation policies are appropriate for a
majority of affected households and more feasible or
desirable relative to alternative investments.  In
particular, it is also important to seek empirical
information to establish the potential for effective food
aid targeting in areas of high HIV incidence, while also
minimizing negative overall rural income and
productivity growth effects.                                    
OBJECTIVES: This paper synthesizes across the
results of a set of country studies on the effects of
prime-age adult mortality on rural households in Kenya,
Malawi, Mozambique, Rwanda, and Zambia, each of
which is based on large representative rural household
survey sets (Table 1).
1 These findings have implications
for the design of efforts to mitigate some of the most
important effects of rural adult mortality, and for key
development policies and priorities. 
Table 1.  Selected Characteristics of Rural Household Survey Datasets For Country Studies
Country  (Year(s)
of Survey)
Sample Size (Population
Representation) 
Type of Survey Recall Period of
Mortality Information
Kenya (1997,2002,2002) N=1422  (Smallholders in
ag-oriented provinces
Panel 4 yrs. 1997-2000
6 yrs.  1997-2002
Malawi (1990, 2002) N=420  (Smallholder
maize growers in major
growing regions
Panel 13 yrs. 1990-2002
Mozambique (2002) N=4908 (Nationally of
small & medium holders
Cross Section (with recall
panel on hh composition)
4 yr. recall  1999-2002
Rwanda  (2002) N=1395 (Nationally of
smallholders)
Cross Section (with panel
on crop area and prod.)
4 yr. recall 1999-2002
Zambia (2000) N= 6922 (Nationally of
smallholders)
Cross Section 5 yr. recall 1996-2000Page 2
FINDINGS: 
First.  We demonstrate that using incidence of prime-age
adult mortality due to illness in rural household survey
data is a reasonable and cost-effective way to identify
households that are most likely affected by
HIV/AIDS-related mortality. Because of the strong
contribution of AIDS deaths to total deaths in the
prime-age range in these highly-infected countries, cases
of adult mortality due to illness give a good indication of
the effects of AIDS-related death.  We likewise
document rural adult mortality rates consistent with
significant HIV/AIDS deaths in rural areas, and the
comparison of these findings to results estimated from
sentinel site HIV prevalence data is internally consistent
(Table 2).  Panel data in Kenya, Malawi, and Rwanda
enable us to show that household dissolution rates across
these particular surveys are relatively low, and thus lend
credibility to the reliability of our estimates of the effects
of prime-age mortality on household welfare. 
Second.  In contrast to the general assumption that
HIV-related mortality is typically associated with
household heads/spouses, the survey findings show that
in four of the five countries researched here, a majority
of deceased PA adults are not household heads/spouses,
and thus not likely to be the primary breadwinners of the
household.  This suggests that the potential magnitude of
rural PA mortality on rural household agricultural and
off-farm incomes and orphaning rates may be less than
those predicted by some of the literature.  It also helps to
explain the relatively low household dissolution rates
found in the Kenya, Malawi, and Rwanda  panel data
sets.  When comparing the pre-death household position
of deceased individuals with the household position of
individuals in non-afflicted households, several
noteworthy points emerge (Table 3).  In four of the five
countries examined, the proportion of deceased females
who were heads or spouses of heads in their households
is lower than the proportion of female heads or spouses
in non-affected households.  
The emerging picture is one of younger female
dependents being the primary casualty of prime-age
adult mortality, not wives or female heads.  The picture
is more complicated among men.  In Kenya, Malawi,
and Rwanda, the proportion of deceased males who were
heads or spouses in their households is higher than the
proportion of male heads/spouses in non-affected
households, while in Mozambique and Zambia, it is the
reverse.  While death of any kind undoubtedly brings
hardship and suffering to affected households, it is
important to note that the magnitude of the economic
consequences appear to vary according to the extent to
which the deceased tend to be primary breadwinners and
core members of the household. 
  
Third.  In the case of Kenya, Malawi, and Rwanda, it
appears that the rural HIV vectors associated with the
infection of recently deceased rural adults (i.e. who were
infected 5-10 years ago) are not associated with higher
relative income and education, as has been found in
previous research in Eastern Africa.  The implication of
these findings is that rural HIV prevention programs in
these countries would require a broad range of media to
reach both the illiterate and more educated rural
population. In addition, these types of findings
demonstrate that representative socioeconomic
information on deceased and non-afflicted rural adults
can be valuable in the design of HIV prevention
programs. 
Table 2.  Survey Findings on Rural Adult Mortality from Illness by Country
Country 
(Mortality
Recall Time Period)
No. HH’s With
at Least One
PA Death
#
HH’s With at
Least One PA
Death
%
Rural Adult
Mortality
Rate
PA Adults /1000
person yrs)
National Adult HIV
Prevalence( Antenatal
Sentinal Sites)
%
Year of
Antenatal
Survey
Kenya  (4 yrs)  83 5.8 4.9 13.5 2000
Malawi (13 yrs) 72 17.1 9.4 15.0 2001
Moz. (4 yrs)  202 3.7 5.2 13.6 2002
Rwanda (4 yrs) 96 6.0 4.9 8.9 2001
Zambia (5 yrs) 574 8.0 7.4 19.6 1999Page 3
Table 3.  Household Position of Deceased and Non-Affected Prime-Age  Adults by Country
Country HH Position Non-Affected Individuals Deceased Individuals
Male Fem. All Male Fem. All
--------- column %  ----------   -------- column %  -----------
Kenya Head/Spouse 24 34 29 59 27 44
Other Member 76 67 71 41 73 56
Malawi Head/Spouse 38 54 47 55 54 54
Other Member 62 46 53 45 46 46
Moz Head/Spouse 60 69 65 40 13 27
Other Member 40 31 35 60 87 73
Rwanda Head/Spouse 47 53 51 56 44 49
Other Member 53 47 49 44 56 51
Zambia Head/Spouse 62 76 69 49 44 46
Other Member 39 24 31 51 56 54
Fourth.  In contrast to the general assumption of labor
scarcity among affected households, results of household
composition analysis demonstrate that affected
households do not uniformly appear to have less
available PA labor than non-affected households, either
because those affected  are able to attract new PA
members or because they had more PA adults prior to
death.  This demonstrates the heterogeneity of available
ex post PA labor among affected households, and the
importance of differentiating among affected household
outcomes by characteristics of the deceased individual
such as household position. Importantly, higher mean
dependency ratios are found in households with a
head/spouse death, thus women in these households may
well face increased demands on their time for domestic
tasks and crop production.
Fifth.  The results question the usefulness of a
homogeneous conceptualization of "affected
households," especially in the context of proposals for
targeted assistance, technology development, and other
programs/policies.  We find that in most cases, although
affected households may well have suffered negative
effects on household crop production and income, the
average affected household has similar ex post land
cultivated, total land area, cultivation rates, and total
income.  But perhaps most importantly, we find that the
gender and household position of the deceased appear to
strongly condition the effects on the household. 
Overall, these findings suggest that poorer households
headed by HIV/AIDS widows are in especially
precarious positions.  
Sixth.  The heterogeneity of both the ex post welfare
indicators and the magnitude of the effects of adult
mortality on household crop production and income
have important policy implications.  For example, the
finding that many affected households have similar
household income and land/labor ratios in comparison
with their non-affected neighbors suggests that it will be
difficult to effectively target food aid, other assistance,
or technologies to a homogeneously-defined group of
"affected households."  Yet certain sub-groups of
affected households may well have lower median
incomes or land holdings after the death, as appears to
be the case with households that have lost a male
household head.  It should be noted that this involves
less than a third of cases in all the countries in this study.
Given the importance of careful targeting to reach the
"hardest-hit" households while minimizing negative
overall rural income and productivity growth effects, the
results suggest that further empirical and practical
investigation will be required.  Another important
consideration is  the need for  targeting to be  undertaken
in  ways that avoid creating incentives for husbands to
leave the area so that households can qualify as
"female-headed" in order to obtain assistance.
Seventh.  The evidence presented here is mixed as to
how adult mortality is affecting cropping patterns.  The
ex post data on crop cultivation cannot speak to potential
changes in crop cultivation across the country studies -
namely, a shift among affected households towards roots
and tubers and a shift away from higher-value crops.
Yet the ex post results show that affected households doPage 4
not tend to have more relative area cultivated to roots
and tubers compared with non-affected households.  
However, analysis of mortality effects on cropping
patterns in Kenya demonstrates that there are some
shifts,  although these  are strongly conditioned by the
gender and household position of the deceased and the
initial asset level of the affected household.  In Rwanda,
controlling for general cultivation shifts among the
non-affected households due to changing relative prices,
there was a significant increase in production of sweet
potatoes among affected households, and a significant
decrease in coffee production.  These results suggest that
some affected households are shifting to less
remunerative crops due to either labor constraints or the
inability to retain specific production/marketing
knowledge of certain cash crops that is lost in the case of
a male death.  Addressing the gender bias in agricultural
production and marketing knowledge and cash crop and
non-farm opportunities could contribute significantly to
improved income potential for many households.
Eighth.  The lack of widespread effects on crop income
among affected households as well as similar cultivation
rates and area cultivated to roots and tubers relative to
non-affected households questions the potential demand
for many proposed labor-saving technologies (LSTs) for
agriculture.  These results suggest that for affected
households as a group, the loss of family labor due to a
death in the household may not necessarily mean that
agricultural labor becomes the limiting input in
agricultural production.  The macro-level picture
emerging from recent demographic population
projections, which include the impact of AIDS-related
deaths, demonstrates that although the epidemic will
reduce life expectancy and population growth
considerably in the hardest-hit countries, the epidemic
will probably not result in a decline in the aggregate
labor-to-available-land ratio.  However, at the
micro-level, the loss by some households of land, farm
assets, and skilled labor may result in greater income and
asset inequality.
Ninth.  Available time-use data from Zambia suggests
that the returns to investing in LSTs for domestic tasks
such as food processing and water/fuel gathering is
likely to be much higher than those for LSTs in
agriculture given that more hours per household would
likely be saved by the former, and that such technologies
would also benefit many poor but non-affected
households.  Caution is therefore warranted before
scarce agricultural research funds are inordinately
diverted to labor-saving crop and input technologies
intended for HIV/AIDS-affected households.  Emerging
results from concurrent research drawing on the
databases used in the present research will help inform
questions of the extent of rural poverty and the kinds of
programs needed to help stimulate broad-based rural
economic productivity growth in the synthesis countries.
  
Tenth.  In closing, it is important to highlight what we
believe may be important, but have not been able to
study. One such area for further research is the linkages
between affected households and communities, as we
will address in cooperating with RENEWAL on a study
in Zambia on the interaction between households and
communities affected by the AIDS epidemic. Finally,
emerging evidence suggests that the poorer strata of
households in rural areas are increasingly likely to be
victims and to suffer the most severe welfare losses
resulting from adult mortality.  If additional research
confirms these patterns, there will be important
HIV/AIDS mitigation as well as prevention implications
that are inescapably tied to the need for greater emphasis
and attention on agricultural and rural economic
development policies to redress constraints to pro-poor
and gender-sensitive economic growth.   Likewise,
research to develop more effective technologies and
policies that can foster broad-based rural income growth
will better enable communities as well as households  to
respond to those hardest-hit by the negative effects of
AIDS-related adult mortality. 
1. The cross-country report this is based on, as well as
country-level reports on this topic,  are downloadable at:
http://www.aec.msu.edu/agecon/fs2/adult_death/index.htm 
*  Mather, Donovan, Jayne, Weber, Chapoto, Mazanghara,
and Mghenyi are with the Department of Agricultural
Economics, Michigan State University; Bailey and Yoo are
with the Department of Economics, Michigan State
University; Yamano is with the Foundation for Advanced
Studies on International Development, Tokyo, Japan.
**  Funding for this research was provided by the Food
Security III Cooperative Agreement (GDG-A-00-000021-00)
between Michigan State University and the United States
Agency for International Development, through the Bureau for
Economic Growth, Agriculture and Trade's Office of
Agriculture and Food Security (EGAT/AFS) with
supplemental funding from the Africa Bureau's, Office of
Sustainable Development. The authors also draw from
analysis supported by USAID/Kenya in collaboration with
Tegemeo/Institute/Egerton University, and from USAI D
Malawi, Mozambique, Rwanda and Zambia.

A Cross-Country Analysis of Household Response to Adult Mortality in Rural Sub-Saharan Africa: Implications for HIV/AIDS Mitigation and Rural Development Policies

A Cross-Country Analysis of Household Response to Adult Mortality in Rural Sub-Saharan Africa: Implications for HIV/AIDS Mitigation and Rural Development Policies

Abstract

Similar works

Full text

Available Versions

Research Papers in Economics