The impact of life-saving interventions on fertility

Many interventions in global health save lives. One criticism sometimes lobbed at these interventions invokes the spirit of Malthus. The good done, the charge goes, is offset by the harm of spreading the earth's limited resources more thinly: more people, and more misery per person. To the extent this holds, the net benefit of savings lives is lower than it appears at first. On the other hand, if lower mortality, especially in childhood, leads families to have fewer children, life-saving interventions could reduce population. This document critically reviews the evidence. It finds that the impact of life-saving interventions on fertility and population growth varies by context, and is rarely greater than 1:1. In places where lifetime births/woman has been converging to 2 or lower, saving one child's life should lead parents to avert a birth they would otherwise have. The impact of mortality drops on fertility will be nearly 1:1, so population growth will hardly change. In the increasingly exceptional locales where couples appear not to limit fertility much, such as Niger and Mali, the impact of saving a life on total births will be smaller, and may come about mainly through the biological channel of lactational amenorrhea. Here, mortality-drop-fertility-drop ratios of 1:0.5 and 1:0.33 appear more plausible. But in the long-term, it would be surprising if these few countries do not join the rest of the world in the transition to lower and more intentionally controlled fertility.