Population chatter for clearer and broader thinking about fertility

Journal of Critical Public Health · 2025-10-28 · 3 citations

This paper examines reproductive vulnerability in Balaka, Malawi by prioritizing population chatter – how ordinary people perceive, narrate, and debate the fertility, mortality, and migration conditions around them. The authors, a cultural anthropologist and a demographer, discuss the translation of the concept of vulnerability in Malawi, identify the common metaphors and predicaments used to express it, and identify articulations of vulnerability in everyday conversation that show how young adults perceive and cope with vulnerabilities during an especially eventful stage of life. Drawing upon 600 pages of ethnographic fieldnotes written in 2015, the analysis is organized around the following question: What we would know about sexual and reproductive health if we privileged ordinary women’s exchanges with one another in everyday conversation over the entrenched measures (i.e., ideal family size, desired time to next birth, unmet need, contraceptive discontinuation rates) that have come to define sample surveys? Results are organized around three key themes: 1) the moral nature of population chatter; 2) widespread discontent with the predominant contraceptive method; and 3) food insecurity as a vulnerability that has relevance for contraceptive behaviors.

:<i>Being Dead Otherwise</i>

American Journal of Sociology · 2024-08-23

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SSRN Electronic Journal · 2024-01-01

The Scope of HIV Uncertainty

2023-01-01

Abstract Using data from a decade-long longitudinal survey of young adults’ experiences with relationships, fertility, and family formation in the context of Malawi’s HIV epidemic, this chapter treats HIV uncertainty as a measurable phenomenon that should be treated as an object of study in its own right. Embracing the condescending caricature of the demographer as “bean counter,” I advance a method for the measurement of personal uncertainty that uses literal beans to solicit subjective probabilities in an interactive format. I then show that uncertainty is a pervasive and patterned feature of the HIV epidemic in Balaka, Malawi and that it characterizes HIV-endemic populations more generally. Put in the perspective of simple proportions, the study shows that Balaka’s generalized HIV epidemic with an infection rate of 12 percent generates an epidemic of uncertainty that reaches 60 percent. Shifting to a survival framework by analyzing hazard models, we discover almost no one is insulated from uncertainty. HIV uncertainty is not only pervasive but also consequential, manifest clearly in the extremely corporal domains of fertility and health.

Conclusion

2023-01-01

Abstract Through the fieldnotes of a resident ethnographer observing daily life in Balaka, Malawi, this chapter weaves together key concepts from the book’s preceding chapters. Between June and October, the chapter’s focal subject Mai a Fatsani juggles food insecurity, water shortages, and aging overlain with continuous HIV uncertainty, relationship uncertainty, and existential uncertainty. This chapter analyzes the myriad uncertainties that plague a single family within a few short months. The paradox of uncertainty is that it represents both problem and possibility for those experiencing it. Following from the analysis of Mai a Fatsani’s family, the chapter reviews the failures and possibilities of HIV policy in the region, arguing for the advantages of certain prevention efforts such as pre-exposure prophylaxis (PrEP) and improvements to basic infrastructure over others, such as compulsory testing and penalties for pregnant women. Building on the widespread assertion that we are indeed “living in uncertain times,” the author concludes with suggestions for what rigorous and systematic engagement with uncertainty might look like. Uncertainty demography is about making the unknown legible in individual lives and in populations.

HIV Uncertainty and the Limits of Testing

2023-01-01

Abstract Although tools for HIV testing and treatment have improved over the past two decades, AIDS-related uncertainty seems almost impervious to biomedical solutions. The health belief model suggests that all it takes to resolve HIV uncertainty is to “know your status.” However, HIV uncertainty is prevalent among young adults in southern Malawi—even among those who were recently tested for HIV. Cheap and portable rapid antigen tests can provide individuals with a determination of their serostatus. However, these diagnoses are fundamentally retrospective; that is, they reflect a set of past-tense behaviors, exposures, and events. HIV uncertainty is simultaneously contemporaneous and prospective: it is also about the future. When we use demographic tools to view uncertainty as a relational and existential condition—and not primarily as a medical issue—we begin to understand it as a consequence of risks and vulnerabilities that are inseparable from social networks, especially romantic relationships. Both the survey data and population chatter show that HIV uncertainty persists within a regime of widespread testing; it is fairly stable over time, irreducible to the individual-level experience, and consequential for the population as a whole.

Ten Years in Balaka

2023-01-01

Abstract The bustling market town of Balaka, Malawi underwent a decade of significant social change between 2009 and 2019. Changes included rapid population growth, urbanization, the introduction and proliferation of mobile phones, the expansion of education, and the arrival of antiretroviral treatments to treat HIV. This period is punctuated by three major shifts in HIV policy, a major change to family law, and a unique Results-Based Financing for Maternal and Neonatal Health (RBF4MNH) initiative. This was a decade of social transformation, and change is predictably accompanied by uncertainty. Yet patterns of HIV prevalence and fertility remain remarkably consistent, presenting genuine puzzles of continuity and change. This chapter introduces the Tsogolo La Thanzi (TLT) study, a decade-long longitudinal survey of over 3000 young adults in Malawi. It describes the challenges of data collection in longitudinal studies, including the perennial problem of disentangling age and time. Finally, we meet Gertrude, a Malawian ethnographer whose keen ear for population chatter provides a valuable perspective on uncertainty, on survey research, and on the core concerns of demography: fertility, mortality, migration, marriage, divorce, and pregnancy.

Relationship Uncertainty and Marriage Instability

2023-01-01

Abstract Sexual relationships always convey a certain amount of risk and vulnerability. This fact is made especially visible when young adults navigate romantic relationships and the sexual realm amid a generalized HIV epidemic. In Balaka, Malawi, where HIV prevalence in the adult population hovers around 14%, trust is costly, and even casual infidelities can have fatal consequences. In this high-stakes setting, relationships are forged, moralized, and managed very deliberately, with high levels of gossip and suspicion characterizing the entire community. At the individual level, relationship formation, relationship dissolution, and marital shopping are strategies for staying safe. At the population level, these strategies produce high rates of marriage and divorce and a pattern of rapid relationship churning that facilitates the spread of HIV. For both men and women, rumor and gossip in population chatter are pillars of decision making in the romantic realm, underscoring uncertainty’s rightful position among the pantheon of social forces.

Ultimate Uncertainties and the Mortality Landscape

2023-01-01

Abstract High deadliness and low urgency (given its long, latent period) makes HIV simultaneously an exceptional disease and a footnote in the complicated lives most young adults lead. Using a vocabulary of net risks to illuminate this paradox of HIV, I connect the demographic transition as understood from the expert’s view to the changing and unpredictable mortality landscape young adults experience and perceive as they navigate Malawi’s HIV epidemic from the inside. I leverage ethnographic and survey data to show that HIV-related uncertainty is just one of many vulnerabilities that shape the mortality perceptions of this population. For decades, HIV dominated the international community’s agenda for allocating resources, but HIV frequently ranks as the third or fourth most pressing concern for infected individuals and their affected families. In light of massive, macro-level declines in mortality rates and available antiretroviral treatment, HIV is a distinctive, acute, often-deadly condition that is simultaneously seen as no big deal—just one of many hassles people worry about and manage in a milieu of existential uncertainty that includes perpetual scarcity, malaria, frequent funerals, and, surprisingly enough, lightning strikes.

Uncertainty Demography

2023-01-01

Abstract Uncertainty demography is the empirical study of known unknowns using the perspectives and tools of demography and population studies. Not to be confused with demographic uncertainty (the errors in our forecasts of future populations), uncertainty demography brings more than a decade of literature by social scientists from John Maynard Keynes to Etienne van de Walle under a unified theoretical framework. After distinguishing uncertainty demography from concepts such as risk and drawing on examples of mortality, fertility, and family formation in four distinct modes of inquiry, I suggest that an empirically grounded demography of uncertainty is useful for the social sciences because it transcends some stalled debates in the field (i.e., positivism vs. interpretivism, choice vs. constraint), emphasizes the interplay between macro and micro social phenomena, and provides unique clarity on how the unknown and unpredictable are manifest in individual lives and in persistent social structures. In contrast to purely theoretical approaches, the term “uncertainty demography” serves two purposes: it captures the growing consideration of uncertainty as a topic in demography and suggests the value of bringing to bear demographic tools to understand the role of uncertainty in social life, broadly.