Health and Human Capital in Sub-Saharan Africa

This dissertation includes two essays examining how changes in human capital levels have affected the lives of people in sub-Saharan Africa. This is done in two specific settings. First, the HIV/AIDS epidemic has had a detrimental impact in South Africa, killing over a quarter of a million people in 2007. There have been a number of studies examining the various ways that HIV/AIDS has directly impacted the lives of HIV-positive individuals. However, a reduction in the health of a population of this magnitude is likely to reverberate across the entire population. The first chapter of this dissertation investigates how the epidemic has affected the labor market in South Africa. Second, a 1985 reform to the education structure in Kenya led to an extra year of schooling. Increases in education have long been shown to coincide with declines in fertility; this is true both across countries and across households within a country. However, much of the previous literature relied on correlations and ordinary least squares analysis, techniques susceptible to omitted variables bias or reverse causation. The second chapter of this dissertation exploits the policy change as a natural experiment to examine if it is the increase in education itself that leads to the declining fertility rates, and analyzes the mechanisms driving the relationship between education and fertility.

The relationship between the HIV/AIDS epidemic and the South African labor market is examined in chapter one by matching individual level data with group specific cumulative AIDS mortality rates. Exploiting the panel nature of the data, I remove individuals whose productivity is most likely impacted by HIV/AIDS, and find evidence that cumulative AIDS mortality has led to reductions in wages of between three and six percent for the African population group (Black South Africans). Furthermore, I also find evidence that the epidemic has lowered employment in South Africa. This result is concentrated among those with the lowest levels of education and employment. Although not large in magnitude, these effects are widespread across a significant portion of the population, contributing to a substantial loss of income throughout the South African economy.

The 1985 policy change in Kenya extended the length of primary school by one year, and led to an increase in schooling for all primary school completers. An instrumental variables approach exploits exogenous variation in the extent of treatment across birth cohorts, which allows for an examination of the reform's effect on outcomes such as the age at first intercourse, marriage, and birth, as well as total fertility. For Kenyan woman, the reform led to an increase in education, delay in marriage, and lower levels of fertility beginning at the age of 20. The effect on fertility becomes increasingly negative through age 25. The longevity of the effect, as well as additional evidence, casts doubt on whether the 'incarceration' hypothesis explains the results. The findings suggest that postponement of marriage, desire for fewer children, and increased use of modern contraceptives are contributing to the reduction in fertility. This evidence is consistent with women gaining greater control over their household fertility decision.