论文标题
挽救生命的影响对生育的影响
The impact of life-saving interventions on fertility
论文作者
论文摘要
全球健康的许多干预措施挽救了生命。有时对这些干预措施的批评引起了马尔萨斯的精神。收费的好处是，将地球有限的资源传播得更薄弱的危害所抵消：每人更多的人，更多的痛苦。在某种程度上，储蓄寿命的净收益低于起初的净收益。另一方面，如果较低的死亡率（尤其是在童年时期）导致家庭生育更少，挽救生命的干预措施可能会减少人口。本文件严格审查证据。它发现，挽救生命的干预措施对生育能力和人口增长的影响因情况而变化，很少大于1：1。在一生的出生/女人一直融合到2或更低的地方，挽救一个孩子的生命应导致父母避免他们本来会有的出生。死亡率下降对生育率的影响将接近1：1，因此人口增长几乎不会改变。在夫妻似乎不太限制尼日尔和马里等夫妻的越来越特殊的地区，挽救生命对总分娩的影响将较小，并且可能主要来自泌乳膜膜的生物学通道。在这里，死亡率 - 差异性 - 滴滴比率为1：0.5和1：0.33似乎更合理。但是从长远来看，如果这几个国家不加入世界其他地区，那将是令人惊讶的。
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.
