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One line of enquiry in demographic research assesses whether climate affects fertility. We extend this literature by examining the ramifications of climate conditions on fertility over a period of public health crisis in a highly unequal, urban middle-income country. We use monthly data for Brazil's 5,564 municipalities and apply spatial fixed-effects models to account for unobserved municipal heterogeneity and spatial dependence. Findings suggest that increases in temperature and precipitation are associated with declines in births. We also show that changes in response to climate conditions became greater during the Zika epidemic, particularly in urban areas. Combined, findings highlight the value of understanding the intersections between climate and fertility across geographic boundaries and during this public health crisis. Epidemics have become more important in people's lives with the recurring emergence of novel infectious disease threats, such as Zika and Covid-19.

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Introduction: Abortion attitudes are influenced by people's socioeconomic and demographic circumstances and can be volatile during times of crisis. Brazil is an interesting case for examining abortion attitudes because of its strict abortion policies, changing religious landscape, high income inequality, and extreme uncertainty generated by the back-to-back Zika and COVID-19 crises. This study seeks to assess Brazilian women's attitudes toward abortion and whether religion and income explain these attitudes in the context of novel infectious disease epidemics. Methods: We used data from a population-based sample of 3996 women ages 18-34 in Pernambuco, Brazil, collected during the onset of the COVID-19 pandemic (May-September 2020). We conducted paired t-tests and multivariate-adjusted logistic regression models with adjusted Odds Ratios (aORs) and 95% CIs to assess differences in support for abortion in the case of fetal congenital Zika syndrome (CZS), maternal Zika infection during pregnancy, and maternal COVID-19 infection during pregnancy. Results: Significantly more women support the right to abortion in the case of fetal CZS (50%) than in the case of maternal Zika infection (40%) and maternal COVID-19 infection (31%). Support for abortion varies by income and religion. Controlling for other demographic characteristics, high-income women have higher odds of supporting abortion in the case of fetal CZS (aOR = 1.92; 95% CI: 1.25-2.94) and maternal Zika infection (aOR = 2.07; 95% CI: 1.33-3.21) than low-income women. Evangelical women have lower odds of supporting abortion in the case of maternal Zika infection (aOR = 0.65; 95% CI: 0.45-0.93) and marginally lower odds of supporting the right to abortion in the case of maternal COVID-19 infection (aOR = 0.69; 95% CI: 0.47-1.00) than women of other religious affiliations. Conclusions and Policy Implications: With increasingly conservative religious groups gaining size in Brazil, we expect to see increasing abortion restrictions. However, this research finds that a sizable portion of women across all incomes and religious affiliations support abortion, particularly in the case of fetal anomalies associated with Zika.

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BACKGROUND: Northeast Brazil has the world's highest rate of Zika-related microcephaly. However, Zika case counts cannot accurately describe burden because mandatory reporting was only established when the epidemic was declining in the region. METHODS: To advance the study of the Zika epidemic, we identified hotspots of Zika in Pernambuco state, Northeast Brazil, using Aedes-borne diseases (dengue, chikungunya and Zika) and microcephaly data. We used Kulldorff's Poisson purely spatial scan statistic to detect low- and high-risk clusters for Aedes-borne diseases (2014-2017) and for microcephaly (2015-2017), separately. Municipalities were classified according to a proposed gradient of Zika burden during the epidemic, based on the combination of cluster status in each analysis and considering the strength of the evidence. RESULTS: We identified 26 Aedes-borne diseases clusters (11 high-risk) and 5 microcephaly clusters (3 high-risk) in Pernambuco. According to the proposed Zika burden gradient, our results indicate that the northeast of Pernambuco and the Sertão region were hit hardest by the Zika epidemic. The first is the most populous area of Pernambuco, while the second has one of the highest rates of social and economic inequality in Brazil. CONCLUSION: We successfully identified possible hidden Zika hotspots using a simple methodology combining Aedes-borne diseases and microcephaly information.

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In order to broaden findings beyond high-income countries, this study used path models to test associations between parent involvement and student achievement in Brazil using a 2017 census of public school students in fifth grade (N = 2,167,729, Mage  = 11, 49 % female, 44% Parda, 29% White, 11% Black, 3% Asian, 3% Indigenous) and ninth grade (N = 1,782,899, Mage  = 15, 51% female, 46% Parda, 29% White, 12% Black, 4% Asian, 3% Indigenous). Parent involvement showed positive associations with student reading and math achievement for fifth graders (ßs = .11 & .09) but essentially null associations for ninth graders (ßs = -.01). Students' homework completion mediated associations in both grades (ßs = .03). Parent education was not a strong moderator of associations.

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This study aims to estimate fertility trends in Brazil in the 2010s and early 2020s during a period of back-to-back novel infectious disease outbreaks - Zika virus and COVID-19. We use Brazilian Ministry of Health and Association of Civil Registrar data from 2011-2021 to measure general fertility rates at the national and state levels. We also used seasonal ARIMA model to forecast fertility rates by month and state in 2021 and compared these forecasts with observed fertility rates. We find that fertility rates were steady over 2011-2015 with no statistically significant variation, followed by a sharp decline during the Zika outbreak in 2016 followed by a return to pre-Zika levels after the end of the epidemic. Furthermore, to evaluate the effect of the COVID-19 pandemic, we make comparisons with observed and forecast rates from 2020-2021, showing that declines were generally larger for observed than for forecast rates, yet statistically insignificant. We argue that the resurgence of the COVID-19 pandemic in 2021 might lead to further declines, as women might have not had enough time to adjust rebound from either the effects of the Zika epidemic. We also discuss the importance of timely availability of live births data during a public health crisis with immediate consequences for fertility rates.

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This study aims to estimate fertility trends in Brazil in the 2010s and early 2020s during a period of back-to-back novel infectious disease outbreaks - Zika virus and COVID-19. We use Brazilian Ministry of Health and Association of Civil Registrar data from 2011-2021 to measure general fertility rates at the national and state levels. We also used seasonal ARIMA model to forecast fertility rates by month and state in 2021 and compared these forecasts with observed fertility rates. We find that fertility rates were steady over 2011-2015 with no statistically significant variation, followed by a sharp decline during the Zika outbreak in 2016 followed by a return to pre-Zika levels after the end of the epidemic. Furthermore, to evaluate the effect of the COVID-19 pandemic, we make comparisons with observed and forecast rates from 2020-2021, showing that declines were generally larger for observed than for forecast rates, yet statistically insignificant. We argue that the resurgence of the COVID-19 pandemic in 2021 might lead to further declines, as women might have not had enough time to adjust rebound from either the effects of the Zika epidemic. We also discuss the importance of timely availability of live births data during a public health crisis with immediate consequences for fertility rates.

O objetivo desta contribuição de dados é estimar as tendências de fecundidade no Brasil nos anos 2010 e início dos anos 2020 durante epidemias consecutivas de doenças infecciosas novas, ou seja, Zika vírus e COVID-19. Utilizamos dados do Ministério da Saúde e do Registro Civil Nacional de 2011-2021 para calcular as taxas mensais de fecundidade nos níveis nacional e estadual. Também utilizamos o modelo ARIMA sazonal para prever taxas de fecundidade por mês e por estado em 2021, e comparamos essas previsões com as taxas de fecundidade observadas. Encontramos que as taxas de fecundidade eram estáveis entre 2011 e 2015, sem variação significativa, seguido por um declínio abrupto durante o surto de Zika em 2016, e seguido por sua vez por um retorno aos níveis pré-Zika depois do fim da epidemia. Além disso, para avaliar o efeito da pandemia de COVID-19, comparamos as taxas observadas e previstas de 2020-2021, mostrando que as quedas geralmente eram maiores nas taxas observadas do que nas previstas, porém sem significância estatística. Argumentamos que o recrudescimento da pandemia de COVID-19 em 2021 poderá levar a mais quedas nas taxas, na medida em que as mulheres não tenham tido tempo suficiente para reagir e se ajustarem aos efeitos da epidemia de Zika. Também discutimos a importância da disponibilidade oportuna de dados sobre nascidos vivos durante uma crise de saúde pública com consequências imediatas para as taxas de fecundidade.

El objetivo de esta aportación de datos es estimar las tendencias de fecundidad en Brasil en la década de 2010 y principios de 2020, durante el período de brotes consecutivos de nuevas enfermedades infecciosas -ZIKV y COVID-19. Se usaron datos procedentes del Ministerio de Salud y del Registro Civil Nacional (ARPEN) desde 2011-2021 para calcular mensualmente las tasas de fecundidad en nivel nacional y en el estado. Se utilizó el ARIMA estacional para pronosticar las tasas de fecundidad por mes y estado en 2021, y se compararon estas predicciones con las tasas de fecundidad observadas. Encontramos que las tasas de fecundidad se mantuvieron estables entre 2011 y 2015, sin variaciones significativas, seguido de un fuerte descenso durante el brote de Zika en 2016, para posteriormente volver a los niveles anteriores al Zika tras el fin de la epidemia. Asimismo, con el fin de evaluar el efecto de la pandemia de COVID-19, hicimos comparaciones con lo observado y la previsión de tasas desde 2020-2021, que muestran que los descensos fueron en general mayores para los índices observados que para los previstos, aunque insignificantes desde el punto de vista estadístico. Sostenemos que el resurgimiento de la pandemia de COVID-19 en 2021 podría provocar nuevos descensos, ya que las mujeres podrían no haber tenido suficiente tiempo para adaptarse a los efectos de la epidemia de Zika. También se discute la importancia de disponer a tiempo de los datos de los nacidos vivos durante una crisis de salud pública con consecuencias inmediatas para las tasas de fecundidad.

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We analyze the trade-offs between health and the economy during the period of social distancing in São Paulo, the state hardest hit by the COVID-19 pandemic in Brazil. We use longitudinal data with municipal-level information and check the robustness of our estimates to several sources of bias, including spatial dependence, reverse causality, and time-variant omitted variables. We use exogenous climate shocks as instruments for social distancing since people are more likely to stay home in wetter and colder periods. Our findings suggest that the health benefits of social distancing differ by levels of municipal development and may have vanished if the COVID-19 spread was not controlled in neighboring municipalities. In turn, we did not find evidence that municipalities with tougher social distancing performed worse economically. Our results also highlight that estimates that do not account for endogeneity may largely underestimate the benefits of social distancing on reducing the spread of COVID-19.

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BACKGROUND: In 2015-2017, the Americas experienced a highly consequential epidemics for pregnancy and childbearing. Mainly transmitted by the mosquito Aedes aegypti, but also through sexual intercourse, the Zika virus poses the risk of congenital Zika syndrome to fetus, which includes microcephaly and other child development complications. When a public health crisis taps directly into reproductive health, typically a feminine realm, responses to the emergency may exacerbate deeply-rooted gender norms. This paper investigates the role of gender in two relational contexts: (a) the government-led response to the pandemic in terms of communication campaigns aimed at preventing Zika infections; and (b) an individual level of response to the emergency, concerning women's negotiation with their sexual partners with regard to the prevention of Zika as well as pregnancies. METHODS: We conducted content analysis of 94 unique pieces from public health communication campaigns produced by governmental agencies with the goal of promoting Zika awareness. Print and online materials were collected from May 2016 to August 2017, and included TV ads, Internet Pop-ups, and pamphlets. We also analyzed transcripts from 16 focus groups conducted with reproductive-aged women (18-40) in Belo Horizonte and Recife, two large cities differently affected by the Zika outbreak. Women answered open-ended questions connected to the epidemic, in areas such as personal knowledge and experiences with the Zika virus, experiences of their friends and acquaintances, their primary information sources, their perceptions of public health efforts toward containing the outbreak, as well as women's contraceptive use. RESULTS: Campaign pieces handling pregnancy and microcephaly were largely gendered. Pieces targeted women, placing on their shoulders the responsibility for protecting a potential fetus from the disease. Importantly, campaigns neglected addressing male's participation on Zika prevention and contraceptive management, while failing to take into account Brazil's large proportion of unplanned pregnancies. Women were placed in a double bind by being expected to prevent both pregnancy and Zika, in a context where gendered power imbalances often translate in women having little power/means for condom negotiation/avoiding unprotected sexual intercourse. CONCLUSION: Government and individual responses to the epidemics reinforced gender roles, situating pregnant women as responsible for averting mosquito bites and microcephaly. Further, prevention campaigns largely excluded men. Since low-socioeconomic status women possessed fewer resources to preclude infection, we also found that beyond the gender divide, this subgroup faced more pronounced Zika prevention challenges as they found it harder to negotiate condom use with their sexual partners and often could not access other types of contraceptives resulting in unplanned pregnancies.

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Socioeconomic and health disadvantages can emerge early in the life course, making adolescence a key period to examine the association between socioeconomic status and health. Past research on obesity in adolescence has focused on family measures of socioeconomic status, overlooking the role of individual-level nascent indicators of socioeconomic disadvantage. Using measured height and weight from nationally representative data from Brazil, we estimate sibling fixed effects models to examine the independent effects of nascent socioeconomic characteristics-school enrollment and work status-on adolescent overweight and obesity, accounting for unobserved genetic and environmental factors shared by siblings. Results show that school enrollment is associated with lower odds of overweight and obesity. Working is not significantly associated with overweight/obesity risk. However, adolescents not enrolled but working face the highest risk of overweight/obesity. Findings suggest that adolescents face added layers of disadvantage from being out of school, with important implications for the accumulation of health disadvantages.

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In late 2015, the Brazilian Ministry of Health and the Pan American Health Organization classified the increase in congenital malformations associated with the Zika virus (ZIKV) as a public health emergency. The risk of ZIKV-related congenital syndrome poses a threat to reproductive outcomes that could result in declining numbers of live births and potentially fertility. Using monthly microdata on live births from the Brazilian Information System on Live Births (SINASC), this study examines live births and fertility trends amid the ZIKV epidemic in Brazil. Findings suggest a decline in live births that is stratified across educational and geographic lines, beginning approximately nine months after the link between ZIKV and microcephaly was publicly announced. Although declines in total fertility rates were small, fertility trends estimated by age and maternal education suggest important differences in how Zika might have impacted Brazil's fertility structure. Further findings confirm the significant declines in live births in mid-2016 even when characteristics of the municipality are controlled for; these results highlight important nuances in the timing and magnitude of the decline. Combined, our findings illustrate the value of understanding how the risk of a health threat directed at fetuses has led to declines in live births and fertility.

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Existing literature documents the key role that parents play in transmitting diet behaviors to their children; however, less is known about differences by parent and child gender within families, especially with attention to household socioeconomic status (SES). We use nationally representative household data from Brazil and ask how parent-child associations of diet behavior differ by gender within lower- and higher-SES households. Results indicate that both maternal and paternal diet behaviors are associated with sons' and daughters' diet behaviors, but the strength of these associations differs depending on the gender of both the parent and the child. Moreover, gender differences in parent-child diet resemblance exist primarily in lower-, but not in higher-SES households. These findings are important for understanding health processes that occur within families and lead to disparities across generations, especially in a middle-income country undergoing sharp economic and nutritional changes.

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While Brazil has high rates of adolescent fertility for its below-replacement total fertility rate, we know little about the causal effects of adolescent childbearing and adolescent union formation for women's education. In this paper, we examine unique data from the 2013 School-to-Work Transitions Survey to address the consequences of adolescent childbearing and adolescent union formation on educational outcomes of Brazilian young women. We apply several analytical strategies to address the endogeneity between adolescent childbearing and educational outcomes. Our findings suggest that childbearing during the teenage years is detrimental to the educational attainment of Brazilian women, and that educational disadvantages persist once we take into account mother's selection into adolescent childbearing. The penalty for adolescent mothers ranges from -1.66 to -1.80 fewer years of schooling and from 41 to 35 percent difference in the probabilities of graduating from high school. Additional findings show that marital unions among adolescent mothers have a compounding role at further hindering women's educational progress. Combined, our findings suggest that young mothers, particularly those in a marital union, face additional layers of disadvantages, demonstrating that early family formation is a meaningful stratifier for women in an already highly-stratified society.

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Despite having been broadly advertised by the mass media, many negative consequences of the Zika virus have been less significant than originally predicted. It is likely that after a few months from the epidemic's onset, personal experience with the virus has altered the person's way to deal with the disease. This study explores the relation between exposure to Zika virus and the social representation of the epidemic. More specifically, one analyzes if increased exposure to the risk of Zika infection changes the characteristics of the web of meanings surrounding the epidemic. Between August and November of 2016, 150 interviews were conducted in the municipality of Governador Valadares, Minas Gerais State, Brazil. Based on the Free Words Association Technique, data on evocations related to the Zika virus were modeled by social network analysis, allowing the characterization of the web of meanings by level of exposure to the risk of Zika infection. The analysis performed here suggests that those never infected by any disease transmitted by the Aedes aegypti mosquito have a lesser representation, incorporating information from the media through lay thinking. In contrast to those with low levels of exposure, the social representation of people infected by Zika is associated with meanings related to the most common symptoms, such as pain, rash, and itching. Personal experience seems to shape the social representation of the disease, increasing the focus on its proximate consequences. Public campaigns designed to foster protective behavior should take into consideration the heterogeneity in the representations of this epidemic to improve adherence to preventive behavior.

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Abstract: Despite having been broadly advertised by the mass media, many negative consequences of the Zika virus have been less significant than originally predicted. It is likely that after a few months from the epidemic's onset, personal experience with the virus has altered the person's way to deal with the disease. This study explores the relation between exposure to Zika virus and the social representation of the epidemic. More specifically, one analyzes if increased exposure to the risk of Zika infection changes the characteristics of the web of meanings surrounding the epidemic. Between August and November of 2016, 150 interviews were conducted in the municipality of Governador Valadares, Minas Gerais State, Brazil. Based on the Free Words Association Technique, data on evocations related to the Zika virus were modeled by social network analysis, allowing the characterization of the web of meanings by level of exposure to the risk of Zika infection. The analysis performed here suggests that those never infected by any disease transmitted by the Aedes aegypti mosquito have a lesser representation, incorporating information from the media through lay thinking. In contrast to those with low levels of exposure, the social representation of people infected by Zika is associated with meanings related to the most common symptoms, such as pain, rash, and itching. Personal experience seems to shape the social representation of the disease, increasing the focus on its proximate consequences. Public campaigns designed to foster protective behavior should take into consideration the heterogeneity in the representations of this epidemic to improve adherence to preventive behavior.

Resumo: Apesar de amplamente noticiadas pela grande mídia, muitas das consequências negativas do vírus Zika foram menos significativas em relação às previsões originais. É provável que depois de alguns meses de epidemia, a experiência pessoal com o vírus já tenha alterado a maneira individual de lidar com a doença. Este estudo explora a relação entre a exposição ao vírus Zika e as representações sociais da epidemia. Mais especificamente, analisamos se o aumento da exposição ao risco de infecção pelo vírus Zika altera as características da teia de significados em torno da epidemia. Entre agosto e novembro de 2016, foram realizadas 150 entrevistas no Município de Governador Valadares, Minas Gerais, Brasil. Com base na técnica do Teste de Associação de Palavras, os dados de citações relacionadas ao vírus Zika foram modelados através da análise de redes sociais, permitindo a caracterização da teia de significados de acordo com o nível de exposição ao risco de infecção. A análise feita aqui sugere que pessoas que nunca foram infectadas por qualquer vírus transmitido pelo Aedes aegypti têm uma representação menos completa, incorporando informações da mídia através do pensamento leigo. Ao contrário daquelas com baixos níveis de exposição, a representação social feita por pessoas infectadas com o vírus Zika está associada aos significados relacionados aos sintomas mais comuns, como dor, exantema e prurido. A experiência pessoal parece moldar a representação social da doença, aumentando o foco nas consequências mais próximas. As campanhas públicas para promover o comportamento preventivo devem levar em conta a heterogeneidade das representações dessa epidemia para poder melhorar a aderência.

Resumen: A pesar de haber sido divulgado ampliamente por los medios de comunicación, muchas de las consecuencias negativas del virus del Zika han sido menos significativas de lo que se predijo originalmente. Parece que tras unos cuantos meses desde el inicio de la epidemia, la experiencia personal con el virus ha alterado la percepción personal sobre cómo lidiar con la enfermedad. Este estudio investiga la relación entre la exposición al virus Zika y la representación social de la epidemia. Más específicamente, este estudio analiza si una mayor exposición al riesgo de infección debida al Zika, modifica las características de la red de significados sobre epidemias. Entre agosto y noviembre de 2016, se realizaron 150 entrevistas en el municipio de Governador Valadares, Minas Gerais, Brasil. Basado en la Free Words Association Technique, la información sobre referencias relacionadas con el virus del Zika se modelaron mediante un análisis del entorno social, permitiendo la caracterización de la red de significados por el nivel de exposición al riesgo de la infección debida al Zika. El análisis realizado aquí sugiere que quienes nunca fueron infectados por ninguna enfermedad transmitida por el mosquito Aedes aegypti tienen una menor representación, incorporando información de los medios de comunicación, a través de un pensamiento generalista. En contraposición con quienes tuvieron un bajo nivel de exposición, la representación social de la gente infectada por Zika está asociada con significados relacionados con los síntomas más comunes, como dolor, sarpullido, y picores. La experiencia personal parece configurar la representación social de la enfermedad, aumentando centro de atención en sus consecuencias más próximas. Las campañas públicas diseñadas para fomentar comportamientos de protección deberían tener en consideración la heterogeneidad en las representaciones sociales de esta epidemia para mejorar la adhesión al tratamiento de la misma.

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Maternal decision-making autonomy has been linked to positive outcomes for children's health and well-being early in life in low- and middle-income countries throughout the world. However, there is a dearth of research examining if and how maternal autonomy continues to influence children's outcomes into adolescence and whether it impacts other domains of children's lives beyond health, such as their education. The goal of this study was to determine whether high maternal decision-making was associated with school enrollment for secondary school-aged youth in Honduras. Further, we aimed to assess whether the relationships between maternal autonomy and school enrollment varied by adolescents' environmental contexts and individual characteristics such as gender. Our analytical sample included 6,579 adolescents ages 12-16 living with their mothers from the Honduran Demographic and Health Survey (DHS) 2011-12. We used stepwise logistic regression models to investigate the association between maternal household decision-making autonomy and adolescents' school enrollment. Our findings suggest that adolescents, especially girls, benefit from their mothers' high decision-making autonomy. Findings suggest that maternal decision-making autonomy promotes adolescents' school enrollment above and beyond other maternal, household, and regional influences.

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The high rate of obesity among adolescents is a global public health problem that has recently expanded to affect middle- and low-income countries. Brazil, which is undergoing a relatively rapid nutrition transition and has inadequate health systems, is currently experiencing the consequences of increasing rates of overweight and obesity concomitantly with the consequences of generations of malnourishment. Given this scenario, Brazil is an ideal context for examining the relationship between family socioeconomic status (SES) and adolescent body mass, as well as how this relationship varies across very different regions within the same country and across the body mass index (BMI) continuum. Guided by a framework that integrates nutrition transition and fundamental cause theories, we use unique nationally representative data with measured height and weight for all household members to conduct quantile regression models. The results suggest that family socioeconomic conditions are important theoretical factors associated with adolescent BMI, but that the way in which family SES impinges on adolescent BMI varies across regions characterized by different locations in the nutrition transition and varying levels of economic development. We also find that family socioeconomic disadvantages operate very differently according to BMI status. The results show that the socioeconomic gradient of adolescent BMI varies by stages of the nutrition transition and economic development and across BMI percentiles.