{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T00:51:25Z","timestamp":1792889485615,"version":"4.5.0"},"reference-count":87,"publisher":"Duke University Press","issue":"3","license":[{"start":{"date-parts":[[2020,5,12]],"date-time":"2020-05-12T00:00:00Z","timestamp":1589241600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2020,5,12]],"date-time":"2020-05-12T00:00:00Z","timestamp":1589241600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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\u2019s 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.<\/jats:p>","DOI":"10.1007\/s13524-020-00871-x","type":"journal-article","created":{"date-parts":[[2020,5,12]],"date-time":"2020-05-12T15:03:21Z","timestamp":1589295801000},"page":"843-872","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":63,"title":["Live Births and Fertility Amid the Zika Epidemic in Brazil"],"prefix":"10.1215","volume":"57","author":[{"given":"Let\u00edcia J.","family":"Marteleto","sequence":"first","affiliation":[{"name":"Population Research Center and Department of Sociology, University of Texas at Austin, Austin, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilvan","family":"Guedes","sequence":"additional","affiliation":[{"name":"Demography Department and Center for Development and Regional Planning (Cedeplar), Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel Z.","family":"Coutinho","sequence":"additional","affiliation":[{"name":"Demography Department and Center for Development and Regional Planning (Cedeplar), Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail","family":"Weitzman","sequence":"additional","affiliation":[{"name":"Population Research Center and Department of Sociology, University of Texas at Austin, Austin, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"73","published-online":{"date-parts":[[2020,5,12]]},"reference":[{"key":"2021012903593424700_CR1","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1353\/dem.2002.0013","article-title":"War, peace, and fertility in Angola","volume":"39","author":"Agadjanian","year":"2002","journal-title":"Demography"},{"key":"2021012903593424700_CR2","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1056\/NEJMc1605389","article-title":"Requests for abortion in Latin America related to concern about Zika virus exposure","volume":"375","author":"Aiken","year":"2016","journal-title":"New England Journal of Medicine"},{"key":"2021012903593424700_CR3","doi-asserted-by":"crossref","first-page":"e0005135","DOI":"10.1371\/journal.pntd.0005135","article-title":"Environmental and social change drive the explosive emergence of Zika virus in the Americas","author":"Ali","year":"2017","journal-title":"PLoS Neglected Tropical Diseases"},{"key":"2021012903593424700_CR4","doi-asserted-by":"crossref","DOI":"10.2139\/ssrn.2798918","volume-title":"Characterization of fertility levels in Brazil, 1970\u20132010","author":"Amaral","year":"2016"},{"key":"2021012903593424700_CR5","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/S1473-3099(17)30727-2","article-title":"Association between microcephaly, Zika virus infection, and other risk factors in Brazil: Final report of a case-control study","volume":"18","author":"Ara\u00fajo","year":"2017","journal-title":"Lancet Infectious Diseases"},{"issue":"1","key":"2021012903593424700_CR6","first-page":"9","article-title":"Modelo de Mar\u00eda and machismo: The social construction of gender in Brazil","volume":"35","author":"Baldwin","year":"2001","journal-title":"Revista Interamericana de Psicolog\u00eda"},{"key":"2021012903593424700_CR7","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1728-4465.2016.00045.x","article-title":"Effects of the 2010 Haiti earthquake on women\u2019s reproductive health","volume":"47","author":"Behrman","year":"2016","journal-title":"Studies in Family Planning"},{"key":"2021012903593424700_CR8","doi-asserted-by":"crossref","first-page":"105","DOI":"10.2307\/1972149","article-title":"A framework for analyzing the proximate determinants of fertility","volume":"4","author":"Bongaarts","year":"1978","journal-title":"Population and Development Review"},{"issue":"Suppl. 1","key":"2021012903593424700_CR9","article-title":"ERICA: Sexual initiation and contraception in Brazilian adolescents","volume":"50","author":"Borges","year":"2016","journal-title":"Revista de Sa\u00fade P\u00fablica"},{"key":"2021012903593424700_CR10","unstructured":"Brasil. (2015a, August26). Febre pelo v\u00edrus Zika: Uma revis\u00e3o narrativa sobre a doen\u00e7a [Zika Virus fever: A narrative review about the disease] (Boletim Epidemiol\u00f3gico Vol. 46, No. 26). Brasilia, Brasil: Minist\u00e9rio da Sa\u00fade, Governo Federal. Retrieved from http:\/\/portalarquivos2.saude.gov.br\/images\/pdf\/2015\/agosto\/26\/2015-020-publica%2D%2D%2D%2Do.pdf"},{"key":"2021012903593424700_CR11","unstructured":"Brasil. (2015b, November11). Portaria N\u00b0 1.813, de 11 de Novembro de 2015. Declara Emerg\u00eancia em Sa\u00fade P\u00fablica de import\u00e2ncia Nacional (ESPIN) por altera\u00e7\u00e3o do padr\u00e3o de ocorr\u00eancia de microcefalias no Brasil [Declaration N\u00b0 1.813, of November 11th 2015. Declaration of Public Health Emergency of National Concern (PHENC) due to alterations in the pattern of occurrence of microcephaly in Brazil]. Bras\u00edlia, Brasil: Minist\u00e9rio da Sa\u00fade, Governo Federal. Retrieved from http:\/\/bvsms.saude.gov.br\/bvs\/saudelegis\/gm\/2015\/prt1813_11_11_2015.html"},{"key":"2021012903593424700_CR12","unstructured":"Brasil. (2015c, November28). Minist\u00e9rio da Sa\u00fade confirma rela\u00e7\u00e3o entre virus Zika e casos de microcefalia [Ministry of Health confirms relationship between Zika Virus and cases of microcephaly]. Bras\u00edlia, Brasil: Minist\u00e9rio da Sa\u00fade, Governo Federal. Retrieved from http:\/\/www.saude.gov.br\/noticias\/agencia-saude\/21014-ministerio-da-saude-confirma-relacao-entre-virus-zika-e-microcefalia"},{"key":"2021012903593424700_CR13","unstructured":"Brasil. (2016, January11). Monitoramento dos casos de microcefalia no Brasil at\u00e9 a Semana Epidemiol\u00f3gica 51\/2015 [Monitoring of microcephaly cases in Brazil until Epidemiological Week 51\/2015] (Boletim Epidemiol\u00f3gico, Vol. 47, No. 1). Bras\u00edlia, Brasil: Minist\u00e9rio da Sa\u00fade, Secretaria de Vigil\u00e2ncia em Sa\u00fade, Governo Federal. Retrieved from http:\/\/portalarquivos2.saude.gov.br\/images\/pdf\/2016\/janeiro\/11\/2015-053-para-substituir-na-p%2D%2Dgina.pdf"},{"key":"2021012903593424700_CR14","unstructured":"Brasil. (2017, February27). Monitoramento integrado de altera\u00e7\u00f5es no crescimento e desenvolvimento relacionadas \u00e0 infec\u00e7\u00e3o pelo v\u00edrus Zika e outras etiologias infecciosas, da Semana Epidemiol\u00f3gica 45\/2015 at\u00e9 a Semana Epidemiol\u00f3gica 02\/2017 [Integrative monitoring of alterations in growth and development associated with infection by Zika Virus and other infectious diseases, from Epidemiological Week 45\/2015 to Epidemiological Week 02\/2017] (Boletim Epidemiol\u00f3gico, Vol. 48, No. 6). Bras\u00edlia, Brasil: Minist\u00e9rio da Sa\u00fade, Secretaria de Vigil\u00e2ncia em Sa\u00fade, Governo Federal. Retrieved from http:\/\/portalarquivos2.saude.gov.br\/images\/pdf\/2017\/fevereiro\/27\/2017_003.pdf"},{"key":"2021012903593424700_CR15","unstructured":"Brasil. (2019, November). S\u00edndrome cong\u00eanita associada \u00e0 infec\u00e7\u00e3o pelo v\u00edrus Zika. Situa\u00e7\u00e3o epidemiol\u00f3gica, a\u00e7\u00f5es desenvolvidas e desafios de 2015 a 2019 [Congenital Zika Syndrome. Epidemiological situation, actions taken and challenges] (Boletim Epidemiol\u00f3gico. N\u00famero Especial). Bras\u00edlia, Brasil: Minist\u00e9rio da Sa\u00fade, Secretaria de Vigil\u00e2ncia em Sa\u00fade, Governo Federal. Retrieved from http:\/\/portalarquivos2.saude.gov.br\/images\/pdf\/2019\/dezembro\/05\/be-sindrome-congenita-vfinal.pdf"},{"key":"2021012903593424700_CR16","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/S1473-3099(16)00095-5","article-title":"Detection and sequencing of Zika virus from amniotic fluid of fetuses with microcephaly in Brazil: A case study","volume":"16","author":"Calvet","year":"2016","journal-title":"Lancet"},{"key":"2021012903593424700_CR17","volume-title":"Novo regime demogr\u00e1fico: Uma nova rela\u00e7\u00e3o entre popula\u00e7\u00e3o e desenvolvimento?","author":"Camarano","year":"2014"},{"key":"2021012903593424700_CR18","doi-asserted-by":"crossref","first-page":"6177","DOI":"10.1073\/pnas.1718476115","article-title":"Implications of the Zika virus and congenital Zika syndrome for the number of live births in Brazil","volume":"115","author":"Castro","year":"2018","journal-title":"Proceedings of the National Academy of Sciences"},{"key":"2021012903593424700_CR19","volume-title":"Fertility and contraception in Latin America: Historical trends, recent patterns","author":"Cavenaghi","year":"2009"},{"key":"2021012903593424700_CR20","first-page":"220","volume-title":"Perfil socioecon\u00f4mico e demogr\u00e1fico da fecundidade no Brasil de 2000 a 2010","author":"Cavenaghi","year":"2014"},{"key":"2021012903593424700_CR21","volume-title":"Proje\u00e7\u00e3o populacional por sexo e grupo et\u00e1rio at\u00e9 2050","author":"Cedeplar","year":"2014"},{"key":"2021012903593424700_CR22","unstructured":"Coutinho\n              R. Z.\n            \n           (2016). The transition to low fertility in Brazil (Doctoral dissertation). Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC. Retrieved from https:\/\/www.semanticscholar.org\/paper\/The-Transition-to-Low-Fertility-in-Brazil-Coutinho\/87c08d11ad9d7ded6248627fd072e835c0b05699"},{"key":"2021012903593424700_CR23","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1002\/ajhb.22534","article-title":"Seasonality updated in 28 European\/Mediterranean countries: A continuing enigma","volume":"26","author":"Cummings","year":"2014","journal-title":"American Journal of Human Biology"},{"key":"2021012903593424700_CR24","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1016\/S0140-6736(14)61494-X","article-title":"Social determinants of health, universal health coverage, and sustainable development: Case studies from Latin American countries","volume":"385","author":"de Andrade","year":"2015","journal-title":"Lancet"},{"key":"2021012903593424700_CR25","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1056\/NEJMc1608612","article-title":"Zika virus infection and associated neurologic disorders in Brazil","volume":"376","author":"de Oliveira","year":"2017","journal-title":"New England Journal of Medicine"},{"key":"2021012903593424700_CR26","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/S0140-6736(17)31368-5","article-title":"Infection-related microcephaly after the 2015 and 2016 Zika virus outbreaks in Brazil: A surveillance-based analysis","volume":"390","author":"de Oliveira","year":"2017","journal-title":"Lancet"},{"key":"2021012903593424700_CR27","volume-title":"Zika: Do sert\u00e3o nordestino \u00e0 amea\u00e7a global","author":"Diniz","year":"2016"},{"key":"2021012903593424700_CR28","first-page":"959","volume":"15","author":"Diniz","year":"2010","journal-title":"Aborto no Brasil: Uma pesquisa domiciliar com t\u00e9cnica de urna"},{"key":"2021012903593424700_CR29","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1590\/1413-81232017222.23812016","article-title":"Pesquisa nacional de aborto 2016 [National Survey of Abortion 2016]","volume":"22","author":"Diniz","year":"2017","journal-title":"Ci\u00eancia & Sa\u00fade Coletiva"},{"key":"2021012903593424700_CR30","unstructured":"Dip\n              A.\n            \n           (2013, September17). A cada dois dias, uma brasileira morre por aborto [Every two days, one Brazilian dies due to abortion]. Retrieved from https:\/\/istoe.com.br\/324829_A+CADA+DOIS+DIAS+UMA+BRASILEIRA+MORRE+POR+ABORTO\/"},{"issue":"Suppl. 2","key":"2021012903593424700_CR31","first-page":"14s","volume":"50","author":"Farias","year":"2016","journal-title":"Utiliza\u00e7\u00e3o e acesso a contraceptivos orais e injet\u00e1veis no Brasil"},{"issue":"1","key":"2021012903593424700_CR32","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1590\/S0034-71402003000100003","article-title":"A robust poverty profile for Brazil using multiple data sources","volume":"57","author":"Ferreira","year":"2003","journal-title":"Revista Brasileira de Econom\u00eda"},{"key":"2021012903593424700_CR33","doi-asserted-by":"crossref","unstructured":"Finlay\n              J. E.\n            \n           (2009). Fertility response to natural disasters: The case of three high mortality earthquakes (Policy Research Working Paper No. 4883). Washington, DC: World Bank. 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(2013). Proje\u00e7\u00e3o da popula\u00e7\u00e3o do Brasil por sexo e idade para o per\u00edodo 2000\u20132060 [Brazilian population projection by sex and age for the period between 2000 and 2060]. Rio de Janeiro, Brasil: Instituto Brasileiro de Geografia e Estat\u00edstica. Retrieved from https:\/\/ww2.ibge.gov.br\/home\/estatistica\/populacao\/projecao_da_populacao\/2013\/default.shtm"},{"key":"2021012903593424700_CR38","unstructured":"Instituto Brasileiro de Geografia e Estat\u00edstica (IBGE). (2019). Pesquisa Nacional por Amostra de Domic\u00edlios Cont\u00ednua (PNAD Cont\u00ednua) [Brazilian National Longitudinal Household Sample Survey (PNAD Cont\u00ednua)]. Rio de Janeiro, Brasil: Instituto Brasileiro de Geografia e Estat\u00edstica. Retrieved from https:\/\/ww2.ibge.gov.br\/home\/estatistica\/populacao\/trabalhoerendimento\/pnad2015\/default.shtm"},{"key":"2021012903593424700_CR39","unstructured":"Itaborai\n              N. R.\n            \n           (2015). 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Retrieved from https:\/\/repositorio.cepal.org\/bitstream\/handle\/11362\/38523\/1\/03_Reis_100A.pdf"},{"key":"2021012903593424700_CR40","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1007\/s10680-004-4095-5","article-title":"Uncertainty and the second space: Modern birth timing and the dilemma of education","volume":"20","author":"Johnson-Hanks","year":"2004","journal-title":"European Journal of Population\/Revue europ\u00e9enne de D\u00e9mographie"},{"key":"2021012903593424700_CR41","volume-title":"Uncertain honor: Modern motherhood in an African crisis","author":"Johnson-Hanks","year":"2006"},{"key":"2021012903593424700_CR42","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1111\/j.1525-1446.2012.01042.x","article-title":"The maternal self-efficacy scale for preventing early childhood diarrhea: Validity and reliability","volume":"30","author":"Joventino","year":"2013","journal-title":"Public Health Nursing"},{"key":"2021012903593424700_CR43","doi-asserted-by":"crossref","first-page":"160","DOI":"10.2307\/146306","article-title":"Effects of schooling on fertility, labor supply, and investments in children, with evidence from Brazil","volume":"34","author":"Lam","year":"1999","journal-title":"Journal of Human Resources"},{"key":"2021012903593424700_CR44","first-page":"663","article-title":"The burden of unintended pregnancies in Brazil: A social and public health system cost analysis","volume":"6","author":"Le","year":"2014","journal-title":"International Journal of Women\u2019s Health"},{"key":"2021012903593424700_CR45","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1111\/padr.12157","article-title":"The emergence of bimodal fertility profiles in Latin America","volume":"44","author":"Lima","year":"2018","journal-title":"Population and Development Review"},{"key":"2021012903593424700_CR46","doi-asserted-by":"crossref","first-page":"171","DOI":"10.11622\/smedj.2017026","article-title":"A review of Zika virus infections in pregnancy and implications for antenatal care in Singapore","volume":"58","author":"Lin","year":"2017","journal-title":"Singapore Medical Journal"},{"key":"2021012903593424700_CR47","doi-asserted-by":"crossref","first-page":"793","DOI":"10.4054\/DemRes.2013.28.28","article-title":"Maternal age at first birth and adolescent education in Brazil","volume":"28","author":"Marteleto","year":"2013","journal-title":"Demographic Research"},{"key":"2021012903593424700_CR48","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1007\/s13524-012-0118-8","article-title":"The changing impact of family size on adolescents\u2019 schooling: Assessing the exogenous variation in fertility using twins in Brazil","volume":"49","author":"Marteleto","year":"2012","journal-title":"Demography"},{"key":"2021012903593424700_CR49","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1111\/padr.12074","article-title":"Women\u2019s reproductive intentions and behaviors during the Zika epidemic in Brazil","volume":"43","author":"Marteleto","year":"2017","journal-title":"Population and Development Review"},{"key":"2021012903593424700_CR50","doi-asserted-by":"crossref","first-page":"47","DOI":"10.2307\/2137686","article-title":"Brazil\u2019s fertility decline, 1965\u201395: A fresh look at key factors","volume":"22","author":"Martine","year":"1996","journal-title":"Population and Development Review"},{"key":"2021012903593424700_CR51","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1590\/S0034-8910.2014048004878","article-title":"Temporal trends and spatial distribution of unsafe abortion in Brazil, 1996\u20132012","volume":"48","author":"Martins-Melo","year":"2014","journal-title":"Revista de Sa\u00fade P\u00fablica"},{"key":"2021012903593424700_CR52","unstructured":"McNeil\n              D. G.\n              Jr.\n            \n           (2015, December28). Zika virus, a mosquito-borne infection, may threaten Brazil\u2019s newborns. The New York Times. Retrieved from https:\/\/www.nytimes.com\/2015\/12\/29\/health\/zika-virus-brazil-mosquito-brain-damage.html"},{"issue":"Suppl. 2","key":"2021012903593424700_CR53","doi-asserted-by":"crossref","first-page":"s193","DOI":"10.1590\/S0102-311X2009001400002","article-title":"Research on abortion in Brazil: Gaps and challenges for the public health field","volume":"25","author":"Menezes","year":"2009","journal-title":"Cadernos de Sa\u00fade P\u00fablica"},{"issue":"67","key":"2021012903593424700_CR54","article-title":"Guillain\u2013Barr\u00e9 syndrome risk among individuals infected with Zika virus: A multi-country assessment","volume":"16","author":"Mier-y-Teran-Romero","year":"2018","journal-title":"BMC Medicine"},{"key":"2021012903593424700_CR55","unstructured":"Minist\u00e9rio da Sa\u00fade. (2017). Sa\u00fade Brasil 2015\/2016: Uma an\u00e1lise da situa\u00e7\u00e3o de sa\u00fade e da epidemia pelo v\u00edrus Zika e por outras doen\u00e7as transmitidas pelo Aedes aegypti. Bras\u00edlia, DF, Brasil: Minist\u00e9rio da Sa\u00fade, Secretaria de Vigil\u00e2ncia em Sa\u00fade, Departamento de Vigil\u00e2ncia de Doen\u00e7as e Agravos N\u00e3o Transmiss\u00edveis e Promo\u00e7\u00e3o da Sa\u00fade. Retrieved from http:\/\/bvsms.saude.gov.br\/bvs\/publicacoes\/saude_brasil_2015_2016_analise_zika.pdf"},{"key":"2021012903593424700_CR56","volume-title":"Portal da sa\u00fade, sistema de informa\u00e7\u00f5es de nascidos vivos [Dataset]","author":"Minist\u00e9rio da Sa\u00fade","year":"2019"},{"key":"2021012903593424700_CR57","unstructured":"Ministry of Health confirms the relation between microcephaly and ZIKV. (2015, November28) G1. Retrieved from http:\/\/g1.globo.com\/bemestar\/noticia\/2015\/11\/ministerio-da-saude-confirma-relacao-entre-microcefalia-e-virus-zika.html"},{"key":"2021012903593424700_CR58","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1056\/NEJMoa1600651","article-title":"Zika virus associated with microcephaly","volume":"374","author":"Mlakar","year":"2016","journal-title":"New England Journal of Medicine"},{"key":"2021012903593424700_CR59","unstructured":"Moreira\n              M.\n            \n           (2013, September\u2013October). Sazonalidade dos nascimentos no Brasil\u20142000\u20132010 [Seasonality of births in Brazil\u20142000\u20132010]. 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