How conflict shapes the impact of infant and child mortality on fertility in the Democratic Republic of the Congo

Abstract

This study investigates the impact of infant or child mortality and its interaction with conflict exposure on fertility in the Democratic Republic of the Congo (DRC). Birth histories of 13,859 married women from the 2007 and 2013/2014 Demographic and Health Surveys were analyzed alongside conflict data from the Uppsala Conflict Data Program. A series of conditional frailty survival models were estimated. Results showed that women who lost an index or non-index child during or before the birth interval were at higher risk of giving birth. These findings provide evidence for an immediate volitional replacement effect, i.e., a deliberate or psychological effort to replace a lost child as soon as possible, as well as a long-term replacement effect reflecting the desire to achieve an ideal family size. The immediate replacement effect was more pronounced among women exposed to conflict, while the long-term effect was weaker. These results, which are robust to alternative measures of conflict, reflect how families respond to infant mortality and conflict. In the short run, conflict increases the urgency to replace deceased children, supporting the fast life history or bereavement theories. By contrast, in the long term, conflict disrupts reproductive planning—likely due to resource scarcity, uncertainty about the future, and other constraints—thereby supporting the economic theory of fertility. Short-term interventions should prioritize improving child health through nutrition and immunization, providing mental health support, and offering culturally sensitive reproductive counseling. In contrast, long-term interventions must focus on economic support and family planning programs to empower women in conflict zones.