Residence in infected neighborhoods and fertility decline during the Zika epidemic in Singapore

Abstract

Regions of the world exposed to Zika-linked microcephaly cases have experienced significant declines in fertility. In urban settings, arboviral outbreaks depend on neighborhood environmental factors including residential land use and density of drainage networks, and tend to be highly localized due to the flight dispersal of the vector mosquito. This study investigates whether fertility decline was significantly higher in neighborhoods containing known Zika cases, compared to unexposed neighborhoods in the city state of Singapore. The results show that the average monthly probability of conception leading to a live birth fell during the Zika epidemic in both exposed and unexposed neighborhoods, and that the decline was not significantly greater in neighborhoods with known cases. The study suggests that the fertility response to perceived infection risks was city-wide rather than localized. Public disclosures of outbreak locations did not lead to a disproportionate response in affected neighborhoods.