Correspondence
Burden of Diseases, Injuries, and Zambia.10–12 Our current framework
Risk Factors Study, our approach is
a systematic scientific effort that
attempts to include all relevant
available data. The data and models
are transparent, peer-reviewed, and
follow the Guidelines for Accurate
and Transparent Health Estimates
Reporting.6
They also claim that our fertility
model is based on uncertain future
pathways. Of course, all long-term
predictions are, but education
trajec­t ories are well determined
because educational attainment is
known after age 25 years. Further,
they claim that our models are
simplistic. There might be nuances
to cultural decisions about having
children, but our fertility model with
female educational attainment and
contraceptive met need explains
80·5% of past variation in fertility.
The UN model, by contrast, uses only
time as a determinant of women’s
reproductive choice.
Finally, Gietel-Basten and Sobotka
claim that our mortality forecasts
are overly pessimistic. Mortality has
almost no effect on population, and
in fact, a slow down or stagnation
Published Online in life-expectancy growth have
August 5, 2021 been observed in many countries
https://doi.org/10.1016/
S0140-6736(21)01746-3 in the past decade. 7–9 Given the
obesity epidemic and other adverse
trends in risk factors, we might, in
many instances, have been overly
optimistic in our forecasts of
mortality.
Nico Keilman suggests that we
are underestimating fertility in sub-
Saharan Africa. His argument is
that the causal pathway between
education and fertility is bidirectional
and should be modelled as such
to avoid bias, possibly in the
opposite direction in settings with
high and low education among
women. The hypothesis is based on
studies of education and fertility
in birth cohorts of Norwegian
and Danish women, plus a study
on the effect of childbearing on
literacy in Bangladesh, Malawi, and
582
12 Psaki SR, Soler-Hampejsek E, Saha J,
Mensch BS, Amin S. The effects of adolescent
and data do not allow for assessing childbearing on literacy and numeracy in
this hypothesis. We appreciate Bangladesh, Malawi, and Zambia. Demography
the comment, however, and will 2019; 56: 1899–929.
consider it in future iterations of our
population forecasts.
We declare no competing interests. This project was
funded by the Bill & Melinda Gates Foundation.
The funder had no role in the development of this
Correspondence.
Stein Emil Vollset, Amanda E Smith,
Catherine Bisignano,
*Christopher J L Murray
cjlm@uw.edu
Institute for Health Metrics and Evaluation,
University of Washington, Seattle, WA 98195, USA
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