We use restricted-access birth records from the National Vital Statistics System (NVSS) to document the full age and parity fertility effects of the Colorado Family Planning Initiative (CFPI). The CFPI provided access to every FDA approved method of contraception for free to anyone living below approximately 200% of the federal poverty line from 2009 to 2015. Previous research has demonstrated important effects on fertility at ages 15-29. We estimate the statewide fertility effect of the CFPI for all age groups (15-44) and for all births and for first and non-first births using the synthetic control method. We find large and statistically significant reductions in birth rates for 15-24-year-olds that largely line up with other recent studies, but we find important heterogeneity across parity. For teenagers, we find reductions in first birth rates of about 9%, but much larger reductions in non-first birth rates of 17%-25%. We also find reductions in overall fertility for 20-24 and 25-29-year-olds, but these are entirely driven by reductions of 5%-9% in non-first birth rates, with no significant changes in first births. For 30-39-year-olds, we find small but statistically significant reductions in fertility of 3%-7% across parity levels, and we find a 6% reduction in fertility for 40-44-year-olds. We also conduct inference using synthetic difference-in-differences (SDID) and placebo-based methods. When we do this, our coefficient estimates are similar, though confidence intervals are wider, with specifications on older age groups no longer statistically significant.

BACKGROUND:Administrative reforms implemented in the Global South are often designed to improve health service delivery for rural communities. Decentralization is one of the most popular strategies, with contemporary versions combining devolution and performance-based management. Our study draws on the experience of health sector reform in Honduras where the government decentralized health service delivery in a third of its municipalities. METHODS:This study aims to assess the consequences of decentralization for equitable health service delivery. Focusing on access to healthcare and satisfaction, we collected and analyzed data for about 9,000 households in a matched sample of 65 municipalities, 23 centrally-administered and 42 decentralized. Indicators of access include individual- and facility-level barriers to receiving care, satisfaction indicators focus on the consultation and overall health system, and indicators of household wealth, gender, education, and race and ethnicity are considered as potential moderators. RESULTS:Relative to centralized administration, our main analysis shows that facility-level barriers to accessing healthcare were lower, satisfaction was higher, and wealth-based disparities were attenuated under decentralization. Exploratory analyses show key differences among three types of intermediary organizations under decentralization: access improvements were most pronounced with associations and municipal governments, satisfaction improvements were greatest with NGOs and associations, and wealth-based disparities attenuated most under NGOs. CONCLUSIONS:Contrary to several previous studies, we find that decentralization can support the improvement of not only outputs and outcomes, but also key aspects related to equitable health service delivery. However, these improvements may be less consistent and depend on the type of organization that manages local health service delivery.

Fertility is a life course process that is strongly shaped by geographic and sociodemographic subgroup contexts. In the United States, scholars face a choice: they can situate fertility in a life course perspective using panel data, which is typically representative only at the national level; or they can attend to subnational contexts using rate schedules, which do not include information on life course statuses. The method and data source we introduce here, Census-Held Linked Administrative Records for Fertility Estimation (CLAR-FE), permits both. It derives fertility histories and rate schedules from U.S. Census Bureau-held data for the nation and by state, racial and ethnic subgroups, and the important life course status of parity. We generate three types of rates for 2000-2020 at the national and state levels by race and ethnicity: age-specific rates and both unconditional and conditional parity- and age-specific rates. Where possible, we compare these rates with those produced by the National Center for Health Statistics. Our new rate schedules illuminate state and racial and ethnic differences in transitions to parenthood, providing evidence of the important subgroup heterogeneity that characterizes the United States. CLAR-FE covers nearly the entire U.S. population and is available to researchers on approved projects through the Census Bureau's Federal Statistical Research Data Centers.

Introduction Understanding mortality variability by age and cause is critical to identifying intervention and prevention actions to support disadvantaged populations. We assessed mortality changes in two rural South African populations over 25 years covering pre-AIDS and peak AIDS epidemic and subsequent antiretroviral therapy (ART) availability.Methods Using population surveillance data from the Agincourt Health and Socio-Demographic Surveillance System (AHDSS; 1994–2018) and Africa Health Research Institute (AHRI; 2000–2018) for 5-year periods, we calculated life expectancy from birth to age 85, mortality age distributions and variation, and life-years lost (LYL) decomposed into four cause-of-death groups.Results The AIDS epidemic shifted the age-at-death distribution to younger ages and increased LYL. For AHDSS, between 1994–1998 and 1999–2003 LYL increased for females from 13.6 years (95% CI 12.7 to 14.4) to 22.1 (95% CI 21.2 to 23.0) and for males from 19.9 (95% CI 18.8 to 20.8) to 27.1 (95% CI 26.2 to 28.0). AHRI LYL in 2000–2003 was extremely high (females=40.7 years (95% CI 39.8 to 41.5), males=44.8 years (95% CI 44.1 to 45.5)). Subsequent widespread ART availability reduced LYL (2014–2018) for women (AHDSS=15.7 (95% CI 15.0 to 16.3); AHRI=22.4 (95% CI 21.7 to 23.1)) and men (AHDSS=21.2 (95% CI 20.5 to 22.0); AHRI=27.4 (95% CI 26.7 to 28.2)), primarily due to reduced HIV/AIDS/TB deaths in mid-life and other communicable disease deaths in children. External causes increased as a proportion of LYL for men (2014–2018: AHRI=25%, AHDSS=17%). The share of AHDSS LYL 2014–2018 due to non-communicable diseases exceeded pre-HIV levels: females=43%; males=40%.Conclusions Our findings highlight shifting burdens in cause-specific LYL and persistent mortality differentials in two populations experiencing complex epidemiological transitions. Results show high contributions of child deaths to LYL at the height of the AIDS epidemic. Reductions in LYL were primarily driven by lowered HIV/AIDS/TB and other communicable disease mortality during the ART periods. LYL differentials persist despite widespread ART availability, highlighting the contributions of other communicable diseases in children, HIV/AIDS/TB and external causes in mid-life and non-communicable diseases in older ages.

Public subsidies for contraception are often justified by assertions regarding their benefits for women's lives, yet there is limited contemporary evidence supporting these assertions. Beginning in 2009 the Colorado Family Planning Initiative abruptly expanded access to the full range of contraceptive methods through Colorado's Title X family planning clinics. Using eleven years of American Community Survey data linked to data from two decennial censuses, we assessed whether exposure to the program led to improvements in college completion among women. Exposure to the Colorado Family Planning Initiative at high school ages was associated with a population-level increase of 1.8-3.5 percentage points in women's on-time bachelor's degree attainment, which represents a 6-12 percent increase in women obtaining their degrees compared with earlier cohorts. Federal and state policies restricting or expanding access to the full range of contraceptive methods can affect women's attainment of higher education in addition to their reproductive health.

We update estimates of the maternal mortality impact of no abortions occurring in the U.S. following the recent release of new national and state abortion incidence data for 2020. This estimate quantifies the increase in maternal deaths that would occur after a total abortion ban solely due to the greater mortality risk of continuing pregnancy to term compared to having an abortion. We estimate the number of additional U.S. maternal deaths by race/ethnicity that would be caused if no abortion occurred, following previously published procedures and using published 2020 statistics on maternal mortality, births, and abortions. After the first year of no abortion occurring, we estimate increased exposure to the risks of pregnancy would cause an increase of 210 maternal deaths per year (24% increase), from 861 to 1071. The increase would be greatest among non-Hispanic Black people, for whom it would be 39%. We also estimate, by state, the number of additional maternal deaths caused by no abortion occurring in the 26 U.S. states that either have banned or the Guttmacher Institute estimates will soon ban abortion. We find that increases in some states would be as great as 29%, while in others, because of already extremely low abortion rates and numbers, less than 1 additional death would be expected. Banning abortion will likely change maternal mortality in ways beyond exposing more people to the existing risks of maternal death; any increase in maternal mortality due to these changes would be in addition to our estimates.

OBJECTIVES:South Africa is experiencing both HIV and hypertension epidemics. Data were compiled for a study to identify effects of HIV and high systolic blood pressure on mortality risk among people aged 40-plus in a rural South African area experiencing high prevalence of both conditions. We aim to release the replication data set for this study.DATA DESCRIPTION:The research data comes from the 2010-11 Ha Nakekela (We Care) population-based survey nested in the Agincourt Health and socio-Demographic Surveillance System (AHDSS) located in the northeast region of South Africa. An age-sex-stratified probability sample was drawn from the AHDSS. The public data set includes information on individual socioeconomic characteristics and measures of HIV status and blood pressure for participants aged 40-plus by 2019. The AHDSS, through its annual surveillance, provided mortality data for nine years subsequent to the survey. These data were converted to person-year observations and linked to the individual-level survey data using participants' AHDSS census identifier. The data can be used to replicate Houle et al. (2022) - which used discrete-time event history models stratified by sex to assess differential mortality risks according to Ha Nakekela measures of HIV-infection, HIV-1 RNA viral load, and systolic blood pressure.

Does access to the full range of contraceptive methods increase young women’s educational attainment? Family planning programs are often justified by claims that it does, but contemporary evidence is unexpectedly weak. We use a natural experiment afforded by a 2009 Colorado policy change to assess the impact of expanded access to contraception on women’s high school graduation. Linking survey and Census data, we follow a population-representative U.S. sample, including large subsamples of young women living in Colorado in 2010 and in comparison states. Using a difference-in-differences design, we find expansion of access to contraception was associated with a statistically significant 1.66 percentage-point increase in high school graduation. This increase in graduation represents a 14% decrease in the baseline percentage not graduating high school before the policy change. Results are robust to a variety of sensitivity tests. Our findings indicate that improving access to contraception increases young women’s human capital formation.

Family planning programs are believed to have substantial long-term benefits for women's health and well-being, yet few studies have established either extent or direction of long-term effects. The Matlab, Bangladesh, maternal and child health/family planning (MCH/FP) pro-gram afforded a 12-y period of well-documented differential access to services. We evaluate its impacts on women's lifetime fertility, adult health, and economic outcomes 35 y after program initiation. We followed 1,820 women who were of reproductive age during the differential access period (born 1938-1973) from 1978 to 2012 using prospectively collected data from the Matlab Health and Demographic Surveillance System and the 1996 and 2012 Matlab Health and Socio-economic Surveys. We estimated intent-to-treat single-difference models comparing treatment and comparison area women. MCH/FP significantly increased contraceptive use, reduced completed fertility, lengthened birth intervals, and reduced age at last birth, but had no significant positive impacts on health or economic outcomes. Treatment area women had modestly poorer overall health (+0.07 SD) and respiratory health (+0.12 SD), and those born 1950-1961 had significantly higher body mass index (BMI) in 1996 (0.76 kg/m(2)) and 2012 (0.57 kg/m(2)); fewer were underweight in 1996, but more were over-weight or obese in 2012. Overall, there was a +2.5 kg/m(2) secular in-crease in BMI. We found substantial changes in lifetime contraceptive and fertility behavior but no long-term health or economic benefits of the program. We observed modest negative health impacts that likely result from an accelerated nutritional transition among treated women, a transition that would, in an earlier context, have been beneficial.

Health systems strengthening is at the forefront of the global health agenda. Many health systems in low-resource settings face profound challenges, and robust causal evidence on the effects of health systems reforms is lacking. Decentralization has been one of the most prominent reforms, and after more than 50 years of implementation and hundreds of studies, we still know little about whether these policies improve, harm or are inconsequential for the performance of health systems in less-developed countries. A persistent problem in existing studies is the inability to isolate the effect of decentralization on health outcomes, struggling with heterogeneous meanings of decentralization and missing counter factuals. We address these shortcomings with a quasi experimental, longitudinal research design that takes advantage of a unique staggered reform process in Honduras. Using three waves of household survey data over 10 years for a matched sample of 65 municipalities in Honduras, we estimated difference-in-difference models comparing changes in outcomes over time between local health systems that were decentralized using one of three types of organizations [municipal governments, associations of mayors or non-governmental organization (NGOs)] and those that remained centrally administered. We find evidence of overall improvements between 2005 and 2016 in several service delivery-related outcomes, and additional improvements in decentralized municipalities governed by NGOs. NGO-led municipalities saw a 15% decrease in home delivery relative to centralized municipalities in 2016, a 12.5% increase in MCH facility delivery and a 7% increase in the use of a skilled birth attendant. There were no detectable positive treatment effects for vaccination, and a slight decline in the weight-for-length z-scores in NGO municipalities, but we find no systematic evidence of decentralization negatively impacting any maternal and child health outcomes. These findings highlight the importance of considering implementation context, namely organization type, when assessing the effects of decentralization reform.

Understanding how sexual behaviors cluster in distinct population subgroups along the life course is critical for effective targeting and tailoring of HIV prevention messaging and intervention activities. We examined interrelatedness of sexual behaviors and variation between men and women across a wide age range in a rural South African setting with a high HIV burden. Data come from the Ha Nakekela population-based survey of people aged 15–85-plus drawn from the Agincourt Health and Socio-Demographic Surveillance System. We used latent class analysis of six sexual behavior indicators to identify distinct subgroup sexual behavior clusters. We then examined associations between class membership and sociodemographic and other behavioral risk factors and assessed the accuracy of a reduced set of sexual behavior indicators to classify individuals into latent classes. We identified three sexual behavior classes: (1) single with consistent protective behaviors; (2) risky behaviors; and (3) in union with lack of protective behaviors. Patterns of sexual behaviors varied by gender. Class membership was also associated with age, HIV status, nationality, and alcohol use. With only two sexual behavior indicators (union status and multiple sexual partners), individuals were accurately assigned to their most likely predicted class. There were distinct multidimensional sexual behavior clusters in population subgroups that varied by sex, age, and HIV status. In this population, only two brief questions were needed to classify individuals into risk classes. Replication in other situations is needed to confirm these findings.

Despite considerable advances in developing new and more sophisticated impact evaluation methodologies and toolkits, policy research continues to suffer from persistent challenges in achieving the evaluation trifecta: identifying effects, isolating mechanisms, and influencing policy. For example, evaluation studies are routinely hampered by problems of establishing valid counterfactuals due to endogeneity and selection effects with respect to policy reform. Additionally, robust evaluation studies often must contend with heterogeneity in treatment, staggered timing, and variation in uptake. And finally, on practical grounds, researchers frequently struggle to involve policymakers and practitioners throughout the research process in order to engender the type of trust needed for policy influence. While it can be difficult to generalize about appropriate evaluation methodologies across contexts, prominent policy interventions like governance reforms for improving health services delivery nonetheless demand rigorous and comprehensive evaluation strategies that can produce valid results and engage policymakers. Drawing on illustrations from our research on health sector decentralization in Honduras, in this paper we present a quasi-experimental, multi-method, and participatory approach that addresses these persistent challenges to policy evaluation.

There is limited rigorous evidence on how control over one’s fertility affects the life course of women in the contemporary United States. Lack of adequate data and challenges in research design limit the ability to isolate the impact. This study focuses on impacts of fertility control on education by taking advantage of a natural experiment in the state of Colorado to estimate the population-level effect of expanded access to contraception on female high school graduation or postsecondary educational enrollment. Preliminary analyses show that increases in access to contraception through the Colorado Family Planning Initiative increased the likelihood of high school graduation. Disclaimer: Any views expressed are those of the authors and not necessarily those of the U.S. Census Bureau. Introduction Over the last 50 years, women’s access to fertility control has increased dramatically. Nonetheless, there is limited rigorous evidence on how control over one’s fertility affects the life course of women in the contemporary United States. Lack of adequate data and challenges in research design limit the ability to isolate the impact. This study focuses on impacts of fertility control on education, which is well-known to be critical to women’s life course trajectories, such as lifetime earnings (Tamborini, Kim, & Sakamoto, 2015) and mortality (Lawrence, Rogers, & Zajacova, 2016). Yet there is little empirical evidence about the impact of fertility control on educational attainment beyond the effect of the initial expansion of access to oral contraceptives and the expansion of Title X in the 1970s (Bailey & Lindo, 2017; Hicks-Courant & Schwartz, 2016; Bailey, 2013; Goldin & Katz, 2002). In this study, we take advantage of a natural experiment to estimate the population-level effect of expanded access to contraception on female high school graduation or postsecondary educational enrollment. The natural experiment consisted of at a statewide initiative to improve access to the full range of contraceptive methods at all Colorado Title X family planning clinics in 2009, and we are able to estimate the effect of this program using individual-level, longitudinally-linked data from the full 2010 Census and the 2010-2015 American Community Surveys (ACS). We anticipate that these analyses will advance academic and policy debates regarding the impact of family planning on women overall and the relative impact on women from different racial and ethnic groups. Background Beginning in November 2009, The Colorado Family Planning Initiative (CFPI) provided funding, training, and support to ensure that all Title X clients in Colorado could choose any FDA-approved method of contraception, regardless of cost. A large component of the Initiative was the provision of free or dramatically reduced-cost long-acting reversible contraceptive (LARC) devices and provider training on LARC insertion to all Title X family planning clinics in Colorado (Philliber Research Associates & Bixby Center for Global Reproductive Health, 2010; Ricketts, Klingler, & Schwalberg, 2014). No comparable program was implemented in any U.S. state at that time. In the six years following the implementation of CFPI, both fertility and abortion rates in Colorado fell substantially compared to prevailing trends and compared to other states (Bailey & Lindo, 2017; Ricketts et al., 2014). CFPI thus offers a natural experiment through which to assess the educational impacts of expanded access to the means of controlling fertility. It is only now possible to study the effect of CFPI because of the availability of population-based samples longitudinally linked by the U.S. Census Bureau and the timing of CFPI. We use restricted data from the 2010 Census and the ACS data from Colorado and other states. Using these data, we construct longitudinal information on women inside and outside of Colorado, allowing us to compare educational outcomes of cohorts women with improved access to highly-effective contraception through CFPI and cohorts with no change in contraception access. All analyses are conducted in the Rocky Mountain Research Data Center. Methods and materials Taking an intent-to-treat approach and employing a difference-in-differences framework, we follow young women from the time of the 2010 Census (April 1, 2010), which occurred roughly four months after the implementation of CFPI. The intervention cohort includes young women who were high school aged at CFPI’s onset in Colorado. These women represent the first cohort whose high school graduation might have been impacted by CFPI. Our control cohort includes young women who were just beyond usual high school age at the onset of CFPI in Colorado. We then compare the difference between the intervention cohort and the nonintervention cohort in Colorado to the differences across these cohorts in three sets of comparison states. See Table 1 below for an illustration of our design. Table 1. Cohort design. While our intervention area is all of Colorado (since the intervention was statewide), we conduct three sets of analyses using three different comparison areas: Colorado compared with surrounding states, Colorado compared with states with similar trajectories in female high school graduation rates prior to 2009, and Colorado compared with all other US states. 201

There is limited information about sexual behavior among older Africans, which is problematic given high HIV rates among older adults. We use a population-based survey among people aged 15-80+ to examine the prevalence of sexual risk and protective behaviors in the context of a severe HIV epidemic. We focus on variation across the life course, gender and HIV serostatus to compare the similarities and differences of young, middle aged, and older adults. Younger adults continue to be at risk of HIV, with potential partners being more likely to have been diagnosed with an STI and more likely to have HIV, partner change is high, and condom use is low. Middle aged and older adults engage in sexual behavior that makes them vulnerable at older ages, including extramarital sex, low condom use, and cross-generational sex with people in age groups with the highest rates of HIV. We find insignificant differences between HIV positive and negative adults' reports of recent sexual activity. This study provides new information on sexual behavior and HIV risk across the life course in rural South Africa to inform HIV prevention and treatment programing.

Several studies have documented an association between ABO blood groups and the risk of cholera [1-4]. The biologic basis for this association, however, has remained elusive despite attempts to identify ABO-related host characteristics that might influence the pathophysiologic sequence of cholera [4]. The association of ABO blood groups and cholera would have considerable practical importance for the control of cholera if ABO blood groups modified the protective efficacy of vaccines against cholera. We evaluated ABO groups as related to the risk of cholera and to cholera vaccine efficacy in the first 2 y of follow-up of a large-scale randomized, double-blinded field trial of killed oral cholera vaccines in rural Bangladesh.

CONTEXTIn rural South Africa, women often delay union formation until they are in their late 20s, though premarital first births are common.METHODSLongitudinal data from the Agincourt Health and Socio-Demographic Surveillance System in rural South Africa were used to examine the relationship between premarital birth and union entry among 55,158 nonmigrant women aged 10-35 who took part in at least one annual census from 1993 to 2012. Discrete-time event history models were used to determine whether the likelihood of union formation differed between women who had had a premarital first birth and those who had not. Associations between single motherhood and union type (marriages or nonmarital partnerships) were identified using logistic regression.RESULTSForty-five percent of women had had a premarital first birth and 25% had entered a first union. Women who had had a premarital first birth were less likely than other women to have entered a first union (odds ratio, 0.6). Women who had had a premarital birth in the past year were more likely than those without a premarital birth to have entered a union (1.5), but women had reduced odds of union formation if they had had a birth 1-2 years earlier (0.9) or at least five years earlier (0.8). Unions formed within two years of a premarital birth had an elevated likelihood of being nonmarital partnerships (1.2-1.4).CONCLUSIONSSingle motherhood is common in the Agincourt HDSS, and women with a premarital first birth face challenges in establishing committed unions with partners.

Refereed Articles Differential mortality from extreme climate events Differential mortality patterns from hydro-meteorological disasters: Evidence from cause-of-death data by age and sex (Emilio Zagheni, Raya Muttarak, Erich Striessnig) Daily mortality changes in Taiwan in the 1970s: An examination of the relationship between temperature and mortality (Zhongwei Zhao, Yuan Zhu and Edward Jow-Ching Tu) Spatial patterns of social vulnerability to weather and climate extremes Assessing the effectiveness of a social vulnerability index in predicting heterogeneity in the impacts of natural hazards: Case study of the Tropical Storm Washi flood in the Philippines (J. Andres F. Ignacio, Grace T. Cruz, Fernando Nardi and Sabine Henry) Social vulnerability to floods in two coastal megacities: New York City and Mumbai (Alex de Sherbinin and Guillem Bardy) Who perceives what? A demographic analysis of subjective perception in rural Thailand (Jacqueline Meijer-Irons) Who is concerned about and takes action on climate change? Gender and education divides among Thais (Raya Muttarak and Thanyaporn Chankrajang) Forecasting future societies vulnerability and adaptive capacity through the lens of human capital Future differential vulnerability to natural disasters by level of education (Erich Striessnig and Elke Loichinger) The demography of human development and climate change vulnerability: A projection exercise (Jesus Crespo Cuaresma and Wolfgang Lutz) A four-dimensional population module for the analysis of future adaptive capacity in the Phang Nga province of Thailand (Elke Loichinger, Samir KC and Wolfgang Lutz)

Social protection grants play a critical role in survival and livelihoods of elderly individuals in South Africa. Rarely is it possible to assess how well a social program reaches its target population. Using a 2010 survey and Agincourt Health Demographic Surveillance System census data we conduct multivariate logistic regression to predict pension receipt in rural South Africa. We find only 80% of age-eligible individuals report pension receipt. Pension non-recipients tend to be male, have poor socio-economic status, live in smaller households, be of Mozambican origin, and have poorer physical function; while older persons living in households receiving other grants are more likely to report pension receipt. We conclude that a reservoir of older persons exists who meet eligibility criteria but who are not yet receiving pensions. Ensuring that they and their households are properly linked to all available social services—whether for child or old-age social grants—is likely to have beneficial and synergistic effects.

BACKGROUND:To inform health care and training, resource and research priorities, it is essential to establish how non-communicable disease risk factors vary by HIV-status in high HIV burden areas; and whether long-term anti-retroviral therapy (ART) plays a modifying role.METHODS:As part of a cohort initiation, we conducted a baseline HIV/cardiometabolic risk factor survey in 2010-2011 using an age-sex stratified random sample of ages 15+ in rural South Africa. We modelled cardiometabolic risk factors and their associations by HIV-status and self-reported ART status for ages 18+ using sex-stratified logistic regression models.RESULTS:Age-standardised HIV prevalence in women was 26% (95% CI 24-28%) and 19% (95% CI 17-21) in men. People with untreated HIV were less likely to have a high waist circumference in both women (OR 0.67; 95% CI 0.52-0.86) and men (OR 0.42; 95% CI 0.22-0.82). Untreated women were more likely to have low HDL and LDL, and treated women high triglycerides. Cardiometabolic risk factors increased with age except low HDL. The prevalence of hypertension was high (40% in women; 30% in men).CONCLUSIONS:Sub-Saharan Africa is facing intersecting epidemics of HIV and hypertension. In this setting, around half the adult population require long-term care for at least one of HIV, hypertension or diabetes. Together with the adverse effects that HIV and its treatment have on lipids, this may have serious implications for the South African health care system. Monitoring of the interaction of HIV, ART use, and cardiometabolic disease is needed at both individual and population levels.

Researchers are often skeptical of sexual behavior surveys: Respondents may lie or forget details of their intimate lives, and interviewers may exercise authority in how they capture responses. We use data from a 2010–2011 cross-sectional sexual behavior survey in rural South Africa to explore who says what to whom about their sexual lives. Results show an effect of fieldworker age across outcomes: Respondents report “safer,” more “responsible” sexual behavior to older fieldworkers, and an effect of fieldworker sex; men report more sexual partners to female fieldworkers. Understanding fieldworker effects on the production of sexual behavior survey data serves methodological and analytical goals.