Recent papers suggest that health improvements have little potential to act as a catalyst for economic growth. The hypothesis underlying these papers is that a reduction in mortality does not lead to a corresponding decrease in fertility, bringing about an increase in population and declining income per capita. We directly investigate the link between mortality and fertility using data from 165 DHS surveys and find that the empirical underpinnings do not support this bleak outlook: reductions in mortality are typically followed by a one-for-one reduction in fertility, at least in countries far along in the demographic transition. Most existing empirical studies conduct their analysis at the individual level and hence can only capture the direct, i.e. ex-post, replacement of child deaths. We argue that in order to analyze the total impact of mortality on fertility, the analysis has to be conducted at higher –regional or country - levels to take into account insurance effects based on mortality expectations. In order to account for the potential endogeneity of fertility and mortality, we present an instrument based on the global vaccination rate.