There is real and present danger that the 2020s will become a ‘lost decade’ with unprecedented reversals in development progress. The pandemic has already caused devastating human suffering across the world, including almost 380,000 deaths. And while children seem to be less susceptible to the direct consequences of the coronavirus (although emerging evidence suggests COVID-19 poses a health threat to them as well), they are becoming the biggest victims of its social and economic impacts.
New research and estimates on the potential socio-economic impact of COVID-19 are released daily and it can be challenging to stay on top of the most relevant insights. We’ve summarised what we believe to be the pandemic’s most severe consequences on children living in low- and middle-income countries. This builds partly on earlier evidence laid out in an UN brief, but incorporates many new findings and estimates as well as some learning from previous pandemics.
We plan to update this blog post every week as new evidence emerges. But despite our best efforts to cover a wide range of impacts on children, we’ll need your help. Please let us know of any research or estimates you’d like to see included.
Children will be affected by COVID-19 and its consequences in many ways, and while it is sometimes difficult to clearly distinguish some impacts, we’ve sorted our insights in four categories:
- Child poverty: COVID-19 likely pushes children into poverty or increases the depth for children already living in poverty – both if measured monetarily or multidimensionally.
- Survive: Disruptions in health services could lead to hundreds of thousands of additional child deaths and leaves millions of children unvaccinated against infectious diseases.
- Learn: With schools closed for the vast majority of children in the world, many will lose out on essential learning and there is a real risk that some children will not come back to school afterwards.
- Be Protected: The disruption of prevention services and the economic consequences of the pandemic will lead to increases in domestic violence, child marriages and other harmful practices, especially for girls and women.
NEW THIS WEEK:
A joint analysis by Save the Children and UNICEF reveals that 586 million children – almost 1 out of 3 children in low- and middle-income countries – have lived in monetary poor households before the pandemic hit. Without urgent action to protect families from the financial hardships caused by COVID-19, the total number of children living in households that cannot make ends meet in low- and middle-income countries could reach 649-672 million by year-end, an increase by 63-86 million children (11-15%).
Previous estimates on poverty (for all age groups) varied between 40-60 million by the World Bank to 84-132 million by the UN (based on the IFPRI poverty model). Our own estimate for Sub-Saharan Africa suggested more than 30 million children in this region alone might be pushed into extreme poverty, reversing much of the progress made in the last decade.
Food security and nutrition
The economic shock which families are facing, coupled with mitigation measures which risk disrupting food supply chains, pose a significant risk of food insecurity. The World Food Programme (WFP) has issued a warning that unless swift action is taken the number of people suffering from acute food insecurity could double, jumping from 135 to 265 million. The Food and Agriculture Organization (FAO) estimates that the economic downturn following the pandemic might lead to an extra 14-80 million malnourished people. The situation is particularly dire for children as school closures mean that 368.5 million children globally who rely on school meals might have lost access to a reliable source of food. Sub-Saharan Africa is particularly affected, with 50% of the global food insecure population located on the continent even before the pandemic started. More than 50 million would suffer from hunger in West Africa alone, and the number of food insecure people could more than double in East Africa, jumping to 43 million. Early estimates suggest significant increases to the prevalence of stunting for children, ranging between 2% and 5%. Finally, the spikes in food prices detected by FAO, WFP, and Global Alliance for Improved Nutrition (GAIN) could further exacerbate malnutrition.
While children seem to make up less than 2% of diagnosed COVID-19 cases, we have reasons to be particularly concerned by the secondary effects of the crisis on children. There is evidence for increasing child mortality either due to weakened or disrupted health services or due to reduced utilisations of routine services. A new paper by Johns Hopkins modelled various reductions of coverage of life-saving interventions and for different time periods for 118 low- and middle-income countries. Reductions in coverage of around 15% for 6 months would result in 253,500 additional child deaths (an increase of 10%), while reductions of around 45% for 6 months would result in 1,157,000 additional child deaths (45% increase). More information on this model and country-by-country estimates can be found in this blog post.
Similarly, the WHO models that suspension in campaigns and loss of access to treatment for malaria could increase malaria deaths by 50% (with scenarios ranging from 7% to 99%), which children being disproportionally affected. A parallel picture emerges in other epidemics, for instance during Ebola in Sierra Leone, where deaths tolls rose significantly during and after the crisis, almost exclusively due to causes of deaths other than Ebola. This was accompanied by significant drops in health seeking behaviour (for instance for diarrhoea, acute respiratory, malaria etc.) in Guinea, Liberia and Sierra Leone.
As a direct consequence of COVID-19, immunisation campaigns – such as those for measles targeting 78 million children in at least 23 largely high-burden countries or those focussed on polio – have been suspended. At present, at least 80 million children under 1 in almost 70 countries are likely affected. This comes at a time when new research suggests that the benefits of continuing immunisation are substantial, even when taking into account the risk of coronavirus infections. Data from March across most of India’s health facilities shows significant drops in child immunisations relative to the same time last year, ranging from 16% for PCV and BCG to 69% for MMR. Those numbers are deeply troublesome as they suggest negative long-term effects on children who are losing out on life-saving vaccines, and are in line with similar observations during the Ebola outbreak. Analysing the latter, World Vision expects reductions in DPT3 immunisation coverage of 30% in some of the poorest countries.
Emerging evidence suggests that the pandemic also jeopardizes children’s mental health. Surveys conducted by Save the Children, the World Bank, and UNICEF in several countries consistently find that the pandemic and its consequences cause abnormal levels of distress in children. Additionally, there are fears that quarantined children “might be more susceptible to mental health problems because of their higher risk of infection, and the grief and fear caused by parental loss or separation.” Previous research on the effect of health-related disasters on children’s psychological wellbeing finds that 30% of isolated or quarantined children met criteria for PTSD, a percentage four times higher than in non-quarantined peers.
Lockdown restrictions are restraining already access to maternal health services, with devastating consequences for some mothers in labour. , and new measures contravening WHO recommendations are damaging maternal and child health alike. For instance, pregnant women have been denied beds in hospitals, and separation from a primary caregiver at birth increases a baby’s risk of death and contracting infections. Further disruptions to health services also has significant impacts on the utilisation of maternal health services, which have seen drops by as much as 33% in India in March, which echoes similar findings in previous epidemics. Johns Hopkins estimates increases in maternal mortality ranging from 8% to 39% depending on the severity and duration of disruptions to routine health care.
The Center for Global Development is building an online and frequently updated inventory capturing many of the indirect health effects of COVID-19 due to disrupted and suspended health services across communicable and non-communicable diseases, immunisation, and child and maternal health.
Almost 1.2 billion children are currently out of school across the world, with impacts of prolonged school closures on remote learning, learning outcomes and school enrolment. UNDP predicts that even in a conservative scenario, the effective out-of-school rate for primary education in 2020 will spike to 20%, with the highest setback suffered by the lowest human development countries.
Remote learning will likely deepen education inequalities and learning gaps because of the digital divide and different loss of learning by socio-economic group. Worldwide, 50% of the students out of the classroom do not have access to a computer, and 40% lack internet access at home; with those figures as high as 90% and 82% in Sub-Saharan Africa, respectively, Additionally, online education might disadvantage girls: globally, 25% fewer women have access to the internet than men, and in Sub-Saharan Africa women are 50% less likely to use the internet than men. Evidence from Ecuador shows that children with less access to remote learning are more than twice as likely not to do any schoolwork.
Prolonged school closures could worsen learning outcomes in the long-term and widening existing inequalities, with an increasing number of children falling below minimum proficiency standards. Summer loss literature could give an indication in terms of potential effects and equity impacts: when schools are closed during the summer breaks, learning for children from more disadvantaged socio-economic backgrounds flattens, while children from privileged socio-economic backgrounds continue to gain new skills.
The third step is getting children back into school once they open and help them to catch up on lost learnings, especially for more disadvantaged children. The experience from the Ebola crisis illustrates this challenge: various evidence finds that an aggravated financial situation made it more difficult for families to send their children back to school. In a heavily affected village in Sierra Leone, school enrolment rates for adolescent girls dropped by as much as one third.
Child marriage & Teenage pregnancies
The mitigation policies for, and economic repercussions of, COVID-19 are likely to have devastating effects for many children’s right to be protected from harmful practices and violence, especially for adolescent girls. The pandemic could cause 13 million additional child marriages by 2030 due to a combination of prevention programmes being paused and potential effects of increasing poverty on the prevalence of early marriage. This mirrors previous evidence from the Ebola outbreak in Liberia, however the impact of such shocks on child marriage may vary depending on the cultural context.
Disruptions to health services and supply chains could lead to loss of access to contraception for 47–49 million women (of all age groups), which may result in 7–15 million unintended pregnancies. Many of those pregnancies may happen to adolescent girls, with previous assessments for Ebola indicating increases of teenage pregnancies in Sierra Leone by up to 65%.
FGM & Gender-based violence
UNFPA and partners project 2 million additional cases of FGM and 200 million cases of gender-based violence as the consequence of the pandemic. While coherent data is still lacking, many countries do experience stark increases in the reports of domestic violence (for instance in Kosovo, Italy, Jingzhou/China and France). Basing on reported increases in domestic violence and given the strong co-occurrence between child abuse and domestic violence, World Vision estimates that over the next three months COVID-19 will drive violence against children (physical, sexual, and emotional) up by 20-32%. A national impact and needs assessment conducted in Bangladesh in April finds that beatings by parents/guardians were up by 42% and calls to the child helpline had increased by 40%.
Child labour, Violence & Birth registration
There are concerns that COVID-19 will increase the prevalence of child labour, as families’ experience economic hardships, parental deaths and school closures. Research by the World Bank, UNECA and Save the Children found similar patterns emerged during the Ebola outbreak. In addition, children face increased risk of physical violence as unemployment of parents is increasing in countries across the world.
Lessons learnt from Ebola suggest that there is a risk that COVID-19 will result in an ‘invisible generation’, with evidence by UNICEF showing that in Liberia birth registrations suffered a 39% decline between 2013 and 2014.
Children are generally a vulnerable group for a variety of reasons (e.g. higher likelihood of being poor, disruption to schooling, dependency and risk of separation from guardians). However, some children are even more vulnerable than others. First and foremost, evidence consistently points to poverty as leading determinant of the severity of the impact of a disaster on a child and their household – a concern mirrored by the estimated increases in child poverty above.
Refugee children are also likely to bear a disproportionate burden of the adverse consequences of the pandemic. Data on refugee children is lacking even in the best of times, and to our knowledge there is currently no evidence on the specific impact of COVID-19 on children on the move. However, as refugee settlements are often packed, inadequate spaces lacking basic sanitary amenities effective mitigation strategies may be much more difficult to introduce.
Young women and girls are likely to suffer disproportionately from the crisis. First, they experience structural vulnerabilities, such as weaker safety nets to protect them from economic shocks. Second, the crisis might exacerbate existing inequalities, jeopardising or reversing hard-won gains towards gender equality. On a final sombre note, women and girls face specific challenges – such as gender-based violence (GBV), child marriage, and teenage pregnancy. As we laid out above, all of these are proven to rise during and in the aftermath of pandemics, with devastating effects for women and especially for adolescent girls. In addition, new evidence from South and Southeast Asia finds that often women’s mental health is more affected than men’s, women are less likely to be covered by health insurance, and women’s unpaid domestic/care work has increased more often than for men.
Children with disability – up to 10% of all children – are disproportional at risk of violence and are particular vulnerable due to their dependence from care givers and face-to-face-services. Additionally, those children are least likely to benefit from remote learning.
Children in emergency/conflict settings face a heightened risk of indirect effects because they likely live in countries plagued by poor infrastructure, weakened health systems ill-equipped to respond and eroded capacity for service provision, where distrust in institutions drives reluctance to follow public health directives and delivery of relief material by external actors might be impeded.
Protecting a Generation
Save the Children has laid out a global call for Protecting a Generation with specific opportunities for the UK Government. These calls are underpinned by our programmatic work, policy positions and evidence of the impact of past health and humanitarian disasters We invite you to collaborate with us as this research continues, and suggest insights, evidence and pieces that we have not yet considered. Thank you.