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The changing face of COVID-19: a live tracker of its impact on children

While children may not be the face of the coronavirus pandemic, they could be its biggest victims. We keep track of the latest evidence and research on the potential socio-economic impacts of the pandemic on children and their rights to survive, learn and be protected.

There is real and present danger that the 2020s will become a ‘lost decade’ with unprecedented reversals in development progress. 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.

In this live tracker we are summarising what we believe to be the pandemic’s most severe consequences on children living in low- and middle-income countries. We will regularly update this tracker whenever new evidence emerges.

Latest update from 30 April 2021, featuring country evidence and novel estimates on key health and nutrition indicators for South Asia by UNICEF, latest results from new rounds of surveys by Innovation for Poverty Actions, and more findings from the Young Lives project.

  

Child Poverty

The scale and depth of financial hardship among families threatens to roll back years of progress in reducing child poverty and to leave children deprived of essential services.

Child poverty is more than the lack of monetary means. To understand the full extent of child poverty as well as the impact of COVID-19 on it, we must look at children’s ability to access health, education, nutrition, water and sanitation and housing services. Using data from more than 70 countries, a new analysis jointly carried out by Save the Children and UNICEF has finds that around 47% of children were severely deprived of at least one of these critical needs before the coronavirus pandemic even hit.

We estimate that approximately 150 million additional children are living in multidimensional poverty due to the COVID-19 pandemic, a 15% increase that brings the total number up to 1.2 billion in low- and middle-income countries.

The economic fallout brought about by COVID-19 will likely reverse a positive, downwards trend and turn back the clock by decades, pushing children into poverty or increasing the depth for children already living in poverty – both if measured monetarily or multidimensionally. Based on economic projections by the World Bank and the IMF, our joint analysis with UNICEF estimates that, without urgent action to protect families, the number of children living in monetary poor households could soar between 90 to 117 million in 2020 (with poverty measured based on national poverty lines). For the first time, we are also able to look ahead to 2021, and while this comes with significant uncertainty, analysis suggests that the spike in poverty is unlikely to subside in 2021.

Across all age groups, the World Bank expects 88-115 million people being pushed back into extreme poverty (as measured by those living below $1.90 PPP per day) due to the pandemic this year, and up to 150 million by 2021.  A large share of the new extreme poor will be concentrated in countries that are already struggling with high poverty rates and numbers of poor, as projections suggest 8 out of every 10 new poor will be in middle-income countries. Before the pandemic, children made up more than half of the world’s extreme poor. UNICEF expects that in the larger South Asian nations poverty rates will climb up by between 0.6 and 3.7%.

Survive

Disruptions to essential health services and food supply due to the pandemic could lead to hundreds of thousands of additional child deaths and contribute to soaring levels of child malnutrition.

While children seem to make up less than 2% of diagnosed COVID-19 cases, we have reasons to be 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. Research by Johns Hopkins University covering 118 low- and middle-income countries and modelling for these effects estimates excess under-five mortality based on the severity and length of disruptions to essential health services. Depending on the scenario, under-five mortality could increase by between 10% and 45%, resulting in 250,000 to 1.2 million additional under-five deaths. A more recent study covering the same set of countries estimates that by 2022 COVID-19 might cause up to 283’000 under-five deaths, most of which in sub-Saharan Africa and South Asia. Latest research from UNICEF suggests that more than 228,000 additional child deaths will have occurred in the six largest South Asian countries by the end of 2020 due to the disruption to essential health services and other contributory factors.

More broadly, there are fears that the COVID-19 response will come at the expense of treating other diseases, especially in lower-income settings. For instance, UNAIDS estimates that in Sub-Saharan Africa alone a six-month disruption of antiretroviral therapy could lead to 500,000 additional AIDS-related deaths in 2020-21. 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%), with children being disproportionally affected.

Children in emergency/conflict settings face a heightened risk of indirect health effects because they likely live in countries plagued by poor infrastructureweakened 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.

The economic shock which families are facing, coupled with mitigation measures which risk disrupting food supply chains, pose a significant risk of food insecurity, with nefarious consequences for children. 

Novel research covering 118 low and middle-income countries projects that by 2022 COVID-19 might result in up to 3.6 million additional cases of stunting and up to 13.6 cases of wasting. A previous analysis published by the Lancet estimated that COVID-19 would have led 6.7 million children under 5 to suffer from moderate to acute wasting in 2020 (a 14.3% increase), with 57% of cases in South Asia and 22% in sub-Saharan Africa. Combined with an average of 25% reduction in coverage of nutrition and health services, this would lead to between 111,000 and 178,000 under-five deaths, more than half of which in Sub-Saharan Africa alone. This happens at a time when, at the height of the lockdown, school closures meant that 368.5 million children globally who rely on school meals might have lost access to a reliable source of food. UNICEF estimates that as of January 2021 39 billion in-school meals have been lost globally since schools closed and expects that food insecurity will spike by 18% on average in the six largest South Asian countries.

For all age groups, estimates vary. 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 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 270 million. Oxfam warns that this might mean up to 12,000 people every day dying of starvation by the end of the year - more daily deaths than the coronavirus alone would cause.

Some regions will likely be more harshly hit than others. 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. Finally, the spikes in food prices detected by FAO, WFP, and Global Alliance for Improved Nutrition (GAIN) could further exacerbate malnutrition.

As a direct consequence of COVID-19, immunisation campaigns have been suspended, despite research suggesting that the benefits of continuing immunisation are substantial, even when taking into account the risk of coronavirus infections, and that children who are losing out on life-saving vaccines might face negative long-term effects. According to the UN, at least 80 million children under 1 in almost 70 countries were likely affected in May; the Measles and Rubella Initiative predicts that 178 million people are at risk of missing measles shots in 2020; and World Vision expects reductions in DPT3 immunisation coverage of 30% in some of the poorest countries. The dire consequences of halted vaccinations campaigns are starting to emerge: 18 out of the 29 countries that have currently suspended measles campaigns because of the pandemic are reporting outbreaks; a mutated strain of poliovirus has been reported in more than 30 countries; and diphtheria and cholera are appearing in South Asia and Sub-Saharan Africa. 

Lockdown restrictions are restraining access to maternal health services, with devastating consequences for some mothers in labourJohns Hopkins estimates increases in maternal mortality ranging from 8% to 39% depending on the severity and duration of disruptions to routine health care. 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. The pandemic has also pushed a drop in the utilisation of maternal health services. Latest research from UNICEF suggests that 11,000 additional maternal deaths will have occurred in the six largest South Asian countries by the end of 2020 due to the disruption to essential health services and other contributory factors, an increase of over 16%.

More generally, an analysis of six of Save the Children’s health projects in five countries shows heavy essential service disruption across continents, with varying degrees of intensity by region and type of service.

While mostly negative, COVID-19 and its economic consequences also have positive effects on a limited set of child health issues. For instance, a temporary drop in pollution is estimated to result in 6000 fewer cases of asthma in children in Europe and 4000 fewer under five deaths in China. Also, greater emphasis on hygiene measures and broader awareness might have contributed to lowering the incidence of infectious diseases and sexually transmitted infections.

The Center for Global Development has built 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.

Survey results from Armenia show that between July and September 2020 13% of families were unable to access needed health services. The rate jumped to 16% for rural families and 24% for families where one or more members have a disability.

UNICEF warns that in Bangladesh treatment for severe acute malnutrition (SAM) for young children fell by 80% and in 2020 compared to 2019, while during the second quarter of 2020, the prevalence of maternal iron deficiency anaemia increased by more than 20% compared to the same time in 2019. Prospective data also finds that the amount of families suffering from food insecurity increased by over 50% during the lockdown period (March-May 2020).

Findings from a survey conducted in Bolivia in July 2020 show that around one in four households (25%) did not receive medical attention when needed. Additionally, just over 1 in 5 households (22%) skipped a meal in the 30 days prior to the survey due to lack of money or other resources.

In Burkina Faso, a survey by IPA finds that almost 1 in 10 (8,4%) respondents or their family members had to delay or skip health care visits due to the lockdown, while 1 in 4 respondents had to limit either the number of size of their meals in the past week - with poorer respondents more likely to report being affected by food security issues. Another survey by the World Bank finds that as of December 1 in 4 (23%) households were experiencing moderate or severe food insecurity. When it comes to access to health services the overwhelming majority (>95%) of respondents seeking health treatment and/or medicines were able to receive them.

Findings from a survey in Cambodia show that as of November 2020 1 in 3 (34%) households were suffering from moderate to severe food insecurity, while virtually all surveyed families could access medicine and medical treatments if needed.

In the Central African Republic, a study completed in June 2020 shows that only 28% of households received medical attention when needed.

Findings from a survey in Chad show that 1 in 4 (24%) households could not access needed medical treatments and 9 out of 10 (88%) were suffering from moderate or severe food insecurity. Rural households reportedly fared worse than urban ones in both dimensions (25 vs 20% for access to health services and 92 vs 75% for food insecurity).

Findings from a study carried out in Chile in August 2020 show that most households received medical attention when needed (93%) whilst 7% skipped a meal in the previous 30 days due to financial difficulties.

A survey carried out in Colombia in August 2020 finds that 35% of respondents had to delay or skip essential healthcare since mid-May and 1 in 3 families reported rescheduling or cancelling necessary medical visits for children under 6. More than 1 in 3 households had to limit portions or meals at least once in the week preceding the survey, with children having to reduce portions and/or skip meals more often than adults. An earlier round of the survey revealed that despite a higher likelihood of receiving new government support over the month before the survey, households with schoolchildren reported being disproportionately affected by food security issues. Findings from a World Bank survey carried out in August 2020 show that 1 in 3 respondents (32%) skipped a meal in the 30 days prior to the survey due to lack of money or other resources and that 11% did not receive medical attention when needed. Latest findings from November 2020 show that disruptions to healthcare (1 in 5 households) and child food insecurity (over 1 in 2 households) were still widespread.

According to a survey carried out in Costa Rica in August 2020 most households (95%) received medical attention when needed, while 14% of households skipped a meal in the 30 days preceding the survey due to lack of money or other resources.

A survey conducted in Côte d'Ivoire in July finds that 14% of respondents skipped or delayed healthcare visits and 45% had to limit the number and/or size of their meals over the past week. A later round of the survey finds that in October 2020 1 in 10 families with children reported that kids in the household had their access to healthcare disrupted since June, while 1 in 2 said that their children were suffering from food insecurity.

A study conducted in the Democratic Republic of Congo in June 2020 found that a sizeable 87% of households received medical assistance when needed. However, 64% skipped a meal in the 30 days prior to the survey due to financial deprivation.

Findings from a survey in Djibouti show that 37% of households in need of healthcare could not access health facilities and 16% could not access basic medicines, while 4 in 10 households (42%) experienced severe food insecurity over the 30 days preceding the survey.

In the Dominican Republic a survey completed in August 2020 shows that 8 in 10 households received medical attention when needed. However, 35% of households skipped a meal in the 30 days prior to the survey due to lack of money or other resources.

According to a survey conducted in Ecuador in July 2020 more than 1 in 5 households (22%) did not receive medical assistance when needed. Further, 29% skipped a meal in the 30 days preceding the survey due to lack of money or other resources.

A survey in Ethiopia finds that in September-October 2020 most households (96%) were able to access health services. However, 1 in 3 households experienced moderate or severe food insecurity, with rural areas experiencing higher rates of deprivation than urban ones. Results from a survey by the Young Lives Project on young men and women find that in June-July around 1 in 6 participants had run out of food since the COVID-19 outbreak. A later round of the survey in November-December 2020 revealed sharp inequalities between regions, with a 24-percentage point increase in food shortages in Amhara and “only” a 3-percentage point increase in Oromia.

Based on a survey carried out in Gabon in May 2020, 68% of households skipped a meal in the previous 30 days due to financial hardship.

According to a survey conducted in Ghana, 10% of respondents say someone in their household delayed or skipped needed healthcare visits since mid-March. Almost 1 in 2 respondents reported reducing meal size and/or number over the week previous to the survey, with families with age-school children being more likely to be unable to afford food due to income drops.

In Guatemala findings from a survey in August suggest that most households (89%) received medical attention when needed, while almost 1 in 5 (19%) skipped a meal in the 30 days preceding the survey due to financial constraints.

A study completed in Honduras in August 2020 found that most households (92%) received the medical attention they needed. However, 31% skipped a meal in the 30 days prior to the survey due to lack of money or other resources.

Findings from a survey in Andhra Pradesh and Telangana in India on young men and women find that in June-July approximately 1 in 6 respondents had run out of food since the onset of the pandemic, at the same time as food prices were on the rise. UNICEF finds that in 2020 the number of children receiving DPT3/Penta 3 vaccinations fell by around 35% in 2020 compared to 2019 and expects that an additional 7,750 maternal deaths will have occurred by the end of 2020.

In Kenya, daily deliveries in a large regional hospital dropped by 33%. A survey by the World Bank finds that most households (~98%) can access needed medicines and medical treatment, but 43% experience food insecurity.

In Madagascar, a study completed in June 2020 shows that while 88% of households received medical attention when needed, almost 1 in 4 households (24%) skipped a meal in the 30 days preceding the survey due to lack of money or other resources.

Findings from a survey Malawi show that the majority of respondents (79%) experience moderate or severe food insecurity, with urban households suffering disproportionately (82 vs 68%). When it comes to health services, around 15% of households in need of medical treatment and/or medicines could not access them. An earlier version of the survey found that households with school children were hard hit by school closures, with almost 1 in 2 respondents reporting children had to skip meals due to the suspension of school meals.

Latest rounds of a high-frequency survey conducted in Mali find most households can access needed healthcare services but 15% of them still experience food insecurity, half of the time due to COVID-19.

Results from a Mexico survey find that 1 in 3 people had to delay or skip essential health care and 20-25% had to limit the size and/or number of meals over the week prior.

Evidence from Mongolia gathered in May 2020 shows that whilst most households (92%) received the medical attention they needed 1 in 5 households (20%) skipped a meal in the previous 30 days due to lack of money or other resources.

Findings from a survey carried out in Mozambique between mid-July and mid-August show that 72% of families were food insecure, I.e. they were unable to buy their usual amount of food over the 7 days preceding the interview.

A study conducted in Nepal comparing key metrics before and during the lockdown finds that restrictive measures led to a 52.4% decrease in institutional childbirth, 50% increase in the stillbirth rate, and a 200% increase in neonatal mortality. UNICEF warns that treatment for severe acute malnutrition (SAM) for young children fell by 80% and in 2020 compared to 2019, while during the second quarter of 2020, the prevalence of maternal iron deficiency anemia increased by more than 40% compared to the same time in 2019.

According to results from a survey in Nigeria, most households (91%) can access preventive care and most women (95%) within them can access ante- and post-natal care if needed. However, as of August 8 out of 10 respondents reported experiencing moderate to severe food insecurity. An earlier version of the same survey found that 1 in 5 households where children aged 0-5 either needed or were due for vaccination could not access child immunization services. It also showed that 69% of households who experienced shocks resorted to reducing food consumption as a coping mechanism. Another study conducted between April and May finds that state-level lockdown measures increase households' experience of food insecurity by 13 percentage points.

UNICEF finds that in Pakistan in 2020 the number of children receiving DPT3/Penta 3 vaccinations fell by around 65% in 2020 compared to 2019 and expects that an additional 2,000 maternal deaths will have occurred by the end of 2020.

A study completed in Papua New Guinea in June 2020 shows that almost 1 in 8 households received medical attention when needed.

In Paraguay a survey completed in August 2020 found that a large proportion of households received medical attention when needed (86%), whilst 13% skipped a meal in the 30 days prior to the study due to lack of money or other resources.

According to a study carried out in Peru in July 2020 shows that more than 1 in 4 households (26%) did not receive medical attention when needed and 22% skipped a meal in the 30 days preceding the survey. A survey conducted by the Young Lives Project shows that in June-July around one in six respondents had run out of food since the beginning of the pandemic, at the same time as food prices were on the rise.

A survey from the Philippines finds that around 1 in 4 respondents had to reduce their meal size and/or number over the week preceding the survey. Poorer households report being disproportionately affected, while families with school-age children reported greater difficulties buying food because of income drops.

Evidence from a survey conducted in Rwanda finds that in June 2020 13% of respondents delayed or skipped needed healthcare visits and more than 50% of households say they have had to reduce food consumption in the week preceding the survey, with rural respondents reporting greater difficulties accessing food. A later round of the survey carried out in October 2020 finds that the situation has worsened, as 2 in 3 households with children say that kids in the family suffer from food insecurity and 1 in 4 reports that children’s access to health suffered from disruptions.

According to a survey conducted in Sierra Leone, in June-July 2020 5% of respondents had to delay or skip necessary healthcare visits and more than 53% had to limit portion sizes at mealtimes or reduce the number of meals they eat. The situation was still dire in October 2020, as 6 in 10 households with children reported that kids in the family were still suffering from food insecurity in the week preceding the survey and 7% said that children in the household could not access needed healthcare visits.

In South Africa lockdown measures have reduced deaths from non-natural causes such as road accidents and homicides, where road injuries are the second biggest cause of death for children age 5 to 14. Results from a survey show that hunger was a problem both before and after the government put in place top-up grants: in April almost 1 in 2 households ran out of food, while in May-June 15% of respondents reported a child had gone hungry in their household in the past seven days, more than half of which for more than 2 days. Additionally, during lockdown around 1 in 4 respondents (23%) could not access medication, condoms or contraception in the past four weeks, with the share climbing to 39% among respondents with a chronic health condition. When it comes to maternal health, 1 in 10 (11%) new or prospective mothers in need of ART reported running out of it, while 1 in 6 reported at least a 2-month gap in care.

In Syria, food prices suffered a +200% increase in under a year, adding a hunger crisis on top of a humanitarian one.

According to a study completed in Tajikistan, almost 3 in 4 households (74%) received medical attention when needed. Further, almost 1 in 3 (30%) skipped a meal in the 30 days preceding the study due to financial constraints.

In Tunisia a survey carried out in May 2020 found that less than 2 in 3 of households (65%) received medical attention when needed.

Findings from a survey carried out in Uganda between October and November 2020 show that over the 30 days preceding the interview 1 in 4 households suffered from moderate or severe food insecurity. Additionally, almost 1 in 10 households either skipped, delayed or was unable to access health services.

Findings from a survey carried out in Vietnam in July 2020 suggest that an overwhelming majority of households (96%) received medical attention when needed. However, more than 1 in 10 households reported that pregnant women, or women who had recently given birth, had not received antenatal care over the past 3 months, and 13% of children under 2 had not visited an immunization centre over the same period preceding the interview. Finally, 1 in 3 households experienced mild food insecurity. Another survey by the Young Lives Project on young men and women finds that in November-December 2020 4% of households had run out of food over the 12 months preceding the survey.

Results from a survey in Zambia find that in December, in around 1 in 6 households with children, children delayed, skipped, or could not access needed healthcare visits since June. A previous round of the survey finds that in June around 40% households had to limit portion sizes at mealtimes or reduce the number of meals at least once in the week preceding the survey.

Learn

The pandemic is going to exacerbate the global learning crisis many low- and middle-income countries were already facing before and pose a real risk that some children will drop out indefinitely.

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. Household wealth is the biggest determinant of internet access, with the overwhelming majority of students living in the poorest households being excluded from accessing online services and therefore many remote learning opportunities. The divide extends beyond internet access: UNICEF research finds that in 40 of the 88 countries for which data is available, urban households are more than twice as lively to own a TV than rural households. Connectivity is an issue not only for households, but for schools too: in low-income countries, only 20% of schools are connected.

Finally, online education might disadvantage girls and children with disabilities. 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. Furthermore, evidence suggests children with disabilities are least likely to benefit from remote learning

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. In short, more privileged children continue to learn at home, while more disadvantaged children fall further behind as schools are closed. 

Cross-country inequalities will broaden, too: evidence by UNICEF, UNESCO, and the World Bank finds that low- and lower-middle-income countries have already lost nearly four months of schooling since the onset of the pandemic compared to an average of six weeks among high-income countries, and have also been more likely not to reopen schools and miss reopening dates. Additionally, while low- and middle-income countries were more likely to enact remedial programmes than high-incomes ones (1 in 2 vs 1 in 3), they were also more likely (20-30%) not to take any measures to improve connectivity for pupils than richer countries (4%).

Estimates by Save the Children suggest that an additional 90-117 million children living in poverty could lead to between 7.0 and 9.7 million more children dropping out of school. The World Bank estimates that the pandemic will result in 7 million dropouts in primary and secondary school, decrease individual LAYS (Learning-Adjusted Years of Schooling) by 0.3-0.9 down to 7-7.6, and cost $10 trillion in future earnings if schools are shut down for 5 months. 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.

Save the Children estimates that almost one year into the pandemic, a staggering 112 billion days of education have been lost worldwide, or an average of 74 per learner. Losses have been largest in Latin American and the Caribbean, South Asia, and the Middle East and North Africa, where children have lost 110, 109, and 80 days of education respectively. UNICEF finds that in Latin America and the Caribbean, 137 million boys and girls were missing out on education by November 2020 due to prolonged school closures.

COVID-19 is having a devastating impact on early education, too: research by UNICEF estimates that at least 40 million children have missed out on early education in their pre-school year because of COVID-19. 

Survey results from Armenia show that between July and September 2020 school-age children in most households (~98%) had engaged in some form of remote learning over the week preceding the survey. However, 7% of families reported that children in the household would not go back to school, and this spiked to 15% in households where one or more family member has a disability.

In Bolivia the proportion of households with children where students are engaged in any learning or educational activities amounts to 78%, according to a study completed in July 2020.

A survey in Burkina Faso finds that only in 50% of households did all children devote time to remote learning during school closures, and almost 4 in 10 respondents could not say with certainty that children in the family will go back to school in June 2020. Richer households are more likely to report that all of their primary-school-aged children are devoting time to home learning, and are also more likely to have a member of the household doing home-schooling. A later round of the survey finds that in November 2020 most (>95%) surveyed families reported that children had gone back to school. Another survey by the World Bank finds that only 7 in 10 children are attending school this academic year, whether remotely or in person.

Findings from a survey in Cambodia show that as of November 2020, 9 in 10 households reported that children in the family had been engaged in remote learning activities over the week preceding the survey, but only 4 in 10 said that they were in touch with teachers. This is an improvement from an earlier version of the survey from September 2020, reporting that, in 1 in 4 households, children had not engaged in any remote learning or education activity over the week preceding the survey, and only 3 in 10 families reported that children were in touch with teachers.

According to findings from a survey in Chad, only 15% of respondents reported that children in their household are engaged in remote learning and only 5% are in touch with teachers. Urban pupils fare better than their rural peers (28 vs 10% and 9 vs 4% respectively), and so do richer students compared to poorer ones (18 vs 11% and 7 vs 3%).

In Chile an overwhelming majority of households (96%) reported that their children are engaged in learning or education activities since schools closed, according to a study completed in August 2020.

A survey carried out in Colombia in May found that the overwhelming majority (96%) of primary- and secondary-age schoolchildren were spending time learning from home while schools are closed. However, the second round of the survey in August finds that many parents would not send their children back to school in the second half of 2020, with younger children being disproportionately affected (between 45 and 50% of parents with pre-school and primary-school children and between 35 and 40% of respondents with children in secondary school or college). Latest findings from November 2020 show that 1 in 3 households with children would not send their kids back to school if they reopened.

In Costa Rica the share of households with children engaged in some form of learning or education activities stands at 96% according to a survey carried out by the World Bank in August 2020.

A survey conducted in Côte d'Ivoire in July 2020 finds that 79% and 84% of primary- and secondary-school children spent time on education while schools were closed, but 20% of respondents did not expect schoolchildren in their households to go back to school once schools reopened. A later round of the survey finds that in October 2020 9 in 10 households with children said that all pupils in the family had resumed schooling and that children had the necessary resources to continue their education at home between June at the start of the new academic year. However, only 1 in 3 reported that a teacher had kept in touch with at least one of the children during lockdown.

Results from a World Bank survey in the Democratic Republic of Congo find that just over half of households contacted (53%) reported having children engaged in any learning or educational activities, based on findings from a study completed in June 2020.

A survey carried out in Djibouti finds that almost 7 in 10 households (69%) stopped sending their children to school as a preventive measure against COVID-19. However, most households reported children were engaged in some kind of educational activity (86 and 90% of primary and secondary school children respectively). Later, most households (92%) reported sending their children back to school as schools reopened in September 2020.

According to a study completed in August 2020 in the Dominican Republic the proportion of households whose children engaged in any learning or education activities amounts to almost 8 in 10 (79%).

Studies conducted in Ecuador and El Salvador in the same period show that more than 9 in 10 households have children engaged in learning or education (94% and 93% respectively).

Evidence from Ecuador shows that children with less access to remote learning are more than twice as likely not to do any schoolwork.

A survey carried out in Ethiopia between August and September 2020 finds that, in households with children who had been in school before the onset of the pandemic, only 17% of primary school and 24% of secondary school children are engaging in remote learning activities during school closures, with urban children being engaged in remote learning more than their rural peers. Results by another survey conducted in November-December 2020 show that although only 2.5% of 19-year-old respondents decided not to re-enrol in education, less than 2 in 3 (64%) had resumed classes, with students in rural areas disproportionately affected (44 vs 79%). A rapid survey eliciting children’s self-reported likelihood of going back to school finds that 2% of boys and girls were unlikely to go back to school, with pupils in lower grades and pupils from impoverished families experiencing a higher risk of dropout.

According to findings from a survey by the World Bank completed in Gabon in May 2020 less than half of households contacted (48%) reported that their children are engaged in any learning or educational activities.

A survey conducted in Ghana finds that 36% and 43% of primary and secondary school pupils respectively are not spending any time on education at home, and those who do spend less time than they did in school. Additionally, only one third of households reported receiving communication from their child’s school.

Evidence gathered in Guatemala and Honduras in August 2020 shows that most children are engaged in learning or educational activities, specifically 90% and 86% respectively.

Findings from a survey in Andhra Pradesh and Telangana in India show that between August and October 2020 due to disruptions to education 1 in 3 students are unable to attend classes and only 72% of young women and 62% of young men are still in education or planning to return to education this academic year. A later round of the survey in November 2020 finds that 1 in 5 19-year-old students were not engaged in any form of learning. Half of those (46%) who were attending classes did so online, a driver of exclusion given the stark digital divide. A rapid survey eliciting children’s self-reported likelihood of going back to school finds that 6% of boys and girls were unlikely to go back to school, with pupils coming from families experiencing a cash crunch during the pandemic reporting a higher risk of dropout.

UNICEF research on Italy reveals that 27% of households reported not having enough devices to support remote schooling needs.

A nationally representative survey carried out in Kenya finds that over 80% of respondents are very worried that the pandemic will have long-term effects on their children’s education. A survey by the World Bank finds that while most children (98%) are either attending school or planning to do so once schools reopen, almost 1 in 2 isn’t spending any time learning from home.

In Madagascar only 40% of households reported that their children were engaged in learning or educational activities since schools closed, according to a World Bank study completed in June 2020.

Findings from a survey in Malawi show that as of November 2020 most households (97%) reported that their children have gone back to school.

A survey conducted in Mali finds that as of September only 1 in 5 (20%) households with age-school children reported they had all gone back to school.

Results from a survey in Mexico find that over 90% of respondents report that all primary and secondary school children in their household are spending time on education while at home, and close to 9 in 10 (87%) say children in the families will most likely or definitely go back to school once these reopen.

Evidence gathered through a survey conducted in Mongolia in May 2020 indicates that 73% of households have children engaged in any learning or education activities since school closures.

According to findings from a survey in Nigeria, in October 2020 only 59% household members aged 5-18 were attending school, fewer than in January/February 2019. As of October 2020, the overwhelming majority (>99%) of school-age children planned to go back to school when it reopened. However, only around 1 in 2 (55%) children reported being engaged in remote learning activities since mid-March. A rapid survey eliciting children’s self-reported likelihood of going back to school finds that 3% of girls and 10% of boys were unlike to go back to school, with pupils in lower grades and pupils from families experiencing a cash crunch during the pandemic reporting a higher risk of dropout.

A rapid survey from Pakistan eliciting children’s self-reported likelihood of going back to school finds that 4% of girls and 7% of boys were unlike to go back to school, with pupils in lower grades and pupils from impoverished families experiencing a higher risk of dropout.

In Paraguay most households (93%) reported having children engaged in some form of learning or education activities since school closures, according to a study completed in August 2020.

In Peru a similar proportion of households (92%) indicates that their children participate in learning or education activities, as it emerges from a study conducted in June 2020. According to a survey by the Young Lives Project conducted in August-November 2020 most students enrolled in formal education could access remote learning; however, 16% of 19-year-olds enrolled in education pre-COVID dropped out our or chose not to re-enrol. A later round of the survey found 1 in 5 19-year-old students (18%) had still not enrolled in November-December 2020.

In a survey from the Philippines only 60% of respondents indicate that children in their household have already enrolled in school and 20% report they will not enrol children if schools reopened in August.

Evidence from a survey conducted in Rwanda found that in July 2020 80% of primary- and secondary-school age children were devoting time to remote learning during school closures. A later round of the survey shows that the situation is steady, as in October 2020 80% of households with children said that pupils were spending at least some time on learning at home during school closures.

Results from a phone survey in Senegal suggest that the likelihood of a child’s engagement in learning activities during lockdown is negatively correlated with wealth and level of education of the respondent. A survey conducted in May 2020 shows that, overall, 54% of households reported having children who were engaged in education or learning activities since school closures.

According to a survey conducted in Sierra Leone, most respondents report all children in primary (78%) and secondary (76%) school in their household are spending time on education at home, but only 55-60% are spending an average of more than two hours per day on education. A later round of the survey found that by October 2020 pupils had returned to school in 80% of families with children.

Respondents to a survey carried out in Tajikistan in May 2020 indicate that just over 1 in 3 (34%) households have children who are still engaged in learning or education since school closures.

In Tunisia, most households (96%) surveyed in a study completed in October 2020 have children who have continued to be involved in learning or education activities since schools closed.

In Uzbekistan the proportion of households who report having children engaged in any learning or education stands at 73%, according to a study by World Bank in June 2020.

Findings from a survey in Uganda show that only 1 in 3 children attended any remote learning activity over the past 7 days and a similar proportion (33%) is attending school as of November 2020.

Evidence gathered in Vietnam in July 2020 shows in 8 out of 10 households school-age children engaged in remote learning during school closures, and the overwhelming majority (98%) were still enrolled in school. Another survey by the Young Lives Project finds that most respondents in the younger cohort (88%) were regularly attending classes in November-December 2020, although students in rural areas were more likely to be missing out on education.

Results from a survey in Zambia find that in June only around 60% of respondents reported that primary- and secondary-age schoolchildren in their households were spending time learning from home during school closures; however, the overwhelming majority (96%) say their children will most likely or definitely return to school after the lockdown. A later round of the survey confirms this, as in December 2020 in 90% of households with children all pupils had resumed schooling and in 95% of them children had spent at least some time on remote learning each day in the week preceding the survey during school closures.

Be Protected

The mitigation policies for, and economic repercussions of, COVID-19 are likely to have devastating effects for many children’s rights, with girls and young women being particularly at risk.

Save the Children’s own estimates predict that the economic fallout of COVID-19 will put up to half a million more girls at risk of child marriage in 2020 and up to 2.5 million more by 2025. 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. UNICEF estimates that the pandemic will put up to an additional 10 million girls at risk of becoming child brides by 2030, with the bulk of the effects being felt between now and 2025, due to the combination of the following contributory factors: school closures, economic insecurity, worsening household income, disrupted access to health services, and death of a parent.

Save the Children projections expect that the increased poverty caused by the pandemic will cause up to 1 million additional teenage pregnancies in 2020. Disruptions to health services and supply chains could lead to loss of access to contraception for 47 million women (of all age groups), which may result in 7 million unintended pregnancies. UNICEF estimates that in South Asia the pandemic and related disruptions will have caused an additional 400,000 teenage pregnancies by the end of 2020. Most likely, the pandemic is undercutting access to contraceptives and SRHS around the world. 

UNFPA and partners project 2 million additional cases of female genital mutilation (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. 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%. 

There are concerns, as families experience economic hardships, parental deaths and school closures, COVID-19 will increase the prevalence of child labour, reversing a 20-year downwards trend. Basing on evidence from South AfricaVietnamEcuador and other countries, the ILO finds that a 1 percentage point rise in poverty leads to at least a 0.7 percentage point increase in child labour, with dramatic consequences considering the major recession the pandemic has caused. Additionally, children face increased risk of physical violence as unemployment of parents is increasing in countries across the world and violence prevention and response services are disrupted. A survey by UNICEF warns that while 104 out of 136 responding countries have suffered disruption in this area (and around two thirds of affected countries reported at least one service suffered heavy disruption), only 70% reported mitigating measures to be in place to tackle the gap.

Children with disabilities – 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

Unprecedented, unstructured, and sometimes unsupervised screen time during lockdown puts children at greater risk of harm, including cyberbullying, online sexual exploitation and abuse, and sextortion. 

Evidence suggests that the pandemic and lockdown measures also jeopardise 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;” similarly, 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. When it comes to teenagers, evidence suggests that social deprivation deriving from implementation of lockdown measures can be harmful at a time when social stimuli are key to adolescents’ development. 

A decline in facilities-based deliveries could cause birth registrations to plummet

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. For instance, women and girls make up 60% of the world’s hungry, making them particularly vulnerable in emergencies. 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.

Evidence from South and Southeast Asia finds that the pandemic is affecting women’s mental health more often 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. A rapid needs assessment conducted by UN Women in mid-April in 49 countries across 5 regions finds that 80% of the countries which provided data registered an increased in calls to helplines (by up to 400%). What is more, 70% of the countries reported a spike in cases reported by health centers – at a time when availability and access to services has plunged.

The Center for Global Development provides a useful overview of new studies researching the impact of the pandemic on violence against women and children (VAW/C). Findings suggest that effects are mixed depending by country, study, and type of violence; however, an apparent drop in VAW/C may well be due to a plunge in service availability and likelihood of reporting during lockdown. 

Children in emergency/conflict settings face a heightened risk of indirect effects because they likely live in countries plagued by poor infrastructureweakened 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. Additionally, children in humanitarian settings face a disproportionate risk of harm when it comes to child protection, with emerging evidence pointing to an increase in child marriages, sexual abuse and exploitation, child labour, and child recruitment into armed forces.

Preliminary evidence by UNFPA points to an increase in domestic violence in Syria, with a small-n interview by Women Now reporting that COVID-19 is contributing to the spike. The Global Protection Cluster warns that in North-West Syria, 80% of communities report spikes in child marriage and child labour as coping strategies for loss of income. Additionally, humanitarians on the ground report that lack of safety nets are forcing people with disabilities to “search for food in rubbish containers or look through landfills for sellable and reusable material.” The same source reports that a similar situation is unfolding in the DRC, where children’s risk of forced labour and commercial sexual exploitation is being exacerbated by a loss of parental livelihoods. Anecdotal evidence gathered by World Vision paints a similarly worrying picture, with reports of children being left to provide for themselves and left vulnerable to abuse due to the complex interplay between conflict, poverty, and public health emergency.

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%.

A survey conducted in Burkina Faso finds that access to contraception has gotten more difficult since the pandemic started for 25% of respondents.

A survey conducted in Colombia finds that almost 1 in 2 (>40%) households reported that their mental health suffered between May and August. A later round of the survey finds that since lockdown began anxiety has increased for over 40% of children age 6-18.

Results from a survey in Ethiopia show worsening subjective well-being, with around 1 in 5 respondents showing symptoms indicating anxiety and a similar proportion of depression.

Findings from a survey in Andhra Pradesh and Telangana in India find that around 1 in 10 respondents reports an increase in experiences of domestic violence and shows symptoms of depression between August and October 2020. A later round of the survey in November 2020 found the situation had improved.

Nigeria and Kenya registered a 30-50% increase in cases of sexual- and gender-based violence (SGBV) since the lockdown started.

A nationally representative survey carried out in August in Kenya finds that almost 7 in 10 (69%) respondents report experiencing more conflicts with family members over the past two months, 62% of which involved physical violence.

A survey conducted in Peru by the Young Lives Project finds that almost 1 in 10 (8%) of respondents reports and increase in domestic violence, while 30% of respondents show symptoms of depression between August and October 2020. A later round of the survey finds that in November-December 2020 the situation had improved (24% respondents showing symptoms of depression) but was still worse than pre-pandemic levels (when the rate stood at 18%).

In the Philippines, the government reported that cases of online child sexual abuse between March and May 2020 tripled compared to the same timeframe in 2019.

In Tanzania the Legal and Human Rights Center has reported an increase in femicides.

Survey results from South Africa find that during lockdown around 1 in 4 respondents (23%) could not access medication, condoms or contraception in the four weeks preceding the interview.

Data on severe acute malnutrition from Save the Children’s Country Office in South Sudan reports a spike in OTP (Outpatient Therapeutic Program) admissions in the months of July and August, with an increase of around 50% and 70% compared to the same period in 2019 and 2018 respectively.

In South Sudan, according to a survey carried out in June 2020, 86% of households received medical attention when needed. However, a sizeable 83% skipped a meal in the 30 days preceding the survey due to financial difficulties. Evidence collected in May 2020 found that the proportion of households whose children were continuing to engage in learning and education since school closures drops to just 1 in 3 (32%).

A survey conducted by the Joining Forces Coalition in May in Uganda finds that 56% of respondents observed child labour had increased since lockdown due to COVID-19 economics.

A rapid needs assessment conducted by Save the Children in Venezuela in June finds that 1 in 3 surveyed households report that aggression and hostility against children at home has increased due to isolation measures. Another study finds 1.7 million students from primary to university education abandoned their studies between 2019 and 2020.

A survey on young women and men in Vietnam finds that in November-December 2020 5% and 6% respondents reported symptoms of anxiety and depression respectively, a drop from an earlier round of the survey.

Cross-country evidence shows that during the lockdown children have been involved in economic activities to varying degrees, sometimes to the detriment of time spent on education (4% in Colombia, 5% in Rwanda, 10% in Zambia and Ghana, 11% in Sierra Leone, 47% in the Philippines). Beyond countries, the rate varies basing on age, too: involvement in economic activities amount to 65-70% for primary school children in Burkina Faso, Côte d'Ivoire, and Mexico, and to around 70-80% for secondary school children in these countries.

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