There’s currently much talk and debate surrounding the notion of students heading back to school during Covid-19. Much has been debated regarding the risk to students, specific safety measures to be implemented by schools, and the need for face-to-face instruction. Though these are valid conversations, we should keep in mind the larger global picture. The United nations recently published a policy brief titled The Impact of Covid-19 on Children. Below I have shared with you a portion of this document, highlighting four bigger picture issues the world’s children are having to face because of the pandemic.
1. Falling into poverty
The physical distancing and lockdown measures needed to save lives and suppress the transmission of the virus have resulted in a significant reduction of economic activity across all major economies and the resultant global recession. The severity of the recession remains to be seen but the socio-economic impacts were laid out in detail in a document titled Shared responsibility, global solidarity: Responding to the socio-economic impacts of COVID-19 issued by the United Nations. Estimates by the IMF anticipate global income contracting by 3 percent in 2020, under the assumption that the pandemic recedes in the second half of this year. An already grave situation could easily become much worse if capital outflows from emerging and developing economies trigger a cascade of disorderly sovereign defaults.
At a household level, the collapse in income threatens the livelihoods of millions of households with children around the world. Inputting the forecasts from the IMF optimistic scenario into an IFPRI poverty model indicates an increase in extreme poverty (PPP$1.90 a day) this year of 84 to 132 million people, approximately half of whom are children, compared to a pre pandemic counterfactual scenario.
These initial estimates capture only the effects of a global downturn on poor households, ignoring the localized effects of household breadwinners being forced to shelter in place, or migrate back to their rural homes, abandoning their normal livelihoods. Financial diaries from 60 low-income households in the Hrishipara neighbourhood in central Bangladesh capture the sudden collapse of daily incomes when lockdown measures are introduced (see Figure 1). Historically, the burden of such shocks on households have disproportionately been borne by girls.
Such income shocks at the household level, even if only temporary, can have devastating effects on children, particularly those living in poor households with limited assets. In many countries, we have seen rapid expansions of social assistance programmes to compensate households for lost income. As of 10 April 2020, 126 countries had introduced or adapted social protection measures, of which 83 provide explicit support for children and their families. However, the coverage of affected families, and of forgone income, is far from complete. The duration of today’s lockdowns remains unclear, as is the likelihood of lockdowns being reintroduced in response to future outbreaks of COVID-19.
The worldwide closure of schools has no historical precedent. 188 countries have imposed countrywide closures, affecting more than 1.5 billion children and youth (see Figure 2). In contrast to previous disease outbreaks, school closures have been imposed pre-emptively: in 27 countries closures were introduced before cases of the virus were recorded. With schools in many countries planning for extended lockdowns, at least 58 countries and territories have postponed or rescheduled exams, while 11 countries have cancelled exams altogether.
The potential losses that may accrue in learning for today’s young generation, and for the development of their human capital, are hard to fathom. To minimize these losses, many schools are offering distance learning to their pupils. However, this option is only available to some. While more than two-thirds of countries have introduced a national distance learning platform, only 30 percent of low-income countries have done so. Girls have less access to digital technology than boys, which may reduce their access to and participation in on-line learning. Children living in informal settlements, camps with limited infrastructure and no access to internet are particularly impacted. Confinement and movement restrictions may be incentives for parties to conflict to occupy, loot or destroy schools facilities and hospitals; while empty schools may be targeted for military use. Children with disabilities and special needs are especially hard to serve through distance programmes. The quality and accessibility of distance learning can be expected to vary greatly both across and within countries. Only 15 countries are offering distance instruction in more than one language.
Those losses will be greatest for children who, triggered by the pandemic, drop out of school altogether. That possibility becomes greater the longer schools are closed and the deeper the economic contraction wrought by the pandemic. Experience with HIV in Kenya shows that those children who lose a parent face reduced odds of returning to school. In situations of continuing conflict, children no longer in school may be incentivized to join armed forces or groups, thus perpetuating the cycle of violence.
3. Survival and health
The direct impact of COVID-19 infection on children has, to date, been far milder than for other age groups. Preliminary data from observed cases in China and the US suggest that hospitalization rates for symptomatic children are between 10 and 20 times lower than for the middle aged, and 25 and 100 times lower than for the elderly. Of hospitalized patients, children are the least likely to require critical care. The share of symptomatic children who lose their lives to the virus in China has been estimated as 1 in 25,000, which is 30 times less than of the middle aged and 3,000 times less than the elderly. Inferences from these data should nevertheless be made with extreme caution, given the limited coverage of existing datasets, and the varied contexts in which COVID 19 is now at large. The epidemiological impact of the virus can be expected to vary over time and in different contexts.
In contrast to the direct impact of COVID-19, the broader effects of the pandemic on child health are significant. Reduced household income will force poor families to cut back on essential health and food expenditures. Drawing again on the forecast for global economic growth from the IMF and the historical relationship between GDP growth and infant mortality in the developing world, hundreds of thousands of additional child deaths could occur in 2020 compared to a pre-pandemic counterfactual scenario. This would effectively reverse the last 2 to 3 years of progress in reducing infant mortality within a single year.
These estimates focus only on the effects of this year’s global recession on child health and do not account for the multiple ways in which health services are being directly disrupted by the pandemic. This includes reduced access to essential reproductive, maternal, newborn and child health interventions, such as antenatal care, skilled attendance at birth, and treatment for pneumonia. It also includes the suspension of all polio vaccination campaigns worldwide, setting back the decades-long effort to eliminate the wild virus from its last two vestiges, Afghanistan and Pakistan, and to tackle recent outbreaks of the vaccine derived virus in Africa, East Asia and the Pacific. In addition, measles immunization campaigns have been suspended in at least 23 countries that had cumulatively targeted more than 78 million children up to the age of 9. Meanwhile, children and adolescents with chronic illnesses, including those living with HIV, are at risk of reduced access to medicines and care.
Child nutrition is a vital concern. 368.5 million children across 143 countries who normally rely on school meals for a reliable source of daily nutrition must now look to other sources. That challenge is made greater by the economic shock facing households, which will negatively affect the diets of children, pregnant women, and breastfeeding mothers. Additionally, hastily implemented lockdown measures risk disrupting food supply chains and local food markets. If these effects are not quickly resolved they pose potentially grave consequences for food security.
Should schools remain closed and cause girls to drop out, we should also anticipate an increase in teenage pregnancy in the year ahead. A recent meta-analysis of the prevalence and determinants of adolescent pregnancy in Africa found that adolescent girls out of school are more than two times more likely to start childbearing than those who are in school.
Water, sanitation and hygiene (WASH) services are also at risk of disruption by lockdown measures, posing further threats to children’s health through water-borne diseases. Over 700 children under five die every day from diarrheal diseases related to inadequate WASH services 19, and this number could rise sharply if existing services collapse. This is especially alarming given the critical role of hygiene in preventing infection and controlling the spread of COVID-19.
The effects of physical distancing measures and movement restrictions on children’s mental health represent another cause for concern. Children today face anxiety about the negative impact of the pandemic on their lives and their communities, and uncertainty regarding the future: how long today’s extraordinary circumstances will endure and how the pandemic will ultimately be resolved. For children facing extreme deprivations, acute stress can impair their cognitive development and trigger longer-term mental health challenges.
For most children, home represents a source of security and safety. But for a minority, the opposite is tragically the case. Violence by caregivers is the most common form of violence experienced by children. Children are also often witnesses to domestic violence against women, the rates of which are thought to have increased in many countries, as detailed in the policy brief on the impact of COVID-19 on women. Such acts of violence are more likely to occur while families are confined at home and experiencing intense stress and anxiety. 60 percent of all children worldwide live in countries where a full or partial lockdown is in place.
Lockdowns tragically also present an opportunity for child abusers to harm children. Children are rarely in a position to report such egregious acts. Yet, at a time of increased need, children no longer have the same access to teachers to report incidents at home, while social work and related legal and protective services for children are being suspended or scaled back. Children’s reliance on online platforms for distance learning has also increased their risk of exposure to inappropriate content and online predators. Growing digitalization magnifies children’s vulnerability to harm.
Just as the combined effect of school closures and economic distress is likely to force some children to drop out of school, the same combination can be expected to compel children into child labour, to become child soldiers, and into child marriage in high-risk countries. Children without parental care are especially vulnerable to exploitation and other negative coping measures.
Poorly planned or executed implementation of containment and mitigation measures present additional risks to children’s safety and the violation of their rights, especially when measures to care for the most vulnerable are not also enacted. Enforced shutdowns, curfews and movement restrictions have led to the sudden closure of refugee camps and residential institutions, and the dispersion of slum-dwellers, including children. Surveillance tools deployed to enforce quarantines and social distancing, and to enable contact tracing, have proven to be a powerful tool in controlling the spread of the virus in certain countries, but on occasion have violated children’s rights to privacy. This includes the public sharing of personal information of infected children, or sufficient information for their personal identification. These approaches risk winding back legal protections and rights that may prove difficult to recover.
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