United Nations on COVID-19 shutdown: “…mitigation measures that may inadvertently do more harm than good… An estimated 42-66 million children could fall into extreme poverty as a result of the crisis this year… could result in hundreds of thousands of additional child deaths in 2020”

On April 15, 2020, the United Nations published this 17 page report, which is titled: Policy Brief: The Impact of COVID-19 on children.

The report cites the predicted harm that will happen to children in low income countries as a result of the COVID-19 global wide shutdown. Examples of this harm to children include increases in malnutrition, loss of education, increased rates of teen pregnancy, reduced access to health care, reduced rates of vaccination, increased rates of infectious disease, increased rates of water borne illness, and increased rates of death.

The report goes on to explain that some of these negative consequences could have very severe, permanent effects on children.

Page 2 refers to: (all of the bolding in this blog post is mine)

...mitigation measures that may inadvertently do more harm than good

and goes on to say:

…An estimated 42-66 million children could fall into extreme poverty as a result of the crisis this year…

The transition from page 2 to page 3 states:

Economic hardship experienced by families as a result of the global economic downturn could result in hundreds of thousands of additional child deaths in 2020, reversing the last 2 to 3 years of progress in reducing infant mortality within a single year. And this alarming figure does not even take into account services disrupted due to the cri-sis – it only reflects the current relationship between economies and mortality, so is likely an under-estimate of the impact. Rising malnutririon is expected as 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. The risks to child mental health and well being are also considerable. Refugee and internally displaced children as well as those living in detention and situations of active conflict are especially vulnerable. 

Page 4 states:

As health services become overwhelmed in car-ing for large numbers of infected patients requir-ing treatment, children and pregnant women are less able to access standard care. Children of frontline workers have also had to adapt to alternative childcare arrangements. Children living in areas of armed conflict, who already struggle extensively to access health services may be further excluded from attention and access to the severely stretched health systems. Physical distancing and lockdown measures, restrictions of movement and border closures, and surveillance strategies are all affecting chil-dren in myriad ways. Face-to-face child services – schooling, nutrition programmes, maternal and newborn care, immunization services, sexual and reproductive health services, HIV treatment, alternative care facilities, community-based child protection programmes, and case management for children requiring supplementary personal-ized care, including those living with disabilities, and abuse victims – have often been partially or completely suspended. 

Page 4 ends with this:

While children are not the face of this pandemic, its broader impacts on children risk being catastrophic and amongst the most lasting consequences for societies as a whole.

Page 6 states:

The physical distancing and lockdown measures needed to save lives and supress the transmis-sion of the virus have resulted in a significant reduction of economic activity across all major economies and the resultant global recession…

At a household level, the collapse in income threatens the livelihoods of millions of house-holds with children around the world. Inputting the forecasts from the IMF optimistic scenario into an IFPRI poverty model4 indicates an increase in extreme poverty (PPP$1.90 a day) this year of 84 to 132 million people, approx-imately half of whom are children, compared to a pre-pandemic counterfactual scenario.

Page 7 states:

The worldwide closure of schools has no his-torical precedent…

… The potential losses that may accrue in learn-ing for today’s young generation, and for the development of their human capital, are hard to fathom…

Page 8 states:

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 pan-demic. 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.

Page 9 states:

Reduced household income will force poor families to cut back on essential health and food expenditures. Drawing again on the forecast for global eco-nomic growth from the IMF and the historical relationship between GDP growth and infant mortality in the developing world15 , 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 ante-natal 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 ves-tiges, 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, chil-dren 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…

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) ser-vices 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, and this number could rise sharply if existing services collapse….

Page 12 states:

The ultimate impact of the crisis on chil-dren hinges on how much time it will take for the pandemic to end. A longer struggle to contain the virus not only prolongs the pain caused by the pandemic, but raises the pros-pect that the pandemic’s impact will have lingering or persistent effects on children.

For instance, the longer economies are on shutdown, the less likely they are to “snap back”. At the household level, struggling families will increasingly see breadwinners lose their jobs or be forced to sell productive assets in order to survive, with long-running consequences for child poverty. The same holds true for other impacts of the pandemic. The longer schools remain closed, the less likely children are to catch up on learning and essential life skills that support a healthy tran-sition to adulthood. The longer immunization campaigns are suspended, the greater and more costly will be the struggle to eliminate polio and to manage measles outbreaks.

For children caught at the apex of this crisis, there is a genuine prospect that its effects will permanently alter their lives. Children facing acute deprivation in nutrition, protection or stimulation, or periods of prolonged exposure to toxic stress, during the critical window of early childhood development are likely to develop lifelong challenges as their neurological devel-opment is impaired. Children who drop out of school will face not only a higher risk of child marriage, child labour, and teenage pregnancies, but will see their lifetime earnings potential pre-cipitously fall. Children who experience family breakdowns during this period of heightened stress risk losing the sense of support and secu-rity on which children’s wellbeing depends.

Page 13 cites multiple, real world examples of the harm that happened to children as the result of the shutdowns during the Ebola epidemic. This includes substantial increases in the problems of childhood nutrition, lack of health care, lack of vaccinations, and lack of education.

Regarding the effects on vaccination during the Ebola epidemic, the report states:

The proportion of Liberian children under 1 who were fully immunized fell from 73 percent before the epidemic, to 36 percent during the epidemic, and recovered only partially to 53 percent by the end of 2015. Measles cases in Liberian children under 5 rose, likely due to the lapse in vaccination programs. The mean number of monthly cases of measles rose from 12 before the epidemic to 60 immediately afterwards.

I never would have guessed that the measures to deal with a new infectious disease would include reducing the vaccination rates for other, older infectious diseases.

In developing countries all over the world, the shutdown due to COVID-19 is causing huge harm, in multiple different ways, to a very large number of children. Some of these things will have permanent effects on these children for the rest of their lives.

April 20, 2020. Tags: , , , , , , . COVID-19, Economics, Education, Health care. Leave a comment.