essay on impact of covid 19 on child rights

These 10 countries are the best at respecting children’s rights

The pandemic is having a profound effect on children. Image:  REUTERS/Loren Elliott

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Stay up to date:.

• A new study uses United Nations data to measure how children’s rights are respected across the globe.
• Iceland, Switzerland and Finland come top.
• But worldwide, millions of children face extreme poverty due to COVID-19.

Of the myriad tragic effects of COVID-19, its impact on young people could prove to be one of its most damaging legacies.

The authors of a new report say the crisis has “turned back the clock” on years of progress made on kids’ well-being and put children’s rights under serious pressure across the globe.

Have you read?

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The KidsRights Index 2020 measures how children’s rights are respected worldwide, and the extent to which countries are committed to improving them.

The data doesn’t directly include the impact of the pandemic, but the wider report, presented in the context of coronavirus, warns of the “ disastrous” impact of the crisis on children .

The index finds the five best places to grow up healthy, well-educated and respected are all developed Western economies. But it does throw up some more surprising results too.

Children’s NGO KidsRights draws on data from UNESCO, the United Nations Development Programme and the UN Convention on the Rights of the Child to compile the annual report.

It groups 20 indicators into five areas: the right to life; the right to health; the right to education; the right to protection; and the enabling environment for child rights.

For 2020, Iceland tops the 182 nations listed, scoring well for its ‘child rights environment’, with legislation that enables child rights, a focus on the best interests of children and respect for their views. For education, it comes joint first with seven other nations,

Switzerland comes second, and top in the protection category, which looks at child labour, adolescent birth rate and birth registration. Finland – another of the joint-top nations for education – is third, while Sweden and Germany make up the top five.

Italy is highlighted for making significant progress in four of the five areas measured. It has climbed from 74th place in 2019 to 15th in 2020.

The five lowest-scoring countries are the Central African Republic, Equatorial Guinea, Sierra Leone, Afghanistan and Chad.

Thailand and Tunisia in top 20

But developed nations don’t exclusively perform better, according to KidsRights. This is because, rather than simply ranking the places where children have the best life, the index scores countries relative to their capacity to implement children’s rights.

So a host of industrialized nations, like the UK (169th), New Zealand (168th) and Australia (135th), sit quite far down the list, while some less developed countries including Thailand (8th) and Tunisia (17th) perform relatively well.

Looking at individual categories provides an interesting picture too. For example, in the life grouping – which considers criteria such mortality rate and life expectancy at birth – the top three consists of Japan, Italy and Singapore. In health, Portugal, Israel and South Korea top the table. And Thailand, Iceland and Tunisia are the top three for enabling child rights.

The first global pandemic in more than 100 years, COVID-19 has spread throughout the world at an unprecedented speed. At the time of writing, 4.5 million cases have been confirmed and more than 300,000 people have died due to the virus.

As countries seek to recover, some of the more long-term economic, business, environmental, societal and technological challenges and opportunities are just beginning to become visible.

To help all stakeholders – communities, governments, businesses and individuals understand the emerging risks and follow-on effects generated by the impact of the coronavirus pandemic, the World Economic Forum, in collaboration with Marsh and McLennan and Zurich Insurance Group, has launched its COVID-19 Risks Outlook: A Preliminary Mapping and its Implications - a companion for decision-makers, building on the Forum’s annual Global Risks Report.

Companies are invited to join the Forum’s work to help manage the identified emerging risks of COVID-19 across industries to shape a better future. Read the full COVID-19 Risks Outlook: A Preliminary Mapping and its Implications report here , and our impact story with further information.

Global underfunding

The KidsRights report warns that globally countries don’t allocate enough money to children’s rights, and that with governments focusing on healthcare and economies during the pandemic, the situation is unlikely to improve.

The impacts of the crisis are being felt in all areas of children’s lives, from health, development and behaviour, to education, economic security and protection from violence and abuse.

More than 1.5 billion children have been affected by school closures; boys and girls have been left more vulnerable to child labour , child marriage and teenage pregnancy; and disrupted vaccination programmes could lead to a big rise in infant mortality.

While children have not, so far, largely been affected by the direct health effects of COVID-19, the pandemic is having a “profound effect” on kids’ well-being , the United Nations says. An extra 42 to 66 million children are at risk of falling into extreme poverty.

As KidsRights founding chairman Marc Dullaert says: “Giving children the cold shoulder can be disastrous in the short, but more so in the long-term, for both the current and the future generation.”

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COVID-19 and its Impacts on Child Abuse and Neglect

Policy Brief

Carter, D, Odama, A, Obi, N, & Lang, H.  (2021).  COVID-19 and its Impacts on Child Abuse and Neglect.  Report submitted for TPS Child Maltreatment class, Brown School.  St. Louis MO:  Washington University.

Download the brief »

Executive Summary

With the onset and continual rise of the COVID-19 pandemic came an influx of societal issues. As schools, jobs, and other essentials shut down, the concern of children and families became a conversation in child welfare. The loss or reduction of job and financial stability, health, housing, and child care, which are closely related to an increase in parental stress, became a national concern during COVID-19 as parental stress is strongly associated with increases in child abuse and neglect (CAN). Families also lost access to social support systems heightening parental stress and increasing mental health issues such as anxiety and depression. All of this combined adversely impacted parental behaviors and parent-child conflicts which are associated with CAN. Additionally, increased proximity of families to neighborhood violence, drug, and alcohol abuse as well as being young parents increased the risk for parental aggression and violence. Many states witnessed a 20-70% decline in reporting as COVID-19 hit. However, this decline could be misleading and reflects the heavy reliance of the child welfare system on reports from mandated professionals such as teachers, physicians, and other professionals who lost contact with children due to COVID-19 restrictions.

Given the limitations that COVID-19 presented, we predict that once COVID-19 has been reduced or cleared it is likely that there will be a large spike in cases reported, substantiated, and services required since CAN reports decreased from diminished community interaction. Additionally, we predict parents will have an increased risk of committing CAN if they experience one or more risk factors that increased in magnitude during COVID-19. We also predict children who are young in age or have parents who experience one or more risk factors that increased in magnitude during COVID-19 will be at an increased risk of being victims of CAN.

Lastly, since policies and procedures prior to the COVID-19 pandemic relied on in-person interaction and services, there are many policy and system recommendations to implement in order to reduce the potential for CAN to occur during COVID-19 or during pandemics. These include prioritizing at-risk families for services and investigations, increasing funds to welfare and family services, increasing community understanding and ability to report CAN, shifting child welfare from a reactive system to a surveillance and preventative system, and advocating for all changes stated prior.

Problems of COVID-19 Related to CAN

Introduction.

The COVID-19 pandemic created a conglomeration of risk factors for both parents and children which increased the likelihood of CAN. The public health measures used to reduce the spread of COVID-19, including stay-at-home orders and social distancing requirements, reduced contact of children with professionals, mandated reporters, and social support systems who would otherwise have been the first line of support and protection for these children. (What COVID-19 Means for America’s Child Welfare System, n.d.) Therefore, many states saw a reduction in the number of CAN reports. However, despite the decrease in reporting, there is evidence that the pandemic created an environment for CAN rates to increase. (Rodriguez et al., 2021)

Parental Stress

During the COVID-19 pandemic, many parents lost the ability to work due to health concerns, were let go from their jobs due to workplace budget cuts, were placed on leave as their workplaces sometimes had to shut down, or had to stop working to provide childcare for their children. Parental job loss during the pandemic increased parental stress from financial instability, housing, and feeding concerns since many also experienced a decrease in the ability to rely on social support systems. (Herd et al., 2020) This parental stress was associated with a nearly five times increase in cases of CAN compared to parents who did not experience job loss (Lawson et al., 2020).

Lack of Available Resources

Additionally, the closure of childcare centers and schools meant that parents either had to stay home and take care of their children all day or work but leave their children home alone or with an older sibling incapable of taking care of a child. The unavailability of childcare may have led to the increase in CAN, particularly supervisory neglect, especially among preschoolers given their dependency at this age. Also, since sexual abuse is perpetrated commonly by people familiar with the victims, the incidence of sexual abuse was likely to increase as parents left their children with other relatives or friends (Herd et al., 2020).

Mental Health Issues

With the combination of increased financial pressures, lack of available resources, and lack of ability to rely on social support systems, many parents encountered an increase in health issues such as anxiety and depression (Katz et al., 2021). These mental health issues combined with unmanaged parental stress may have led to adverse parenting behaviors and parent-child conflicts, including CAN (What COVID-19 Means for America’s Child Welfare System, n.d.; Schneider et al., 2017; Bullinger et al., 2020).

Environmental Factors

At the community level, the increased proximity of families to neighborhood violence, poverty, unemployment, and drug and alcohol abuse from the shelter-in-place orders, put families at risk of aggression and violence. Domestic violence reports increased during COVID-19 as a result of lockdowns and research has shown that children exposed to domestic violence in the household are at an increased risk of experiencing maltreatment (Herrenkohl et al., 2008). Additionally, younger parents were more likely to be the perpetrators of CAN while younger children were more likely to be victims of physical and mental abuse during COVID-19 (Lawson et al., 2020).

CAN Reporting Rates

Given all these factors that could potentially affect CAN incidence during the pandemic, there was speculation that there would be a huge increase in CAN and CM rates after the start of COVID-19. Interestingly, the data presented by multiple states showed a decrease in CAN & CM reports.

States like Michigan, Kentucky, New Hampshire, and Louisiana also reported double-digit decreases in CAN reports but the exact magnitude was not given (The Hunt Institute, 2021). Although not every state presented data on its CAN/CM reporting rates post-pandemic, we predict that they too observed significant decreases in their reporting rates. Based on current data, there seems to be no difference based on geography.

Not just reporting rates, but hospitals also noted a decrease in CAN-related emergency room visits and hospital admissions during the pandemic (Leigh, 2021). A study from Benioff Children’s Hospital and Children’s Mercy KC (Leigh, 2021) theorized that financial stipends and eviction protections might have played a part in buffering the risks of child neglect and maltreatment hence leading to a reduction in CAN incidence but there is very little evidence to show. Data suggests that these decreases in reporting and hospital admission rates are more likely due to mandated reporters and other professionals having less contact with children and thus being unable to report suspected cases.

Per AP News analysis, the national rates of CAN and CM reports and investigations decreased by 18% in 2020 compared to 2019. These rates fell sharply as schools pivoted to online learning and a 59% drop in CAN reports from school sources was noted (AP NEWS, 2021). The United States child welfare system is heavily reliant on reports from teachers, doctors, and other professionals to detect CAN. With the stay-at-home orders minimizing contact of children with these professionals, the system was rendered helpless in carrying out its mandate. Also, other aspects of the child welfare system such as home investigations, court appearances, and home-visiting-based parenting programs were cut off. (What COVID-19 Means for America’s Child Welfare System, n.d.).

Current Policy and Deficits

Most policies surrounding CAN prior to COVID-19 were tailored and reliant upon in-person services, financial stability of clients (to a degree), and operations of services without major restrictions. This included the ability to access daycare, schooling, health visits, and child welfare as well as the ability to work. Additionally, while already underfunded and overworked, child welfare functioned as a reactive system that relied on mandated reporters in order to initiate investigations.

However, due to the nature of how COVID-19 spread, many in-person services decreased or ceased which limited mandated reporters’ ability to report, reduced the ability to utilize services that reduce CAN, and child welfare itself failed its clients as reporting was reduced, funds further strained services, and in-person services and investigations could not take place. Thus, the current policies related to CAN saw major failure with COVID-19 due to the modes of organization and lack of contingency plan if a pandemic of such scale and spreadability occurred.

Predictions and Recommendations

Predictions.

It is more than likely that CAN reports and investigations greatly decreased during COVID19 but did not accurately reflect CAN incidents that were taking place. Given the reduction of preventative services, limitation of mandated reporter access, and reduced ability of child welfare to investigate and provide services, it is more than likely that rates of CAN increased during COVID-19. Thus, once COVID-19 has been cleared, or more normalcy is regained, it is likely that there will be a large spike in cases reported, substantiated, and services required (The Hunt Institute, 2021). Additionally, those impacted during COVID-19 by CAN but were unable to be screened or provided aid will more than likely need additional services as the length of time exposed to CAN may have increased during COVID-19.

Those Impacted

Parents who encountered job loss, loss of childcare services, loss of social support systems, young parents, and/or experienced an increase of risk factors that were already established as predictors of CAN, were more likely to encounter parental stress which has been associated with an increase in CAN incidents. Thus, parents falling into any or multiple of the mentioned categories would be predicted to have an increased risk of committing CAN during COVID-19. In terms of children, young children who are unable to take care of themselves alone, children having to rely on family members or friends for childcare, and children having parents of any of the mentioned categories above are predicted to have an increased risk of encountering CAN during COVID-19. This is mainly due to the fact that services that were normally available became limited in scope and practice which left children vulnerable environmentally, physically, and mentally.

Recommendations

In response, policy recommendations include prioritizing at-risk families for services and investigations, increasing funds for welfare and family services, increasing community understanding and the ability for reporting CAN, shifting child welfare from a reactive system to a surveillance and preventative system, and advocating for all changes mentioned above.

Currently, while some prioritization takes place in services selection, COVID-19 presents even further risk factors which need to be evaluated and prioritized including those who are facing increased parental stress, increased financial hardships, younger parents, and those with younger children. By prioritizing at-risk families during pandemics for services and investigations, both in virtual or alternative in-person meetings, families are not lost within the system which could increase the likelihood for CAN to occur since services and investigations are being utilized (The Hunt Institute, 2021).

Secondly, a general increase in funds for welfare and family services will ensure that infrastructure is in place for families through continuing services, programs, and educational resources so that CAN during particularly straining times are avoided (The Hunt Institute, 2021). Since child welfare already has a strained budget, an increase in funding during pandemic times is fundamental so that CAN cases do not increase due to a lack of availability of services, programs, and educational resources. Funds also ensure that there is a workforce that is able to distribute such services, programs, and educational resources. Since the workforce within child welfare is already strained, due to high turnover rates and high caseloads, workforce stability could see an even greater labor shortage which would limit services, programs, and educational resources that can increase CAN if not monetarily protected (The Hunt Institute, 2021).

Third, since the pandemic limited many mandated reporters from being able to see children in person to report CAN, reports and investigations decreased. However, this does not mean that CAN also decreased. With mandated reporters being the majority of persons to report to child welfare, the system lost a huge portion of those identifying and reporting CAN. Thus, the job must shift to community and family members as they are more likely during pandemics to see children in person (Herd et al., 2020). However, without proper education and knowledge as to what CAN is, how to report it, and what happens when it is reported, reports among the community and family members are likely to decrease. Thus, by educating the community and family members on how to report CAN, the child welfare system may not lose as much in reporting and investigating during COVID-19 or pandemic times (Herd et al., 2020).

Fourth, while the current child welfare system is a reactive system, it needs to switch to both a proactive/preventative and reactive system (Herd et al., 2020). Since reports decreased due to limited in-person interaction with mandated reporters, child welfare lost much of its leverage in being able to aid CAN. Thus, it must also identify families which are at a higher risk for CAN and link services between families and needs prior to cases of CAN (Herd et al., 2020). In doing so, if another pandemic were to occur limiting mandated reporters, families may at least have services that would aid in reducing the risk for a case of CAN, especially under times where parental stress levels are escalated.

Lastly, advocating to the public, policymakers, and stakeholders on all recommendations listed above is highly necessary. Without such entities being aware of the following deficits and how to repair them, actions cannot take place. Thus, child welfare and auxiliary systems will perpetually not function during pandemics or similar times if such systems are not restructured.

The importance of reducing CAN incidents cannot be emphasized enough. With the onset of COVID-19, reports of CAN have reduced since there is limited accessibility to spot and report CAN in addition to the limited resources for reporting or investigation. Though, given the increase in the magnitude of risk factors associated with CAN; such as parental stress from job loss, financial stability, health, housing, child care, access to social support systems, and increases in mental health issues; it is likely that CAN rate increased. Since systems and policies prior to COVID-19 were centered around in-person abilities, and in-person abilities are strongly diminished under COVID-19, it is recommended that policies and systems adapt towards working around or with COVID-19 public health measures. This includes altering prioritizing and prevention methods, reporting measures, funding measures, and advocacy efforts.

AP NEWS. (n.d.). Pandemic means far fewer eyes on kids’ welfare. https://apnews.com/article/pandemics-coronavirus-pandemic-only-on-ap6b4277f410b9bebd4459479649de0fc3

Bullinger, L., Raissian, K., Feely, M., and Schneider, W. (2020). The Neglected Ones: Time at Home During COVID-19 and Child Maltreatment.

Hansen, A. L. (2020). Child Maltreatment Reporting Statistics During the Covid-19 Pandemic: A Cursory Analysis. https://digital.sandiego.edu/law_chlb_research_scholarship

Herd, T., Connell, C., Duprey, E., Jackson, Y., Noll, J., Lee, S., & Mason, A. (2020, July). Covid19: Child Maltreatment Policy brief. Research-to-Policy Collaboration. Retrieved November 15, 2021, from https://www.research2policy.org/covid19-policy-brief-childmaltreat.

Herrenkohl, T. I., Sousa, C., Tajima, E. A., Herrenkohl, R. C., & Moylan, C. A. (2008). Intersection of Child Abuse and Children’s Exposure to Domestic Violence. Trauma, Violence, & Abuse, 9(2), 84–99. https://doi.org/10.1177/1524838008314797

Katz, C., Priolo Filho, S. R., Korbin, J., Bérubé, A., Fouché, A., Haffejee, S., Kaawa-Mafigiri, D., Maguire-Jack, K., Muñoz, P., Spilsbury, J., Tarabulsy, G., Tiwari, A., Thembekile Levine, D., Truter, E., & Varela, N. (2021). Child maltreatment in the time of the COVID-19 pandemic: A proposed global framework on research, policy and practice. Child Abuse & Neglect, 116, https://doi.org/10.1016/J.CHIABU.2020.104824

Lawson, M., Piel, M. H., & Simon, M. (2020). Child Maltreatment during the COVID-19 Pandemic: Consequences of Parental Job Loss on Psychological and Physical Abuse Towards Children. Child Abuse & Neglect, 110, 104709. https://doi.org/10.1016/J.CHIABU.2020.104709

Leigh, S. (2021, Narch 2). Child Abuse Surges in Times of Crisis- The Pandemic May Be Different. University of California San Fransico. https://www.ucsf.edu/news/2021/03/419961/child-abuse-surges-times-crisis-pandemicmay-be-different

Rodriguez, C. M., Lee, S. J., Ward, K. P., & Pu, D. F. (2021). The Perfect Storm: Hidden Risk of Child Maltreatment During the Covid-19 Pandemic. Child Maltreatment, 26(2), 139–151. https://doi.org/10.1177/1077559520982066

State responses to child neglect and abuse during the pandemic. The Hunt Institute. (2021, August 28). Retrieved November 15, 2021, from https://huntinstitute.org/resources/2021/08/state-responses-to-child-neglect-and-abuse-pandemic/.

What COVID-19 means for America’s child welfare system. (n.d.). Retrieved November 18, 2021, from https://www.brookings.edu/research/what-covid-19-means-for-americas-childwelfare-system/

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Ahead of World Children’s Day on 20 November, a new report by UNICEF South Africa shows how COVID-19 has presented multiple challenges for children in the country as their safety, nutrition and health have been compromised, while their education has been disrupted.

The report, titled “ How COVID is changing the face of childhood in South Africa ,” details the work that UNICEF has been doing to mitigate the effects of the pandemic and notes that the longer the crisis persists, the deeper its impact on children’s education, health, nutrition and well-being.

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• v.78(1); 2022 Jan

Impact of COVID-19 on child health and healthcare services

Himashree bhattacharyya.

a Associate Professor (Community & Family Medicine), All India Institute of Medical Sciences (AIIMS), Guwahati, Assam, India

Rashmi Agarwalla

b Assistant Professor (Community & Family Medicine), All India Institute of Medical Sciences (AIIMS), Guwahati, Assam, India

Ankur Khandelwal

c Assistant Professor (Anaesthesiology & Critical Care), Sharda University School of Medical Sciences & Research, Greater Noida, Uttar Pradesh, India

COVID-19 has crippled mankind with a devastating effect on all age groups, including children and adolescents. The impact of COVID-19 may not be completely reflected in indicators of morbidity and mortality; however, this crisis can have a profound effect on the overall well-being, including serious repercussions on child survival. These effects can be primarily grouped into: (a) decreased access to vital child healthcare services like newborn care and immunization, (b) nutritional deprivation, (c) poverty, orphans and strays, and (d) mental impairment and compromised learning. In the long term, targets of Sustainable Development Goals may perhaps be missed. Children from low socioeconomic populations and those in already destitute or vulnerable situations suffer a harder blow as they are the ones who might be more impoverished or deprived of essential healthcare services. Children seem to be the greatest victim in this universal crisis. The problem that had started as a public health emergency has grown in tremendous magnitude over time such that it demands major policy reforms in child health and overall development. 1

COVID-19: child health and health services

The last two years have witnessed an almost complete shutdown of vital child health and welfare services in terms of nutritional programs, maternal and newborn care, immunization services, and community-based child protection programs. With the closure of the schools, the usual learning, as well as opportunities for social interactions, have been seriously disrupted. In India, since the onset of the lockdown in March 2020, the focus of all the healthcare workers has shifted toward the pandemic. Routine immunization is one of the worst affected services, with at least 68 countries globally experiencing disruptions. This has possibly resulted in an estimated 80 million children being left unvaccinated following the pandemic. 2 Analysis of data from the Health Management Information System in India shows that monthly immunizations dropped by 70% nation-wide in April 2020, but then rebounded substantially. 3 The Ministry of Health and Family welfare issued a guidance note in April 2020 regarding the continuation of essential services, including immunization. Immunization strategies were clearly outlined as per designated areas, which included: (a) Containment and Buffer zone, and (b) Areas beyond Buffer zone and Green zone. 4 India is already lagging behind in terms of immunization of the under-five age population. As per the latest National Family Health Survey (NFHS-4), merely 62% of the children aged between 12 and 23 months were found to have all basic vaccinations, and only 54% received all the basic vaccinations by the age of 12 months. This percentage is much lower than India’s global comparators like China, Bangladesh, and Vietnam. 5 A recent retrospective observational study in Rajasthan found a substantive decline in the rate of immunization in the state during the lockdown. This decline was higher in children from a poorer, less educated background and residing in COVID-19 red zones. 6

The prolonged lockdown also led to economic insecurity, thereby causing food shortages and a rise in the prices of food items. This is preventing many families from providing their children with the nutrition that is needed for their physical and mental development. This can have lifetime implications for children. As of 2019, 114 million children under age five were stunted, and 14 million children under age five were affected by severe wasting. 7 Overall, 6.7 million additional children under age five suffered from wasting during the first year of the pandemic (i.e. a 14.3% increase in the number of children who are wasted) in the absence of timely action, leading to an estimated 10,000 additional child deaths per month during this same period. 8 A policy brief published on the impact of COVID-19 in children in India revealed that there were 1,315 children admitted across 966 Nutrition Rehabilitation Centers (NRCs) in April 2020, which is only 9% of the 15,796 children admitted in April 2019. 9 Only 14.9% of the children between 6 and 59 months received iron and folic acid supplementation by the last quarter of 2019–20, and only 9.1% had received it by the end of the first quarter of 2020–21. Only 2.9% of the children in the same age group received deworming tablets in 2019–20. 10 It has been predicted that child malnutrition would increase by 10-20% because of COVID-19, and an additional 6000 children probably would die every day from preventable causes because of the disruption in healthcare services. 11

It is likely that the already-stretched health system will pivot to prioritize the COVID-19 response, potentially resulting in a spike in other childhood diseases and outbreaks. A global survey reported that people had faced substantial barriers in accessing healthcare services during the pandemic in terms of closure of healthcare centers (10%), long queues at healthcare centers resulting in not being assessed or treated (12%), and a shortage of required medication at healthcare centers and pharmacies (15%). 7 Home-based, facility-based, and zonal-based quarantine and isolation measures can all negatively impact children and their families to seek quality healthcare services. A substantial reduction in pediatric emergency care utilization has raised concerns regarding potential delays in seeking healthcare services with increased rates of morbidity and mortality. 12 Nationwide lockdown and lack of comprehensive guidelines for maternal and child healthcare (MCH) have left these vulnerable populations in need of essential healthcare services. These have led to an exacerbation of childhood diseases like acute respiratory infections, diarrhea, and other water-borne diseases, not to mention the upsurge of vaccine-preventable diseases, which can claim considerable lives in the days ahead. India bears one-sixth of the global under-five mortality burden with an estimated 882 thousand under-five deaths in 2018. Of them, nearly 550 thousand newborns die within the first 28 days after birth. 2 The child healthcare services become more compromised when a pandemic such as the one we are encountering now hits the population. The recent Global Financing Facility brief indicated that if the coverage of all essential MCH interventions reduced in a similar way, India might observe an increase of 40% in child mortality. 13

COVID-19: mental health of children

COVID-19 has brought with it issues like closure of schools, postponement and cancellation of exams, quarantine and isolation of children and adolescents along with adults. Children with a lack of technology and internet services have found it difficult to cope with online classes. These issues have led to huge challenges to consider in terms of mental health and behavioral issues in children. The psychological effects of COVID-19 on children have a wide spectrum from mood fluctuations, conduct disorders, anxiety disorders to suicidal tendencies.

Some of the studies have highlighted the challenges faced by children and adolescents during these 1.5 yrs of the COVID-19 pandemic. In a study by Jiao et al. , parents of young children revealed that children suffered from sleep disturbances, loss of appetite, and separation-related anxiety and felt fearful and lonely during the COVID-19 pandemic. 14 It seems that increasing screen time use correlates positively with unhealthy eating, lack of physical exercise, more total ill-being, as well as attention and physical problems. A study found that older adolescents and youth are anxious regarding the cancellation of examinations, exchange programs, and academic events. 15

As mentioned by the Centers for Disease Control and Prevention (CDC) 2019, children with special needs are encountering special challenges during this pandemic. These children have a low tolerance to uncertainties, and there is an aggravation of symptoms due to the enforced restrictions. 16 Children are also psychologically affected due to quarantine and isolation while being separated from parents or caregivers. The children may develop feelings of sadness, anxiety, fear of death, fear of parents’ death, and fear of being isolated in the hospital, which may have a very detrimental effect on their psychological development. 16

A web-based study conducted in Punjab among 400 parents revealed that 73.15% and 51.25% of the children were having signs of increased irritation and anger, respectively, and 18.7% and 17.6% of the parents also mentioned the symptoms of depression and anxiety, respectively, among their children, which were also augmented by the changes in their diet, sleep, weight and more usage of the electronic equipment. 17 Closure of schools and activity centers for long periods have deprived the children of educational, psychological and developmental attainment. 18

There is a lack of a database worldwide and from India regarding the effect of COVID-19 on the mental health of children. The long-term effects of the psychological issues in children and adolescents will be a big burden and a very difficult challenge to tackle the post-COVID-19 pandemic.

COVID-19: poverty and orphanhood

The lockdowns due to COVID-19, which seemed inevitable, made a large section of children vulnerable to poverty. The poor and marginalized children have been hit hard by the consequences of the lockdown. While the stringent lockdown during the first wave pushed the families into poverty, the brutal second wave left many children orphans. As per the UNICEF report on COVID-19, the global socioeconomic crisis caused by the pandemic could push 142 million more children into monetarily poor households in developing countries. The total number of children living in poor households globally could reach just over 725 million in the absence of any mitigating policies, and nearly two-thirds of these children live in sub-Saharan Africa and South Asia. The report has also highlighted the fact that the harmful effects of this pandemic will not be distributed equally. The poorest countries and in places where children are already living in disadvantaged and vulnerable positions will see severe damages. 19 Child poverty is strongly associated with parental employment status also. A joint report by the International Labor Organization and United Nations Children’s Fund estimates that a 1% rise in poverty leads to at least 0.7% increase in child labor. 20 The coronavirus pandemic is forcing India’s children out of school and into farms and factories to work, worsening a child-labor problem that was already one of the most critical in the world.

India’s economy contracted by almost 24% last quarter, and schools remain closed across the country as thousands of new COVID-19 cases continue to be recorded daily. Millions of families have been forced to consider child marriage to alleviate poverty. Up to 2.5 million more girls around the world are at risk of marriage in the next 5 years because of the COVID-19 pandemic, the organization “Save the Children” has warned. 21

As per the “Save the Children” survey, the closure of schools is also putting increased pressure on families to provide food for children who may otherwise have received free school meals. Around 89% of the respondents in the survey from 37 countries whose children had been out of school for 20 weeks or more reported that they had trouble paying for food. Many vulnerable children rely on food provided at schools as their only or main meal of the day, so it substantially contributes to their daily nutrition intake. With more children out of school, and COVID-19 resulting in even more families sliding into poverty, hunger and malnutrition among children will continue to increase, thus forming a vicious cycle. 21

Orphanhood and the death of caregivers is a hidden issue of COVID-19. Orphanhood, as defined by UNICEF, is death of one or both the parents. As per the Lancet report, it was estimated that globally, from March 1, 2020, to April 30, 2021, around 1,134,000 children (95% credible interval 884,000–11,85,000) experienced the death of primary caregivers, including at least one parent or custodial grandparent. Around 1,562,000 children (1,299,000–1,683,000) experienced the death of at least one primary or secondary caregiver. 22 As per the BBC news reports, many children have been orphaned in India too. Children lost one or both their parents to COVID-19, and these children are now susceptible to poverty, abuse, and trafficking thus leaving a long-term effect of COVID-19. 23

Way forward

The policymakers should ensure affordable and equitable access to healthcare services with prioritization for vulnerable children and their families, especially those with pre-existing health conditions, as the public health emergency continues.

The public health investment should be increased such that safe and nutritious food is affordable and accessible for all. Scaling up of social protection schemes, providing information on nutrition and guidance on infant and young child feeding, involvement of civil society organizations and communities in the monitoring of service provision, addressing the livelihood and food system/supply challenges are some of the key issues to be addressed in order to build up a strong and resilient public health and nutrition system as a response to any public health emergency.

The government should ensure that there is no disruption of essential healthcare services, which are critical for child survival in terms of immunization, child health, nutrition, education, etc. Clear-cut guidelines should be issued by the respective state and district health authorities regarding the availability of routine immunization services. Any policy changes in the wake of COVID-19 should be clearly communicated to the public. The safety of clinics and hospitals should be ensured so that parents are encouraged to come for consultation and vaccination of their children.

Separate task forces for testing, contact tracing, and patient care in the context of COVID-19 should be formulated so as to free the frontline healthcare workers from providing the much-needed essential services at the primary and secondary health centers. Investments should be made in data and technology infrastructure to expand the reach of telehealth and teleconsultation in rural areas. 7

Children and young adolescents need to be educated about COVID-19 and preventive behavior, which will be helpful in the long run. Mental health check-ups of children and students need to be conducted, and there is an urgent requirement of coordinated and innovative mental healthcare delivery for children and adolescents. Policies should be formulated taking into account the developmental stage of the child e.g. preschoolers, school age, adolescents. School re-entry and opening guidelines should be well formed, keeping in mind key points regarding social distancing and hygiene. Children of the lower socioeconomic background will have to be supported to get back to school through the help of community workers and NGOs.

Children and young adolescents may not be directly affected by the COVID-19 pandemic in terms of mortality and morbidity, but the burdens of other dimensions are heavily borne by them. Collaborative work of parents, psychiatrists, psychologists, pediatricians, and community health workers will be required to counter the post-COVID challenges in this vulnerable age group. The underprivileged section will require special attention. Continuity of healthcare along with an integrated approach can go a long way in delivering quality healthcare to children during such health emergencies.

Disclosure of competing interest

The authors have none to declare.