Children of COVID Times: A Call to Address Vulnerabilities and Prioritize Inclusion

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Deepshikha Singh, Aneesh Kurian, Vrinda Datta

Humans across the world are severely affected by the cataclysm of COVID-19, which is unleashed in the form of economic and healthcare crisis. Though pandemic has posed an existential threat in the lives of all people across age and identities, children are the worst sufferers of this sudden unforeseen crisis of human existence. In a Press release on 16 April 2020, UN Secretary-General António Guterres called for countries to prioritize children’s safety and education amid the COVID-19 Pandemic,

I am especially concerned about the well-being of the world’s children.  Thankfully, children have so far been largely spared from the most severe symptoms of the disease.  But their lives are being totally upended.  I appeal to families everywhere, and leaders at all levels:  Protect our children. António Guterres, UN Secretary-General

Survival and health at stake

Though the available evidence suggests that COVID-19 infection would not cause a direct impact on child mortality, it may have a far-reaching and long-term negative impact on their physical, cognitive, social, and psychological development.

Pandemic has magnified the stressors of household poverty across the world. According to a recent analysis on estimates of the impact of COVID-19 on global poverty, COVID-19 has posed a severe challenge to the achievement of the UN Sustainable Development Goal of ending poverty by 2030. There would be a potential reversible of approximately a decade of global gains in reducing poverty. In the worst-case scenario based on high per capita income and consumption contraction, there would be an additional 450-580 million people in the world living in poverty, relative to the recorded figures in 2018 (Sumner, Hoy, & Ortiz-Juarez, 2020). Globally, an estimated 152 million children are already engaged as child labourers. The pandemic will push millions of children back to poverty and child labour. It is aggravating the living conditions for those who are below the poverty line in many low and middle-income countries. According to the latest estimates from UNICEF and Save the Children, the number of children living in household poverty across low and middle-income countries will increase by up to 86 million and reach a total of 672 million by the end of the year 2020 if no urgent actions are taken. Out of this figure, nearly 448 million children live in South Asia and sub-Saharan Africa. Children with experiences of multidimensional poverty will be highly vulnerable, and their needs for nutrition, hygiene, sanitation, healthcare, learning, and social protection will be largely compromised.

In India, the COVID-19 pandemic has caused a fall in income for many families. The households in the lowest income quintile have suffered the most due to lockdown measures. Small-scale businesses and occupations in the informal sector are worst hit, where remote working was not at all possible in most cases. More than 90 percent of families with a monthly income in the range of Rs 3801 to 12734 have experienced a loss in income. The deprivation and disadvantages associated with forgone income will have a devastating impact on children. There will be a decline in consumption and access to essential healthcare services for these families. Child survival and health would be at stake, which will increase child mortality and morbidity in the country.

Additionally, children in poor households will be exposed to the increased risks of violence, abuse, and neglect over a long time. The burden of lost income is a catalyst for an increase in domestic violence and maltreatment of women and children. These sudden household economic shocks are generally endured by family members who have limited power and autonomy. In this adverse situation, the oppressions of patriarchy and gender power relations will be reinforced and become more receptive to traditional Indian societies. There are chances that children will be bonded and controlled within the family. For instance, in India, household poverty indicates an impending risk of child marriage, especially for the girl child, to escape the onus of responsibility or to gain monetary benefits in exchange for child marriage. It is likely that many cases of child marriages have gone unnoticed due to the lockdown. In a country like India where the number of child marriages is more than the total population of countries like Germany and the Philippines, a potential rise in child marriages is alarming. It would lead to a higher rate of early childbearing and poor birth and developmental outcomes causing maternal and child deaths. Child marriages leading to poor development outcomes for children will ultimately drive the intergenerational cycle of poverty.

 

In addition to imperilled survival and health, COVID-19 has exacerbated the learning crisis in the world. Globally, around 1.5 billion children are out of school due to containment measures. While children’s learning in many high- to middle-income households is continued through distance learning measures, learning of children in low-income families is impeded. Home schooling is not a reality for these children who have no access to distance learning materials, toys, computers, and a reliable internet connection. Moreover, children and parents in low-income households, especially in rural or peri-urban regions, are not skilled enough in using technology for distance learning. Unfortunately, for many of them, education is only a last thing in mind when they are grappling with bare subsistence and survival. This learning crisis is related not only to a temporary school or preschool shutdown but also linked to the likelihood of a sharp increase in school dropout rate. Once the schools or ECCE centres are open, there is a risk that millions of children would not be able to join back amid an economic crisis. This holds particularly for female children who would be at primary risk of school dropout due to shared responsibilities of agriculture support, household chores, and caregiving. Male children will be at higher risk of doing child labour or supporting family heads in a struggle to earn income. To the least, children’s attendance would fall due to their engagement in carrying out the household or economic responsibilities, if not the complete school withdrawal. Children of migrant workers who returned to villages or towns with their parents are now disconnected with their schools in cities, and there is only a little possibility that their parents would turn back anytime soon and the children would attend the school. School closures have not only caused learning crisis for these children but also deprived some 370 million children worldwide who depend on schools and shelters for meals. Now, many children from low-income families are likely to live through hunger and starvation, bringing malnutrition close at hand.

 

Young children in the age group of 0-6 years are more likely to experience the negative socioeconomic impact of COVID-19. In many parts of the world, public provision of early childhood development has met with serious challenges of timely and effective service delivery. This has seized early stimulation opportunities for health, nutrition, responsive care, learning, and play.

Young children will likely be the most harmed by the pandemic. With greater vulnerabilities, less emotional preparation and resilience, and fewer immunities in the case of health, their nutritional status will be damaged, their sense of security threatened, their health compromised, and their cognitive and social-emotional development seriously disrupted. Sheldon Shaeffer, Member, Chair of the ARNEC Board of Directors

 

On 14 April 2020, the Ministry of Health and Family Welfare in India has released guidelines on Enabling Delivery of Essential Health Services during COVID-19 outbreak. The guidelines ensure the delivery of essential services related to pregnancy and newborn care, childhood illness, and immunization, along with other critical services in family planning and adolescent healthcare. The guidelines suggest the alternative service delivery mechanism, including teleconsultation, modified outreach and home visits, ambulance triaging, and ensuring essential supplies of medicines and diagnostics. However, the ground realities were much harder. The community health workers faced serious challenges in reaching out to the most vulnerable in the containment and buffer zones and delivering the essential healthcare services amid the contagion. In many cases, the frontline health workers informed that people in informal settlements are reluctant to receive door-to-door services due to the fear of being shifted to isolation wards or contracting the virus from healthcare workers. At the ground level, healthcare and other frontline workers are facing practical challenges till today. Many healthcare/sanitization workers with substandard quality personal protective equipment (raincoats in some cases) are often scared about their safety. However, the need for income is more prominent than the fear of contracting the disease. Accredited Social Health Activists (ASHA), Auxiliary Nurse Midwives (ANM), and Anganwadi Workers (AWW) are entrusted mainly with conducting household survey for suspected cases and spreading community awareness about COVID-19. Their role and responsibilities are now concentrated more on COVID-19 related activities, and the routine provision of ECD services has taken a back seat. A large proportion of children under five years of age, particularly those who are marginalized, could not access essential early childhood development services or could only access the fragmented services being delivered in bits and pieces.

In many cases, the beneficiaries are reluctant to use the services to avoid contact with the health workers. The routine Reproductive, Maternal, New born, Child and Adolescent Health + Nutrition (RMNCAH+N) services are also disrupted due to the measures to contain the virus. Screening of children through mobile health workers is deferred, and services at district early intervention centres are being provided on-demand and available to a few walk-in beneficiaries. The absence of transport to reach the facilities is a significant challenge faced by beneficiaries to contact for healthcare services. Though birth-dose vaccination is continued at all health facilities as the newborns are already in hospitals, the community outreach for routine immunization services during Village/Urban Health Sanitation and Nutrition Day is limited to facility-based on-demand immunizations. Beneficiaries are kept on the waiting list because of the modified outreach. The disrupted mobilization for active immunization in villages would lead to a further fall in vaccination rates and children at higher risk of health and wellbeing. Overall, the suspended or delayed government’s essential routine services for young children would cause long-term health consequences. Though the price of COVID treatment is capped in many states, the treatment costs of non-COVID diseases have skyrocketed, especially in private clinics and hospitals. The exorbitant prices charged covering ambulance to the treatment of non-COVID patients have generated a fear of out-of-pocket expenditure among the low-income families. Such localized economic catastrophe will severely affect children with any pre-existing illnesses or comorbidities who need urgent medical attention.

 

The looming global recession resulting from the COVID-19 pandemic could cause hundreds of thousands of additional child deaths this year, effectively reversing recent gains in reducing infant mortality. And this alarming figure does not even take into account services disrupted due to the crisis – it only reflects the current relationship between economies and mortality, so is likely an under-estimate of the impact. UN Report, 16 April 2020

 

Before the pandemic affected the world, the World Health Organization has reported that globally 85 percent of the deaths among children and young adolescents in 2018 occurred in the first five years of life, accounting for 5.3 million deaths. Out of this, 2.5 million children died in the first month of life in 2018, and an estimated 250 million children are at risk of not receiving the appropriate developmental interventions in the very first year of their lives. COVID-19-related disruption of early childhood development services is likely to increase the maternal and child death rate across the world, particularly in low-income countries. More recently, UNICEF reported a study covering 118 low and middle-income countries conducted by the Johns Hopkins Bloomberg School of Public Health. This study indicates that there will be an increase in child wasting, and an additional 1.2 million under-five deaths could occur in just six months due to the suspension of the primary healthcare system and early childhood health screening.
COVID-19 has caused severe challenges for the continuation of routine health services in India. According to the recent estimates of UN Inter-Agency Group for Child Mortality Estimation (UN-IGME), India has made significant progress in reducing the neonatal mortality rate with a decline from 57 deaths per 1000 live births in 1990 to 23 deaths per 1000 live births in 2018. India has been accelerating the progress towards achieving SDG target of ending preventable deaths of newborns and children under 5 years by 2030. This sudden onslaught of COVID-19 outbreak, if not addressed timely through targeted interventions, may wipe off the impressive gains and downturn the progress to achieve SDG targets.

 

Vulnerabilities superimposed

 

COVID-19 has not created a set of new vulnerabilities in children’s lives; rather, it reveals how pre-existing vulnerabilities cascade a chain of risks during any disaster. In COVID times, the pre-existing vulnerabilities have gained momentum and build upon one another to produce unprecedented challenges. Worldwide, many children have been living in precarious conditions resulting from socioeconomic inequalities. In India, millions of children have been deprived of their basic developmental needs. Their fundamental rights were violated even before the pandemic hit. An outbreak of such an unheard-of scale like COVID-19 has employed pre-existing vulnerabilities to generate multiple risks in the lives of children. Deprivations caused by the COVID-induced social and economic upheavals are gradually shaping the course of social exclusion for millions of children in India. Pandemic has posed challenges of basic survival for those who were already at the margins of society, comprising children living in extreme poverty and cultural impoverishment.

Childhood as a socio-cultural construction with distinct experiences reflects that some children will be worst affected by the pandemic both in the immediate and long term. These different experiences of many childhoods stem from social identities, including age, gender, ability, poverty, caste, ethnicity, geographical location, regional socio-political environment, and other personal and family background factors. The intersection of one or more factors across and between cultures may produce profound vulnerabilities for children who live a most marginalized and excluded life. These vulnerabilities are not caused by the pandemic episodes alone; instead, they emerge due to the life conditions arising out of the social inequalities, producing extensive sufferings and making some children more vulnerable than others. For instance, children in their early years growing up in a refugee camp and experiencing the impacts of poverty, together with the risks of exploitation and abuse, are distinctively vulnerable to the additional dangers of the pandemic. COVID-19 disaster indeed intimidated all, but those with increased exposure and vulnerabilities are likely to face myriad of risks. Children in vulnerable conditions would experience significant inequalities in opportunities for growth, development, and learning as well as protection and safety because of the limited resources available to them to recover from the negative experiences.

In India, COVID-19 has already wreaked havoc on millions of vulnerable children and would jeopardize their lives in multiple ways rendering some children traumatized. Urban disadvantaged children in ultra-poverty, child labours, abandoned and homeless children, children in disaster or conflict-affected areas, children in institutions- foster homes, refugee camps, children of migrant workers, prisoners and sex workers, children in conflict with law or children with pre-existing chronic diseases, developmental delays or disabilities form some of the most vulnerable groups of children.

The mass exodus of migrant workers in India is an instance which discloses that for some pandemic is a disturbance in routine life, but for others who are underprivileged, it is a disaster. Due to the lockdown-induced migrant crisis in the country, we have witnessed the incidences of adversity, morbidity, and deaths occurred within two months. Many children have lost their lives, and some were orphaned during this arduous journey back home. This proves that disaster’s impact is distributed disproportionately based on the economic layers of the society. The ones with higher vulnerabilities absorb enormous consequences. During the pandemic, children of migrant workers are most vulnerable as they survived the shocks of the economic, social, and psychological disorder ever-present in our society. Such incidence has exposed to view society’s insensitivity towards children who belong to weaker economic sections. This has revealed how ‘childhood’ receives differential interpretation, institutionalization, and treatment by society.

COVID-19 has not only affected the health and nutrition services for vulnerable children but has also put their psychological well-being at greater risk, including that of very young ones. Children in difficult circumstances are increasingly experiencing the psychosocial impacts of the pandemic events. There is a sharp increase in the perpetration of violence against children, including physical, verbal, and sexual violence. In most cases, the perpetrator was a child’s acquaintance. Intimate partner violence has become rampant in families, and children are witnessing acts of violence more frequently. This would wage damaging effects on their mental as well as spiritual health. There is a risk of internalized fear of safety, and children themselves may adopt an aggressive and violent behavior of adults.

Child safety is threatened by and large. Children in difficult circumstances who are more vulnerable than before may fall an easy prey into the clutches of organized crimes like drugs and human trafficking. The decision of some States to relax the labour laws in the face of the pandemic will put children at high risk of child labour and trafficking. Child protection services from government and non-government organizations are trying to rescue children who have become the victims of child-related offenses amid COVID. However, due to the containment measures, many children are still invisible who are in distress and need legal protection. According to the latest research brief launched by the United Nations Office on Drugs and Crime, the economic consequences of COVID-19 would likely cause an increase in migrant smuggling and cross-border trafficking in longer-term across the continents.

This paints a picture of how intense and overlapped are the vulnerabilities for some group of children who belong to underprivileged economic, social, environmental, and cultural groups. Inequalities and exclusion of vulnerable children should not be viewed in isolation to COVID-exclusive risks instead as a cumulative risk of pre-existing conditions, pandemic, and other events happening concurrently.

Mitigating the Impacts of COVID-19 on Children

Response to the impacts of COVID-19 requires strategic planning and targeted interventions to counteract the negative consequences and gain substantial benefits in the immediate and long term. However, this crisis demands a rapid response, which could speed the short term positive developmental gains for children. It is crucial to find solutions for immediate mitigation of COVID-19 impacts on children, particularly for those who are vulnerable because of their age, location, or circumstances. This is a time to prioritize actions to address the pre-existing vulnerabilities and prioritize inclusion of marginalized.

Some measures to mitigate the humanitarian crisis of COVID-19 in the lives of vulnerable children and their families are discussed-

Ensure Continuation of Critical Early Childhood Development Services. Children in the first eight years of their life facing impacts of COVID-19 need immediate intervention as the foundation stage of life cannot wait. If missed, there will be no other alternative to compensate for the lost window of opportunity. It is crucial to ensure that young children receive regular ECD interventions. Routine services of health check-up, immunization, nutrition, hygiene and sanitation, and responsive care have to be resumed and continued with all necessary precautions against the virus. Public healthcare centres and ECD facilities need to acknowledge their transformed role to provide safe and effective service delivery to beneficiaries amid the pandemic.

ECD services need to integrate mental health services for caregivers and children to ensure that young children thrive in healthy families. Ways for smooth teleconsultation and counselling need to be extended to families in need of support. Caregivers must be equipped with adequate knowledge and resources on how to sustain early learning activities for young children at home. Play and early learning strategies need to be transacted through tele/online modules on ways to engage young children at home. These efforts are much required to ensure that COVID-19 does not interfere with the most critical period of child development.

Support and Sensitize ECD Workforce. ECD workforce, including public, private, and NGO sector, need massive support from the authorities to ensure the smooth and effective delivery of ECD services amid the COVID-19 crisis. Frontline community health workers like ASHA, ANM, AWW need support in the form of guidance and capacity building to overcome the challenges they face in reaching out to the community in most disadvantaged locations. Ways to gain community’s and people’s cooperation need to be worked out. Health and economic concerns of ECD workforce are at stake, and this needs to be addressed so that they feel encouraged to take up their responsibilities during these challenging times.

Empower Families in Disadvantaged Conditions. ECD centres are more likely to remain close for an indefinite period. This has made the collaboration of parents and ECD workforce a necessary condition to support children at home for an extended period. Parents are now the vanguards steering their child’s development at home. ECD workforce has a new role in providing continuous and engaged support to families for creating an enabling environment at home. Family-empowerment programs need to be developed to focus on building parents’ skills on ways to promote child development at home and, at the same time, cope with the negative impacts of COVID-19. Underprivileged and low-income families need livelihood support in the form of vouchers/cash transfers without discrepancies. This would enable them to meet their essential requirements and overcome the pressure of lost income. Families of migrant workers, domestic help, and others working in informal sectors must be provided skill development to enable them to sustain their families and take care of the development needs of children. Children in slums and other informal urban spaces need resources to meet the challenges of a limited supply of essential services, including healthcare.

Provide Mental Health Support to Families. COVID-19 is a time to prioritize the mental health of children and families. Families are dealing with increased anxiety, frustration, and depression over the economic, health, or any other associated reasons. A disturbed psychological environment in families could be detrimental for a child’s holistic development, especially the socioemotional development. Family-centred mental health services are highly needed during this humanitarian crisis. There is an emerging need to address parental or maternal depression, especially for newly delivered mothers suffering from post-partum depression amid COVID-19. Regular mental health support can be provided through counselling and psychosocial therapy in tele/online mode or direct intervention wherever necessary. The support from mental health organizations at the community-level could be life-saver for families who had undergone traumatic experiences and at-risk of breakdown and suicide. Families, especially women, must be empowered with right information about safe platforms to seek help against violence or depression.

Sensitize Community. Vulnerable communities must be provided with the right information, counselling, and advice through improved access to digital technology. There is a need to monitor that caregivers, children, family members, and community workers had received knowledge resources on maternal and child care, nutrition, hygiene, sanitation, COVID-specific information, and coping strategies.

Involve Community Members as Partners and Leaders. Government and civil society initiatives must engage families and communities as partners for collective actions to ensure that health services, nutrition, care, and protection reach all children. This will help to develop the local resilience among families and children in the community and support self-organize skills for crisis management. Community-led projects must be promoted to fulfill the targeted goals of child development and learning. Local mitigation measures would prove useful as local needs can be heard and acted. Mobilizing community participation to prevent the outbreak in the region and safeguarding children’s rights to health, development, and protection would prevent the potential reverse of developmental gains.

Provide Rapid Response to Children in Difficult Circumstances. Children in disadvantaged circumstances form a group whose rights have been violated to the most. Thus, they must be a priority for State parties for now onwards towards fulfilling the obligations ratified under the UN Convention on the Rights of the Child. COVID-19 is a warning that social justice and human rights be delivered to most vulnerable children. Rapid response with stringent actions are required within the social protection system to ensure safety and justice for most vulnerable children who fall victim to exploitation, trafficking, substance abuse, and sexual assault. Children in refugee camps, shelter homes, observation homes, children in conflict-affected areas and children with disabilities need special attention as they often remain invisible and unheard. Children on streets, abandoned, orphaned, and homeless children must be safely rehabilitated to child care centres. These centres must ensure adequate measures for food, hygiene, sanitation, recreational opportunities, psychosocial counselling for all children, and psychological therapy for traumatized children. Timely response must reach to distress calls made on behalf of children in need of protection from harm and violence. There must be an active outreach in liaison with government, police, and local welfare bodies to rescue children who are exploited and falling victim to crimes amid the crisis of COVID-19.