An estimated 1.5 million children worldwide have experienced the death of a parent, custodial grandparent, or other relative who cared for them, as a result of COVID-19, according to a new global study involving UCL researchers, published today in The Lancet.
Of the 1.5 million children, more than 1 million experienced the death of one or both parents during the first 14 months of the pandemic, and another half a million experienced the death of a grandparent caregiver living in their own home, the study estimates.
Children who have lost a parent or caregiver are at risk of profound shortand long-term adverse effects on their health, safety, and wellbeing, such as increasing the risk of disease, physical abuse, sexual violence, and adolescent pregnancy. The researchers call for urgent action to address the impact of caregiver deaths on children into COVID-19 response plans.
Dr Susan Hillis, one of the lead authors on the study, from the U.S. Centers for Disease Control and Prevention COVID-19 Response Team says: "For every two COVID-19 deaths worldwide, one child is left behind to face the death of a parent or caregiver. By April 30, 2021, these 1.5 million children had become the tragic overlooked consequence of the 3 million COVID-19 deaths worldwide, and this number will only increase as the pandemic progresses. Our findings highlight the urgent need to prioritize these children and invest in evidence-based programs and services to protect and support them right now and to continue to support them for many years into the future - because orphanhood does not go away."
Before the pandemic, there were an estimated 140 million orphaned children worldwide. These children have greater risks of mental health problems, family poverty, and physical, emotional, and sexual violence. They are also more likely to die by suicide or develop a chronic disease, such as heart disease, diabetes, cancer, or stroke.
The COVID-19 pandemic has resulted in more children facing the loss of a parent or caregiver. In addition, as older adults are the most vulnerable to COVID-19, many children living in multigenerational families will have experienced the death of a grandparent. Evidence shows that grandparents are increasingly playing key roles in providing care and financial support for their grandchildren worldwide.
Study author Professor Lucie Cluver, Oxford University, UK, and the University of Cape Town, South Africa, says: "We have strong evidence from HIV and Ebola to guide solutions. We need to support extended families or foster families to care for children, with cost-effective economic strengthening, parenting programs, and school access. We need to vaccinate caregivers of children - especially grandparent caregivers. And we need to respond fast because every 12 seconds a child loses their caregiver to COVID-19."
Before this report, there were no global figures to quantify how many children have been affected by the loss of a caregiver during the COVID-19 pandemic, either directly (due to the virus) or indirectly (due to another condition that was exacerbated due to the pandemic). The study’s researchers developed mathematical models using the best available data as an initial attempt to estimate the magnitude of this hidden impact of the pandemic on children.
Implementing methods similar to those used by the UNAIDS Reference Group on Estimates, Modelling and Projections for estimating the number of children orphaned by AIDS , the authors based the COVID-19 orphanhood estimates on mortality data for 21 countries that account for 77% of global COVID-19 deaths. The analysis included both reported COVID-19 deaths between 1 March 2020 and 30 April 2021 and the number of excess deaths (when such data were available), during the same time-period, to account for variations in country-specific reporting systems.
The researchers linked COVID-19 death rates to fertility data for males and females from those 21 countries to estimate the number of children who had lost a parent as a consequence of COVID-19. Loss of both parents was accounted for so that children were not counted twice.
The researchers extended their analysis to include deaths of grandparents or other older adults aged 60 to 84 years who were living in the same household as the children, based on United Nations Population Division’s statistics on household composition. These figures take into account custodial grandparents (living with grandchildren in absence of parents), who have primary responsibility for their grandchildren’s care, as well as co-residing grandparents and other older family members, who live in the same household (with grandchildren and parents) and have secondary, but not primary caring responsibilities.
Mathematical modelling was used to extrapolate the findings from these 21 countries to the rest of the world, using country-level data on COVID-19 deaths and fertility rates. The model showed a high correlation between female fertility rate and the ratio of orphans to deaths.
The findings suggest that at least 1,134,000 children experienced the death of their mother, father, or custodial grandparents, as a consequence of COVID-19. Of these, an estimated 1,042,000 lost their mother or father, or both. Overall, 1,562,000 children are estimated to have experienced the death of at least one parent or a custodial or other co-residing grandparent (or other older relative).
Countries with the highest rates of children losing their primary caregiver (parent or custodial grandparent) included: Peru (1 child per 100, totalling 98,975 children), South Africa (5 children per 1,000, totalling 94,625 children), Mexico (3 children per 1000, totalling 141,132 children), Brazil (2 children per 1,000, totalling 130,363 children), Colombia (2 children per 1,000, totalling 33,293 children), Iran (>1 child per 1,000, totalling 40,996 children), USA (>1 child per 1,000, totalling 113,708 children), and Russian Federation (1 child per 1,000, totalling 29,724 children).
In April 2021, in India, the researchers estimate an 8.5-fold increase in the numbers of children newly orphaned (43,139) compared to March 2021 (5,091).
For almost every country, deaths were greater in men than women, particularly in middle and older ages. Overall, up to five times more children lost their fathers than lost their mothers.
The authors note that children experiencing COVID-19-associated deaths of parents or caregivers are at greater risk of family separation and institutionalization, such as being placed in orphanages or care homes. They argue this should be avoided because it has negative effects on social, physical, and mental development.
Co-author, Professor Lorraine Sherr (UCL Institute for Global Health) said: "Without immediate action, the COVID-19 pandemic is destined to leave millions more children orphaned for decades to come. This is a critical moment to understand how COVID-19 will affect the lives of children, how lessons learned from prior emergencies can be adapted, and how an understanding of complex adversities can maximize the effectiveness of our response."
The authors note some limitations to their results. Their study is based on the best available data, but many countries do not have robust reporting systems for deaths or fertility. Additionally, data on country-specific prevalence of orphans before the pandemic was lacking, so their estimates of double orphans are limited to deaths of both parents during the pandemic.
As part of this work, the authors developed a real-time COVID-19 calculator, providing ongoing updated estimates of COVID-19-associated orphanhood and death of caregivers for every country in the world. These estimates as of the end of April 2021, along with an evidence-based strategy for action as described in the paper, can also be found in a policy report authored by the Global Reference Group for Children Affected by COVID: "Children: The Hidden Pandemic 2021 - A joint report of COVID-19-associated mortality and a strategy for action."