How action can help millions of children orphaned by COVID-19

As new crises unfold, it is important we do not lose sight of the less visible aftermath of the pandemic. Behind the numbers of people dying tragically from COVID-19 there are children.  The good news is that cases and deaths are starting to come down. The bad news is that one tragic consequence is still going up – that of orphanhood due to COVID-19. In the current context, we are also reminded that COVID-19 is not the only cause of orphanhood – and that the solutions to manage its consequences are critically important.  

Globally, every COVID-19 death leaves a child facing the loss of a parent or other adult caregiver.  Updated estimates that we recently released in The Lancet Child and Adolescent Health reveal that by the end of October 2021, 5 million COVID-19 deaths had occurred and 5.2 million children under age 18 years had lost a mother, father, and/or grandparent caregiver who lived in their household. This crisis is more rapid and consequential than HIV/AIDS.

From 1987 to 1997, some 5 million children had lost one or both parents to HIV/AIDS. COVID-19 hit that same number in just two years and continues to grow at an alarming pace. The rate of parent and caregiver loss from May to October 2021 was twice that of the prior 14 months—double the impact in half the time. COVID-19 mortality moves quickly, delivering a devastating shock that upends children’s lives in a matter of days or weeks. 

This crisis is escalating in low-income countries with their comparatively younger populations. The regions facing the greatest burden of parent or caregiver loss are poorly equipped to address it, particularly Africa, South Asia, and parts of East Asia. Every death in Zimbabwe, Malawi, Nigeria, and Kenya leaves two children behind.  A staggering 3.4 million children in India have lost a primary or secondary caregiver.

What can be done?

Three measures are essential to address this growing global crisis. These policy solutions are based on tested, evidence-based approaches developed by groups including the World Bank, UNICEF, USAID, CDC, WHO, and the President’s Emergency Plan for AIDS Relief (PEPFAR).

1. Prevention is key. The best way to stop the surge in parent and caregiver loss is to address COVID-19 mortality. Parental loss only stops when deaths stop. Equitable immunization policies keep kids in families.
2. Preparing families should be a priority. The vast majority of children losing a parent have living relatives, yet many children will be at risk of being placed in residential care such as orphanages or children’s homes which evidence shows are highly detrimental to their safety, well-being and physical and social development.  Infants and young children need family-based nurturing care and stimulation critical to their longer-term heath, education, stability, and lifelong earning potential. Governments and NGOs need to collaborate to rapidly identify children at risk of losing a caregiver to COVID-19, and to ensure that child remains in safe and nurturing family care with relatives, through foster care, or through adoption. USAID’s Global Development Alliance Changing the Way We Care initiative is a sound framework for scaling up proven practices for strengthening families and avoiding child separation for COVID-19-affected children.
3. Children need protection and support. Our recent estimates point to important age and gender dimensions in formulating appropriate policy responses. Three out of four of the COVID-19 parental and caregiver deaths are men, many of whom are primary earners in the household, presenting a need for financial support to affected families. In addition, most affected children are adolescents who face risks of child labor, and decreased school enrollment and lower attendance. Adolescent girls face increased risks of sexual exploitation, child marriage, and boys face disproportionate pressure to supplement family incomes or join gangs and militias. We need to tackle this myriad of risks and adversities head on. That means investing in cutting-edge and effective cash transfer, jobs, and education programs. These cash plus care programs need to be nested within a strengthened public child welfare and protection system to address the entire spectrum of these children’s needs, from early childhood development to protection from violence and exploitation.

We must work to address the needs of children facing parental and caregiver loss from COVID-19 through these and other measures. Inaction will lead to incalculable costs for future generations.  With numbers growing by the day, the pandemic’s most vulnerable victims need rapid, focused support.