More than 1.5 million children lost a primary or secondary caregiver due to the COVID-19 pandemic

More than 1.5 million children around the world are estimated to have lost at least one parent, custodial grandparent, or grandparent who lived with them due to death related to COVID-19 during the first 14 months of the pandemic, according to a study published today in The Lancet. 

The study highlights orphanhood as an urgent and overlooked consequence of the pandemic and emphasizes that providing evidence-based psychosocial and economic support to children who have lost a caregiver must be a key part of responding to the pandemic.

The analysis used mortality and fertility data to model rates of COVID-19-associated orphanhood (death of one or both parents) and deaths of custodial and co-residing grandparents (ages 60-84) from March 1, 2020 to April 30, 2021, across 21 countries. This study was funded in part by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

In the paper, “COVID-19-associated deaths” referred to the combination of deaths caused directly by COVID-19 and those caused indirectly by other associated causes, such as lockdowns, restrictions on gatherings and movement, decreased access or acceptability of health care and of treatment for chronic diseases.

Traumatic experiences, such as the loss of a parent or caregiver, are associated with increases in substance use, mental health conditions, and other behavioral and chronic health conditions. NIDA supports research aimed at understanding the impact of trauma on young people, preventing substance use after experiencing hardship, and treating substance use in populations that experience trauma.

“Studies like this play a crucial role in illuminating the COVID-19 pandemic’s long-lasting consequences for families and the future mental health and wellbeing of children across the globe,” said NIDA Director Nora D. Volkow, M.D. “Though the trauma a child experiences after the loss of a parent or caregiver can be devastating, there are evidence-based interventions that can prevent further adverse consequences, such as substance use, and we must ensure that children have access to these interventions.” 

To estimate pandemic-associated orphanhood and caregiver deaths, the study used excess mortality and COVID-19 mortality data for 21 countries that accounted for 77% of global COVID-19 deaths during 2020 and early 2021. These include Argentina, Brazil, Colombia, England and Wales, France, Germany, India, Iran, Italy, Kenya, Malawi, Mexico, Nigeria, Peru, Philippines, Poland, Russian Federation, South Africa, Spain, United States, and Zimbabwe.

The authors estimate that 1,134,000 children lost a parent or custodial grandparent due to COVID-19-associated death. Of these, 1,042,000 children were orphaned of a mother, father, or both – most lost one, not both parents. 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).

The countries with the highest numbers of children who lost primary caregivers (parents or custodial grandparents) included South Africa, Peru, United States, India, Brazil, and Mexico. The countries with rates of COVID-19-associated deaths among primary caregivers (>1/1000 children) included Peru, South Africa, Mexico, Brazil, Colombia, Iran, United States, Argentina, and Russia.

The study found that for every country, COVID-19 associated deaths were greater in men than women, particularly in middle- and older-ages. Overall, there were up to five times more children who lost a father than who lost a mother.

“We know from our research that loss of a parent or caregiver can upend children’s lives and potentially affect their development if they are not in a stable home setting. If we take into consideration variants of concern or possible severity of illness among youth, we must not forget that the pandemic continues to pose a threat to parents and caregivers – and their children,” said Chuck A. Nelson, III, Ph.D., study author, Boston Children’s Hospital.

While research on the science of substance use and addiction remains the primary focus of NIDA’s work, NIDA is supporting COVID-19 research, and has issued over $15 million in funding for COVID-19-related projects since the start of the pandemic that could leverage current infrastructure, projects, or scientific knowledge and resources.

Empower parents, enable breastfeeding

UNICEF and WHO are calling on governments and all employers to adopt family-friendly policies that support breastfeeding.

The theme of this year’s World Breastfeeding Week is “Empower Parents, Enable Breastfeeding.” 

Family-friendly policies – such as paid parental leave – enable breastfeeding and help parents nurture and bond with their children in early life, when it matters most. The evidence is clear that during early childhood, the optimal nutrition provided by breastfeeding, along with nurturing care and stimulation, can strengthen children’s brain development with impacts that endure over a lifetime.

Family-friendly policies are particularly important for working parents. Mothers need time off from work to recover from birth and get breastfeeding off to a successful start. When a breastfeeding mother returns to work, her ability to continue breastfeeding depends on having access to breastfeeding breaks; a safe, private, and hygienic space for expressing and storing breastmilk; and affordable childcare at or near her workplace.

Time off work is also important for fathers: Paid paternity leave allows fathers to bond with their babies and promotes gender-equality, including through the sharing of childrearing and household responsibilities.

Returning to work too soon is a barrier to the early initiation of breastfeeding, exclusive breastfeeding in the first six months and continued breastfeeding until age 2 or longer – practices that can boost children’s immune systems, shield them from disease, and provide protection from noncommunicable diseases later in life.  Breastfeeding also protects maternal health — women who breastfeed reduce their risk of breast and ovarian cancers.

In addition to their impact on children, family-friendly policies support women’s participation in the workforce, improve their physical and mental health^,and enhance family well-being. They also advance business objectives and strengthen the economy. Such policies have been shown to increase employee retention, improve job satisfaction, and result in fewer absences. In short, family-friendly policies are good for families, babies and business.

As the world marks World Breastfeeding Week, WHO and UNICEF call on governments and all employers to adopt family-friendly policies – including paid maternity leave for a minimum of 18 weeks, and preferably, for a period of six months – as well as paid paternity leave.

In line with the policy actions advocated by the WHO-UNICEF-led Global Breastfeeding Collective, we also call for greater investments in comprehensive breastfeeding programmes, improved breastfeeding counselling and support for women in health facilities and the community, and an end to the promotion of breast-milk substitutes to enable parents to make informed decisions on the best way to feed their infants. 

Together, with the support of governments, employers and communities, we have the power to enable breastfeeding and support families in fostering a nurturing environment where all children thrive.