The COVID-19 pandemic has negatively impacted maternal and child health and nutrition in South Asia. An estimated 235,000 additional child deaths and 11,000 additional maternal deaths occurred between January 2020 to June 2021 due to disruptions in essential health services. School closures in the region have impacted over 420 million children, with many unable to access remote learning. Girls have been disproportionately affected, with over 4.5 million estimated to drop out of school, increasing risks of early marriage and pregnancy. Policy recommendations include reestablishing health services, safely reopening schools, and strengthening social safety net programs focused on vulnerable populations such as children and adolescents.

1. DELIVERING FOR NUTRITION IN SOUTH ASIA
Implementation Research in the Context of COVID-19
December 2021
Aatekah Owais, PhD MPH
Research Associate,
SickKids’ Centre for Global Child Health
South Asia situation
Impact of COVID-19 on
maternal and child health and
nutrition

2. South Asia is home to 1.8 billion people
• 1 in 10 live below USD 1.90
• 1.5 million under-5 deaths in 2018
• One-third of children under-5 are stunted and 15% are wasted
• <50% of pregnant women received 4+ ANC visits
Given existing challenges, impact of COVID-19 mitigation strategies on
health and well-being of women and children is cause for serious concern
Background

3. COVID-19 has triggered an economic crisis
 Disruptions in food systems and livelihoods
 Increase in food insecurity and consumption of poor quality diets
GNI per capita in LMICs: ↓8% in 2020
People living in extreme poverty: +140 million
Number facing acute food insecurity in LMICs: +130 million (to 265 million)
Most at risk of food insecurity: Afghanistan and Nepal
Rely on food imports and remittance inflows
Poorer households and those in urban, slum areas are most affected
High number of daily wage laborers
Increase in food prices due to disruptions in trade and supply chains
Minimal ability of governments to expand social safety nets
 Several governments have increased program budgets
Childhood wasting: + 6.7 million (↑14.3%)  3.9 million in South Asia
Impact of COVID-19 in South Asia | I
WFP, 2020; Headey et al. Lancet 2020. S0140-6736(20)31647-0

4. Impact of COVID-19 in South Asia | II
Additional risk factors for reversing gains in maternal and child nutrition
Disruption in essential health services  increase in unintended pregnancies and
adverse birth outcomes
School closures  decrease in educational attainment, especially for girls
Indisputable evidence of increased maternal education  improved maternal
nutrition  decrease in intergenerational undernutrition
Akseer et al. AJCN 2020;112:251–256

5. Conceptual framework for the impact of COVID-19 mitigation
strategies on maternal, child and adolescent health and well-being

6. Impact on maternal and child mortality in South Asia
Coverage disruption calculated from health systems databases
Actual coverage data used to compare Jan – Dec 2019 vs. Jan – Dec 2020 and Jan – Jun
2021 by quarter
• 2020 Q1 disruption: Change between Jan – Mar 2019 and Jan – Mar 2020
• 2020 Q2 disruption: Change between Apr – Jun 2019 and Apr – Jun 2020
• 2020 Q3 disruption: Change between Jul – Sep 2019 and Jul – Sep 2020
• 2020 Q4 disruption: Change between Oct – Dec 2019 and Oct – Dec 2020
• 2021 Q1 disruption: Change between Jan – Mar 2019 and Jan – Mar 2021
• 2021 Q2 disruption: Change between Apr – Jun 2019 and Apr – Jun 2021
Lives Saved Tool (LiST) to estimate impact of service disruption of key SRMNCH
service

7. Observed disruption of essential SRMNCH services
in South Asia, Jan 2020 – Jun 2021*
*Compared to 2019 levels

8. Impact on maternal and child mortality in South Asia
Jan 2020 – Jun 2021:
Child mortality (<59 months)  ~235,000 additional deaths = ↑10%
~150,000 will occur in the neonatal period
Stillbirths  ~100,000 = ↑8%
Maternal mortality  ~11,000 additional deaths = ↑12%
> 4.5 million unintended pregnancies = ↑10%
*Compared to 2019 levels

9. Impact on education
~420 million school-aged children in South Asia out of school
beginning March 2020
Oct 2021: Mean duration of full/partial closures = 64 weeks
1 in 3 cannot be reached by remote learning1
Best case scenario – actual number is likely much higher
Rural areas and/or poorer households less likely to access remote learning
Loss in educational attainment due to
Loss of learning time
Loss of already acquired learning due to school closures
Increase in children dropping out of school
1UNICEF Remote Learning Factsheet, 2020

10. ~9.5 million children at risk of dropping out of school permanently
> 3 million primary school-aged
> 6 million middle school-aged
Increasing inequality in educational attainment with >40% dropouts from
poorest HH
Mean years of education lost = 7.3 years  20% decrease in lifetime
earnings
Impact on education

11. Impact on girls
> 4.5 million girls estimated to drop out of school
Many will be married off
> 450,000 adolescent pregnancies
 Adverse birth and child health outcomes

12. Policy and action recommendations
Re-establish essential health services
Using tele-medicine
Strengthening infection prevention and control
Ensuring supply-chain and delivery of essential commodities
Safe re-opening of schools
Limit on class sizes
Alternating school days
Mask mandates and temperature check
Safe transportation to and from schools
Social safety net programs
Increased focus on vulnerable populations including children and
adolescents

13. Thank you