5 Questions on the Impact of Pandemics and Epidemics on Child Protection
(23 July 2020) A new rapid review from UNICEF Innocenti collects and synthesizes the available evidence on the impacts of COVID-19 and previous pandemics, epidemics, and their control measures on child protection and offers key lessons learned for global and national responses to COVID-19 and recommendations for future research priorities.The rapid review was conducted between March and June 2020, led by UNICEF Innocenti’s Shivit Bakrania, who specializes in evidence synthesis. To learn more about how this rapid review came about and what the most interesting, and importantly – relevant – findings are, we sat down (virtually) with Shivit to ask him 5 questions to help unpack this rapid research review. 1. Where did the idea to do a rapid research review on child protection in pandemics and epidemics come from?Shivit: At Innocenti, we are increasingly using evidence synthesis as an important tool to consolidate available knowledge, and build on what is already known in order to identify gaps and reduce duplication. In March 2020, when COVID-19 was declared a pandemic, there was not much in the way of robust empirical evidence on how COVID-19 affects the lives of children and adolescents. However, we were seeing various editorials and commentary on the socio-economic stresses that COVID-19 was creating for children, adolescents and their families. Some of this commentary was suggesting that competition for scarce resources, limited access to social supports, and safe spaces and parental stresses could all increase the vulnerability of children and adolescents to abuse, neglect, maltreatment, exploitation and violence. We thought it would be useful for UNICEF and other stakeholders interested in child well-being and protection to rapidly synthesize the evidence on the effects of major pandemics and epidemics on these outcomes. This could help predict some of the vulnerabilities we need to be addressing at an early stage of COVID-19, rather than waiting for new research specifically linked to COVID-19 which may take time. The rapid review therefore aims to draw more attention to the often invisible but important protection issues that need to be a core part of COVID-19 response and to determine where the response should be focused and strengthened. 2. How does the review help inform our responses to better protect children during COVID-19?Shivit: We identify the state of the evidence base on the effects of pandemics and epidemics, and their infection control measures, on different child protection outcomes. The outcomes include (but are not limited to): stigma, child labour, early and adolescent pregnancy, child marriage, orphanhood, intimate partner violence, sexual violence and exploitation, suicide and self-harm, and school enrolment, dropout and attendance. These are serious rights violations that children and adolescents experience, and epidemics often exacerbate those risks. By knowing the state of the evidence, we can identify likely risk areas and we can see where further research needs to be conducted. We draw some of the lessons from the literature. By identifying some of the key impacts and pathways toward impact, we can identify where responses can best be targeted in order to ensure the risks to children are reduced. The evidence suggests that the key areas to focus on are:Focus on children in vulnerable circumstances, including orphans.Responding to stigmatization and discrimination: this is a key pathway toward other longer-term psychosocial and mental health effects.Investing in social protection: Social safety nets could reduce the participation of children in paid and exploitative labour and decrease the chances of school dropout. This may further decrease the chances of early marriage and teenage pregnancy. Promoting access to health and protective services: The evidence emphasizes the importance of prioritizing services to respond to issues of violence against women and girls, including within the health system. Access to justice: The evidence finds that access to the police and formal justice was restricted in many locations. Particular attention could be given to the role of community leaders and customary justice systems, ensuring that cases of criminal sexual violence are recorded and referred to the formal justice system. Ensuring continued access to education. Download the research brief summarizing findings from the rapid reviewRead the full working paper: Impacts of Pandemics and Epidemics on Child Protection: Lessons learned from a rapid review in the context of COVID-19Learn about the process for conducting the rapid review from the study protocol View the interactive Evidence Gap Map on Pandemics, epidemics and outcomes on child protection and violence3. Can you walk us through the process for conducting this research review? Shivit: A rapid review is a fast form of evidence synthesis. It takes the template for a systematic review, which involves a comprehensive, explicit, transparent and replicable approach to collating and synthesizing evidence, and adds certain shortcuts. This entails undertaking: systematic searches in a range of databases; screening the results for relevance; extracting relevant data from the included studies; and synthesizing the evidence from studies to draw out the key findings. Systematic reviews take on average 1-2 years to complete, but this is often too long for decision-makers who need evidence more quickly. Therefore, rapid reviews offer a compromise between comprehensiveness and timeliness. 4. What stood out to you or surprised you in the findings? Was anything unexpected or alarm-raising?Shivit: The findings underline many of the assumptions we were making at the beginning of the pandemic, but there was a distinct lack of evidence from previous pandemics on how children have been affected. Most of the evidence is clustered on HIV/AIDs (and its effects on stigma) and (to a lesser extent) the Ebola crisis in West Africa. There was very little research focusing on certain vulnerable sub-groups of children, such as street-connected children or those with disabilities. We found that the pathways between infectious disease outbreaks and child protection outcomes were complex and moderated by many factors. In many cases, outbreaks and their associated infection control measures amplified existing inequalities and vulnerabilities. The key pathways include:Being orphaned – by losing one or both parents – was a direct outcome of infectious disease outbreaks and also a key risk factor towards other negative child protection outcomes.Stigmatization and discrimination of infected children and adolescents, or of those living with infected individuals, were significant drivers of other negative outcomes for children and adolescentsReductions in household income and the illness or death of breadwinners meant that children were increasingly engaged in wage labour, meant that younger children and girls were less likely to be engaged in child labour, and lead to increases in child marriageEarly and adolescent pregnancy was associated with infection control measures such as quarantine and social isolation. Economic insecurity and a lack of food increased pressures on families and caregivers, and school closures increased the likelihood of girls spending more time with older men. Child abuse and maltreatment increased during and after pandemics and epidemics, both for those co-residing with infected adults and those living with caretaker families. Infectious disease outbreaks intensified the experience of sexual violence and abuse, particularly of women and girls. Quarantines and lockdown conditions presented higher risks, resulting in increased domestic stress, the exercise of controlling behaviors by perpetrators, and restricted access of victims to services and help. 5. What do you hope will come out of this review – next steps for research? Better policies and programmes?Shivit: By identifying the key pathways, we hope that policies can be better targeted to prevent risks to children and adolescents. By identifying the state of the evidence and the gaps, we hope that future research can better prioritized. BONUS question: Walk us through the evidence gap map or EGM. What’s unique about it and how does it support research?Shivit: The EGM presents the evidence included in the rapid review in an interactive and visual manner. Users can see the clusters and gaps of evidence on child protection outcomes from different pandemics and epidemics. They can filter the evidence by infection control measure, by country and by different sub-groups of children and adolescents. By using these functions, users can access the evidence that is relevant to them, to inform decision making on policies or future research.