A new report argues the decades long efforts to improve health should be shielded from the effects of the pandemic and the response to it

The past 10 years have been a time of remarkable progress for improving the health of the world’s women, children, and adolescents. But despite considerable progress, major inequities persist between and within countries, and across the world’s regions. 

In 2019, the United Nations Secretary-General (UNSG) issued a call for a Decade of Action to address these pervasive inequities and to accelerate efforts to meet the sustainable development goals (SDGs). However, the covid-19 pandemic has subsequently introduced a major new challenge for improving the health of women, children, and adolescents. 

In 2010 the Every Woman Every Child (EWEC) movement was launched by the UNSG to address the major health challenges facing women, children, and adolescents around the world. Since 2015 the movement has been tied to the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030) (Global Strategy), which was developed as a concrete roadmap to reach related SDG targets.[1] Since March 2020, when the covid-19 pandemic was declared, the challenges and prospects confronting the EWEC movement have radically shifted. 

A new report, which we have authored along with other EWEC partners, takes stock of progress and synthesises information on the impact of covid-19 on women’s, children’s, and adolescents’ health.[2] The report, Protect the Progress: Rise, Refocus and Recover, highlights that although minimising the pandemic’s impact should be at the forefront of countries’ planning, other efforts to improve the health of all women, children, and adolescents should not be adversely affected.  

How was the world doing before the pandemic?

The report tells a story of mixed progress. The number of deaths among children under the age of 5 reached an all time record low in 2019, and the number of maternal deaths dropped by around 35% in the past two decades.[3][4] Coverage of essential interventions increased on average around the world, with some interventions, such as immunisations, the presence of a skilled birth attendant, and access to safe drinking water, exceeding 80%. Greater political commitment led to the mobilization of over US$ 186 billion and 776 multi-stakeholder commitments to improve women’s, children’s, and adolescents’ lives.

Yet progress has not been universal, and deep rooted inequities have meant that birthplace and wealth status still play a definitive role in whether children and adolescents survive and are able to reach their full potential. These same social determinants, plus pervasive gender inequality, have limited women’s economic opportunities and political participation, undermining overall development. For example, 82% of deaths in children under the age of 5 and 86% of maternal deaths are concentrated in sub-Saharan Africa and South Asia where resources are more constrained. The majority of the 144 million children who are stunted and the 47 million children who are wasted also live in these two regions.[5] Maternal, child, and adolescent mortality rates are substantially higher in countries affected by conflict, resulting in many women, children, and adolescents being left behind because of political turmoil and factors beyond their control. Climate change and its environmental impact is also a looming threat for today’s and future generations.     

How has covid-19 impacted women, children, and adolescents?  

The covid-19 pandemic has already resulted in millions of infections and hospitalisations and close to one million deaths. The pandemic and responses by governments are beginning to reverse some of the progress made since EWEC began 10 years ago. Efforts to contain covid-19 have frequently resulted in disruptions to the delivery of essential services, putting women, children, and adolescents at higher risk of death, disease, and disability from preventable and treatable causes. Some of the most severely impacted services have been routine immunisation services, malaria bed net distribution campaigns, family planning, and antenatal care services.[6] As a result of these disruptions to health services, potentially catastrophic consequences for women, children, and adolescents have been forecasted.[7][8][9]  

Covid-19 and responses to it have also negatively impacted the food system through trade restrictions and disruptions in transportation, increasing the risk of food insecurity for millions of families. Widespread school closures are a serious detriment to learning and human capital development, with some children and adolescents likely never to return to school and others potentially exposed to increasing levels of domestic violence and higher risks of early pregnancy.[10]

What can be done to stay on track? 

Covid-19 has made the road ahead more difficult, but there is reason for optimism. The United Nations had its beginnings in the devastation of the second world war and it played a significant part in the rapid recovery of countries in its aftermath. The same principles that were in action then are needed now and are already embedded in the EWEC movement. Through multilateral action, multisectoral approaches, and strong partnerships—all guided by high quality data—much can be accomplished to realise an equitable and brighter future for all women, children, and adolescents. 

The solution to the covid-19 crisis and the complex challenges posed by climate change and continued conflicts is simultaneous action across all three pillars of the primary healthcare model. This includes investing into health systems so that they provide access and quality services to all and are resilient to shocks; coordination across sectors to prevent any mother, child, or adolescent from slipping through the cracks; and greater empowerment of communities so that people can help shape programmes and policies according to their needs, and hold governments to account. These actions can be achieved through the power of partnerships and continued commitment to the EWEC vision.

Jennifer Requejo, senior adviser for health and HIV, Division of Data, Analysis, Planning and Monitoring, United Nations Children’s Fund, New York.

Theresa Diaz, unit chief for epidemiology and monitoring and evaluation in the Department of Maternal, Newborn, Child, Adolescent Health and Ageing in the World Health Organization, Geneva, Switzerland. Twitter: @TheresaDiazWHO

Ties Boerma, director of the Countdown to 2030 for Women’s, Children’s and Adolescent’s Health and professor at the University of Manitoba, Canada.

Cesar Victora, scientific director of the International Center for Equity in Health at the Federal University of Pelotas, Brazil.

Petra ten Hoope-Bender, technical adviser for sexual and reproductive health and rights at the UNFPA Office of Geneva, Switzerland. Twitter: @Ptenh

The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

This article was drafted with the help of our EWEC Secretariat, UN agency, GFF, and Countdown to 2030 partners. Updates from EWEC can be found here: @UN_EWEC

We have read and understood BMJ policy on declaration of interests and declare the following interests: None.

References

[1] Global Strategy for Women’s, Children’s and Adolescents’ Health (2016 –2030): Data portal (which includes information on all 60 indicators). In: Global Health Observatory (GHO) data. Geneva: World Health Organization; 2016. https://www.who.int/gho/publications/gswcah_portal/en/
[2] Every Woman Every Child, UNICEF, WHO, UNFPA, GFF, Countdown to 2030. Protect the Progress: Rise, Refocus and Recover. UNICEF, September 2020. 
[3] World Health Organization (WHO), United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA), World Bank Group, United Nations Population Division. Trends in maternal mortality: 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2019.
[4] UNICEF, WHO, World Bank Group and United Nations. Levels and trends in child mortality. UNICEF 2020.
[5] UNICEF, WHO, International Bank for Reconstruction and Development/The World Bank. Levels and trends in child malnutrition: key findings of the 2020 edition of the Joint Child Malnutrition Estimates. Geneva: World Health Organization; 2020. https://www.unicef.org/reports/joint-child-malnutrition-estimates-levels-and-trends-child-malnutrition-2020
[6] Surveys include: WHO Essential Health Services Survey, https://www.who.int/publications/i/item/WHO-2019-nCoV-EHS_continuity-survey-2020.1; UNICEF Situation tracking for COVID-19 socioeconomic impacts May–June 2020, https://data.unicef.org/resources/rapid-situation-tracking-covid-19-socioeconomic-impacts-data-viz/; WHO, UNICEF Immunization Pulse survey, April 2020 https://www.who.int/immunization/monitoring_surveillance/immunization-and-covid-19/en/
[7] Roberton T, Carter ED, Chou VB, Stegmuller RA, Jackson BD, Tam Y et al. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. Lancet Glob Health. 2020;8(7):e901–8. doi:https://doi.org/10.1016/S2214-109X(20)30229-1.
[8] Jewell BL, Mudimu E, Stover J, Ten Brink D, Phillips AN, Smith JA et al. Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19: results from multiple mathematical models. Lancet HIV. 2020;7(9):e629–40. doi: https://doi.org/10.1016/S2352-3018(20)30211-3.
[9] The potential impact of health service disruptions on the burden of malaria: a modelling analysis for countries in sub-Saharan Africa. Geneva: World Health Organization; 2020. https://www.who.int/publications/i/item/the-potential-impact-of-health-service-disruptions-on-the-burden-of-malaria
[10] Impact of the COVID-19 pandemic on family planning and ending gender-based violence, female genital mutilation and child marriage: pandemic threatens achievement of the transformative results committed to by UNFPA. Interim Technical Note. New York: UNFPA; 2020. https://www.unfpa.org/sites/default/files/resource-pdf/COVID-19_impact_brief_for_UNFPA_24_April_2020_1.pdf