The world’s most vulnerable people are suffering and dying from the effects of the “shadow pandemic”

The international community must recommit to the health of women, children, and adolescents, write Helen Clark, board chair of PMNCH and former prime minister of New Zealand, and Kersti Kaljulaid, president of Estonia and newly appointed United Nations’ Secretary-General’s global advocate for Every Woman Every Child

The spillover effects of the covid-19 pandemic on women, children, and adolescents have been under-reported in the media, yet they are significant. While women, children, and adolescents are not more likely than other population groups to get ill or die from covid-19, they are experiencing interruptions to essential health and social services caused by lockdowns and by the diversion of resources to manage the virus. The impact of this amounts to a “shadow pandemic,” which is affecting many millions of people.

Surveys conducted over the past year have revealed the scale of the impact: 39% of 124 countries surveyed reported a drop in coverage of family planning services; 38% reported drops in the coverage of maternal health services (antenatal and postnatal); and up to 200 000 additional stillbirths could occur over 12 months in 117 low and middle income countries.

We should heed the words of a pregnant woman in Kenya who feared being left to give birth without expert care and support: “I am worried because I’m not sure if I will find the facility open or if I will find nurses during delivery”, she said. Sadly, she is far from alone. 

In India, an adolescent girl bears witness to the lack of even the most basic sanitary supplies, saying: “Girls in quarantine tore up and used their own clothes as they didn’t have access to sanitary pads.”

An 18 year old Colombian woman with polycystic ovarian syndrome reports being unable to get any kind of medical appointment during the pandemic: “I stopped getting my period, and I want to find out what’s going on, but I can’t.”

These are themes repeated by disadvantaged and vulnerable people the world over. They desperately need healthcare, services, and supplies, and are entitled to receive them, but the pandemic has torn away the fragile support structures they rely on.

More than one third of countries are still reporting disruptions to immunization services. This particularly puts children at risk. Our attempts to manage covid-19 must not compromise our campaigns against other killer diseases, such as measles and polio.

Act together, act swiftly

These disruptions to essential services cannot continue. The international community must come together swiftly to protect the most vulnerable from the indirect effects of covid-19, even as it urgently addresses the virus itself through mass vaccination and other public health measures.

It is not simply a matter of preventing suffering and hardship. Women, newborns, children, and adolescents are at risk of dying as a result of the covid-19 pandemic without ever catching the disease.

In our respective roles of board chair of Partnership for Maternal, Newborn and Child Health (PMNCH) and newly appointed United Nations global advocate for Every Woman Every Child, we call on world leaders to commit to bold, meaningful, and co-ordinated global action on women’s, children’s, and adolescents’ health.

In 2015, global leaders agreed on sustainable development goals (SDGs) for the next 15 years. Progress toward them, however, has stalled, or even reversed, as a result of the pandemic. The world urgently needs to get back on track to achieving them—including the targets of the health SDGs and of the Every Women Every Child Global Strategy for Women’s, Children’s, and Adolescents’ Health (2016-2030).

All efforts to get back on track must be driven by the central principle of the SDGs: “leave no one behind.” At the moment, millions are slipping further and further behind, with those caught in the cross-currents of conflict, fragile situations, and migration bearing a disproportionate burden. Getting back on track will require an unprecedented global effort, co-ordinated and led at the highest level and resourced by massive fresh investment. Working in partnerships and through multilateral cooperation will be critical.

Progress on the health SDGs was already too slow before the pandemic began—with huge health inequities persisting between countries and regions. This is highlighted by regional disparities in maternal deaths. Globally, while the number of maternal deaths dropped 35% between 2000 and 2017, sub-Saharan Africa and South Asia accounted for 86% of all maternal deaths.

Vaccines, equity, and data

So, what should the world be doing to protect the most vulnerable? A high priority is to do everything possible to ensure the equitable distribution of covid-19 vaccines through the international COVAX initiative. Access to therapeutics and testing, and to other vital tools and commodities such as personal protective equipment (PPE) and medical oxygen, also needs to be massively scaled up.

PMNCH lists other urgent priorities in its Call to Action on COVID-19 campaign. This has seven key goals: protecting access to sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH) services; improving gender equality and access to sexual reproductive health and rights; improving quality care; supporting and protecting frontline health workers; ensuring stronger social safety nets; clean water and sanitation; and prevention of violence.

An equity based approach is essential to ending the covid-19 pandemic, but this depends on first gaining a detailed understanding of where inequities exist and who is affected. In May, the World Health Organization presented the 194 member states of the World Health Assembly with stark evidence of how badly the pandemic is affecting women’s, children’s, and adolescents’ health. It highlighted weaknesses in data systems, and especially the inability to monitor disruptions to essential health services in real time. To improve the volume and quality of health data dramatically, we strongly recommend expanding access to and use of digital technologies in health. These can be transformative, as we’ve already seen in Estonia. With the right infrastructure in place, they are a great equalizer, serving and uniting a whole country and enabling the most disadvantaged to access and shape health services.

We urge countries and the international community at large to recommit to the health and wellbeing of women, children, and adolescents. The pandemic has set progress back, but we owe it to the most vulnerable people in our world to get back on track and build back better and fairer. 

Helen Clark is the PMNCH board chair. She was prime minister of New Zealand from 1999–2008. From April 2009 she was administrator of the UN Development Programme, serving two terms.

Competing interests: none declared.

Kersti Kaljulaid is president of Estonia. Recently appointed the first global advocate of the United Nations Secretary-General for Every Woman Every Child (EWEC). In 2018-2020, Mme Kaljulaid was the co-chair to the High-Level Steering Group for EWEC. 

Competing interests: none declared.