Opinion: Supporting parents and children in the early years during (and after) the COVID-19 crisis

The coronavirus pandemic is a shock of global proportions, but its impacts – both current and future – are unlikely to be felt equally. While pregnant women and children have so far been largely spared from the direct health effects of COVID-19 (Sutton et al. 2020), the associated uncertainty, disruption in economic activity and reduction in essential services are causing increased stress and economic burden on parents. These costs are unlikely to be borne equally: vulnerable parents and children – be it of low socioeconomic status, disabled, at risk of harm, in poor quality or overcrowded housing, or single parents – are at particular risk.

It has been noted that, unlike previous recessions, the current crisis has two particular features: it is harming women’s labour market prospects more than men’s; and it is increasing the volume of home production, currently widening existing gender inequalities, for example in relation to childcare (Hupkau and Petrongolo 2020). What are the likely consequences for children? While an evolution of gender norms and a speedy economic recovery are possible, the existing literature shows that profound shocks at critical stages of development can have long-term consequences (Conti et al. 2019). However, preventing longer term damage is possible, if we act promptly.

Possible impacts of COVID-related shocks

The COVID-19 pandemic is an unprecedented mix of shocks. In addition to the public health threat, there is the stress associated with possible personal losses, the health risk in case of key workers, the risk of facing unemployment with related income loss, the reduction in vital services, and the increase in isolation following the social distancing restrictions. While there is no directly comparable precedent, the existing literature can provide some insights.

• Stress. Several studies have examined different sources of stress experienced in the prenatal period and in the first years of life, ranging from wars and terrorist attacks, to natural disasters and extreme weather events, or to the death of a family member. They have shown adverse impacts not only on physical health and cognition, but also on mental health – usually affecting to a greater extent women of lower socioeconomic status (SES) (Almond et al 2018, Conti et al. 2019).
• Economic hardship. Plenty of evidence exists on the adverse impacts of the Great Recession. A study from the US (Currie et al. 2015) shows an increase in health disparities between more and less advantaged mothers, with the former reporting increased prevalence of unhealthy behaviours and worse physical and mental health, while the latter even show benefits. Changes in labour market conditions also affect intrahousehold conflict, domestic violence and child abuse (Doyle and Aizer 2018).The costs could be high: for example, the lifetime costs of child maltreatment in UK amount to £89,390 and £940,758 per victim for non-fatal and fatal cases, respectively (Conti et al. 2017).

Hence, the covid-19 pandemic is likely to increase inequalities in multiple inputs in the production of child development, with low-SES, vulnerable parents less able to provide safe, stable and stimulating home environments, food security, nurturing care, appropriate time investments or sensitive parenting.

Policies to mitigate the effect of COVID-19 on parents and children

What can be done to mitigate the negative effects of COVID-19? Protecting workers against income losses is obviously critical, and the government has implemented a series of reforms to this effect (Adam et al. 2020); further actions will likely be needed to prevent an increase in child poverty. However, it is now crucial to also provide direct support to parents whose economic security is threatened, or who have lost vital sources of support, such as nurseries and children’s centres, or networks of relatives and friends.

Home visitation for parents is a widespread early-intervention strategy in many countries. I have contributed to recent evidence on a flagship programme targeting first-time disadvantaged mothers, the Nurse Family Partnership (NFP) in the US, showing long-term improvements in maternal and child outcomes and reductions in government welfare expenditures (Kitzman et al. 2019, Olds et al. 2019). In face of the COVID-19 pandemic, the NFP has switched to telehealth to ensure the continuity of services; however, in some sites, family nurses are being redeployed.4 In England, where NFP is present since 2007 under the name Family Nurse Partnership, most services continue via telehealth to help first-time teenage mothers.

In addition to more targeted programmes, in England there is also a universal health visiting service. While no evaluation to date exists, evidence from the Scandinavian countries on similar universal programmes shows long-term impacts on health and socioeconomic outcomes (Conti et al. 2019). Notwithstanding the evidence, councils have seen a £531 million cash terms reduction to their public health budgets between 2015/16 and 2019/20.

Prior to the pandemic, a third of health visitors were already responsible for 500-1000 children, instead of the 250 recommended. In face of the pandemic, many community health services (including health visiting, but excluding safeguarding) have been partially or completely stopped. Home visits are now carried out mostly virtually, with the number of universal contacts reduced and prioritised, face-to-face contacts only carried out in case of a compelling need, and with a focus on vulnerable families. However, there is substantial variation, within and across sites, due both to differences in operationalisation of the national guidelines, definitions of vulnerabilities, and available technology. This increases the risk that newly vulnerable parents and children are undetected and left without help. Additionally, in some areas, health visitors have been redeployed in large numbers, possibly as many as 50-70% for up to six months. This increase in inequality of access to universal services is likely to translate into increases in inequalities in child development, hence it is imperative that redeployment calculations account for potential increases in local demand due to increased needs. While available evidence is scarce, a study from Denmark (Kronborg et al. 2016) shows that a two-months nurse strike which caused a reduction in care around birth increased the number of general practitioner (GP) contacts in the first month of life11 and reduced exclusive breastfeeding.

It is now known that inequalities in many dimensions of child development emerge early, and if not promptly acted upon, tend to persist and widen. I have shown that inequalities in foetal development by neighbourhood deprivation emerge since the beginning of gestation (Conti et al. 2018), and that inequalities in socio-emotional skills at five years of age have increased between the 1970-2000 birth cohorts (Attanasio et al. 2020). To avoid further increases as a result of COVID-19, it is imperative to ensure sustainable delivery of early interventions in support of parents and children. Going forward, we should use this crisis to rethink the system towards a greater focus on prevention, greater integration between children’s education, health and social care services, and a cabinet-level Children and Families’ Minister in order to make our society more resilient for the next crisis – whatever its nature might be.

This article was first published in Vox on 1 May.

Links

• Dr Gabriella Conti’s academic profile
• UCL Department of Economics
• UCL Faculty of Social and Historical Sciences