By the time the global pandemic was declared by the World Health Organization on 11 March 2020, essentialmaternal, newborn, child and adolescent health services across South Asia were already being shut down. During the second quarter of 2020, access to all essential
SRMNCAH2 services declined substantially, and sometimes precipitously. Even where services remained
open, use decreased. In Bangladesh and Nepal, for example, the number of young children being treated for severe acute malnutrition (SAM) fell by over 80 per cent. India and Pakistan both saw reductions in the number of children receiving DPT3/Penta 3 vaccinations of around 35 and 65 per cent respectively.
Our estimates indicate that by the end of 2020, disruption on such a scale is likely to have contributed to more than 228,000 additional deaths among children under five years in the six largest South Asian countries compared to the previous year. A spike in the number of maternal deaths of over 16 per cent is also expected, with 7,750 more in India and over 2,000 more in Pakistan, making a total of around 11,000 additional maternal deaths estimated across South Asia. An additional 3.5 million unintended pregnancies are likely to have occurred during 2020. During the second quarter of 2020, rates of maternal iron deficiency anemia increased by over 40 per cent in Nepal and 22 per cent in Bangladesh when compared to the same period of 2019. Among adolescents, a rise in disease-related mortality is likely, with nearly 6,000 additional deaths from malaria, Tuberculosis (TB), HIV/AIDS and typhoid. Some 420 million South Asia children have been affected by school closures since the beginning of the pandemic, and an estimated 9 million are expected to drop out of school permanently. Around 50 per cent of them will be girls. Given the cultural and social context of South Asia, this is expected to lead to an increase in child marriages, resulting in an additional 400,000 adolescent pregnancies, as well as an increase in the number of maternal and neonatal deaths, and in rates of child stunting. It will also impact negatively on cognitive capacity and skills, and the prospects of decent employment, as well as social and emotional well-being. COVID-19 mitigation measures – including travel restrictions and lockdowns – have had broader consequences for public health as well, due to increased levels of unemployment, poverty and food insecurity. The larger South Asian nations are expected to see a rise in poverty rates of between 0.6 and 3.7 per cent, and an average increase in food insecurity of 18 per cent. Even as South Asian countries continue to tackle the direct effects of COVID-19, there is a critical need for governments to address the severe long-term fallout from the pandemic. According to our estimates, due to the disruption to essential SRMNCAH services and other contributory factors, an additional 228,000 child deaths, and more than 11,000 maternal deaths will have occured in the region in 2020 alone. In addition, rates of undernutrition, including anaemia, stunting and wasting are likely to increase due to the rise in food insecurity and poverty. In Bangladesh, for example
prospective data shows that the number of households experiencing food insecurity grew by more than 50 per cent during stay-at-home orders implemented in March –May 2020.