Changes in stillbirths and child and youth mortality in 2020 and 2021 during the Covid-19 pandemic
Authors: Acosta Enrique , Hug Lucia , Cruz-Castanheira Helena , Sharrow David , Silva José Henrique Monteiro da , You Danzhen 
Published: September 2023

Background

The COVID-19 pandemic’s impact on mortality, especially among the elderly, has been extensively studied. While COVID-19 rarely causes direct mortality in children and youth, the pandemic’s indirect effects might harm these age groups. Yet, its influence on stillbirths and mortality rates in neonates, infants, children, and youth remains poorly understood. This study examines disruptions in such trends across 95 countries in 2020 and 72 in 2021, providing the inaugural comprehensive analysis of COVID-19’s effect on young mortality and stillbirths.

Methods

We estimate expected mortality levels in a non-pandemic setting and calculate relative mortality changes (p-scores) by applying generalized linear models to data from civil registers and vital statistics systems (CRSV) and from the Health Management Information System (HMIS). We then use these estimates to analyze, for each age group, the distribution of country-specific mortality changes and the proportion of countries experiencing mortality deficits, no changes, and excess.

Results

For most countries and territories, stillbirths and mortality at ages under 25 did not differ from expected levels in 2020 and 2021. However, when focusing on the countries that did show changes, more countries experienced mortality deficits than excess. The exception was stillbirths in both years and mortality among neonates and those aged 10-24 in 2021, where more countries had an excess rather than a deficit. Overall, a quarter of the countries examined experienced increases in stillbirths and young adult mortality (20–24).

Conclusion

Despite global disruptions to essential services, stillbirths and youth mortality were as expected in most countries, defying expectations. However, this doesn’t dismiss hypotheses suggesting delayed adverse effects on the youngest that may require more time to be noticeable at the population level. Close and long-term monitoring of health and deaths among children and youth, particularly in low-income and lower-middle-income countries, is required to fully understand the lasting impacts of the COVID-19 pandemic.

Key messages

This study aims to assess the global impact of the COVID-19 pandemic on stillbirths and child and youth mortality during the years 2020 and 2021.

We found that despite the pandemic severity and the related socioeconomic disruptions worldwide, most of the 95 countries and territories under analysis experienced no changes in stillbirths and under-25 mortality.

These findings are important because the impact of the pandemic on the youngest ages remains poorly understood; it contributes essential information for conceiving tailored interventions that can effectively mitigate the adverse consequences of the pandemic on children and youth; and highlight the urgency of strengthen surveillance systems for monitoring health and deaths among children and youth, particularly in low-income and lower-middle-income countries.