Innocenti Working Papers

The initial impression that pediatric SARS-CoV-2 infection is uncommon and generally mild has been replaced by a more nuanced understanding of infectious manifestations in children and adolescents across low-, middle-, and high-income countries and by demographic structure, with recognition of a widening disease spectrum. Critical knowledge gaps, especially in low- and middle-income countries remain, that have significant public policy and programme implications. Insufficient data dis-aggregated by age, geography and race/ethnicity are hindering efforts to fully assess prevalence of infection and disease in children and adolescents and their role in transmission. Potential biologic differences in susceptibility to infection and transmissibility between children and adults need to be assessed. Determination of mother-to-child SARS-CoV-2 transmission during pregnancy or peripartum requires appropriate samples obtained with proper timing, lacking in most studies. Finally, predictors of disease progression, morbidity and mortality in children need to be determined particularly as the pandemic moves to low- and middle-income countries, where poor nutritional and health conditions and other vulnerabilities are more frequent among children than in higher-income settings. Countries, UN agencies, public health communities, donors and academia need to coordinate the efforts and work collectively to close the data and knowledge gaps in all countries (high, middle and low income) for better evidence to guide policy and programme decision-making for children and COVID-19 (coronavirus) disease.

This rapid review collates and synthesizes evidence on the child protection impacts of COVID-19 (coronavirus) and previous pandemics, epidemics and infectious disease outbreaks. It provides lessons for global and national responses to COVID19 and recommendations for future research priorities. The evidence on the impacts of pandemics and epidemics on child protection outcomes is limited and skewed towards studies on the effects of HIV/AIDS on stigma. There is also some evidence on the effects of Ebola on outcomes such as orphanhood, sexual violence and exploitation, and school enrolment, attendance and dropout. The evidence on other pandemics or epidemics, including COVID-19, is extremely limited.

This paper examines the impact of the United Republic of Tanzania’s Productive Social Safety Net (PSSN) on child work and education. Targeting extremely poor households, the programme provides cash transfers that are partly conditional on the use of health and education services, along with a public works component. We relied on a cluster-randomized evaluation design, assigning villages to one of three study arms: cash transfers only; cash transfers combined with public works (i.e., the joint programme); and control. We complemented the quantitative analysis with findings from in-depth interviews and focus group discussions with children and caregivers, involving a subsample of participants from all three study arms. Due to household investment of PSSN benefits in livestock, the programme caused a shift from work for pay outside the household to work within the household, mostly in livestock herding. The programme improved child education outcomes. These findings were echoed in the qualitative data – participants referred to working on family farms as being both safer for children and more beneficial for the family. Participants further discussed the importance of PSSN funds in paying for schooling costs. Impacts were generally no different for communities that received cash only and communities that received both cash and public works components. School dropout, however, decreased in villages where the joint programme was implemented but remained unchanged in villages receiving cash only.

Balancing the need to collect data to support good decision-making versus the need to protect children from harm created through the collection of the data has never been more challenging than in the context of the global COVID-19 (coronavirus) pandemic. The response to the pandemic has seen an unprecedented rapid scaling up of technologies to support digital contact tracing and surveillance. As the pandemic progresses, we are also likely to see the emergence of more applications that link datasets as we seek to better understand the secondary impacts of the pandemic on children and their families. This working paper explores the implications for privacy as the linking of datasets increases the likelihood that children will be identifiable and consequently, the opportunities for (sensitive) data profiling. It also frequently involves making data available to a broader set of users or data managers. While it is recognized that reuse of unidentifiable data could potentially serve future public health responses and research, the nature of, access to and use of the data now and in future necessitate accountability, transparency and clear governance processes. It requires that these be in place from the outset. These are needed to ensure that data privacy is protected to the greatest degree possible and that the limitations to the use of these data are clearly articulated.

This paper provides a framework for analyzing constraints that apply specifically to women, which theory suggests may have negative impacts on child outcomes (as well as on women). We classify women’s constraints into four dimensions: (i) low influence on household decisions, (ii) restrictions on mobility, (iii) domestic physical and psychological abuse, and (iv) limited information access. Each of these constraints are in principle determined within households. We test the impact of women’s constraints on child outcomes using nationally representative household Demographic and Health Survey data from India, including 53,030 mothers and 113,708 children, collected in 2015-16. We examine outcomes including nutrition, health, education, water quality, and sanitation. In our primary specification, outcomes are measured as multidimensional deprivations incorporating indicators for each of these deficiencies, utilizing a version of UNICEF’s Multidimensional Overlapping Deprivation Analysis index. We identify causal impacts using a Lewbel specification and present an array of additional econometric strategies and robustness checks. We find that children of women who are subjected to domestic abuse, have low influence in decision making, and limited freedom of mobility are consistently more likely to be deprived, measured both multidimensionally and with separate indicators.

The 2030 Agenda for Sustainable Development is a new opportunity to address the key development challenges of our time with the aim to improve the well-being and rights of all people while protecting the natural environment. Children are important agents and beneficiaries in this process: many children are not only among the most vulnerable groups affected by poverty, inequality, conflict and climate change, they are also the generation that will reach adulthood during the realization of the 2030 Agenda. To create the sustainable, long-term transformation ambitiously laid out in Agenda 2030, new transformative approaches to policy must be implemented and applied to children and youth—approaches that target the underlying generative framework of social injustice as opposed to implementing affirmative remedies that simply seek to alleviate the symptoms. The objective of this paper is to develop a conceptual framework to help assess the transformative potential of policies – particularly with regard to their impact on children and youth – and how these are meaningfully integrated and represented in decision-making processes. It will shed light on the policy space for transformative change by analysing a range of relevant factors which present both challenges and opportunities for fostering child rights and well-being through the implementation of Agenda 2030. The paper then applies the framework to a selection of policy areas that are of high relevance for child development, such as social policy and care policy assessing necessary means of implementation such as resource mobilization and governance systems and looking at economic and environmental impacts in a cross-cutting way. The aim is to stretch boundaries and invite new thinking on how to grasp the numerous opportunities offered by the Sustainable Development Goals (SDGs) to approach development challenges holistically and from a child-centred perspective. This involves integrating economic, social and environmental dimensions of development and fostering cross-sectoral approaches.

There is growing recognition among international organizations, scholars and policymakers that education systems must produce equitable outcomes, but there is far less consensus on what this means in practice. This paper analyses differences in inequality of outcome and inequality of opportunity in educational achievement among primary and secondary schoolchildren across 38 countries of the European Union (EU) and/or the Organisation for Economic Co-operation and Development (OECD). The analysis focuses on reading achievement, drawing on data from the Progress in International Reading Literacy Study (PIRLS) and the Programme for International Student Assessment (PISA). We use several measures to operationalize the two concepts of inequality in education. Our results show that inequality of outcome does not necessarily go hand in hand with inequality of opportunity. These two concepts lead to measures that produce very different country rankings. We argue that information on both inequality of outcome and inequality of opportunity is necessary for a better understanding of equity in children’s education.

Experience with urban social assistance programmes is still limited. Many of the existing urban programmes are extensions or duplicates of rural programmes, but urban-sensitive social protection needs to reflect the distinct vulnerabilities of the urban poor. Furthermore, applying a child lens requires identifying and addressing the specific risks and multiple deprivations that are experienced by half of urban children in developing countries. As a result, designing social assistance for urban contexts faces challenges such as accurately targeting the poor (given the spatial geography of urban poverty) and setting appropriate payment levels (given the high and variable costs of urban living). Geographic targeting (e.g. informal settlements), proxy means testing (if urban-sensitive) and categorical targeting (e.g. street children) are popular mechanisms in urban areas, but community-based targeting is often inappropriate (because of urban social fragmentation) while self-targeting can be unethical (e.g. where wages below market rates are paid in public works projects) and might contradict rights-based approaches. These are relevant challenges to address when designing urban social protection programmes. We apply these reflections to Ghana. The country is a relevant case study because it is growing and urbanizing rapidly. But as the result of urbanization, urban poverty and deprivations are rising even though national poverty rates have halved. Anti-poverty policies and social protection interventions remain biased towards the rural poor. The ‘urbanization of poverty’ in Ghana has created problems such as overcrowded housing, limited access to sanitation, and outbreaks of communicable diseases. This paper provides guidance on the critical questions to ask to design in Ghana a successful urban social protection programme with a child lens.

Parenting interventions can dramatically reduce violence against children and improve a child’s future. Yet in the past, research has mainly focused on young children in high-income countries, and most of the research has only used quantitative methodology. By contrast, this qualitative study focuses on teenagers and their caregivers who attended a parenting programme in South Africa, contributing to a small but growing body of research on parent support programmes for teenagers in low and middle-income countries. The research examines the Sinovuyo Teen Parenting programme, which was developed and tested between 2012 and 2016 in South Africa. The main qualitative study was carried out in the last year (2015–2016) and is the focus of this paper. It complements a cluster randomized controlled trial. This qualitative study captures the experiences of teenagers and parents who attended the Sinovuyo Teen Parenting programme in 2015. Importantly, the study gives an insight into how the caregivers and teenagers changed as a result of participating in the study. Findings show that both caregivers and teenagers valued the programme and their participation fostered better family relations and reduced violence at home. Their views are important for practitioners, programme implementers and researchers working in violence prevention and child and family welfare. More research is needed, however, to show whether these changes can be sustained.