An ethical analysis of COVID-19 impacts from a global child lens: It’s time to prioritize children’s rights!

Sydney Campbell, Carlo Cicero Oneto, Manav Preet Singh Saini, Nona Attaran, Nora Makansi, Raissa Passos Dos Santos, Shilni Pukuma, Franco A Carnevale

 

There can be no keener revelation of a society’s soul than the way in which it treats its children.

— President Nelson Mandela, 1995

 

  1. Introduction

The COVID-19 pandemic has led to numerous impacts on individuals, communities, and societies around the world, especially in resource-limited nations[1] where health systems, and economies as a whole, face significant resource constraints . For children and adolescents (henceforth, young people), there is no denying the challenges this pandemic has imposed and the immediate, mid-term, and long-term impacts it threatens. However, while resource-rich and resource-limited nations may have distinctive challenges and priorities, one thing is true for both: the interests of young people are too frequently subordinated to the interests of adults. As such, the aim of this analysis is to highlight some of the ways in which young people in various countries (namely: Brazil, India, Iran, Lebanon, Mexico, Nigeria, and Syria) have been impacted by the current pandemic and to examine these impacts from a child rights and justice-based ethical lens to understand how these impacts have been morally ‘good’ and ‘bad’. We selected these countries as ‘global exemplars’ of the diverse regions where the McGill University VOICE research program (VOICE: Views On Interdisciplinary Childhood Ethics) has active childhood ethics engagements, allowing us to develop a transversal ‘global’ analysis while simultaneously working with team members who have local regional ties and expertise.

 

  1. Outlining Impacts

Through scanning literature on the ways young people have been affected by the pandemic in each of the countries aforementioned, many of the various ways young people have been adversely impacted were revealed. Specifically:

  • Young people have been witnessing or personally experiencing more violence in their homes due to confinement and heightened familial stress (2-11);
  • Pre-existing social, class, and economic disparities have resulted in additional vulnerabilities to immediate and long-term impacts from the pandemic for many young people (7, 12-16), along with distinctive experiences for young people from privileged positions (e.g., being at risk of becoming overweight due to decreased activity and processed foods) compared to young people from less privileged positions (e.g., being at risk for malnutrition) (17). One clear example of this arises from the fact that young people from Indigenous communities in Brazil have been more significantly impacted by the pandemic due to the historical and social disadvantages these communities face (18);
  • Young people have experienced significant mental health impacts, such as stress being passed down by financial worries of parents and physiological health worries about their family (19), more mental health diagnoses and reported fear (20, 21), and impacts from being hospitalized if COVID-19 is contracted and from broadly living in confinement (22);
  • Socialization-related problems and other social challenges have been incurred due to the pandemic and directly impact the well-being of young people (7, 12). For example, in Iranian culture when there is a death in a family, the immediate and close community/social circle usually gathers for a three-day mourning period to support the family and young people who experienced the loss, but this has not been able to happen during the pandemic and parents, who may also be grieving, have had to act as the sole support for their children (23, 24). Also, as illustrated by Anant Kumar et al. (6), children in India (along with other countries) have lost the opportunity to play outdoors and socialize, potentially affecting psychosocial experiences and development;
  • Relatedly, changes in behaviours, including irritability, development issues (21) and an increase in aggression (11) have been experienced by many young people due to the confinement and social isolation;
  • Use of internet as a way to continue socializing has led to excessive internet usage for some young people combined with increased risk of harm and risky actions, such as participating in ‘challenges’ on social media spaces (e.g., drinking boiling water or harmful substances) (25), less time being spent outside, and being more likely to experience cyberbullying due to more time spent in virtual spaces (20);
  • The pandemic has posed numerous constraints to virtually every aspect of education for young people in the countries examined. For one, it has caused a large number of young people to be out of school, perpetuating a pre-existing educational gap present in certain regions, such as Nigeria (26). Additionally, many households in Mexico, Brazil and Lebanon (amongst other countries) lack stable internet connectivity and related resources, making it exceedingly difficult to continue with school and, thereby, widening pre-existing socioeconomic gaps in education (13, 19, 27-29). Moreover, it has contributed to an overarching concern related to school closures resulting in lack of social experiences, activities, and independence for young people;
  • Young people without parents (either those who became ‘orphans’ due to the pandemic or young people who were previously in foster care settings) have had their financial and holistic support (i.e., support related to all interfaces of the person—body, mind, and spirit) withdrawn and have received limited protective support by the government or arms-length institutions/organizations (4, 8). They have also encountered a greater risk of infection from having to live in group settings (14, 16);
  • Some strategies to respond to the pandemic (e.g., physical distancing) have impacted food systems and supply lines for nutritious, affordable foods (including production, transportation, and sales) leading families to face malnutrition or rely on nutrient-poor alternatives (30, 31);
  • Displaced persons in Syria and Nigeria, who are already facing significant disadvantages, harms, and challenges, have experienced additional trauma, fear, and physical and mental health impacts from the pandemic. Additionally, in Syria the majority of displaced persons are women and children (32); in one camp in northeast Syria (namely, the ‘Al Hol’ camp), more than 50% of the 65000 refugees are under the age of five (31). As such, the pandemic has added an additional layer of complexity to already dire humanitarian crises (10, 33);
  • In Mexico, more young people under the age of 14 have died than in the US or Spain, likely due to high rates of childhood obesity, child labour, and informal employment that impacts young people throughout the country (34). Likewise, young people in many regions, such as Iran, also face heightened risk of physiological effects from the virus due to the shortage of necessary resources, vaccination hesitancies, and unregulated and potentially harmful self-treatment (35-37);
  • Boys from families in Nigeria following Almajiri Islamic practices have been exposed to a higher risk of infection, have lost support from the communities they are situated in, have been unable to move freely in the country, and have had to quarantine without their families (38);
  • For young people with cancer in many areas of the world (e.g., Mexico), collateral effects have been experienced due to changes in cancer treatment trajectories (39); and
  • Sufficient and appropriate education about COVID-19 has been missing for young people in some regions (e.g., Iran), thereby contributing to further increases in stress/fear, misunderstandings related to appropriate care regimes, higher risks of infection, and suppressed emotions (35, 40-42).

 

While this list highlights an overview of only some of the complex, problematic impacts young people are facing, there are some positive outcomes that can be associated with the pandemic within these countries too. For one, authorities in some areas (e.g., Mexico and Iran) have developed and utilized ingenious solutions to providing education to students that does not depend on having stable internet connection. These solutions are based on data that indicates most citizens and families in the country have a television or radio in their homes and, as a result, education has been provided to young people through programing delivered on television or on the radio, depending on where in the country the young person is located (27, 43). Though this is certainly not a perfect solution, as it does not entirely account for or serve households with one television/radio and multiple children in distinctive grades (27, 28), it does indicate innovation. Additionally, increased time spent at home has meant that young people in many countries around the world, such as Iran, are able to have increased interaction with their parents and this has been positive for some (though not all) (44). Furthermore, sanitation packages have been distributed by government and non-profit agencies to working and homeless young people in resource-limited countries, like Iran, as a protective and preventive measure (45).

 

  1. Common features across jurisdictions

In conducting an overarching analysis of these findings, we identified several underlying commonalities among these impacts that transverse the geography in which a young person is living and confronting the harms. First, and as aforementioned, literature from each country indicates that young people are experiencing and/or witnessing increased violence or threats of violence. This increased risk of violence indicates that there is inadequate sanctioned protection for vulnerable children, despite decades of research that has shown periods of financial and psychological stress to be associated with an intensification of domestic violence that children experience (46). In relation to the Canadian context, that members of our team initially examined (47), worries about risks of violence seemed more pronounced for young people in resource-limited nations.

 

Second, the literature scans revealed that for these resource-limited countries, less resources have been invested in child health and well-being broadly and, by extension, very few resources in the pandemic response plans have been invested to deal with the impacts of COVID-19 on children specifically. The downstream effects of reduced child welfare budgets has been revealed by the pandemic’s threats on the lives of children, warranting policy action by political leaders in each jurisdiction.

 

Third, in the countries that were examined for this commentary (and in other resource-limited nations), there are large and widening health inequalities that exist as a result of socioeconomic disparities (48). In the context of the COVID-19 pandemic, young people and their families that experience greater social disadvantages and less privilege are prone to experiencing much greater immediate and long-term problems. In addition, implementation of school supports have often not adequately accounted for the most vulnerable or disadvantaged families and children in a society, perpetuating the social disparities even further. In Canada and the US, similar findings have been revealed in this pandemic (49), but these disparities and the implications the poorest people in a country are facing during the pandemic are extreme in resource-limited nations.

 

Fourth, findings from each of these countries emphasize needs for community support in order to assist young people and families with the challenges they are facing. As a result, and not surprisingly based on existing evidence (50), there seems to be a collectivist-lens that is foundational to the ways harms are experienced and redressed from a global child perspective. This was exemplified by the relational nature of various harms, whereby the pandemic has caused an increase in parental economic, physiological, and psychosocial stress that has ripple effects leading many young people to being in more perilous physical, emotional, and mental states. The importance of the collectivism inherent to these countries was also exemplified by the concern for the current lack of community support that young people and families have access to in Iran following a death, that they otherwise would have experienced (through a three-day mourning period).

 

Fifth, our analysis revealed that COVID-19 impacts tend to have an inherent temporal feature, either through being constructed as immediate impacts that require immediate rectification (as has been the case in each country that has employed pandemic plans that aim to reduce mortality rates from the virus) or being constructed as mid- to long-term impacts, which do not require urgent attention or upfront investment in resources. The latter, longer-term timeline has been used in many discussions of how young people are likely to be impacted by COVID-19 and, as such, the needs of young people have been associated with narratives that justify diverting resources towards more immediate impacts first (rather than investing/re-investing resources into areas where young people are being most significantly impacted).  Temporality is, therefore, used as a frame to justify prioritization, while also implicitly regarding young people as ‘human becomings’ such that their lives become valued for what will come later rather than recognizing the young person in the moment—‘here and now’—and acknowledging their experiences as human experiences that warrant urgent attention. In the limited COVID-19 work that has utilized a childhood ethics approach, this temporal focus has been shifted to indicate the necessity of supports for young people that are attentive to where the young person is, ‘here and now’, and to mitigate the harms and impacts as much as possible (47).

 

Finally, the importance of young people’s voices and participation was not accorded significant value or attention within the countries examined, which is especially interesting when compared to analyses within Westernized contexts that have discussed, in depth, the importance of including children in pandemic policy development and the ways to do so (47, 51). There were a couple of instances where young people’s participation was mentioned. For example, in one paper by Brazilian scholars listening to the voices of young people was positioned as a solution to the excessive internet usage concern rather than being viewed an aspect of young people’s worlds that has not been granted adequate consideration (25). Additionally, in a small section of an article pertaining to the Indian context, young people’s participation was discussed only in relation to the mobilization of communities (7). Though additional research would be required to understand why the voices of young people are not recognized as requiring urgent attention in resource-limited countries or from a global perspective, the lack of substantial discussion does demonstrate an important tone and helps illustrate the challenges young people are facing in trying to be heard.

 

  1. Applying an ethical lens

Although these impacts have been studied and discussed, an analysis of the global child impacts using an ethical lens—to understand the ways in which these impacts are good and/or bad—has not been reported to date. Therefore, in what follows we examine the ways in which pandemic plans have been morally sound or ‘good’ and, in contrast and using a children’s rights and justice-based framework, the ways in which pandemic plans have been morally problematic or ‘bad’. First, pandemic response plans have, from a strict consequentialist lens (52), been morally permissible in that quarantine and/or physical distancing efforts have reduced infection, transmission, and death rates compared to what they otherwise would have been (53). This has been the justification generally used by decision-makers to explain why reducing transmission is a priority at all costs—even when young people are silently suffering consequences associated (directly or indirectly) with pandemic precautionary measures. Additionally, positive outcomes associated with these measures (such as the two positive impacts aforementioned) have been celebrated and used as further justification for these approaches.

 

Despite the benevolent aims of pandemic measures, they may also lead to some morally impermissible, albeit inadvertent, outcomes. Most prominently: each country’s response to COVID-19 has failed to acknowledge many rights of young people. Leaders in positions of power have made decisions about the relative importance of particular pandemic impacts with systemic dismissal or under-recognition of what is really at stake for young people. According to the United Nations Convention on the Rights of the Child (henceforth, CRC), young people hold particular rights and responsibilities—as such they have the same general human rights as adults and a specific set of rights that recognizes their special needs as rooted in their best interests (54). The aim of the CRC is to ensure that every young person actualizes their potential, as the CRC safeguards the rights of young people to realize this aim (55). Articles within the CRC that outline rights particularly relevant for this discussion generally fall into three main categories: (a) participation, (b) protection from and prevention of abuse, neglect, discrimination, exploitation, and other harms, and (c) provision of assistance to support basic needs that young people have (56, 57). Essentially, the CRC uses an ‘interests’ conception of rights, such that any action that pertains to a young person must hold the young person’s best interests as a primary consideration (57, 58).

 

Drawing on advances in childhood ethics, a conceptualization of best interests that aligns with a view of young people as human beings with rights involves ‘an authentic recognition of their voices and agency’ (59). Relatedly, one’s agential capacities are understood as relying on the relationships one has and environments one is embedded within, as these orient how one discerns what is meaningful and what matters—illustrating a shift towards relational notions of autonomy and agency (59). Therefore, a focus on the best interests of a young person that aligns with these advances in childhood ethics entails authentically listening to the perspectives, experiences, and interests of young people (whether they have recognized decisional autonomy or not), while also being attentive to the individuals and communities that are involved in their lives. This understanding of best interests also aligns with the inherent community-centeredness of the jurisdictions included in this commentary and, through meaningful consideration of the context one is situated in, also allows for openness to the incorporation of local customs and outlooks into the conceptualization of agency employed (59).

 

Pandemic response plans in the countries examined within this analysis have demonstrated that children’s rights, likely unintentionally, have not been adequately considered within the COVID-19 context. Essentially the ‘three p’ rights categories aforementioned have been largely ignored or violated by pandemic response plans. First, young people have not been able to participate meaningfully in pandemic planning efforts in any of these countries, despite being directly affected by measures themselves. This concern has not appeared to be a primary consideration on the agendas of the countries examined here. Article 12 in the CRC states that young people have a ‘right to express [their] views freely in all matters affecting [them]’ and for their views to be ‘given due weight in accordance with the age and maturity of the child’ (58). As such, lacking public policy space in the COVID-19 context, for these views to be considered, is a direct breach of young people’s rights to participate. Additionally, the lack of transparency to disseminate COVID-19 related information with young people conflicts with the rights that young people are due according to Article 13 of the CRC (58).

 

Second, and as previously highlighted, confinement, school closures, and other pandemic measures have meant that some disadvantaged children are compelled to live in harmful homes and community settings, as young people are inadequately protected because harm is more difficult to prevent behind closed doors. Most clearly, article 19 in the CRC claims that, ‘States Parties shall take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation’ and, in addition, ‘such protective measures should, as appropriate, include effective procedures for the establishment of social programs to provide necessary support for the child and for those who have the care of the child’ (58). In the context of COVID-19, young people continue to face mental health impacts, especially those within marginalized communities and facing social disadvantages, as the implementation of measures to redress these harms have not been adequately prioritized. Depending on the country, other articles associated with ‘protection’ within the CRC also appear to be violated by pandemic responses, as demonstrated by impacts highlighted above, including: article 22 (protection of children with refugee status), article 23 (protection of children with preexisting mental or physical conditions), article 24 (rights of children to be able to access a high standard of health and health care in order to protect against threats to one’s health), article 25 (protection of children in state care, including foster care), article 32 (protection from economic exploitation and performance of child labour that interfere with education, health, or well-being), article 34 (protection from sexual exploitation and sexual abuse), and article 36 (protection against all other forms of exploitation) (58).

 

Finally, the ‘provisional’ articles within the CRC are meant to outline the ways in which state bodies will provide support to young people and the associated rights young people have to receive this support. However, as the summarized impacts above have illustrated, there are numerous ways in which these actions by governments are not being sufficiently actualized, thereby undermining young people’s rights. Specifically, rights that seem to be infringed are associated with: article 17 (provision of information by mass media aimed towards and focused on young people), article 18 (provision of support for parents who are raising children, where necessary), article 26 (providing sufficient social security that takes into account the resources and circumstances of the child), article 28-29 (provision of education to young people that aligns with their capacities), and article 31 (provision of time and space to rest and to engage in play and other recreational activities) (58).

 

While many government responses have certainly been effective for reducing virus transmission, to differing degrees depending on the country, they have remained inadequately attentive to young people’s rights—rights that have, by many ethics, legal, and human rights scholars, been deemed to have strong normative force due to their conceptual indifference from human rights generally (60). Consequently, young people have been silenced in the pandemic by having their social status pushed to the margins of the political backbone in each country. However, given that pandemic responses are, largely, paternalistic in nature for the purpose of promoting public health as a whole, some might still ask why children’s rights matter (or ought to matter) in the context of a global pandemic. This question misses the mark. The restriction of individual and group rights is a significant concern in many countries and requires substantial evidence to indicate why and when it is permissible to override these rights for a ‘greater good’, but the same consideration is often not granted in cases where children’s rights are overridden. As such, why do violations to children’s rights (for collective good) seem to not be granted the same regard?

 

Responding to this question, in a way that aligns with the notion of ‘best interests’ developed above, forces us to return to the initial question and work backwards to understand why rights (in this case, children’s rights) have moral thrust. In doing so, a natural alignment emerges with the Capability Approach (CA) to justice (as constructed by Sen (61), and expanded by Nussbaum (62) and Venkatapuram (63)) and allows an additional layer of ethical rigor to be added to our commentary’s assessment. CA asserts ‘supporting—protecting, providing, expanding, restoring, and so forth—the capabilities of individuals to conceive, pursue, and revise their life plans’ to a minimum threshold (63, pg. 90). The initial premise of this ethical framework is that the ‘opportunity to reach states of proper functioning and well-being are of basic moral significance and that the freedom to reach these states is to be analyzed in the language of “capabilities”’ (64, pg. 259). Capabilities are of primary focus rather than goods (e.g., income) because goods only gain value based on what people can do or be through these goods (63, pg. 90). In Nussbaum’s account of CA, she distinguishes her approach by identifying ten ‘core capabilities’ that all citizens ought to have available to them (64, 65), many of which overlap with the children’s rights outlined in the CRC. These capabilities include:

  1. Being able to live a normal lifespan
  2. Being able to have good bodily health, nutrition, and shelter
  3. Having capacity for bodily integrity (specifically, being able to move freely, be free from violence, and opportunities for reproductive choice)
  4. Being able to use senses, imagination, and thought in an informed way through diverse education
  5. Having capacity for emotions and emotional attachments
  6. Being able to possess practice reasoning to form a conception of the good
  7. Being able to live meaningfully in affiliations with others and with one’s self
  8. Being able to have concern for other species
  9. Being able to play
  10. Having capacity to control environment through being an active citizen and being able to participate politically

According to Nussbaum, all ten of these capabilities, up to the threshold level required for sufficient dignity of the person, form the ‘minimum requirements of justice’ and, as such, justice requires that societies ensure the world (beyond an individual state one resides in) does not interfere with individuals’ development of their core capabilities and political participation (64, pg. 260). It is a demanding approach to justice because it requires us to not obstruct an individual’s attempt at flourishing (a negative requirement), while also supporting efforts made by individuals to flourish (a positive requirement) (64). CA is considered a ‘partial theory of justice’ by Nussbaum, as it does not provide a comprehensive list of the necessary and sufficient requirements of justice, but rather relies on a minimum threshold (63, pg. 90).

 

Nussbaum (at least initially) claimed that the focus on capabilities is more readily applicable to adults based on the dominant belief that we must respect the choices of adults to determine their own lives, while, for young people, our focus ought to be on achieving a minimal state of functioning (63). However, supporting this dichotomy between approaches to justice for adults and young people fails to treat the young person as a moral agent and undermines the societal need to take the choices and preexistent capabilities of all young people seriously. Advances in childhood ethics make the case for there being applicability of CA to young people. Therefore, considering the partial nature of this approach, expansion of CA may focus more particularly on the ways in which young people require relational support to have their needs met, based on the psychological, political, biological, and legal disadvantages they face.

 

In terms of the connection between CA and children’s rights, capabilities have been positioned as ‘a clarification that enhances the connection between human rights (and children’s rights) and human dignity’ as dignity is inherent to the ten capabilities. Since human rights (and children’s rights) safeguard capabilities, they also can also safeguard human dignity (66); this is also true in the case of children’s rights safeguarding the capabilities and, by extension, dignity of young people (67). Capabilities are also granted the status of being affiliated with a basic human right or moral entitlement following global deliberation (68), and this is also true when we examine the ways in which the rights within the CRC were determined.

 

Therefore, when it comes to the question of why we ought to regard children’s rights with the same major consideration that the human rights of adults are afforded, the answer is clear: both human rights (broadly) and children’s rights (specifically) outline the capabilities and dignity we ought to protect. In the context of COVID-19, where various rights of children are not being protected, upheld, or prioritized in the face of mandatory choices about resource allocation, young people are having their capabilities undermined and ignored and, by extension, their dignity threatened. When young people are not able to participate, are not protected despite evidence that indicates increasing psychological, social, physiological, and economic harms (including significant risk of abuse), and not supplied provisions to improve their lives, their capabilities are not sufficiently met to the threshold degree such that dignity is ensured. As a result, this pandemic has exposed the significant injustices that young people are forced to confront, in the resource-rich contexts (like Canada, as identified by members of our team in another commentary (47)), but especially in resource-limited contexts (like the countries examined in this commentary).

 

 

  1. Ways forward/recommendations

Therefore, it is the task of governments, NGOs, and policymakers (in the resource-limited countries that are affected, but also those that exist as allies in resource-rich nations) to redress harms faced by young people and the task of the UN Committee on the Rights of the Child, along with national youth protection advocates and bodies, to hold each country accountable to their commitment to children’s rights outlined by the CRC. With this in mind, we finish with the following broad recommendations and calls to action:

  • Invest government resources to (a) support parents/families/caregivers and educators to improve communication with and resources for young people, (b) improve healthcare infrastructure, and (c) support organizations and centers that aim to improve child well-being;
  • Integrate parental recommendations established by UNICEF regarding the inclusion of young people, transparency of pandemic-related information to engage with young people, avoiding violence, supporting play (in safe ways), and ensuring parents/caregivers are supported to act as calm as possible when discussing COVID-19 with their children (69);
  • Prioritize the needs of young people and families from less privileged positions or settings (e.g., families with lower socioeconomic statuses, homeless children, orphans, families from marginalized communities, etc.) to ensure their capabilities and interests are met and to mitigate impacts of systemic disadvantage within a pandemic context;
  • Engage in and financially support specialized research that is focused on ‘global’ pandemic child ethics, including studies that assess why child participation is often not situated as a priority in a global context;
  • Develop educational (school-based) tools and strategies to teach children that are informed by the actual identified needs of young people and their families from diverse socioeconomic positions;
  • Consider the implementation of free (government/agency funded) mental health support, programs and tools in each country, based on the prominence of concern for the mental health of young people as a result of psychological impacts they have had to experience during and following COVID-19;
  • Learn from compassionate community models to develop more robust community health frameworks that support the collectivist values and needs of the ‘global child’ and family; and
  • As Dr. Kay Tisdall stated on a recent panel hosted by a variety of children’s rights interest groups (70), ‘we need to stop asking whether we involve children and young people, so the question [can] become how we are going to do so’ and, by extension, how to do so as meaningfully and effectively as possible; this is true in the context of the pandemic where young people, especially those from resource-limited nations, face significant injustices.

 

The words of President Nelson Mandela’s included at the outset of this piece were intended to highlight the duties individuals, institutions, governments, and societies have towards young people. Though they face significant impacts and injustices from the pandemic, linked to the ways their capabilities, rights, and dignity have been overlooked (especially in resource-limited nations), we must act to relieve these impacts and find suitable, effective, and young person-guided solutions to avoid future instances of similar harm. There is still time to build a better ‘soul’ (as President Nelson Mandela said) for individual countries and for our world. There is still time to prioritize the young person as they are—‘here and now’.

 

 

[1] We chose this term as it reflects many of the challenges that were identified in the searches conducted for this commentary, pertaining to the limited health care, socioeconomic, political, and welfare resources available for the countries chosen in this analysis. The term was also selected because it departs from the ‘developing nations’ rhetoric that has been said to subsume resource-limited countries under Western nations and to imply a hierarchy.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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