Babies and the coronavirus crisis: learning from first national lockdown
Asked to consider the long-term knock-on impacts of the pandemic on the young, many minds will go to the months of school closure, or the diminished opportunities facing those leaving school into a heavily recessed economy. The evidence to justify such concerns is plenty. But whilst the need to act now to protect the futures of ‘generation Z’ (aged 7 to 24) has rightly received increasing recognition, it is not clear that the threats posed to the wellbeing and life chances of the very youngest children has received the attention it deserves. Today’s tragic news that the number of babies subject to serious injury through abuse or neglect during the Covid pandemic is up by a fifth, and that under 1s make up 40% of ‘serious incident notifications’ may come out of the blue to many.
A lot of the discourse on how babies have fared since March has been framed around the immediate impacts and inconveniences to parents. Whilst the wellbeing of babies is inextricably linked to that of their parents, until recently this has seemed to tip the balance of calculations away from strong, clear, consistent action to protect babies’ needs. For example, that in their rebuttal of a Parliamentary petition signed by 226,000 people calling for a 3 month extension to maternity pay in light of Covid19, the government’s sympathies were expressed only in relation to restricted “freedom that parents would normally have to socialise their children” and for the fact that “the experience of becoming a mother or father may not have been what some new parents had expected”.
A similar dynamic was in evidence during the Spring lockdown in relation to a broader set of issues. The NHS Community Prioritisation Plan published in March listed Health Visiting as a service which should "partially stop" setting the scene for large scale redeployment and a situation where the vast majority of babies were not seen face-to-face - an instruction that was later revoked by the Chief Nurse, although anecdotally we hear that some health visitors remain in other roles and many babies born since March have still not been seen face-to-face. At the same time, there was a lack of guidance to professionals about whether partners should be attending births, scans and other ante- and postnatal appointments or allowed into neonatal units creating a postcode lottery. And gaps in advice to childminders, professionals providing breastfeeding support and parent support groups persisted long into the crisis causing confusion on what was permitted, for example around use of PPE and social distancing with babies. It seems babies were just not top of the list of the government’s crisis worries.
Emerging findings from analysis we have been conducting with the First 1001 Days Movement, suggest many professionals have long been concerned about significant and wide-reaching hidden harms of the first lockdown, including from the displacement of services, on babies.
We conducted an online survey of senior leaders of pregnancy and 0-2s services across the UK. There were 235 survey respondents including Health Visiting services, Perinatal and Child Mental Health support services, Parenting or Child Behaviour Support services and Breastfeeding Support services - each 20%+ of respondents plus leaders of various home visiting services, maternity and neonatal services, Early Help, Children’s Centres, childcare providers, baby banks and a range of specialist support services. When asked to state the extent to which babies had been impacted during the Spring lockdown, based on direct observation within their service, the message was clear:
Nearly all respondents (98%) said the babies their organisation works with had been impacted by parental anxiety/stress/depression affecting bonding/responsive care. This was ubiquitous with 73% of respondents reporting that many of the babies they work with were impacted.
Nearly all respondents (92%) said within their organisation they had observed family ‘self-isolation’, for example where parents are unwilling to attend routine appointments or step outside the home for fear of Covid-19, with half saying that many babies they work with were impacted.
Nearly all respondents (91%) had observed sudden loss of family income or increased risk of food poverty, with 45% saying many of the babies they work with were impacted.
Nearly all respondents had observed more sedentary behaviour and less stimulation/play (90%), with half saying many babies were impacted.
The vast majority (88%) said that those they work with were at risk of poorer outcomes due to loss of direct contact with essential services for at risk families (e.g. social services, Early Help, perinatal mental health), with 45% saying many babies they work with were impacted.
The vast majority (87%) said that those they work with were at risk of poorer outcomes due to loss of direct contact with essential health services (e.g. maternity care, health visitors, GPs, A&E), with 40% saying many babies were impacted.
The vast majority (80%) said that those whey work with had experienced increased exposure to domestic conflict, child abuse or neglect, with 29% saying many babies they work with had been impacted.
Over half (57%) had observed lower likelihood of breastfeeding due to lack of professional support, rising to 72% of specific breastfeeding support organisations. Views on the proportion impacted were most split here with 23% saying many had been impacted and 17% saying no impact at all.
The survey responses also give weight to the widely anticipated trend that most intense months of lockdown would be followed by a surge in demand for services, although not every service is experiencing this. When we asked how much demand for their service increased as lockdown measures initially eased (June to August), our respondents said on average it had grown by 47%. This included 25% who said that demand for their service had grown by more than 60%, and 10% who had seen a 80%+ growth.
Causality is notoriously hard to prove. Yet strikingly over three quarters of our respondents (77%) believed that ‘growing need due to the impacts of lockdown’ was a main reason behind the surge in demand for their service in the months after, with those providing parent or infant perinatal mental health services most likely to say this was the case. Nearly half of respondents (47%) also cited ‘short-term demand as services catch up’. Well over a third (38%) also thought that ‘growing need due to factors pre-dating March’ was a main reason for growing demand, with the vast majority who gave this answer also citing ‘the impacts of lockdown’ as a main driver. This crossover lends weight to mounting evidence that the pandemic has served to compound prior disadvantage against a context of already growing need amongst families and widening gaps for children. “Other” reasons given for the rise in demand included a sense of there being “no-where else to go” and knock-ons from reduced contact with other services such as Health Visiting, GPs and CAMHS in the preceding months.
Of course, our survey is only a small window into the impacts of lockdown on babies, as perceived by UK professionals. The wider evidence base on the impacts of the pandemic and the first phase of lockdown in relation to babies, and all age groups, will continue to grow in the coming months. This learning has the potential to enable more balanced assessments of risks and priorities by local and national decision-makers as we move into the next phase of this crisis, with the inevitable challenges and choices that brings. It is encouraging to see significant green shoots in this respect in the November lockdown, with more emphasis on maintaining regular health services, the exclusion of under fives from the two people limit for people meeting outside, and an explicit announcement that parent support groups will continue. All of these things should help reduce the dangerous and scarring effects of this lockdown.
The extent to which such learning does inform our recovery actions will, however, depend on the systems and cultures which are in place. On this there is also an opportunity to learn from lockdown responses to date. The national policy vacuums that existed during the first months of the pandemic set the scene for significant local variation in the service offer to under 2s. Where and why were the needs of babies given due consideration? And where they were not, why was this? With the First 1001 Days Movement we are now exploring in-depth the factors which influenced local decision-making around pregnancy, babies and toddlers in the period from March to August. We hope this will provide a useful window into how we can build futures systems which are capable of pulling together to improve the future life chances of our youngest citizens.