The combination of four forces—constrained supply, reduced resources, suppressed demand and worsening socioeco-nomic inequality—creates a likelihood that the indirect effects on health and nutrition will be more harmful than the direct health consequences of the disease. Projections already suggest that COVID-19 could lead to up to a 45% increase in child deaths and a 39% increase in maternal deaths across low and middle-income countries. Such a back-slide would undermine dramatic gains made since 2000. Under-five mortality has declined by 43% globally, with 4.3 million fewer annual deaths in 2017 than 2000. During the same period, the prevalence of stunted growth in children under age 5 declined from 32% to 22%, or 48.7 million fewer children.
Progress in maternal and child health is at especially high risk during the COVID-19 response. The suspension of national immunisation programmes has been projected to cause 140 child deaths per COVID-19 death averted, putting 80 million infants at risk of contracting vaccine-preventable diseases. Disruptions in distribution campaigns for insecticide-treated bed nets and effective antimalarial treatments have been projected to set malaria mortality back to levels not seen in 20 years under the worst scenario, with most of those affected being children. The socioeconomic consequences of the pandemic could leave mothers and children especially vulnerable to health risks, and pose new challenges for the utilisation and access of healthcare.