10.5 Million Children Bereaved by COVID-19: What the Global Evidence Shows

By May 2022, an estimated 10.5 million children worldwide had had a parent or caregiver die of COVID-19, about 7.5 million of them a mother or father^[1]. These are modelled minimum estimates, not counts: almost no country counted these children as it went, and very little research has followed what happened to them since.

For a child whose mum, dad or grandparent died of COVID-19, the death could come quickly and at a distance: hospital visits were often restricted, goodbyes happened by phone or not at all, and funerals were small or delayed. It came while schools were closed and friends, grandparents and the usual sources of comfort were out of reach. Millions of children went through this at the same time, in every part of the world. This study sets out what the research shows about how many children were bereaved, where and who they were, what is known about how they have fared, and how governments responded.

The global numbers are models, and each update has raised them

No country set out to count, in real time, the children whose parents or carers died of COVID-19. The global figures come instead from a group of researchers at Imperial College London, the University of Oxford, the US Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) and others. They combined each country's deaths by age and sex with its birth rates to estimate how many children each adult who died was likely to have had. The studies call this "orphanhood" (the death of one or both parents) and "caregiver death". They count parents and custodial grandparents as primary caregivers, and grandparents or older relatives living in the home as secondary caregivers^[2].

The first estimate, published in The Lancet in July 2021, modelled 21 countries that between them accounted for 76.4% of the world's COVID-19 deaths up to April 2021, then extended the results to the world. It estimated that from March 2020 to April 2021, 1,134,000 children had a primary caregiver die, and 1,562,000 a primary or secondary caregiver^[2]. An update with newer mortality data revised the April 2021 figure to 2,737,300. By the end of October 2021, the estimate had risen 90% to 5,200,300, as 5.0 million recorded COVID-19 deaths meant 5.2 million children had a parent or caregiver die^[3].

Recorded COVID-19 deaths missed many deaths. WHO estimates 14.83 million excess deaths worldwide in 2020 and 2021, 2.74 times the 5.42 million reported as due to COVID-19^[4]. Rerunning the model with WHO's excess deaths, the researchers estimated that by 1 May 2022, 10.5 million children had had a parent or caregiver die, 7.5 million of them a parent. Using other excess-death estimates, from The Economist and the Institute for Health Metrics and Evaluation, gave higher figures of 14.8 million and 14.1 million. The authors describe the WHO-based figure as the more conservative one^[1].

The researchers are plain about the limits: "modeling estimates cannot measure actual numbers of children affected by caregiver death", and they call for future pandemic surveillance to include these children^[1]. How many children are bereaved of a parent in ordinary years is itself mostly estimated; we look at that in how many children are bereaved of a parent.

Where a child lived changed the odds many times over

The pandemic did not fall evenly. In the first 14 months, the modelled rate of children whose parent or custodial grandparent died ranged from 10.2 per 1,000 children in Peru to 0.1 per 1,000 in Germany. South Africa (5.1), Mexico (3.5), Brazil (2.4) and Colombia (2.3) were also high^[2]. In England and Wales, the model put the figure at 8,886 children, or 0.6 per 1,000, of whom 6,136 had a father die and 2,357 a mother^[2].

The estimates also show how much depends on when, and how, deaths were measured. For the period to April 2021, the first study put India at 119,170 children whose parent or custodial grandparent had died, 0.3 per 1,000^[2]. Once WHO's excess-death estimates were used and the period extended to May 2022, India had the largest number of any country: an estimated 3.49 million children who had a parent or other caregiver die, with Indonesia (660,000), Egypt (450,000), Nigeria (430,000) and Pakistan (410,000) next^[1]. By WHO region, Southeast Asia accounted for 40.6% of the world's affected children and Africa for 24.3%, against 4.7% in Europe^[1].

These differences reflect more than how hard COVID-19 hit. Birth rates, the age at which people have children and how often grandparents live with and raise children all change how many children each death affects^[2]. The uncertainty is also wide: the interval around India's estimate of 3.49 million runs from 2.43 million to 4.73 million children^[1].

For most of these children it was their father who died, and many were teenagers

The first global study found between two and five times as many children whose father had died as children whose mother had died^[2]. Across the 20 months to October 2021, 76.5% of children estimated to have had a parent die were bereaved of their father and 23.5% of their mother^[3]. Most were older children: an estimated 2,146,700 were aged 10 to 17, against 736,800 aged 5 to 9 and 491,300 aged under five^[3].

Within countries, the impact followed existing inequalities. In the United States, a CDC-led study estimated that from April 2020 to June 2021 more than 140,000 children had a parent or grandparent caregiver die. The risk was 1.1 to 4.5 times as high for children from racial and ethnic minority groups as for non-Hispanic White children, and highest for Hispanic children in southern border states, Black children in the south-east and American Indian and Alaska Native children in states with tribal areas^[5]. A separate US estimate, matching deaths to mid-May 2022 with household survey data, found 216,617 children had a caregiver they lived with die: for 77,283 it was a parent, and more than 17,000 were bereaved of the only caregiver they lived with. Non-White children were more than twice as likely as White children to have had a caregiver die^[6].

COVID-19 added to bereavement that was already common. A US model covering all causes of death estimated that in 2021, 2.91 million children (4.2%) had at some point had a parent or grandparent caregiver die, rising to 6.4% of American Indian or Alaska Native and 4.7% of Black children^[7].

Where countries checked their own records, the picture was clearer

A few countries have tried to go beyond the global model. In Brazil, researchers used national datasets to estimate that in 2020 and 2021, 1.3 million children had a parent or co-resident caregiver die from any cause. Of these, 673,000 had one or both parents die, 149,000 of them of COVID-19, and 635,000 had a grandparent or other relative they lived with die, 135,000 of COVID-19^[8]. The rate of COVID-19-associated parental death varied more than threefold between states, from 4.4 per 1,000 children in Mato Grosso to 1.4 in Pará. When the team compared their model with civil registry records and with death certificates reviewed by hand in the city of Campinas, the pattern matched but the registry figures were lower: the authors conclude that administrative sources undercount these children^[8].

Thailand used its civil registration database directly. From April 2020 to July 2022, 42,194 COVID-19 deaths there left 4,139 children whose parent had died, 452 of them (10.9%) under the age of five^[9]. Because it comes from death records rather than a model, it is closer to a count, and it is the exception. For most countries, including the UK, we found no published count of children whose parent died of COVID-19; the figures that exist are model outputs. We set out the wider gaps in the data on bereaved children.

How these children have fared is barely studied

Research on what happens to children after a parent dies, from any cause, is substantial; we summarise it in our study of mental health after a parent's death. Research on children bereaved by COVID-19 specifically is thin. A 2024 scoping review of children and young people bereaved during the pandemic found only three studies that met its criteria. Its themes included that the usual sources of support, family and friends among them, were out of reach, and that schools were a valuable source of help^[10].

In the UK, a national survey of adults bereaved during the pandemic included free-text answers from 104 parents and guardians about their children. Participants were recruited through the media, social media and organisations, so they are a self-selected group, not a representative sample. They described children separated from the relative before the death, cut off from friends and family, and with routines and support networks disrupted. Support from schools and bereavement services was valued, but some families could not get specialist grief or mental health support^[11].

Some of the first longitudinal results come from South Africa. In Cape Town, 211 children and adolescents aged 9 to 18 whose parent or caregiver had died of COVID-19 were compared with 210 who had not been bereaved. Poor mental health became more common in the bereaved group between the two interviews, and was more common among girls. Among the factors linked with a likely mental disorder were food insecurity (2.91 times the odds) and exposure to domestic violence (1.74 times the odds); better access to basic necessities was linked with lower odds^[12]. A small Iranian study compared 44 adolescents whose parent had died of COVID-19 with 44 matched peers over 18 months. It found more emotional, behavioural and post-traumatic stress symptoms in the bereaved group, and noted that none of them had access to mental health services^[13]. Both are small, and neither can say whether these difficulties were caused by the death or by everything around it.

Few governments made a dedicated response

By September 2022, the global modelling team reported that only two countries, Peru and the United States, had made national commitments to address COVID-19-associated orphanhood^[1]. Peru, which had the highest modelled rate, introduced a monthly pension of 200 soles for children whose parent had died of COVID-19, paid to the person caring for them through the national family welfare institute (Inabif). By October 2022, according to Peru's state news agency, 5,000 children were being paid and 20,000 more were being enrolled. Under Law 31405, the pension had been widened to children in poverty or extreme poverty whose parent had died of any cause^[14]. Thailand pays (as described in 2023) 2,000 baht a month until the age of 18 to children whose parent died of COVID-19, alongside free schooling and universal health coverage. Thai public health researchers describe the payment as insufficient to cover living and education costs^[9]. We compare wider state support for bereaved families in our study of state support.

What the evidence asks of us

• Count bereaved children in every emergency. The researchers behind the global estimates call for pandemic surveillance to include children whose caregivers die^[1]. The Brazilian team argues that stronger vital registration "can put children at the center of public health responses"^[8]. Thailand's civil registration figures show it can be done^[9].
• Build care for bereaved children into pandemic plans. The modelling team sets out three components: prevent caregiver deaths; prepare families to provide safe and nurturing care for children who need it; and protect bereaved children through economic support, violence prevention, parenting support and ensuring school access^[1]. Their first study argued that psychosocial and economic support can help families care for these children and keep them out of institutions^[2].
• Treat money and safety as part of bereavement support. In South Africa, food insecurity and domestic violence were among the factors most closely linked with poor mental health in bereaved children, and the authors point to poverty and violence reduction^[12]. Where cash support exists, its value matters^[9].
• Fund schools and specialist services, and tell families about them. The UK survey authors recommend support for communication within families and schools, adequate funding for school and community bereavement and mental health services, and better signposting^[11]. In Iran, none of the bereaved adolescents studied had access to mental health services^[13].
• Reach the children most affected. In the US, children from racial and ethnic minority groups were at up to 4.5 times the risk^[5]. Globally, most affected children were adolescents and most were bereaved of a father^[3]. Support has to be designed for them.
• Follow these children up. Only a handful of studies have looked at children bereaved during the pandemic^[10]. The South African cohort, designed to recruit 500 bereaved and 500 comparison children and followed up 12 to 18 months later, is the kind of study needed in many more countries^[15].

Millions of children were bereaved in a short time, in conditions that made grieving harder. The research does not say what each of them needs. It does show how many there are likely to be, where, and how little has yet been done to find and follow them, and that part can still change.

Language: this piece uses plain words such as “died” rather than euphemisms, because they are clearer. “Orphanhood” is used only as the studies’ own term.

Why we're publishing this

Children bereaved by COVID-19 were among the pandemic's least visible groups. Few were counted, and fewer still were followed up. We brought this evidence together so that bereaved children, their families and the charities, schools and services supporting them have it in one place, cleanly sourced, for funders, commissioners and governments planning for the next emergency. The case is theirs; our part is to say plainly what the data show. This study is part of our research library on children and young people bereaved of a parent.

How to read this data

Almost every number here is a modelled estimate, not a count. The global figures combine each country's deaths by age and sex with its birth rates to estimate how many children were affected. They are described as minimum estimates and carry wide uncertainty intervals, especially where death registration is weak. The three global estimates used different periods and mortality data (reported COVID-19 deaths, then excess deaths), so their rise is not a like-for-like trend. Definitions differ too: "orphanhood" means the death of one or both parents; "primary caregivers" add custodial grandparents; "secondary caregivers" add grandparents or older relatives living in the home. The two US estimates use different methods, periods and definitions, and the all-cause US figure covers every cause of death, not only COVID-19. Brazil's figures are modelled from national datasets and checked against registry records; Thailand's come from civil registration. Peru's pension figures come from a state news agency report and are from 2022. The UK survey is a self-selected sample, and the South African and Iranian outcome studies are small; none of these shows that the death caused the difficulties described. We found no published count of COVID-bereaved children for the UK, and no long-term follow-up study of these children from a high-income country.

Use this data

Free to cite with attribution to Understanding Bereavement. Charities, schools, services and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This study summarises published research about groups of people for general information. It is not medical advice or bereavement support, and it cannot describe or predict anything about an individual child or family. If you are worried about a child or about yourself, please speak to a GP or another qualified professional.

Sources

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