Social Protection Has Prevented More Than Three Million Child Deaths in 46 Low- and Middle-Income Countries

A longitudinal study in 46 low- and middle-income countries has concluded that the expansion of social protection coverage between 2000 and 2021 contributed to preventing more than 3 million deaths in children under the age of five. The protective effects were even more pronounced during the COVID-19 pandemic, when nearly 600,000 child deaths were averted. The study, coordinated by ISGlobal, a centre supported by the ”la Caixa” Foundation, co-funded by the Rapid Social Response Trust Fund (World Bank Group) and published in eClinicalMedicine, highlights the importance of maintaining and scaling up these programmes to advance the Sustainable Development Goals.

The COVID-19 pandemic represented a major setback in the fight against poverty and child malnutrition. By 2021, the crisis had pushed as many as 115 million people into extreme poverty. This, coupled with disruptions in food systems —exacerbated by the pandemic and geopolitical conflicts—, led to a rise in hunger, which affected 828 million people worldwide in 2021. In response, governments and international organisations expanded social protection (SP) programmes in many countries, including emergency cash transfers, subsidies and other interventions. This proved key to cushioning the knock-on effects of the economic collapse on child health.

Against this backdrop, the study analyses the combined impact of all SP programmes on child mortality, stunting and wasting (low weight for height), using real data from 46 countries between 2000 and 2021. Until now, no retrospective analysis had assessed these effects over two decades, nor during the critical years of the pandemic.

The benefits of strengthening social protection in times of crisis

The research team compiled over a thousand annual country-level observations and used statistical models to assess the effect of social protection coverage, i.e. the percentage of the population receiving any benefit.

“Our sample included 46 low- and middle-income countries, with at least two observations of social protection coverage over the 22-year study period,” explains Elisa Landin-Basterra, researcher at ISGlobal and first author of the study. “We estimated the number of deaths averted by comparing the real situation with a hypothetical scenario without social protection,” she adds.

The results show that for every 1% increase in social protection coverage, child mortality decreased by 0.34%, wasting by 0.14%, and stunting by 0.29%. These associations were stronger during the pandemic, and particularly among girls. The largest reduction in mortality was observed in children aged 1 to 2 years. In absolute terms, it is estimated that social protection prevented 3.05 million deaths in children under five between 2000 and 2021, including 583,590 during the pandemic.

Towards more inclusive and resilient protection systems

Inequalities in access to adequate nutrition and healthcare affect the risk of female child mortality, and these gaps could be reduced through gender-sensitive social protection programmes that prioritise maternal education, women’s empowerment, and timely access to perinatal care. Expanding social protection programmes —particularly with a gender focus and specific attention to early childhood— would bring significant public health benefits.

“Our findings underscore the role of social protection in addressing inequalities in child health, strengthening household resilience, and protecting children living in low- and middle-income countries, particularly in today’s context of polycrisis,” concludes Davide Rasella, ICREA researcher at ISGlobal and coordinator of the study.

Reference

Landin Basterra E, Gentilini U, Medeiros Cavalcanti D, Ferreira da Silva A, Oliveira Ferreira de Sales L, Silva NJ, et al. Impact of social protection on child malnutrition and mortality across 46 LMICs: a longitudinal study over two decades with insights from the COVID-19 pandemic. eClinicalMedicine. 2025;87:103414. doi: 10.1016/j.eclinm.2025.103414