challenges of education during pandemic

COVID-19 has fuelled a global ‘learning poverty’ crisis

The pandemic saw empty classrooms all across the world. Image:  REUTERS/Marzio Toniolo

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• Before the pandemic, the world was already facing an education crisis.
• Last year, 53% of 10-year-old children in low- and middle-income countries either had failed to learn to read with comprehension or were out of school.
• COVID-19 has exacerbated learning gaps further, taking 1.6 billion students out of school at its peak.
• To mitigate the situation, parents, teachers, students, governments, and development partners must work together to remedy the crisis.

Even before COVID-19 forced a massive closure of schools around the globe, the world was in the middle of a learning crisis that threatened efforts to build human capital—the skills and know-how needed for the jobs of the future. More than half (53 percent) of 10-year-old children in low- and middle-income countries either had failed to learn to read with comprehension or were out of school entirely. This is what we at the World Bank call learning poverty . Recent improvements in Learning Poverty have been extremely slow. If trends of the last 15 years were to be extrapolated, it will take 50 years to halve learning poverty. Last year we proposed a target to cut Learning Poverty by at least half by 2030. This would require doubling or trebling the recent rate of improvement in learning, something difficult but achievable. But now COVID-19 is likely to deepen learning gaps and make this dramatically more difficult.

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Temporary school closures in more than 180 countries have, at the peak of the pandemic, kept nearly 1.6 billion students out of school ; for about half of those students, school closures are exceeding 7 months. Although most countries have made heroic efforts to put remote and remedial learning strategies in place, learning losses are likely to happen. A recent survey of education officials on government responses to COVID-19 by UNICEF, UNESCO, and the World Bank shows that while countries and regions have responded in various ways, only half of the initiatives are monitoring usage of remote learning (Figure 1, top panel). Moreover, where usage is being monitored, the remote learning is being used by less than half of the student population (Figure 1, bottom panel), and most of those cases are online platforms in high- and middle-income countries.

COVID-19-related school closures are forcing countries even further off track from achieving their learning goals. Students currently in school stand to lose $10 trillion in labor earnings over their working lives. That is almost one-tenth of current global GDP, or half the United States’ annual economic output, or twice the global annual public expenditure on primary and secondary education.

In a recent brief I summarize the findings of three simulation scenarios to gauge potential impacts of the crisis on learning poverty. In the most pessimistic scenario, COVID-related school closures could increase the learning poverty rate in the low- and middle-income countries by 10 percentage points, from 53% to 63%. This 10-percentage-point increase in learning poverty implies that an additional 72 million primary-school-age children could fall into learning poverty , out of a population of 720 million children of primary-school age.

This result is driven by three main channels: school closures, effectiveness of mitigation and remediation, and the economic impact. School closures, and the effectiveness of mitigation and remediation, will affect the magnitude of the learning loss, while the economic impact will affect dropout rates. In these simulations, school closures are assumed to last for 70% of the school year, there will be no remediation, mitigation effectiveness will vary from 5%, 7% and 15% for low-, middle- or high-income countries, respectively. The economic channel builds on macro-economic growth projections , and estimates the possible impacts of economic contractions on household income, and the likelihood that these will affect primary school age-school-enrollment.

Most of the potential increase in learning poverty would take place in regions with a high but still average level of learning poverty in the global context pre-COVID, such as South Asia (which had a 63% pre-pandemic rate of learning poverty), Latin America (48%) , and East Asia and the Pacific (21%). In Sub-Saharan Africa and Low-income countries, where learning poverty was already at 87% and 90% before COVID, increases would be relatively small, at 4 percentage points and 2 percentage points, respectively. This reflects that most of the learning losses in those regions would impact students who were already failing to achieve the minimum reading proficiency level by the end of primary—that is, those who were already learning-poor.

To gauge at the impacts of the current crisis in Sub-Saharan Africa and the Middle East and Northern Africa we need to examine other indicators of learning deprivation. In these two regions children are on average the furthest below the minimum proficiency level, with a Learning Deprivation Gap (the average distance of a learning deprived child to the minimum reading proficiency level) of approximately 20%. This rate is double the global average (10.5%), four times larger than the East Asia and Pacific Gap (5%), and more than tenfold larger the Europe and Central Asia average gap (1.3%). The magnitude of learning deprivation gap suggests that on average, students on those regions are one full academic year behind in terms of learning, or two times behind the global average.

In the most pessimistic scenario, COVID-19 school closures might increase the learning deprivation gap by approximately 2.5 percentage points in Sub-Saharan Africa, Middle East and North Africa, and Latin America. However, the same increase in the learning deprivation gap does not imply the same impact in qualitative terms. An indicator of the severity of learning deprivation, which captures the inequality among the learning deprived children, reveals that the severity of learning deprivation in the Middle East and Sub-Saharan Africa could increase by approximately 1.5 percentage points, versus an increase of 0.5 percentage points in Latin America. This suggests that the new learning-deprived in Latin America would remain closer to the minimum proficiency level than children in Middle East and Sub-Saharan Africa. As a consequence, the range of options required to identify students’ needs and provide learning opportunities, will be qualitatively different in these two groups of countries— more intense in Sub-Saharan Africa and the Middle East than in Latin America.

In absolute terms, Sub-Sharan Africa and the Middle East and Northern Africa would remain the two regions with the largest number of learning-deprived children. The depth of learning deprivation in Sub-Saharan Africa will increase by three times more than the number of children who are learning-deprived. This is almost three times the global average, and four times more than in Europe and Central Asia. This suggests an increase in the complexity and the cost of tackling the learning crisis in the continent.

Going forward, as schools reopen , educational systems will need to be more flexible and adapt to the student’s needs. Countries will need to reimagine their educational systems and to use the opportunity presented by the pandemic and its triple shock—to health, the economy, and the educational system—to build back better . Several policy options deployed during the crisis, such as remote learning solutions, structured lesson plans, curriculum prioritization, and accelerated teaching programs (to name a few), can contribute to building an educational system that is more resilient to crisis, flexible in meeting student needs, and equitable in protecting the most vulnerable.

The results from these simulations are not destiny. Parents, teachers, students, governments, and development partners can work together to deploy effective mitigation and remediation strategies to protect the COVID-19 generation’s future. School reopening, when safe, is critical, but it is not enough. The simulation results show major differences in the potential impacts of the crisis on the learning poor across regions . The big challenge will be to rapidly identify and respond to each individual student’s learning needs flexibly and to build back educational systems more resilient to shocks, using technology effectively to enable learning both at school and at home.

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Educational challenges and opportunities of the Coronavirus (COVID-19) pandemic

Jaime saavedra.

We are living amidst what is potentially one of the greatest threats in our lifetime to global education, a gigantic educational crisis. As of March 28, 2020, the COVID-19 pandemic is causing more than 1.6 billion children and youth to be out of school in 161 countries. This is close to 80% of the world’s enrolled students.  We were already experiencing a global leaning crisis, as many students were in school, but were not learning the fundamental skills needed for life. The World Bank’s “ Learning Poverty ” indicator – the % of children who cannot read and understand at age 10 – stood at 53% of children in low- and middle-income countries – before the outbreak started. This pandemic has the potential to worsen these outcomes even more if we do not act fast.

What should we be worried about in this phase of the crisis that might have an immediate impact on children and youth? (1) Losses in learning (2) Increased dropout rates (3) Children missing their most important meal of the day. Moreover, most countries have very unequal education systems, and these negative impacts will be felt disproportionately by poor children. When it rains, it pours for them.    

Learning . Starting the school year late or interrupting it (depending on if they live in the southern or northern hemisphere) completely disrupts the lives of many children, their parents, and teachers. A lot can be done to at least reduce the impact through remote learning strategies. Richer countries are better prepared to move to online learning strategies, although with a lot of effort and challenges for teachers and parents. In middle-income and poorer countries, the situation is very mixed and if we do not act appropriately, the vast inequality of opportunities that exists – egregious and unacceptable to start with – will be amplified. Many children do not have a desk, books, internet connectivity, a laptop at home, or supportive parents. Others do. What we need to avoid – or minimize as much as possible – is for those differences in opportunities to expand and cause the crisis to have an even larger negative effect on poor children’s learning.  

Fortunately, we are seeing a lot of creativity in many countries. Rightly so, many ministries of education are worried that relying exclusively on online strategies will imply reaching only children from better-off families. The appropriate strategy in most countries is to use all possible delivery modes with the infrastructure that exists today. Use online tools to assure that lesson plans, videos, tutorials, and other resources are available for some students and probably, most teachers. But also, podcasts and other resources that require less data usage. Working with telecommunication companies to apply zero-rate policies can also facilitate learning material to be downloaded on a smartphone, which more students are likely to have. 

Radio and TV are also very powerful tools. The advantage we have today, is that through social networks, WhatsApp or SMS, ministries of education can communicate effectively with parents and teachers and provide guidelines, instructions and structure to the learning process, using content delivered by radio or TV. Remote learning is not only about online learning, but about mixed media learning, with the objective of reaching as many students as possible, today.

Staying engaged. Maintaining the engagement of children, particularly young secondary school students is critical. Dropout rates are still very high in many countries, and a long period of disengagement can result in a further increase. Going to school is not only about learning math and science, but also about social relationships and peer-to-peer interactions. It is about learning to be a citizen and developing social skills. That is why it is important to stay connected with the school by any means necessary. For all students, this is also a time to develop socio-emotional skills and learn more about how to contribute to society as a citizen. The role of parents and family, which has always been extremely important, is critical in that task. So, a lot of the help that ministries of education provide, working through mass media, should also go to parents. Radio, TV, SMS messages can all be used to provide tips and advice to them on how to better support their children.

Meals.  In many parts of the world, school feeding programs provide children with their most nutritious meal of the day. They are essential for the cognitive development and well-being. These programs are complex logistical and administrative endeavors. It is not easy, but countries should find the way to provide those meals using the school buildings in an organized fashion, community buildings or networks, or, if needed, distribute directly to the families. If delivering meals or food is not feasible logistically, cash transfer programs should be expanded or implemented to compensate the parents. Planning is needed, but one has to be ready to flexibly adjust plans, as the information we have about the likely paths of the pandemic change day by day, influenced by the uncertainty around which mitigation measures countries are taking. The process of reopening of schools might be gradual, as authorities will want to reduce agglomeration or the possibility of a second wave of the pandemic, which can affect some countries. In that uncertain context, it might be better to make decisions assuming a longer, rather than a shorter scenario. The good news is that many of the improvements, initiatives, and investments that school systems will have to make might have a positive long-lasting effect.

Some countries will be able to increase their teachers’ digital skills. Radio and TV stations will recognize their key role in supporting national education goals – and hopefully, improve the quality of their programming understanding their immense social responsibility. Parents will be more involved in their children’s education process, and ministries of education will have a much clearer understanding of the gaps and challenges (in connectivity, hardware, integration of digital tools in the curriculum, teacher’s readiness) that exist in using technology effectively and act upon that. All of this can strengthen the future education system in a country.

The mission of all education systems is the same. It is to overcome the learning crisis we were already living and respond to the pandemic we are all facing. The challenge today is to reduce as much as possible the negative impact this pandemic will have on learning and schooling and build on this experience to get back on a path of faster improvement in learning. As education systems cope with this crisis, they must also be thinking of how they can recover stronger, with a renewed sense of responsibility of all actors and with a better understanding and sense of urgency of the need to close the gap in opportunities and assuring that all children have the same chances for a quality education.

• The World Region
• COVID-19 (coronavirus)

Human Development Director for Latin America and the Caribbean at the World Bank

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How is COVID-19 affecting student learning?

Subscribe to the brown center on education policy newsletter, initial findings from fall 2020, megan kuhfeld , megan kuhfeld senior research scientist - nwea @megankuhfeld jim soland , jim soland assistant professor, school of education and human development - university of virginia, affiliated research fellow - nwea @jsoland beth tarasawa , bt beth tarasawa executive vice president of research - nwea @bethtarasawa angela johnson , aj angela johnson research scientist - nwea erik ruzek , and er erik ruzek research assistant professor, curry school of education - university of virginia karyn lewis karyn lewis director, center for school and student progress - nwea @karynlew.

December 3, 2020

The COVID-19 pandemic has introduced uncertainty into major aspects of national and global society, including for schools. For example, there is uncertainty about how school closures last spring impacted student achievement, as well as how the rapid conversion of most instruction to an online platform this academic year will continue to affect achievement. Without data on how the virus impacts student learning, making informed decisions about whether and when to return to in-person instruction remains difficult. Even now, education leaders must grapple with seemingly impossible choices that balance health risks associated with in-person learning against the educational needs of children, which may be better served when kids are in their physical schools.

Amidst all this uncertainty, there is growing consensus that school closures in spring 2020 likely had negative effects on student learning. For example, in an earlier post for this blog , we presented our research forecasting the possible impact of school closures on achievement. Based on historical learning trends and prior research on how out-of-school-time affects learning, we estimated that students would potentially begin fall 2020 with roughly 70% of the learning gains in reading relative to a typical school year. In mathematics, students were predicted to show even smaller learning gains from the previous year, returning with less than 50% of typical gains. While these and other similar forecasts presented a grim portrait of the challenges facing students and educators this fall, they were nonetheless projections. The question remained: What would learning trends in actual data from the 2020-21 school year really look like?

With fall 2020 data now in hand , we can move beyond forecasting and begin to describe what did happen. While the closures last spring left most schools without assessment data from that time, thousands of schools began testing this fall, making it possible to compare learning gains in a typical, pre-COVID-19 year to those same gains during the COVID-19 pandemic. Using data from nearly 4.4 million students in grades 3-8 who took MAP ® Growth™ reading and math assessments in fall 2020, we examined two primary research questions:

• How did students perform in fall 2020 relative to a typical school year (specifically, fall 2019)?
• Have students made learning gains since schools physically closed in March 2020?

To answer these questions, we compared students’ academic achievement and growth during the COVID-19 pandemic to the achievement and growth patterns observed in 2019. We report student achievement as a percentile rank, which is a normative measure of a student’s achievement in a given grade/subject relative to the MAP Growth national norms (reflecting pre-COVID-19 achievement levels).

To make sure the students who took the tests before and after COVID-19 school closures were demographically similar, all analyses were limited to a sample of 8,000 schools that tested students in both fall 2019 and fall 2020. Compared to all public schools in the nation, schools in the sample had slightly larger total enrollment, a lower percentage of low-income students, and a higher percentage of white students. Since our sample includes both in-person and remote testers in fall 2020, we conducted an initial comparability study of remote and in-person testing in fall 2020. We found consistent psychometric characteristics and trends in test scores for remote and in-person tests for students in grades 3-8, but caution that remote testing conditions may be qualitatively different for K-2 students. For more details on the sample and methodology, please see the technical report accompanying this study.

In some cases, our results tell a more optimistic story than what we feared. In others, the results are as deeply concerning as we expected based on our projections.

Question 1: How did students perform in fall 2020 relative to a typical school year?

When comparing students’ median percentile rank for fall 2020 to those for fall 2019, there is good news to share: Students in grades 3-8 performed similarly in reading to same-grade students in fall 2019. While the reason for the stability of these achievement results cannot be easily pinned down, possible explanations are that students read more on their own, and parents are better equipped to support learning in reading compared to other subjects that require more formal instruction.

The news in math, however, is more worrying. The figure below shows the median percentile rank in math by grade level in fall 2019 and fall 2020. As the figure indicates, the math achievement of students in 2020 was about 5 to 10 percentile points lower compared to same-grade students the prior year.

Figure 1: MAP Growth Percentiles in Math by Grade Level in Fall 2019 and Fall 2020

Source: Author calculations with MAP Growth data. Notes: Each bar represents the median percentile rank in a given grade/term.

Question 2: Have students made learning gains since schools physically closed, and how do these gains compare to gains in a more typical year?

To answer this question, we examined learning gains/losses between winter 2020 (January through early March) and fall 2020 relative to those same gains in a pre-COVID-19 period (between winter 2019 and fall 2019). We did not examine spring-to-fall changes because so few students tested in spring 2020 (after the pandemic began). In almost all grades, the majority of students made some learning gains in both reading and math since the COVID-19 pandemic started, though gains were smaller in math in 2020 relative to the gains students in the same grades made in the winter 2019-fall 2019 period.

Figure 2 shows the distribution of change in reading scores by grade for the winter 2020 to fall 2020 period (light blue) as compared to same-grade students in the pre-pandemic span of winter 2019 to fall 2019 (dark blue). The 2019 and 2020 distributions largely overlapped, suggesting similar amounts of within-student change from one grade to the next.

Figure 2: Distribution of Within-student Change from Winter 2019-Fall 2019 vs Winter 2020-Fall 2020 in Reading

Source: Author calculations with MAP Growth data. Notes: The dashed line represents zero growth (e.g., winter and fall test scores were equivalent). A positive value indicates that a student scored higher in the fall than their prior winter score; a negative value indicates a student scored lower in the fall than their prior winter score.

Meanwhile, Figure 3 shows the distribution of change for students in different grade levels for the winter 2020 to fall 2020 period in math. In contrast to reading, these results show a downward shift: A smaller proportion of students demonstrated positive math growth in the 2020 period than in the 2019 period for all grades. For example, 79% of students switching from 3 rd to 4 th grade made academic gains between winter 2019 and fall 2019, relative to 57% of students in the same grade range in 2020.

Figure 3: Distribution of Within-student Change from Winter 2019-Fall 2019 vs. Winter 2020-Fall 2020 in Math

It was widely speculated that the COVID-19 pandemic would lead to very unequal opportunities for learning depending on whether students had access to technology and parental support during the school closures, which would result in greater heterogeneity in terms of learning gains/losses in 2020. Notably, however, we do not see evidence that within-student change is more spread out this year relative to the pre-pandemic 2019 distribution.

The long-term effects of COVID-19 are still unknown

In some ways, our findings show an optimistic picture: In reading, on average, the achievement percentiles of students in fall 2020 were similar to those of same-grade students in fall 2019, and in almost all grades, most students made some learning gains since the COVID-19 pandemic started. In math, however, the results tell a less rosy story: Student achievement was lower than the pre-COVID-19 performance by same-grade students in fall 2019, and students showed lower growth in math across grades 3 to 8 relative to peers in the previous, more typical year. Schools will need clear local data to understand if these national trends are reflective of their students. Additional resources and supports should be deployed in math specifically to get students back on track.

In this study, we limited our analyses to a consistent set of schools between fall 2019 and fall 2020. However, approximately one in four students who tested within these schools in fall 2019 are no longer in our sample in fall 2020. This is a sizeable increase from the 15% attrition from fall 2018 to fall 2019. One possible explanation is that some students lacked reliable technology. A second is that they disengaged from school due to economic, health, or other factors. More coordinated efforts are required to establish communication with students who are not attending school or disengaging from instruction to get them back on track, especially our most vulnerable students.

Finally, we are only scratching the surface in quantifying the short-term and long-term academic and non-academic impacts of COVID-19. While more students are back in schools now and educators have more experience with remote instruction than when the pandemic forced schools to close in spring 2020, the collective shock we are experiencing is ongoing. We will continue to examine students’ academic progress throughout the 2020-21 school year to understand how recovery and growth unfold amid an ongoing pandemic.

Thankfully, we know much more about the impact the pandemic has had on student learning than we did even a few months ago. However, that knowledge makes clear that there is work to be done to help many students get back on track in math, and that the long-term ramifications of COVID-19 for student learning—especially among underserved communities—remain unknown.

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New World Bank report: Remote Learning during the pandemic: Lessons from today, principles for tomorrow 

WASHINGTON, D.C., Nov. 18, 2021— Education systems around the world reacted to COVID-19 by closing schools and rolling out remote learning options for their students as an emergency response.  New World Bank analysis of early evidence reveals that while remote learning has not been equally effective everywhere, hybrid learning is here to stay.

Going forward, for remote learning to deliver on its potential, the analysis shows the need to ensure strong alignment between three complementary components: effective teaching, suitable technology, and engaged learners.

“Hybrid learning – which combines in-person and remote learning – is here to stay. The challenge will be the art of combining technology and the human factor to make hybrid learning a tool to expand access to quality education for all,” emphasized Jaime Saavedra, World Bank Global Director for Education .   “Information technology is only a complement, not a substitute, for the conventional teaching process – particularly among preschool and elementary school students. The importance of teachers, and the recognition of education as essentially a human interaction endeavor, is now even clearer.”

The twin reports, Remote Learning During the Global School Lockdown: Multi-Country Lessons and Remote Learning During COVID-19: Lessons from Today, Principles for Tomorrow , stress that three components are critical for remote learning to be effective:

• Prioritizing effective teachers: a teacher with high subject content knowledge, skills to use technology, and appropriate pedagogical tools and support is more likely to be effective at remote instruction.
• Adopting suitable technology: availability of technology is a necessary but not sufficient condition for effective remote learning.
• Ensuring learners are engaged: for students to be engaged, contextual factors such as the home environment, family support, and motivation for learning must be well aligned.

The reports found that many countries struggled to ensure take-up and some even found themselves in a remote learning paradox: choosing a distance learning approach unsuited to the access and capabilities of a majority of their teachers and students.

“Emerging evidence on the effectiveness of remote learning during COVID-19 is mixed at best,” said Cristóbal Cobo, World Bank Senior Education and Technology Specialist, and co-author of the two reports . “Some countries provided online digital learning solutions, although a majority of students lacked digital devices or connectivity, thus resulting in uneven participation, which further exacerbated existing inequalities. Other factors leading to low student take-up are unconducive home environments; challenges in maintaining children’s engagement, especially that of younger children; and low digital literacy of students, teachers, and/or parents.”

“While pre-pandemic access to technology and capabilities to use it differed widely within and across countries, limited parental engagement and support for children from poor families has generally hindered their ability to benefit from remote learning,” stressed Saavedra .

Despite these challenges with remote learning, this can be an unprecedented opportunity to leverage its potential to reimagine learning and to build back more effective and equitable education systems. Hybrid learning is part of the solution for the future to make the education process more effective and resilient. 

The reports offer the following five principles to guide country efforts going forward:

• Ensure remote learning is fit-for-purpose. Countries should choose modes of remote learning that are suitable to the access and utilization of technology among both teachers and students, including digital skills, and that teachers have opportunities to develop the technical and pedagogical competencies needed for effective remote teaching. 
• Use technology to enhance the effectiveness of teachers. Teacher professional development should develop the skills and support needed to be an effective teacher in a remote setting.
• Establish meaningful two-way interactions. Using the most appropriate technology for the local context, it is imperative to enable opportunities for students and teachers to interact with each other with suitable adaptations to the delivery of the curriculum.
• Engage and support parents as partners in the teaching and learning process. It is imperative that parents (families) are engaged and supported to help students access remote learning and to ensure both continuity of learning and protect children’s socioemotional well-being.
• Rally all actors to cooperate around learning . Cooperation across all levels of government; as well as partnerships between the public and private sector, and between groups of teachers and school principals; is vital to the effectiveness of remote learning and to ensure that the system continues to adapt, learn, and improve in an ever-changing remote learning landscape.

World Bank Education Response to COVID-19

In response to the deepening education crisis, the World Bank has rapidly ramped up its support to developing countries, with projects reaching at least 432 million students and 26 million teachers – one-third of the student population and nearly a quarter of the teacher workforce in current client countries. The World Bank is the largest source of external financing for education in developing countries. In the last two fiscal years, our support to education has reached $11.5 billion.

World Bank Group Response to COVID-19

Since the start of the COVID-19 pandemic, the World Bank Group has deployed over $157 billion to fight the health, economic, and social impacts of the pandemic, the fastest and largest crisis response in its history. The financing is helping more than 100 countries strengthen pandemic preparedness, protect the poor and jobs, and jump start a climate-friendly recovery. The Bank is also supporting over 60 low- and middle-income countries , more than half of which are in Africa, with the purchase and deployment of COVID-19 vaccines, and is making available $20 billion in financing for this purpose until the end of 2022.

For more information on the twin reports, please visit their website .

For more information on the World Bank and Education, please visit:  www.worldbank.org/education

Follow us on: @WBG_Education

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Lessons from Teaching and Learning at Stanford During the COVID-19 Pandemic

A Review, 2020–21

We seek to help Stanford collectively learn the lessons of COVID-19 pandemic remote teaching

The disruption to teaching and learning during the COVID-19 pandemic, as devastating as it was, also contains germs of opportunity. The Stanford community responded resourcefully, and innovations arose that could enhance education in years to come.

For this review, Stanford Digital Education gathered stories about how the campus supported academic continuity during the period of emergency remote instruction. The people we interviewed — Stanford leaders, faculty, staff, and students — provided diverse perspectives on the challenges they faced and the impact of pandemic measures. 

We hope our review leads to reflection on our shared pandemic experience, struggles, and progress. We believe this effort will serve as the foundation on which Stanford can design its future digital education strategy.

View or download the full report

“As we emerge from the pandemic, the skills and confidence that instructors developed for emergency remote teaching can be translated to more intentionally designed learning experiences.”

Vice Provost for Digital Education Matthew Rascoff

“The pre-pandemic campus experience had leveled the playing field in many ways: students ... had the same access to the internet, libraries, and study spaces. Pandemic learning removed this shared experience and brought once-hidden differences into the light.”

Excerpt from the introduction to the report

5 takeaways from our pandemic research

• Emergency remote instruction marks a shift in Stanford’s identity.
• Staff have a new and vital role in shaping instructional innovation and in building new collaborative networks.
• The move to remote education worsened access for many students, though some saw an improvement.
• The faculty-student relationship changed.
• A culture of empathy grew.

Read more about our five learnings.

Months of research  View the Stanford work we build upon.

Learn about our purpose and methods.  

Stanford stakeholders interviewed See the list of interviewees.

Explore the Stanford pandemic education report

Innovative Pedagogy

Pandemic emergency teaching presented substantial challenges to instructors, but it also generated opportunities for significant transformation of students’ remote learning experiences. Many curricular practices at Stanford were reshaped to promote active, interactive, and experiential education — including more flexible classroom assessments and opportunities for flipped learning.

Support Structures

Many new programs to support student learning have emerged as a result of the shift to emergency remote pandemic teaching, including expanded roles for graduate and undergraduate teaching assistants. Relationships between faculty and technology support staff have been largely strengthened, and there is new awareness of teaching support structures at Stanford overall.

Professional Communities

The pandemic fostered significant growth among professional and online learning communities both within and outside of Stanford. Stanford’s impact on these communities has been far-flung, informing pandemic teaching and learning practices at institutions both nationally and globally.

Supporting the Whole Student

The impact of COVID-19 highlighted inequities among students in higher education. The digital divide contributed to socioemotional distress among vulnerable student populations. A new focus on empathy, support, and student well-being lessened some aspects of these negative impacts.

Future considerations

• How can Stanford continue the culture of academic ingenuity and innovation that shone during the pandemic?
• How do we provide digital education opportunities that enhance equity and access for students?
• Under what circumstances should faculty and academic instructors be able to teach with flexibility, using such instructional modalities as fully online, hybrid, or flipped instruction?
• Should students be afforded alternatives to attending classes in-person and having more options of alternative forms of assessment?
• What should be students’ role in course design?
• Is there a need to maintain and grow professional knowledge-sharing networks and online teaching resources such as the Teaching Commons, the Teach Symposium,  and the Digital Ambassadors program?

First-generation/low-income students reporting that they didn't have a quiet place to study at home

Students reporting feeling overwhelmed often or very often in spring 2020

Students who were very concerned about maintaining friendships and social connections when classes went online

Explore the spring 2020 survey from Stanford's Institutional Research and Decision Support office.

COVID-19 and education: The lingering effects of unfinished learning

As this most disrupted of school years draws to a close, it is time to take stock of the impact of the pandemic on student learning and well-being. Although the 2020–21 academic year ended on a high note—with rising vaccination rates, outdoor in-person graduations, and access to at least some in-person learning for 98 percent of students—it was as a whole perhaps one of the most challenging for educators and students in our nation’s history. 1 “Burbio’s K-12 school opening tracker,” Burbio, accessed May 31, 2021, cai.burbio.com. By the end of the school year, only 2 percent of students were in virtual-only districts. Many students, however, chose to keep learning virtually in districts that were offering hybrid or fully in-person learning.

Our analysis shows that the impact of the pandemic on K–12 student learning was significant, leaving students on average five months behind in mathematics and four months behind in reading by the end of the school year. The pandemic widened preexisting opportunity and achievement gaps, hitting historically disadvantaged students hardest. In math, students in majority Black schools ended the year with six months of unfinished learning, students in low-income schools with seven. High schoolers have become more likely to drop out of school, and high school seniors, especially those from low-income families, are less likely to go on to postsecondary education. And the crisis had an impact on not just academics but also the broader health and well-being of students, with more than 35 percent of parents very or extremely concerned about their children’s mental health.

The fallout from the pandemic threatens to depress this generation’s prospects and constrict their opportunities far into adulthood. The ripple effects may undermine their chances of attending college and ultimately finding a fulfilling job that enables them to support a family. Our analysis suggests that, unless steps are taken to address unfinished learning, today’s students may earn $49,000 to $61,000 less over their lifetime owing to the impact of the pandemic on their schooling. The impact on the US economy could amount to $128 billion to $188 billion every year as this cohort enters the workforce.

Federal funds are in place to help states and districts respond, though funding is only part of the answer. The deep-rooted challenges in our school systems predate the pandemic and have resisted many reform efforts. States and districts have a critical role to play in marshaling that funding into sustainable programs that improve student outcomes. They can ensure rigorous implementation of evidence-based initiatives, while also piloting and tracking the impact of innovative new approaches. Although it is too early to fully assess the effectiveness of postpandemic solutions to unfinished learning, the scope of action is already clear. The immediate imperative is to not only reopen schools and recover unfinished learning but also reimagine education systems for the long term. Across all of these priorities it will be critical to take a holistic approach, listening to students and parents and designing programs that meet academic and nonacademic needs alike.

What have we learned about unfinished learning?

As the 2020–21 school year began, just 40 percent of K–12 students were in districts that offered any in-person instruction. By the end of the year, more than 98 percent of students had access to some form of in-person learning, from the traditional five days a week to hybrid models. In the interim, districts oscillated among virtual, hybrid, and in-person learning as they balanced the need to keep students and staff safe with the need to provide an effective learning environment. Students faced multiple schedule changes, were assigned new teachers midyear, and struggled with glitchy internet connections and Zoom fatigue. This was a uniquely challenging year for teachers and students, and it is no surprise that it has left its mark—on student learning, and on student well-being.

As we analyze the cost of the pandemic, we use the term “unfinished learning” to capture the reality that students were not given the opportunity this year to complete all the learning they would have completed in a typical year. Some students who have disengaged from school altogether may have slipped backward, losing knowledge or skills they once had. The majority simply learned less than they would have in a typical year, but this is nonetheless important. Students who move on to the next grade unprepared are missing key building blocks of knowledge that are necessary for success, while students who repeat a year are much less likely to complete high school and move on to college. And it’s not just academic knowledge these students may miss out on. They are at risk of finishing school without the skills, behaviors, and mindsets to succeed in college or in the workforce. An accurate assessment of the depth and extent of unfinished learning will best enable districts and states to support students in catching up on the learning they missed and moving past the pandemic and into a successful future.

Students testing in 2021 were about ten points behind in math and nine points behind in reading, compared with matched students in previous years.

Unfinished learning is real—and inequitable

To assess student learning through the pandemic, we analyzed Curriculum Associates’ i-Ready in-school assessment results of more than 1.6 million elementary school students across more than 40 states. 2 The Curriculum Associates in-school sample consisted of 1.6 million K–6 students in mathematics and 1.5 million in reading. The math sample came from all 50 states, but 23 states accounted for 90 percent of the sample. The reading sample came from 46 states, with 21 states accounting for 90 percent of the sample. Florida accounted for 29 percent of the math and 30 percent of the reading sample. In general, states that had reopened schools are overweighted given the in-school nature of the assessment. We compared students’ performance in the spring of 2021 with the performance of similar students prior to the pandemic. 3 Specifically, we compared spring 2021 results to those of historically matched students in the springs of 2019, 2018, and 2017. Students testing in 2021 were about ten points behind in math and nine points behind in reading, compared with matched students in previous years.

To get a sense of the magnitude of these gaps, we translated these differences in scores to a more intuitive measure—months of learning. Although there is no perfect way to make this translation, we can get a sense of how far students are behind by comparing the levels students attained this spring with the growth in learning that usually occurs from one grade level to the next. We found that this cohort of students is five months behind in math and four months behind in reading, compared with where we would expect them to be based on historical data. 4 The conversion into months of learning compares students’ achievement in the spring of one grade level with their performance in the spring of the next grade level, treating this spring-to-spring difference in historical scores as a “year” of learning. It assumes a ten-month school year with a two-month summer vacation. Actual school schedules vary significantly, and i-Ready’s typical growth numbers for a “year” of learning are based on 30 weeks of actual instruction between the fall and the spring rather than on a spring-to-spring calendar-year comparison.

Unfinished learning did not vary significantly across elementary grades. Despite reports that remote learning was more challenging for early elementary students, 5 Marva Hinton, “Why teaching kindergarten online is so very, very hard,” Edutopia, October 21, 2020, edutopia.org. our results suggest the impact was just as meaningful for older elementary students. 6 While our analysis only includes results from students who tested in-school in the spring, many of these students were learning remotely for meaningful portions of the fall and the winter. We can hypothesize that perhaps younger elementary students received more help from parents and older siblings, and that older elementary students were more likely to be struggling alone.

It is also worth remembering that our numbers capture the “average” progress by grade level. Especially in early reading, this average can conceal a wide range of outcomes. Another way of cutting the data looks instead at which students have dropped further behind grade levels. A recent report suggests that more first and second graders have ended this year two or more grade levels below expectations than in any previous year. 7 Academic achievement at the end of the 2020–2021 school year , Curriculum Associates, June 2021, curriculumassociates.com. Given the major strides children at this age typically make in mastering reading, and the critical importance of early reading for later academic success, this is of particular concern.

While all types of students experienced unfinished learning, some groups were disproportionately affected. Students of color and low-income students suffered most. Students in majority-Black schools ended the school year six months behind in both math and reading, while students in majority-white schools ended up just four months behind in math and three months behind in reading. 8 To respect students’ privacy, we cannot isolate the race or income of individual students in our sample, but we can look at school-level demographics. Students in predominantly low-income schools and in urban locations also lost more learning during the pandemic than their peers in high-income rural and suburban schools (Exhibit 1).

In fall 2020, we projected that students could lose as much as five to ten months of learning in mathematics, and about half of that in reading, by the end of the school year. Spring assessment results came in toward the lower end of these projections, suggesting that districts and states were able to improve the quality of remote and hybrid learning through the 2020–21 school year and bring more students back into classrooms.

Indeed, if we look at the data over time, some interesting patterns emerge. 9 The composition of the fall student sample was different from that of the spring sample, because more students returned to in-person assessments in the spring. Some of the increase in unfinished learning from fall to spring could be because the spring assessment included previously virtual students, who may have struggled more during the school year. Even so, the spring data are the best reflection of unfinished learning at the end of the school year. Taking math as an example, as schools closed their buildings in the spring of 2020, students fell behind rapidly, learning almost no new math content over the final few months of the 2019–20 school year. Over the summer, we assume that they experienced the typical “summer slide” in which students lose some of the academic knowledge and skills they had learned the year before. Then they resumed learning through the 2020–21 school year, but at a slower pace than usual, resulting in five months of unfinished learning by the end of the year (Exhibit 2). 10 These lines simplify the pattern of typical learning through the year. In a typical year, students learn more in the fall and less in the spring, and only learn during periods of instruction (the chart includes the well-documented learning loss that happens during the summer, but does not include shorter holidays when students are not in school receiving instruction).

In reading, however, the story is somewhat different. As schools closed their buildings in March 2020, students continued to progress in reading, albeit at a slower pace. During the summer, we assume that students’ reading level stayed roughly flat, as in previous years. The pace of learning increased slightly over the 2020–21 school year, but the difference was not as great as it was in math, resulting in four months of unfinished learning by the end of the school year (Exhibit 3). Put another way, the initial shock in reading was less severe, but the improvements to remote and hybrid learning seem to have had less impact in reading than they did in math.

Before we celebrate the improvements in student trajectories between the initial school shutdowns and the subsequent year of learning, we should remember that these are still sobering numbers. On average, students who took the spring assessments in school are half a year behind in math, and nearly that in reading. For Black and Hispanic students, the losses are not only greater but also piled on top of historical inequities in opportunity and achievement (Exhibit 4).

Furthermore, these results likely represent an optimistic scenario. They reflect outcomes for students who took interim assessments in the spring in a school building 11 Students who took the assessment out of school are not included in our sample because we could not guarantee fidelity and comparability of results, given the change in the testing environment. Out-of-school students represent about a third of the students taking i-Ready assessments in the spring, and we will not have an accurate understanding of the pandemic’s impact on their learning until they return to school buildings, likely in the fall. —and thus exclude students who remained remote throughout the entire school year, and who may have experienced the most disruption to their schooling. 12 Initial results from Texas suggest that districts with mostly virtual instruction experienced more unfinished learning than those with mostly in-person instruction. The percent of students meeting math expectations dropped 32 percent in mostly virtual districts but just 9 percent in mostly in-person ones. See Reese Oxner, “Texas students’ standardized test scores dropped dramatically during the pandemic, especially in math,” Texas Tribune , June 28, 2021, texastribune.org. The Curriculum Associates data cover a broad variety of schools and states across the country, but are not fully representative, being overweighted for rural and southeastern states that were more likely to get students back into the classrooms this year. Finally, these data cover only elementary schools. They are silent on the academic impact of the pandemic for middle and high schoolers. However, data from school districts suggest that, even for older students, the pandemic has had a significant effect on learning. 13 For example, in Salt Lake City, the percentage of middle and high school students failing a class jumped by 60 percent, from 2,500 to 4,000, during the pandemic. To learn about increased failure rates across multiple districts from the Bay Area to New Mexico, Austin, and Hawaii, see Richard Fulton, “Failing Grades,” Inside Higher Ed , March 8, 2021, insidehighered.com.

The harm inflicted by the pandemic goes beyond academics

Students didn’t just lose academic learning during the pandemic. Some lost family members; others had caregivers who lost their jobs and sources of income; and almost all experienced social isolation.

These pressures have taken a toll on students of all ages. In our recent survey of 16,370 parents across every state in America, 35 percent of parents said they were very or extremely concerned about their child’s mental health, with a similar proportion worried about their child’s social and emotional well-being. Roughly 80 percent of parents had some level of concern about their child’s mental health or social and emotional health and development since the pandemic began. Parental concerns about mental health span grade levels but are slightly lower for parents of early elementary school students. 14 While 30.7% percent of all K–2 parents were very or extremely concerned, a peak of 37.6% percent of eighth-grade parents were.

Parents also report increases in clinical mental health conditions among their children, with a five-percentage-point increase in anxiety and a six-percentage-point increase in depression. They also report increases in behaviors such as social withdrawal, self-isolation, lethargy, and irrational fears (Exhibit 5). Despite increased levels of concern among parents, the amount of mental health assessment and testing done for children is 6.1 percent lower than it was in 2019 —the steepest decline in assessment and testing rates of any age group.

Broader student well-being is not independent of academics. Parents whose children have fallen significantly behind academically are one-third more likely to say that they are very or extremely concerned about their children’s mental health. Black and Hispanic parents are seven to nine percentage points more likely than white parents to report higher levels of concern. Unaddressed mental-health challenges will likely have a knock-on effect on academics going forward as well. Research shows that trauma and other mental-health issues can influence children’s attendance, their ability to complete schoolwork in and out of class, and even the way they learn. 15 Satu Larson et al., “Chronic childhood trauma, mental health, academic achievement, and school-based health center mental health services,” Journal of School Health , 2017, 87(9), 675–86, escholarship.org.

In our recent survey of 16,370 parents across every state in America, 35 percent of parents said they were very or extremely concerned about their child’s mental health.

The impact of unfinished learning on diminished student well-being seems to be playing out in the choices that students are making. Some students have already effectively dropped out of formal education entirely. 16 To assess the impact of the pandemic on dropout rates, we have to look beyond official enrollment data, which are only published annually, and which only capture whether a child has enrolled at the beginning of the year, not whether they are engaged and attending school. Chronic absenteeism rates provide clues as to which students are likely to persist in school and which students are at risk of dropping out. Our parent survey suggests that chronic absenteeism for eighth through 12th graders has increased by 12 percentage points, and 42 percent of the students who are new to chronic absenteeism are attending no school at all, according to their parents. Scaled up to the national level, this suggests that 2.3 million to 4.6 million additional eighth- to 12th-grade students were chronically absent from school this year, in addition to the 3.1 million who are chronically absent in nonpandemic years. State and district data on chronic absenteeism are still emerging, but data released so far also suggest a sharp uptick in absenteeism rates nationwide, particularly in higher grades. 17 A review of available state and district data, including data released by 14 states and 11 districts, showed increases in chronic absenteeism of between three and 16 percentage points, with an average of seven percentage points. However, many states changed the definition of absenteeism during the pandemic, so a true like-for-like comparison is difficult to obtain. According to emerging state and district data, increases in chronic absenteeism are highest among populations with historically low rates. This is reflected also in our survey results. Black students, with the highest historical absenteeism rates, saw more modest increases during the pandemic than white or Hispanic students (Exhibit 6).

It remains unclear whether these pandemic-related chronic absentees will drop out at rates similar to those of students who were chronically absent prior to the pandemic. Some students could choose to return to school once in-person options are restored; but some portion of these newly absent students will likely drop out of school altogether. Based on historical links between chronic absenteeism and dropout rates, as well as differentials in absenteeism between fully virtual and fully in-person students, we estimate that an additional 617,000 to 1.2 million eighth–12th graders could drop out of school altogether because of the pandemic if efforts are not made to reengage them in learning next year. 18 The federal definition of chronic absenteeism is missing more than 15 days of school each year. According to the Utah Education Policy Center’s research brief on chronic absenteeism, the overall correlation between one year of chronic absence between eighth and 12th grade and dropping out of school is 0.134. For more, see Utah Education Policy Center, Research brief: Chronic absenteeism , July 2012, uepc.utah.edu. We then apply the differential in chronic absenteeism between fully virtual and fully in-person students to account for virtual students reengaging when in-person education is offered. For students who were not attending school at all, we assumed that 50 to 75 percent would not return to learning. This estimation is partly based on The on-track indicator as a predictor of high school graduation from the UChicago Consortium on School Research, which estimates that up to 75 percent of high school students who are “off track”—either failing or behind in credits—do not graduate in five years. For more, see Elaine Allensworth and John Q. Easton, The on-track indicator as a predictor of high school graduation , UChicago Consortium on School Research, 2005, consortium.uchicago.edu.

Even among students who complete high school, many may not fulfill their dreams of going on to postsecondary education. Our survey suggests that 17 percent of high school seniors who had planned to attend postsecondary education abandoned their plans—most often because they had joined or were planning to join the workforce or because the costs of college were too high. The number is much higher among low-income high school seniors, with 26 percent abandoning their plans. Low-income seniors are more likely to state cost as a reason, with high-income seniors more likely to be planning to reapply the following year or enroll in a gap-year program. This is consistent with National Student Clearinghouse reports that show overall college enrollment declines, with low-income, high-poverty, and high-minority high schools disproportionately affected. 19 Todd Sedmak, “Fall 2020 college enrollment update for the high school graduating class of 2020,” National Student Clearinghouse, March 25, 2021, studentclearinghouse.org; Todd Sedmak, “Spring 2021 college enrollment declines 603,000 to 16.9 million students,” National Student Clearinghouse, June 10, 2021, studentclearinghouse.org.

Unfinished learning has long-term consequences

The cumulative effects of the pandemic could have a long-term impact on an entire generation of students. Education achievement and attainment are linked not only to higher earnings but also to better health, reduced incarceration rates, and greater political participation. 20 See, for example, Michael Grossman, “Education and nonmarket outcomes,” in Handbook of the Economics of Education, Volume 1 , ed. Eric Hanushek and Finis Welch (Amsterdam: Elsevier, 2006), 577–633; Lance Lochner and Enrico Moretti, “The effect of education on crime: Evidence from prison inmates, arrests, and self-reports,” American Economic Review , 2004, Volume 94, Number 1, pp. 155–89; Kevin Milligan, Enrico Moretti, and Philip Oreopoulos, “Does education improve citizenship? Evidence from the United States and the United Kingdom,” Journal of Public Economics , August 2004, Volume 88, Number 9–10, pp. 1667–95; and Education transforms lives , UNESCO, 2013, unesdoc.unesco.org. We estimate that, without immediate and sustained interventions, pandemic-related unfinished learning could reduce lifetime earnings for K–12 students by an average of $49,000 to $61,000. These costs are significant, especially for students who have lost more learning. While white students may see lifetime earnings reduced by 1.4 percent, the reduction could be as much as 2.4 percent for Black students and 2.1 percent for Hispanic students. 21 Projected earnings across children’s lifetimes using current annual incomes for those with at least a high school diploma, discounting the earnings by a premium established in Murnane et al., 2000, which tied cognitive skills and future earnings. See Richard J. Murnane et al., “How important are the cognitive skills of teenagers in predicting subsequent earnings?,” Journal of Policy Analysis and Management , September 2000, Volume 19, Number 4, pp. 547–68.

Lower earnings, lower levels of education attainment, less innovation—all of these lead to decreased economic productivity. By 2040 the majority of this cohort of K–12 students will be in the workforce. We anticipate a potential annual GDP loss of $128 billion to $188 billion from pandemic-related unfinished learning. 22 Using Hanushek and Woessmann 2008 methodology to map national per capita growth associated with decrease in academic achievement, then adding additional impact of pandemic dropouts on GDP. For more, see Eric A. Hanushek and Ludger Woessmann, “The role of cognitive skills in economic development,” Journal of Economic Literature , September 2008, Volume 46, Number 3, pp. 607–68.

This increases by about one-third the existing hits to GDP from achievement gaps that predated COVID-19. Our previous research indicated that the pre-COVID-19 racial achievement gap was equivalent to $426 billion to $705 billion in lost economic potential every year (Exhibit 7). 23 This is the increase in GDP that would result if Black and Hispanic students achieved the same levels of academic performance as white students. For more information on historical opportunity and achievement gaps, please see Emma Dorn, Bryan Hancock, Jimmy Sarakatsannis, and Ellen Viruleg, “ COVID-19 and student learning in the United States: The hurt could last a lifetime ,” June 1, 2020.

What is the path forward for our nation’s students?

There is now significant funding in place to address these critical issues. Through the Coronavirus Aid, Relief, and Economic Security Act (CARES Act); the Coronavirus Response and Relief Supplemental Appropriations Act (CRRSAA); and the American Rescue Plan (ARP), the federal government has already committed more than $200 billion to K–12 education over the next three years, 24 The CARES Act provided $13 billion to ESSER and $3 billion to the Governor’s Emergency Education Relief (GEER) Fund; CRRSAA provided $54 billion to ESSER II, $4 billion to Governors (GEER II and EANS); ARP provided $123 billion to ESSER III, $3 billion to Governors (EANS II), and $10 billion to other education programs. For more, see “CCSSO fact sheet: COVID-19 relief funding for K-12 education,” Council of Chief State School Officers, 2021, https://753a0706.flowpaper.com/CCSSOCovidReliefFactSheet/#page=2. a significant increase over the approximately $750 billion spent annually on public schooling. 25 “The condition of education 2021: At a glance,” National Center for Education Statistics, accessed June 30, 2021, nces.ed.gov. The majority of these funds are routed through the Elementary and Secondary School Emergency Relief Fund (ESSER), of which 90 percent flows to districts and 10 percent to state education agencies. These are vast sums of money, particularly in historical context. As part of the 2009 American Recovery and Reinvestment Act (ARRA), the Obama administration committed more than $80 billion toward K–12 schools—at the time the biggest federal infusion of funds to public schools in the nation’s history. 26 “The American Recovery and Reinvestment Act of 2009: Saving and Creating Jobs and Reforming Education,” US Department of Education, March 7, 2009, ed.gov. Today’s funding more than doubles that previous record and gives districts much more freedom in how they spend the money. 27 Andrew Ujifusa, “What Obama’s stimulus had for education that the coronavirus package doesn’t,” Education Week , March 31, 2020, www.edweek.org.

However, if this funding can mitigate the impact of unfinished learning, it could prevent much larger losses to the US economy. Given that this generation of students will likely spend 35 to 40 years in the workforce, the cumulative impact of COVID-19 unfinished learning over their lifetimes could far exceed the investments that are being made today.

Furthermore, much of today’s federal infusion will likely be spent not only on supporting students in catching up on the unfinished learning of the pandemic but also on tackling deeper historical opportunity and achievement gaps among students of different races and income levels.

As districts consider competing uses of funding, they are juggling multiple priorities over several time horizons. The ARP funding needs to be obligated by September 2023. This restricts how monies can be spent. Districts are balancing the desire to hire new personnel or start new programs with the risk of having to close programs because of lack of sustained funds in the future. Districts are also facing decisions about whether to run programs at the district level or to give more freedom to principals in allocating funds; about the balance between academics and broader student needs; about the extent to which funds should be targeted to students who have struggled most or spread evenly across all students; and about the balance between rolling out existing evidence-based programs and experimenting with innovative approaches.

It is too early to answer all of these questions decisively. However, as districts consider this complex set of decisions, leading practitioners and thinkers have come together to form the Coalition to Advance Future Student Success—and to outline priorities to ensure the effective and equitable use of federal funds. 28 “Framework: The Coalition to Advance Future Student Success,” Council of Chief State School Officers, accessed June 30, 2021, learning.ccsso.org.

These priorities encompass four potential actions for schools:

• Safely reopen schools for in-person learning.
• Reengage students and reenroll them into effective learning environments.
• Support students in recovering unfinished learning and broader needs.
• Recommit and reimagine our education systems for the long term.

Across all of these actions, it is important for districts to understand the changing needs of parents and students as we emerge from the pandemic, and to engage with them to support students to learn and to thrive. The remainder of this article shares insights from our parent survey of more than 16,000 parents on these changing needs and perspectives, and highlights some early actions by states and districts to adapt to meet them.

1. Safely reopen schools for in-person learning

The majority of school districts across the country are planning to offer traditional five-days-a-week in-person instruction in the fall, employing COVID-19-mitigation strategies such as staff and student vaccination drives, ongoing COVID-19 testing, mask mandates, and infrastructure updates. 29 “Map: Where Were Schools Required to Be Open for the 2020-21 School Year?,” Education Week , updated May 2021, edweek.org. The evidence suggests that schools can reopen buildings safely with the right protocols in place, 30 For a summary of the evidence on safely reopening schools, see John Bailey, Is it safe to reopen schools? , CRPE, March 2021, crpe.org. but health preparedness will likely remain critical as buildings reopen. Indeed, by the end of the school year, a significant subset of parents remain concerned about safety in schools, with nearly a third still very or extremely worried about the threat of COVID-19 to their child’s health. Parents also want districts to continue to invest in safety—39 percent say schools should invest in COVID-19 health and safety measures this fall.

2. Reengage and reenroll students in effective learning environments

Opening buildings safely is hard enough, but encouraging students to show up could be even more challenging. Some students will have dropped out of formal schooling entirely, and those who remain in school may be reluctant to return to physical classrooms. Our survey results suggest that 24 percent of parents are still not convinced they will choose in-person instruction for their children this fall. Within Black communities, that rises to 34 percent. But many of these parents are still open to persuasion. Only 4 percent of parents (and 6 percent of Black parents) say their children will definitely not return to fully in-person learning—which is not very different from the percentage of parents who choose to homeschool or pursue other alternative education options in a typical year. For students who choose to remain virtual, schools should make continual efforts to improve virtual learning models, based on lessons from the past year.

For parents who are still on the fence, school districts can work to understand their needs and provide effective learning options. Safety concerns remain the primary reason that parents remain hesitant about returning to the classroom; however, this is not the only driver. Some parents feel that remote learning has been a better learning environment for their child, while others have seen their child’s social-emotional and mental health improve at home.

Still, while remote learning may have worked well for some students, our data suggest that it failed many. In addition to understanding parent needs, districts should reach out to families and build confidence not just in their schools’ safety precautions but also in their learning environment and broader role in the community. Addressing root causes will likely be more effective than punitive measures, and a broad range of tactics may be needed, from outreach and attendance campaigns to student incentives to providing services families need, such as transportation and childcare. 31 Roshon R. Bradley, “A comprehensive approach to improving student attendance,” St. John Fisher College, August 2015, Education Doctoral, Paper 225, fisherpub.sjfc.edu; a 2011 literature review highlights how incentives can effectively be employed to increase attendance rates. Across all of these, a critical component will likely be identifying students who are at risk and ensuring targeted outreach and interventions. 32 Elaine M. Allensworth and John Q. Easton, “What matters for staying on-track and graduating in Chicago Public Schools: A close look at course grades, failures, and attendance in the freshman year,” Consortium on Chicago School Research at the University of Chicago, July 2007, files.eric.ed.gov.

Chicago Public Schools, in partnership with the University of Chicago, has developed a student prioritization index (SPI) that identifies students at highest risk of unfinished learning and dropping out of school. The index is based on a combination of academic, attendance, socio-emotional, and community vulnerability inputs. The district is reaching out to all students with a back-to-school marketing campaign while targeting more vulnerable students with additional support. Schools are partnering with community-based organizations to carry out home visits, and with parents to staff phone banks. They are offering various paid summer opportunities to reduce the trade-offs students may have to make between summer school and summer jobs, recognizing that many have found paid work during the pandemic. The district will track and monitor the results to learn which tactics work. 33 “Moving Forward Together,” Chicago Public Schools, June 2021, cps.edu.

In Florida’s Miami-Dade schools, each school employee was assigned 30 households to contact personally, starting with a phone call and then showing up for a home visit. Superintendent Alberto Carvalho personally contacted 30 families and persuaded 23 to return to in-person learning. The district is starting the transition to in-person learning by hosting engaging in-person summer learning programs. 34 Hannah Natanson, “Schools use home visits, calls to convince parents to choose in-person classes in fall,” Washington Post , July 7, 2021, washingtonpost.com.

3. Support students in recovering unfinished learning and in broader needs

Even if students reenroll in effective learning environments in the fall, many will be several months behind academically and may struggle to reintegrate into a traditional learning environment. School districts are therefore creating strategies to support students  as they work to make up unfinished learning, and as they work through broader mental health issues and social reintegration. Again, getting parents and students to show up for these programs may be harder than districts expect.

Our research suggests that parents underestimate the unfinished learning caused by the pandemic. In addition, their beliefs about their children’s learning do not reflect racial disparities in unfinished learning. In our survey, 40 percent of parents said their child is on track and 16 percent said their child is progressing faster than in a usual year. Black parents are slightly more likely than white parents to think their child is on track or better, Hispanic parents less so. However, across all races, more than half of parents think their child is doing just fine. Only 14 percent of parents said their child has fallen significantly behind.

Even if programs are offered for free, many parents may not take advantage of them, especially if they are too academically oriented. Only about a quarter of parents said they are very likely to enroll their child in tutoring, after-school, or summer-school programs, for example. Nearly 40 percent said they are very likely to enroll their students in enrichment programs such as art or music. Districts therefore should consider not only offering effective evidence-based programs, such as high-dosage tutoring and vacation academies, but also ensuring that these programs are attractive to students.

In Rhode Island, for example, the state is taking a “Broccoli and Ice Cream” approach to summer school to prepare students for the new school year, combining rigorous reading and math instruction with fun activities provided by community-based partners. Enrichment activities such as sailing, Italian cooking lessons, and Olympic sports are persuading students to participate. 35 From webinar with Angélica Infante-Green, Rhode Island Department of Education, https://www.ewa.org/agenda/ewa-74th-national-seminar-agenda. The state-run summer program is open to students across the state, but the Rhode Island Department of Education has also provided guidance to district-run programs, 36 Learning, Equity & Accelerated Pathways Task Force Report , Rhode Island Department of Education, April 2021, ride.ri.gov. encouraging partnerships with community-based organizations, a dual focus on academics and enrichment, small class sizes, and a strong focus on relationships and social-emotional support.

In Louisiana, the state has provided guidance and support 37 Staffing and scheduling best practices guidance , Louisiana Department of Education, June 3, 2021, louisianabelieves.com. to districts in implementing recovery programs to ensure evidence-based approaches are rolled out state-wide. The guidance includes practical tips on ramping up staffing, and on scheduling high-dosage tutoring and other dedicated acceleration blocks. The state didn’t stop at guidance, but also flooded districts with support and two-way dialogue through webinars, conferences, monthly calls, and regional technical coaching. By scheduling acceleration blocks during the school day, rather than an add-on after school, districts are not dependent on parents signing up for programs.

For students who have experienced trauma, schools will likely need to address the broader fallout from the pandemic. In southwest Virginia, the United Way is partnering with five school systems to establish a trauma-informed schools initiative, providing teachers and staff with training and resources on trauma recovery. 38 Mike Still, “SWVA school districts partner to help students in wake of pandemic,” Kingsport Times News, June 26, 2021, timesnews.net. San Antonio is planning to hire more licensed therapists and social workers to help students and their families, leveraging partnerships with community organizations to place a licensed social worker on every campus. 39 Brooke Crum, “SAISD superintendent: ‘There are no shortcuts’ to tackling COVID-related learning gaps,” San Antonio Report, April 12, 2021, sanantonioreport.org.

4. Recommit and reimagine our education systems for the long term

Opportunity gaps have existed in our school systems for a long time. As schools build back from the pandemic, districts are also recommitting to providing an excellent education to every child. A potential starting point could be redoubling efforts to provide engaging, high-quality grade-level curriculum and instruction delivered by diverse and effective educators in every classroom, supported by effective assessments to inform instruction and support.

Beyond these foundational elements, districts may consider reimagining other aspects of the system. Parents may also be open to nontraditional models. Thirty-three percent of parents said that even when the pandemic is over, the ideal fit for their child would be something other than five days a week in a traditional brick-and-mortar school. Parents are considering hybrid models, remote learning, homeschooling, or learning hubs over the long term. Even if learning resumes mostly in the building, parents are open to the use of new technology to support teaching.

Edgecombe County Public Schools in North Carolina is planning to continue its use of learning hubs this fall to better meet student needs. In the district’s hub-and-spoke model, students will spend half of their time learning core content (the “hub”). For the other half they will engage in enrichment activities aligned to learning standards (the “spokes”). For elementary and middle school students, enrichment activities will involve interest-based projects in science and social studies; for high schoolers, activities could include exploring their passions through targeted English language arts and social studies projects or getting work experience—either paid or volunteer. The district is redeploying staff and leveraging community-based partnerships to enable these smaller-group activities with trusted adults who mirror the demographics of the students. 40 “District- and community-driven learning pods,” Center on Reinventing Public Education, crpe.org.

In Tennessee, the new Advanced Placement (AP) Access for All program will provide students across the state with access to AP courses, virtually. The goal is to eliminate financial barriers and help students take AP courses that aren’t currently offered at their home high school. 41 Amy Cockerham, “TN Department of Education announces ‘AP Access for All program,’” April 28, 2021, WJHL-TV, wjhl.com.

The Dallas Independent School District is rethinking the traditional school year, gathering input from families, teachers, and school staff to ensure that school communities are ready for the plunge. More than 40 schools have opted to add five additional intercession weeks to the year to provide targeted academics and enrichment activities. A smaller group of schools will add 23 days to the school year to increase time for student learning and teacher planning and collaboration. 42 “Time to Learn,” Dallas Independent School District, dallasisd.org.

It is unclear whether all these experiments will succeed, and school districts should monitor them closely to ensure they can scale successful programs and sunset unsuccessful ones. However, we have learned in the pandemic that some of the innovations born of necessity met some families’ needs better. Continued experimentation and fine-tuning could bring the best of traditional and new approaches together.

Thanks to concerted efforts by states and districts, the worst projections for learning outcomes this past year have not materialized for most students. However, students are still far behind where they need to be, especially those from historically marginalized groups. Left unchecked, unfinished learning could have severe consequences for students’ opportunities and prospects. In the long term, it could exact a heavy toll on the economy. It is not too late to mitigate these threats, and funding is now in place. Districts and states now have the opportunity to spend that money effectively to support our nation’s students.

Emma Dorn is a senior expert in McKinsey’s Silicon Valley office; Bryan Hancock and Jimmy Sarakatsannis are partners in the Washington, DC, office; and Ellen Viruleg is a senior adviser based in Providence, Rhode Island.

The authors wish to thank Alice Boucher, Ezra Glenn, Ben Hayes, Cheryl Healey, Chauncey Holder, and Sidney Scott for their contributions to this article.

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Post-pandemic challenges for schools

Harvard Staff Writer

Ed School dean says flexibility, more hours key to avoid learning loss

With the closing of schools, the COVID-19 pandemic has revealed many of the injustices facing schoolchildren across the country, from inadequate internet access to housing instability to food insecurity. The Gazette interviewed Bridget Long, A.M. ’97, Ph.D. ’00, dean of the Harvard Graduate School of Education and Saris Professor of Education and Economics, regarding her views on the impact the public health crisis has had on schools, the lessons learned from the pandemic, and the challenges ahead.

Bridget Long

GAZETTE:   The pandemic exposed many inequities that already existed in the education landscape. Which ones concern you the most?

LONG:   Persistent inequities in education have always been a concern, but with the speed and magnitude of the changes brought on by the pandemic, it underscored several major problems. First of all, we often think about education as being solely an academic enterprise, but our schools really do so much more. Immediately, we saw children and families struggling with basic needs, such as access to food and health care, which our schools provide but all of a sudden were removed. We also shifted our focus, once we had to be in lockdown, to the differences in students’ home environments, whether it was lack of access to technology and the other commitments and demands on their time in terms of family situations, space, basic needs, and so forth. The focus had to shift from leveling the playing field within school or within college to instead what are the differences in inequities inside students’ homes and neighborhoods and the differences in the quality and rigor and supports available to students of different backgrounds. All of this was just exacerbated with the pandemic. There are concerns about learning loss and how that will vary across different income groups, communities, and neighborhoods. But there are also concerns about trauma and the mental health strain of the pandemic and how the strain of racial injustice and political turmoil has also been experienced — no doubt differently by different parts of population. And all of that has impacted students’ well-being and academic performance. The inequities we have long seen have become worse this year.

GAZETTE:   Now that those inequities have been exposed, what can leaders in education do to navigate those issues? Are there any specific lessons learned?

LONG:   Something that many educators already understood is that one size does not fit all. This is why education is so complex and why it has been so challenging to bring about improvements because there’s no silver bullet. The solution depends on the individual, the community, and the classroom.

At first, the public health crisis underscored that we needed to meet students where they are. This has been a long-held lesson among experienced education professionals, but it became even more important. In many respects, it butted up against some of our systems, which tried to come up with across-the-board approaches when instead what we needed was a bit of nimbleness depending on the context of the particular school or classroom and the individual needs of students.

Where you have seen some success and progress is where principals and teachers have been proactive and creative in how they can meet the needs of their students. What’s underneath all of this, regardless of whether we’re face-to-face or on technology, is the importance of people and personal connections. Education is a labor-intensive industry. Technology can help us in many respects to supplement or complement what we do, but the key has always been individual personal connection. Some teachers have been able to connect with their students, whether by phone or on Zoom, or schools, where they put concerted effort into doing outreach in the community to check on families to make sure they had basic needs. Some schools were able to understand what challenges their students were facing and were somewhat flexible and proactive to address those challenges, especially if they already had strong parental engagement. That’s where you have continued to see progress and growth.

“In many respects, this crisis forced the entire field to rethink our teaching in a way that I don’t know has happened before.”

GAZETTE:   You spoke about concerns about learning loss. What can we do to avoid a lost year?

LONG:   One of the difficulties is that the experience has differed tremendously. For some students, their parents have been able to supplement or their schools have been able to react. The hope is that they will not lose much learning time, while other students effectively haven’t been in school for almost a year; they have lost quite a bit of ground. As a teacher, you can imagine your students come back to school, and all of a sudden, students of the same chronological age are actually in very different places, depending on their individual family situation and what accommodations were able to be made. I think there’s a great deal we can do to try to address that. First of all, we have to have some understanding of what gains students have made as well as things they haven’t learned yet. That means taking a moment to see where a student is in their learning. The second thing is to make sure we’re capturing the lessons learned from this pandemic by identifying places where teachers and schools used a combination of technology, outreach, personal instruction, and tutors and mentors, and helped students make progress in their learning. We need to share those lessons more broadly so that other districts can see examples that have worked.

As we look ahead, I think it will take extending learning time to close the gaps. Schools will have to decide whether that is after school, weekends, or summer, and whether or not that’s going to involve the teachers themselves, or if it’s going to be using the best tools that are out there, such as videos and technology platforms that students and families use themselves. There has already been talk by some districts of extending the school year into summer or having summer-camp-type programs to give students additional time to work through some of the material.

The other important piece is partnerships. Schools oftentimes work with members of the community or nonprofit organizations, and that’s a really important layer in our system. After-school programs, enrichment programs, tutors, and mentors are essential, and we really want to continue with that expanded sense of capacity and partnership. It’s going to have an impact on all of us if we lose a generation, or if this generation goes backwards in terms of their learning. It certainly is in all of our best interests to try to contribute to the solution.

GAZETTE:   Many parents gained renewed appreciation of the work teachers do. Do you think the pandemic would lead to a reappraisal of the profession?

LONG:   Certainly, in the beginning, there was so much more appreciation for what teachers do. As parents needed to start doing homeschooling, there was a new understanding of just how difficult teaching is. Imagine having a classroom with different personalities, different strengths and assets, and also different weaknesses, and somehow being nimble enough to continue that class moving forward. As time has gone on, I worry a little bit about the level of contentiousness in some communities as schools haven’t reopened. There is the balancing act between caring for children’s learning and the fact that we have to make sure that the adults are safe and supported. You hear stories of teachers trying to teach from home while they are also homeschooling their own children. I would hope that coming out of this would be an appreciation of the amazing things teachers do in the classroom, as well as also some acknowledgement that these are people who are also living through a devastating pandemic with all the stress and strain that every individual is going through.

One other point is that given that we know that teachers do more than just academics, we need to make sure our teachers are trained to be able to provide social emotional support to students. As some of the students come back into the classroom, we need to acknowledge that they may be dealing with devastating losses, or the frustration of being kept inside, or the violence that is happening in their homes and neighborhoods. It’s very hard to learn if you’re first dealing with those kinds of issues. Our teachers already do so much, and we need to support them more and provide even more training to help them address that wide-ranging set of challenges their students may be facing even before they can get to the learning part.

“Something that many educators already understood is that one size does not fit all. This is why education is so complex and why it has been so challenging to bring about improvements because there’s no silver bullet.”

GAZETTE:   Are there any silver linings in education brought on by the pandemic?

LONG:   The first one is when we all needed to pivot last spring, and especially this fall, many educators took a moment to pause and reflect on their learning goals and priorities. There was a great deal of discussion, both in K‒12 and higher education, to think carefully and deliberately about the ways in which we could make sure our teaching was engaging and active and how we could bring in different voices and perspectives. In many respects, this crisis forced the entire field to rethink our teaching in a way that I don’t know has happened before. The second silver lining is the innovation and creativity. Because there wasn’t necessarily one right answer, you saw a lot of experimentation. We have seen an explosion of different approaches to teaching, and many more people got involved in that process, not just some small 10 percent of the teaching force. We’ve identified new ways of engaging with our students, and we’ve also increased the capacity of our educators to be able to deliver new ways of engagement. From this process, my hope is that we’ll walk away with even more tools and approaches to how we engage our students, so that we can then make choices about what to do face-to-face, how to use technology, and what to do in more of an asynchronous sort of way. But key to this is being able to share those lessons learned with others, how you were able to still maintain connection, how you were better able to teach certain material, and perhaps even build better relationships with parents and families during this process. Just the innovation, experimentation, and growth of instructors in many places has been very positive in so many respects.

GAZETTE:   In which ways do you think the education system should be transformed after this year? How should it be rebuilt?

LONG:   First, we’ve all had to understand that education and schools are not a spot on a map. They are actually communities; they have to include families, nonprofit organizations, and community-based organizations. For a university in particular, it’s not just about coming to campus; it’s actually about the people coming together, and how they are involved in learning from each other. It’s great to push on this reconceptualization and to be clear that education is an exchange of information, of perspective, of content, and making connections, regardless of the age of the student. The crisis has also forced us to go back to some of the fundamentals of what do we need students to learn, and how are we going to accomplish those goals. That has been a very important discussion for education. And the third part is realizing that education is not a one-size-fits-all. The best educators use multiple methods and approaches to be able to connect with their students, to be able to present material, and to provide support. That’s always been the case. How do we meet students where they are? That framing is one that I hope will not go away because all students have the potential to learn, and it’s a matter of how to personalize the learning experience to meet their needs, how we notice and provide supports to help learners who are struggling. That really is at the core of education, and I hope that we will take away that lesson as we look ahead.

GAZETTE:   What do you think the role of higher education should be in this new educational landscape?

LONG: Higher education has an incredibly important role, and in particular given the economic recession. Traditionally, this is when many more people go into higher education to learn new skills, given what’s happening in the labor market. We have yet to see what the long-term impact is going to be, but in the short term, one thing we’ve noticed is that college enrollments are down. That’s very alarming and may have to do with how suddenly and how quickly the pandemic affected society. The first thing that higher education is going to have to think about is increasing proactive outreach — how to connect with potential students and how to help them get into programs that are going to give them skills necessary for this changing economy. Unfortunately, they’ll be doing this in a context where students are going to have greater needs, and where it’s not quite clear if funding from state and local governments is going to be declining. That’s the challenge that higher education will have to face. While it’s an amazing instrument in helping individuals further their skills or retool their skills, we need to make investments and make sure individuals can actually access the training available in our colleges and universities.

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GAZETTE:   What are your hopes for the Biden administration in the area of education?

LONG:   Government has a very important role in education, but it has to be balanced with the importance of local control and the fact that the context of every community is slightly different. Certainly, as we’ve been in the middle of a public health crisis, this has been incredibly challenging for schools. Schools had been trying to continue providing food and health care and connect with their students and, all of a sudden, they had to become experts in public health and buildings. This is something that falls under the purview of the federal government. Having access to the best doctors, the best public health officials, and people who think about buildings, and how to make things safe, the government needs to put that information together to give guidance to schools, principals, and teachers. It’s the government that can say, “Here are the risks, and here are the things you can do to mitigate those risks. Here are the conditions that are necessary for buildings. Here is what we know in terms of preventing spread, and here is what we know about the impact on children of different ages, and how we can protect the adults.” That kind of guidance would be incredibly helpful, as you have all of these individual school districts trying to sort through complex information and what the science says and how it applies to their particular context. Guidance is No. 1.

No. 2 is data. It’s very important having some understanding about where we stand in terms of learning loss, what we need to prioritize, and what areas of the country perhaps need more help than others. The other key component is to gauge what lessons have been learned and share the best practices across all school districts. The idea is to use the federal government as a central information bank with proactive outreach to schools. Government also plays a critical role in funding the research that will document the lessons from this pandemic.

It’s going to be incredibly helpful to have a more active federal government. As we have a better sense about where our students are the most vulnerable, and what are the kinds of high-impact practices that would be most beneficial, it’s going to be critical having the funding to support those kinds of investments because they will most certainly pay off. That possibility, I’m much more optimistic about now.

This interview has been condensed and edited for length and clarity

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• Nancy L Leech University of Colorado Denver
• Sophie Gullett University of Colorado Denver
• Miriam Howland Cummings University of Colorado Denver
• Carolyn A Haug Colorado Department of Education

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Outlier: How one NJ school district upped test scores and beat COVID's learning loss

A recent email from the state Department of Education took Union City Schools Superintendent Silvia Abbato by surprise. 

The district, which serves some of New Jersey’s poorest students, had achieved a distinction. Its 11 schools were all meeting academic goals without state assistance — setting it apart from the 44 largest districts, even though Union City ranks third for students with high needs.

New immigrants keep arriving in this Spanish-speaking conclave of Hudson County, once a magnet for Cuban exiles — 54.6% of its population is foreign born, according to the 2020 census. 

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“We have noticed that year-in and year-out, Union City School District has been experiencing exceptionally strong outcomes for some of our state’s most challenging students,” the state email said. What was it doing differently? The state wanted to learn. 

New Jersey’s Education Department wasn’t the only one taking notice. 

Harvard economist Thomas Kane called Union City an “outlier” in New Jersey. According to the Education Recovery Scorecard — a Harvard and Stanford University collaboration examining academic recovery after the COVID-19 pandemic in 30 states — Union City’s students improved in reading between 2019 and 2022, while many other districts flailed.

The district also had the least learning loss because of the COVID-19 pandemic — and a significant recovery, even compared with such wealthier, higher-performing districts as Edison in Middlesex County and the West Windsor-Plainsboro Regional School District in Mercer County.  

That's why Union City's success — in spite of its student population challenges and the pandemic — make it stand out as a possible case study to replicate for other New Jersey urban districts that serve large minority and low-income student populations, including Paterson and Passaic.

Union City's success through the pandemic occurred because of some very specific, quick-thinking decisions by administrators there — such as getting laptops to nearly all students soon after schools shut down during the pandemic, raising staff morale by using relief dollars to save jobs, and distributing food to families once a week to limit COVID exposure.

But its success in limiting learning loss — and recovering so quickly after the pandemic — was also based on a strong foundation of key decisions carried out over several decades by a district once so troubled it was threatened with a state takeover.

Because of the pandemic's disruption, most schools nationwide are still far behind their own 2019 levels of math achievement, Kane’s study showed. Between 2019 and 2022, American eighth graders lost 40% of pre-pandemic progress in math.

One of the pandemic's worst impacts in K-12 education is that it has widened achievement gaps for minority students. New Jersey’s Black and Hispanic students lost nearly a third of a year’s learning in math compared with white students.

Pandemic learning loss still high in many districts

Kane's study showed that in 2022, Newark, Perth Amboy, Paterson and New Brunswick were still more than one grade behind their own 2019 learning levels.  

But Union City, a similarly high-poverty district, lost very little and has almost fully recovered, Kane said. What makes that all the more impressive is that in Union City, 35% of students are non-English native speakers and 84% are low income.  

Edison and West Windsor-Plainsboro lost 1.23 and 1.18 points each in math — more than one year’s worth of learning between 2019 and 2022. Union City, at 0.26 points, lost only a quarter of a year’s worth of learning. 

Those two districts do outperform Union City in overall math and English proficiency. But Union City schools made gains in reading during and after the pandemic’s shutdowns, while Edison lost three-quarters of a year’s worth of learning and West Windsor lost a third of a year. Both districts had not returned to their pre-pandemic reading levels in 2023. 

At the José Martí STEM Academy in Union City, established in 2019 for the district's gifted high-schoolers, soaring English and math proficiency rates at 91% and 61% in 2022-23 showed barely a dent from the pandemic, which hit while the school was in its infancy.

The Passaic city school district, like Union City, has many low-income and Hispanic students. By 2022, its students had lost three-quarters of a year’s progress in math, worse than Union City but far better than Paterson and even Edison. 

When asked why, suburban, higher-income Edison, with 23% low-income students, declined to comment.  

In the city of Passaic, 97% of students are low-income. Its administrators were aware of Union City’s success. They said they “strive” to emulate it, “recognizing the immense value of a high-performing urban educational system.” 

Quick thinking when COVID hit

Union City already had strong foundations from the 1990s, when it rebooted after the state nearly took over its schools. Those decades of work provided a strong underpinning during the pandemic — there were no quick-fix silver bullets.

Still, Abbato, the superintendent, needed to think quickly when the virus hit.

When schools closed due to COVID in early 2020, 90% of her students did not have laptops. The district had only 5,600 district laptops to distribute; Abbato sent kids home with whatever technology was available, bypassing some supply chain delays.

“We emptied our classrooms and labs,” Abbato said. Despite progress during the coronavirus lockdown, about 89,000 students across the state were still home without learning devices or internet access in June 2020.

When Union City schools reopened in September 2020, every student from grades one through 12 had a laptop and Wi-Fi access, Abbato said. Chromebooks were also purchased for children enrolled in the district's early childhood programs.  

Abbato also decided that easy and safe food delivery was essential to building confidence within the community. Most urban districts had families visit schools to pick up food on multiple days of the week. Abbato made an executive decision: Union City families would receive an entire week’s supply of food in one school visit. 

When the food suppliers told her this was impossible due to supply problems, she told them to find a way — even if it meant including more dry, non-perishable foods in the weekly packets. 

This would give families flexibility in a community already reeling from the virus and leery of further exposure. COVID-19 was the leading cause of death in New Jersey among Black, Hispanic, Asian and foreign-born residents in 2020, according to the state Health Department. Hudson County was among the worst hit. 

In-person tutoring over remote

Last year, when the state awarded thousands of dollars in high-impact tutoring grants to help kids catch up from COVID learning loss, Abbato decided to stick with the district's own teachers, while most districts, struggling from the ongoing teacher shortage, purchased virtual tutoring platforms.

In-person tutoring matters, she said. “The teachers know the students — they’re with them every day,” she said. District teachers tutored small groups with a $614,000 grant.

Studies have linked longer remote schooling to increased learning loss. Union City also was remote through most of the 2020-21 school year but reopened for in-person learning in May 2021. As in many suburban schools, remote students alternated with in-class cohorts.

In comparison, Passaic city’s students were all remote from mid-March 2020 until summer school began in July 2021, two months after Union City. It, too, offered summer and after-school programming for all students. But its Chromebook distribution went on throughout 2020, the district said.

Threatened with state takeover

A failing district in 1989, Union City was threatened with a state takeover, said David Kirp, a professor at the Goldman School of Public Policy at the University of California, Berkeley, whose book “Improbable Scholars” profiles the district's later success.

The district replaced top administrators during a one-year reprieve from Trenton. Veteran bilingual teacher Fred Carrig was put in charge of fixing the schools. His core team included Abbato, then an elementary school math and science supervisor.

Combining innovation and research with standard reform, the district began to change within the year. The team visited each school and sold teachers on new approaches.  

“The curriculum had no continuity” before, Abbato told NorthJersey.com. That had to change. 

The same lessons were now taught in the same sequence districtwide, so as not to affect kids who moved within the city during the school year, Kirp said.

Carrig devised “learning centers” by assigning kids who were similar academically into groups in the same classroom to help homeroom teachers keep tabs on them. And students were exposed to lots of language in what Kirp calls a “word-soaked” curriculum.

Boosted early childhood education

The district boosted its early childhood education. In an unusual feat, it continues to provide private centers with its own curriculum, which the centers then implement, Abbato said. The first cohort of fourth graders who went through the revamped preschool program improved "dramatically" on the New Jersey Assessment of Skills and Knowledge, a state test, she said.

Fourth graders meeting or exceeding state standards in English almost doubled from 45% to 86% between 1998 and 1999, when the district revamped its preschool program, and between 2002 and 2003, according to a study by the Education Law Center .

The study also showed that Union City students spent more time on instruction than did students throughout New Jersey, even in the wealthiest districts.

But at the heart of Union City’s continued success is a bedrock: its sense of community. 

Abbato’s twin sister, Adriana Birne, runs the district’s much-lauded early childhood center — U.S. Education Secretary Miguel Cardona visited in February. 

Abbato and her twin are nearly lifelong residents, having arrived in Union City as children when their parents immigrated from Cuba. Teachers stay on, and many are former students. A retired teacher returns to paint elaborate jungle murals on the walls of Colin Powell Elementary, said a beaming Teresita Diaz, its principal.

During a recent school visit to Colin Powell, Abbato greeted every employee — many by name. She remembered if they had been out sick. A class of fourth graders, undaunted by visitors, was ready to answer questions and walk up to the front of the class. A sense of pride pervaded.  

Senior administrators also credited Union City Mayor Brian Stack, a Democratic state senator, who pays close attention to the schools while bringing along a Trenton connection. 

Stack also appoints Union City's school board members; they are not elected. "It's another reason we're successful. BOE members have remained for many years and are aware of long-term initiatives," Abbato said.

Problems are more scalable in Union City than in larger districts such as Paterson, Abbato acknowledged. Central office personnel are assigned to specific schools, sometimes targeting specific grades. 

“We’re not a large district," she said. "We use our data to drive decisions, and we have a stable leadership. That plays a great role. There’s not that many transfers and changes within schools. You want stability.” 

The district spent 80% of its $50 million federal COVID relief grant through the American Rescue Plan on salaries and benefits for staff. Job security — even for non-instructional staff — during the pandemic has paid off.

Challenges remain for Union City

Still, the district has its share of challenges. 

Federal law requires states to identify low-income schools that are struggling. In 2021-22, the Murphy administration flagged Union City's 300-student PK-3 Hudson Elementary School as needing targeted support .  

“We immediately went as a team to that school,” Abbato said. Her team of supervisors made scheduled and unannounced visits, bringing new hires up to speed with district practices and creating a blueprint. 

“We monitored to make sure everything was being followed at the the classroom level,” Abbato said. 

A year later, in 2022-23, Hudson Elementary was off the state list. 

Another problem area is math, where proficiency is only 33%, well below state targets.  

Abbato said she is working on it, especially high school algebra. Both nationally and in the district, “Algebra scores aren’t where we want them to be,” she said.  “We have a large immigrant population, and the English is a little easier for them to capture than math, which needs problem solving, using both formulas and language.” 

Unique bilingual program

Reading is Union City’s big success. Nearly three-quarters of its students speak Spanish at home, yet the district surpassed state averages for English proficiency. 

Its advanced bilingual program is unique. Students who exit ESL services continue to receive additional, in-class support from appointed staff. Teachers are ESL/bilingual-certified, and on the district’s tab. "Almost no one else does that," Abbato said. "Here it’s part of the contract. We used to do it for all teachers, but now it's too costly, so we offer it to selected teachers.”

Then there’s the “port of entry” program, with an extra ESL class period and native language instruction for over-age immigrant students who may have recently crossed the border.  

Abbato navigates the statewide teacher shortage with professional development and word-of-mouth hiring from within the town. 

The district’s approach to children with learning disabilities is also unique, at a time when out-of-district special education costs are skyrocketing. It retains around 91% of special needs kids — including the autistic population — in district, through special resource programming. The city of Passaic sends 15% of its special needs students outside the district.

“If they’re going to outside providers, they’re on a bus at least an hour each way,” Abbato said. “They’re getting home late. They’re not in the community. I think its best when we have our students with us.” 

“From being part of the team that first put in improvements in the district,” said Abbato, now in her 10th year as superintendent, “it’s just overwhelming to see the progress.” 

This article originally appeared on NorthJersey.com: Outlier: How one NJ school district upped test scores and beat COVID's learning loss

Education Workforce

They started teaching during the pandemic year. where are they now, by emily tate sullivan     apr 23, 2024.

Kindlena / Shutterstock

Around this time four years ago, a seismic event was rippling across education.

In April 2020, teachers were beginning to realize that their schools’ closures would not be all that temporary. They’d need to make do with haphazard plans for distance learning through the end of the school year — perhaps longer.

For most educators, the pandemic was a defining moment in their careers, a situation more disruptive than they could’ve imagined.

For first-year teachers, it was baptism by fire.

In summer 2020, EdSurge profiled nine first-year teachers to understand what it was like for them to launch their careers during the pandemic year (2019-20).

Now, all of them are (or would be) in their fifth year in the classroom — a year by which about 44 percent of educators have left the profession. We checked in with them this month to see how they’re doing, what they’re up to and where they are now.

Six of the original nine responded to our queries. Of those six, one left teaching during her third year, and another will resign next month, at the end of the school year. The other four are still teaching and plan to continue.

EdSurge asked them to share about the challenges, rewards and lessons from their first five years — and, if they left, to elaborate on what drove them out. Their written responses are below, lightly edited for clarity and brevity.

Read the original story, from August 2020, here . Or listen to some of the teachers reflect on their first year during an episode of the EdSurge Podcast.

Lauren Bayersdorfer

Age : 28 Location : East Rutherford, New Jersey Status : Still teaching Starting salary : ~$65,000 Current salary : ~$70,000

Can you give a brief overview of what you’ve taught over the past five years?

I spent the first 3.5 years of my career at Weehawken High School, where I taught Algebra I (students in grades seven to nine) and AP Calculus (grades 11-12). For the past 1.5 years, I have been teaching Algebra I and geometry for grades nine and 10 at Becton Regional High School.

What has been the most challenging and rewarding part of your job?

The most challenging part has definitely been trying to keep students engaged in the classroom and interested in their learning. It's hard to teach math, period. But to compete with TikTok, social media and talking to their friends makes it that much more difficult.

The most rewarding part has been to get to know the kids on a more personal level, whether by incorporating occasional community-building activities in the classroom, or through the privilege of being their coach outside of the classroom. In addition, being able to learn from — and form friendships with — colleagues has been rewarding.

What has been the most surprising part of your teaching experience so far?

Just simply how difficult and demanding the job is. I normally walk more than 10,000 steps during school hours and am always exhausted by the end of the school day. Sometimes I just need a few minutes in my car to decompress before I run errands, go home and do more work. You always try to tell yourself, “It's only a job,” and not work outside of contract hours, but teaching is so much more than a job. It's a passion.

How do you think starting your career during the height of COVID-19 shaped your teaching experience and approach?

It showed me how, before any of the items in the job description and responsibilities [related to] teaching them math, that my No. 1 goal is to build relationships with students. You never know what any student is tackling. Coming to your class or seeing you in the hallway might be the highlight of their day!

Jamie Wong Baesa

Age : 28 Location : Lorena, Texas Status : Still teaching, but leaving at the end of this school year Starting salary : ~$40,000 Current salary : ~$48,000

I have been in the same school (and same classroom!) since I first started. However, my roles and responsibilities have shifted. I started out teaching seventh grade math and did that for three years. Being in a small school, they needed help taking on extra elective sections, so I also started teaching eighth grade art in my fourth year. Finally, this year, I’ve added sixth grade math, so now I have a hand in all three grade levels at our middle school.

The most challenging part of my job has been “all the other stuff” that comes with teaching. I teach math and art, but I also teach kids how to disagree in a healthy way, how to handle stress, how to communicate effectively, how to read and write, how to engage in the world we live in and how to manage social media. No one tells you that when you become a teacher, your role encompasses so much. We are with these students for eight hours every day, and the influence and opportunity we have is incredible, but also really hard, especially coming out of the pandemic. We aren’t trained to be professional counselors, but a lot of times this role (and many others) are thrust upon us because we are available and we care. I think this is also what leads to teacher burnout. We do so much more than our job descriptions and do not necessarily get the compensation or training we need to do it all.

The most rewarding part of my job has always been relationships — with students and with coworkers. Teaching is 100 percent a people profession, and it has been a joy to interact daily with so many wonderful humans, to see each individual grow and change and go through different life stages — good and bad. To have a tight-knit community like this has been very impactful for me.

In my five years, I had a hard time figuring out what “normal” was supposed to be in teaching. From a year cut short by COVID-19, to a hybrid year, to a year where we pretended nothing had happened — every year was a rollercoaster and vastly different from the previous one.

On the bright side, my teaching approach became one of adaptability and resilience. I had to constantly ask myself: What really matters? Is it that the student can tell me what lateral surface area is, or is it that a student who has a family member with autoimmune disease feels safe at school every day? It was not always such a dramatic dichotomy, but I think many can relate to this idea of survival. We taught what we could, we emphasized the content and skills that would last, but we also just made sure everyone was safe, healthy and getting what they individually needed. This shifted my perspective and helped me remember that, just as we try to individualize instruction, we also remember that every student (and teacher) is going through something different and needs both grace and accountability.

I think teaching these past five years has made me more empathetic and reminded me that isolated classrooms [existing] in a school bubble aren’t realistic. The students I see daily are responding to society and the events in our world and will one day have a huge impact as its future citizens. I hope in a similar manner, my impact extends beyond [sharpening] mathematical understanding to [supporting students in] how to be productive, kind, discerning humans in our world.

Wong Baesa is resigning at the end of the school year to pursue a career outside of K-12 education. While she says she still fully believes in the importance of educating the future generation, she hopes to be able to do so outside of a classroom setting.

Kristen Bao (Stein)

Age : 29 Location : Oklahoma Status : Left teaching in year three

Sadly, I left the classroom after the first quarter of the 2021-22 school year after teaching for just over two years. There were many factors that contributed to that decision.

On the practical side, I spent a great deal of effort on personal financial discipline during the first two years of my career and found success in attaining the short-term financial goal I had set for myself (saving up a six-month emergency fund). I also bought my first car, with $2,500 cash. So in year three of teaching, when I started thinking about my long-term goals and ran some financial planning calculations based on Oklahoma's pay-rate at the time, I found that even if I saved 33 percent of my income, between student loans and saving for retirement (because the compensation from the Teachers’ Retirement System of Oklahoma is not actually enough to live on during retirement), it would take me nearly a decade to be able to save for a down payment on a home. Even though I told myself every day to remember, “You're not in this for the money, you never were,” this realization was incredibly disheartening, and I don't think I was ever really able to get over that throughout the first nine weeks of the year I resigned.

At the same time, I also continued to deal with imposter syndrome. As a new teacher, I constantly felt inadequate, unable to accomplish the feats my veteran coworkers seemed to be completing with ease. I was always wondering when everyone — my principal, my students, their parents, my fellow teachers — would realize that I didn't belong there. These feelings were complicated by the fact that I was actually able to build amazing relationships with everyone in that list. Parents were lavishing me with gifts, words of gratitude and encouragement throughout the year. Students would write me notes telling me how much they loved having me as their teacher. Right before I resigned, my principal had even given me the most positive evaluation I had received since I started. She practically raved about how much I had improved in every area and how much potential she knew I still had to excel even further with time and patience.

But none of that was enough. I knew I couldn't sustain the level of success and productivity that she was depending on, or that my students needed. I had increasingly severe anxiety attacks throughout the first nine weeks of my third year of teaching. Some small thing would fall through the cracks, and I would experience symptoms such as shortness of breath for hours on end, a lump in my throat, being on the verge of tears, headaches and blurred vision. On the day that one of these attacks lasted the entire eight-hour school day, I finally opened up to my dearly beloved mentor teacher down the hall about all of these things. As I drove home after sharing with her, I knew it was time for me to step away.

I experimented with a few other career paths before I became a district executive for the Boy Scouts of America in September 2022. When this job found me, I knew it was an incredible opportunity to participate in an organization that precisely aligned with my passion. I know that I was created to contribute to helping children and families in my community flourish. This is exactly what I get to pour myself into when I wake up each morning in this current role.

Hannah Coffey (Long)

Age : 30 Location : Petaluma, California Status : Still teaching Starting salary : ~$46,000 Current salary : ~$83,000

I have taught the same grade, transitional kindergarten (TK), since I started teaching, but I have moved schools twice. In the 2021-22 school year, I moved to an elementary school in Santa Rosa, California. It was a significant raise in pay, but a 30-minute commute. That school has a lot of strengths and I learned a lot, but it had its flaws and complications as well. Long story short, I left. I almost stopped teaching.

Then, I got my dream job at Sonoma Mountain Charter. It is a wonderful school with a wonderful staff. It is close to my house, and I have the privilege of working with my mom, who is one of the school counselors in the district. It is an arts charter school, and there are a lot of ways teachers and students participate in the arts. Students learn to play instruments, participate in plays and engage in an amazing art adventure week, in which students are placed in mixed-age cohorts, and work on art projects together. As an artist myself, it is so nice to get to use my art degree so much in my professional life.

One of the challenges I faced was with varying opinions over COVID protocols. My mom has cancer and my husband has asthma, so COVID could have been very serious for either of them; as a result my husband and I were incredibly careful. That part is still hard. I wear a mask to this day. At one point, I decided I was not going to wear a mask, and seven days later, I got COVID for the first time. So I went back to masking.

The most rewarding part of teaching is the ability to help shape the future. It is a big responsibility that I take very seriously. I try to teach using multicultural materials. I teach about gender inequality and how to be kind, empathetic and accepting. Setting the foundation for most more advanced skills is amazing. A huge part of teaching littles is helping them develop a love of learning. I have to tell my students that we can’t read words on the board anymore because it is time for recess, and they beg me to continue reading. They LOVE asking questions and discovering new things. It is really amazing and truly fun!

When we returned to school in March 2021 … I had a third of my class in person in the morning, another third of my class online at the same time, then the last third in person in the afternoon. [I was surprised by] how different the kids were from how they were at home [on Zoom], as well as some of the parenting choices that we were experiencing. It was hard to get a hold of parents, and we had to tell parents to put pants on and not swear while their kids were Zooming.

I think that starting my career at the height of COVID shaped my teaching experience in a lot of different ways. We were asked to do so much. I had 28 students, and I taught a class that combined TK and kindergarten students. I was in graduate school. I was planning my wedding (which was ultimately postponed). My mom was in treatment. My [now] husband wasn’t working. It was an extremely stressful time, and then we went on an extended spring break and never came back that year. I remember driving around to my students’ houses at the end of the year just to say goodbye from a distance.

Teaching has gotten so much easier, which is normal, especially if you stay in the same grade. But it’s also because [other parts of my life have slowed down]. I graduated with my master’s degree, so that stress was gone. And I moved schools, so I was making more money, so that stress was gone. Then we had the wedding, so that stress was gone. The vaccines came out, so at least we were a little protected. Now I don’t have a long commute, I teach in a well-paying district, and I have a great team of early childhood educators I get to work with. I get to focus on making the kids’ experience at school the best one they could possibly have.

Mikia D. Frazier

Age : 27 Location : Hinesville, Georgia Status : Still teaching Salary : N/A

I have been extremely fortunate to continue teaching my favorite grade level, fourth grade, and my favorite subject, English language arts (ELA). Since starting my career, the dynamic of my department has changed a few times, so I’ve taught ELA by itself as well as ELA and social studies. Currently I am on a team of two [fourth grade teachers], so I teach ELA and social studies while my partner teaches math and science.

The most challenging part of my job has been helping my students recover from the pandemic, in terms of educational progress and social-emotional development. My current fourth graders experienced “COVID learning” during their formative years of kindergarten and first grade. While they have been back to “regular school” for a few years, I can still see the social and emotional [gaps]. However, I do feel that they are making great strides.

Another challenging part of my job has been managing all that is expected of teachers inside and outside of the classroom. We wear so many hats and make so many decisions in a day. Our students, colleagues, communities and families need us to show up for them — all in different ways. Sometimes, it can get very overwhelming. Juggling being a teacher with being a full-time student has also been a very interesting feat. Since my first year teaching, I’ve earned two degrees — my master’s degree in 2020 and a specialist degree in 2022. I’m currently working toward my leadership certification and hope to begin a doctorate program soon. The balancing act is definitely a challenge, but I’m working extremely hard to achieve my personal and professional goals while continuing to enjoy the profession.

The most rewarding part of my job is, and will always be, the relationships that I build with my students. This year is definitely a full-circle moment, as I have realized that the first group of students I had when I entered the profession in 2019 is going to high school next year! Whenever I see them out and about in the community, they still talk about memories [from that year] and how I’m their favorite teacher. While teaching can be a very tough and demanding job, the children always find a way to remind me of my impact on their lives.

The most surprising part of my teaching experience thus far is the fact that being a teacher never stops. Of course, I always knew it was a full-time job. I knew that teachers spent weekends and late nights working on all of their school tasks. But I didn’t understand the reality that teaching becomes such a part of you, sometimes you can’t turn it off. I often catch myself randomly thinking about a new strategy to try or a new project to do. It surprises me that sometimes I simply just cannot turn it off.

Starting my career at the height of COVID literally altered my brain chemistry as an educator. It was as if one of the wildest things that could ever happen actually did. I learned in that first year that anything can happen, and we have to learn to adapt. We were thrown into an entirely different realm of education with no handbook. Most of us were building the plane as we were flying it, but ultimately we landed safely. That first school year showed me that teachers are capable of absolutely anything. I figured that if I could survive that, I could survive anything. The experience taught me to adapt, [helped me develop] an immense level of patience and it taught me that I could persevere through a lot.

Steve Middleton

Age : 46 Location : San Antonio, Texas Status : Still teaching Starting salary : ~$56,000 Current salary : ~$58,000

Over the past five years, I've experienced both consistency and transitions in my teaching career. I started at one public middle school where I taught digital communications, and then moved to a different one in the district, called Bush Middle School. At Bush, I teach technology applications, computer science and robotics.

In the past five years, the most challenging part of my job has been dealing with unsupportive colleagues at my previous school.

The most rewarding aspect has been implementing innovative strategies in my classes, such as starting a weekly email initiative in which students send an email home to their parents/guardians every Monday with an update about their learning. In the emails, students include a screenshot of their grades across all classes, two fun or interesting things from school, and a plan to complete any missing assignments. I’ve been doing this for about three years now, and it serves a few purposes. It breaks a negative cycle where parents only hear from their child’s school when something is wrong. It empowers students to take responsibility for their learning. It promotes transparency among students, teachers and families.

The weekly email is not schoolwide yet. However, word has gotten out, and my district has asked me to give a training on it to other technology teachers in the district for next school year.

The most surprising part of my teaching experience thus far has been witnessing the incredible resilience and determination of my students. Despite any challenges they may face, they continue to push forward and demonstrate their eagerness to learn. This unwavering dedication has been both humbling and inspiring, as it serves as a constant reminder that the work I do is ultimately about the students and their growth. Their perseverance has undoubtedly played a pivotal role in motivating me as an educator.

This unprecedented situation compelled me to think outside the box, develop innovative solutions and adapt to constantly changing circumstances. It also taught me that fostering independent learning skills in students must begin at an early age. The pandemic served as a powerful reminder that, just as I cannot drink water for them when they are thirsty, I cannot absorb knowledge on their behalf — the effort to learn must come from within.

Emily Tate Sullivan ( @ByEmilyTate ) is a senior reporter at EdSurge covering early childhood, child care and K-12 education. Reach her at emily [at] edsurge [dot] com.

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ORIGINAL RESEARCH article

Understanding health education needs of pregnant women in china during public health emergencies: a qualitative study amidst the covid-19 pandemic.

• 1 Department of Nursing, Quanzhou Medical College, Quanzhou, Fujian, China
• 2 Nursing Department, Quanzhou Women and Children's Hospital, Quanzhou, Fujian, China
• 3 Department of Imaging, Anxi County Hospital, Quanzhou, Fujian, China
• 4 Department of Child Health Care, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China

Background: Public health emergencies impose unique challenges on pregnant women, affecting their physiological, psychological, and social wellbeing. This study, focusing on the context of the corona virus disease in 2019 (COVID-19) pandemic in China, aims to comprehensively explore the experiences of pregnant women amidst diverse public health crises. Herein, we investigate the health education needs of pregnant Chinese women in regard to public health emergencies to provide a scientific foundation for the development of targeted health education strategies.

Objective: The study described in this article aims to explore the health education needs of pregnant Chinese women in the context of public health emergencies specifying the types of emergencies of pandemics and to provide a scientific basis for targeted health education interventions.

Methods: Thirteen pregnant women were purposively selected, and the rationale for this sample size lies in the qualitative nature of the study, seeking in-depth insights rather than generalizability. Data collection involved semi-structured interviews, and the Colaizzi, which is a structured qualitative technique used to extract, interpret, and organize significant statements from participant descriptions into themes, providing a comprehensive understanding of their lived experiences.

Results: The analysis yielded six prominent themes encompassing the following areas: I. Personal protection and vaccine safety; II. Knowledge of maternal health; III. Knowledge of fetal health; IV. Knowledge of childbirth; V. Knowledge of postpartum recovery; and VI. Knowledge sources of health education for pregnant women and their expectations of healthcare providers. Theme I was analyzed with two sub-themes (needs for personal protection knowledge, vaccine safety knowledge needs); Theme II was analyzed with three sub-themes (nutrition and diet, exercise and rest, sexual life); Theme III was analyzed with three sub-themes (medications and hazardous substances, pregnancy check-ups, and fetal movement monitoring); Theme IV was analyzed with three sub-themes (family accompaniment, analgesia in childbirth, and choice of mode of delivery); Theme V was analyzed with one sub-theme (knowledge of postnatal recovery); Theme VI was analyzed with one sub-theme (expectations of Healthcare providers). Sub-themes within each main theme were identified, offering a nuanced understanding of the multifaceted challenges faced by pregnant women during public health emergencies. The interrelation between sub-themes and main themes contributes to a holistic portrayal of their experiences.

Conclusion: The study emphasizes the need for healthcare professionals to tailor health education for pregnant women during emergencies, highlighting the role of the Internet in improving information dissemination. It recommends actionable strategies for effective health communication, ensuring these women receive comprehensive support through digital platforms for better health outcomes during public health crises.

1 Introduction

Pregnancy ushers in a period of diverse physiological, psychological, and social changes, necessitating specialized attention to address the unique needs of expectant women ( 1 ). The coronavirus disease outbreak in 2019 (COVID-19) has disproportionately affected pregnant individuals worldwide, with altered immune responses and compromised lung function placing them at heightened risk of infection ( 2 ). This increased susceptibility raises concerns about the potential for adverse pregnancy outcomes ( 3 ). In response to the COVID-19 pandemic, home isolation emerged as an important preventive measure against the spread of the virus, presenting pregnant women with the dual challenge of managing the inherent health challenges of pregnancy alongside the additional stresses and complexities introduced by the pandemic ( 4 ).

In this evolving landscape, the content and methods of delivering health education to pregnant women have significantly changed. Despite these developments, research on healthcare for pregnant women during epidemics, particularly within the Chinese context, remains scarce. Existing literature has largely focused on the psychological impacts of such crises on pregnant women ( 5 – 9 ).

In addition to focusing on the psychological wellbeing of pregnant women, it is also important to consider the broader spectrum of challenges they face, including physical health concerns and the need for social support during epidemics. Studies have demonstrated that epidemics like COVID-19 pose significant risks to the physical health of pregnant women, increasing the likelihood of complications such as preterm birth, preeclampsia, and gestational diabetes ( 10 , 11 ). Moreover, the impact of social distancing and healthcare system strain on the availability and quality of prenatal care further complicates these physical health challenges. In addition, social support plays a vital role in mitigating the psychological impact of epidemics on pregnant women ( 12 ). The reduction in face-to-face interactions and the increased reliance on virtual platforms for support have transformed the nature of social networks, with varying implications for maternal wellbeing. By integrating this broader spectrum of research, the complex interplay between psychological, physical and social factors affecting pregnant women during epidemics can be more clearly determined. This comprehensive approach not only enriches our understanding of their health education needs but also highlights the necessity for multifaceted health education strategies that address these interconnected aspects.

This study aims to fill this research gap by utilizing qualitative interviews to investigate the health education needs of pregnant Chinese women during public health emergencies, with a specific focus on the COVID-19 outbreak that began in China in 2021. The focus on China in this study is particularly relevant due to the country's unique challenges during the COVID-19 pandemic. China was the epicenter of the COVID-19 outbreak, facing unprecedented public health challenges that required rapid and large-scale interventions ( 13 ). This situation significantly impacted pregnant women, who faced heightened risks due to altered immune responses and compromised lung function, increasing their vulnerability to infection. Furthermore, the implementation of stringent lockdown measures and hospital visitation restrictions introduced additional complexities for accessing prenatal care and support systems ( 14 , 15 ). These factors underscore the importance of exploring the health education needs of pregnant Chinese women during such emergencies. By concentrating on the Chinese context, this study aims to uncover insights that can inform targeted health education strategies, acknowledging the nuanced ways in which cultural, social, and healthcare system factors intersect to influence health education needs and outcomes during public health crises.

Thus, we designed this present study to explore the specific health education requirements and information-seeking behaviors of pregnant Chinese women during the COVID-19 outbreak. The ultimate goal is to provide insights for healthcare institutions and professionals to develop effective health education strategies. These strategies are intended to safeguard the health and wellbeing of expectant mothers and their unborn children, offering a foundational framework to guide future research and practice in health education during similar health crises.

2 Research methodology

2.1 study participants.

A purposive sampling method was utilized to select 13 pregnant women for pre-interview participation who attended pregnancy healthcare examinations at an obstetrics outpatient clinic in a maternity and child healthcare hospital in Quanzhou City, Fujian Province, from December 2021 to June 2022. The selection process adhered to specific inclusion criteria: (1) Pregnant women aged 35 years or younger, with a gestational age of 12 weeks or more; (2) No presence of comorbidities or complications at the time of study; (3) A minimum education level of junior high school, ensuring adequate literacy for understanding and responding to the study's requirements; and (4) Willingness to provide informed consent. The study exclusion criteria were: (1) Severe audiovisual or cognitive impairments that could affect the participant's ability to understand questions or provide coherent responses; (2) A history of mental illness; and (3) Unwillingness to cooperate after the study's objectives and procedures had been explained by the investigator.

The study sample size was determined by the principle of information saturation, where the recruitment continued until no new themes were identified in the data. Following these criteria, 13 pregnant women were selected for the study, each assigned a unique identifier ranging from A to M.

2.2 Research instruments

2.2.1 basic information questionnaire.

This questionnaire was designed to collect baseline data from the pregnant women participating in the study, such as their gestational age, personal age, level of education, pregnancy type, and whether the pregnancy was intentional.

2.2.2 Interview outline

The interview outline was initially drafted by referring to the relevant literature ( 16 – 20 ) and by consultations with experts in nursing, obstetrics, and individuals outside the participant pool for pre-testing. After undergoing two rounds of revisions by nursing and obstetric experts and three pre-test sessions with non-participants, the final interview guide was established. The outline covered the following key questions:

(1) During the COVID-19 epidemic, what are your specific needs for health education, information, or healthcare services related to pregnancy?

(2) What are the primary methods or channels through which you seek out health education or information on pregnancy?

(3) How do you prefer to receive pregnancy-related health education and information from healthcare providers?

2.3 Research methods

2.3.1 data collection.

The study was approved by the Ethics Committee of Quanzhou Medical College (Approval No. 2021007). Using the phenomenological method, this qualitative research conducted in-depth, face-to-face interviews with each participant, lasting between 20 and 40 min. To ensure the accuracy and completeness of the data, follow-up telephone calls were made after each interview for content confirmation, allowing participants to add further insights or clarify previous statements.

Prior to conducting the interviews, necessary preparations were made, including the setup of tape recorders and notebooks to accurately capture the dialogue. Participants were informed about the study's objectives, its importance, the confidentiality of their responses, and their rights as participants, establishing a foundation of trust. Interviews were held in a private obstetrics room to guarantee confidentiality and create a comfortable setting for the participants.

To uphold the integrity of our study and minimize potential biases in data collection, rigorous steps were taken to train the interviewers and ensure their neutrality throughout the interviewing process. The following measures were implemented: (1) Interviewer training: prior to engaging with participants, interviewers underwent comprehensive training sessions conducted by experienced researchers in qualitative data collection. These sessions focused on the ethical considerations of interviewing pregnant women during public health emergencies, emphasizing the importance of neutrality, empathy, and open-mindedness. (2) Practice interviews: to refine their interviewing skills and familiarize themselves with potential challenges, interviewers conducted practice interviews with individuals who did not participate in the main study. Feedback from these practice sessions was critically reviewed, and additional training was provided where necessary to enhance the interviewers' proficiency. (3) Use of structured interview guides: interviewers utilized structured interview guides that were carefully designed and reviewed by the research team. These guides aimed to maintain consistency across interviews while allowing for flexibility to explore emergent themes. The questions were framed to minimize any inadvertent biases and to encourage participants to express their experiences openly. (4) Ongoing supervision and debriefing: throughout the data collection period, regular supervision meetings and debriefing sessions were conducted with the interviewers. This provided a platform to discuss any challenges faced during interviews and to address any potential biases that might have emerged. Consistent communication ensured that the research team remained vigilant in maintaining data collection standards.

Utilizing a semi-structured interview format based on a pre-developed outline allowed for the flexibility to adjust questions and their sequence as needed, tailoring the approach to each participant's responses. The researchers actively engaged with participants, guiding the conversation, posing questions, and seeking clarification when necessary, all the while maintaining a focus on the study's central theme.

A key aspect of the methodology was the emphasis on creating an environment conducive to open and honest communication. Participants were encouraged to share their thoughts and feelings freely. In addition to verbal responses, researchers also observed and noted non-verbal cues such as facial expressions, tone, pauses in speech, and body language. These observations were recorded and included in the data analysis to provide a comprehensive understanding of the participants' experiences.

2.3.2 Data organization

After each interview, we stored the original audio data and the general information questionnaire of the research subjects together in a designated folder. Within 2 days of concluding each interview, the audio data was transcribed into textual form and coded according to the alphabetical numbers assigned to each participant (A to M). The time and location of the interview were noted at the beginning of the text. After transcription, the texts underwent a meticulous review process to ensure their accuracy compared to the original recordings. Once validated, these accurate transcripts were saved in the unique digital folder for each participant, facilitating organized data retrieval for analysis.

To enhance the overall credibility of our study, we take the following approach:

Validation of findings: (1) Member checking: to enhance the credibility of our findings, we employed member checking as a form of validation. A subset of participants was provided with a summary of the identified themes and findings. Their feedback and reflections on whether these accurately represented their experiences were actively sought. This iterative process allowed us to refine and validate the interpretation of our data. (2) Peer debriefing: regular debriefing sessions were conducted within the research team. The interdisciplinary nature of our team facilitated a comprehensive discussion of the emerging themes, interpretations, and any potential biases. Peer debriefing served as a form of internal validation, ensuring that diverse perspectives were considered during the analysis. (3) Audit trail: an extensive audit trail was maintained throughout the research process. Detailed records of the data collection, coding, and analytical decisions were documented. This audit trail serves as a transparent account of our research journey, enabling others to follow our analytical processes and decisions.

Triangulation of findings: (1) Data source triangulation: we collected data through multiple sources, including individual interviews and, where applicable, relevant documents. Triangulating data from various sources enriched the depth and comprehensiveness of our findings, providing a more holistic understanding of pregnant women's experiences during public health emergencies. (2) Methodological triangulation: in addition to Colaizzi's phenomenological method, which served as our primary analytical approach, we applied methodological triangulation by exploring quantitative data related to demographic variables. This combination of qualitative and quantitative methods added layers to our understanding and strengthened the robustness of our findings.

3.1 Basic information

The baseline information of the study participants is shown in Table 1 .

Table 1 . Basic information of pregnant women ( n = 13).

3.2 Findings

3.2.1 theme 1: personal protection and vaccine safety, 3.2.1.1 needs for personal protection knowledge.

Twelve of the study participants reported concerns about their knowledge regarding personal protective measures in the context of the epidemic. These individuals participated in regular maternity examinations and adopted a range of protective strategies to mitigate the risk of viral infection. Nonetheless, there was prevalent anxiety concerning the potential implications of maternal infection on both fetal and maternal health. While some adhered rigorously to prescribed protective guidelines, they further expressed a desire for healthcare facilities to strengthen their infection control protocols. Conversely, a subset of participants decided against attending hospital-based maternity check-ups, citing these concerns.

Participant A detailed the protective measures she adopted, saying, “For my pregnancy test last week, I wore two masks and goggles. Upon returning home, I immediately used alcohol for disinfection, changed, and thoroughly cleaned everything before going back to the hospital. My aim is to ensure complete protection and prevent any accidental virus transmission,” she added, visibly concerned (frowns).

Participant B expressed apprehension about hospital environments: “I avoid hospital visits unless absolutely necessary for my baby's health. Hospitals are crowded, and surfaces like door handles and elevator buttons might not be sanitized properly. I wish there were more rigorous disinfection practices in place.”

Participant C shared her unease about hospital visits, stating, “Even though I try to keep a distance, people often crowd together in lines. The hospital's lax approach to managing crowds increases my anxiety about obtaining a safe pregnancy test,” she remarked, frowning (frowns).

Participant D considered alternative preventive measures: “I've looked into mask effectiveness online and thought about herbal remedies for COVID-19 prevention. A neighbor knowledgeable in traditional medicine suggested a formula I'm thinking of trying.”

Participant E, recognizing the pandemic's severity, said, “With the current state of the COVID-19 epidemic, it's crucial for me to learn about protective measures during pregnancy and how to manage risks.”

Participant G, voicing her fears, mentioned, “The possibility of COVID-19 affecting my baby and me is a significant concern. I'm avoiding crowded places and taking all necessary precautions. I'm also looking for information on preventing infection during pregnancy.”

Participant H stressed the importance of medical advice: “I'm looking for guidance from healthcare professionals on how to protect myself and my fetus during the pandemic.”

During her second pregnancy, Participant H felt more anxious: “This pandemic has made me more worried than during my first pregnancy. I'm concerned about the virus's potential impact on my fetus during childbirth.”

Participant I was confused by conflicting information: “Although I've seen reports on TV and online about COVID-19′s effects on pregnant women and fetuses, I'm still unsure about the best actions to take.”

Approaching her due date, Participant J shared her concerns about hospital visits: “With my due date near, the thought of hospital visits is worrisome. Constantly wearing a mask is challenging, and my anxiety grows daily,” she said, frowning.

Participant K discussed the difficulties in accessing prenatal care: “Every maternity check-up requires health and travel code verification, which is tedious. Despite having appointments, long waits are common. The strict infection control and limited check-up slots often conflict with my schedule, leaving me worried about completing necessary checks for my fetus's health,” she explained, frowning.

Participant L contemplated the repercussions of contracting the virus: “If I were to catch the virus, I'm concerned about its impact on my unborn child, especially if it complicates hospital visits for labor or delivery.”

Expressing fears of reinfection, Participant M said, “Having had COVID-19 before, I'm worried about how it might affect my unborn child and the unsettling thought of getting the virus again,” her concern evident in her expression.

Collectively, while all participants expressed concerns about their knowledge of personal protective measures, their levels of anxiety and the extent of protective strategies they adopted varied significantly. For example, Participant A took extensive protective measures, including wearing multiple masks and goggles, which indicates a high level of anxiety and a strong desire for comprehensive protection. In contrast, other participants, like Participant D, explored alternative preventive measures, such as herbal remedies, suggesting a divergence in trust or confidence in conventional medical advice vs. traditional or alternative health practices.

3.2.1.2 Vaccine safety knowledge needs

Six participants highlighted their need for information on the safety of the COVID-19 vaccine during pregnancy. Concerns were focused on the potential adverse effects on the fetus, particularly when the vaccine was administered during unplanned pregnancies or within the first trimester. Questions also emerged regarding the effectiveness of partial vaccination with only three doses instead of the full series (COVID-19 vaccine full vaccination, meaning that the vaccine should be given in three consecutive doses, with the second dose to be completed as far as possible within 8 weeks of the first dose, and the third dose to be completed as far as possible within 6 months of the first dose).

Participant A shared her concerns about early vaccination: “I was vaccinated with the COVID-19 vaccine early in my pregnancy, which was unexpected. I'm worried about the possible negative effects on my baby's health.”

Participant E, who became pregnant soon after receiving the vaccine, expressed her fears: “I got pregnant 2 weeks after my third dose of the vaccine, without any plans for pregnancy at that time. Had I known, I might have reconsidered getting the vaccine, especially since there were advisories against pregnant women receiving it. The situation is quite worrying now.”

Participant H was confused by the varying advice: “The guidance regarding vaccination for pregnant women appears inconsistent. It's sometimes advised against, yet also presented as a protective measure against the virus. I'm unsure about the safety of receiving the vaccine during pregnancy.”

Participant K, nearing her due date, sought clarity: “With my baby's development well underway, is it safe for me to receive the vaccine now, or should I wait until after the delivery and breastfeeding period?”

Participant L had doubts about vaccine coverage: “After receiving one dose of the COVID-19 vaccine, I'm left wondering whether it fully protects against COVID-19-related pneumonia.”

Participant M, contemplating the need for a complete vaccination series, asked: “I had two doses before getting pregnant and didn't complete the third dose before conceiving. Is my vaccination still effective? And is completing the third dose crucial for ongoing protection?”

Here, we observed a clear division in attitudes toward hospital visits for maternity check-ups. Some participants, such as Participant B, avoided hospital visits due to concerns about insufficient sanitation and the risk of exposure in crowded settings. Others, however, despite sharing these concerns, continued to attend check-ups, emphasizing the importance of regular medical supervision for the baby's health. This divergence highlights a conflict between the perceived risk of exposure and the perceived necessity of prenatal care. Conflicting information and decision-making: participant I's confusion about the best actions to take due to conflicting information underscores a significant divergence in how participants processed and acted upon COVID-19-related health information. This variation suggests a need for clear, consistent, and trustworthy health communication tailored to pregnant women's concerns.

In addition, the participants' concerns also reflect divergent views on the efficacy and safety of the COVID-19 vaccine during pregnancy. For instance, Participant E's regret about receiving the vaccine close to conception due to advisories against pregnant women getting vaccinated highlights the confusion and mixed messages surrounding vaccination. Meanwhile, Participant L's uncertainty about the protection offered by a single vaccine dose points to a gap in understanding about vaccine efficacy and the importance of a complete series.

3.2.2 Theme II: maternal health

3.2.2.1 nutrition and diet.

Thirteen study participants, especially those in their first pregnancy, with unplanned pregnancies, experiencing severe early pregnancy symptoms, or concerned about excessive weight gain, expressed significant concerns about maintaining a healthy diet. They were in search of advice on appropriate dietary choices and what foods to avoid.

Participant A highlighted the challenge of balancing nutrition with early pregnancy symptoms: “Understanding the critical role of nutrition during pregnancy, I find it difficult to identify foods that are both nutritious and suitable for managing early pregnancy symptoms.”

Participant B, facing an unplanned pregnancy, sought guidance on nutrition: “Being unprepared due to my unplanned pregnancy, I am keen to learn what is best for the health of both myself and my baby, including how to maintain a healthy weight and ensure the baby's nutritional needs are met.”

Participant C, experiencing her first pregnancy, expressed concerns about weight management: “My family encourages me to eat more because it's my first pregnancy. However, I am worried about gaining too much weight and want to know how to balance getting enough nutrients without excessive weight gain.”

Participant D recognized the importance of dietary knowledge: “I know diet is important during pregnancy, but need information on specific foods that should be included or avoided.”

Participant E dealt with the impact of nausea on diet: “Dealing with constant nausea makes eating well difficult. I'm drawn to acidic foods like hawthorn (Hawthorn is a kind of sour fruit, and many pregnant women want to have sour food when they are pregnant and vomiting. Although food with sour flavor can relieve nausea and vomiting that occur in pregnant women, not all sour food is suitable for pregnant women to consume, and hawthorn is an exception. Hawthorn is an exception. Hawthorn has the effect of breaking blood and dispersing silt, which can stimulate uterine contraction and may induce miscarriage. Hawthorn contains a lot of fruit acids, which have the effect of astringency and stimulating the gastric mucosa. After pregnancy, pregnant women's spleen and stomach function is poor, eating more hawthorn is easy to reduce the digestive ability and cause indigestion) but am confused by mixed messages regarding their safety.”

Participant E also questioned the timing of folic acid intake: “I conceived unexpectedly and began folic acid late. Could this lead to developmental issues, as suggested online?”

Participant F emphasized the need for detailed guidance: “As this is my first pregnancy, I'm looking for detailed advice from healthcare providers on diet, exercise, and what symptoms to expect for a healthy pregnancy journey.”

Participant G discussed the need for a balanced diet: “It's vital for pregnant women to carefully manage their diet to ensure they're getting enough nutrients while avoiding too much caffeine, sugar, and other harmful substances. Following medical advice and regular check-ups are key.”

Participant H shared concerns about late folic acid supplementation: “This pregnancy was unexpected, and I started taking folic acid later than recommended. I'm worried about how this delay might affect my baby's development.”

Participant I focused on the importance of holistic health care: “Maintaining overall health through a balanced diet, sufficient rest, and regular exercise is essential for pregnant women.”

Participant J inquired about dietary management in late pregnancy: “As I approach the end of my pregnancy, I wonder if strict dietary control is still necessary.”

Participant K addressed the issue of weight management: “Finding a balance between the weight gain recommendations from doctors and family advice is difficult. I need guidance on how to provide the best nutrition for my baby without excessive weight gain.”

Participant L aimed for a balanced approach to health: “My main goal is to keep myself healthy while minimizing any negative impact on the fetus. I'm interested in learning about recommended dietary and exercise practices.”

Participant M desired comprehensive information: “I want to learn more about all aspects related to pregnancy, including diet, exercise, and mental health.”

The participants displayed varied strategies in managing nutritional intake, balancing between craving management and symptom alleviation. While some sought specific dietary advice to mitigate early pregnancy symptoms, others focused on weight management, indicating a spectrum of priorities and concerns related to diet. In addition, there was a clear divergence in approaches to weight management, with some participants concerned about excessive weight gain and seeking guidance to avoid it, while others felt pressure to eat more to support the baby's growth, reflecting varied familial and cultural influences on dietary practices during pregnancy.

3.2.2.2 Exercise and rest

During our interviews, nine participants shared insights into their experiences with exercise during pregnancy. It was observed that the comfort level and ability to engage in physical activity varied significantly across different pregnancy stages. Women in their mid-pregnancy often found it easier to participate in exercise, whereas early pregnancy symptoms and the fear of inducing premature labor were common deterrents. As pregnancy progressed, the intensity and variety of exercises diminished, with walking emerging as the most favored form of physical activity.

Participant B discussed her exercise routine: “I've been engaging in prenatal yoga and fitness routines tailored for pregnant women. I feel more comfortable being active in my mid-pregnancy despite early pregnancy discomforts. Before I exercise, I always check online to ensure the activities are safe.”

Participant C, in her thirties and nearing the third trimester, expressed interest in expanding her exercise options beyond walking, seeking safe activities suitable for this later stage of pregnancy.

Participant E encountered challenges with staying active due to early pregnancy symptoms like nausea and vomiting, which sometimes made even walking difficult.

Participant F, experiencing pregnancy for the first time, mentioned her simple exercise routine: “I take walks after dinner but am uncertain about other exercises that would be safe for me.”

Participant G, an older first-time pregnant woman, highlighted the importance of caution and the value of walking as a shared activity with her husband, emphasizing the need for precise guidance on safe exercises from professionals.

Participant H preferred walking as her main form of exercise, consistent with her activities in previous pregnancies, though she noted that hot weather often deterred her from going outside.

Participant I adjusted her activities to accommodate her growing belly, opting for evening walks as a cautious exercise option.

Participant L engaged with online exercise programs, focusing on stretching and gentle movements, and intentionally avoided intense activities such as hiking and sports.

Participant M found a suitable exercise in yoga, attending classes led by an instructor to ensure fitness while being mindful of her body's post-pregnancy changes.

These accounts reflect the diverse approaches to exercise among pregnant women, underscoring the importance of safety, comfort, and personal preferences in maintaining physical activity during pregnancy. Overall, the comfort and ability to engage in exercise varied, with some participants integrating specific prenatal routines comfortably into their daily lives, while others found even mild exercise challenging due to symptoms or concerns about safety, indicating a need for personalized exercise guidance. Moreover, the degree of engagement in physical activities showed divergence, with some participants actively seeking out safe exercises and others defaulting to walking as a safe option, highlighting differences in personal initiative, perceived safety, and available resources for exercise during pregnancy.

3.2.2.3 Sexual life

For this topic, discussions around sexual life during pregnancy revealed a notable reticence among participants, a reflection of broader cultural attitudes. Only a few women felt comfortable sharing their experiences, underscoring the sensitivity and privacy typically associated with this topic in Chinese culture. The primary concern for those who did speak on the matter was the safety of the fetus, influencing their decisions to engage in or abstain from sexual activity, especially during the early and late stages of pregnancy.

Participant B, drawing on her personal experience from a second pregnancy, noted that the middle trimester is often seen as a safer period for sexual activity. She emphasized the importance of proceeding with caution, acknowledging sexual intimacy as a part of life but one that requires careful consideration during pregnancy.

Participant L spoke openly about her experiences with intimacy, sharing that she and her husband had engaged in sexual activity with her husband on top, a position they found to be safe during what is considered a relatively safe month of pregnancy. Her openness highlighted a level of comfort and excitement in exploring intimacy within the perceived safety parameters of pregnancy.

Participant M, at 20 weeks pregnant, expressed a keen interest in exploring sexual intimacy discreetly with her husband. She valued conversations with individuals who had more experience in this area, indicating a desire for guidance and reassurance.

These accounts illustrate the varied approaches to navigating sexual intimacy during pregnancy among the participants. While some felt comfortable discussing and exploring this aspect of their lives, others preferred silence or abstention, guided by concerns for fetal health and influenced by cultural norms. These underscore the importance of providing personalized, flexible, and culturally sensitive health education and support to address the varied concerns and priorities of pregnant women effectively.

3.2.3 Theme III: fetal health

3.2.3.1 medications and hazardous substances.

Within the scope of concerns related to fetal health, some of our participants voiced apprehensions regarding the use of medications during pregnancy. The focus of their worry included antibiotics, exposure to chemicals, as well as the impact of smoking and alcohol consumption, all feared for their potential adverse effects on fetal development.

Participant D reflected on her actions before knowing she was pregnant, stating, “I was not aware of my pregnancy during the 1st to 2nd months, and during that time, I dyed my hair and frequently ate fast food. Now, I'm burdened with anxiety about how these actions may have affected my fetus.”

Participant H discussed the challenges posed by social obligations, “Due to my husband's work-related events, we often find ourselves in environments where smoking and drinking are prevalent. Discovering our unplanned pregnancy and with an NT scan [Nuchal Translucency scan] on the horizon, my concerns for the fetus's wellbeing have significantly heightened.”

Participant I recounted her dilemma with medication, “While we were planning for a pregnancy, I inadvertently took cold medicine shortly before learning I was pregnant. The uncertainty of how this might affect my baby's development is a constant worry, with the fear of potential abnormalities being particularly distressing.”

Here, we observed variance in participants' perceptions of risk regarding medication use and exposure to hazardous substances, with some expressing significant anxiety about accidental exposures early in pregnancy, while others were more concerned about social environments' impact on fetal health.

3.2.3.2 Pregnancy check-ups

The topic of pregnancy check-ups emerged as a point of concern for several participants, who were eager for clarity on the procedures involved, the implications for fetal health, and the necessary precautions to be observed before and after these check-ups.

Participant A was curious about the protocols for assessing the risk of Down's syndrome, asking, “Why are there different recommendations from doctors for Down's syndrome testing—between screening and non-invasive DNA tests? How do these methods operate, and is there any risk to the baby associated with them?”

Participant H brought up questions about a specific diagnostic procedure, “I'm trying to understand amniocentesis better. It was never suggested in my earlier pregnancies. What exactly does it involve, is it considered safe for someone of my age, and what are the risks to the baby?”

Participant L expressed concerns related to the scheduling of ultrasound appointments amid the ongoing pandemic, “The epidemic has led to the rescheduling of maternity exams, including my 21-week check-up. This has left me wondering about the best timing for undergoing a 3D or 4D ultrasound.”

Participant M sought detailed information on fetal development assessments, “I'm curious about macrosomia and what it entails. Which specific aspects of fetal development are examined for potential abnormalities? Is it necessary to fast before undergoing such an exam, given that my baby tends to be more active when I feel full? Could this activity level influence the results of the ultrasound?”

Overall, the participants differed in their information needs regarding pregnancy check-ups, with some seeking detailed explanations of specific procedures and their implications, while others were more concerned about the logistical aspects of scheduling and attending check-ups during the pandemic.

3.2.3.3 Fetal movement monitoring

Fetal movement is a significant indicator of a baby's wellbeing inside the womb, and it's understandable why it would be a source of concern for expecting mothers. The participants' experiences and questions highlight the need for clear, accessible information on what to expect and how to effectively monitor fetal movements.

Participant C's challenge with the impracticality of hourly movement counts due to a busy schedule is a common concern. Practical advice for busy mothers-to-be could involve setting aside specific times when they are more likely to notice movements, such as after meals or during periods of rest.

Participant F's experience of reduced fetal movement after overeating and the subsequent relief of finding everything was fine with her baby underlines the importance of awareness and prompt action when changes are noticed. It also points to the need for guidance on how normal physiological activities, like eating, can influence fetal movement.

Participant G's proactive approach, opting for an extra ultrasound after noticing changes in movement due to skipped meals, reflects the anxiety that can come with the responsibility of monitoring fetal health. This situation underscores the need for clear guidelines on when to seek medical advice and how maternal activities and behaviors can affect fetal movements.

Participant M's concern about not feeling fetal movements by 20 weeks and the resulting frequent hospital visits for reassurance speak to the anxiety first-time mothers, in particular, might experience. This highlights the necessity for education on the expected timeline for feeling fetal movements and when the lack of movement warrants medical attention.

Finally, Participant J's worry about decreased fetal movement as labor approaches and the reassurance received from a doctor touches on the need for continuous communication and reassurance from healthcare providers. It emphasizes the importance of understanding the normal changes in fetal movement patterns toward the end of pregnancy and when to seek help.

Overall, there was a range of practices and levels of concern regarding fetal movement monitoring. Some participants were proactive and sought additional check-ups upon noticing changes, while others experienced anxiety due to not feeling movements at expected times, highlighting varied responses to monitoring fetal health signs. These experiences point to a broader need for accessible, clear information and guidance for expectant mothers on monitoring fetal movements, understanding what is normal, and recognizing signs that may warrant further medical evaluation.

3.2.4 Theme IV: knowledge of childbirth

This theme encompasses the participants' perspectives and concerns regarding childbirth, highlighting their preferences for family accompaniment, considerations about labor analgesia, and choices regarding the mode of delivery. Each subtheme reflects a blend of personal desires, medical considerations, and emotional responses to the prospect of childbirth.

3.2.4.1 Family accompaniment

The desire for family support during childbirth was important for several participants, reflecting the emotional and psychological comfort it provides.

Participant C expressed a wish for her husband's presence to share in the birth experience.

Participant I hoped for her mother's support, emphasizing the value of maternal presence during such a significant life event.

Participant J, while valuing family support, acknowledged the critical role of medical staff in ensuring safety and wellbeing during childbirth.

Participant K offered a different perspective, preferring privacy over the presence of her husband during potentially messy childbirth moments.

Collectively, we observed that participants had divergent views on family support during childbirth, with some desiring the presence of their partner or mother for emotional support, while others preferred privacy, highlighting the personal nature of childbirth preferences.

3.2.4.2 Analgesia in childbirth

The discussion around labor analgesia revealed a range of emotions, from fear and confusion to the desire for a pain-free experience.

Participant G discussed the dilemma between fearing labor pain and worrying about the potential impact of analgesia on the baby.

Participant I, with a previous positive experience with painless labor, was open to using analgesia again, depending on the situation.

Participant J sought clarity on the availability and safety of painless labor options across hospitals, reflecting common concerns among expectant mothers.

Participant K, influenced by her friends' experiences, prioritized pain reduction in her childbirth plan.

From these, it can be observed that attitudes toward labor analgesia varied significantly, from fear of its effects on the baby to a strong preference for pain reduction. This diversity underscores the complexity of decisions around pain management in childbirth.

3.2.4.3 Choice of mode of delivery

The choice between vaginal birth and cesarean section was a topic of contemplation and concern for participants.

Participant G expressed a preference for vaginal birth but was wary of the potential for complications leading to emergency cesarean sections. She said “With the increasing prevalence of cesarean sections, I worry about unsuccessful attempts leading to further distress.”

Participant I felt encouraged by a smooth first delivery, hopeful for a similar experience the second time around, mentioning “A smooth first delivery suggests a smoother second one.”

Participant J, close to her due date, considered a cesarean section, influenced by fear of labor pain and the perceived control it offers over the birthing process. She revealed, “In my advanced stage, I'm unsure. I might defer to my doctor's recommendation, though I lean toward a cesarean due to fear of pain.”

Participant K aspired to a vaginal birth but was apprehensive about the associated pain. She mentioned “I aspire to a vaginal birth but dread the pain,” illustrating the complex considerations women navigate when deciding on their preferred mode of delivery.

Overall, the preferences for vaginal birth vs. cesarean section were mixed, influenced by previous experiences, fears of labor pain, and perceptions of control over the birthing process. This variation illustrates the personal and complex nature of deciding on a mode of delivery.

3.2.5 Theme V: knowledge of postnatal recovery

This part captures the concerns and anticipations of seven mothers regarding their recovery after childbirth. The focus on body image, abdominal skin recovery, and pelvic floor muscle strength reflects a blend of personal health priorities and societal influences. Traditional practices and cultural beliefs, such as the “sitting in the moonlight” period, play a significant role in shaping their recovery expectations and timelines.

Participant A worries about the impact of age on her postnatal recovery, highlighting a common concern that recovery might be more difficult for older mothers. This reflects a broader societal perception about the challenges of post-pregnancy body changes and weight loss in older women.

Participant D's experience brings attention to the physical and emotional impact of visible post-pregnancy changes, such as a prominent stomach and stretch marks, which can lead to uncomfortable social interactions and concerns about physical appearance.

Participant E, planning for weight loss after her third child, indicates a proactive approach to postnatal recovery, recognizing the importance of dedicating time and effort to regain pre-pregnancy body weight and shape.

Participant H's mention of temporary urinary incontinence after her second childbirth emphasizes the practical health concerns associated with pelvic floor recovery. Her commitment to rehabilitation post-birth underscores the importance of addressing these issues to improve quality of life and physical wellbeing.

Participant J's plan to rest for a month before focusing on weight loss suggests a balanced approach to recovery, acknowledging the need for physical rest and a gradual return to pre-pregnancy fitness and body shape.

Participant L's comment on the perceived benefits of early childbirth on recovery speed reflects cultural and societal beliefs about age and postnatal recovery. This belief may influence younger mothers' expectations and concerns about their post-pregnancy bodies.

Participant M's curiosity about specific postpartum changes, such as buttock enlargement and urinary leakage, highlights the desire for more comprehensive information on the physical recovery process. This interest in understanding the nuances of postnatal changes suggests a proactive approach to managing and mitigating these issues.

Collectively, these reflections underscore the complexity of postnatal recovery, encompassing physical, emotional, and societal dimensions. The mothers' concerns and plans reveal a deep-seated need for support, information, and practical strategies to navigate the postpartum period effectively.

3.2.6 Theme VI: sources of knowledge on health education for pregnant women and their expectations of healthcare providers

Participants in the study reported using a variety of sources for health education during pregnancy, including the Internet (via platforms like Baidu and mother-and-baby applications), WeChat groups, the experiences of friends, and the advice of healthcare professionals. They often combined these methods to gather necessary information, with thirteen participants particularly favoring online resources.

Participant A described her method: “During my first pregnancy, I used Baidu for dietary questions, adhered to the advice found in books, and consistently discussed any concerns with medical staff during check-ups.”

Participant B preferred direct consultation with healthcare experts: “My main sources are doctors and nurses. The epidemic makes hospital visits difficult, so I also participate in WeChat groups for updates, even though these discussions sometimes miss professional insights.”

Participant C highlighted the utility of digital applications: “I use a pregnancy app for intermittent insights and confirm its advice with doctors. Remote consultations would be a beneficial option under the current health advisories.”

Participant D suggested the importance of professional guidance in online forums: “I participate in WeChat groups for expectant mothers, recommending these forums host discussions led by healthcare experts.”

Participant E utilized a mix of past experiences and digital tools: “With two pregnancies behind me, I rely on my own experiences and conversations with friends who are pregnant, along with updates from a pregnancy app named ‘Beauty Grapefruit.”'

Participant F mentioned the logistical challenges of attending hospital classes: “Hospital maternity classes are useful but scheduling conflicts arise. Having the option to replay these classes would aid in learning.”

Participant G described a proactive strategy: “I independently researched and read literature on pregnancy, supplementing this with insights from friends and family.”

Participant H used a blend of historical knowledge and current discussions: “I base my understanding on previous pregnancies and enhance it with current group discussions.”

Participant I engaged with local support networks: “I join a local WeChat group of pregnant women for active discussions on health topics. My attendance at in-person classes is sporadic due to the epidemic.”

Participant J sought information online: “I use the internet to investigate practices related to pregnancy.”

Participant K called for clear communication from healthcare providers: “It's crucial that healthcare providers offer detailed, patient-focused explanations. Online platforms could help address our questions more efficiently, considering their tight schedules.”

Participant L adopted a multifaceted approach: “Being my first pregnancy, I extensively read and seek out online consultations.”

Participant M interacted within digital communities cautiously: “I participate in WeChat discussions, but direct responses from doctors are rare due to their obligations. I limit my interactions to reduce any risk of complications.”

Overall, this theme illustrates the diverse and adaptive strategies pregnant women employ to educate themselves about health during pregnancy and their expectation for accessible and clear communication from healthcare providers.

4 Discussion

4.1 personal protection and vaccine safety.

This study highlights the measures Chinese pregnant women undertake to protect themselves and their unborn children amidst public health crises, such as the COVID-19 pandemic. Participants exhibited a readiness to self-isolate and curtail routine pregnancy check-ups, motivated by the objective to avert potential infections. Nonetheless, it is crucial to acknowledge that excessive anxiety during epidemics can lead to negative outcomes, as highlighted in prior research ( 21 ). The Chinese government has recommended a prudent approach, advising pregnant women to minimize non-essential medical visits while emphasizing the importance of attending essential prenatal examinations ( 22 ). Furthermore, healthcare facilities have adopted stringent infection control protocols, including facility disinfection, the provision of one-on-one consultations, and the enforcement of social distancing during wait times ( 23 ) Media and internet resources have been instrumental in communicating protective strategies, thus reducing the anxiety of pregnant women before consultations and enhancing their safety during medical visits ( 17 ).

Moreover, participants expressed significant concerns regarding the safety and efficacy of the COVID-19 vaccine. Given their dual role as healthcare recipients and guardians of their own and their fetuses' wellbeing, they sought affirmation on the vaccine's appropriateness. Although public health guidelines such as social distancing and mask usage are critical, the introduction of the COVID-19 vaccine presented an additional layer of preventive measures ( 24 , 25 ). Initially, the National Health and Wellness Commission advised against administering the COVID-19 vaccine to women of childbearing potential and those breastfeeding. However, subsequent studies have validated the vaccine's safety and efficacy for pregnant individuals ( 26 – 29 ). Research indicates that COVID-19 vaccination does not increase the likelihood of teratogenic effects, congenital anomalies, spontaneous abortions, or low birth weights in comparison to those who are unvaccinated ( p < 0.05).

4.2 Knowledge needs of pregnant women and fetal health

This study highlights the critical need to address the knowledge gaps among pregnant women regarding dietary practices essential for fetal development. Participants expressed a strong desire for information on nutritious dietary choices, underscoring the need for comprehensive and actionable counseling from healthcare providers. Such counseling should provide clear guidelines on prenatal nutrition, focusing on the consumption of nutrient-dense foods, the avoidance of potentially harmful substances, and methods to alleviate common pregnancy-related discomforts.

Collaboration between healthcare providers and dietitians is essential in delivering accurate information and personalized dietary advice that meets individual preferences and needs. Given the unique challenges and uncertainties presented by public health crises, healthcare professionals have a significant duty to educate and support pregnant women in making informed dietary decisions that promote maternal and fetal health. Proper nutrition during pregnancy is vital for the health of both the mother and the fetus ( 30 ). By offering evidence-based guidance, healthcare providers can enable pregnant women to make wise dietary choices, thus improving health outcomes.

During public health emergencies, the mental health of pregnant women has become a critical concern ( 31 ). Insights from interviews conducted in this study indicate that participants experienced increased stress, anxiety, and emotional instability, particularly highlighted during the COVID-19 pandemic. It is essential to develop targeted mental health resources and support mechanisms to assist pregnant women in effectively managing these challenges. Initiatives should include stress management techniques, counseling services, and awareness campaigns about available support networks. The integration of mental health support into routine prenatal care is crucial for addressing the psychological wellbeing of pregnant women during public health crises ( 31 ). This approach should include systematic screening for mental health issues, offering counseling services, and ensuring timely referrals to specialized resources. Evidence-based interventions, such as the Centering Pregnancy (CP) model of care, positive cognitive exercises, and peer support, have shown effectiveness in enhancing emotional wellbeing during pregnancy ( 32 – 36 ). CP originated in the United States ( 36 ) and consists of three main components, as follows: (1) Creation of a discussion group: 8–12 pregnant women of similar gestational weeks are divided into a group, and each group is led by a doctor and a midwife, respectively (the families of the pregnant women may also participate). (2) Pregnancy self-management: doctors or midwives conduct one-on-one antenatal check-ups for pregnant women. Pregnant women are instructed and encouraged to complete simple examinations such as weight, blood pressure, abdominal circumference, and fetal heartbeat monitoring on their own and record them. After the check-up, the pregnant woman can consult the midwife about her problems. If it is a common problem during pregnancy, the midwife encourages her to solve it together as a group. Between examinations, pregnant women can communicate and discuss freely. (3) Group discussion: starting from 12 to 16 weeks, group discussion is organized on a regular basis, 0.5–2 h each time for a total of 10 sessions. Pregnant women are encouraged to speak and discuss, share their feelings and experiences, guide the content of the discussion, and answer the questions raised by the pregnant women. Currently, CP is widely used in Western countries, including North America, Australia, the United Kingdom, and Africa ( 37 – 39 ), and it is agreed that CP is the best model of maternal health care, which promotes active participation of pregnant women, improves their mental health, and enhances satisfaction with care, prenatal knowledge, and ownership of self-care; and reduces the risk of preterm labor and cesarean section ( 40 – 43 ), while in China, the use of CP is still in its infancy. In China, the use of CP is still in its infancy, and some studies have found that CP can reduce pregnant women's fear of labor, enhance their breastfeeding self-efficacy ( 44 , 45 ), promote comprehensive support from midwives, family members, and peers at the same time, and improve coping with perinatal problems ( 46 ). Mindfulness is the ability to describe an individual's awareness of being in the present moment. The level of mindfulness can be a useful predictor of depression to some extent, with higher levels of mindfulness being associated with lower levels of depression ( 33 ). When the level of positive thinking of pregnant women is low, they are unable to focus on the present moment and frequently focus on negative life events during pregnancy or after delivery, which may cause them to have negative emotions such as irritability and depression. Research has shown that a certain period of positive thinking training can improve the participants' positive thinking level and negative emotions ( 33 ). Currently, the most important positive thinking interventions include positive thinking stress reduction therapy and positive thinking cognitive behavioral therapy ( 33 ), which can reduce the generation of negative emotions, improve the quality of life, and promote the emotional stability of the mind during pregnancy and postpartum care.

4.3 Improving health education and guidance during pregnancy

Public health emergencies can restrict pregnant women's access to routine antenatal screening services due to hospital limitations and concerns for the safety of both the women and their fetuses. These restrictions may affect the detection of pregnancy complications and their overall management. To maintain continuous care, healthcare systems must adopt innovative methods for providing remote prenatal monitoring, health education, and guidance, such as through telemedicine and virtual counseling. Since the beginning of the COVID-19 pandemic in 2019, there has been a notable increase in pregnant women seeking personal protection against the novel coronavirus infection during pregnancy and childbirth ( 9 ). Furthermore, about 71.0% of Chinese pregnant women have turned to health apps, official microblogs, and WeChat public channels for information, highlighting the Internet's critical role during public health crises as an essential resource for pregnant women to obtain pregnancy-related information ( 47 , 48 ).

The study revealed that participants predominantly utilized internet searches, pregnancy health applications, WeChat groups, and public forums for acquiring health-related information during public health emergencies. Nonetheless, skepticism concerning the expertise of information sources, including biomedical professionals, led to pregnant women harboring reservations about the reliability of health knowledge obtained online. They exhibited a greater trust in health education and information disseminated by certified biomedical practitioners. It is observed that medical professionals participating in group chats, such as on WeChat, may find it challenging to meet the personalized health education needs of each pregnant woman effectively. While telemedicine serves as a feasible option for certain prenatal care aspects, it faces limitations, such as the incapacity to perform specific physical examinations or tests remotely ( 49 ). As healthcare systems endeavor to provide continuous care amidst public health crises, it is imperative for providers, community-based organizations, and policymakers to develop and advocate for virtual support groups, online forums, and educational resources specifically designed for the needs of pregnant women. These initiatives can cultivate a sense of community, offer emotional support, and ensure access to trustworthy information, thereby mitigating isolation and improving overall wellbeing. Therefore, establishing robust communication channels between healthcare providers and pregnant women is essential for conveying accurate information, addressing concerns, and enabling shared decision-making.

4.4 Limitations

This study acknowledges the potential influence of social desirability bias on our findings, given the sensitive nature of the topics discussed. While measures were taken to ensure a comfortable and confidential environment for participants, the possibility that respondents might tailor their answers to what they perceive as more socially acceptable cannot be entirely ruled out. This bias could affect the authenticity and depth of the data collected, as participants might underreport or alter their experiences and needs. Additionally, its qualitative approach, while insightful, limits the ability to quantify the prevalence of specific needs or opinions, as it lacks quantitative data. This restricts the generalizability of findings and the measurement of opinion distribution among the broader population. Future research could benefit from employing mixed methods or anonymous data collection techniques to mitigate this limitation and capture a more authentic range of responses.

5 Conclusion

This study sheds light on the critical health education needs of pregnant women during public health emergencies during the COVID-19 pandemic. The empirical evidence provided serves as a valuable foundation, offering guidance for health education practitioners to develop targeted and impactful educational content. Nevertheless, this study is constrained by its limited sample size, the geographical limitation of the sample, and the potential for sample selection bias. To strengthen these findings, future research could include a broader and more diverse participant base and employ a variety of data collection techniques. In summary, this research emphasizes the vital role of health education for pregnant women during the COVID-19 pandemic, providing meaningful insights for healthcare providers and setting a direction for future investigations in this field. The insights from this pandemic highlight the importance of encouraging pregnant women to attend maternity examinations in a timely manner and to utilize biomedical resources wisely, ensuring the health and safety of both mothers and infants during public health challenges. By adopting comprehensive safety measures and isolation protocols, access to medical care for pregnant women can be improved, and leveraging internet resources can effectively promote the dissemination of healthcare knowledge related to pregnancy.

Data availability statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Ethics statement

The studies involving human participants were reviewed and approved by the Research Ethics Review Committee of Ethics Committee of Quanzhou Medical College (the code of ethics: No. 2021007). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.

Author contributions

XS: Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Supervision, Writing – original draft, Writing – review & editing. YZ: Data curation, Funding acquisition, Methodology, Project administration, Resources, Supervision, Visualization, Writing – review & editing, Conceptualization. MC: Data curation, Formal analysis, Funding acquisition, Investigation, Project administration, Resources, Validation, Visualization, Writing – review & editing. XX: Data curation, Formal analysis, Investigation, Software, Writing – review & editing, Resources. GL: Conceptualization, Data curation, Methodology, Project administration, Supervision, Validation, Visualization, Writing – review & editing.

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was supported by the Fundamental Project: Guided Science and Technology Plan Project of Quanzhou City (2021N137S).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: pregnant women, health education, public health emergencies, qualitative research, COVID-19

Citation: Su X, Zhang Y, Chen M, Xu X and Liu G (2024) Understanding health education needs of pregnant women in China during public health emergencies: a qualitative study amidst the COVID-19 pandemic. Front. Public Health 12:1271327. doi: 10.3389/fpubh.2024.1271327

Received: 12 September 2023; Accepted: 22 April 2024; Published: 02 May 2024.

Reviewed by:

Copyright © 2024 Su, Zhang, Chen, Xu and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Yuezhen Zhang, 499368300@qq.com

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