The impact of family structure on the health of children: Effects of divorce

Abstract

Nearly three decades of research evaluating the impact of family structure on the health and well-being of children demonstrates that children living with their married, biological parents consistently have better physical, emotional, and academic well-being. Pediatricians and society should promote the family structure that has the best chance of producing healthy children. The best scientific literature to date suggests that, with the exception of parents faced with unresolvable marital violence, children fare better when parents work at maintaining the marriage. Consequently, society should make every effort to support healthy marriages and to discourage married couples from divorcing.

Epidemiology

The demographics of families are changing, and with that, the philosophical underpinnings of relationships are also changing. Many young adults feel marriage is old-fashioned and confining, and that open cohabitating relationships provide a healthier option that is more conducive to personal development. If a relationship does not provide personal happiness, parents often believe that their children will adapt to new family relationships so that divorce or separation will have few long-term, adverse consequences. These beliefs have led to marriage occurring later, women having fewer children and doing so later in life, single mothers giving birth to many of our children, more parents cohabitating, and fewer children living with their married, biologic parents.

In 1960, the average age of a woman's first marriage was 20.3 years; that of men was 22.8 years. But by 2010, that changed so that the median age at first marriage was 25.8 years for women and 28.3 years for men (Copen et al. 2012). In 1960, the rate of marriage for women was 76.5 per 10,000, but this had decreased to 37.4 per 10,000 by 2008. The birth rate for the United States is now so low that it is below replacement rate, and 41 percent of all births in 2009 were to unmarried women. Nearly one in five births to women in their thirties was non-marital in 2007, compared with one in seven in 2002.

Children's lives track with these statistics. In 1970, 84 percent of children lived with their married biologic parents, whereas by 2009, only 60 percent did so. In 2009, only 29 percent of African-American children lived with their married biologic parents, while 50 percent were living in single-mother homes. Furthermore, 58 percent of Hispanic children lived with married biologic parents, while 25 percent were living in single-mother homes. Importantly, a recent Harvard study on single-parent families revealed that the most prominent factor preventing many children from upward mobility is living with a single parent (Chetty et al. 2014).

In addition, the number of couples who choose to cohabit rather than marry has increased dramatically, with 4.9 million cohabiting couples in 2002, versus just 500,000 in 1970 (U.S. Census Bureau 2003). Half of the unmarried births are to mothers who are in cohabitating relationships, and seven in ten children of cohabitating couples will experience parental separation. The dissolution rate of cohabitating couples is four times higher than married couples who did not cohabitate before marriage (Osborne, Manning, and Stock 2007).

The Centers for Disease Control stopped gathering complete data on the number of children affected by divorce in 1988, and at that time more than one million children were affected (Cohen 2002). Since then, the incidence of divorce has continued to climb, and according to the 2009 American Community Survey, only 45.8 percent of children reach age 17 years while still living with their biologic parents who were married before or around the time of the child's birth (Fagan and Zill 2011). The majority of divorces affect younger children since 72 percent of divorces occur during the first 14 years of marriage. Because a high percentage of divorced adults remarry, and 40 percent of these remarriages also end in divorce, children may be subjected to multiple family realignments (Cohen 2002).

The precipitating causes of divorce have also changed over time. Prior to no-fault divorce laws, the legal procedures for obtaining a divorce were often difficult and expensive, so that only the most dysfunctional marriages ended in divorce. Children who are removed from the most dysfunctional environments are more likely to do better after the divorce. However, with the introduction of no-fault divorce laws, it is likely that the child has not experienced severe levels of parental discord, so the divorce has more adverse effects on the child. One study seems to conclude that the majority of more recent divorces were not preceded by an extended period of marital conflict (Amato and Booth 1997 as quoted in Amato 2001).

Divorce and parental separation are damaging to children, families, the economy, and society as a whole, and this paper outlines these adverse effects. While recognizing that not all children or parents will experience every negative consequence listed below, given the seriousness of these adverse outcomes and the magnitude of the issue, it is important that pediatricians support public policies that promote the health and preservation of the child's biologic family.

Evaluating the Literature

When evaluating the scientific research on the effects of divorce on children and parents, it is important to consider all of the factors affecting the outcome, including family dynamics, children's temperaments and ages at the time of divorce, and family socioeconomic status, as well as any behavioral or academic concerns present prior to divorce. Some adverse effects noted in the literature after divorce are actually diminished when controlled for their presence prior to divorce. It is also important to note that violence in a home is never acceptable and can have serious adverse effects on children's behavior, development, academic success, and future health.

Effects of Divorce on Children

Each child and each family are obviously unique, with different strengths and weaknesses, different personalities and temperaments, and varying degrees of social, emotional, and economic resources, as well as differing family situations prior to divorce. Despite these differences, divorce has been shown to diminish a child's future competence in all areas of life, including family relationships, education, emotional well-being, and future earning power. One review of the literature conducted in the United Kingdom found that “although children are at increased risk of adverse outcomes following family breakdown and that negative outcomes can persist into adulthood, the difference between children from intact and non-intact families is a small one, and the majority of children will not be adversely affected in the long-term” (Mooney, Oliver, and Smith 2009). There is much research, however, that offers evidence to the contrary.

Two large meta-analyses, one reported in 1991 and the other reported ten years later in 2001, showed that “children with divorced parents continued to score significantly lower on measures of academic achievement, conduct, psychological adjustment, self-concept, and social relations” (Amato and Keith 1991; Amato and Booth 1997 as quoted in Amato 2001).

This research demonstrates that, when a child experiences parental divorce, there are significant losses that must be acknowledged.

The child may lose time with each parent

• 1. Parents must adjust to their own losses as well as to their new role as a divorced parent. Thus, parents may not have as much emotional strength and time to invest in parenting, i.e., the parents experience a “moratorium on parenting.”
• 2. Although laws are gradually changing, most children spend more time with one custodial parent and obviously have less time with each parent overall.
• 3. For most children, this means much less time spent with their fathers.
• 4. The child may also spend less time with their mother as she may need to work longer hours to support the family.

The child may lose economic security

• 1. 
  Custodial mothers experience the loss of 25–50 percent of their pre-divorce income.

  • a. Women who divorced in the past 12 months were more likely to receive public assistance than divorced men (23% versus 15%) (U.S. Census Bureau 2011).
  • b. Even five years after the divorce, mothers who remain single have only risen to 94 percent of their pre-divorce income, while continuously married couples have increased their income.
  • c. In 2000, the median income of single-mother households was 47 percent that of married-couple households (American Academy of Pediatrics 2003).
• 2. Only 50 percent of custodial mothers have child support agreements, and 25 percent of mothers who have been granted support receive no payments.
• 3. Custodial fathers also experience financial loss; although they tend to recover financially more quickly and rarely receive child support.
• 4. Loss of income may lead to increased work time for parents, as well as a change in residence.
• 5. 
  Children living with single mothers are much more likely to live in poverty than children living with both married parents (Edwards 2014).

  • a. In 2009, children living with a divorced parent were more likely to live in a household below the poverty level (28%) compared with other children (19%) (U.S. Census Bureau 2011).
• 6. 
  Unmarried women are more likely to remain in poverty compared with married individuals and unmarried men (Edwards 2014).

  • a. Approximately 32.2 percent of people in single-mother families in poverty during the first two months of 2009 continued to be in poverty for 36 months. In contrast, only 18.7 percent of people in married-couple families in poverty during this same time remained in poverty for 36 months.
• 7. 
  Children living with single parents are less likely to experience upward financial mobility.

  • a. The fraction of children living in single-parent households is the strongest negative correlate of upward income mobility according to one study (Chetty et al. 2014).
  • b. The percentage of married families in a community also contributes to future upward economic mobility of all children in the community (Chetty et al. 2014).

The child may lose emotional security (Amato and Afifi 2006)

• 1. 
  The child may have a weakened relationship with his/her mother.

  • a. Divorced mothers are less able to provide emotional support (Miller and Davis 1997).
• 2. 
  The child may have a weakened relationship with his/her father.

  • a. Divorced fathers spend less time with their children.
  • b. A study in 1996 found that fewer than half of children living with a divorced mother had seen their fathers at all in more than one year, and only one in six saw their fathers once a week (Popenoe 1996, as quoted in Fagan and Churchill 2012, 6).
  • c. Divorced fathers are rated as less caring by their adolescents (Dunlop, Burns, and Bermingham 2001).
  • d. The child may find it more difficult to trust his/her father (King 2002).
• 3. The child may have a weakened relationship with grandparents or relatives—especially the parents of the noncustodial parent (Kruk and Hall 1995).
• 4. The child may lose family traditions, celebrations, and daily routines. Even adult children whose adult parents divorced later in life experienced the loss of family traditions and disruption of celebrations (Pett, Lang, and Gander 1992).
• 5. The change in residence may lead to loss of friends, school environment, and other support systems.

The child may have decreased social and psychological maturation

• 1. College students whose parents were divorced were more likely to experience verbal aggression and violence from their partner during conflict resolution (Billingham and Notebaert 1993).
• 2. Children of divorced parents may have lower scores on self-concept and social relations (Amato 2001).
• 3. Anxiety and depression seem to worsen after the divorce event (Strohschein 2005).

The child may change his or her outlook on sexual behavior

• 1. There is increased approval (by children of divorced parents) of premarital sex, cohabitation, and divorce (Jeynes 2001).
• 2. There is earlier sexual debut (Jónsson et al. 2000).
• 3. Girls whose fathers left the home before they were five years old were eight times more likely to become pregnant as adolescents than girls from intact families (Ellis et al. 2003).
• 4. Boys similarly have earlier sexual debut and higher rates of sexually transmitted disease when they have experienced divorce in their family.
• 5. As adults, the female children of divorced parents experience less trust and satisfaction in romantic relationships (Jacquet and Surra 2001).
• 6. The children of divorced parents are less likely to view marriage as permanent and less likely to view it as a lifelong commitment (Weigel 2007).
• 7. The children of divorced parents are two to three times more likely to cohabit and to do so at younger ages (Amato and Booth 1997, 112, as quoted in Fagan and Churchill 2012, 26).

The child may lose his/her religious faith and practice (Myers 1996)

• 1. Following a divorce, children are more likely to abandon their faith (Feigelman, Gorman, and Varacalli 1992).
• 2. As adults, those raised in step-families are less likely to be religious than those raised by both biologic parents (Myers 1996).
• 3. Since religious practice has benefits in areas such as sexual restraint, the child of divorce may lose this protection (Rostosky, Regnerus, and Wright 2003).

The child may lose cognitive and academic stimulation

• 1. Children in divorced homes have less language stimulation.
• 2. Children of divorced parents are more likely to have lower grade point averages (GPAs) and be asked to repeat a year of school (Jeynes 2000).
• 3. A study of eleven industrialized countries showed that children living in two-parent families had higher math and science scores (Jeynes 2000).
• 4. Children in single-mother families were twice as likely to have been absent from school for eleven or more days in the past year due to illness or injury (6%) compared with children in two-parent families (3%) (Pong, Dronkers, and ampden-Thompson 2003).
• 5. Children of married parents attained higher income levels as adults.

The child may be less physically healthy

• 1. 
  Fewer children in nuclear families were considered to be in poor health than children in non-nuclear families (12% of children in nuclear family versus 22% of children of single parent) (CDC/NCHS National Health Interview Survey 2012).

  • a. Emergency room usage is higher for children in all other family types over that experienced by children in nuclear families (Family Structure and Children's Health in the United States 2010).
  • b. Children in nuclear families were less likely than children in other family types to have a learning disability or attention deficit/hyperactivity disorder regardless of parents' education, income, or area of residence (Family Structure and Children's Health in the United States 2010).
• 2. Children living with married parents are less likely to be abused or neglected. In one study, the relative risk that children from a single-parent family would be physically abused or neglected more than doubled (Family Structure and Children's Health in the United States 2010).

The child may have a higher risk of emotional distress

• 1. A study of almost one million children in Sweden demonstrated that children growing up with single parents were more than twice as likely to experience a serious psychiatric disorder, commit or attempt suicide, or develop an alcohol addiction (Brown et al. 1998).
• 2. Children of single parents are twice as likely to have emotional and behavioral problems—8 percent versus 4 percent for children from two parent households (Kelleher et al. 2000; Ringsback-Weitoft et al. 2003).
• 3. The CDC reported on adverse family experiences among children in nonparental care. The study found, “Children living with one biological parent were between 3 and 8 times as likely as children living with two biological parents to have experienced neighborhood violence, caregiver violence, or caregiver incarceration or to have lived with a caregiver with mental illness or an alcohol or drug problem” (Bramlett and Radel 2014).

Effects of Divorce on Parents

Parents who divorce also experience adverse effects on their physical, emotional, and financial well-being, which may also in turn affect their children.

Married (male/female) people are more likely to have better physical health

• 1. Married people smoke and drink less (ChildStats.gov 2013).
• 2. Married men are less likely to commit suicide than men who are divorced or separated (Schoenborn 2004).
• 3. Married individuals have the lowest incidence of diabetes, hypertension, and heart disease (Kposowa 2000).
• 4. Married men are more likely to live longer after a diagnosis of cancer, especially prostate cancer (Pienta 2000).
• 5. 
  Married men live longer than men who never married.

  • a. In the Framingham Offspring Study, married men had a 46 percent lower rate of dying from cardiovascular disease than unmarried men (Goodwin et al. 1987).

Married (male/female) people are more likely to have higher incomes

• 1. Individuals who are married have greater wealth.
• 2. The longer they stay married, the greater the wealth accumulation (Marriage and Men's Health 2010).
• 3. Men especially benefit, as married men earn 22 percent more than single men (Waite and Gallagher 2000, 97–123).
• 4. Women who experience divorce face a 27 percent decrease in their standard of living (Stratton 2002).

Married women are more likely to be physically safer than divorced or separated women

• 1. Married and widowed women experienced less intimate partner violence than divorced or separated women.¹

Married individuals are more likely to be involved in their community

• 1. Married people have more civic responsibility, are more likely to volunteer in service projects, and are more likely to be involved in schools and churches (National Crime Victimization Survey 2012).

Divorce may have adverse long-term emotional effects for parents

• 1. In Wallerstein's long-term study, half of the women and one-third of the men were still very angry with their former spouses (Keyes 2002).
• 2. One-third of the women and one-fourth of the men felt that life was unfair and disappointing (Wallerstein and Blakeslee 2004).
• 3. In only 10 percent of divorces did both partners feel they achieved happier lives (Wallerstein and Blakeslee 2004, 29).
• 4. One-fourth of the older divorced men remained isolated and lonely (Wallerstein and Blakeslee 2004, 40).

One study demonstrated that those who were unhappy in their marriage when first surveyed, but remained married, were likely to have an improved relationship and be happier five years later than those who divorced (Wallerstein and Blakeslee 2004, 45).

Effects of Divorce on Society

Divorce adversely affects society by

• 1. Diminishing the child's future competence.
• 2. Weakening the family structure.
• 3. Contributing to early sexual experimentation leading to increased costs for society.
• 4. Adversely affecting religious practice—divorce diminishes the frequency of religious worship.
• 5. Diminishing a child's learning capacity and educational attainment.
• 6. Reducing the household income.
• 7. Increasing crime rates and substance use, with associated societal and governmental costs (Waite and Gallagher 2000).
• 8. Increasing risk for school suspensions, “Persons in Need of Supervision” status, binge drinking, and marijuana use (Demuth and Brown 2004; Eckenrode, Mrcynyszyn, and Evans 2008; Osborne, Manning, and Stock 2007).
• 9. Increasing emotional and mental health risks, including suicide.

Studies have attempted to estimate the financial cost of divorce to the United States, with most recent estimates reaching $33.3 billion per year, and with adolescent pregnancy costing at least $7 billion (Schramm 2003).

Conclusion

There are clearly negative long-term consequences of divorce—children, parents, and society all suffer. Wallerstein's long-term study shows that many children never have full “recovery” as each special event, holiday, or celebration reminds the child of his/her loss. Given these tremendous costs borne by all individuals affected by divorce, as well as the costs to society, it is the responsibility of physicians—especially pediatricians, who care for children in the context of their families—to advocate for public health policies that promote marriage and decrease the likelihood of divorce.

Biography

Dr. Jane Anderson is a Clinical Professor of Pediatrics at the University of California, San Francisco, where she practiced for 33 years until her retirement in November, 2012. She continues there as a volunteer faculty member. She has authored numerous articles on general pediatric topics, has presented lectures on adolescent brain development and parenting in both the US and China, and has received teaching awards from medical students and pediatric residents, including the 2014 Volunteer Faculty Teaching Award from the pediatric residents at the University of California, San Francisco. Dr. Anderson provided testimony on behalf of Alaska’s parental notification law demonstrating in her testimony that parental notification is in the best interest of adolescents, and the judge upheld the law.

She has been married to her husband, Karl, for 39 years, and has four children. She participates annually in short-term medical missions trips with Medical Servants International, and is on the Board of Directors of the National Physician Center. She has been a member of the American College of Pediatricians since 2002 and currently serves on its Board.