The Pediatrician's Role in Family Support Programs

Abstract

The health and welfare of children depend on the ability of families, alone or with the assistance of others, to meet their needs. This task has become increasingly difficult for many families. Pediatricians need to be able to recognize situations in which families may have difficulty fulfilling parental obligations and assist the family in finding available additional support.

CHANGES IN FAMILIES

The structure of families and patterns of family life in the United States have undergone some profound changes during the past quarter century. The proportion of births to unmarried women increased between 1960 to 1985 from 5.3% to 22% and has continued in the same direction.^1-3 Since 1960 the divorce rate has more than doubled,^1-3 and it is estimated that 25% of children growing up in this decade will experience a divorce.⁴ Although remarriage rates are high, over a third again end in divorce.⁵ As a consequence, 8% fewer children are living with two parents (74.8% in 1989 versus 83.1% in 1971),^6,7 and only 61% live with both biologic parents.⁸ Further evidence of change in family life is that almost 60% of all mothers with preschool-aged children are in the labor force, reflecting a twofold increase since 1970.⁹ A decline in the purchasing power of family income, the lack of comparable wages for women, and significant rates of homelessness have all stressed families and contributed to the continuing escalation of the percentage of children who live in poverty. Finally, internal migration within the country has separated many families from the natural support systems provided by their extended families, leaving parents socially isolated and interrupting the intergenerational transmission of advice and support.