Single Parenting

The family unit acts as the context in which children grow and thrive, with various configurations that define one’s family structure. Although families are classically defined by biological relationships, units made of adoptive, blended, and chosen family are becoming increasingly commonplace: single or dyadic parents, whether opposite-sex or same-sex partners; extended family members, such as grandparents or aunts and uncles; and family friends are a few types of families that exist. In recent decades, there has been an increasing number of children raised by single parents. Here, we will explore the impact that single parenthood has on the outcomes of families raised in this structure.The number of children raised in single-parent homes in the United States has been on the rise since the 1970s. At that time, single families were almost entirely women and their children. However, there has been an increasing proportion of father-led single-parent families in recent years. In 2022, 14.3 million children resided in single-mother homes, whereas 3.5 million children resided in single-father homes. Currently, single-parent families constitute a third of households with children.Single parenthood is a universal experience in all ethnic groups. However, children of Black (63%) and American Indian–Alaska Native (50%) backgrounds are most likely to live in single-parent homes, whereas white (24%) and Asian-Pacific Islander (16%) children are less likely; Latino (42%) and multiracial (39%) families lie in the middle range. When considering citizenship status, only 25% of children born to immigrants are raised by single parents, compared with 37% in families with US-born parents.The increasing prevalence of single parenthood in the United States is complex and multifactorial. Cultures worldwide encourage multigenerational households, whereas the US is known for individualistic ideals that promote single living. Since the 1970s, rates of nonmarital births have been increasing, with major contributors including lack of access to contraception as well as inadequate sex education. The rising use of assistive reproductive technology, surrogacy, and adoption as alternate pathways to parenthood have also created single-parent families of higher socioeconomic status, or “single parents by choice.” Currently, 30% of all adoptions in the US are single-parent adoptions, and one major gamete bank has reported that single mothers represent 50% of their clientele.Marriage rates have been decreasing steadily—with the main demographic of those who marry being those with high income and higher education—in direct response to increasing divorce rates in the United States. Many families experience parental separation, with the custodial parent frequently being declared the single parent in the literature. Currently, nearly 1 in 2 marriages end in divorce, with 20% of children born to married couples experiencing divorce in the first decade of life. This is multiplied for those born to nonmarried parents, in which more than 50% of couples separate prior to reaching adulthood.It is important to note that there are a significant number of people who are unable to parent due to external factors. Men and women die in active duty daily. On average, men are more likely to experience early death whether due to medical illness or injury. Unfortunately, the COVID-19 pandemic was a major source of parental loss, with a 2021 issue of Pediatrics estimating that 143 000 children had experienced death of a caregiver from coronavirus. And, in recent years, we have seen the impact of changes in immigration policies that have resulted in family disruption, which has drawn parallels to mass incarceration in communities of color.The loss of a second parent to assist in child-rearing brings a significant reduction in family income. In 2022, 30% of single-parent families reported living below the poverty line—5 times as likely compared with married couples at that time. Custodial mothers have similar rates of poverty (27%) unlike custodial fathers (11%). Although child support is shown to offset the impact of poverty, state programs do not consider the noncustodial parent’s ability to pay, with approximately 30% of custodial parents reporting never receiving payment. With a single income, parents are at a significant disadvantage in affording food, housing, and other household necessities.In recent years, poverty has come to be recognized by the American Academy of Pediatrics as one of the most significant adverse childhood experiences, being a substantial social determinant of health due to the cumulative effects of toxic stress. The impact of poverty persists whether one is reared in a single-parent or dual-parent family; children experiencing poverty are more likely to have lower educational achievement, limiting vertical mobility in subsequent generations. However, if the single-parent family has access to resources, then there is no difference in quality of parent-child relationships nor in frequency of behavioral problems when compared with their dual-parent peers.The significance of resources that support parents cannot be understated. However, it is important to note that many programs are designed for two-parent households; for example, parent-based interventions for adolescents with alcohol and substance use disorders do not address the needs of single-parent families, even though adolescents raised by single parents are more likely to engage in the these behaviors. Similarly, being raised by a single parent is associated with slightly higher rates of death due to accidental injury, such as vehicle-related deaths and falls, compared with those in dual-parent families due to decreased parental supervision as well as hazards related to substandard housing.When considering specific health conditions, children in single-parent homes tend to have worse outcomes; Black youth from single-parent families have poorer type 1 diabetes control compared with children from other backgrounds as well as with those in two-parent homes. This was attributed to insufficient diabetes-related supplies, unskilled school staff, and difficulty with access to healthy food. Additionally, the families reported fears related to police targeting as well as neighborhood safety concerns being a multiplier for diabetes-related stress.With only one household income, single parents often have limited access to healthy food options. Combined with the lack of a partner to share household tasks and decision-making, single parents are limited in the ability to provide homemade meals and opportunities for physical activity for their children. As a result, children raised in single-parent homes have higher body mass indexes and greater risk of metabolic syndrome than those in dual-parent homes due to these obesogenic factors in the home environment.But what of the parents experiencing single parenthood themselves? Numerous studies have shown that single parents have doubled rates of depression with suicidality, anxiety, and low self-esteem compared with partnered parents, related to both decision-making stress and stigmatization. Additionally, single parents who pursue higher education have significant difficulties with housing and food security, student loan debt, and overall lower educational achievement compared with their peers. However, it is currently unknown how many single-parent families experience homelessness due to shelter-related data aggregating all residents with children as “families” without accounting for the number of parents involved.Community engagement and social supports are vital in combating depression in single parents. Support from grandparents and friends in proximity to the family, the so-called village to raise a child, has been shown to be protective against depression for single parents. This effect is particularly powerful when grandparents are able to provide childcare or financial support for the home. The importance of one’s village is even demonstrated in the military, which provides on-base childcare services and youth centers for single parents in the army.Despite the challenges mentioned above, single parents are able to provide nurturing home environments for their children. With stable and loving relationships, children can thrive in any given family structure. In fact, single parenthood may be preferred if the previous home environment was distressing in anticipation of parental separation due to familial arguments or, in some cases, even unsafe due to abuse. Family structures change over time, and children can overcome the negative impacts of those changes by having a supportive home provided by their single parent.As single parenthood becomes increasingly common in society, more research is needed to elucidate the needs of single-parent families. To ensure that children from these families reach their potential, single parents benefit from support such as income-based nutritional programs, public housing, and child tax credits, all of which directly aid families with meeting their basic needs. The support of friends and family enables parents, regardless of income and educational status, to build their own safeguards against the challenges of single parenthood. With a supportive and loving parent, children from single-parent families are able to build resilience, allowing them to reach their potential for lifelong success.Comment: I have known and worked with many single parents in my pediatric practice, in my social circle, and within my family constellation. Yet, it was through a JAMA perspective piece entitled “A piece of my mind. Cultural competency,” written by a dear colleague of mine Dr Marjorie S. Rosenthal, that I gained better insight into some of the emotional challenges of being a single parent.1 Dr Rosenthal became a single parent of a 7-week-old and a 2½-year-old when her beloved husband died suddenly in a tragic motor vehicle accident. Although she had a career as a pediatrician and resources of parents, grandparents, and siblings, so didn’t struggle with some of the socioeconomic factors mentioned in this In Brief, she poignantly described the loneliness and challenges of now having to make decisions on her own, especially during the middle of the night. She also emphasized the importance that we, as pediatricians, not make assumptions about single parents but instead embrace them with empathy, kindness, and admiration for how challenging it is to be a single parent. This In Brief emphasizes the importance of building communities of support to help each other. These communities are essential to the well-being of all involved. And let us not forget the large number of fathers who are now assuming the role of a single parent. It does take a village to raise children, and deliberate action to build those villages/communities is essential.Janet R. Serwint, MDEditor Emeritus, In BriefI would like to share gratitude for my dear colleague the late Dr Benard Dreyer, who will forever be an inspiration to all for a career in children’s health advocacy.