Marriage and the Family

American College of Pediatricians – September 2014

ABSTRACT: Family structure significantly affects the development outcome of children. This article examines the research and concludes that the family structure which leads to optimal child development is the family headed by two biological parents in a low-conflict marriage. The American College of Pediatricians urges policy makers to advocate for this family structure.

What factors in a child’s life have the greatest impact on their overall health and well being? Two of the richest resources for wellness are a child’s parents and family. Parents, pediatricians, social scientists, and other child-development professionals have long appreciated how important good schools, safe neighborhoods and sufficient economic support are for the health and well-being of children. After years of neglecting the issue, social scientists in the last 20 years have come to recognize another important resource: the significant effect the marital status of the child’s parents has on children. The positive impact of a married mother and father on a child’s development has been scientifically verified across all measures of well-being. 

It is now acknowledged that the married mother-father parent unit significantly and positively impacts how a child will do in every important measure of well-being and maturity. There is no question that some children can and do thrive in non-intact families. Part of the work of the American College of Pediatricians, however, is to educate parents, pediatricians, policy makers, and society about factors that are most likely to enhance a child’s well-being in as many areas as possible. Family form is certainly one of these!

A growing and increasingly sophisticated body of research indicates that children with married parents (both a mother and a father) have more healthful measures of:

  • thriving as infants
  • physical and mental health
  • educational attainment
  • protection from poverty
  • protection from antisocial behavior
  • protection from physical abuse

Child Trends, a leading non-partisan research organization committed to the health and well-being of children, examined the question of what family form best contributes to child health. Their research found: “… that family structure matters for children, and the family structure that helps children most is a family headed by two biological parents in a low-conflict marriage.”1

The National Marriage Project at Rutgers University, in a 2007 report on marriage in America, comments that more and more children today are “not living in families that include their own married, biological parents, which by all available empirical evidence is the gold standard for insuring optimal outcomes in a child’s development.”2

The married mother and father family unit provides many important health benefits for the child, including:

Reduced Infant Mortality and Morbidity

Infants of all races born to unmarried mothers are significantly more likely to die at or near birth, to have low birth weights, and to be premature when compared with infants born to married mothers. Being born to an unmarried mother increases the likelihood of infant mortality by approximately 50 percent, with the greatest risk to babies born to unmarried white mothers over age 20.3 Even in countries that have nationalized health care systems and strong supports for single mothers, higher infant mortality is associated with being unmarried.4

Better Physical and Mental Health

Long-term research suggests increased incidence of health problems in children with divorced or single parents. The health advantages of married homes for adults and children remain constant even after taking socioeconomic status into account. In addition, the health effects of family structure for children extend deep into adulthood.5 The National Center for Health Statistics found that children living with their married parents needed professional help for behavior and psychological problems at half the rate of children not living with both biologic parents.6

Superior Educational Attainment

Family sociologist Paul Amato explains that, “children born outside marriage reach adulthood with less education, earn less income, have lower occupational status, and are more likely to be (out of school and unemployed).”7 This is true of children in single parent homes and cohabiting parent homes. Even children living with cohabiting biologic parents, contrasted with children living with parents who have been continually married, have elevated levels of behavior and emotional problems and lower levels of interest in school and completing homework.8

Protection from Poverty

Parental unemployment alone was once a primary indicator of childhood poverty, but in the last few decades that indicator has changed. Now family structure is more closely correlated with childhood poverty than just parental unemployment. “The proliferation of single-parent households,” notes another scholar, “accounts for virtually all of the increase in child poverty since the early 1970s.”9 New data from the U.S. Census Bureau shows that — all things being equal — children living with cohabiting parents are more than twice as likely to live in poverty as children living with their married parents, 34 percent vs. 10 percent.10

Protection from Antisocial Behavior

Children with married parents are substantially less likely to cause problems at school, use drugs including alcohol, be prematurely/promiscuously sexually active, or participate in violent or criminal behavior.11

Protection from Physical Abuse

Numerous studies indicate that children living in homes with a non-biological adult, especially a male, face substantially elevated risk of physical abuse, even death.12

The American College of Pediatricians wants parents, pediatricians, and policy makers to understand that the enduring, healthy, harmonious marriage between a man and a woman not only brings health, happiness and fulfillment to the adults, but these benefits also flow to their children! Society encourages many other healthful activities, so there are compelling reasons for society to encourage efforts to make marriages work as well. Married biologic parents are a rich resource for health and wellness for children. Society must take an interest in promoting the public institution of marriage as the foundation of the natural family. This is the best for children. We expect society’s support and we expect our nation to advocate for nothing less.

Principle Authors: Den Trumbull, MD and Michelle Cretella, MD

Originally posted 2008
Updated September 2014

The American College of Pediatricians is a national medical association of licensed physicians and healthcare professionals who specialize in the care of infants, children, and adolescents. The mission of the College is to enable all children to reach their optimal, physical and emotional health and well-being. More information is available at

A printable Adobe Acrobat (pdf) copy of this position is available by clicking Marriage and the Family.

Additional research: 162 Reasons to Marry, Benefits of Family for Children and Adults, and Family Structure and Children’s Health in the United States, paying particular attention to the conclusion as found on page 27.


  • 1. Kristin Anderson Moore, et al. “Marriage From a Child’s Perspective: How Does Family Structure Affect Children, and What Can We Do about It?” Child Trends Research Brief, June 2002, p. 6.
  • 2. David Popenoe and Barbara Whitehead. “The State of Our Unions 2007: The Social Health of Marriage in America” The National Marriage Project, (Rutgers, The State University of New Jersey, July 2007), p. 6.
  • 3. Trude Bennett, “Marital Status and Infant Health Outcomes,” Social Science and Medicine 35 (1992) 1178-1187.
  • 4. In Sweden: A. Armntzen et al., Marital Status as a Risk Factor for Fetal and Infant Mortality,” Scandinavian Journal of Social Medicine 24 (1996) 36-42; In England: J. Schulman, “Social and Biological Factors in Deaths of Children Aged Under 3,” Population Trends 92 (1996) 5-14; In Finland: E. Frossas et al., “Maternal Predictors of Perinatal Mortality: The Role of Birthweight,” International Journal of Epidemiology 28 (1999) 475-478.
  • 5. W. Bradford Wilcox et al., Why Marriage Matters, Twenty-Six Conclusions from the Social Sciences, 2nd Edition, (New York: Institute for American Values, 2005), p. 23.
  • 6. Deborah A. Dawson, “Family Structure and Children’s Health and Well-being: Data from the National Health Interview Survey on Child Health,” Journal of Marriage and the Family, 53 (1991): 573-584.
  • 7. Paul Amato. “The Impact of Family Formation Change on the Cognitive, Social and Emotional Well-Being of the Next Generation.” in The Future of Children, “Marriage and Child Wellbeing,” Volume 15, Number 2, Fall 2005, (Woodrow Wilson School of Public and International Affairs at Princeton and The Brookings Institution), p. 78.
  • 8. Susan Brown “Family Structure and Child Well-Being: The Significance of Parental Cohabitation,” Journal of Marriage and the Family, 66 (2004) 351-367.
  • 9. Daniel P. Moynihan, “A Dahrendorf Inversion and the Twilight of the Family: The Challenge of the Conference,” in Daniel P. Moynihan, Timothy M. Smeeding and Lee Rainwater, eds., The Future of the Family, (New York, New York: Russell Sage Foundation, 2004), p.xxi.
  • 10. Rose M. Kreider, “Living Arrangements of Children,” Current Population Reports, (Washington, DC: U.S. Census Bureau, 2008), p. 6.
  • 11. Gary Painter and David Levine, “Family Structure and Youths’ Outcomes: Which Correlations are Causal?” Journal of Human Resources 35 (2000) 524-549.
  • 12. Michael N. Stiffman, et al., “Household Composition and Risk of Fatal Child Maltreatment,” Pediatrics, 109 (2002): 615-621.