Health Policy
Report on Psycho-Social Aspects of Single-Parent Families
Introduction 
There has been such an increase in the number of single-parent families over the last twenty years that, now in the mid-nineties, almost one child in three in Europe spends part of its childhood - before the age of sixteen - with just one of its parents.
According to an OECD survey, in most countries the overwhelming majority (80% or over) of single parents are women. Demographic indicators would suggest that the trend is set to continue, primarily as a result of the combined effect of an increase in the incidence of divorce and separation and a declining rate of remarriage. Similarly, the proportion of births outside marriage, often to mothers who have never been married, is on the increase, but varies somewhat between the different European countries.
The health of members of single-parent families may be poor as a result of various conditions prevailing in this type of family set-up:
• the financial situation of single-parent families is very often precarious;
• the accumulation of social roles by single parents creates a physical and psychological overload that can also have repercussions on the children;
• the social and emotional life of members of single-parent families is thrown off balance by the pain of separation, divorce or bereavement.
Furthermore, the community network of support for single parents is often limited following the break-up of a couple. The stress generated by all these factors can lead to a variety of psychosomatic symptoms (tiredness, insomnia, depression, behavioural problems), which entail frequent visits to the doctor or the social services and regular use of medicines. Studies have shown that being a single mother with a dependent child is often associated with greater morbidity and more frequent use of medical services as compared with mothers living as part of a couple. Moreover, ill-health on the part of the parent has an influence on the health of the child. Likewise the ill-health of the child will have an effect on the parents' health.
Single-parent families represent a challenge for social policy and, specifically, health policy. Greater flexibility and sensitivity are called for in the design of health policies if these are to support the "single-parent family" to do its job correctly.
Family policy throughout Europe (benefits, leave, income tax relief, etc.) with regard to single-parent families has been directed towards them as a special group having special problems, which are on the increase, because of their family situation. Scientific results and experiences of the social action indicate the single-parent family and health issues are increasingly related to woman's rights, to poverty and to long-standing unemployment.
Therefore, the health of the single-parent families in the future will derive less from family policy and increasingly from a more general policy to foster employment and combat poverty and from health and social services meeting the specific needs of these families.
Latest trends regarding the demographic and socio-economic characteristics of single-parent families
The family, long considered a basic unit of social and economic organisation has been undergoing significant and rapid changes in recent decades. While the traditional nuclear family remains the most frequent type it has declined as a proportion of all families. The less traditional but similarly structured consensual union has become a more visible and accepted family type and the number of single-parent units and lone-parent families have grown rapidly.
There are several paths into lone-parenthood: marriage and childbirth with subsequent widowhood, separation, divorce or childbirth without marriage. Multiple events may lead to an exit from, or re-entry to, lone-parenthood: reconciliation, marriage or remarriage, repeated or new events of widowhood; separation and divorce; and, eventually, the growth of children into adulthood. Hence the definition of lone-parent families is often unclear depending on the age limit set for the children in order to be included, the type of household formed and the inclusion or exclusion of unmarried cohabiting couples.
The surge in the growth of lone-parent families began in the 1960's in North-America and slightly later elsewhere. Since the early 1970's in some countries, such as France and Switzerland, numbers have increased relatively moderately - by 20% or less. But at the other extreme (in Great Britain for example) the increase has exceeded 50%, with the majority of countries experiencing between 30 and 50 %. The driving force behind this growth - separation and divorce - has been strengthened by falling marriage and remarriage rates. Birth to women who are not married, although by no means equal in importance in all countries, is a rapidly growing contributor. Widows form the largest group in Ireland and Spain but in most other countries they are the second most numerous after the divorce.
These numbers understate the size of the group in one important respect. Many more adults and children experience lone-parenthood over their life cycles than counted at any single time. As a result, lone-parenthood may affect many more people than a snapshot reveals.
When two-parent and lone-parent families are compared, lone-parent families have fewer children on average and the children tend to be older. The popular conception of a lone-parent family is often that of a young mother with a toddler. But this view is in conflict with the facts. Although in all countries the vast majority of lone parents are mothers - 80% and over - divorced and separated mothers, followed by widows, make up the largest proportion in most countries. They are older on average than married mothers and hence their youngest child is also older.
Most studies on divorced and separated mothers show that those who marry young are more likely to experience marital breakdown than those who marry at a later age. On the other hand, studies also show that women who are older when their marriages dissolve are less likely to remarry and thus they experience longer durations of lone parenthood. The net effect is unclear. The situation is further complicated by the strong possibility of anticipated lone parenthood influencing the decision to divorce or separate. The expected state of lone parenthood and the financial and social difficulties that one is likely to experience might possibly keep dissolving marriages together.
Hence, we can hypothesise that separated and divorced mothers are those in part who can afford it. It is also the better off who are most apt to find partners, meaning that even within this group there is a clear line of cumulative disadvantage.
The problems of lone-parent families themselves are similar to those of each of the larger groups to which they may belong - families, the poor, women, children, the employed and the unemployed, as well as all groups that experience disadvantage or disruption in life-cycle patterns. It is the compounding of economic difficulties that results in a high probability that a lone-parent family will also be a poor one. Poverty rates among the lone-parent families are often higher than those in the general population or those in the sub-groups from which lone parents originate.
The nomenclature "lone-parent family" implies a homogeneity within the group and also disparities between this and other groups that are both often absent. The presence of children is a characteristic of what both unifies and distinguishes the group; it is the children who are among the prominent concerns attached to the phenomenon of lone-parent families. In sum, the problems go beyond designation as a family type. However a change in family status may be the catalyst that reveals underlying economic vulnerability; it is the vulnerability to economic disadvantage that is the problem.
Although details differ from country to country, several generalisations seem likely to be valid across countries:
� Female-headed lone-parent families are at risk of economic disadvantage - for some, relative to their previous situation, and for others, in absolute terms.
� Earnings, although important, are not a guarantee that the disadvantage will not be perpetuated. This may not be surprising, it being well documented that women are concentrated in lower-paid occupations and have the dominant share of part-time employment in most countries.
� An important distinction among lone mothers - perhaps the most important one - is related to earnings capacity: this includes differences in educational attainment, training and skills, and prior work experience. These are not only indicators of earnings potential, but they may also pre-ordain other life-chances, such as marriage or remarriage. The role of remarriage and marriage is of vital importance because this is the most typical route out of economic adversity for single parents. Hence, what we have here is a sort of vicious circle where the present economic circumstances are influenced by and also influence the possibilities of change for the better.
� For many women - perhaps for the majority - lone-parenthood is transitory, although not insignificant in duration; these are the women who are more likely to have attributes related to higher earnings capacity. The groups that remain may require different or more intensive assistance, or may need it for a longer period.
� There is an inherent conflict in the dual responsibility for the financial well-being of the family and the care of dependent children. Working time may be limited, or the costs of working high. This too suggests that, for many, earnings alone may not be enough.
Thus, the problems faced by single-parent families stem from a variety of causes: the lack of support from the absent parent, the inadequacy of earnings or the inability to work at all whether due to personal attributes, labour market characteristics or domestic responsibilities and other limitations on working ability or on return to work, or some combination of them.
Public policies and income support systems, whether by acts of omission or commission, are at times inadequate to the task of assisting lone-parent families. Partly due to attitudes to lone-parent families and partly to the fact that in modern industrialised countries in which a woman who has children and who does not work is becoming the exception rather than the rule, societies are less inclined to agree that the lone mother ought to remain outside the labour force. Hence, in general, although many countries provide social support for lone mothers through social insurance, family payments, child support, housing assistance and tax concessions among others, there is a strong tendency of policies that encourage lone mothers to join the labour market and not to rely on financial aid.
Participation in labour market - Barriers to earning
Earnings lead to self-sufficiency, for most able-bodied, non-elderly households but the connection weakens when households are headed by women with children. Despite relatively high labour force participation rates among lone mothers in most countries, there are barriers which limit the return to work. Many relate to problems encountered by women generally: average earnings are below those of men, job opportunities are concentrated in a narrow range of occupations and female unemployment rates in most countries tend to be above those of men.
The link between earnings and adequacy of income is weaker still when financial responsibility extends to children. More income is required than in the case of a single adult, the presence of dependent children may limit working time and the choice of hours of work. The costs of child care, among other costs may leave them with discretionary income that does not meet the needs of the family. Despite these barriers the labour force participation rate of lone mothers are close to those for married mothers in most countries. In most countries lone mothers are most likely to work full-time than are married mothers and less likely to work part-time.
As the level of participation in the labour market of lone and married mothers within countries is similar it can be concluded that the primary explanation for differences between countries in participation by lone mothers lay in factors affecting mothers in general, such as the structure of labour market, relative availability of full-time and part-time jobs, education and training for women, formal and informal child care and parental leave.
Lone-parents are more likely to work if they are already employed when they become lone-parents. Thus, measures which encourage participation by women generally and mothers in particular will lead to higher employment levels by lone mothers. Such measures include improving women's education and vocational skills, employment conditions such us maternity and parental leave and child care to encourage mothers to remain in the labour force. While these measures would involve a cost to governments they would be likely to reduce expenditure on public assistance.
There are a number of factors that might affect the value of earnings and these influence lone-parent families selectively. These include various forms of supplemental compensation, taxation and other payments connected to work. The form and structure of these payments/benefits may have different effects on different earning or income classes or may even distinguish among workers by the pattern and level of work effort. Although most are applied generally they are more likely to affect the work decisions (the incentive to return to work) and the earnings per se of lower wage earners among whom women are over-represented.
Supplemental compensation may take a variety of forms: sick leave, vacation time, paternity or maternity leave, health benefits, occupational pension rights, subsidised lunches or leisure time activities among others. On the cost side are work-related expenses including direct taxes on earnings and income and social and financial benefits forgone on other activities.
Access to child care is likely to be a key factor influencing a lone mother's involvement in the labour market and her return to working. The availability and cost of child care is of obvious interest to all families with children, but access to child care is essential for mothers who work and whose children are not old enough to be left alone. For lone mothers who burden unshared financial and parental responsibilities the availability of affordable child-care facilities may be imperative in order to meet existing obligations.
The growth of the share of women in the labour force points to a more general employment-related need with perhaps a priority need among lone mothers. However, child-care policies usually are designed not for a special group of users nor are they designed only to reconcile paid work with family obligations. For example the largest provider of child care services in virtually all countries is the compulsory school system through the provision of custodial care as a secondary purpose. Child-care policies most frequently address the youngest age group (below school age) yet this has not exhausted the child-care needs of working mothers particularly when limited hours of work are not consistent with financial needs. Few countries have comprehensive child-care strategies to assist working mothers.
The form of public intervention differs among countries, from direct provision of child-care services at reduced cost, to subsidise the providers or the parents by direct grants or, indirectly, through the tax system.
A lone mother at home with her children is often believed to be in an advantageous situation particularly when it is a matter of choice, and not a forced situation caused by lack of adequate child care or job opportunities or other constraints on working. The implication is that the advantages outweigh the forgone earnings. Hence the decision not to work may cost more than is immediately apparent. Work experience and on-the-job skill development are lost, existing skills deteriorate and become obsolete. The result is not only a loss of earnings but also of earning capacity. In conclusion: the strands of evidence confirm both the value of working and the difficulty in doing so, partly due to the conflicting roles and obligations in connection with the children, and partly due to the relatively low returns to available work.
Despite the difficulties, many do work. Those who stay at home at one stage are quite likely to work later on. In most industrialised countries, the likelihood that a woman will never work is relatively low and is diminishing. For the woman who is the lone adult in a family and remains unmarried, it is almost certain that work at some point will be a necessity. For those who enter lone-parenthood with existing skills and experience that enable them to compete successfully in the labour market, the issue is the retention and continuing improvement of their competitive edge. For this group, the availability of appropriate and affordable child-care may be the primary supporting policy required.
There are, however, those who come to lone-parenthood with existing disadvantages: low educational attainment, few, if any, skills, and little or no relevant work experience. For this group, lone-parenthood exacerbates an existing problem, but does not, by itself, create it. This group represents the core among lone parents of the long-term disadvantaged, those who are less likely to attain self-sufficiency through their own efforts and are also less likely to marry or remarry. Working as a way of meeting the responsibilities associated with children, financial and otherwise, takes on different dimensions for them. Affordable child-care may be a necessary condition, but is hardly sufficient in the absence of appropriate employment-related skills and experience. Consequently, an investment in improving their "human capital" - and the time and income required to do it - may be necessary.
Public policy and private support
Earlier, when marital dissolution was less frequent and birth out of wedlock more unusual - and less commonly admitted - the dominant group of lone parents consisted of those who had lost a spouse through death, usually premature death. The social reaction was likely to be sympathetic with a willingness to help. The widow was frequently no longer young, was less likely to have worked than women today, and if she had worked, probably left her job after marriage or the birth of her first child. She was not expected to work thereafter; her first duty was to her children. This remained so after the premature death of the spouse. The widower, on the other hand, was expected to continue in his role of breadwinner and, if possible, to remarry in order to meet other obligations to home and family.
Although this picture is not fully evident for all countries, it is nevertheless the stereotype according to which many public systems were (and are) based. The widow and the children are usually included in social insurance schemes, the obligations of the deceased spouse are met, at least in part, even after death, through the public income transfer system. Whether or not the widow chooses to augment her income through paid work may be of little concern to public authorities.
Lone-parenthood through other than the death of a spouse frequently is not seen in the same light as are widows. Whether due to an underlying sense of disapproval, or a perception that an inherent voluntary element, mitigates public responsibility, or whether due to concern about the potential costs of public support, or other factors, the result is a degree of ambivalence about what is expected of lone mothers: are they to stay at home and take care of children, or to work?
Times have clearly changed, the economic situation is different just as the causes of lone-parenthood have changed. Women are more commonly in gainful employment, many with young children. Just as lone-parents may be in a contradictory situation when faced with dual responsibilities, so may public income maintenance systems exhibit similar contradictions. On the one hand to move lone parents towards greater economic self-sufficiency may be desirable; on the other hand, public income maintenance, if it does indeed maintain the family, may conflict with work incentives. "Generosity" may conflict not only with work incentives, but also with another goal-minimising public expenditures.
The lone parent must put together a complex package of support using a variety of resources whose relative importance will vary over time and which have a complex interrelationship. This package may include income from other households of which she was formerly a member. The income may be received from her parents or a former partner or cohabitee including both capital and periodic transfer payment to herself or her children. Secondly, it will include whatever she earns, which in turn will be affected by the present child-care responsibilities, her skills and training and by the effect of time she has spent out of the labour market caring for other family members, old and young.
Finally she may draw on transfer payments from the State in her capacity as a parent, usually through the basic means tested assistance or welfare schemes rather than the more generous insurance schemes associated with regular employment. The balance among the various sources of income will alter over time according to the age, state of health, marital status, the age of the youngest child and the cause of the lone parenthood. The balance between public and private provision will be directly linked to the family status.
Currently the majority of post-divorce lone-parent households do not rely to any significant extent on private maintenance payments. (Or, if they do, the sum is not too significant.) The main part of the income package is made up from state benefits and the earnings. The relationship between these two sources has a great importance. In Sweden, for example, state support is directed towards this group and not diminished by the mother's earnings. In the United Kingdom the mother's earnings directly reduce her state support. The financial obligations of parents to children continue even when marriages dissolve or were never formed. Despite general agreement on this support from the non-custodian parent is often absent. As a result the corner stone of many national public policies concerns enforcement of private financial responsibilities.
Although it is ideologically significant, the role of family law in supporting lone-parent families is small. Lack of compliance is a universal problem. This may well be for the reason of lack of resources and the addition of new set of dependants. But even with full compliance accepted child support levels are not sufficient to cover the costs of child rearing whether they be direct or indirect because of forgone career earnings. Again, it is the poor families who are the worst off because of the inability of the non-custodian parent to contribute significantly to the household expenses. The divorce rate has increased so rapidly that neither public attitudes nor legal systems have yet developed a consensual view about what the law can achieve for the lone-parent family. There is no clearly expressed public view concerning:
1. what are acceptable as continuing financial obligations for the members of the same family who no longer live in the same household;
2. whether a custodian who seeks all the money she can get from her ex-husband in family support is "sucking the husband dry" or a good mother;
3. whether divorce is an event in the life of two adults or a process with permanent intergenerational consequences for all concerned.
Legal remedies have their origin in the approach to divorce and the legal system is better equipped to solve a dispute such as dividing up property than in planning the financial future for a group of people whose resources and needs will alter over time.
The evidence suggests that the room for improvement is considerable; it is nevertheless clear that changes in allocation do not create new resources: the courts can allocate only what exists. Thus the margin for improvement is most likely to be found where stable income or claims on income exist; approaches which are based on the poor supporting the poor stand to achieve little. Hence, if public support is to play a significant role (as indeed it does in the majority of countries) it must go beyond the legal enforcement of private responsibilities and intervene directly through public transfer systems. The shape and form the public transfer system takes varies from country to country depending on a range of factors from fiscal restraints to general ideological issues. The only way justice could be done to the topic is through a country by country review of social policy targeting lone parents which is beyond the scope of this paper.
Support can take the form of tax allowances for lone parents if the policy targets an incentive to work, direct cash benefits helping through transitory periods or permanently until the child reaches a certain age or various forms of subsidies ranging from housing to child care. Non-governmental organisations might also play an active role in lessening the burden of single parents. They might provide support along the line of governmental organisations or target non-financial needs of lone-parent families through providing social support, education, retraining, informal child care and aiding in lone-parent families' handling of social and psychological difficulties. In many countries self-help groups and civil organisations play an increasingly significant role. This has multiple beneficence in as much that it not only assists the families but also takes pressure off public expenditure.
Although mostly problems of a financial nature were under review here, this does not mean that single-parent families only face burdens in this aspect. Divorce, separation and death are often shattering life events and the results of, as well as cornerstones in, long term difficulties. These influence all aspects of being and, if not handled satisfactorily, have serious consequences on the social, physical and mental well-being of those affected. In the absence of a helpful informal social support network, or, in addition to it, non governmental and professional agencies might make the difference that counts. In many countries the possibilities yielded by non-governmental organisations are as yet unexplored to their full potential so a policy implication could be the aiding of these social lay organisations.
Attitudes and behaviour
Many of the difficulties that single-parent families have to contend with stem from psychological attitudes and patterns of behaviour on the part of society that must be modified if an individual single-parents family is to be helped to overcome a period of crisis.
Single-parent families suffer all too often from discrimination and prejudice (e.g. job-seeking, housing, child care facilities). Negative attitudes on the part of those whose role is to help and advise single-parents can result in a rejection of aid and counselling.
The fact that most single-parent families are headed by women can lead to increasing rather than decreasing inequality between women and men. Some gender role behaviour and attitudes are changing and, as a result, accompanying changes need to be made in what to consider and of what to be sensitive.
There is evidence from the social-psychological literature that people are often threatened and made uncomfortable by those who have experienced a life crisis, particularly if they feel vulnerable to a similar fate. Moreover, those who indicate that they are coping well with life crises are less likely to be judged negatively and avoided by others than those who indicate that they are having some difficulties in coping. These results suggest that those in greatest need of social support may be the least likely to get it.
There is a lack of research on social support systems and coping strategies in the phase after taking up the custody of a child. Overall, little is still known about how people organise and balance various problems and activities simultaneously. There is a need to examine how members of single-parent families (and families in general) cope with a variety of different problems.
Among the questions that the social services would need to have the answer to are:
– What are the consequences of the accumulation of various burdens?
– What is the maximum load that can be borne by single-parents and their private support system ?
– How much help is necessary in certain defined conditions?
– When is the best moment to give help and what is the optimal duration of any measures taken?
– How efficient are various forms of help?
General conclusions
Lone parent families face many problems which, singly, or in combination, may also arise for members of the larger community who are also economically vulnerable: the distinct concerns regarding the growth in their numbers, the likely increasing concentration of low-income units among lone-parent families, the compound disadvantages they face, and the presence of children. The paucity of paths out of economic disadvantage underlies the case for public intervention. The general policy implication is that, in addition to short term remedial policies, it may be cost-beneficial in the long term to reinforce measures to prevent economic vulnerability, particularly those that alleviate labour market disadvantages across the general population, and those of women in particular. Labour market disadvantage and potential dependency on the State represent a cost, but not the only one; the loss of productive resources is also a cost borne by all society and is a bequest to its children.