Cohabitation: Effects of Parental Cohabitation and other Non-marital Sexual Activity on Children – Part 2 of 2

American College of Pediatricians – July 2014

Effects of non-marital sexual activity involve not just the children who may be conceived through it, but also involve children who were born in prior relationships (marital or non-marital) and future children born after the current relationship either dissolves or progresses to marriage, as well as the children of those children and continuing future generations. The divorce or separation of a couple (and divorce or separation is more common when the couple has a history of non-marital sex including cohabitation) may even affect their nieces and nephews or their children’s friends who then worry that their own parents will separate. Compared to couples married at the birth of a child, those cohabiting at the child’s birth were more than four times as likely to separate in the following three years (Table 1).   The increased risk varied from double among African-Americans, to triple among Mexican-Americans to nearly 8-fold among European-Americans.

Table 1. Cumulative Percent of Unions Ending in Separation or Divorce by 36 months after Child’s Birth by Union Status at Child’s Birth and Race or Ethnicity1

Married vs. CohabitatingAll Race CombinedWhiteBlackMexican/American
Married at birth
(n=886)
11.1%5.8%27.2%9.3%
Cohabiting at birth
(n=1,363)
48.7%45.5%57.4%28.8%
Total (n=2,249)23.1%10.9%43.9%15.6%

Note: Results based on life-table estimates. Source: Fragile Families and Child Wellbeing Study

The literature often does not differentiate between children living with a divorced or unmarried parent or whether or not the unmarried parents/parent-stepparent are cohabiting or living separately. Looking at it from a child’s perspective, the proportion of children born to married parents is steadily decreasing and the rate of parental separation (combining separation of cohabiting parents and divorce of married parents) is steadily increasing. There is no evidence that separation of cohabiting parents is less traumatic to a child than is divorce. Because children whose parents cohabited before, during, or after their birth are at increased risk to experience parental separation and also a stepparent (married or cohabiting) situation, information on the risks to children in all of these situations will be included.2 The effects of non-marital sex on children can roughly be grouped into the following areas: Mortality and physical morbidity; psychological, emotional, and behavioral problems; educational; poverty; and repeating the cycle.

Incidence

One-third of men and women entering into cohabitation have children from a previous relationship3 and many have children while cohabiting. The number of cohabiting women who become pregnant is rising. By 2006, 19% of all cohabitations led to pregnancy within the first year, as did 25% of those involving teenagers. Only 19% of those who became pregnant while cohabiting married within six months of becoming pregnant, and even among college graduates, less than half did.4,5 According to a study of U.S. women who had a stillbirth from 2006-2008, less than half of the mothers were married, more than a quarter were cohabiting, and a quarter were neither,6 up from 11% of women between 1990 and 1994 who were cohabiting at the time of giving birth.7

Numbers

The percent of children living in nuclear families dropped to 47.3% in 2007. This is an underestimate because married parents who had both a child over 18 and younger children living at home were not included in “nuclear families”; children living with their married grandparents were also not included. 8

Table 2. Incidence of cohabitation and marriage according to age and gender

WomenTeens
15-17
Teens
18-19
Teens
15-19
20-2425-2930-3535-3940-44
Currently
cohabitating
0.8%9.8%18.7%16.8%12.1%7.8%7.2%
In first
marriage
0.3%2.1%17.3%42.3%53.7%55.9%49.6%
Marriage
only
1.5%12.4%24.2%28%32.4%37.7%
Cohabitate
only
10.9%28.2%25%13.6%10.4%5.2%
Premarital
cohabit
0.8%14.6%33.6%44.2%39.8%33%
Post marital
cohabit
0.3%2.4%5.4%11.1%19.3%
Ever
cohabitated
11.7%43.1%60.9%63.2%61.3%57.4%
MenTeens
15-17
Teens
18-19
Teens
15-19
20-2425-2930-3535-3940-44
Currently
cohabitating
0.3%5.5%15%19.5%15%12.3%9.4%
In first
marriage
0.7%11.3%32.8%50.9%54.1%50.2%
Marriage onlyQNS10.4%21.1%25.3%26.4%25.9%
Cohabit
only
5.1%27.5%29.8%17.5%12.8%8.9%
Premarital
cohabit
0.4%6.3%27.6%42.4%46.2%44.3%
Post marital
cohabit
QNS1.1%2.4%5.8%13.3%
Ever
cohabitated
5.5%33.9%58.5%62.3%64.7%66.5%

In the above table, the rows dividing teens into two age groups came from 2006-2010 data,9 whereas those combining the groups came from 2002 data.10 In all age groups, cohabitation is more common than marriage that does not involve either preceding or subsequent cohabitation, and it is likely that half of the children in the U.S. today are affected by parental cohabitation.

As noted in Part I, children born within a cohabiting relationship are much more likely to experience the separation of their parents. Of children born to cohabiting couples, 48.7% experienced separation of their parents by their third birthday compared to 11.1% of those born to married couples,11 with a third again as many marriages which were preceded by cohabitation and twice as many first cohabitations ending within 10 years compared to marriages not preceded by cohabitation.12 Mothers who married prior to conception were half as likely to have children by a different father as those who married during pregnancy, and three to four times less likely than those who married several years after that child’s birth or did not marry.13 Half of those cohabitating for more than six years had children from a previous relationship. (Children from the current relationship were not included in the report.) Since the average age of those in the study was under 30, presumably most of these children were young.14

Table 3. Estimated annual number of children born and aborted of unwed and cohabiting parents

 Unwed pregnanciesCohabiting
% of all births40.7% 1524.7% 16
Annual births 2012
(n=3,952,841) (17)
1,608,806 (calculated)976,350 (calculated)
% of all abortions85.3% 1829.2% 15
No. of annual abortions
2011 (n=1,058,500) (20)
902,900 (calculated)309,082 (calculated)
Total births = induced
abortions per year
(N=5,011,041)
2,511,706 (calculated)1,285,432 (calculated)

  *Numbers and percentages used in this table are from the most recent years available (births from 2012, abortions from 2011, and percentages from 2006-2008), so the calculated totals are rough estimates. Since cohabitation is increasing annually, the totals calculated for cohabitation are probably underestimates.

It is estimated that over 2.5 million babies a year are conceived by unwed parents, among whom nearly a million and a half had parents who were cohabiting at the time of abortion or birth. The numbers above do not include spontaneous abortions or ectopic pregnancies or stillbirths; nor do these figures reflect children whose parents married during pregnancy, siblings born prior to cohabitation, or younger siblings born to married couples who had previously cohabited and are also at increased risk of parental separation.

Mortality and Morbidity
As noted above, when a child is conceived outside of marriage, the child can be born or it can be denied further life through abortion. Since nearly 85% of abortions are performed on unmarried women, 29% on cohabitating women, and 14% on married women, abortion is more likely when non-marital sex is involved.  The abortion index is the relative risk of abortion for a group of women compared to all women ages 15-44 (control value set at 1.0).  A child conceived by a cohabitating woman is at 10 times higher risk of abortion compared to one conceived in marriage (3.46 relative rate/abortion index for cohabiting women compared to 0.34 for married women)  Cohabitation is a higher risk factor for abortion (abortion index 3.46) than age (abortion index 2.03 for women aged 20-24, the most prevalent age group) or race (abortion index 2.06 for non-Hispanic African-Americans, the highest risk racial group).21 Among women who have ever been pregnant, and who have ever had an abortion, 89% have at some time been in a cohabiting relationship, and 41% have been in three or more cohabiting relationships.22 .  Direct effects of abortion on children involve death the vast majority of the time.  Evidence is overwhelming that abortions are painful to the fetus after 20 weeks, and there is some evidence that abortions may be painful to the younger fetus.23 Since 1.3% of abortions are done after 20 weeks gestation and 7% are done between 14-20 weeks24, fetal pain is another consequence of abortion.  A few babies will survive abortion attempts, and those infants are often left with disabilities. Indirect effects of a previous history of maternal abortion on children conceived later include higher risk of death and disability through early prematurity25 and an increased incidence of the effects of living with a depressed mother26,27,28,29 or one who abuses drugs or alcohol.30 There is also a higher incidence of being orphaned at a young age.31,32,33,34 Low birth weight babies were also 1.4 to three times less frequent among mothers who married prior to conception35, mothers under age 16 (Teen moms <16 may not be cohabiting, but their parents are more likely to have been. See the section on “Repeating the cycle” which discusses the increased incidence of adolescent sexual activity and pregnancy among girls raised in families without both biological/adoptive parents) are more likely to give birth to a baby born prematurely with low birth weight36 which can lead to infant death, blindness, deafness, respiratory problems, mental retardation, cerebral palsy, dyslexia, and hyperactivity.37 Children in nuclear families rate about twice as well as children in single households or cohabiting families on many measures: more have dental care and a local physician, and they have less ER visits and have missed less school.38 Married women are twice as likely to breastfeed (60% vs. 30%) and for longer.39 Compared to children living with married biological parents, those whose single parent had a live-in partner had more than eight times the rate of maltreatment overall.40

Table 4. Harm Standard According to Family Structure41

Child lived with
(estimated numbers from
census 2005-7)
Harm Standard per 1000
children
Abuse
Harm Standard per 1000
children
Sexual Abuse
Harm Standard per 1000
children
Neglect
Harm Standard per 1000
children
All maltreatment
Married biological
parents
2.90.54.26.8
Cohabiting
parents
12.12.412.623.5
Single parent
only
10.22.419.628.4
Parent + unmarried
partner
33.69.92757.2
Other married parents
(includes parent and
married stepparent)
17.44.39.324.4

Controlling for socioeconomic and other demographic factors, mothers under age 16 at the time of their first birth are more than twice as likely as 20- to 21-year-old mothers to be reported for child neglect or abuse and four times as likely as mothers 22 and older. Children of mothers who were 15 or younger at their first birth were 50% more likely to have a child placed in foster care than women who were 20 to 21 years old; children of women 22 or older at first birth were the least likely to be placed in foster care.42 Single-mother, cohabiting two-parent, and married two-parent families with infants were compared on maternal and infant behavior, Home Observation for Measurement of the Environment (HOME) scores, and infant’s security of attachment. Married mothers and their infants demonstrated more positive behavior and received higher HOME scores when the infant was six and 15 months old than did their cohabiting and single counterparts. Married families were also better off than single and cohabiting families on several demographic, parent personality, financial, and social context measures. Single and cohabiting families were similar across most measures. Selection variables (maternal age, ethnic group, and education) explained much, but not all, of the family structure differences in the mother-infant relationship and the HOME scores.43 The lack of stability in a home with parental separation or divorce can interfere with the development of a secure attachment to a dependable caretaker in infants; this is thought to form the basis for future relationships. Preschool-aged children may regress in development after parental divorce.44 Children whose mothers had previous abortions had less supportive home environments (among one- to four-year-olds) and more behavioral problems (among five- to nine-year-olds) than children of women without a history of abortion.45 Women in cohabiting relationships are more often depressed than married women. The addition of children increases depression initially (but not long-term) for those cohabiting, but did not affect married women.46 After controlling for education, race, and income differences, limiting the evaluation to women who had been in stable relationships for two years still showed more depression among those cohabiting, as well poorer responsiveness (“less sensitivity”) to their children’s emotional needs.47 Children whose mothers are consistently depressed have larger amygdalas (as do children raised in orphanages),48 and have increased cortisol responses to stress.49 Parental depression has been linked to increased risk of behavior problems, anxiety, depression, academic decline, and social relationship problems.50 Compared to children of cohabitating parents, children of married parents are four times less likely to experience separation of their parents in their first three years (49% vs. 11%) and three times less likely to have older half siblings, a situation that leads to increased tension in the home and higher chance of separation.51 Children whose parents divorce have not only increased risks of physical injuries, disease, hospitalization, somatization, early mortality, increased substance, alcohol and tobacco abuse, increased incidence of obesity, respiratory diseases, adolescent sexual activity and pregnancy, but also have higher risk of hypertension and asthma in adulthood. Some of these may be related to decreased parental monitoring, while others, such as hypertension, may be a result of increased cardiac reactivity and cortisol levels in response to stress.52

Longitudinal studies of Cherlin and colleagues found that the gap in psychological well-being between offspring from divorced and non-divorced families grew larger with time.53 Some problems in adulthood experienced by children of divorce include low socioeconomic attainment, poor subjective well-being, and increased marital problems and divorce.54 Twin studies that control for genetic predisposition to depression have also shown that parental divorce increases the risk of depression in adulthood.55

Both boys and girls raised in single-parent households had significantly increased risks compared with those in two-parent households for psychiatric disease both in childhood and as young adults, for suicide, for alcohol-related disease and death, and for drug addiction and drug-related death.56

Table 5. Increase Risk to Children and Adolescents Raised in One vs. Two Parent Homes in Sweden

 Mortality Risk
Girls
Mortality Risk
Boys
Morbidity Risk*
Girls
Morbidity Risk*
Boys
Suicide2.431.831.78-2.442.05-2.79
Violence2.544.041.69-2.631.35-2.10
Addiction3.735.31
Alcohol-related
disorder
2.00-2.961.88-2.66
Drug-related
disorder
2.38-4.533.01-5.63
Psychiatric
disease
1.77-2.462.15-2.97

* Range of relative risk across four models

All the findings in Table 5 reached statistical significance except for intentional violence in girls with lower CIs above 1; ranges are with and without modifications for potential parental confounding and mediating factors. Children of divorce in kindergarten through fifth grade had more depression and anxiety than those from intact families.  Adult women whose parents had divorced are at elevated risk for suicide even without known depression.57 These results were confirmed in another study showing that the general mortality risk, as well as the risk of committing suicide for 16- and 28-year-old males with a single-parent family background, was significantly increased compared with males from a two-parent family background.58 Compared with children in single households or cohabiting families, children in nuclear families have about half the learning disabilities and attention deficit hyperactivity disorder, less behavior problems, less definite or severe emotional or behavior problems, and fewer parents describe their children as worried.59

Problem Behavior, Delinquency, and Crime 

Children whose parents married prior to their conception showed less aggression at age three than children whose parents married while they were in utero or just after birth, and they showed less aggression than children whose parents married more than a year after they were born.60 A NICHD study of 1,015 first grade school children investigated the effect of early familial structure changes. Children born into cohabiting families had the most familial structure changes (64% had at least one change and 22% had three or more changes by the time they finished kindergarten). Teacher reports of problem behavior in children during the transition to first grade were correlated with instability in family structure and increased from those in two-biological married parent families to single mother families, yet were highest in those born into cohabiting households. 61 Follow-up revealed that early familial structure changes also adversely affected behaviors and peer interactions for boys in fifth grade.62 A study investigating associations between family instability (changes in parents’ intimate partners, work hours, residence, children’s schools) and adolescent adjustment showed that instability was associated with increased caregiver-reported externalizing and internalizing behaviors (including youth- reported cigarette use); reduced teacher-reported frustration tolerance, social skills, and task orientation; and lower academic grades. There was also an increased risk for school suspensions, “Person in Need of Supervision” status, binge drinking, and marijuana use.63 An analysis of 1,335 couples five to 10 years after beginning either cohabitation or marriage revealed a higher incidence of alcohol abuse among men and women who were cohabiting at the start of the study compared to those who were married. Interestingly, these differences were not apparent in the first five years of the relationship.64

Table 6. Alcohol Abuse in Cohabitating and Married Families

Initial Family StructureCohabitatingCohabitatingCohabitatingMarriedMarried
Family Structure
5-10 years later
SeparatedCohabitatingMarriedSeparated/DivorcedMarried
Alcohol problem
(Men)
9.6%7.8%4.4%6.8%3.7%
Alcohol problem
(Women)
4.3%3.9%0.7%0.9%0.6%

Thus, the children of cohabiting parents are more likely to be exposed to the negative effects of parental and/or step-parental substance abuse. Adolescents with divorced parents have more alcohol and drug abuse and rule violations than those from intact families.65 Children reared in an intact family, by both of their biological parents, are statistically less likely to commit a minor or serious crime compared to all other family living arrangements (single mom, single dad, biological dad married to step-mom, or biological mom married to step-dad.)66 Cohabitation was not specifically studied, but since cohabiting unions are much more likely to dissolve than marriages not proceeded by cohabitation, children whose parents cohabited are more likely to be raised in one or more of the other family living arrangements and thus more likely to have committed a criminal offense than those raised by married parents.

Educational Achievement

Even after taking into account many socioeconomic factors surrounding the teen mother, children of teen moms tend to have lower academic and cognitive outcomes in kindergarten. Later academic achievement also appears to be affected. A girl is less likely to complete high school if her mom was 18 or 19 years old at her birth compared with a girl whose mom was 20 or 21 years old. This finding is likely to be a small reflection of a greater trend: academic outcomes are improved for children whose mothers wait even longer – until their mid- or late 20s – to have them.67 Children from two-parent households read significantly better in first grade than do those from single-parent households,68 while those from non-intact families had more academic problems and lower GPAs.69 Those from non-intact families are less likely to graduate from high school and to attend college; only 30-50% of this is accounted for by the increased poverty of non-nuclear families.70 Family instability (changes in parents’ intimate partners, work hours, residence, and children’s schools) was associated with lower task orientation and lower academic grades for adolescents.71 Compared with control students in intact families, both male and female children experiencing parental divorce fared less well in most well-being measures at the four time points evaluated. The effects of the disruption process on students’ test scores linearly declined over time; the effects of divorce on social-psychological measures exhibited a U-shaped time pattern. Over time, differences in family social and economic resources mediated the detrimental effects of the disruption process to varying degrees.72

Poverty and Economic Well-being

The poverty rate among married women is 5.3% vs. 26.5% among single women who head households according to the U.S. Census Bureau.73 Children born to cohabiting parents are more likely to experience poverty and food and housing shortages.74 Only 12% of children from married families lived with a biological parent and stepparent, but 54% of those living with a cohabitating home had a biological parent and a non-biological one in the home. Typically stepchildren do not receive the same family benefits (food, clothing, gifts, schooling, and health care) as biological children.

Table 7. Poverty Level and Family Structure

Family StructureCombined incomes below
poverty level
Parent + married
stepparent
10%
Parent + cohabiting
"stepparent"
19%
Married biological
parents
8%
Single dad13%
Single mom43%
Cohabiting biological
parents
23%

The number living in “social [financial] poverty,” which counts the income of both cohabitating parents in calculating the poverty level, rose from 8% of those living with both biological married parents to 10% of those in married stepparent homes, to 13% living with single dads, to 19% of those in cohabitating “stepparent” situations, to 23% of those living with both cohabitating parents, to 43% of those living with single moms. By 1999, an estimated 4.3 million children were living in cohabitating homes.75 While six- to 11-year-old children in step/cohabitating households with more resources had less detrimental effect, added resources did not ameliorate the negative effect of non-nuclear families for adolescents.76 In another study, roughly one in seven children in unmarried-parent families also live with their parent’s unmarried partner. Although these children have two potential caretakers and economic providers, results indicate that parental resources fall short of their counterparts in married-couple families. A cohabiting partner’s economic contribution results in a 29% reduction in the proportion of children in cohabiting-couple families living in poverty, but still they fare poorly in comparison with children in married-couple families.77 Repeating the cycle In the Fragile Families and Child Wellbeing Study, 62% of those who were married at the birth of their child had lived with married parents at age 15, compared to only 37% of those cohabitating at the birth of their child.78 About one-third of women who lived with both parents (biological or adoptive) at age 14 themselves were divorced within 10 years, but over half of those who did not live with both parents at age 14 were divorced within the first 10 years of marriage.79 In 1995, a survey of women aged 15-44 showed the following results80:

Table 8. Effects of Family Structure in Childhood upon Women: Sex and Marriage

Effect on
children
Lived with both parents
from birth until leaving
home
Both then one
parent
StepparentLived with unmarried
parent only
Virgins at marriage15%8%6%6%
Sex before age 156%12%15%18%
Had premarital child12%21%19%42%
Married67%53%58%41%
Of those who married,
later divorced
32%36%41%44%
Raped17%20%27%27%

In a study comparing those married vs. those cohabitating for more than a year, 25% of those married grew up without both parents living with them at age 16 compared to 38% of those cohabitating. 81

Girls were two to three times as likely to have a first birth under age 20 if their mothers had had a first birth in their teens. Living with biological or adoptive parents at age 14 decreased teen pregnancy rates by two-thirds. Lack of maternal higher education was also strongly correlated with teen pregnancy. About 12% of younger teens and 21% of older teens would be pleased to learn they were expecting a baby (1-2% less among girls and more among boys); those raised by their two parents had less positive attitudes than those in blended or single/non-marital households.82

Summary

In summary, cohabitation puts at risk both those who cohabitate and their current and future children and grandchildren. These risks to the children include: parental separation, step-parents, half-siblings, and step-siblings with increased internal family strife; induced death; death and disability due to prematurity and/or low birth weight including blindness, deafness, respiratory problems, mental retardation, cerebral palsy, dyslexia, and hyperactivity; poorer medical and dental care and nutrition, more missed school, and increased risk of behavior problems, anxiety, depression, academic decline, and social relationship problems; increased risk of child abuse; increased risks of physical injuries, disease, hospitalization, somatization, and early mortality; increased substance, alcohol and tobacco abuse; increased incidence of obesity, respiratory diseases, adolescent sexual activity and pregnancy (including increased risks of death and prematurity to the children of these adolescents); a higher risk of hypertension, asthma, and depression in adulthood; more psychiatric disease in childhood, suicide attempts and suicides, alcohol-related disease, and narcotics-related disease; low socioeconomic attainment, poor subjective well-being, and increased marital problems and divorce; lower academic achievement and more involvement in both petty and serious crime; more poverty, a higher risk of being raped; and more teen sex, premarital parenthood, and divorce themselves, thus carrying on the negative consequences to the third and fourth generations.

Pediatricians and others who care for children, adolescents, and young people should include information on the risks of cohabitation in their anticipatory guidance.

Part 1 of this paper: The Effects of Cohabitation on Men and Women Involved

Primary author: Patricia Lee June, MD, FCP
July 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.

A PDF of this statement can be printed here:  Cohabitation Part 2 of 2

References

1. Osborne C, Manning WD, Stock PJ. Married and cohabiting parents’ relationship stability: A focus on race and ethnicity. J Marriage Fam. 2007; 69: 1345-1366, 1354 Table 2.
2. Anderson J. The Impact of Family Structure on the Health of Children: Effects of Divorce. May 12, 2014. www.ACPeds.org. Accessed May 2014.
3. Goodwin PY, Mosher WD, Chandra A. Marriage and cohabitation in the United States: A statistical portrait based on cycle 6 (2002) of the National Survey of Family Growth. National Center for Health Statistics. Vital and Health Statistics. 2010; 23(8). http://www.cdc.gov/nchs/data/series/sr_23/sr23_028.pdf. Accessed February 16, 2012.
4. Copen CE, Daniels K, Vespa J, Mosher WD. First marriages in the United States: Data from the 2006–2010 National Survey of Family Growth. Division of Vital Statistics. U.S. Department of Health and Human Services Centers for Disease Control and Prevention. National Center for Health Statistics. 2012; 49. http://www.cdc.gov/nchs/data/nhsr/nhsr049.pdf. Accessed September 10, 2013.
5. 2006–2010 National Survey of Family Growth National Health Statistics Reports. 2013; 64: 5-6. http://www.cdc.gov/nchs/data/nhsr/nhsr064.pdf. Accessed May 9, 2014.
6. The Stillbirth Collaborative Research Network Writing Group. Causes of death among stillbirths. JAMA. 2011; 306(22): 2459-2468.
7. Bumpass L, Lu HH. Trends in cohabitation and implications for children’s family contexts in the United States. Popul Stud. 2000; 54(1): 29-41.
8. Family structure and children’s health in the United States: Findings from the National Health Interview Survey, 2001-2007. Vital Health Statistics. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. National Center for Health Statistics. 2010; 10(246). http://www.cdc.gov/nchs/data/series/sr_10/sr10_246.pdf . Accessed March 5, 2012.
9. Copen CE, Daniels K, Vespa J, Mosher WD. First marriages in the United States: Data from the 2006–2010 National Survey of Family Growth. Division of Vital Statistics. U.S. Department of Health and Human Services Centers for Disease Control and Prevention. National Center for Health Statistics. 2012; 49. http://www.cdc.gov/nchs/data/nhsr/nhsr049.pdf. Accessed September 10, 2013.
10. Goodwin PY, Mosher WD, Chandra A. Marriage and cohabitation in the United States: A statistical portrait based on cycle 6 (2002) of the National Survey of Family Growth. National Center for Health Statistics. Vital and Health Statistics. 2010; 23(8): Tables 13,14. http://www.cdc.gov/nchs/data/series/sr_23/sr23_028.pdf. Accessed September 10, 2013.
11. Osborne C, Manning WD, Stock PJ. Married and cohabiting parents’ relationship stability: A focus on race and ethnicity. J Marriage Fam. 2007; 69: 1345-1366.
12. Bumpass LL, Sweet JA. National estimates of cohabitation. Demography. 1989; 26: 615-625. Lichter DT, Qian Z, Mellott LM. Marriage or dissolution? Union transitions among poor cohabitating women. Demography. 2006; 43(2): 223-240. Bumpass L, Lu HH. Trends in cohabitation and implications for children’s family contexts in the United States. Popul Stud. 2000; 54(1): 29-41.
13. Data from The Fragile Families and Child Wellbeing Study (Fragile Families) reported in Osborne C,  Palmo N. Do children benefit if their unmarried parents marry? A focus on young children’s behavior. LBJ School of Public Affairs, Population Research Center, University of Texas at Austin. https://www.utexas.edu/lbj/chasp/research/downloads/Doc6marriage_timing_.pdf Published June 2009. Accessed May 9, 2014.
14. Kenney CT, McLanahan SS. Why are cohabitating relationships more violent than marriages? Demography. 2006; 43(1):127-140, *calculate from raw data in Table 2.
15. Martin JA, Hamilton BE, Michelle JK. Osterman MJK, et al. Births: Final Data for 2012 National Vital Statistics Reports. 62(9) Dec 30, 2013 Tables 1 and 13.  http://www.cdc.gov/nchs/fastats/births.htm. Accessed June 25, 2014.
16. The Stillbirth Collaborative Research Network Writing Group. Causes of death among stillbirths. JAMA. 2011; 306(22): 2459-2468.
17. Martin JA, Hamilton BE, Michelle JK. Osterman MJK, et al. Births: Final Data for 2012 National Vital Statistics Reports. 62(9) Dec 30, 2013 Tables 1 and 13.  http://www.cdc.gov/nchs/fastats/births.htm. Accessed June 25, 2014.
18. Pazol K, Creanga AA, Burley KD, et al. Abortion surveillance — United States, 2010 Surveillance Summaries. Morbidity and Mortality Weekly Reports (MMWR). Centers for Disease Control and Prevention. 2013; 62p.(SS08): 1-44. Page 1. Accessed June 17, 2014.
19. Jones RK, Finer LB, Singh S. Characteristics of U.S. abortion patients 2008, New York. Guttmacher Institute, 2010. http://www.guttmacher.org/pubs/US-Abortion-Patients.pdf. Accessed May 9, 2014.
20. Jones RK and Jerman J. Abortion Incidence and Service Availability In the United States, Volume 46, Number 1, March 2014 http://www.guttmacher.org/pubs/journals/psrh.46e0414.pdf.  Accessed June 18, 2014.
21. Pazol K, Creanga AA, Burley KD, et al. Abortion surveillance — United States, 2010 Surveillance Summaries. Morbidity and Mortality Weekly Reports (MMWR). Centers for Disease Control and Prevention. 2013; 62p.(SS08): 1-44. Page 1. Accessed June 17, 2014.
22. Fagan PF, Talkingham S. Demographics of women who report having an abortion: Preliminary inquiry from The National Survey of Family Growth 2006-2010. http://downloads.frc.org/EF/EF14A37.pdf. Accessed June 26, 2014.
23. Fetal Pain: The Evidence available at http://www.doctorsonfetalpain.com/. Published 2014. Accessed May 9, 2014.
24. Pazol K, Creanga AA, Burley KD, et al. Abortion surveillance — United States, 2010 Surveillance Summaries. Morbidity and Mortality Weekly Reports (MMWR). Centers for Disease Control and Prevention. 2013; 62p.(SS08): 1-44. Page 1. Accessed June 17, 2014.
25. Rooney B, Calhoun B. Induced abortion and risk of later premature births. Journal of American physicians and surgeons. 2003; 8(2): 46-49. Klemetti R, Gissler M, Niinimäki M, Hemminki E. Birth outcomes after induced abortion: A nationwide register-based study of first births in Finland.
26. Fergusson DM, Horwood JL, Ridder EM. Abortion in young women and subsequent mental health. J Child Psychol Psychiatry. 2006; 47(1): 16-24. Huang Z, Hao J, Su P, Huang K, Xing X, Cheng D, Xiao L, Xu Y, Zhu X, Tao F. The impact of prior abortion on anxiety and depression symptoms during a subsequent pregnancy: Data from a population-based cohort study in China. Bulletin of Clinical Psychopharmcology. 2012; 22.
27. Coleman, PK. Abortion and mental health: Quantitative synthesis and analysis of research published 1995-2009. Br J Psychiatry. 2011; 199: 180-186. Comment: One of the studies in this meta-analysis was weighed incorrectly; the author has since corrected this and reanalyzed the data: the overall pattern of results did not change remarkably. Data from 877,181 women were used in this meta-analysis; Stress, Depression and Suicide: A Study of Adolescents in Minnesota, Barry Garfinkel et al in Responding to High Risk Youth, Minnesota Extension Service, University of Minnesota (1986) A history of abortion was 6 to 10 times more frequent among girls who attempted suicide in this study; eighty-nine percent of those attempting suicide were depressed with over half severely depressed.This data leads us to the conclusion that depression is a consequence of abortion.
28. Reardon DC, Ney PG, Scheuren FJ, Cougle JR, Coleman PK, Strahan T. Deaths associated with pregnancy outcome: A record linkage study of low income women. South Med J. 2002; 95(8): 834-841.
29. Gissler M, Kauppila R, Merilainen J, Toukomaa H, Hemminki E. Pregnancy associated deaths in Finland 1987-1994: Definition problems and benefits of record linkage. Acta Obstet Gynecol Scand. 1997; 76: 651-657.
30. Amaro H, Zuckerman B, Cabral H. Drug use among adolescent mothers: Profile of risk. Pediatrics. 1989; 84: 144-151; Keith LG, MacGregor S, Friedell S, et al. Substance abuse in pregnant women: Recent experience at the Perinatal Center for Chemical Dependence of Northwestern Memorial Hospital. Obstet Gynecol. 1989; 73(5 Pt l): 715-720.
31. Gissler M, Kauppila R, Merilainen J, Toukomaa H, Hemminki E. Pregnancy associated deaths in Finland 1987-1994: Definition problems and benefits of record linkage. Acta Obstet Gynecol Scand. 1997; 76: 651-657.
32. Gissler M, Berg C, Bouvier-Colle M, Buekins P. Pregnancy-associated mortality after birth, spontaneous abortion, or induced abortion in Finland, 1987-2000. Am J Obstet Gynecol. 2004; 190: 422-427.
33. Reardon DC, Ney PG, Scheuren FJ, Cougle JR, Coleman PK, Strahan, T. Deaths associated with pregnancy outcome: A record linkage study of low income women. South Med J. 2002; 95(8): 834-841.
34. Reardon D, Coleman P. Short and long term mortality rates associated with first pregnancy outcome: Population register based study for Denmark 1980–2004. Med Sci Monit. 2012; 18(9): 71-76. http://www.medscimonit.com/index.php?/archives/article/883338.
35. Data from The Fragile Families and Child Wellbeing Study (Fragile Families) reported in Osborne C, Palmo N. Do children benefit if their unmarried parents marry? A focus on young children’s behavior. LBJ School of Public Affairs, Population Research Center, University of Texas at Austin https://www.utexas.edu/lbj/chasp/research/downloads/Doc6marriage_timing_.pdf Published June 2009. Accessed May 9, 2014.
36. Chen XK, Wen SW, Fleming N, Demissie K, Rhoads GG, Walker M. Teenage pregnancy and adverse birth outcomes: A large population based retrospective cohort study. Int J Epidemiol. 2007; 36: 368-373. Cunnington AJ. What’s so bad about teenage pregnancy? JFam Plann Reprod Health Care. 2001; 27: 36-41.
37. Carlo WA, McDonald SA, Faranoff AA, et al. Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks’ gestation.  JAMA. 2011; 306(11): 2348-2358. Rudolph CD and AM, eds. Rudolph’s Pediatrics. 21st ed. New York, NY: McGraw-Hill Medical; 2003: 127-165.
38. Family structure and children’s health in the United States: Findings from The National Health Interview Survey, 2001-2007. Vital Health Statistics. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. National Center for Health Statistics. 2010; 10(246). http://www.cdc.gov/nchs/data/series/sr_10/sr10_246.pdf. Accessed March 5, 2012.
39. Abma JC, Chandra A, Mosher WD, et al. Fertility, family planning, and women’s health: New data from the 1995 National Survey of Family Growth. Vital Health Stat 23. No. 19. Hyattsville, MD: National Center for Health Statistics, US Dept of Health and Human Services; 1997. DHHS Publication No. (PHS)97-1995. http://www.cdc.gov/nchs/data/series/sr_23/sr23_019.pdf
40. Sedlak A, Mettenburg J, Li S, Basena M,  Greene A, McPherson K,  Petta I. Fourth National Incidence Study of Child Abuse and Neglect (NIS-4): Report to Congress 2010; 5-19. http://www.acf.hhs.gov/programs/opre/abuse_neglect/natl_incid/reports/natl_incid/nis4_report_congress_full_pdf_jan2010.pdf. Accessed on March 8, 2012.
41. Ibid. pp. 5-20 and 5-22.
42. George RM, Harden A, B.J. Lee BJ. Consequences of teen childbearing for child abuse, neglect, and foster care placement. In: Hoffman SD, Maynard RA, eds. Kids Having Kids: Economic Costs and Social Consequences of Teen Pregnancy. 2nd ed. Washington, D.C.: The Urban Institute Press; 2008: 276-278.
43. Ibid.
44. Kleinsorge C, Covitz LM. Impact of divorce on children: Developmental considerations. Pediatr Rev. 2012; 33(4): 147-154.
45. Coleman PK, Reardon DC, Cougle JR. The quality of caregiving environment and child development outcomes associated with maternal history of abortion using the NLSY data. J Child Psychol Psychiatr. 2002; 43(6): 743-757.
46. Brown SL. The effect of union type on psychological well-being: Depression among cohabiters versus marrieds. J Health Soc Behav. 2000; 41: 241-255.
47. Klausli JF, Owen MT. Stable maternal cohabitation, couple relationship quality, and characteristics of the home environment in the child’s first two years. J Fam Psychol. 2009; 23(1): 103-106. doi 10.1037/a0014588
48. Tottenham N,  Hare TA, Quinn BT, McCarry TW, Nurse M, Gilhooly T,  Milner A, Galvan A,  Davidson MC, Eigsti IM, Thomas KM,  Freed P, Booma ES, Gunnar M, Altemus M, Aronson J, and Casey BJ. Prolonged institutional rearing is associated with atypically large amygdala volume and difficulties in emotion regulation. Dev Sci. 2010; 13(1): 46–61. Mehta MA, Golembo NI, Nosarti C, Colvert E, Mota A, Williams SCR, Rutter M and Sonuga-Barke EJS. Amygdala, hippocampal and corpus callosum size following severe early institutional deprivation: The English and Romanian Adoptees study pilot. J Child Psychol Psychiatr. 2009; 50: 943–951.
49. Lupien SJ, Parent S, Evans AC, et al. Larger amygdala but no change in hippocampal volume in 10-year-old children exposed to maternal depressive symptomatology since birth. Proc Natl Acad Sci U S A. Published online before print. August 15, 2011. doi: 10.1073/pnas.1105371108
50. Kleinsorge C, Covitz LM. Impact of divorce on children: Developmental considerations. Pediatr Rev. 2012; 33(4): 147-154.
51. Osborne C, Manning WD, Stock PJ. Married and cohabiting parents’ relationship stability: A focus on race and ethnicity. J Marriage Fam. 2007; 69: 1345-1366.
52. Nunes-Costa RA, Lamela DJPV, Figueiredo BFC. Psychosocial adjustment and physical health in children of divorce. J Pediatr (Rio J). 2009; 85(5): 385-396.
53. Chase-Lansdale PL, Cherlin AJ, Kiernan KE. The long-term effects of parental divorce on the mental health of young adults: A developmental perspective. Child Dev. 1995; 66, 1614-1634 and Cherlin AJ, Chase-Lansdale PL, McRae C. Effects of divorce on mental health throughout the life course.  Am Sociol Rev. 1998; 63: 239-249 cited in Amato, PR. The consequences of divorce for adults and children. J Marriage Fam. 2000; 62: 1269-1287.
54. Amato, PR The consequences of divorce for adults and children. J Marriage Fam. 2000; 62: 1269-1287.
55. Kendler KS, Neale MC, Kessler RC, et al. Childhood parental loss and adult psychopathology in women. Arch Gen Psychiatry. 1992; 49: 109-116 cited in Amato, PR. The consequences of divorce for adults and children. J Marriage Fam. 2000; 62: 1269-1287.
56. Weitoft GR, Hjern A, Haglund B, Rosén M. Mortality, severe morbidity, and injury in children living with single parents in Sweden: A population based study. Lanc. 2003; 361: 289, 291-292.
57. Kleinsorge C, Covitz LM. Impact of divorce on children: Developmental considerations. Pediatr Rev. 2013; 33(4): 147-154.
58. SAUVOLA A, RÄSÄNEN PK, JOUKAMAA MI, JOKELAINEN J, JÄRVELIN MR, and ISOHANNI M. Mortality of young adults in relation to single-parent family background. Eur J Public Health. 2001; 11(3): 285.
59. Family structure and children’s health in the United States: Findings from The National Health Interview Survey, 2001-2007. Vital Health Statistics. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. National Center for Health Statistics. 2010; 10(246).  http://www.cdc.gov/nchs/data/series/sr_10/sr10_246.pdf. Accessed March 5, 2012.
60. Osborne C, Palmo N. Do children benefit if their unmarried parents marry? A focus on young children’s behavior. Population Research Center, University of Texas at Austin. 2009. http://www.utexas.edu/lbj/chasp/publications/downloads/Doc6marriage_timing_.pdf.  Accessed March 8, 2012.
61. Cavanagh SE, Huston AC. Family instability and children’s early problem behavior. Soc Forces. 2006; 85(1): 551-581.
62. Cavanagh SE, Huston AC. The timing of family instability and children’s social development. J Marriage Fam. 2008; 70(5): 1258-1270.
63. Eckenrode J, Marcynyszyn LA, Evans GW. Family instability during early and middle adolescence. J Appl Dev Psychol. 2008; 29(5): 380-392.
64. Kenney CT, McLanahan SS. Why are cohabitating relationships more violent than marriages? Demography. 2006; 43(1): 127-40, *calculated from raw data in Table 2.
65. Kleinsorge C, Covitz LM. Impact of divorce on children: Developmental considerations. Pediatr Rev. 2013; 33(4): 147-154.
66. Demuth S, Brown SL. Family structure, family processes, and adolescent delinquency: The significance of parental absence versus parental gender. J Res Crime Delinq. 2004; 41(1): 58-81.
67. Manlove JS, Terry-Humen E, Mincieli LA, Moore KA. Outcomes for children of teen mothers from kindergarten through adolescence. In: Hoffman SD, Maynard RA, eds. Kids Having Kids: Economic Costs and Social Consequences of Teen Pregnancy. 2nd ed. Washington, D.C.: The Urban Institute Press; 2008: 182-183.
68. Thompson MS, Alexander KL, Entwisle DR. Household composition, parental expectations and school achievement. Soc Forces. 1988; 67: 424-451.
69. Halpern-Meekin S, Tach L. Heterogenity in two-parent families and adolescent well-being. J Marriage Fam. 2008; 70(2): 445.
70. Astone NM, McLanahan SS. Family structure, parental practices and high school completion. Am Sociol Rev. 1991; 56: 309-320.
71. Eckenrode J, Marcynyszyn LA, Evans GW. Family instability during early and middle adolescence. J Appl Dev Psychol. 2008; 29(5): 380-392.
72. Sun Y, Li Y. Children’s well-being during parents’ marital disruption process: A pooled time-series analysis. J Marriage Fam. 2002; 64: 472-488.
73. Lichter DT, Qian Z, Mellott LM. Marriage or dissolution? Union transitions among poor cohabitating women. Demography 2006; 43(2): 223-240.
74. Manning WD, Brown S. Children’s economic well being in married and cohabiting parent families. J Marriage Fam. 2006; 68: 345-362.
75. Ibid.
76. Brown SL. Family structure and child well-being: The significance of parental cohabitation. J Marriage Fam. 2004; 66(2): 362.
77. Manning W, Lichter D. Parental cohabitation and children’s economic well-being. J Marriage Fam.1996; 58(4): 1003.
78. Osborne C, Manning WD, Stock PJ. Married and cohabiting parents’ relationship stability: A focus on race and ethnicity. J Marriage Fam. 2007; 69: 1345-1366.
79. Goodwin PY, Mosher WD, Chandra A. Marriage and cohabitation in the United States: A statistical portrait based on cycle 6 (2002) of the National Survey of Family Growth. National Center for Health Statistics. Vital and Health Statistics. 2010; 23(8): 32, Table 16.
80. Abma JC, Chandra A, Mosher WD, et al. Fertility, family planning, and women’s health: New data from the 1995 National Survey of Family Growth. Vital Health Stat 23. No. 19. Hyattsville, MD: National Center for Health Statistics, U.S. Department of Health and Human Services; 1997. DHHS Publication No. (PHS)97-1995 Table 11 p.22; Table 20, p. 31; Table 22, p. 33; * percent of those who have ever had sex who were married at first intercourse Table 24, p. 35;Table 32, p. 43;.Table 36 p.47  Available at http://www.cdc.gov/nchs/data/series/sr_23/sr23_019.pdf. Since the survey includes women aged 15-44, it does not include marriages or divorces that occurred after the survey, so overall rates are lower than lifetime rates.
81. Ibid.
82. Abma JC, Martinez GM, Copen CE. Teenagers in the United States: Sexual activity, contraceptive use, and childbearing, National Survey of Family Growth 2006-2008. National Center for Health Statistics. Vital and Health Statistics. 2010; 23(30).

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