This document summarizes a chapter on the historical evolution of families in the U.S. It describes how family structures have changed over time from predominantly nuclear families pre-industrialization to more diverse structures today including blended, LGBTQ+, and single-parent households. It also discusses trends such as declining marriage rates and increasing diversity in family income, and how factors like racism, poverty, and lack of access to resources affect family health outcomes.

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Week 7
Chapter 3
Instructor: Gina Crosley-Corcoran, MPH
PBH 805 – Maternal & Child Health

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The Historical Evolution of Families in the
U.S.
Pre-Industrialization: the nuclear
structure (i.e., husband-father,
wife-mother, and children) was
the most prevalent family system
Post-Industrialization: reduced
accessibility to extended familial
relationships further elevated
the role of the nuclear family in
society
The past 50 years: the definition
of family has evolved to include
the diversity of familial
composition including:
•Transactional, transitional, and
situational families
•Blended families
•LGBTQ+ Families

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Changes in American Family Composition
 By the end of World War II, the makeup of American families
was defined through the close kinship ties shared in
communities of proximate multigenerational families.
 Over the past 50 years, trends in family units have changed
with a reduction in two-parent households and an increase in
one-parent mother-led family households.
 More than 25% of American children grow up without a
father in the household.
 5% of children live with their grandparents who are primary
caregivers.

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Family Composition by Race and Ethnicity
 While the number of two-parent
family groups has declined, in 2018
most children younger than 18 lived
with married parents.
 Father-child and mother-child family
groups have increased.
 Historic and structural racism have
contributed to low marriage rates
among Black Americans resulting in
large numbers of single mother-led
households. The rate of Black father
engagement with their children is
the same as the rate of White father
engagement with their children.

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Family Composition, Immigrants, and
Refugees
 The percentage of children
younger than 18 years who had at
least one foreign-born parent has
grown from 15% in 1994 to 26% in
2018, reflecting the changing
ethnic composition of American
families
 Stringent U.S. immigration policies,
including the separation of
children from parents, have
detrimental psychological and
physical health impacts on children
and parents alike.

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Marriage
• Social advancements have empowered women to delay or not pursue marriage to begin a family.
• The median age at first marriage has increased across all racial and ethnic groups.

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Extended Families, Cohabitating Parents,
and Fathers
 There are an increasing number of extended families and
children living in cohabitating family households.
 The growing number of children living with extended and
cohabitating parents can be attributed to a decrease in
marriage and an increase in births outside of marriage
 An increasing percentage of American fathers are becoming
custodial parents.

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Changes in Family Median Income
• Although median household income has increased
since 2000, disparities exist by gender, race, and
ethnicity.
• In 2018, married-couple households had the highest
median income, followed by single male households,
and then single women households.
• 2018–2019: Black and Hispanic households had the
lowest median household incomes due to historic and
structural racism’s influence on access to vital resources.

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Changes in Family Median Income

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Influence on Family Health:
Parents in the Workforce
 47% of women are in the U.S. labor force, with participation
varying by race and ethnicity.
 Women’s participation in the workforce is mediated by their
educational attainment, marital status, and parental status.
 Familial economic efforts are often supported by mothers who
engage in non-paid labor including childbearing, childcare,
household labor, elderly care, and volunteer work.
 In 72.8% of married-couple families, both parents worked
outside the home. In those which did not, a majority of stay-at-
home parents were White non-Hispanic mothers.

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Influence on Family Health:
Childcare
 In 2016, almost 70% of the 24 million children younger than 5
years not yet enrolled in kindergarten were regularly in some
form of nonparental care.
 Although varying by race and ethnicity, a majority of parents
across all groups had their children in nonparental care.
 The cost of childcare is significant and continues to grow, and
the demand for federally provided resources to alleviate this
burden exceeds the support available.

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Poverty and Family Health
In 2018, over 38 million
Americans lived in
poverty.
Nearly 1 in 6 children in
the U.S. lived in poverty
in 2018.
Due to historic and
structural racism, nearly
73% of poor children
are of color.
Growing up in poverty
has lifetime
implications for
educational attainment
and future earnings.

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Poverty and Family Health

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Race, Ethnicity, Immigration, and Poverty
 In 2019, the U.S. poverty rate decreased to 10.5%, yet Black,
Hispanic, and Native American people suffer the burden of
income inequality more than White and Asian people.
 U.S. refugee and immigrant children made up the 32% of all
low-income families due to a lack of immigration
documentation and unstable jobs, which limit access to
government support programs
 Rates of poverty are unequally distributed across U.S.
regions, with southern states and rural communities
experiencing a greater burden compared to northern states
and urban communities.

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Poverty and Family Well-Being
 There are many health impacts that families living in poverty
experience, including:
 Low birth weight and infant mortality
 Chronic illness
 Stress-related illnesses
 Poverty also makes families vulnerable to:
 Abuse and neglect of children
 Food and housing insecurity

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Structural Patriarchy and Racism
 Patriarchy is a system of oppression that advantages people
who identify as male.
 Structural racism has restricted access to resources such as
health care, safe housing, education, and wealth, thereby
impacting the life and wellbeing of people of color.
 Both patriarchy and structural racism are responsible for
policies that have influenced family composition and
function, including public housing, incarceration, access to
reproductive care, and immigration policies

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Policies, Community Context, and Family
Health
 The Patient Protection and Affordable Care Act (ACA) was
developed for the purpose of expanding access to health
insurance for more than 27 million Americans.
 Poor families have particularly benefited from the ACA
because of increased health care access; affordability; and
use of preventive, outpatient, and inpatient services

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Conclusion
 Increasing proportion of women participating in the labor
force has increased need for childcare.
 Changes in family structure and in the economic system are
weakening supports for families.
 Patriarchy and structural racism have heavily influenced
policies that limit access to resources important for American
families.
 The ACA has increased access to health care for middle- and
low-income families.

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Week 7 Assignments
Discussion Board
Quiz on Chapter