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Changes in Family Structure

Family structure refers to the organization of individuals who are related by blood, marriage, adoption, or strong social bonds into a household. In the United States, family structure has been through two dramatic shifts in the past 160 years. The first shift occurred between 1850 and 1950 and saw the decline of the vertically extended household that included grandparents, parents, and children in the same dwelling and the rise of the nuclear family household, which included married biological parents and full siblings only. Since then, family structure has transitioned into a plurality of forms. Factors that contribute to family structure change since 1950 include delayed marriage, divorce, remarriage, cohabitation, nonmarital fertility, family formation among gay and lesbian couples, and population aging. These changes in family structure require resilience in families experiencing them and increased complexities for interacting with the health care system. Health professionals also need to adapt to these new structures as they partner with families to promote family health.

Delayed Marriage

According to the U.S. Census Bureau, at the turn of the 20th century, the median age at first marriage was about 22 years for women and 26 years for men. Over the next half-century, the age at first marriage declined for women and men and reached a low point of about 20 years for women and 22.5 years for men in 1956. This decline and the nearly universal entry into marriage in the late 1940s and 1950s have been attributed to a postwar economic recovery that facilitated early family formation. Since then, the age at marriage has increased steadily. In 2005, the median ages at marriage for women and men were 25.3 years and 27.1 years, respectively. The rising age at marriage has coincided with the development of more reliable and accessible contraceptive methods, women's increased educational attainment and labor force participation, and a cultural shift in attitudes toward greater tolerance for premarital sex and cohabitation.

While age at marriage has risen, the probability that an adult will ever marry has held steady overall. Over the past century, about 90% of women in the United States eventually married, according to Andrew J. Cherlin, a family sociologist. However, not everyone is equally likely to marry: Among women born since 1960, college-educated and white women are more likely to eventually marry than are African American women or women with less than a college education. Racial differences are especially striking. Among African American women in the United States, just over 6 out of 10 women born since 1960 are expected to eventually marry, compared to over 9 out of 10 white women in the same birth cohort, according to data from the 1995 Current Population Survey. Social scientists have long been interested in investigating differences in the likelihood of marriage by race, ethnicity, and social class and have debated the relative influence of welfare policy, patterns of economic restructuring and male unemployment, the decoupling of childbearing from marriage, and cultural attitudes about the symbolic and practical significance of marriage.

Divorce

Divorce is the legal dissolution of a marriage. In the United States, 1 in 10 marriages ended in divorced in 1890, a rate that caused considerable public alarm at the time. Divorce rates rose incrementally through the 20th century and escalated during the 1960s and 1970s, peaking in 1980. Since then, divorce rates have declined, but they remain high compared to those in other developed countries. Today, nearly half of first marriages for men and women under age 45 are expected to end in divorce within 15 years, according to the National Center for Health Statistics (NCHS). As with marriage, the risk of divorce is not equally distributed in the population. Hispanic and white women experience similar rates of divorce, while divorce rates are highest for African American women (with 55% of unions ending within 15 years) and lowest for Asian women (23% of unions end within 15 years). Divorce rates are highest in the first five years of marriage, and women who marry in their teen years, who have a high school education or less, or who have low family incomes are more likely to divorce than are their counterparts.

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