On February 23, 2011 United States’ Attorney General Eric Holder notified U.S. House of Representatives speaker John Boehner that the Justice Department would no longer defend the 1996 Defense of Marriage Act. Holder stated that he and President Obama had concluded that the law’s definition of marriage as being between a man and a woman was unconstitutional. (Perhaps a more significant question is the constitutionality of the president and his attorney general deciding which laws are to be defended and which are not.

The executive branch’s decision was but the latest sortie in an ongoing assault against traditional families. There are many indicators that our society’s efforts to destroy the family have been extremely effective. Between 1970 and 2000, the proportion of children living in 2-parent families decreased from 85% to 69%. Only ¾ of children living in a 2-parent home are living with both biological parents.

Today more than one quarter (26%) of all children live with a single parent. This is usually their mother, but the percentage of children being raised by a single father has doubled over the past two decades. In 1960 only 5.3 % of infants were born to single mothers. By 2000 a third of babies in the U.S were being born to unmarried women. A quarter of unwed mothers have a “live-in” partner. While they state at the time of birth that they intend to get married, few have done so within a year of the child’s arrival.

Cohabitation, which is often referred to as living together, has become socially acceptable. The arrangement is viewed by many as a way to explore the relationship and check for compatibility before entering into a marriage contract. Unfortunately, couples that choose to cohabitate prior to marriage are much more likely to break up than couples who marry before moving in with each other. Ironically, those who choose to cohabitate are significantly more likely to divorce if they do subsequently marry.

The divorce rate nearly doubled in the last half of the twentieth century. Today half of all marriages end in divorce. Over 1 million children are affected by divorce every year. Some of the consequences of divorce include a lowered economic status and separation of children from one of the parents. This almost always means separation from the absent parent’s extended family as well. Nearly a third of divorced couples continue to fight over child custody and visitation issues on an ongoing basis. Children, shared between parents, often find it difficult to develop a stable social life as they rotate time between two separate families. As a result, children of divorced parents are at greater risk of emotional and behavioral problems, depression, physical illness, and poor performance in school.

I recognize that there are many reasons for which couples choose to divorce and I am aware that “shotgun weddings” are at best an imperfect response to unintended pregnancies. I realize that some children may do poorly while living with their father and mother while others may excel under the influence of a single parent. Nevertheless, having observed different family situations for decades as a family physician, I am in full agreement with the American Academy of Pediatrics (AAP) Task Force on the Family, which published its report in 2003. After an extensive review of the role of the family in child health they concluded:

“A well-functioning family of 2 parents and their children is potentially the most secure, supportive, and nurturing environment for children. Parenting is difficult and is easier when shared. Children do best when raised by 2 caring, cooperative parents with adequate social and financial resources. Having married parents, in general, is good for children—economically, socially, spiritually, and psychologically. Marriage strengthens children’s claims to the economic resources, love and affection, nurturing, and social capital of both parents, including access to extended families. Marriage helps promote and support responsible and caring parenting. Moreover, parents’ help, support, encouragement, and love for each other enhance their effectiveness as parents. Parents’ love and respect for each other promote the child’s well-being.”

The above summary states that a family unit, based upon a solid marriage, is the basis for good health. This is because a strong family provides greater economic, social, psychological and spiritual resources.

Marriage conveys economic benefits because the husband and wife are pooling their financial resources. This is especially important when children are a part of the family unit. Even if the wife is not working, her presence in the home provides great economic benefit. Single parent families are often at a great economic disadvantage. Poorer families often have less nutritious diets, neglect dental care, and overlook the need for nutritional supplementation. These deficiencies can cause health to decline over time.

Economic statistics related to single parent families are quite striking. Divorced women with children are four times more likely than married women to have an income that is under the poverty line. A single mother is nine times more likely than a married woman to have an income that is less than half the official poverty line. The costs to society are enormous. It has been estimated that a single divorce costs state and federal governments an average of $30,000 in court costs, bankruptcies, food stamps, and public housing benefits.

A family headed by a married mother and father provides stronger social support for several reasons. When the marriage is intact two extended families are available to interact with and provide encouragement to family members. When divorce occurs, interaction with the extended family of the non-custodial parent is usually lost. I have witnessed this firsthand.

When I was growing up it was customary for the children and grandchildren of my maternal grandmother to gather at her home for Sunday dinner during the summer months. The adults would play whist (a card game that has been replaced by bridge in most circles) or pitch horseshoes and we children would play a variety of games including hide and seek and cowboys and Indians. Although most of us are not close, my cousins and I still notify and rely on each other for support in times of crisis. One year my uncle Warren and his wife divorced. I never saw his sons again, and we have had no contact since that time. The divorce created a small, barely noticeable crack in my social support network, but the loss of contact with a grandmother, aunts, uncles, and cousins created a huge void in that of my two cousins.

Social support goes beyond that of the extended family. Husbands and wives commonly have different interests and therefore bring distinctive social contacts to the relationship. This means that the support network of a two-parent family is significantly larger than that of a single-parent family.

The psychological impact of a loving family cannot be overestimated. The marriage commitment brings with it a level of security and comfort that does not exist in a cohabitation arrangement. The ability of married couples to turn to each other for support in tough times gives them an advantage in coping with the ups and downs of life. It is through the support of their parents and siblings that children are able to develop the strength to deal with insults on the playground and other challenges.

Parenting is infinitely more difficult when faced alone than when a spouse is available to support and reinforce childrearing decisions. The strain of single parenting can make it more difficult to maintain a relationship in which one is viewed not only a disciplinarian but as a confidant with whom challenges can be discussed and worked out. The importance of parental counsel was driven home to me when my eldest daughter was a freshman in high school. One of her classmates committed suicide. The tragedy generated classroom discussions about how the young person’s despair might have been identified and the suicide prevented. My daughter was stunned by some of the comments she heard. “Dad,” she confided in me as I was driving her to an extracurricular event, “did you know that some kids can’t talk to their parents?”

Prior to that time she had never considered that her personal family experience was not universal. While there will be unfortunate exceptions, free-flowing parent-child communication should be the norm. Parents should be the first individuals to whom children turn to in a crisis. Unfortunately, our society has chosen to undermine the family unit by discouraging teens from turning to their parents for guidance in decisions, particularly those pertaining to sexual conduct.

There are many schools in our nation that do not allow nurses to dispense over-the-counter pain relievers or fever reducers to students without first obtaining parental consent, but which allow oral contraceptives or condoms to be given out freely without the knowledge of the student’s parents. In many states a teenage girl who becomes pregnant is automatically declared an “emancipated minor” and allowed to obtain an abortion without the knowledge of her parents.

Societal concerns surrounding early sexual activity consider primarily pregnancy prevention and reduction of venereal disease risk. Psychological effects are, for the most part, ignored to the harm of girls and boys alike.

Early sexual activity has profoundly detrimental psychological effects. Some of these include increased worry, regret, self-deprecation, fear of commitment, feelings of betrayal, and depression. These can adversely affect future relationships and diminish one’s ability to enjoy life to its fullest extent.

Abortion has even greater psychological consequences that are largely ignored and unreported. I subscribe to services that publish queries from writers, radio show hosts, and others looking for potential interviewees. Early in February the following query from Courtney Hutchison, a reporter for ABC news caught my attention:

Summary: Need Women Glad They had an Abortion. "I'm writing a story about the many "faces" of abortion, from those who feel totally comfortable with having had them to those who know it was the right decision but are still upset years later, to those women who wish they could go back and have the baby. So far, however, I've had a hard time finding stories of women who did not suffer psychological trauma of some sort following an abortion. I was wondering if there are those out there willing to share their stories about why an abortion was the best choice for them and why (though unfortunate, sad, etc) for them, was not particularly traumatic?"

The fact that the reporter was having great difficulty finding women who were not psychologically traumatized by having an abortion speaks volumes. It is difficult to imagine undergoing any surgical procedure without the support of friends and family to aid in preparation and recovery. Imagine what it must be like for a teenager to go through an abortion alone and in secret.

The spiritual resources provided by family was the final area cited as promoting good health. I have heard it said that parents should not “impose” their personal spiritual beliefs upon their children, but rather allow them to freely choose their own. It is impossible to impose a belief upon someone who does not choose to accept it, but I believe that it is a grave error for parents to avoid practicing their religious beliefs in the home and teaching children their spiritual heritage.

A child who is not exposed to and encouraged to adopt the faith of its parents is at a great disadvantage in developing a strong personal faith capable of dealing with life’s challenges.

I was witness to the importance of a strong familial faith early in my medical career. One Saturday a 43 year-old man developed a sore throat due to a streptococcal infection. Lacking a spleen, which had been removed following an injury earlier in his life, his body was incapable of containing the organism. It rapidly spread throughout his body, and he died three days later. As his primary physician, the duty of telling his family fell on my shoulders. In the ICU waiting room I found his children, wife, and elderly parents.

The news was painful for all of them, but it affected each generation differently. His children were distraught and nearly inconsolable. His wife wept, but exuded a quiet strength, knowing that God was present and would see her through the loss of her husband. His parents were unshaken. His mother simply smiled as she explained how she could accept the untimely loss of one of her beloved children.

“My husband and I accepted Jesus as our personal savior shortly after we were married,” she related. “We raised our children in our faith and saw each of them accept Him as well. Our entire family is safe in Christ, but Richard is the first of us to see the Lord face to face. I’m looking forward to the time when we will all be together again.”

The following months and years were difficult for Richard’s wife, but her faith never wavered. Her example allowed the children to come to terms with their loss. Today the family’s faith is alive and well and they have a wonderful outlook on life.

The importance of the role of the family in matters related to health was first conveyed to me by Dr. Roger Lienke, who encouraged me to come to Oklahoma to do my family practice residency. Dr. Lienke, like me, was a Minnesota native. He had specialized in pediatrics following his graduation from medical school in 1946. Over time he had become convinced that he could not effectively care for a child outside of the context of its family. In 1967 he founded the University of Oklahoma Family Medicine residency program. The accuracy of Dr. Lienke’s observation was confirmed by the 2003 AAP Task Force on the Family report:

“Feeling connected to their family is healthy for children, adolescents, mothers, and fathers. Belonging to a family is a dynamic process in which parents influence children, spouse affects spouse, and children change parents. Children’s physical and emotional health and their cognitive and social functioning are strongly influenced by how well their families function. It is essential that pediatricians realize that the family is their patient—not just the child. Everything the pediatrician does for the child is within the context of the family. Therefore, for pediatric care to be effective, it must be family oriented.”

A healthy family is one of the key pieces to the wellness puzzle. If you belong to a family in which faith, hope, and love are alive you have a great advantage in achieving optimum health. Just as it is possible to build personal health it is possible to build a healthy family. The most important element in both can be summed up in a single word – commitment.

Over the course of my career I have counseled many couples who were facing marital challenges. Those who chose to remain committed to each other, work out their difficulties, and go on together in almost every instance came out happier and stronger than those who decided to enter into divorce proceedings. Successful marriages and loving families do not occur by chance. They develop only when family members agree to invest time and effort in building and strengthening their relationships with each other. Building a healthy family can be costly, but nothing in life will pay greater dividends.