Photo: Katie Tegtmeyer /flickr

The American College of Pediatricians recently published a paper, Cohabitation, which cautions adolescents and young adults about the negative consequences of cohabitation for both themselves and their children, and urges parents to teach their children about the advantages of waiting until marriage.

More young people are now first cohabiting than are marrying without prior cohabitation, yet research shows that, rather than being a stepping-stone to a healthy marriage, living together before marriage (cohabitation) makes couples more likely to break-up and more likely to divorce if they do marry. It results in lower marital satisfaction and increased negative communication.  Cohabiting couples spend less time together; men are more likely to spend their time on personal pleasure than do married men.

Cohabiting couples are now less likely to later marry than 40 years ago. Controlling for other factors that increase risk of divorce, marriages preceded by cohabitation are still 50 percent more likely to end in divorce.  (Some recent studies challenge this, but are scientifically flawed and omit the raw data.)  Also 27 percent of cohabitations dissolve without marriage in the first three years.

Cohabiters commit increased violence against their partner. Women are nine times more likely to be killed by a cohabiting partner than by their husband. Severe violence is four times as common among cohabiting couples; any violence is nearly 50 percent more common among couples cohabiting before marrying and doubled among couples continuing to cohabit after five years.

Men who cohabit without marrying in 5 to 10 years have more than double the rate of alcohol abuse as married men; women who cohabit without marrying have 4 to 7 times the rate of alcohol abuse as married women.

Cohabiters, both men and women, have rates of infidelity in the preceding year more than triple that of married spouses. Among the married, those cohabiting prior to marriage were 50 percent more likely to be unfaithful as those marrying without cohabiting.

Poverty is more common among cohabitating women and their children. Their male partners have both a higher unemployment rate (15 percent vs 8 percent), and work fewer hours if employed. Cohabitating women are ten times more likely to have an abortion than married women, and suffer from its associated mortality and morbidity. In fact, 89 percent of women who have had abortions have at one time cohabited; 40 percent have lived with three or more men. Abortion also puts future children at risk, especially from extremely premature birth.

Children are more likely to suffer

Children who survive also suffer due to parental cohabitation.  They have increased risk of losing a parent to divorce or separation, possibly multiple times.  Children born of cohabiting parents are over four times more likely to suffer separation of their parents by their third birthdays (49 percent) than those born to married parents (11 percent).  (This increase is double among African-Americans, triple among Mexican-Americans, and nearly eight-fold among whites.)  One-fourth of teens and 19 percent of cohabiting women overall become pregnant within six months; of these, less than one-fifth overall marry within six months (less than half among college graduates).

Nearly one-third of couples enter into cohabitation with a child from a previous relationship, as do half of those cohabitating for six years or longer. Children living with a parent and unmarried partner (live-in boyfriend) have 20 times the risk of sexual abuse and eight times the risk of all maltreatment compared to children living with married biological parents.  Even if the couple marries, stepchildren have over eight times the risk of sexual abuse and triple the overall risk of abuse of neglect. Girls living with a step-parent had 60 percent higher risk of being raped than girls living with their biological parents.

Women in cohabiting relationships have more depression than married women, and poorer responsiveness to their children’s emotional needs.  Children whose mothers are depressed have increased cortisol responses to stress (which may explain their increased hypertension in adulthood). Children with unmarried mothers are half as likely to be breastfed, leading to higher rates of asthma, pneumonia, ear and intestinal infections, diabetes, obesity, and lower intelligence.

Children born of married parents were far more likely to live with both biological parents at age 15 than were children born to cohabiting parents (62 percent vs 37 percent).  Children from single parent homes had twice the risk of suicide, alcohol and drug abuse and psychiatric disease as did those from two parent homes, and their risk of dying from addiction was over three times for girls and five times for boys. These risks continue into adulthood.  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.  Children reared by both biological parents are less likely to commit a minor or serious crime compared to all other family living arrangements.

Children whose parents lived together (before or after their birth) are at increased risk for living in poverty, and experiencing school failure from first grade through college, resulting in lower levels of education and earning lower incomes as adults. In addition, they face a greater risk of suffering from medical neglect, as well as chronic physical and mental health problems.

Living with biological or adoptive parents at age 14 decreased teen pregnancy rates by two-thirds; girls were more likely to marry rather than cohabit and less likely to divorce if married. Cohabitation increases the risk of broken relationships/divorce for the children involved, perpetuating the cycle.

In summary, while cohabitation appears to be a practical stepping-stone to a healthy marriage, it actually increases risks both to those who cohabit and to their current and future children and grandchildren. Cohabiting couples are more likely to break up, and more likely to divorce if they do marry.  They are more likely to be unfaithful than married spouses, to be violent toward the other partner, and to abuse alcohol.

Risks to their children include: parental separation, step-parents, half-siblings, and step-siblings leading to increased internal family strife; induced death; death/disability from prematurity; more behavior problems, anxiety, depression, academic decline, and social relationship problems; more child abuse and physical injuries.

Such children are also at risk of increased substance, alcohol and tobacco abuse; increased physical and mental health problems in childhood and adulthood, more suicide attempts and suicides, more alcohol and drug-related disease; more poverty; more involvement in both petty and serious crime.

They are also more at risk of rape, teen sexual activity, premarital pregnancy (including increased risks of death and prematurity to the children of these adolescents) and divorce themselves, thus carrying on the negative consequences to the third and fourth generations.

Parents, pediatricians and other heath care providers, educators, the media and policymakers alike need to educate adolescents about the risks of cohabitation and the life-long benefits of marriage for the entire family and society. The institution of marriage is one of the best and most cost-effective public health tools society has. Adolescents and young adults should be encouraged to save sexual relationships for marriage to achieve optimal health for themselves, their children and society at large.

Patricia Lee June, MD, FCP, is a member of the board of the American College of Pediatricians.