World Health Day – Supporting Single Parents

The theme of World Health Day 2021 is “building a fairer, healthier world.” At Sprout Health Solutions, our focus this year is on the health inequalities faced by single parents. We explore some of the issues faced by single parents generally, and during the COVID-19 pandemic, and consider what can be done to prevent avoidable mental and physical health inequalities experienced by this group.

Background

14% of children worldwide live in families headed by a single parent¹ The US has some of the highest rates at about 25% of children living in single parent families and Switzerland with some of the lowest at less than 10%.² The average rate across England, Scotland and Wales is 21%.² The vast majority of single parent households (90% in the UK) are headed by women.³

Health inequalities

Several studies have found that single mothers report lower health, experience more health-related difficulties and mortality than partnered mothers.^4-7 Single fathers appear to be more at risk of poor self-reported health, emergency department visits and mortality than single mothers.^8,9 The risk of mental health problems including clinical depression and anxiety disorders is also greater in single parents than partnered parents.^10-12

Potential reasons for health disparities

Stress: Circumstances often experienced by single parents may influence their health behaviours and outcomes. For example, single parents are often faced with the difficult role of being both the primary earner and the only caregiver. Chronic daily stressors and adverse life events contribute to health inequalities, including depression.¹⁰

Limited financial resources: Despite similar rates of employment to partnered parents,¹³ single parents are more likely to live in poverty than other family structures. For example, in the UK single parents report not having enough income to cover living costs¹⁴ and in the US, households headed by a single mother are more likely to experience food insecurity than other family types.¹⁵

Welfare regimens: The type of welfare regime employed by a country could make the situation worse. A study conducted across 27 EU countries found that single mothers in Anglo Saxon countries (where welfare for single parents was means tested and limited) and Bismarckian countries (where female employment was discouraged through tax disincentives) were most vulnerable to the adverse impact of socio-economic risk factors.¹⁶

Social support: Compared to married mothers, single mothers report lower levels of perceived social support and less frequent contact with friends and family. One study found that single mothers who experienced low levels of social support were several times more likely to suffer depressive symptoms than those with higher levels of social support.¹⁰

Health behaviours: Single parents have also been found to be more at risk of low physical activity, poor diet, high blood pressure and smoking relative to those in two parent households.^7,9

Stigma: Single parents often face stigma – for example despite the average age of single parents being 39 years, 87% having either one or two children and high employment rates in the UK,¹⁷ they are often conveyed in society as being young and unemployed with multiple children.¹⁸

COVID-19 and the hidden consequences for single parents

Balancing work, childcare and home-schooling: Single parents have faced numerous challenges as a result of the COVID-19 pandemic. During periods of lockdown, many single parents who work from home have had the impossible task of balancing work with full time childcare, home schooling and housework. Those who continue to work outside the home have faced organising work around childcare and home-schooling.¹⁹

Economic difficulties:  Single parents are more likely to have lost their jobs, been furloughed or experienced a decline in working hours due to the pandemic than partnered parents .^19,20 Many single parents are having to rely on local food aid programmes.²⁰

Detachment from social support: A consequence of social distancing during the pandemic has been enforced isolation from social support systems including friends and family members who often provide essential practical and emotional support.²¹

Stigmatisation: Single parents have faced dilemmas about the safety of taking their children grocery shopping during the pandemic and encountered negative judgements from shop staff about shopping with their children.¹⁹

Mental health impact: Compared to other households with young children, single parents have reported increased emotional distress during the pandemic – including anxiety, depression, stress and loneliness, as well as higher levels of distress in their children.²²

Recommendations

Recognise the importance of support for single parents and facilitate the use of social support networks

Not all single parents are socially isolated, but social isolation has been associated with health problems. There is a need to develop strategies to identify socially isolated single parents and offer practical and social support. Facilitating the use of social networks and peer-led support has been found to enhance health and wellbeing.²³

Provide financial support, affordable childcare and access to appropriate employment but don’t force single parents into poorly paid work that increases stress

Governments have responded to the link between poverty and poor health by engaging single parents in welfare to work programmes; however a systematic review showed that available employment was often poorly paid, conflicted with the demands of parenting and had a negative impact on mental health.¹³ An alternative is the provision of high-quality employment and skills support; the creation of high quality flexible and part time jobs; improvement to childcare support and sufficient social security both for those out of work and those in employment.²⁰

Recognise that single parents may be at increased risk of health problems

Talk to patients to understand their social situation and the pressures they are under. This may help healthcare professionals develop tailored strategies to help single parents make better health decisions, influence their behaviour and obtain social support.

Prioritise single parents in COVID-19 lockdown strategy and exit policies

Regardless of vaccination rollout programmes, COVID-19 will be around for a while and future lockdowns are possible. Gaining practical help and protecting mental health will continue to be vital over the coming months. Governments should recognise single parents as a potentially at-risk group, prioritise them for financial support and furlough if they request it, allow access to friends or family members and provide clear guidelines and provisions when single parents become ill during COVID-19.

Strategies for single parents during COVID-19

The UK charity Gingerbread has a helpline for single parents where expert advisors can offer practical advice. The Single Parent Helpline number is 0808 802 0925

The Child Mind Institute, a US non-profit organisation dedicated to transforming the lives of children and families struggling with mental health and learning disorders has put together some strategies for single parents during the pandemic. You can find these here:

https://childmind.org/article/single-parenting-during-the-coronavirus-crisis/

Reference

1. Global Issues. 320 Million Children in Single-Parent Families. Accessed at https://www.globalissues.org/news/2016/10/15/22568 on 6 April, 2021
2. OECD Family Database SF 1.3 Further information on the living arrangements of children. Accessed at https://www.oecd.org/els/soc/SF_1_3_Living-arrangements-children.pdf on 6 April, 2021
3. Ringbäck Weitoft G, Haglund B, Rosen M. Mortality among lone mothers in Sweden: a population study. Lancet 2000; 355: 1215–19
4. Ringbäck Weitoft G, Haglund B, Hjern A, Rosén M. Mortality, severe morbidity and injury among long-term lone mothers in Sweden. Int J Epidemiol 2002; 31: 573–80
5. Ringbäck Weitoft G, Haglund B, Rosen M. Mortality among lone mothers in Sweden: a population study. Lancet 2000; 355: 1215–19
6. Merschel, M. The heart health risks of being a single parent. Accessed at https://www.heart.org/en/news/2020/12/02/the-heart-health-risks-of-being-a-single-parent on 6 April, 2021
7. Chiu M, Rahman F, Kurdyak P, Cairney J, Jembere N, Vigod S. Self-rated health and mental health of lone fathers compared with lone mothers and partnered fathers: a population-based cross-sectional study. J Epidemiol Community Health 2016; 71: 417–23
8. Chiu, M., Rahman, F., Vigod, S., Cairney, J., Kurdyak, P. Mortality in single fathers compared with single mothers and partnered parents: a population-based cohort study. Lancet Public Health 2018; 3: e115-23
9. Rousou, E., Kouta, C., Middleton, N. Association of social support and socio-demographic characteristics with poor self-rated health and depressive symptomatology among single mothers in Cyprus: a descriptive cross-sectional study. BMC Nurs. 2016; 15: 15.
10. Cairney, J., Boyle, M., Offord, D.R., Racine, Y. Stress, social support and depression in single and married mothers. Soc Psychiatr Epidemiol, 2003, 38 (8): 442-9
11. Targosz, S., Bebbington, P., Lewis, G., Brugha, T., Jenkins, R., Farrell, M. & Melzer, H. Lone mothers, social exclusion and depression, Psychological Medicine 2003, 33 (4), 715-72
12. Campbell, M., Thompson, H., Fenton, C., Gibson, M. Lone parents, health, wellbeing and welfare to work: a systematic review of qualitative studies. BMC Public Health 2016; 16; 188
13. Gingerbread, 2021 The single parent debt trap Accessed at https://www.gingerbread.org.uk/policy-campaigns/publications-index/the-single-parent-debt-trap/on 6 April, 2021
14. US Department of Agriculture Economic Research Service. Food insecurity has declined overall but remains high for some groups. Accessed at https://www.ers.usda.gov/amber-waves/2019/december/food-insecurity-among-children-has-declined-overall-but-remains-high-for-some-groups/ on 6 April, 2021
15. Van de Velde, S., Bambra, C., Van der Bracht, K., Eikemo, T.A, Bracke, P. Keeping it in the family: the self-rated health of lone mothers in different European welfare regimes. Sociology of Health & Illness 2014, Vol. 36 No. 8: 1220–1242
16. Single Parents on Holiday. Single Parent Statistics: UK Facts and Figures. Accessed at https://singleparentsonholiday.co.uk/single-parent-statistics-new-facts-and-figures/ on 6 April, 2021
17. Stack, R.J., Meredith, A. The Impact of Financial Hardship on Single Parents: An Exploration of the Journey From Social Distress to Seeking Help. Journal of Family and Economic Issues 2018, 39, 233-242
18. Gingerbread. Caring without sharing. Single parent’ journey through the COVID-19 crisis. Interim Report. Accessed at https://www.gingerbread.org.uk/wp-content/uploads/2020/11/Gingerbread-Caringwithoutsharing-v3.pdf on 6 April, 2021
19. Gingerbread. Tacking single parent poverty after the coronavirus Accessed at https://www.gingerbread.org.uk/policy-campaigns/publications-index/tackling-single-parent-poverty-after-coronavirus/ on 6 April, 2021
20. The Nation. I never felt like a ‘single’ parent. Then the coronavirus hit. Accessed at https://www.thenation.com/article/society/coronavirus-family-single-parents/ on 6 April, 2021
21. RAPID-EC Project Rapid assessment of pandemic impact on development early childhood household survey project. Accessed at https://medium.com/rapid-ec-project/home-alone-the-pandemic-is-overloading-single-parent-families-c13d48d86f9e on 6 April, 2021
22. Single Parents Wellbeing. An evaluation of five Wellbeing Workshops in South Wales created and facilitated by Single Parents Wellbeing for single parents. Accessed at https://www.mentalhealth.org.uk/sites/default/files/single-parents-wellbeing-evaluation-web.pdf on 6 April, 2021.