Promoting the Well-Being of Children Whose Parents Are Gay or Lesbian

COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY

HEALTH
Pediatrics 2013;131;827; originally published online March 20, 2013;
DOI: 10.1542/peds.2013-0376

The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/131/4/827.full.html

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly

publication, it has been published continuously since 1948. PEDIATRICS is owned,
published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
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 FROM THE AMERICAN ACADEMY OF PEDIATRICS
Organizational Principles to Guide and Define the Child
Health Care System and/or Improve the Health of all Children

POLICY STATEMENT

Promoting the Well-Being of Children Whose Parents

Are Gay or Lesbian
COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND
FAMILY HEALTH abstract
KEY WORDS To promote optimal health and well-being of all children, the American
civil marriage, adoption, foster care, nurturing children, children
of gay and lesbian parents, marriage equality
Academy of Pediatrics (AAP) supports access for all children to (1) civil
marriage rights for their parents and (2) willing and capable foster
This document is copyrighted and is property of the American
Academy of Pediatrics and its Board of Directors. All authors and adoptive parents, regardless of the parents’ sexual orientation.
have filed conflict of interest statements with the American The AAP has always been an advocate for, and has developed policies
Academy of Pediatrics. Any conflicts have been resolved through to support, the optimal physical, mental, and social health and well-
a process approved by the Board of Directors. The American
Academy of Pediatrics has neither solicited nor accepted any being of all infants, children, adolescents, and young adults. In so
commercial involvement in the development of the content of doing, the AAP has supported families in all their diversity, because
this publication. the family has always been the basic social unit in which children
The recommendations in this statement do not indicate an develop the supporting and nurturing relationships with adults that
exclusive course of treatment or serve as a standard of medical
they need to thrive. Children may be born to, adopted by, or cared for
care. Variations, taking into account individual circumstances,
may be appropriate. temporarily by married couples, nonmarried couples, single parents,
All policy statements from the American Academy of Pediatrics grandparents, or legal guardians, and any of these may be hetero-
automatically expire 5 years after publication unless reaffirmed, sexual, gay or lesbian, or of another orientation. Children need secure
revised, or retired at or before that time. and enduring relationships with committed and nurturing adults to
enhance their life experiences for optimal social-emotional and cog-
nitive development. Scientific evidence affirms that children have
similar developmental and emotional needs and receive similar par-
enting whether they are raised by parents of the same or different
genders. If a child has 2 living and capable parents who choose to
create a permanent bond by way of civil marriage, it is in the best
interests of their child(ren) that legal and social institutions allow
and support them to do so, irrespective of their sexual orientation. If
2 parents are not available to the child, adoption or foster parenting
www.pediatrics.org/cgi/doi/10.1542/peds.2013-0376 remain acceptable options to provide a loving home for a child and
doi:10.1542/peds.2013-0376 should be available without regard to the sexual orientation of the
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). parent(s). Pediatrics 2013;131:827–830
Copyright © 2013 by the American Academy of Pediatrics

INTRODUCTION
All children need support and nurturing from stable, healthy, and well-
functioning adults to become resilient and effective adults. On the basis
of a review of extensive scientific literature, the American Academy of
Pediatrics (AAP) affirms that “children’s well-being is affected much
more by their relationships with their parents, their parents’ sense of
competence and security, and the presence of social and economic
support for the family than by the gender or the sexual orientation of
their parents.”1

PEDIATRICS Volume 131, Number 4, April 2013 827

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Families’ structural forms are varied. In decisions (including medical decisions) lives, and the availability of economic
2010, married adults were raising 65.3% for them. A report from the AAP Task and socio-economic resources.”19
of all children in this country.2 The other Force on the Family noted that married Therefore, the AAP has endorsed, for more
34.7% of children (25.9 million of 74.63 couples have more financial and social than a decade, a policy supporting the
million children) were living in a variety resources to nurture and raise children.8 benefits of both parents in a same-gender
of situations. Many were being raised by Additionally, “married men and women couple having legal rights and respon-
parents who were single or cohabiting, are physically and emotionally healthier sibilities for their child(ren), for example,
either by choice or by circumstance. and are less likely to engage in health through second-parent or coparent ad-
Growing numbers of grandparents are risk behaviors . . . than are unmarried option.20 A special article in Pediatrics in
stepping in as parents to 2.5 million adults.”8 A number of studies have 2006 reviewed the legal issues associated
children when necessary.2 When none of documented “a positive relationship be- with civil marriage, civil union, and do-
a child’s biological relatives is available tween the quality of marital life and mestic partnership and noted a number
or able to provide necessary nurturing family functioning.”9 The Task Force re- of disparities for children growing up in
and support, other arrangements exist port emphasized: “As we move forward, various legal arrangements.10 The Amer-
to nurture children. Foster parenting and the Academy and pediatricians stand ican Medical Association has recently
adoption are substitute arrangements ready to serve all children in all families, noted the disparities that exist for
that can provide financial, emotional, regardless of the family structure in parents of the same gender who lack
social, and legal support for children. In which they live.”8 marriage equality as well as for their
2007, >400 000 children were in foster There are few social or legal restric- children.21 Many other professional
care, and 130 000 children were adopted tions limiting the ability of 2 unrelated organizations have adopted policies urg-
by unrelated adults.3,4 adults to marry in the United States. ing legislative changes and legal mecha-
Increasing numbers of same-gender These include (1) age: states have dif- nisms, including adoption, foster
couples are raising children today, ferent age limits before which parental parenting, and civil marriage, for gay and
and the numbers are likely to increase permission is required for marriage; lesbian adults who wish to be parents.*
in the future. The US 2010 Census (2) numerosity: there is a long-standing Civil unions and domestic partnerships
reported that 646 464 households in- prohibition on bigamy/polygamy; (3) do not confer the same legal rights,
cluded 2 adults of the same gender.5,6 the existence of blood relationships; protections, and benefits to children that
These same-gender couples are rais- and (4) cognitive capacity to consent. civil marriage provides.10
ing ∼115 000 children aged ≤18 years The only other exception applies to Public policy related to marriage and
and are living in essentially all coun- adults seeking same-gender relation- family is largely a state function. Con-
ties of the United States.5,6 When these ships (in most states). sequently, the laws across the country
children are combined with single gay There is extensive research documenting that regulate marriage, adoption, and
and lesbian parents who are raising that there is no causal relationship be- foster parenting by gay men and les-
children, almost 2 million children are tween parents’ sexual orientation and bians are an inconsistent patchwork.
being raised by gay and lesbian children’s emotional, psychosocial, and Even civil marriage in a state that
parents in the United States.7 behavioral development.1,10–19 Many stud-
Civil marriage is the legal and social ies attest to the normal development of *National organizations that support marriage
institution in modern society that serves children of same-gender couples when equality: American Civil Liberties Union (June
1998), National Association of Social Workers
as the basic building block for family the child is wanted, the parents have (June 2004), American Psychological Association
structure and child-rearing. Marriage is a commitment to shared parenting, (July 2004), American Psychiatric Association (May
generally considered the optimal re- and the parents have strong social and 2005), American Psychoanalytic Association
(January 2008), American Bar Association (August
lationship between 2 adults who share economic supports. Indeed, current re-
2010), American College of Nursing (July 2012),
responsibility for children. Marriage search has concluded that “In all, it is and American Academy of Family Physicians
brings 2 extended families together to now well-established that the adjust- (October 2012). National organizations that
support gay and lesbian parenting and the
provide long-term security and social ment of children and adolescents is
nurturing of children: American Academy of Child
and emotional support to all members best accounted for by variations in the and Adolescent Psychiatry, American College of
of the newly formed family. Marriage quality of the relationships with their Obstetrics and Gynecology, American Medical
offers many legal rights and responsi- parents, the quality of the relationship Association, Child Welfare League of America,
National Adoption Center, National Education
bilities, including the joint responsi- between the parents or significant Association, North American Council on Adoptable
bility to care for children and to make adults in the children’s and adolescents’ Children, and Voice for Adoption.

828 FROM THE AMERICAN ACADEMY OF PEDIATRICS

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 FROM THE AMERICAN ACADEMY OF PEDIATRICS

permits it does not ensure access to structure, on the basis of the common 3. Foster care placement for eligible
federal benefits. The federal Defense of principles of justice. If a child has children to qualified adults without
Marriage Act (1996; Pub. L. No. 104-199) 2 living and capable parents who regard to their sexual orientation.
denies members of married same- choose to create a permanent bond
gender households access and bene- by way of civil marriage, it is in the ACKNOWLEDGMENT
fits equivalent to those available to best interests of their child(ren) that The authors and the committee thank
households headed by married parents legal and social institutions allow and James G. Pawelski, MS, for his valuable
of different genders, such as (1) Social support them to do so. If 2 parents are contributions to the development of
Security and related programs, (2) not available to the child, adoption or this policy statement.
housing and food stamps, (3) federal foster parenting remain acceptable
civilian and military service benefits, (4) options to provide a loving home for LEAD AUTHORS
employment benefits, (5) immigration a child and should be available Benjamin S. Siegel, MD
and nationality status, (6) remedies and without regard to the sexual orien- Ellen C. Perrin, MD, MA
protections for crimes and family vio- tation of the parent(s).
COMMITTEE ON PSYCHOSOCIAL
lence, and (7) certain loans and financial ASPECTS OF CHILD AND FAMILY
guarantees.10,21 For this reason, the AAP RECOMMENDATIONS HEALTH, 2012–2013
has joined with other national organ- Benjamin S. Siegel, MD, Chairperson
The AAP works to ensure that public Mary I. Dobbins, MD
izations in support of the position that
policies help all parents, regardless of Arthur Lavin, MD
the Defense of Marriage Act is uncon-
sexual orientation and other charac- Gerri Mattson, MD
stitutional.† John Pascoe, MD, MPH
teristics, to build and maintain strong,
A core mission of the AAP is to support Michael Yogman, MD
stable, and healthy families that are
the best interests of all children, re- able to meet the needs of their chil- LIAISONS
gardless of their home or family dren. In particular, the AAP supports: Ronald T. Brown, PhD—Society of Pediatric
1. Marriage equality for all capable Psychology
†
Amici Curiae: Brief of the American Psychological
Mary Jo Kupst, PhD—Society of Pediatric Psy-
and consenting couples, including chology
Association, the Massachusetts Psychological
Association, the American Psychiatric Association,
those who are of the same gender, D. Richard Martini, MD—American Academy of
the National Association of Social Workers and its as a means of guaranteeing all fed- Child and Adolescent Psychiatry
Massachusetts Chapter, the American Medical eral and state rights and benefits, Barbara Blue, MSN, RN, CPNP, PMHNP-BC—
Association, and the American Academy of National Association of Pediatric Nurse Practi-
and long-term security for their tioners
Pediatrics Nos. 10-2204, 10-2207, and 102214 in the
United States Court of Appeals for the First Circuit. children. Terry Carmichael, MSW—National Association
The Commonwealth of Massachusetts v the United 2. Adoption by single parents, copar- of Social Workers
States Department of Health and Humans Services
ents adopting together, or a second
et al, November 3, 2011; Brief of the American CONSULTANT
Psychological Association, the American Academy parent when 1 parent is already George J. Cohen, MD
of Pediatrics, the American Psychiatric a legal parent by birth or adoption,
Association, the American Psychoanalytic
Association, the National Association of Social
without regard to the sexual orien- STAFF
Workers and its New York City and State Chapters, tation of the adoptive parent(s). Stephanie Domain, MS, CHES
and the New York State Psychological Association.
No. 12-2335(L), 12-2435(Con) in the United States
Court of Appeals for the Second Circuit; Windsor v
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 Promoting the Well-Being of Children Whose Parents Are Gay or Lesbian
COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY
HEALTH
Pediatrics 2013;131;827; originally published online March 20, 2013;
DOI: 10.1542/peds.2013-0376
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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly

publication, it has been published continuously since 1948. PEDIATRICS is owned, published,
and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk
Grove Village, Illinois, 60007. Copyright © 2013 by the American Academy of Pediatrics. All
rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

Downloaded from pediatrics.aappublications.org at Amer Acad of Pediatrics on May 23, 2013