AMERICAN FAMILIESThe strains of intensive caregiving can com-
promise the provider’s ability to continue in the
caregiving role. A number of researchers have
concluded that greater assistance from the govern-
ment as well as from the workplace is needed to
assist family members and others who provide
care to older adults in the community (e.g. Lechner
1992). Such assistance not only benefits the health
and well-being of care providers and recipients,
but also allows elders to continue living in the
community setting for a longer period of time, as
is preferred by most elders and their families.
CROSS-NATIONAL COMPARISONSThe family trends described here are not unique
to the United States. Other western societies also
have witnessed a rise in the age at first marriage, an
increased divorce rate, increased numbers of child-
ren born to unmarried women, and an increase in
the numbers of women who participate in paid
labor. Although the trajectories of these trends are
similar for most western societies, differing pro-
portions of individuals and families are represent-
ed in these trends across societies. For example,
although the average age at marriage has been
rising in the United States and most other western
societies, the average age at first marriage is lower
in the United States than in most of the European
countries. And although a rising divorce rate has
been a feature of the majority of western societies,
the rate of divorce is highest in the United States.
Out-of-wedlock births also have increased in west-
ern societies over the course of the century. How-
ever, in contrast to Scandinavian countries includ-
ing Sweden and Denmark, more children in the
United States live in a single-parent household
than with cohabiting parents.
A striking gap between the United States and a
number of other countries is found in its relatively
high rate of infant mortality. Infant mortality is
linked with poverty and the lack of adequate nutri-
tion and health care. The wealth enjoyed by the
United States as a nation belies the economic
deprivation experienced by subgroups within the
society. In 1988, the U.S. infant mortality rate was
10 babies per 1,000 live births. This rate was higher
not only as compared with other western societies,
but also compared with many nonwestern coun-
tries. In a ranking of infant mortality rates world-
wide, which were ordered from the lowest to the
highest rates, the United States ranked eighteenth
from the bottom. This rate was higher than that
found in countries including Singapore, Spain,
and Ireland, which are poorer relative to the Unit-
ed States, but which have lower levels of economic
inequality within the society (Aulette 1994). A
statement from the Children’s Defense Fund illus-
trates the high risks for infant mortality faced by
racial-ethnic minority groups within the United
States: ‘‘A black child born in the inner-city of
Boston has less chance of surviving the first year of
life than a child born in Panama, North or South
Korea or Uruguay’’ (Children’s Defense Fund 1990,
p. 6, cited in Aulette 1994, p. 405). (The famine
experienced within North Korea during the 1990s
likely would remove that country from this listing.)The United States is unique among western
societies in its lack of a national health care pro-
gram, which helps to explain its higher infant
mortality rate. In 1997, 43.4 million Americans,
or slightly over 16 percent of the U.S. population,
had no health insurance coverage for the entire-
ty of that calendar year. The lack of health in-
surance is especially acute among the poor. Al-
though the Medicaid program is intended to
provide health coverage to the poor, 11.2 million
poor Americans, or one-third of all poor people in
the United States, had no health coverage in 1997
(Bennefield 1998).In the absence of concerted social policy meas-
ures, infant mortality and other risks faced by poor
Americans are unlikely to diminish in the near
future. Using the Gini index (a measure of income
concentration), the U.S. Bureau of the Census
reported that income inequalities within the coun-
try increased by 16 percent between 1968 and- Even greater inequalities have developed
since 1992: Between 1968 and 1994 the rate of
increase in U.S. income inequality was over 22
percent (Weinberg 1996). At the same time, the
percentage of Americans with incomes below the
poverty line also increased—from 11.7 percent in
1979 to 13.3 percent in 1997 (Dalaker and
Naifeh 1997).
AMERICAN FAMILIES AND THE FUTURETraditional distinctions between ‘‘family’’ and
nonfamily’’ are increasingly challenged. Though