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© 2006 American Academy of Pediatrics
Special article in Pediatrics outlines laws
affecting children of same-gender parents
Lori O'Keefe
Correspondent
"As the (acute transport) nurses entered the room to take us to the treatment room, I looked deep into my son's eyes and at that moment I knew that we would make it through this darkness as one connected family. Where each member has their gift to share, their strength to pass on, and their job to support the others in need."
These are the words written on Julie's blog while her 4-year-old son Ben was hospitalized and being treated for leukemia.
Although Ben, his brother, Tyler, and their mothers consider themselves a family, federal and state statutes do not legally recognize them as one.
Although Julie left her job to stay at home with the children, her family is fortunate to have health insurance coverage through their other mother Kate's employer. Some same-gender families are not as fortunate. Still, Kate is not legally able to adopt the boys in their state because they are a same-gender couple.
Yet if Kate lost or left her job, Ben and Tyler — both of whom have pre-existing conditions — would be faced with the possibility of no insurance coverage and costly medical treatments, creating a financial burden on the family and the state.
This is just one of the challenges encountered by children of same-gender couples.
To better understand the difficulties facing children in non-traditional families as a result of civil union, marriage and domestic partnership amendments, the AAP Board of Directors requested an analysis of the issues.
The analysis, "The Effects of Marriage, Civil Union and Domestic Partnership Laws on the Health and Well-being of Children" is published in the July Pediatrics (2006;117:349-364). It examines demographics, public policies on marriage and adoption, and the legal and financial effects of public policies on the children of same-gender parents.
"The Board feels a commitment to do whatever is in the best interest of children," said David T. Tayloe Jr., M.D., FAAP, District IV Chair and member of the Board. "The Academy isn't rendering an opinion. We're providing information that allows a better understanding of how children fare in families with two gay or lesbian parents."
The Board commissioned the analysis in response to a resolution titled, AAP Response to the Proposed Marriage Amendment to the Constitution of the United States of America, which was adopted and ranked third out of the top 10 issues by voting members at the 2004 Annual Leadership Forum.
While the analysis is not Academy policy, the Board felt it should be made widely available for scientific and academic discussion and encouraged its publication in Pediatrics.
The analysis was a collaborative effort by representatives from the AAP Committee on Psychosocial Aspects of Child and Family Health; the Committee on Early Childhood, Adoption and Dependent Care; the Committee on Adolescence; the Committee on State Government Affairs; the Committee on Federal Government Affairs and the Section on Adoption and Foster Care.
According to Census 2000 findings, same-gender couples are raising children in at least 96% of all counties in the nation. In addition, more same-sex couples (6%) are raising adopted children than heterosexual married couples (5.1%) and unmarried heterosexual couples (2.6%).
It is difficult to determine exactly how many children are being raised by a gay or lesbian parent or parents because there is no uniform collection source for these data and many families may not make their status known due to confidentiality issues and safety concerns. The best estimates, however, range from 1 million to 10 million children in the United States. The analysis reports that two-thirds of these children live in the 42 states that do not allow second-parent adoption. In addition, 42 states have enacted laws that allow marriage only between a man and woman.
Children of same-gender couples do not have access to many of the rights, benefits and protections that children of heterosexual couples do, including more than 1,100 federal statutory provisions.
"In the public mind, this is an issue regarding adults, but it really is an issue that impacts children tremendously," said Ellen C. Perrin, M.D., FAAP, one of the authors.
"Kate and I understand that people consider marriage to be a spiritual union," said Julie. "We have our own perception of what our marriage and spiritual union is, but we care more about having the right to protect our children and being equal parents especially as we move through saving our child's life."
Although Dennis L. Vickers, M.D., FAAP (left), and his partner, Vuthik T. Chhay, reside with their adopted son in a county where they are recognized as domestic partners, their family is not allowed the same protections given to families with married partners.
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Dennis L. Vickers, M.D., M.P.H., FAAP, and his partner live in Illinois, where they were allowed co-parent adoption of their son. In addition, they are registered with the county as domestic partners, but Dr. Vickers said that while he was conducting research as one of the authors of the analysis, he learned that domestic partnerships and civil unions do not allow the same protections allowed by marriages.
"There are things I think of now that I have a child that I didn't think about five years ago," said Dr. Vickers. "I want to know that my child will have benefits such as survivorship benefits and health insurance."
Yet, federal and many state laws leave children of same-sex couples vulnerable and unprotected and prevent the nonbiological or non-jointly-adoptive parent from accessing such rights on their behalf as:
- enrolling children in public and medical assistance programs;
- consenting to medical care or emergency medical treatment;
- being involved in the child's education; and
- visitation rights and/or custody should the relationship end or the biological parent die.
"It matters to children to have legal protection and to be accepted in their community," said Dr. Perrin. "Children thrive better in a community that is supportive and welcoming, and the legal community is part of the community."
"This analysis makes it clear that there isn't any evidence that children of gay or lesbian parents have worse outcomes than children of heterosexual parents," said Dr. Tayloe. "Children who have two responsible adults in their (lives) have better outcomes."
The analysis notes that studies have found that children born to and raised by lesbian couples display the same development, social competence, self-esteem and behavioral difficulties as children raised by heterosexual couples. In addition, preadolescent children of lesbian mothers have not experienced gender-identity confusion.
Dr. Perrin said pediatricians should not assume every family is heterosexual, and it is important to learn about and discuss family dynamics. She also recommends that hospitals change policies about hospital visitation rights for same-gender parents. Pediatricians also might consider becoming community advocates by advising groups, schools and libraries about diversity and becoming advocates for patients and their families by writing articles and speaking to the media, she concluded.
Resources
Visit the Member Center of the AAP Web site at www.aap.org/moc for speaking points on how to address this issue with parents, patients and the media.
For more information, see the AAP policy statement Coparent or Second-Parent Adoption by Same-Sex Parents (Pediatrics. 2002;109:339-340) and technical report by the same name (Pediatrics. 2002;109:341-344).
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