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Mothering alone: cross-national comparisons of later-life disability and health among women who were single mothers
  1. Lisa F Berkman1,2,
  2. Yuhui Zheng3,
  3. M Maria Glymour4,5,
  4. Mauricio Avendano4,6,
  5. Axel Börsch-Supan7,
  6. Erika L Sabbath1,8
  1. 1Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA
  2. 2Departments of Social and Behavioral Sciences; Epidemiology; and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  3. 3School of Public Policy and Management, Tsinghua University, Beijing, China
  4. 4Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA
  5. 5Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
  6. 6London School of Economics and Political Science, LSE Health, London, UK
  7. 7Munich Center for the Economics of Aging at the Max Planck Institute for Social Law and Social Policy, Munich, Germany
  8. 8School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
  1. Correspondence to Dr Lisa F Berkman, Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA 02138, USA; lberkman{at}


Background Single motherhood is associated with poorer health, but whether this association varies between countries is not known. We examine associations between single motherhood and poor later-life health in the USA, England and 13 European countries.

Methods Data came from 25 125 women aged 50+ who participated in the US Health and Retirement Study, the English Longitudinal Study of Ageing and Survey of Health, Ageing and Retirement in Europe. We tested whether single motherhood at ages 16–49 was associated with increased risk of limitations with activities of daily living (ADL), instrumental ADL and fair/poor self-rated health in later life.

Results 33% of American mothers had experienced single motherhood before age 50, versus 22% in England, 38% in Scandinavia, 22% in Western Europe and 10% in Southern Europe. Single mothers had higher risk of poorer health and disability in later life than married mothers, but associations varied between countries. For example, risk ratios for ADL limitations were 1.51 (95% CI 1.29 to 1.98) in England, 1.50 (1.10 to 2.05) in Scandinavia and 1.27 (1.17 to 1.40) in the USA, versus 1.09 (0.80 to 1.47) in Western Europe, 1.13 (0.80 to 1.60) in Southern Europe and 0.93 (0.66 to 1.31) in Eastern Europe. Women who were single mothers before age 20, for 8+ years, or resulting from divorce or non-marital childbearing, were at particular risk.

Conclusions Single motherhood during early-adulthood or mid-adulthood is associated with poorer health in later life. Risks were greatest in England, the USA and Scandinavia. Selection and causation mechanisms might both explain between-country variation.

  • Cohort studies
  • Life course epidemiology

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