Working with children and young people is both rewarding and challenging. Nurses and midwives caring for this client group do so, most commonly, within the context of the family. It is important therefore to understand the nature and shape of the family as a mediator and facilitator for children and young people, their health and wellbeing. This chapter, therefore, situates the child, young person and family in contemporary New Zealand and Australian society and examines the underpinnings of children and young people’s health and healthcare in these countries.

Family life has changed over recent decades in both Australia and New Zealand with a rise in divorce, increasing workforce participation by both parents, and single parenting. Such changes have brought into question the quality of family life, especially for children. However, historical analysis tends to point to the importance of a longer term view of family development (Featherstone 2004). The nature and pattern of family life have changed over time and have probably done so for centuries.

Early in the twenty-first century the focus, however, tends to be nostalgic for the 1950s, an era that seems to be considered the benchmark for ideal family life. An understanding and critique of trends in family life are therefore important, as they influence and shape the way health professionals may view family functioning and child health and, more broadly, how governments prioritise social and health policy and service provision.

Any discussion of the family needs to be prefaced with contemporary working definitions. There are a number of definitions of family that can inform thinking about family within the context of child, youth and family health. For example, for the purpose of census data collection, the ABS (Australian Bureau of Statistics 2002) defines family as:

In New Zealand, and again in the context of social statistics, one definition suggests that the family ‘consists of a couple, with or without children, or one parent with children, usually living together in a household. Couples can be same sex or opposite-sex’ (Statistics New Zealand 2004 p. 1). It is clear that, in these constructions, the family is about household, and the child and young person are optional rather than integral, and it is certainly far from the idealised 1950s family.

Discussion about the family within the nursing context, however, requires a broad definition. For example, Wright and Leahey suggest that ‘the family is who they say they are’ (2005 p. 60). While the definitions of family vary, it is important to understand the social, cultural and political factors that might shape the way family is considered. There may be an ideal image of a family embedded in our thinking about families, but the reality is that the nature and shape of families is dynamic and the result of decades, and centuries, of social change. Family diversity then is a response to changing times.

Gilding (2001) observes that there have been a number of distinct eras in family structure in postcolonial Australia. The first was the era of federation, over a century ago, when families were enmeshed in wider relationships. They may have produced a variety of goods and services in the home and opened their home to guests and extended family. Middle class households employed servants (domestic service being the main source of employment for women). For the working class family, households were commonly overcrowded, experiencing difficult economic circumstances.

This was a time of declining birthrate, one of the responses to which was the infant welfare movement. The declining birthrate was blamed on the ‘selfishness’ of women who would prefer the luxuries of life over rearing children (Royal Commission 1904 p 17, cited in Gilding 2001). This decline was the cause of a moral panic about the population and about women’s role in the family and society. In addition, the declining birthrate was a concern in both countries as each sought to develop a labour force. The effect was increased surveillance of mothering and an increasing separation of the domestic and private from the commercial and public space.

The postwar decades of the 1950s and 1960s saw the predominance of the nuclear family and the dominance of western values, despite the increasing ethnic diversity in each country. Women became ‘housewives’ as fewer servants were employed and households were more likely to be a single family, and the growth of the welfare state meant that financial support was more readily available (Gilding 2001). This era promoted marriage and the family and is often reflected upon as the time of the ‘traditional’ family (Gilding 2001).

In the following decades there was significant change occurring to the family. During the 1970s and 1980s there was increasing diversity, women increasingly entered the workforce, children stayed at home and at school longer, and it was the age of sexual liberation. It was a time when there were fewer marriages, more de facto relationships, more divorce and fewer children (Gilding 2002). There was also increasing diversity in migrant families and therefore ethnicity (Poole 2005). For some, the family had undergone irreparable change.

Over a century of change, diversity and panic about the family, and more recent fears from politicians and the media, have led to fear that the family is in decline. In 2003, in Australia, however, 87% of the population lived in family households (Australian Bureau of Statistics 2004). The family is not in decline as such, but the characteristics of the family have changed. For example, the family of the twenty-first century is characterised by the activities and products of a technological age (Gilding 2002).

The shape of the contemporary twenty-first century family is expected to change further, with concerns of population decline, as the number of couple-only families is predicted to increase and the number of couple families with children is predicted to decline over the next decade (Australian Bureau of Statistics 2004). During this time it is predicted, also, that one-parent families will remain stable, a picture that tends to contrast with expectations and rhetoric that the one-parent family is more common than couple families.

The family characteristics survey conducted in Australia in 2003 demonstrates the diversity of family types within Australia. Families were identified as comprising couples with or without children, lone parents with children or families comprising related adults (Australian Bureau of Statistics 2004). At the time of the survey, 60% of families were families with children, with 79% of the children classed as dependent children. Of families with at least one child aged 0–17 years, 71% were intact couple families, 22% were one-parent families, 4% step-families and 3% blended families (Australian Bureau of Statistics 2004). Important to note is that 23% of children in the 0–17 age group were living in circumstances were a natural parent was living elsewhere (i.e. as a result of separation). A growing family group is that of grandparent families, with over 22,000 identifying as such in 2003. In this group, the younger partner was younger than 55 years in 39% of families, with the majority being over 55 years.

New Zealand projections (Statistics New Zealand 2004) estimate that trends in family types up to 2021 will see a growth in couples without children and one-parent families (up to approximately 26%) and a decrease in two-parent families. In 2001, 84% of two-parent families and 77% of one-parent families had dependent children. The 2006 New Zealand census data (Statistics New Zealand 2006) suggest that 42% of families are couples with children and 39.9% are couples without children, while 18.1% are one-parent families.

To explore your understanding of ‘family’, consider the critical questions and reflections in Box 1.1.