MEDICAL MATTERS Tom O'Dowd'Are you on your own?' is how many GPs check out if the patient has become a lone parent. 'Just me and the kid' clinches it.
Very young lone parents seem to wait for a number of years before having another child. The first baby has to be absorbed into the extended family. Things become fraught when the baby starts to walk, needs more room and Mum begins to make plans to return to work or education.
For all the literature and folk wisdom extolling the virtues of the extended family, the GP can be sure of many requests for a medical note for the council to support a housing move. The note must stress illnesses, overcrowding and damp. I always advise the patient to get herself on to the electoral roll in order to interest local politicians doing their best. Going along to a councillor asking for help when your name is not on the list of his or her potential electors is taking too much for granted. It may take years to come through and any help is welcome.
The medical note cannot state that this young woman is fed up living with her mother who in turn is feeling exploited. She was looking forward to a bit of freedom from juggling home and work and is now landed with a new baby even if it is a grandchild. We cannot say that the young Mum wants to start a home with her fella and get on with the business of being a family. It would put a different complexion on neighbourhoods if housing points were awarded to couples trying to make a go of being a family.
You can always tell if the couple intend to make an effort at joint parenting if the child is given the surname of both mother and father. Such double-barrelled surnames are now a sign of serious commitment in a marriage-less community. Sometimes the surname reverts to the mother's as reality bites and the man fades off the parenthood scene.
Young couples, whether rich or poor, usually start out in love. The Fragile Families cohort study in New York found that 86 per cent of unmarried couples considered themselves romantically involved. Seventy-two per cent of the mothers said the chances of marrying the father of the baby were 'fifty fifty'. It is possibly the same in Ireland.
So why don't the poor marry? In Ireland the churches are still synonymous with marriage and wedding frocks, flowers and videos. With the decline in religious practice we have not yet got across the civil aspects of marriage. Indeed, we have not provided many places to get a civil marriage or licensed enough non-clerical persons to conduct the ceremony locally. We cannot complain about the low rates of marriage among the poor when access to registry offices is itself poor.
There are more substantial barriers to sustaining an ongoing relationship. Poor education is an old reliable that turns up in all studies on social deprivation. For young men low pay means long hours which mean absence from home. An absent father sets a pattern for the next generation that seems to endanger future family relationships.
In other words, the same reasons that gave rise to early pregnancy also make it difficult to sustain a family relationship. These reasons are rooted in emotional, social, educational and financial poverty. No matter how much our wealthy society looks for other reasons, poverty comes back to bite its big fat wealthy bum.
In the US, Australia and the UK, child support has been an issue where governments chase fathers to pay their share to support the family. The schemes have been fraught with financial, emotional and political difficulties. They have even included a proposal to withdraw driving licences from fathers who don't pay up. The Australians have had to face criticisms of sexism in their implementation of child support schemes.
More than anything, child support has galvanised fathers into action. They seem to be older, articulate men who have bonded already with their children. They have nonetheless put fatherhood on the agenda and are shaping our thinking about the role of fathers.
Who is going to tell younger less-articulate men about fatherhood? Who is going to tell them that their kids will do better if they are around? Well, it is going to have to be other fathers - if necessary, celebrity fathers.
We are going to have to engage the authority and experience of young footballers, rappers, soap stars and kids themselves to tell dads they matter and are needed - an important project for the Department of Social and Family Affairs.
' Dr Tom O'Dowd is professor of general practice at Trinity College Dublin and a practising GP.