DeepDives is a bi-weekly essay series exploring key issues related to the economy. The goal of the series is to provide Hub readers with original analysis of the economic trends and ideas that are shaping this high-stakes moment for Canadian productivity, prosperity, and economic well-being. The series features the writing of leading academics, area experts, and policy practitioners. The DeepDives series is made possible thanks to the ongoing support of Centre for Civic Engagement.

Last month’s Council of the Federation meeting dedicated a lot of attention to the “recruitment and retention of health-care workers” as a key part of addressing broader health-care challenges. The notion of a major labour supply problem in Canadian health-care systems is commonly represented in the news media and popular conversation. Scarcely a week goes by without yet another story or study about physician access and shortages in Canada’s health system.

There’s no doubt that family physicians play a crucial role as the point of first contact and gatekeeper for health services, and it has been estimated that there are at least 6 million Canadians without access to a family or primary care physician, with some estimates being higher.

While Canada is not alone in having physician access issues, it remains that, among the ten high-income Commonwealth Fund Survey countries, adults in Canada recently reported the lowest rate of having a regular doctor at 86 percent, with New Zealand and the Netherlands at the top at 97 and 99 percent respectively.

Why Canadians continue to experience a health-care system with shortages of physicians and other health-care professionals is a health policy problem springing from a conjunction of forces that span provincial and federal policies towards health care and its funding, physician behaviour, and demographic and technological changes.

Yet there’s also a risk here that we can overstate or at least misunderstand the problem. The truth is that in the case of physicians Canada currently has the most physicians it has ever had. The issue does not appear to be a shortage in the number of physicians per se, but rather the quantity and mix of output physicians produce relative to the incentives available.

This DeepDive aims to assess whether Canada actually has a physician supply problem and provide an overview of the burdens that Canadian physicians face.

Does Canada have a physician shortage problem?

The basic dimensions of the problem are well-established. Nationally, a Canadian Medical Association Journal (CMAJ) report has stated that as many as one-fifth of Canadians are without a primary care physician, but there is variation across Canada’s regions, with 13 percent of Ontarians saying they are without a family physician while 27 percent of people in British Columbia and 31 percent in Atlantic Canada say they don’t have one.

These numbers have increased rather dramatically since the pandemic, given that in 2019, Statistics Canada estimated there were 4.5 million without a family physician. However, this is a long-standing problem going as far back as 2005 when 14 percent of Canadians—at the time 3.5 million people—reported having no family physician. Moreover, even with a family doctor, large proportions of Canadians are reporting difficulty in getting appointments, as 29 percent of those with a physician said it was hard to get an appointment.

In trying to understand the issues affecting physician supply and access, the first step is to look at physician numbers. When it comes to international comparisons, Canada ranks near the bottom among the OECD countries for physicians per 1,000 population. In 2021 (See Figure 1), the number of doctors in OECD member countries ranged from 2.5 or fewer per 1,000 population in Türkiye, Colombia, and Mexico to over 5 per 1,000 in Norway, Austria, Portugal, and Greece.

Of 47 countries compared by the OECD in 2021, Canada ranked 35th at 2.9 physicians per 1,000 population. Canada is actually above the United States and Japan at 2.7 and 2.6 per 1,000, respectively, but well below countries such as Italy at 4.1 or Denmark at 4.4. There are, however, some caveats to these numbers. For example, the numbers in Portugal and Greece are overestimates as they include all doctors licensed to practice, not just those actively practicing. As well, while many European countries have higher physician per capita numbers, this is also a function of health systems built around more physician-centred services with lower ratios for other health professionals such as nurses.

Another point to make is that while Canada ranks low in physicians per capita, it has seen substantial growth in numbers over the last decade. When it comes to the percentage increase in physicians per 1,000, Canada is mid-ranked across these 47 OECD comparison countries in the increase since 2011. Yet, if one looks at physician numbers in Canada over the longer term, Canada has the most physicians per capita that it has ever had. Figure 2 plots the total number of physicians per 100,000 population in Canada from 1971 to 2022, revealing three distinct phases. First, there was a period of increase from 1971 to 1993 that saw physicians per 100,000 rising from 125 to 192—a 54 percent increase. From 1993 to 2007, numbers remained flat, averaging 189. From 2007 to 2022, they again increased from 194 to 247—an increase of 27 percent.

It should also be noted that these are national figures, and there are variations in physician supply not only by province and territory but across rural and urban areas. For example, in 2022, total physicians per 100,000 population ranged from highs of 270 per 100,000 in British Columbia and Nova Scotia to lows of 215 per 100,000 in Prince Edward Island and Saskatchewan, respectively. Then there are the three territories that range from a high of 203 in The Yukon to a low of 72 in Nunavut.

Figure 3 shows that while these trends have marked both family and specialist physicians, it’s family physicians that appear to have taken the greater blow in the 1993 to 2007 period. This decline came after a period when they increased faster than specialist physicians. From 1971 to 1993, family physicians per 100,000 population increased by 64 percent—from 62 to 102 per 100,000—while specialist physicians grew only 45 percent—from 62 to 90 per 100,000. From 1993 to 2007, specialist physicians per 100,000 increased slightly while family physicians declined. Since 2007, specialist physicians per 100,000 grew by 30 percent, whereas family physicians increased by 25 percent, with the numbers now being nearly on par at 124 and 123 per 100,000, respectively.

The post-1993 decline, particularly amongst family physicians, has often been attributed to the implementation of the Barer-Stoddart Report. In the wake of slowing economic growth and rising health expenditures, provincial health ministers commissioned health economists Morris Barer and Greg Stoddart in 1990 to produce a report on medical resource policy. They delivered back in 1991 with a massive report on medical training and practices that recommended, among other things, reducing medical school entry class size by 10 percent. The report also recommended reforming physician payment methods away from fee-for-service where possible, increasing the use of alternative service delivery models, and initiatives to boost physician access in rural communities. Physicians in that era came to be seen as a factor in rising health expenditures based on theories of supplier-induced demand that argued as gatekeepers to the health-care system, physicians could essentially create their own demand for services.

The result of a reduction in medical school admissions was eventually physician shortages and care disruptions in the 1990s and beyond. The responsibility for implementing the report rested with provincial governments, which focused mainly on reducing physician supply without the additional human resource measures the report suggested. All this occurred against the backdrop of federal health transfer reforms that brought about the Canada Health Transfer in the wake of the federal fiscal crisis of the 1990s.

Indeed, one can construct a counterfactual physician supply for Canada by running a regression of total physicians per 100,000 population from the period 1971 to 1993 and then using the coefficients to project physician numbers to the present, as shown in Figure 4. The divergence in physician supply occurred after 1993, and even with increases in medical school enrollment that began after 2005, the long-term effects on supply are apparent as by 2022, physicians per 100,000 stood at 247, while if they had continued to increase at the pre-1993 trend—all other things given—the number would be 16 percent higher at 287. Put another way, there could presently be approximately 16,000 more physicians on top of the current 96,000 physicians in Canada if growth had continued at pre-1993 rates.

In the end, physicians are viewed not only as health service providers by provincial governments but also as cost centres and a source of expenditure increases and, ultimately, budgetary pressures. While governments seek to meet the need for health-care services through physicians, the supply of physicians is also regulated by governments through medical school admissions and licensing, and payment systems have sought to ensure efficiencies in expenditures.

Governments perceive physicians as a major cost driver despite evidence that while “physician numbers are a positive and significant driver of provincial government health care spending,” it remains that “the overall contribution to real per capita health spending is relatively small for most provinces.” Nevertheless, provincial-territorial government spending per physician, after adjusting for inflation, has actually been in decline for over a decade.

Figure 5 presents a plot of real provincial-territorial government spending per physician (in 2020$), which peaked in 2010 and has since declined by over 8 percent—from $459,000 to $420,000. This decline reflects the move by many provincial governments since the Great Recession period to hold down fee increases and cap payments to physicians, which may, in turn, affect their labour supply behaviour. In lieu of fee increases, provincial governments have encouraged their physicians to incorporate, given the more favourable corporate tax rate regime, but recent changes to federal capital gains taxation inclusion rates have complicated that strategy. However, part of this spending decline is also a function of physicians seeing fewer patients as a result of two other reasons: first, physicians have been working fewer hours over time and of the remaining time, a substantial portion is filled with paperwork.

Growing pressures on physician services

Access and availability of physician services are affected by demand and supply factors. These are rooted in the structure of our health-care system and changing social, economic, and demographic forces. The demand factors include increasing utilization of services per capita. There is also a growing population as Canada’s population has soared past 40 million from 35 million a decade ago. Then there are the increased demands from an aging population as the proportion over age 65 grows in conjunction with rising needs in mental health, particularly amongst younger populations. Technological change also offers new and better procedures—witness, for example, the improvements in cataract care and knee and hip replacements—that, in turn, can foster enhanced demand and increased expectations.

While physician supply has increased, many current physicians are reaching retirement age and leaving the workforce, counteracting the effects of increased domestic medical school graduates. It has been estimated that one in six family doctors are nearing retirement age. While some of this could be counteracted by recruiting more international medical school graduates, there is again a long process for accreditation of these graduates and a shortage of residency positions for them, thereby restricting their entry into the physician workforce. Also, even when more family physicians are trained and graduated, a larger proportion don’t go into traditional primary care but rather go into other fields, such as sports medicine, work solely in hospital emergency rooms or anesthesiology, or work part-time. Part of this is a function of changing preferences, and part is due to monetary incentives given the costs and administrative burdens of running family practices. Obviously, financial and market incentives are a factor if physicians pursue work where they can earn more than they could by seeing more patients as a family physician where fees are capped.

As well, on average, physicians are working less than they did a decade ago as more seek better work-life balances. Indeed, in a recent study by Boris Kralj, Rabiul Islam, and Arthur Sweetman of McMaster University, the authors used Statistics Canada labour force data to analyze the average weekly hours worked by physicians over the 1987–2021 period. Overall, weekly physician work hours remained stable from 1987 until 1997, after which they declined—average weekly hours decreased by 6.9 hours from 52.8 in 1987–1991 to 45.9 in 2017–2021. Among male physicians, work hours declined notably after 1997, while those of female physicians remained relatively stable at around 45 per week. Hours worked by married physicians also declined significantly, amounting to 7.4 fewer hours per week, while unmarried physicians displayed a decline of 2.2 hours. When population aging and population growth are accounted for in conjunction with declining work hours, it becomes apparent that boosting effective physician supply is more than simply increasing physicians per 100,000 population.

While physicians are working fewer hours, they are also experiencing higher administrative burdens given the highly regulated nature of provincial government health systems that reduce patient-centred working time and the explosion of technology that has expanded health information. Governments and health bureaucracies ultimately determine what public health services should be, what procedures are necessary or unnecessary, and what the budgetary envelope will be. The allocation of public money requires accountability, and this desire for efficiency, combined with new technology, has created an exponential increase in paperwork and administrative costs for physicians.

According to the Canadian Medical Association (CMA), the time spent on unnecessary administrative work by physicians, which takes up 18.5 million hours per year and is equivalent to 55.6 million patient visits per year, could be streamlined by governments. For example, it takes most physicians 21-30 minutes to fill out a typical federal disability form. Indeed, suggestions for reducing the administrative burden on physicians include simplifying, reducing, or eliminating federal forms, eliminating unnecessary sick notes, and improving health information systems to make data clear and accessible.

This administrative burden generates burnout, especially amongst family practitioners, more than half of whom say they spend excessive amounts of time on electronic medical records and forms at home. Indeed, the financial burden for family practitioners of hiring staff to help deal with their office management and paperwork burden is another disincentive to new physicians entering family practice. Generally speaking, a family practice is a small business with rising costs and expenses, but physicians have no control over the price of their services while simply increasing the quantity of patients they see runs up against reducing time per patient, rising paperwork burdens, and work-life balance concerns. Adding to all the burnout is, of course, the aftermath of COVID-19, which saw the delay in diagnoses and surgeries and has generated a large workload of catching up.

Key takeaways

The physician supply issue, in the end, is a conundrum. Is there a shortage of physicians? Borrowing words from that quintessential bureaucrat, Sir Humphrey Appleby, the answer is both yes and no, if you forgive the expression. In 1971, there were 125 physicians per 100,000 population, and their services seemed abundant. In 2022, there are 247 physicians per 100,000, and there are issues of scarcity and access.

While there are more of both family and specialist physicians, a host of reasons have reduced their effective supply of services even as their numbers have expanded and total spending on health, both per capita and as a share of GDP, has grown. To this can be added a desire for better work-life balance by physicians in the wake of the pandemic’s more stressful work environment. Even when there are more physicians, an increasing proportion prefer to specialize, and even if they remain family physicians, they often do other gigs ranging from sports medicine to Botox either because of lifestyle considerations or financial incentives.

One can increase the number of physicians by boosting medical school enrollments further and licensing more international medical graduates, but this is no guarantee that they will go into family practice. Moreover, this takes time and ultimately runs up against provincial government budgetary constraints, given every new physician is seen as a billing number and cost centre.

Of course, one might venture that if governments don’t want to spend more on physicians or reduce their administrative burdens, the public should be allowed to spend their own money on attaining the physician services they need. Here, we come up against the politics of Canadian health care whereby there is a commitment to public health care and the belief that more private care creates an inequitable and unfair two-tier health care even as increasing numbers of Canadians experience the unfairness of not having access to the physician services they expect.

Provincial governments essentially ration access to public medical care but don’t make it easy to spend your own money on health care unless you choose to cross the border into the United States—a result that is a version of two-tier care we seem prepared to live with.

What is to be done? We have been doing pretty much the same thing for the last thirty years. Problems brew for a long time and then periodically rear their head as health crises of waiting lists, crowded emergency departments, and shortages of physicians and other health professionals fester.

These events are then punctuated by infusions of public money that provide a short-term solution and a return to the status quo, with U.S. health care providing an occasional safety valve for those with the financial means and ability to travel. Such a system worked adequately in the face of measured and slow changes in health-care needs and demand, and a relatively younger population, but the pandemic exacerbated the issues.

In the case of physician numbers, when combined with a pickup in the pace of demographic and technological change, increased utilization, and changes in physician work practices, the problems have become magnified. The pace of change has picked up, but our ability to cope with change has not. It’s time for some new thinking from governments.

DeepDives is a bi-weekly essay series exploring key issues related to the economy. The goal of the series is to provide Hub readers with original analysis of the economic trends and ideas that are shaping this high-stakes moment for Canadian productivity, prosperity, and economic well-being. The series features the writing of leading academics, area experts, and policy practitioners. The DeepDives series is made possible thanks to the ongoing support of Centre for Civic Engagement.

Few policy goals command broader political support than increasing the well-being of children. It seems self-evident that any society that wants to secure its long-term future needs to be investing in the citizens, workers, and taxpayers of tomorrow. Both the Conservative government of Stephen Harper—with its Universal Child Care Benefit—and the current Trudeau government—with its Canada Child Benefit—made income support for families with children a key policy priority.

However, the policy debate about how best to improve outcomes for children—both in Canada and in countries such as the United States and the United Kingdom—has had something of a blind spot in recent years. Despite the enormous changes in rates of marriage and divorce over the last half-century, there has been very little discussion of the role that family structure has to play in affecting children’s well-being. As we shall see, fewer than six out of 10 Canadian children live with their original parents, and many of those will see their families break up before they reach adulthood.

And yet, there seems to be a fear that any discussion of the relative merits of different family structures is “hurtful to the families being talked about and hurtful to our culture,” in the words of the Vanier Institute for the Family, a Canadian think tank that focuses on family issues. As well-known economist Tyler Cowen said in a 2022 interview with The Hub, “For many people, [family structure] is a subject you’re not even really allowed to bring up.”

But perhaps not anymore.

Two-parent families in the spotlight

The last year has seen two American authors put their heads above the parapet. The first was Melissa Kearney, an economics professor at the University of Maryland, a research associate at the National Bureau of Economic Research, and a senior fellow at the Brookings Institution. Her September 2023 book The Two-Parent Privilege: How Americans Stopped Getting Married and Started Falling Behind is a data-driven look at how divergences in family structure in the U.S. have exacerbated high rates of income inequality. In a podcast discussion with The Hub in March she drew attention to the situation in the U.S., where:

the most highly educated, high-income segments of society are still getting married at high rates, raising their kids in two-parent families at high rates. Others in society who are struggling economically, their economic struggles are made worse by the fact that now they’re more likely to have just one adult, one parent in the household. Their kids fall further behind and that cements the inequality and perpetuates it across generations.

While the Washington Post, perhaps not surprisingly, dismissed Kearney’s book as “tiresome,” the reaction of the other house journal of liberal America was quite different: the New York Times published a guest essay by Kearney outlining the ideas in her book, and columnist Nicholas Kristof gave her work a sympathetic review in a column entitled “The One Privilege Liberals Ignore.”

In March of this year, Brad Wilcox, a sociologist from the University of Virginia, published Get Married: Why Americans Must Defy the Elites, Forge Strong Families, and Save Civilization, a book with a similarly clear message about the benefits of marriage for children. In another Hub podcast discussion, he argued that:

poor kids in communities across America are more likely to rise from poverty into affluence, that classic rags to riches story, when they’re growing up in communities where there are lots of two-parent families. A poor kid growing up in Salt Lake City is much more likely to become affluent as an adult compared to a poor kid growing up in Atlanta. That’s in large part because there are many more two-parent families in Salt Lake than there are in Atlanta.

Both these books build on extensive evidence from the U.S. and elsewhere that children who grow up in intact families—i.e. with their original parents (biological or adoptive)—have higher educational attainment, are less likely to engage in risky or delinquent behaviour, and have lower incarceration rates and teen pregnancy rates. Nor is the benefit of being in an intact family simply a result of the much greater financial resources relative to single-parent families: boys especially can often go astray without a father present in the home to be an appropriate role model. (This point is made eloquently in the new book Of Boys and Men, written by Richard Reeves, a former adviser to the British Liberal Democrat leader Nick Clegg and now senior fellow at the Brookings Institution.)

Children also do less well in stepfamilies: children are much more likely to be abused or neglected in a stepfamily than they are in an intact family. Furthermore, at least in the U.S. data, families where the parents are married also seem to produce better outcomes for children than families where the parents are in a common-law relationship (i.e. cohabiting), partly because those relationships are less stable, and this instability has a negative effect on children.

With the idea that marriage might produce better outcomes for children than common-law relationships or single parenthood now the focus of serious debate in the U.S., it is perhaps a good moment to take a look at the state of two-parent families in Canada, which is what we plan to do in the rest of this article.

Trends in two-parent families over time

Figure 1 shows the proportion of Canadian children living in one of three family types: married; common law (sometimes called co-habiting); and single parent. The share of children in married-couple families has declined steadily over time, from 93.6 percent in 1961 to 63 percent today. Of that 30.6 percentage point drop in the share of children in married-couple families, about half (15.9 percentage points) is accounted for by a rise in the share of single-parent families, with the other half (14.7) accounted for by a rise in the share of children in common-law couple families.

Interestingly, the biggest decline in the proportion of children in married-couple families took place not in the 1960s or 1970s, the decades that saw the legalisation of divorce and the decriminalisation of homosexual activity, but in the 1990s, as the children of the baby boomers came of age. Since 2011 the pace of decline has slowed although not halted, with the proportion of children in married couple families dropping 1.9 percentage points between 2011 and 2021, compared to a 5.8 percentage point drop between 2001 and 2011.

Intact families versus stepfamilies

It’s important to note that not all children in married-couple families live with their original parents (either birth parents or adoptive parents). Many live in stepfamilies, due to their parents being divorced and they now live with one of their original parents and this parent’s new spouse. Statistics Canada breaks down stepfamilies into two types: simple stepfamilies, where all the children living at home are the original children of only one of the parents; and complex stepfamilies, where there are children who have different birth parents.

This distinction matters significantly for outcomes, because, as noted above there is significant evidence that children do not do as well, on average, in stepfamilies as they do in intact families.

Figure 2 below shows how the children in married-couple families are distributed between intact families, simple stepfamilies, and complex stepfamilies. Of Canadian families, 58.1 percent of children live in intact families, with 2 percent in simple stepfamilies and 2.9 percent in complex stepfamilies. Thus, a bit less than a tenth of children in married-couple families live in stepfamilies.

Figure 3 shows the same breakdown for common-law couples, where 9.7 percent of children in Canadian families live in intact families, whereas 2.2 percent live in simple stepfamilies and 2.8 percent in complex stepfamilies. This means that about a third of children in common-law couple families live in stepfamilies.

The much higher prevalence of stepfamilies in common-law relationships likely reflects the reluctance of people who have lived through the breakup of a previous relationship to remarry, as well as the greater instability of these relationships.

Adding together the proportion of children in intact married-couple families and intact common-law couple families implies that 67.8 percent of Canadian children live in an intact family. However, that number is simply a snapshot in time: many children currently in intact families will see those families break up over time, so the proportion of children who reach adulthood still in an intact family is likely to be significantly less.

Breakdown by province and urban-rural

How do the proportions of children in different types of families vary across the country? Figure 4 answers this question for the provinces and territories. Quebec has the lowest proportion of children in married-couple families, with only 42 percent in this kind of family (compared to 63 percent for Canada as a whole) and 35 percent in common-law families (compared to 15 percent for Canada). This difference reflects the Quiet Revolution of the 1960s, when Quebec went from being one of the most religious parts of Canada to one of the most secular. Interestingly though, the proportion of children in single-parent families is only 23 percent, just slightly above the Canadian average of 22 percent, and so the greater incidence of common-law couples doesn’t seem to have led to many more children in single-parent families.

Looking at the rest of Canada, the Territories also have a high incidence of children in common law families: in this case, however, they also have a higher proportion of children in single-parent families—29 percent, the highest in Canada.

Alberta has the highest proportion of children in intact families, with 72 percent of children in this kind of family, closely followed by B.C. and Ontario (both at 70 percent). Manitoba (66 percent) and Saskatchewan (64 percent) have somewhat lower proportions of children in intact families.

Interestingly, the Atlantic provinces of Newfoundland and Labrador, Nova Scotia, and New Brunswick have significantly lower proportions of children in intact families (60, 59, and 57 percent respectively), with correspondingly higher shares of children in common-law and single families. This difference with Ontario and the West may reflect the rural nature of these three Atlantic provinces. Figure 5 shows the breakdown for large Census Metropolitan Areas (CMAs) (Montreal, Toronto, and Vancouver), small CMAs (other towns and cities with over 100,000 people), and non-CMAs (small towns and rural areas).

It’s readily apparent that there are fewer intact families in more rural areas: in the three largest CMAs, 67.1 percent of children live in intact families, compared to 64.9 percent of children in smaller CMAs, and only 55.3 percent in non-CMAs.

Family size 

Are married couples likely to have more children than unmarried couples or single parents? This seems a relevant question to ask given the significant decline in Canada’s fertility rate, which is now the lowest in our history. Unfortunately, we don’t have data on fertility rates by family structure, because data on the common-law status of the parents isn’t collected at birth. However, we do have data on family sizes by family type. These are shown in Figure 6 below.

The data show that intact married couple families have somewhat more children than intact common-law couples: 1.9 children per family for married couple families compared to 1.7 for common-law couple families. When it comes to stepfamilies the average number of children is similar for both married and common-law couples: 1.5 for simple stepfamilies and 2.9 for complex stepfamilies. The higher average number of children in complex stepfamilies arises partly because partners are often bringing children from both previous relationships, and partly because they have gone on to have children in this new relationship. By definition, a simple stepfamily would only have children from one of the previous relationships.

The average number of children in single-parent families is only 1.6, similar to that in simple stepfamilies and common-law couple families. Obviously, single parents are much less likely to have additional children, although the parent may have more children once he or she has a new partner and is no longer in a single-parent family.

Overall, these data seem to suggest that married couples have higher fertility rates than common-law relationships, although the difference isn’t large. Whether this difference is because marriage makes people more likely to want children, or because people who want children are more likely to get married is of course hard to say without conducting an in-depth experimental study.

International comparisons

We now look at how Canada compares to five other G7 countries: the U.S., the U.K., France, Germany, and Italy. (Comparable data were not available for Japan). Because these other countries report data for children aged less than 18, we have adjusted the Canadian data to match. Beginning with the U.S. and the U.K., two countries that are culturally quite similar to Canada, we can see from Figure 7 that Canada has a smaller share of children in married couples: 62.2 percent compared to 64.7 percent for the U.K. and 67.7 percent for the U.S. The comparatively low proportion for Canada reflects the greater popularity of cohabitation: 16.9 percent of Canadian children under 18 are in common-law couples, compared to 13.7 for the U.K. and only 4.7 percent for the U.S.

This high proportion in Canada is entirely driven by Quebec: without Quebec, the proportion of children in common-law families would be lower than the U.K., although still higher than the U.S. When it comes to single-parent families, Canada has a lower proportion of children in this family type, with only 20.9 percent compared to 21.7 percent in the U.K. and 27.5 percent in the U.S. The high proportion of children in single-parent families in the U.S. is driven by the Black population, for which the proportion is slightly over 50 percent.

Turning now to the three continental European countries, we see that France has a significantly higher proportion of children in common-law relationships—26.3—than any of the other countries. This proportion is similar to, although slightly lower than, the 35 percent of children in common-law couples in Quebec. In both cases the retreat from marriage reflects societies that have, officially at least, rejected the Catholic church and embraced secularism, although it is notable that it is still the case in both places that more children live in married couples than in common-law couples. The proportion of children in single-parent families in France is 22.6 percent, only a little above that in Canada or the U.K.

In contrast, both Italy and Germany are more traditional, with 76 percent (Germany) and 77 percent (Italy) of children in married-couple families. In both countries, the proportion of children in common-law families is much lower than in France, the U.K., or Canada, although somewhat above the U.S. The proportion of children in single-parent families is much lower: around 15 percent for both countries, compared to over 20 percent for the other four countries.

Overall, when we look at other countries, Canada is on the low side when it comes to children in married-couple families, largely owing to the popularity of common law relationships in Quebec. However, the proportion of children in single-parent families is about average, lower than in the U.S., about the same as in the U.K., and France, but higher than in Germany and Italy.

Key takeaways

Canadians have every reason to care about the kinds of families that children grow up in. As we saw in the introduction, children who grow up with both their original parents do better across a whole range of life outcomes. What we see in the data is a gradual erosion in the proportion of children who grow up in these kinds of families. In 2021, only 58 percent of children lived in intact married-couple families, and many of these children will see their parents split up before they attain adulthood themselves.

Looking across Canada, the traditional married couple family is, unsurprisingly, most prevalent in Alberta and least prevalent in Quebec, although the proportion of children in single-parent families is higher in several of the maritime provinces than in the other provinces, probably reflecting their more rural nature. The territories are somewhat apart, with a significantly higher proportion of children in single-parent families, and significantly fewer in married-couple households.

Internationally, Canada has somewhat fewer children in married-couple families than the other G7 countries for which we have data, but the proportion of children in single-parent families is in the middle of the pack.

Thus, while there is no reason to panic about the state of two-parent families in Canada, there is cause for concern. Simply increasing monetary benefits to children will fail to deal with many of the underlying drivers of poor outcomes for children, such as the absence of a paternal role model. Policymakers need to think about what policies can encourage families to stay together and so provide the best possible environment for children to thrive. That debate is now very active in the U.S., and we in Canada need to have our own debate if we truly want to improve life for Canada’s children.