CINXE.COM

<!DOCTYPE html><html lang="en-US"><head><title>Just a moment...</title><meta http-equiv="Content-Type" content="text/html; charset=UTF-8"><meta http-equiv="X-UA-Compatible" content="IE=Edge"><meta name="robots" content="noindex,nofollow"><meta name="viewport" content="width=device-width,initial-scale=1"><style>*{box-sizing:border-box;margin:0;padding:0}html{line-height:1.15;-webkit-text-size-adjust:100%;color:#313131;font-family:system-ui,-apple-system,BlinkMacSystemFont,Segoe UI,Roboto,Helvetica Neue,Arial,Noto Sans,sans-serif,Apple Color Emoji,Segoe UI Emoji,Segoe UI Symbol,Noto Color Emoji}body{display:flex;flex-direction:column;height:100vh;min-height:100vh}.main-content{margin:8rem auto;max-width:60rem;padding-left:1.5rem}@media (width <= 720px){.main-content{margin-top:4rem}}.h2{font-size:1.5rem;font-weight:500;line-height:2.25rem}@media (width <= 720px){.h2{font-size:1.25rem;line-height:1.5rem}}#challenge-error-text{background-image:url(data:image/svg+xml;base64,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);background-repeat:no-repeat;background-size:contain;padding-left:34px}@media (prefers-color-scheme:dark){body{background-color:#222;color:#d9d9d9}}</style><meta http-equiv="refresh" content="390"></head><body class="no-js"><div class="main-wrapper" role="main"><div class="main-content"><noscript><div class="h2"><span id="challenge-error-text">Enable JavaScript and cookies to continue</span></div></noscript></div></div><script>(function(){window._cf_chl_opt={cvId: '3',cZone: "publications.aap.org",cType: 'managed',cRay: '9177d646592540bf',cH: 'uKDO73QSrOCtnmx.ZA8YXBKOJN8772N5EyZrfKUVXIs-1740487993-1.2.1.1-jvU4VdfvKZiCPHXODMMoRqzbl2brOcQ6sxu7Hz3Q5R99qPNk051OCET9A8M1gWUK',cUPMDTk: "\/pediatrics\/article\/118\/1\/349\/69577\/The-Effects-of-Marriage-Civil-Union-and-Domestic?__cf_chl_tk=U_Tn2nBTU9dqTT12bSZLAiX5QUsWr5PO_t_i9gfPp8A-1740487993-1.0.1.1-YeZezHNV3WnmruPDuMx923W6yNYS2Na9fo5qbXmvZFw",cFPWv: 'b',cITimeS: '1740487993',cTTimeMs: '1000',cMTimeMs: '390000',cTplC: 0,cTplV: 5,cTplB: 'cf',cK: "",fa: "\/pediatrics\/article\/118\/1\/349\/69577\/The-Effects-of-Marriage-Civil-Union-and-Domestic?__cf_chl_f_tk=U_Tn2nBTU9dqTT12bSZLAiX5QUsWr5PO_t_i9gfPp8A-1740487993-1.0.1.1-YeZezHNV3WnmruPDuMx923W6yNYS2Na9fo5qbXmvZFw",md: "tJ4_fb4guPkC.QAHNLtyaTXOVE_7DMHEvsKCUBSZRwA-1740487993-1.2.1.1-L0LAaoJaBITocJrdVSGKRFbPj2noKvzXIv.kVXhQjfBgOCrDjRqjqYdITH.PAXs3Cxk0PdTSxCiJvFyoFOtHpu36vxd0u5EnKiX0PuC_PvfTVKslVPazEMoDsKU5M5_A_X7say6iBCYuOlE6NCImxjvOjou72GKmh7.s8n7qhy.yRgsgyRKU4JtRXNfoa.PPKMoEGaKwPbyg.6vaBoZnqgpSf1nzSWzt_dD1rl0g_CndiOHNJTs2xQ7mor9PGfnUqk9f3a3BVW6iK0BX2O1xhDg_vzZTwoSwLGxc9kF3rGYrOGZrkdQTBoD8Bw53XC2XEg6VofKOhRjuPCTHrkyMqtoGX2U1BwYkAZd_8NDOcZQF4Ksoyr4iUv_1QyHoO8a7qe6BIf5GpmXSzQ7YTNm4JkoHd0xWa5GAi.n3TxOBRQ7iwMsR9682OHY9c1dyQ0WB8fuZjXnCY_rFB9jxgE60YpesJTiSQ4rFhE7UmHVrwolFyedCaRZbTAHIWjwpYlh6hP1RkA6LCqCsgncLKD1nPuG_OsCGHBlgAFZep3j2Bv80tce9COJgLjAMW0jJ4EEL9Xw4Q_L7I15F_Zp0jhOQr9zuyvj4CzlV5PTNC51ZHLIOm3rlhxNSAoziVVtXVlwO2keyY0dthWywBfHOG7KtAhRuItJiEon7rcEtcoChAdOA5oJpgtt3DrWzmbsi3ZLGI2opuzwyQgBhBgqMeVipjCSXjYjmJaXlxGz881iG6_9dgA7ACZE2lR7qmHUxuh0t5FeCwT7qr8_.FKWnpsvJoq3hARayPJJFaBpvZQg3zdsVUybc9huSC4uqIXRAPrU4BHG_AewVarhuOJxeClMwz8E61qo1t7057DiOkWpjRgpOvKJQ4gXGxTlbiRv161n79amv9RYDzG90W9U3tS7dqgzsi_Nc0DhR11yHg6eQ_.XOcVz4SiqD6RdNvHuMeLJU7YrMygV5PtP0beSKPvkAog9euXmzBzw5kzJndHH2HT3BXkISm81gEXxIFJ9rTlxLHPAdS7JjI_iQ8lVVeMXbVGtSsWYbfTZMtEsUIOT7PszRMsKsuGZQqOn5EV6tKc5KPp3w6ZLG1ZMkyt9qmiOlJ4EsBp1x7wPG1Yt1UYiOTfngd8MJfJKyn67TAyewFIrEhhmSn9nayVP4ZE4PZ_B4vRJLUIENgOC0cJnU8Jinm_Rg6LAAuLIKHvkdYMMKmiRTqLwk3DmWp1dtH.oi.YXxS7nynsrt3XhYCNDtMMX79Od6QFuIi5adtoNtnIMBbFC_O.Z6v5RdrjfakowUp83Pp5NnZ945bpWB2ZxA9sb7yanx7GCxgAz_BuLFP3j9UzEmiRgVnlZfTQHx7QW3CNa2oP72yd6bryiFEK5fQKlzWWvtjJddDSnAhDYPgoEK6P52kE.ryoATzlRKMS9M5Boy.6Bn2y3QNBIkCzrO8Bu6j_enSMbbvXs.6Q2ks96iIzM7iTPI0SSF2pUBaM6r3JTnTKL.21DjQ19v.HJs4l028Dp4x6dOaJ4gHYAEDheYaaPIvygONgpllct4WdmphRyn3GSKVs8Dn.b.PjfgwC1iRIcRmyYVYucbZDhfHIn3d98cTuwhepcDvKI2NTWjXEnpb4Eb6DvRdBGI_w19_mNb5Tn6cL_64_YuqNxtx9ajCnPikFEf6XqR6TnjWMizlLHks6o0j2D8tv.wUiT4uadBNNRmlwi17QfXBX679yEwW7MPqb0r9YQbwq5rMRrLktwbSWXrAJKhmfkwxDXPFUksk84L1cyOCtXjqNBAotr.OPS1TQ6kP.hIfEvtjnxCXBZOHTb20CzQt7M89XKMVnzUdhOj9iT3D9HtAP8qRtX__VVtkAD0dNCqh.egoXu2yzjRd0ei1UgPRlU4vN3pjaoHUgrsGcel6DIDkyxe9LKDCR9ItVQ0R90LwgQB63cJzZxC_cLWA5BzljO3SyCb6wcv1CU2LAf6RM7HHFoofEGH95kjXzrh2y9RJh3N05cZ8zXAr9o3KEueJ.ryCp8Fok_sF.RuvPGuYi5k_mb7BGvpWNcWk__kaMO7aYhDn1VAqexA8egnGViCwQ2fYQkgwgwsFFAJIlKofDVzIQTpn4ciclzIKLtvBWTwfir27uq3w3pqPSXKS9CcaRn6UveTow0MY2S9sXie_WTik7YOlNmKHDmyrTitm4RHNfvOZlAx1MBtU1YzgxmDpYBDGKzKCONjtjX9TUhN6E8RRSu3hQYxvn0oNI6nksDWtMFYac1uItNipTlcTfXg_z08XY6POL3jJKV2mrh.bo13njxuQqoQfaj3I.6_024tFkTrSkjSVgYJys7x8zu3slGhc293cyao4GCCQ.5vqctBVfjNqmOXvtBMkA7diyblR4xyAkpKIAZ6cooSHRYS_PGbMu5ogQUNxs2aKsU5xWcQXmQ6uzQDCnzVT4mVa4Uoza5V6cqxMn6_Wpg8KU02lovCNhsKjcKoYnKAVYyRa63AeMAmiD_RWuc_S_J9nqu85I6CP5FHpvwIfYOgjih.29nfiro4BGT2z4f6oKZLs9c9oylovCuZPYC_uIROnit4oIIImF5HvSZqZ.vsUmnUFAjbSYFemfIFPXeIzg9we7HDwyDVTFevxIZ6kmS6_2XRh4jIdPmICFbpbmhh6bGp2ZhDFq4vHaX7juXN0xPmETrqH7Ohcv.4RVx9HMvBLv1wv2En6R_gJLwoHkhWKeFz_C910sV4FDbeUyEMmnsD2dOjO_X9mNzFSvNg",mdrd: "QiFYcqCMdK17iUjd8Frl6U4EPUIPQaVuArRuTv4Ko2Y-1740487993-1.2.1.1-HqQOG4gxl4tMTYnbNOJVQWb5Ie61OXFgYAwJNdb0LHUpda4nFD3yj6jZYJHr3e7NYbnEB2RLlLi1k8I1FqObXlfCoqpTLHKzXDr4xu.grSP78F3iP7nqY2g5rKtf3duAUWtZ76zIjAjwT8inmv3iji.xk6GAf19avhUkyK1OEnCPQGJsTk7d4yANiB6YgjyJ0cZ4p4DTfeUmS3QwBAjOBEzto3XVPyO.uedysCaaCKRd28dVi.uN9m9NgrHqqUvhB33o8SdNC84Q9VK3miUUeJS0D.Bd1bS3.WdyavFS1wG61YqdtLvHukEv9O2apImdPaByoPcgpyq1DSdWVaSKEi8cvvEpuER_uYYFi4.L3qQ1WR5LMOH4UqctPsCqqMvJE0v8DGcJKRj2yRWM_cBbZpDLYU171636JsZft72TaTAlXZegCrCOd0acxn8Z3GmMJLgOUphdT9iK28aftcu8pQf4964784bemVfp6F1vkSQTGg9iWAkrbtB1nUr1yw6CQnnJHguGdTSG49.hqdbW1ZxoJsNQLBpXjgQkdXAAMEl5kDC5sZ41hyVuxyQA1seFOLe15GTduVVUvI.yZFjcrOI63BCqziIG4eOEnD.jIs7QWO0g6mMWo5WCMIMYrB3YBTRllR9T90qPvOMfPAqBZ35LcZp42.8clIzuiYERZwhOxydCF81wTicnQHX3oBJMOqAgFpfeztkZEyg_hupxJhhzSGbKF4Lq2GvCPRVd37tLVGvLDjESv.GBTM4yNhYRxe.jHttXe3oa5TNqnBOnPZIl8tvoDZKb13m9wF4EBkK_l7QTf39daJCbI8T.ar1ZndnuoWamA7a1ArNPrsY8euiGBWQzxu3SuB0_8N7R.rs7Q2FaGL6rWuji.H2yznnh2w8kju_Ikwx0KNGwYOYjXbofIoaq.bWmVcsdxAs4LwwIyD8dcj5lUoUaFx6TP.2IZSWtl8wnIneWRAKQt77P2TfjGSZMBdHuGSrmXP126Fgo10rn9LB2Wr6tIScdgqwua74fIa75zHAG8cf8hbfA4OmDMEM90OXa5MmEsIAnOVhkiYxPGmr2WWDuuBmum.z9eid2B7wW3d1xPxm7hzy0zUlkqow.g_TJSXgMHZS9o8ILm4Yrv18OJMld33TEAG672zZZLRjo19MXqS8BUA48kEqHN7HtZLn4lnvxYFrYEYxTMrEsLWBMurkGPEN3JGW1h1hZBqq1th0nlv4_27lqKwNvg4mb1eTz6lAd7PxVrVwORpU6uBAoGHulA5mrBh.jz_xeqOElMzwLqoVrA1MxHTBvzQepUMXgar9I2ysFmDNPSf6jjmVFuLFVPSJ9dWLe_IENgI1PZLVxeJPD9zBokIPEwC_Qr_mDCDp4S2WkSWYo2_3eMAYQTwXag2TxCS.txyDACswJHFP303sQFBoE8DZwET7Fpw7.B7KXOSfOMPatsyNQNSp4cOr8jld9xg9xKCyfHihGABrlF3Z1_9RILkmRxOzwv0JKhChyuVmU4ChNMZHBSw1Oho6.WyOBiwV23EzQ..uQFaFctAuhK59aHkLktkXejsN7BT7icAppHrtlkU_XrBT9NZ4yGHbh0bexRBl3H98DzhSCGvMxY7VspCrG0YE0B5yb2Tpl5NMuuApbyBZofMmJ4s66de5WDTzU.oIuC5_TGZv1tKVNeSxBhVHxiCo3lF7tXBFL5BGCynRbYH_v8SSdScYy0pKpNKwqEWui1Vr0kEL00lML9Dnq30.Sxv.paGdRHrYkrHmN3ycIoG7VKdaSWs9rm9IzvwuN8U978aMvJ6D1xWmy1iNYrUPefrD62IByoYHH3Bj.A5n7UTN__W3bdlR.uzsi_vPQlvhOwb3vIKuEuR.IgGn6LeVUxHKUWjwExQT0MtbRqlTGz_wXQnz3S5dBwknZ5qbNe93TPTaREn9F5bAbU7W8QRnmp3lZ7ZxA9NQm2yWfY_nX9hyQVy0I4EaNJL9ua.t3"};var cpo = document.createElement('script');cpo.src = '/cdn-cgi/challenge-platform/h/b/orchestrate/chl_page/v1?ray=9177d646592540bf';window._cf_chl_opt.cOgUHash = location.hash === '' && location.href.indexOf('#') !== -1 ? '#' : location.hash;window._cf_chl_opt.cOgUQuery = location.search === '' && location.href.slice(0, location.href.length - window._cf_chl_opt.cOgUHash.length).indexOf('?') !== -1 ? '?' : location.search;if (window.history && window.history.replaceState) {var ogU = location.pathname + window._cf_chl_opt.cOgUQuery + window._cf_chl_opt.cOgUHash;history.replaceState(null, null, "\/pediatrics\/article\/118\/1\/349\/69577\/The-Effects-of-Marriage-Civil-Union-and-Domestic?__cf_chl_rt_tk=U_Tn2nBTU9dqTT12bSZLAiX5QUsWr5PO_t_i9gfPp8A-1740487993-1.0.1.1-YeZezHNV3WnmruPDuMx923W6yNYS2Na9fo5qbXmvZFw" + window._cf_chl_opt.cOgUHash);cpo.onload = function() {history.replaceState(null, null, ogU);}}document.getElementsByTagName('head')[0].appendChild(cpo);}());</script></body></html>