JenWell
Holistic Well-Being

Strengthening Families

26 February 2026

Strengthening Families – The First Step
Susan Fouché
In the previous article, two foundational questions were explored: Where do we start? and Why do we need to strengthen families? The conclusion reached was that the starting point is the family itself. The Merriam-Webster Dictionary defines family as “the basic unit in society traditionally consisting of two parents rearing their children” or “any of various social units differing from but regarded as equivalent to the traditional family” (Merriam-Webster.com dictionary, n. d). As a “basic unit in society,” the family can also be understood as the smallest social group from which society is formed. If families are strengthened, society is strengthened. This raises the next critical question: What happens when we strengthen society?
Strengthening families is not merely a therapeutic or social welfare goal; it is a long-term societal investment. Strong families enhance resilience, reduce violence, and contribute to healthier, more connected communities. In the context of persistent adversity, the family remains one of the most powerful protective environments for South African children. Strengthening families therefore involves not only responding to existing harm, but also preventing adverse childhood experiences (ACEs) by building supportive environments in which children feel safe, connected, and valued (Mendes-Sousa et al, 2025). This work begins within the boundaries of the family. The caregiving capacity of families, functions as a critical protective factor: strong familial support can buffer children from psychological distress by providing emotional regulation, continuity of care, and safe spaces in which stress can be processed—protective functions that are compromised when families themselves are under strain (Mkhize et al, 2024). This article explores the first and most foundational step in strengthening families.
The First Chapter
In their book Tracing the Roots of Violence, Robin Karr-Morse and Meredith S. Wiley recount the story of a sixteen-year-old boy, Jeffrey, who was sentenced to death after he and his peers stole a car, robbed a convenience store, and murdered an elderly man in his home while under the influence of drugs. Jeffrey already had a juvenile criminal record at the time of the offense (Karr-Morse & Wiley, 1997). The authors observe that in cases such as Jeffrey’s, society often tells the whole story of a person’s life—except for the first chapter (Karr-Morse & Wiley, 1997).
According to Karr-Morse and Wiley (1997), this “first chapter” encompasses gestation, birth, and infancy. They argue that this period frequently goes unseen and unacknowledged, yet its effects reverberate throughout the individual’s life and, ultimately, within society itself. Hill Walker similarly notes that many offenders aged twelve years and younger display consistent early patterns of aggression, bullying, tantrums, and coercive interactions with others, suggesting that problematic behavioural trajectories are often established early in life (Walker, 1996 as cited by Karr-Morse & Wiley, 1997).
Gestation, Birth, and Infancy
The human brain develops at its fastest rate from birth to approximately two years of age (Knickmeyer et al., 2008; Schneider et al., 2022; Karr-Morse & Wiley, 1997). During this period, the brain undergoes rapid growth and organisation, making it particularly sensitive to both protective and harmful influences. Prenatal exposure to illicit drugs has been associated with preterm birth, sustained newborn jitteriness, slowed fetal and postnatal somatic growth, delayed language development, impaired self-regulation, and poor sustained attention. Such exposure has also been linked to impairments in memory, verbal reasoning, and attention, as well as increased impulsivity, hyperactivity, and oppositional behaviours. Motor and cognitive impairments have likewise been documented. Prenatal exposure to alcohol and tobacco has been shown to result in similar developmental difficulties during childhood (Peterson et al, 2020).
Research further demonstrates that maternal stress during pregnancy can affect multiple domains of neurodevelopment, including cognitive development, motor development, behaviour, temperament, memory, and learning (Matas-Blanco & Caparrós-González, 2020). Several investigators highlight that maternal stress during the first half of gestation plays a particularly important role in increasing the risk of cognitive developmental alterations. Maternal stress has also been associated with behavioural difficulties during both childhood and adolescence (Matas-Blanco & Caparrós-González, 2020). In addition, prolonged exposure of the foetus to elevated levels of glucocorticoids—particularly during the third trimester—has been linked to later learning problems. These outcomes are thought to be related to altered hippocampal development due to cortisol excess and may become evident between two and five years of age (Matas-Blanco & Caparrós-González, 2020).
Exposure to intimate partner violence (IPV) during pregnancy represents another significant risk factor. Adverse effects on fetal health can include low birth weight, preterm birth, fetal injury, and even fetal death. Children born to mothers who experience IPV during pregnancy may also face long-term consequences, including developmental delays, behavioural problems, and chronic health conditions (Agarwal et al, 2023). Behavioural and emotional difficulties—such as anxiety, depression, aggression, and antisocial behaviour—have been observed among children exposed to IPV during pregnancy, with these challenges often persisting into adolescence and adulthood and affecting school performance, employment, and social relationships (Agarwal et al, 2023). Cognitive delays have likewise been reported in this population (Agarwal et al, 2023).
Support for a biosocial perspective is further illustrated in a study conducted with Danish participants, which examined the interaction between biological and social risk factors (Raine et al, 1997).  This research tested the hypothesis that birth complications, when combined with early maternal rejection, increase the likelihood of adult violent offending (Raine et al, 1997).  The findings demonstrated a highly significant interaction: individuals who experienced both birth complications and early maternal rejection were most likely to engage in violent crime in adulthood (Raine et al, 1997).
Conclusion
Taken together, these findings underscore the profound importance of the earliest stages of life in shaping later developmental outcomes. Gestation, birth, and infancy constitute a critical foundation upon which emotional regulation, cognitive capacity, and behavioural patterns are built. The evidence presented highlights that biological vulnerabilities, when combined with adverse caregiving environments, can significantly increase the risk of later behavioural and social difficulties. Conversely, protective relational experiences during this period can mitigate risk and promote resilience.
Karr-Morse and Wiley (1997) emphasise that the interactive process most protective against later violent behaviour occurs within the first year of life, during which a secure attachment relationship with a primary caregiver is established. Through this relationship, the infant develops the capacity for higher cognitive processing, emotional regulation, and social engagement—capacities that form the foundation for mitigating later aggression (Karr-Morse & Wiley, 1997).
Strengthening families, therefore, begins with recognising and supporting this first chapter of life. Investment in maternal well-being, safe and supportive caregiving environments, and early relational security is not only an intervention for individual families, but a preventative strategy for society at large. By prioritising gestation, birth, and infancy within family-strengthening initiatives, we address the roots of later violence, distress, and dysfunction. In doing so, we lay the groundwork for healthier families, more resilient children, and, ultimately, a stronger and more cohesive society.
Bibliography
References
Agarwal, S., Prasad, R., Mantri, S., Chandrakar, R., Gupta, S., Babhulkar, V., Srivastav, S., Jaiswal, S., & Wanjar, M. B. (2023). A comprehensive review of intimate partner violence during pregnancy and its adverse effects on maternal and fetal health. Cureus, 15(5), e39262. https://doi.org/10.7759/cureus.39262
Karr-Morse, R., & Wiley, M. S. (1997). Ghosts from the nursery: Tracing the roots of violence. Atlantic Monthly Press.
Knickmeyer, C. R., Gouttard, S., Kang, C., Evans, D., Wilber, K., Smith, J. K., Hamer, R. M., Lin, W., Gerig, G., & Gilmore, J. H. (2008). A structural MRI study of human brain development from birth to 2 years. The Journal of Neuroscience, 28(47), 12176–12182.
Matas-Blanco, C., & Caparros-Gonzalez, R. A. (2020). Influence of maternal stress during pregnancy on child’s neurodevelopment. Psych, 2, 186–197. https://doi.org/10.3390/psych2040016
Mendes-Sousa, M. M., Perrone, M. B., de Melo, R. B., Ribeiro, M. V. V., Chao, Q., Torres, C., et al. (2025). The impact of family stress and resilience on child development: A scoping review. Trends in Psychiatry and Psychotherapy, 47, e20220556. https://doi.org/10.47626/2237-6089-2022-0556
Merriam-Webster. (n.d.). Family. In Merriam-Webster.com dictionary. Retrieved February 9, 2026, from https://www.merriam-webster.com/dictionary/family
Mkhize, M., Van der Westhuizen, C., & Sorsdahl, K. (2024). Prevalence and factors associated with depression and anxiety among young school-going adolescents in the Western Cape Province of South Africa. Comprehensive Psychiatry, 131, 152469. https://doi.org/10.1016/j.comppsych.2024.152469
Peterson, B. S., Rosen, T., & Dingman, S. (2020). Associations of maternal prenatal drug abuse with measures of newborn brain structure, tissue organization, and metabolite concentrations. JAMA Pediatrics, 174(9), 831–842. https://doi.org/10.1001/jamapediatrics.2020.1622
Raine, A., Brennan, P., & Mednick, S. A. (1997). Interaction between birth complications and early maternal rejection in predisposing individuals to adult violence: Specificity to serious, early-onset violence. American Journal of Psychiatry, 154(9), 1265–1271. https://doi.org/10.1176/ajp.154.9.1265


26 February 2026

Strengthening Families – Where Do We Start? 
Susan Fouché
By adolescence, a significant proportion of South African children have already been exposed to multiple forms of victimisation. Findings from the Optimus Study highlight alarmingly high levels of violence experienced by young people aged 15–17, including exposure to family violence, theft, robbery, bullying, threats, and physical attacks—often occurring within spaces that should provide safety and care. Nearly a quarter of young people reported exposure to violence in the home, while many experienced persistent bullying, threats, or direct physical assault. These patterns are gendered: girls are disproportionately affected by abuse, neglect, and bullying, while boys are more likely to experience other forms of violence.
The consequences of such early and repeated exposure to violence are severe and long-lasting. Children who experience abuse or chronic victimisation are more likely to engage in risky sexual behaviour and substance misuse, and to develop mental and physical health problems. These difficulties undermine academic success, future employment, and the ability to maintain healthy relationships. Beyond individual harm, the cumulative impact places a significant burden on national development through increased healthcare costs, social service demands, and lost economic productivity. Strengthening families is therefore not only a child protection priority but a critical strategy for promoting social well-being and sustainable development in South Africa (Burton et al, 2015).
My interest in this topic was deepened when I encountered the Strengthening Families Program developed by Dr Karol Kumpfer and accessed its freely available Handouts and Worksheets. As a foster parent since 2008, founder of a small non-profit organisation supporting children in the foster care system, and a recently qualified social worker, I have witnessed firsthand the pressures faced by South African families. In this series of articles, I explore the strengthening of families through a combination of evidence-based research, programme insights, and professional experience.
Two foundational questions guide this discussion: Where do we start? and Why do we need to strengthen families? Evidence suggests that the answer lies in rising levels of child and youth distress, alongside weakening family environments shaped by broader social, economic, and cultural forces (Institute for American Values et al, 2003).  Today I will unpack a few of the reasons why we need to strengthen families.
1. Rising Mental and Behavioural Health Challenges
Vulnerable social environments, including poverty and housing insecurity, are closely linked to child mental health difficulties (Mendes-Sousa et al, 2025). UNICEF reports high levels of emotional distress among South African adolescents: 24 % of learners in Grades 8–11 reported feelings of depression, hopelessness, and sadness, while 21 % reported having attempted suicide at least once. A Cape Town study cited in this analysis found that 41 % of adolescents experienced depression, 21 % post-traumatic stress disorder, and 16 % anxiety (UNICEF, 2024).
These findings are supported by Mkhize et al (2024), who found that 33.5 % of school-going adolescents aged 10–14 in the Western Cape reported symptoms of depression, while 20.9 % reported anxiety. Parental mental health plays a significant role in these outcomes. A review by Mendes-Sousa et al (2025) found that over 43 % of the studies they reviewed reported associations between parental depression—particularly maternal depression—and child internalising symptoms, behavioural problems, and developmental delays. Depressive symptoms can reduce caregivers’ emotional availability, responsiveness, and consistency, all of which are critical for healthy child development.
2. Socio-Economic Stressors and Family Functioning
Poverty, unemployment, and inequality remain pervasive in South Africa and profoundly affect family functioning. Children raised in environments characterised by material hardship and community danger are at increased risk for emotional and behavioural problems (Daines et al, 2021). Poverty amplifies parental stress and restricts access to essential resources such as healthcare, nutritious food, safe housing, and quality education.
The first multidimensional child poverty study conducted by Statistics South Africa and UNICEF found that 62 % of South African children are multidimensionally poor, with severe deprivation concentrated in rural areas, female-headed households, and larger families (UNICEF, 2020). These persistent stressors strain caregiving capacity and weaken emotional bonds within families.
3. Adverse Childhood Experiences and Cumulative Risk
According to the Optimus Study, one-third of South African children experience abuse before the age of 18, often repeatedly rather than as isolated incidents (UNICEF, 2020). Exposure to Adverse Childhood Experiences (ACEs)—including abuse, neglect, household dysfunction, and violence—has cumulative negative effects on mental and physical health across the life course.
Attachment research shows that early caregiving relationships are central to emotional regulation, self-control, and social functioning. Insecure attachment patterns are associated with increased emotional and behavioural difficulties (NICE, 2024). A large cohort study using twin data demonstrated that the association between ACEs and adult mental health outcomes persists even after controlling for shared genetic and environmental factors, highlighting the importance of early prevention and family-wide interventions (Daníelsdóttir et al, 2024).
4. Declining Quality of Parent–Child Interactions
Modern economic demands often reduce opportunities for meaningful parent–child interaction. Work pressures, transport challenges, and financial stress limit quality time and emotional availability. Poor marital relationships, alcohol misuse, and parental mental health difficulties further disrupt parent–child interactions and contribute to children’s emotional distress (Mendes-Sousa et al, 2025; Tan et al, 2024).
Emerging research also highlights the impact of “phubbing”—parents’ excessive attention to mobile devices—on child emotional well-being. Maternal phone use during interactions has been associated with weaker attachment bonds, emotional regulation difficulties, and behavioural problems in children (Lv et al, 2022).
5. Family Fragmentation
Family fragmentation remains widespread in South Africa. In 2008, only 35 % of children lived with both biological parents, while 40 % lived with their mother only. The majority of children living with neither parent still had at least one living parent (Budlender & Lund, 2011). Research shows that fragmented and high-conflict home environments are associated with increased child stress, poorer socio-emotional development, and long-term mental health risks (Mendes-Sousa et al, 2025).
6. Parenting Knowledge and Skills Gaps
Gaps in parenting knowledge and skills—such as inconsistent discipline, limited understanding of child development, and poor emotional communication—are strongly associated with child internalising and externalising problems (Mendes-Sousa et al, 2025). The National Academies of Sciences, Engineering and Medicine (2016) report that parenting knowledge related to warmth, routines, responsive caregiving, and appropriate discipline is linked to positive child outcomes across multiple domains.
Parents consistently report that participation in parenting programmes improves their skills, understanding of child behaviour, relationship quality, and personal well-being (Butler et al, 2019). Conversely, low parenting self-efficacy contributes to stress and burnout, which negatively affect parent–child relationships and child well-being (Aktu, 2024).
7. Social Support and Community Connections
Families do not function in isolation. Social support from extended family, schools, community organisations, and social services strengthens resilience and buffers stress (Lutya, 2012). In South Africa’s context of historical disruption, migration, and inequality, rebuilding community-based support systems is essential. Youth aged 12–22 remain both the most frequent victims and perpetrators of violence, underscoring the need for preventive, family-centred interventions (Jantjies & Popovac, 2011).
8. Conclusion
The evidence is clear: strengthening families is a foundational strategy for improving child and adolescent mental health, preventing behavioural problems, and promoting long-term social stability. Effective interventions must be multidimensional—addressing economic stress, parenting skills, mental health, social support, and community cohesion.
Strengthening families is not merely a therapeutic goal; it is a societal investment that enhances resilience, reduces violence, and supports healthier, more connected communities. In the face of persistent adversity, the family remains one of the most powerful protective environments for South African children.  Strengthening families means not only responding to existing harm but also preventing ACEs by building supportive environments where children feel safe, connected, and valued (Mendes-Sousa et al, 2025).  This should start within the family boundaries. The caregiving capacity of families is a critical protective factor. Strong familial support can buffer children from psychological distress by providing emotional regulation, continuity of care, and safe spaces for processing stress — all of which are compromised when families struggle (Mkhize et al, 2024).
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