Women at Work

The Fight for Children

Women's advocacy groups have been a powerful lobbying force through out history. They pressured Congress to enact legislation to regulate the working hours of women and children . Many created their own programs in American cities. In Baltimore, Maryland, during the 1920s, women's clubs and city associations focused on improving health conditions at work and on restricting child labor. Eliza Ridgely started the Children's Playground Association to keep Baltimore children off the streets and the Arundel Good Government Club, a powerful women's group, advocated child welfare legislation and spoke out against children working in nearby coal mines.

In 1907, Congress authorized the investigation of child and female labor practices. As a result of the preliminary findings of this study, President Theodore Roosevelt assembled the First White House Conference on Children in 1909. This conference called for the development of a Children's Bureau and in 1912, President William Howard Taft appointed Julia C. Lathrop, who had been working with Jane Addams at Hull House in Chicago, to head the new Bureau. These were exuberant times for women's groups who heralded the appointment of Lathrop as the first woman to head a Federal statutory agency (U.S. Department of Health, 1976).

The Children's Bureau understood child health to include not only biology but also the many components of the child's social environment. The first mandates of the new Children's Bureau were to study: all matters pertaining to the welfare of children and child life among all classes of our people, and shall especially investigate the questions of infant mortality, the birth rate, orphanage, juvenile courts, desertions, dangerous occupations, accidents and diseases of children, employment, legislation affecting children in the several States and Territories (U.S. Government, 1912).

By 1920, the Bureau had completed 11 studies on infant mortality and had expanded its campaign to register all births. The Children's Bureau reported in 1915 that more than 3,000 women volunteers had worked on door-to-door birth registration campaigns and had lobbied legislatures to pass compulsory birth registration laws. By 1921, the Bureau of the Census had established a birth registration area covering 27 states. In addition, the Children's Bureau published such important lay pamphlets as Infant Care in 1914, which became the government's all-time bestseller.

A Children's Bureau infant mortality study fielded in Baltimore revealed that the death rate for black babies was more than double that of white babies (219 per 1,000 versus 104 per 1,000). Using the presence of a bathtub as an index of socioeconomic status, the Children's Bureau learned that houses with bathtubs had an infant mortality rate of 72.6 per 1,000. Bureau research continued to replicate a correlation between family income and infant mortality: as income doubled, the infant mortality rate fell by 50%. Lathrop concluded that high infant mortality among the urban poor was not because parents were "hopelessly stupid, or incorrigibly lazy;" instead, she explained that "poverty takes away the defenses by which the effects of ignorance may be evaded".

During World War I, the Children's Bureau led an international effort to prevent infant mortality. The Bureau sent staff volunteers to work with the American Red Cross. Julia Lathrop and Grace Abbott (Children's Bureau chief from 1921-1934) visited France, England, and Belgium to study the effects of the first World War on European children. Partly as a result of these international connections, the Second White House Conference on Children, held in May 1919, included participants from Belgium, France, Great Britain, Japan, and Serbia. In her study of the formation of the Children's Bureau, Lindenmeyer concludes that by 1930, the Children's Bureau was understood to be a world leader in the child welfare movement.

Using the momentum and political capital accumulated during the war years, Lathrop began to formulate the National Maternity and Infancy Act, commonly referred to as the Sheppard-Towner Act. Her plan, released in the Children's Bureau's 1917 annual report, called for a national effort modeled on Dr. S. Josephine Baker's program in New York City, which used nurse home visitors, improved health care access for mothers, and routine physical examinations of young children. In January of 1919, Jeannette Rankin, the first woman elected to the U.S. Congress, introduced H.R. 12634, a "Bill to Encourage Instruction in the Hygiene of Maternity and Infancy". During 1919, two similar bills were introduced in the Senate, one by Senator Morris Sheppard. In December of 1919, Horace Mann Towner of Iowa introduced H.R. 10925. Children's Bureau staff, Medical Women's National Association and women's movement advocates joined the fight to pass the Sheppard-Towner legislation. Upon taking office in 1921, a new President, Warren Harding, pitched Sheppard-Towner to Congress, and the Act was passed in April of that year (U.S. Congress, 1921).

Through the Sheppard-Towner Act, Federal funds were matched by state funds and used to establish maternal and child health services in each state. Dr, Martha May Eliot has argued that the primary effect of the Sheppard-Towner Act was educational, supporting "employment of full-time or part-time physicians and public health nurses by State and local public health agencies to conduct prenatal and infant care conferences in smaller cities and towns...issuance to physicians of standards of infant care and of good prental, delivery, and postnatal care for mothers; systematic effort to teach a few principles of good maternity care to the large number of untrained midwives...".

Although many histories record that the Sheppard-Towner Act simply faded from the national agenda and was not renewed due to a lack of interest, Eliot and others remember it differently:

[Sheppard-Towner] was killed, in Congress. Thanks to a number of organizations, conservative political groups, and primarily the American Medical Association and the Catholic Church, that had not liked it at all, even from the beginning. This was the first time federal money was used for social welfare. In spite of the 4 million expectant mothers and infants reached by this bill, these organizations opposed anything resembling "communism". They felt that it was the first step toward socialized medicine, as they called it. And the government would sooner or later take over all of medical care, which of course was...their nightmare. The bill lapsed in 1929.

To show support for the Act, some prominent members of the AMA Section on Pediatrics resigned and formed the American Academy of Pediatrics (AAP). Although Congress did not renew Sheppard-Towner for funding in 1929, this legislative experiment laid the groundwork for a much larger movement: the Social Security Act of 1935.

Sheppard-Towner can be thought of as a legislative link between the military pensions of the Civil War and the future funds appropriated for maternal and child health. The Federal government had admitted responsibility for, and specifically demonstrated a commitment to, promoting the welfare of the nation's children. The 1930 White House Conference on Child Health and Protection recommended a revival of the Sheppard-Towner Act and endorsed the system of grants-in-aid to states. This conference confirmed the benefits of Federal-state cooperation: the grant-in-aid approach could positively affect a large population of children by providing funding for a wide range of programs and services.

In the 1930s, the "women of the Children's Bureau";Grace Abbott, Katherine Lenroot, and Martha May Eliot, recommended three new programs to Franklin Roosevelt's administration, all intended to promote "security ... [for] the whole child". The three programs included a prototype aid-to-dependent children plan; a program to help children with special needs, including abused or neglected children; and a reconstruction of the Sheppard-Towner Act. The Abbot-Lenroot-Eliot troika devised this last portion of the plan to re-build and improve upon state health programs for children. Eliot included in the program children up to 21 years of age. She recalls that Abbot found this all "a little overwhelming, but I being very young and naive, thought 'why not?' and [Abbot] agreed that we would title our proposal 'Maternal and Child Health' instead of maternal and infant care" (Schlesinger Rockefeller Oral History Project, 1973-1974, p. 46).

The efforts of these three women to include child health provisions into the Social Security Act of 1935 were largely successful, although the Children's Bureau was not given authority to administer the aid-to-dependent children program and a proposal for compulsory health insurance was dropped as it was considered to be too radical. Because of their forward looking proposals, the Children's Bureau was able to continue its work with a new and strengthened authority.

Over the next decade, the Federal commitment to maternal and child health services rapidly increased in response to organized efforts on behalf of women and children. In 1938, the Children's Bureau called the Conference on Better Care for Mothers and Babies and a report issued by the U.S. Interdepartmental Committee to Coordinate Health and Welfare Activities reflected the concerns of this conference. As a result, Title V appropriations increased from $8 million in 1935 to $11 million in 1939. Under the new guidelines, non-matching funds were reserved for special projects, including training grants to institutions of higher learning for specialized instruction of nurse midwives, social workers, physicians, and public health officers.

Meanwhile, in 1943, Congress increased Children's Bureau funding to help states continue maternity services for wives of military men. This landmark, the Emergency Maternity and Infant Care (EMIC) program, emphasized quality gynecologic, obstectric, and pediatric care and raised the standards of maternity and newborn services in American hospitals (U.S. Department of Health, 1976). From 1943 to 1948, EMIC offered maternity and infant care to the wives and children of the four lowest pay grades of servicemen. These families received prenatal care, delivery, and six-weeks postpartum care. Infants received complete medical care for their first year of life.

The success of EMIC led to another increase in Children's Bureau funding in 1946. Title V funds, including those for training grants,increased to $22 million. It was this 1946 appropriation which prompted public health institutions to establish separate maternal and child health training programs through Children's Bureau grants. The Department of Public Health Administration in the Johns Hopkins School of Hygiene and Public Health was one of the first to receive such a grant and in October of 1947, the Division of Maternal and Child Health was officially established under the leadership of Paul Harper.

Eight other schools of public health received Children's Bureau training grants over the next decade. The Bureau's efforts to establish academic maternal and child health programs are evidenced in their 1950 Conference on Evaluative Studies Related to Maternal and Child Health and Crippled Children's Programs. This conference encouraged research and the evaluation of existing programs. The Children's Bureau no longer functioned as the source of studies; instead, it provided initiative to academic institutions to take up their own research. As Bierman observed, the Children's Bureau had evolved from the agency of inquiry it was in its formative years to one of advocacy (1966). Bureau grants stimulated the structure of faculty at academic institutions and secured an alliance between community practice and academic maternal and child health programs.

During the 1960s, Title V of the Social Security Act was amended once more to give a broader definition of health for mothers and children. In 1962, Harper spoke before Congress as an APHA representative to recommend that the Public Assistance Act be amended to include children with handicapping conditions and to allow for additional grants-in-aid to low-income mothers. Harper stressed the importance of prenatal care for the prevention of infant mortality and mental retardation. In 1963, Congress approved these Special Project grants for maternity and infant care.

Throughout the 1960s, Federal activity in education, health, and social welfare continued to increase. President John F. Kennedy was influential in his support of programs for children with mental retardation and other handicaps. In 1965, President Lyndon B. Johnson signed an unprecedented series of laws designed to help fight the War on Poverty: Medicare was enacted to provide universal health care to the elderly and, almost as a footnote, Congress funded Medicaid to provide health insurance to low-income women and children; amendments to Title V established Children and Youth projects; the first Neighborhood Health Center grant was awarded; and Head Start held its first 8-week summer session.

Hutchins has noted that as early as the 1930s, efforts were made by opposition groups to move the Children's Bureau from its position of high visibility. In 1946, the Bureau was transferred to the Social Security Administration (SSA), and placed in a position a full two levels lower in governmental hierarchy. In 1963, the Bureau was moved from SSA to the Welfare Administration within the Department of Health, Education and Welfare.

In 1969, Children's Bureau functions were transferred to the Maternal and Child Health Service within the Bureau of Community Health Service Administration. The 1970s would present new challenges both in the types of maternal and child health programs run in states and schools of public health, and in the methods used to obtaining Federal funding.

Today, the Children's Bureau is one of four bureaus within the Administration on Children, Youth and Families (ACYF). ACYF is, in turn, administered within the Administration for Children and Families (ACF). The Children's Bureau provides grants to states, tribes, and communities to fund child protective services, family preservation and support, foster care, adoption, and independent living programs for children and youth. It is the Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration, that is in many respects, the true successor agency to the original Children's Bureau. With the stated mission to "promote and improve the health of our Nation's mothers and children," MCHB is the arbiter of Title V funds to states and tribes and it continues to give training grants to schools of public health, including Johns Hopkins (MCHB, 1997). In 1997, MCHB had a total budget of $825 million to fund such programs as the Healthy Start Initiative, the Emergency Medical Services for Children Program, and the Ryan White CARE Act to fund HIV services and research.