For Mothers and Children: The Sheppard-Towner Act of 1921

Summary

In the Nineteenth century, industrialization, urbanization, and an influx of impoverished immigrants combined to create dangerous and unsanitary living conditions. By the early Twentieth century, forty percent of Americans were living in poverty and perspectives on public health began to change. The Progressive Movement opposed the traditional view of poverty as a vice and advocated working to improve the lives of the needy. Scientific advances led reformers to believe that professional health departments could reduce major health threats by educating the public about infectious disease and nutrition. They saw infant mortality as a strategic choice for securing government funding for public health programs. Childbirth was an emotional issue, as almost all American women had been personally affected by the death of a child. Reformers believed that helping mothers to better carry, bear, and rear healthy infants would decrease infant mortality.

As a result of intense lobbying by women's organizations, infant mortality became a matter of national concern. Cities, then states, established tax supported bureaus of child hygiene. In 1912, Congress created the Children's Bureau to report on all matters concerning children's welfare. Its first duty was to investigate infant mortality. The Bureau found a shockingly high rate of infant mortality, linked to poor housing and low income. Studies also showed that education and proper health care for mothers increased an infant's chance of survival. Volunteers worked with the Bureau to spread awareness and promote child welfare. Meanwhile, WWI had made apparent the importance of having a healthy and able-bodied population that could defend itself. The Children's Bureau took the opportunity to recommend that Congress provide the states with grants to develop programs that would combat infant and maternal mortality.

The first bill to use federal funds to protect mothers and infants was introduced in 1918 and was immediately met with great hostility. Detractors argued that it was socialistic, infringed on states' rights, and authorized the government to intrude into private matters. They claimed that women were better off using common sense. The American Medical Association also opposed the bill, claiming it promoted socialized medicine and gave power over health care to women who weren't doctors. Underlying the opposition was the fear that the proposal would lead to the end of the family as women would come to believe that the state, not their husbands, ought to take care of them.

Eventually, a heavily compromised version of the bill passed. The Sheppard-Towner Maternity and Infancy Protection Act of 1921 (the Act) granted federal matching funds to states for use in educating women about maternal and child hygiene. These funds could not be used for outright aid or medical care. States used the funds to research infant and maternal mortality, educate of mothers, train midwives and nurses, and investigate medical facilities. Infant mortality greatly decreased while the Act was in effect, but maternal mortality rates remained high, possibly because actual medical care was needed to save mothers and the Act didn't provide any funds for actual care. In 1929 the Act was automatically repealed. Federal care for mothers and children ceased until the 1935 Social Security Act, which provided only need-based aid and was limited to the poor.