Sheppard–Towner Act

The political and social organization and activism by women in the Progressive Era led to the establishment of the United States Children's Bureau in the Department of Labor. The bureau was staffed and run largely by white women professionals with backgrounds in medicine, social science, and the settlement movement.[6] Reports from the Children's Bureau that found 80% of all expectant mothers did not receive any advice or trained care.[7] The Bureau also investigated high rates of infant and maternal mortality rates. After examining 23,000 infants, they concluded that the infant mortality rate was 111.2 deaths per 1000 live births, which was higher than most other industrialized countries.[4]

The research by the Children's Bureau asserted that many infant deaths were preventable and attributed them to the lack of infant care knowledge. Women in rural areas, for example, had limited access to medical care and professional treatment. Less than half the women in a rural area in Wisconsin were attended to by doctors, and even then, the doctors sometimes arrived post-birth to cut the cord. The study also found a correlation between poverty and mortality rate. If a family earned less than $450 annually, one in six babies died within the first year; between $640 and $850, one in ten; over $1250, one in sixteen.[4]

The Children's Bureau allied with other women's groups like the Women's Joint Congressional Committee in the wake of the passage of the Nineteenth Amendment to advocate for an act to improve medical care for women and children. Their advocacy constitutes an example of maternalist reform on a federal level.[8]

Representative Horace Mann Towner (R-Iowa) and Senator Morris Sheppard (D-Texas) introduced the bill in 1920. It was modeled after a similar bill presented in the previous session by Representative Jeannette Pickering Rankin (R-Montana) and sponsored by Julia Lathrop, head of the Children's Bureau. The Senate passed the bill in December 1920 after debates about funding and administration. The House did not vote on the bill since the hearings were held at the end of December. Opposition to the bill included the anti-suffragist Women Patriot Corporation and the American Medical Association, who feared that government intervention would lead to non-medical provisions of medical services. However, the opposition was yet not as organized as the Women's Joint Congressional Committee, Children's Bureau, and other allies.[9] President Harding endorsed the bill in April 1921 and it was reintroduced to congress. The House passed the bill 279 to 39, and the Senate passed it 63 to 7.[4]

The act provided a guide to the instruction of hygiene of maternity and infancy care through: 1) public health nurses, visiting nurses, consultation centers, and childcare conferences; 2) the distribution of educational materials on prenatal care, and 3) the regulation and licensure of midwives.[9] Appropriation of $1,480,000 for fiscal year 1921–1922 and $1,240,000 for the next five years ending on June 30, 1927, were made for the act. Of the funds, $5000 would go to each state with a dollar for dollar matching up to an explicit cap determined by the state's population. Costs of administering the program would not exceed $50,000.[7] The program was administered by Children's Bureau, though the states could decide how to utilize the money themselves.[4]

The Sheppard–Towner Act led to the creation of 3,000 child and maternal health care centers, many of these in rural areas, during the eight years it was in effect.[7]

Cases brought to the Supreme Court claiming the act was unconstitutional were dismissed in 1923.[13] The act was due for renewal in 1926, but was met with more vocal, organized opposition than in 1921. The American Medical Association saw the act as a socialist threat to its professional autonomy and increased their lobbying efforts, despite the Pediatric Section of the AMA House of Delegates' endorsement of the act's renewal.[14] The rebuking of the Pediatric Section by the full House of Delegates led to the members of the Pediatric Section establishing the American Academy of Pediatrics.[15] In the Journal of the American Medical Association, members of the AMA also critiqued the role of lay women administrators in the Children's Bureau, arguing that the administration of mother and infant health policy should take place under the medical, predominantly male, leadership of the Public Health Service.[16]

Other opponents included the National Society of the Daughters of the American Revolution, which had supported the act in 1921, and the anti-suffragist Woman Patriot Publishing Company (formerly Woman Patriot Corporation), who accused the Sheppard-Towner bill of being a communist plot. In January 1927, a group of senators initiated a filibuster on the act, with Utah Senator William H. King arguing that the bill was championed by "neurotic women,...social workers who obtained pathological satisfaction in interfering with the affairs of other people,...and Bolsheviks who did not care for the family and its perpetuity.”[17]

As a compromise, the Sheppard–Towner Act was extended for another two years and expired on June 30, 1929. Women's groups unsuccessfully continued to organize and revive the act in the following years. Sheppard-Towner set the framework for the inclusion of substantial provisions for maternal and infant care in the Social Security Act of 1935.[5]

According to a 2021 study, the inability of the Sheppard–Towner Act to collect data from the states on the administration of the program contributed to its defeat.[3] The legacy of the program in the long-term was that administrators sought greater federal oversight over Title V of the Social Security Act, having learned the lessons of the Sheppard–Towner Act.[3]

• Carson, Thomas; Bonk, Mary, eds. (1999). "Sheppard-Towner Act". Gale encyclopedia of U.S. economic history, vol. 2. Detroit: Gale Cengage. p. 915. ISBN 978-0-7876-3888-7.
• Johnson, Kimberly S. (2007). "From healthy babies to the welfare state: the Sheppard-Towner Act of 1921". Governing the American state: Congress and the new federalism, 1877–1929. Princeton: Princeton University Press. pp. 136–155. ISBN 978-0-691-11974-8.
• Ladd-Taylor, Molly (1992). "Federal help for mothers: the rise and fall of the Sheppard-Towner Act in the 1920s". In Helly, Dorothy O.; Reverby, Susan M. (eds.). Gendered domains: rethinking public and private in women's history. Ithaca: Cornell University Press. pp. 217–227. ISBN 978-0-8014-2444-1.
• Ladd-Taylor, Molly (1994). "'We mothers are so glad the day has come': mothers' work and the Sheppard-Towner Act". Mother-work: women, child welfare, and the state, 1890–1930. Urbana: University of Illinois Press. pp. 167–196. ISBN 978-0-252-02044-5.
• Loudon, Irvine (1992). "The geography and politics of maternal care in the USA: introduction". Death in childbirth: an international study of maternal care and maternal mortality, 1800–1950. Oxford: Clarendon Press. pp. 274–280. ISBN 978-0-19-822997-1.
• Meckel, Richard (1990). Save the Babies: American Public Health Reform and the Prevention of Infant Mortality. Baltimore: Johns Hopkins University Press. pp. 200–219.
• Skocpol, Theda (1992). "Statebuilding for mothers and babies: the Children's Bureau and the Sheppard-Towner Act". Protecting soldiers and mothers: the political origins of social policy in the United States. Cambridge, Mass.: Belknap Press of Harvard University Press. pp. 480–524. ISBN 978-0-674-71765-7.
• U.S. Congress (1921). Protection of maternity: hearing before the Committee on Education and Labor, U.S. Senate, 67th Congress, 1st session, on S.1039, a bill for the public protection of maternity and infancy, on April 25, 1921. Washington, D.C.: U.S. G.P.O. OCLC 40658009.
• U.S. Congress (1921). Public protection of maternity and infancy: hearings before the Committee on Interstate and Foreign Commerce, U.S. House of Representatives, 67th Congress, 1st session, on H.R. 2366, on July 12, 13, 14, 15, 16, 18, 19, 20, 21, 22, and 23, 1921. Washington, D.C.: U.S. G.P.O. OCLC 13768477.
• Wertz, Richard W.; Wertz, Dorothy C. (1989). "Government involvement". Lying-in: a history of childbirth in America (expanded ed.). New Haven: Yale University Press. pp. 201–233. ISBN 978-0-300-04088-3.