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The Sheppard-Towner Act

Pioneering Public Health Legislation for Maternity and Infancy Care in Early 20th Century America.

Act Overview 👇 Key Impacts 📈

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Act Overview

Legislative Landmark

The Promotion of the Welfare and Hygiene of Maternity and Infancy Act, widely recognized as the Sheppard-Towner Act, was a pivotal piece of U.S. legislation enacted in 1921. It established the first federal funding program dedicated to improving maternity and childcare services across the nation.

Enactment and Duration

Sponsored by Senator Morris Sheppard and Representative Horace Mann Towner, the Act was signed into law by President Warren G. Harding on November 23, 1921. This significant federal initiative remained in effect for eight years, concluding on June 30, 1929.

Social Security Precursor

The Sheppard-Towner Act represented the federal government's initial foray into social security legislation. Its passage was notably influenced by the burgeoning political and economic power of women's organizations following the ratification of the Nineteenth Amendment, demonstrating a significant shift in policy advocacy.

Historical Context

The Children's Bureau Initiative

The groundwork for the Act was laid by the U.S. Children's Bureau, established in the Department of Labor. Staffed primarily by women professionals in medicine and social sciences, the Bureau's research highlighted alarming rates of infant and maternal mortality. Their findings indicated that a substantial majority of expectant mothers lacked access to professional medical advice or trained care, particularly in rural areas.

Mortality and Socioeconomic Factors

Bureau investigations revealed a stark correlation between socioeconomic status and infant mortality. Families with lower annual incomes experienced significantly higher infant death rates. For instance, families earning less than $450 annually had an infant mortality rate of approximately 1 in 6, compared to 1 in 16 for families earning over $1250.

Maternalist Reform

In collaboration with influential women's groups, such as the Women's Joint Congressional Committee, advocacy for federal intervention in maternal and child health intensified. This collective effort is recognized as a prime example of "maternalist reform," leveraging newly acquired political influence to address critical social welfare issues at the federal level.

Legislative Journey

Introduction and Endorsement

The bill was first introduced in 1920, building upon earlier proposals. Despite initial debates concerning funding and administrative structures, and facing opposition from groups like the Women Patriot Corporation and the American Medical Association (AMA), the bill gained momentum. President Harding's endorsement in April 1921 was crucial, leading to its eventual passage in both the House (279-39) and the Senate (63-7).

Congressional Support

The legislative process involved significant debate, particularly regarding the extent of federal involvement in healthcare. However, the strong lobbying efforts by the Children's Bureau and allied women's organizations, coupled with the growing awareness of maternal and infant health issues, ultimately secured congressional approval.

Key Provisions

Healthcare Centers and Services

The Act authorized federal appropriations to support states in establishing and operating centers for maternity and infancy hygiene. These centers provided crucial services, including:

  • Guidance through public health nurses and home visits.
  • Establishment of consultation centers for prenatal and postnatal care.
  • Organization of childcare conferences.
  • Distribution of educational materials on prenatal and infant care.

Funding Mechanism

The legislation allocated $1,480,000 for the fiscal year 1921-1922, with $1,240,000 annually for the subsequent five years. Funds were distributed to states based on population, requiring states to match federal contributions dollar-for-dollar to receive their allocation. The Children's Bureau administered the program, allowing states considerable flexibility in implementation.

Midwifery Regulation

A significant component of the Act involved the regulation and licensure of midwives. This aimed to professionalize childbirth attendance, particularly in areas where lay caretakers were prevalent, thereby enhancing safety standards for both mothers and newborns.

Impact and Outcomes

Expansion of Services

During its eight years of operation, the Sheppard-Towner Act facilitated the establishment of approximately 3,000 child and maternal health care centers nationwide. Many of these centers were established in rural and underserved areas, significantly expanding access to essential health services.

Reduction in Mortality Rates

While a downward trend in infant mortality was already underway, studies suggest the Act contributed to this decline. States that invested more in child-life and health initiatives saw notable reductions in infant mortality. Nursing visits and the establishment of health centers proved particularly effective, with a greater impact observed in non-white populations, indicating the program's success in addressing disparities.

Statistical analyses indicate that increased spending on child-life and health/sanitation initiatives correlated with reduced infant mortality. For example:

  • Spending on child life reduced infant mortality by approximately 2.8 deaths per 1000 live births per standard deviation.
  • Spending on health and sanitation reduced infant mortality by approximately 6.27 deaths per 1000 live births per standard deviation.
  • Home nurse visits were associated with a reduction of about 1.8 deaths per 1000 live births.
  • Health centers decreased infant mortality by approximately 2.25 deaths per 1000 live births per standard deviation.

Crucially, the program's benefits were disproportionately higher for non-white populations, suggesting it played a vital role in mitigating existing health inequities.

Shift in Childbirth Practices

The Act played a significant role in the "medicalization" of pregnancy and childbirth. It encouraged a greater reliance on medical professionals and standardized practices, leading to a decline in the traditional role of midwives, particularly in urban centers. While this shift aimed to improve safety, it also sometimes overlooked the cultural practices of traditional caregivers.

Opposition and Demise

Legal Challenges

The constitutionality of the Act was challenged, but the Supreme Court dismissed these cases in 1923. However, opposition intensified as the Act approached its renewal date in 1926.

American Medical Association (AMA)

The AMA voiced concerns that federal intervention threatened professional autonomy and could lead to non-medical personnel administering healthcare. They lobbied against the Act's renewal, advocating for administration by the U.S. Public Health Service rather than the Children's Bureau, which they viewed as dominated by female administrators.

Broader Opposition

Groups such as the Daughters of the American Revolution, which had initially supported the Act, later opposed it. Anti-suffragist organizations also attacked the bill, labeling it a "communist plot." Senators engaged in filibusters, characterizing proponents as "neurotic women" and "Bolsheviks."

Expiration and Legacy

Facing sustained opposition, the Sheppard-Towner Act was extended for two years but ultimately expired on June 30, 1929. Despite its expiration, the Act's framework and the lessons learned regarding federal oversight and data collection significantly influenced the inclusion of maternal and infant care provisions in the Social Security Act of 1935.

Sources

Cited Works

  1. Text of the Act
  2. United States House of Representatives. "The Sheppard–Towner Maternity and Infancy Act". History, Art & Archives.
  3. Bezark, Michelle. "Our arithmetic was unique": The Sheppard-Towner Act and the Constraints of Federalism on Data Collection Before the New Deal. Journal of Policy History. 2021.
  4. Moehling, Carolyn M., and Melissa A. Thomasson. The Contribution of Sheppard-Towner to the Decline in Infant Mortality in the 1920s. NBER Working Paper No. 17996. 2012.
  5. Barker, Kristin. Birthing and Bureaucratic Women: Needs Talk and the Definitional Legacy of the Sheppard-Towner Act. Feminist Studies. 2003.
  6. Almgren, Gunnar; Kemp, Susan P.; Eisinger, Alison. The Legacy of Hull House and the Children's Bureau in the American Mortality Transition. Social Service Review. 2000.
  7. Lemons, J. Stanley. The Sheppard-Towner Act: Progressivism in the 1920s. The Journal of American History. 1969.
  8. BELLINGHAM, BRUCE; MATHIS, MARY PUGH. Race, Citizenship, and the Bio-politics of the Maternalist Welfare State: "Traditional" midwifery in the American South under the Sheppard-Towner Act, 1921–29. Social Politics. 1994.
  9. Barker, Kristin. Women Physicians and the Gendered System of Professions: An Analysis of the Sheppard-Towner Act of 1921. Work and Occupations. 1998.
  10. Moehling, Carolyn M.; Thomasson, Melissa A. The Political Economy of Saving Mothers and Babies: The Politics of State Participation in the Sheppard-Towner Program. The Journal of Economic History. 2012.
  11. BELLINGHAM, BRUCE; MATHIS, MARY PUGH. Race, Citizenship, and the Bio-politics of the Maternalist Welfare State: "Traditional" midwifery in the American South under the Sheppard-Towner Act, 1921–29. Social Politics. 1994.
  12. Ladd-Taylor, Molly. 'Grannies' and 'Spinsters': Midwife Education under the Sheppard-Towner Act. Journal of Social History. 1988.
  13. Lemons, J. Stanley. The Sheppard-Towner Act: Progressivism in the 1920s. The Journal of American History. 1969.
  14. Harding Signs Sheppard-Towner Act–November 23, 1921. American President A Reference Resource. Miller Center, Univ. of VA.
  15. Siegel, Benjamin S.; Alpert, Joel J. The profession of pediatrics. In Kliegman, Robert M.; Marcdante, Karen J.; Jenson, Hal B.; Behrman, Richard E. (eds.). Nelson essentials of pediatrics. 5th ed. Elsevier Saunders. 2006.
  16. Barker, Kristin. Women Physicians and the Gendered System of Professions: An Analysis of the Sheppard-Towner Act of 1921. Work and Occupations. 1998.
  17. Cott, Nancy. Social and Moral Reform. K.G. Saur. 1994.
  18. Carson, Thomas; Bonk, Mary, eds. Sheppard-Towner Act. Gale encyclopedia of U.S. economic history, vol. 2. Gale Cengage. 1999.
  19. Johnson, Kimberly S. 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 University Press. 2007.
  20. Ladd-Taylor, Molly. 'We mothers are so glad the day has come': mothers' work and the Sheppard-Towner Act. In Helly, Dorothy O.; Reverby, Susan M. (eds.). Gendered domains: rethinking public and private in women's history. Cornell University Press. 1992.
  21. Ladd-Taylor, Molly. 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. Cornell University Press. 1992.
  22. Loudon, Irvine. 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. Clarendon Press. 1992.
  23. Meckel, Richard. Save the Babies: American Public Health Reform and the Prevention of Infant Mortality. Johns Hopkins University Press. 1990.
  24. Skocpol, Theda. 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. Belknap Press of Harvard University Press. 1992.
  25. U.S. Congress. 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. U.S. G.P.O. 1921.
  26. U.S. Congress. 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. U.S. G.P.O. 1921.
  27. Wertz, Richard W.; Wertz, Dorothy C. Government involvement. Lying-in: a history of childbirth in America. expanded ed. Yale University Press. 1989.

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References

References

  1.  Text of the Act
  2.  "The Sheppard-Towner Act: Progressivism in the 1920s: J. Stanley Lemons. The Journal of American History, vol. 55, No. 4 (Mar., 1969), pp. 776-786
  3.  Lemons, J. Stanley. "The Sheppard-Towner Act: Progressivism in the 1920s." The Journal of American History 55, no. 4 (1969): 776-786.
A full list of references for this article are available at the Sheppard–Towner Act Wikipedia page

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