KRISTE LINDENMEYER
Saving Mothers and Babies: The
Sheppard-Towner Act in Ohio,
1921-1929
In 1985 (the year for which the latest
statistics are available), 10.6
American babies died for every 1,000
live births in the United States.
This is a dramatic improvement over the
country's 1921 infant mortal-
ity rate of 76 per 1,000, but as in
1921, the United States' rate continues
to compare poorly with many other
industrialized countries. In 1921,
the United States rate ranked
seventeenth out of twenty "modern"
nations.1 The 1985 rate
placed the U.S. eighteenth, and a Children's
Defense Fund report contends that,
contrary to popular opinion, infant
mortality is actually worsening in some
categories. Dr. Marsden
Wagner, director of the World Health
Organization's maternal and
child health program, maintains that
"infant mortality is not a health
problem ... [but] ... a social
problem" which should be addressed
through "more social education for
families" and by insuring that the
"basic level of financial and
social support ... be provided to families. "2
But, his is not a new idea. In 1921, the
United States Congress passed
legislation designed to attack the
country's high infant mortality rate by
"promoting" better prenatal
and infant care.
The Sheppard-Towner Maternity and
Infancy Act was passed in 1921
as the first federal health care
legislation to "promote the welfare" and
prevent unnecessary deaths of mothers
and babies in America.3
Kriste Lindenmeyer is a Ph.D. candidate in
history at the University of Cincinnati.
1. For a comprehensive
list of
the nations cited in the
1921 Congressional Hearing
on
Sheppard-Towner, see Promotion of the
Welfare and Hygiene of Maternity and Infancy:
The Administration of the Act of
Congress of November 21, 1921, Fiscal Year
Ended June 30, 1929, (Washington,
D.C., 1931), Children's Bureau Publication
(CB pub.) No. 203, 139.
2. Associated Press, "High Infant-death
Rate in U.S. Blamed on Skimpy Social
Help," Cincinnati Enquirer, 3
February 1988, sec. B, p.8; see also Children's Defense
Fund, A Children's
Budget: An Analysis of Our Nation's Investment in Children,
(Washington, D.C.,
1988), 61-62.
3. The Sheppard-Towner Act passed the
U.S. Senate by a vote of 63-7 on July 22,
1921. An amended version passed the
House on November 21, 1921, by a vote of 279-39.
106 OHIO
HISTORY
Administered by the Children's Bureau
(established in 1912), it was
also the first peacetime health care
legislation which provided grants-
in-aid to the states.4 Some
scholars investigating the Sheppard-Towner
Act have concentrated on the question of
why or how the United
States, alone among western industrial
nations, did not enact a
compulsory health insurance or maternity
benefits program. Others
have focused on the important role women
reformers played in the
Act's passage. Some have argued that
this law was a forerunner of the
1935 Social Security Act.5 An
evaluation of the legislative history of the
Sheppard-Towner Maternity and Infancy
program illuminates beliefs
about gender roles, rights of parents
and children, professionalization,
medical care, and the role that the
government should play in the lives
of U.S. citizens. But, as Molly
Ladd-Taylor recently remarked: "an
evaluation of the bill must rest ultimately
on an analysis of the actual
work that Sheppard-Towner funded in the
states."6
The Senate quickly approved the amended
version and President Harding signed the
measure on November 23, 1921. Congressional
Record, 67th Congress,
1st session,
4215-17, 7916-8178; Public No. 97, U.S.
Statutes At Large, April 1921 to March 1923,
67th Cong., 1st sess., (Washington,
D.C.), 224.
4. The Army Appropriation Act approved
July 8, 1918, established the Interdepart-
mental Social Hygiene Board to fight
venereal disease. This board functioned until July
1, 1922, with an annual expenditure of
$100,000. A permanent Division of Venereal
Diseases in the Public Health Service
with an annual appropriation of $1,400,000 was
also established under the terms of the
Act. This was the only other federal legislation
which dealt directly with health care
appropriations to the states. U.S. Statutes At
Large, 886-87, (Washington, D.C., 1919). Also see years 1920
forward for subsequent
appropriations.
5. For a historiographical discussion of
the development of U.S. public health care
policy, see Daniel M. Fox, "History
and Health Policy," Journal of Social History, 18
(Spring, 1985), 349-64. The following
deal with the legislative history of the Sheppard-
Towner Act: Edward R.
Schlesinger, "The Sheppard-Towner Era: A Prototype Case
Study in Federal State
Relationships," American Journal of Public Health, 57 (June,
1967), 1034-40; Joseph B. Chepaitis,
"The First Federal Social Welfare Measure: The
Sheppard-Towner Maternity and Infancy
Act, 1918-1932," (Ph.D. dissertation,
Georgetown University, 1968); Chepaitis,
"Federal Social Welfare Progressivism in the
1920's," Social Service Review, 46
(June, 1972), 213-30; J. Stanley Lemons, The Woman
Citizen: Social Feminism in the
1920's, (Urbana, 1974); Lemons,
"The Sheppard-
Towner Act: Progressivism in
the 1920's," Journal of American History, 55 (December,
1969), 776-86; Louis J. Covotsos,
"Child Welfare and Social Progress: A History of the
United States Children's Bureau,
1912-1935," (Ph.D. dissertation, University of Chica-
go, 1976); Sheila M. Rothman, Woman's
Proper Place: A History of Changing Ideals
and Practices, 1870 to the Present, (New York, 1978); Kristine Siefert, "An Exemplar
of Primary Prevention in Social Work:
The Sheppard-Towner Act of 1921," Social Work
in Health Care, 9 (Fall, 1983), 87-102; Molly Ladd-Taylor, Raising
Baby the Government
Way: Mothers' Letters to the
Children's Bureau, 1915-1932, (New
Brunswick, 1986);
Kriste Lindenmeyer-Dick, "Saving
Mothers and Babies: The Sheppard-Towner Mater-
nity and Infancy Act 1921-1929 With
Emphasis on Its Effects in Ohio," (M.A. thesis,
University of Cincinnati, 1987).
6. Molly Ladd-Taylor, "Protecting
Mothers and Infants: The Rise and Fall of the
Sheppard-Towner Act," paper
presented at the June 1987 Bershire Conference.
Saving Mothers and Babies 107
Debate concerning federal promotion of
maternal and infant care
moved to state legislatures after
President Harding signed the Sheppard-
Towner Act on November 23, 1921.
Powerful lobbying efforts led by
the various state Leagues of Women
Voters and Departments of Health
eventually secured approval in every
state but Connecticut, Illinois,
and Massachusetts.7 The
history of the Sheppard-Towner Act in Ohio
illustrates the attitudes and
complications encountered by an attempt
to prevent the needless deaths of
mothers and their babies in the 1920s.
The Controversy in Ohio
On December 7, 1921, just two weeks
after the bill became law,
Roscoe G. Leland, M.D., chief of the
Ohio Department of Health's
Division of Child Hygiene, wrote to
Children's Bureau chief, Grace
Abbott, requesting copies of the
Sheppard-Towner Maternity and
Infancy Act. He explained that the
members of the Ohio Department of
Health desired "to qualify as early
as possible in order that our work
may start with the least possible
delay." His chief, State Director of
Health Dr. Harry H. Snively, supported
state acceptance of the bill.8
Subsequently, Governor Harry L. Davis
(R) made Ohio one of the first
states to accept the provisions of the
act in December 1921 when he
agreed to the provisions of the law
until a vote of the legislature could
be held.
However, in the final analysis, Davis'
and the Health Department's
quick reaction to federal passage of
Sheppard-Towner was not enough
to permit Ohio to take full advantage of
the program. Because the
7. The Connecticut legislature claimed
that such programs infringed on state's
rights, and lobbying by the Illinois
State Medical Association prevented approval of the
act in that state. Massachusetts and one
of its citizens, Harriet A. Frothingham, a
member of the Woman Patriots (an
anti-woman's suffrage organization), brought
separate suits against the act on
constitutional grounds. The cases were combined and
argued before the U.S. Supreme Court.
The Court judged that Frothingham's claim of
unfair taxation was so minor that the
Court had no jurisdiction, and thus avoided ruling
on the act's constitutionality. See
Chepaitis, "The First Federal Welfare Measure ..,"
161-214; Massachusetts v. Mellon and
Frothingham v. Mellon, 262 U.S. 447.
8. Letter from Robert G. Leland
to Grace Abbott, December 7, 1921, Children's
Bureau Papers (CBP), Record Group (RG)
#102, Box 251, 11-37-1, National Archives
(NA); Harry H. Snively (1869-1931) was
born in Brownsville, Ohio. He taught school
and received his medical degree from
Ohio State University, served as medical director
of the American Red Cross in Russia in
1915, and directed health inspection work in
Bordeaux, France, during World War I. In
1919, he was appointed chief of staff to the
American Red Cross typhus expedition in
Poland. In 1920, he returned to Columbus as
the surgical, medical, and sanitary
director of the Ohio National Guard. "Introducing
Ohio's New Health Director," The
Ohio State Medical Journal (OSMJ), 17 (July, 1921),
529.
108 OHIO HISTORY
state's biennial legislature did not
meet until January 1923, no matching
funds could be voted and the Ohio
Department of Health was only able
to accept 40 percent of the federal
funds available to it for 1922. A state
allotment of $550 for publicity from the
Ohio State Emergency Board
and $1,637.95 from the Department of
Health Budget constituted the
state's only contribution to
Sheppard-Towner work during 1922.9
When the Ohio legislature met in January
1923, former Cleveland
Director of Welfare, Representative
Dudley Blossom (R-Cleveland),
introduced H.B. No. 583 providing for
state acceptance of the provi-
sions of the Sheppard-Towner Maternity
and Infancy Act. The new
Democratic governor, Victor Donahey,
appointed John Emerson Mon-
ger, M.D., as director of the Ohio State
Department of Health on
January 8, 1923.10 Monger's predecessor,
Harry Snively (health direc-
tor from July 1, 1921, to January
8, 1923), had asked for $38,843.46 to
implement an appropriate Sheppard-Towner
program in the depart-
ment's 1923 budget. Monger, however, was
hesitant about, if not
antagonistic to, the federally assisted
maternity and infancy plan.11
Lucia Johnson Bing, executive secretary
of the Ohio League of
Women Voters (OLWV), wrote Grace Abbott
in February, 1923,
expressing concern about Monger's
attitude.12
She explained that after a confidential
interview with Dr. Leland,
(who retained his position as chief of
the Division of Child Hygiene),
she went to see Ohio's new health
officer. She asked Monger if he
would appear before the Ohio joint state
legislative council of women's
9. The maximum appropriation available
to Ohio for 1922 was $17,993.41, but only
$7,187.95 was actually accepted.
"Promotion of the Welfare," CB pub. No.203, p.3;
Letter of acceptance of the Maternity
and Infancy Act from Governor Harry L. Davis to
Grace Abbott, December 27, 1921, CBP, RG
#102 Box 251, 11-37-1, NA; Letter from
W. Albert Davis, Ohio Director of
Finance, to Snively, April 11, 1922, CBP, RG #102
Box 251 11-31-1, NA.
10. John E. Monger (1878-1932) was born
in Connersville, Indiana. In 1890, his
family moved to Greenville, Ohio. In
1902, he was graduated from the University of
Cincinnati College of Medicine. After
graduation, he set up a general practice in
Greenville until 1917 when he became
state vital statistics registrar (1917-1920) and
moved to Columbus, Ohio. "Ohio's
New Health Director," (OSMJ), 19 (February,
1923), 76.
11. Juliette Sessions, "Report of
State President," The Ohio Woman Voter (OWV),
I (June, 1923), no.12, 4; Grace R.
Peters, "The Sheppard-Towner Act in Ohio," OWV,
11 (February, 1923), no. 8, 9.
12. Lucia Johnson Bing was born in North
Amherst, Massachusetts, and received an
A.B. from Smith College. Her husband,
Simeon H. Bing, taught at Ohio University. She
served as the executive secretary of the
OLWV and as the NLWV chairperson for child
welfare as well as a state
representative on the NLWV board. During World War I she
served on the Women's Committee for
National Defense and later as head of the
child-placing department of the
Cleveland Humane Society and superintendent of state
charities for the Ohio Department of
Public Welfare. Ruth Neely, ed., "Lucia J. Bing,"
Women of Ohio, (Cleveland?, circa 1939), vol.3, 941.
Saving Mothers and Babies 109 |
|
organizations and speak about his plans for Sheppard-Towner work. Bing wrote that Monger "replied flatly that he would not, because he hadn't any yet." Furthermore, "he felt the act was in such an uncertain state due to the attacks being made on it in Massachusetts and in the District [references to suits challenging the bill's constitutionality] that he preferred to wait and not get his fingers burned." Monger told Bing that "he intended to go to Chicago for the meeting of the American Medical Association, and there he would talk with the 'boys' and find out what was going on and what the general attitude was in the states toward the work." When Bing indicated that it "would be rather late then to get an appropriation from the legislature, he said 'Well, you women go ahead and if you can get me the money, I'll spend it, and give you my word to carry out the policy of the previous administration.' " Juliette Sessions, OLWV president, added a paragraph to Bing's letter. She lamented that "the prospect for the success of the hygiene of maternity and infancy in Ohio is most discouraging."13 Besides the
13. Letter from Lucia Johnson Bing and Juliette Sessions to Grace Abbott, February 9, 1923, CBP, RG #102 Box 251 11-37-2, NA. Juliette Sessions (1868-1929) was born in S. Wilbraham, Massachusetts, and moved to Columbus, Ohio, after her mother's death in 1877, with her sister to live with a cousin. She spent two years at Ohio State University |
110 OHIO HISTORY
patronizing tone of Monger's remarks,
Sessions and Bing must have
regretted his reliance on members of the
American Medical Associa-
tion (AMA) for an opinion about the
bill. The AMA was the Sheppard-
Towner Act's strongest opponent, and the
Ohio State Medical Asso-
ciation was the most vocal state
organization which helped to shape the
national organization's official
anti-Sheppard-Towner policy.14
Ample evidence of opposition to
Sheppard-Towner by Ohio's pro-
fessional medical organization exists in
editorials of the Ohio State
Medical Journal (OSMJ). For example, the journal's editorial board
endorsed the congressional testimony of
Dr. Charles E. Humiston,
president of the Illinois State Medical
Society who contended that the
"principle of federal state aid as
a means of financing public health
activities, is financially and
economically unsound, and is unfair and
unjust as a method of taxation."
The journal agreed that "public health
work is a function of the state and
local governments and should be
paid out of state and local funds and
directed by state and local
officials." The rationale was that
the "furnishing of instruction or care
to mothers or any other persons needing
such instruction is just as
much a function of local government as
is the providing of food and
clothing for the destitute . .."
and that the "assumption and exercise of
these functions by the Federal
Government is an invasion of the
legitimate activities of the
state." In 1923, as the Ohio legislature
deliberated about matching funds, the
journal praised opponents of the
Sheppard-Towner Act and contended that
"the federal encroachment
upon state rights is brought about
through sympathetic appeals and
'sob-sister' yarns" and argued that
"taxpayers pay every cent of it and
much more than they probably would if
the states looked after affairs
rightfully their own, because, the
farther the supply depot is from the
place where the supplies are to be used,
the more it costs to deliver
them." 15
and was graduated from
the University of Michigan in 1893. She also did some graduate
work at Harvard and
Columbia. Sessions taught history and civics in the Columbus
public schools for 24
years, then served as a Board of Education member from 1922-27
and as its president
from 1927-29. She was active as a suffragist and in the OLWV until
her death. "Miss
Juliette Sessions," OWV, 8 (January, 1930), no.6, 5.
14. In 1920, there
were 7,802 physicians in Ohio, 2,432 of whom were members of the
AMA. Only New York (5,302), Pennsylvania (4,407), and Illinois (4,584) had more AMA
members. The Ohio
State Medical Association had joined with the state medical
societies in
Massachusetts, New York, Illinois, and Indiana to lead the medical lobby
opposing
Sheppard-Towner. During the AMA's 1923 San Francisco convention the Ohio
delegation exceeded
that of any state not directly bordering California; James G.
Burrow, AMA: Voice of American Medicine, (Baltimore, 1963), 399, 402; Lemons,
"The
Sheppard-Towner
Act," 780.
15. "Ohio Again
to the Front," OSMJ, 19 (July, 1923), 553; "Federal-State-
Saving Mothers and Babies 111
At its annual meeting in Cincinnati on
May 4, 1922, the Ohio State
Medical Association had adopted a
resolution stating "that it was the
opinion of the Association that the
Sheppard-Towner Act may not
function in the best interest of the
public and resolving that the
committee on public policy and
legislation be directed to use its every
honorable means to deter the Ohio
Legislature from the appropriation
of any monies for the purpose of
providing medical attendance under
the provisions of the said law."16
In response to criticism from the
OLWV, Dr. J.H.J. Upham of Columbus,
chairman of the Ohio State
Medical Association, explained that members
of the State Medical
Association had helped to prepare the
state's proposed Sheppard-
Towner Plan sent to Washington for
approval. Upham and other
members of the Ohio State Medical
Association contended that they
believed "earnestly in the
dissemination of proper educational material
and adequate supervision of obstetrical
practice." But they argued
"that this work can best be done by
the states; themselves or their local
subdivisions rather than through a
federal, detached, impersonal,
expensive and paternalistic
system." Throughout the life of the
Sheppard-Towner program, OSMJ articles
condemned it. 17
Another group of opponents in Ohio
pointed to the fact that the
program's benefits were available to all
citizens, and not just those
unable to afford private medical
services. Bleeker Marquette, head of
the Cincinnati Community Chest, feared
that he would have a difficult
time gaining support for such a program
in Cincinnati. Marquette
wondered why "it was deemed advisable
to make provisions of the Act
available not only to those who might
need assistance, but for all
residents of the state regardless of
their financial condition." While he
denied that he held such a belief, he
maintained that he could "foresee
opposition to the Bill on this
point." Marquette believed that some
Cincinnatians might oppose any plan
which threatened to violate local
control over charity work. This
interpretation was a misunderstanding
of the Sheppard-Towner Act's intention
because it failed to recognize
Medical Problems," OSMJ, 17
(September, 1921), 603-04; see original testimony
U.S. Congress, House, Committee on
Interstate and Foreign Commerce, Hearings on
H.R. 2366, 67th Congress, 1st session, (Washington, D.C., 1921).
16. "Two Resolutions:" OWV,
I (June, 1922), no.l, 14; "Maternity and Infancy,"
OSMJ, 18 (August, 1922), 540; for a reprint of the resolution
see "The Seven Years
History of the Sheppard-Towner Maternity
and Infancy Act With Special Reference to
Activities in Ohio," OSMJ, 25
(July, 1929), 563-64.
17. "Medical Men vs. Mothers?"
OSMJ, 18 (October, 1922), 700-01; "The Seven
Years History," p.564; see for
example these articles in the OSMJ: "Facing Federal
Fallacies," 19 (March, 1923), 200;
"Modern Meiosis," 19 (April, 1923), 277; "The
Federal Aid Fallacy," 19 (April,
1923), 2; "The Sheppard-Towner Act," 22 (March,
112 OHIO HISTORY
that the purpose of the legislation was
to encourage good maternal and
infant care for all Americans regardless
of socioeconomic status.18
Major support for the Blossom Bill, in
Ohio and elsewhere, was led
by the state League of Women Voters. The
OLWV had adopted
a resolution at its state convention May
11-12, 1922, advocating
"an appropriation by the
legislature to the State Department of Health
for administration of the
Sheppard-Towner Law." An article in
the OLWV's publication, The Ohio
Woman Voter, characterized hos-
tility to the bill as "Medical Men
vs. Mothers." Members of the
OLWV lobbied state legislators and
"some progressive men in the
state Medical Society" were asked
to see Dr. Monger to gain his
backing. In addition, Bing and Sessions
persuaded Abbott to send a
Children's Bureau staff physician, Ethel
M. Walters, M.D., to Ohio to
help lobby for passage of the bill.
There were some pro-Sheppard-
Towner physicians, like the Cincinnati
obstetrician who wrote Abbott
that he was "heartily in favor of
it," but the majority of the state's
organized doctors opposed such
legislation.19
The Ohio Woman Voter urged passage of the Blossom bill by noting
that "Ohio loses 800 mothers and
11,000 babies each year from
preventable causes." In an effort
to quiet fears that the act breached
parental rights, it explained that
"no official under this Act may enter
any home over the protest of the parents
or guardian of a child." And
finally, it emphasized that the
"service contemplated in Ohio under
this Act is purely educational."
The OLWV instructed its members to
"KNOW the Sheppard-Towner Act,
THINK it, TALK it, and USE
ALL YOUR INFLUENCE that the State
Legislature MAKES the
1926), 203; "Purpose of Federal
Maternity Aid," 22 (October, 1926), 835; "Sophistry of
Paternalism," 23 (January, 1927),
19-20; "Sheppard-Towner Activities," 24 (January,
1928), 56; "The Sheppard-Towner
Act," 24 (February, 1928), 107; "Maternity and
Infancy Developments in Ohio Under
Sheppard-Towner Act As Set Forth in An Official
Report," 24 (November, 1928),
886-88; "The Seven Years History," 25 (July, 1929),
563-67.
18. Bleecker Marquette, Cincinnati
Community Chest, to Julia Lathrop (then chief of
the Children's Bureau), November 24,
1920; Lathrop answered that the "bill is designed
to emphasize public responsibility for
the protection of life just as already through our
public schools we recognize public
responsibility for the education of the child....
otherwise I fear that the service would
degenerate into poor relief." December 1, 1920,
CBP, RG #102 Box 232, 10-6-0 NA.
19. "Two Resolutions," 14;
Upham's explanation of the Ohio State Medical Asso-
ciation's position was in response to
this editorial. Bing and Sessions
to Abbott, February 9, 1923, and letter
from Cincinnati Obstetrical Society Member,
Dr. Emil J. Alban, to Lathrop, December
13, 1920, CBP, RG #102 Box 232, 10-6-0,
NA; Memo from Mrs. Lucia Johnson Bing to
Miss Abbott, February 18, 1923, Caro-
line E. Newburgh to Abbott, March 3,
1923 and Bing to Abbott, March 10, 1923, CBP,
RG #102, Box 251, 11-37-2, NA.
Saving Mothers and Babies 113
FULL APPROPRIATION and ACCEPTS the ACT
which will give
Ohio a greater chance to protect the
mothers and babies of the state."20
Along with drawing support through the Ohio
Woman Voter, Juliette
Sessions lectured and led discussions
throughout the state. In March,
1923, she spoke to a meeting of the
Cincinnati League of Women
Voters (CLWV). Significantly, the CLWV
felt that the topics of Miss
Session's speech-maternity and infant
health care, equal guardianship
of children, and child care-would not be
of sufficient interest to the
mostly male members of the Cincinnati
Chamber of Commerce and
therefore did not seek a suggested joint
meeting of the two organiza-
tions. They apparently felt that the
Maternity and Infancy Act was
solely a women's issue.21
Mainly due to the efforts of the OLWV
and political pressure applied
by a female member of the state senate,
Maude C. Waitt (R), H.B. No.
583 passed the Ohio House (81-2) and
Senate (31-0).22 This bill and the
matching funds appropriation bill (H.B.
No. 622) were signed into law
by Governor Vic Donahey on April 24,
1923, making a total of
$43,843.46 (a $5,000 outright grant,
plus a match of $38,843.46) of
federal funds available annually to Ohio
beginning July 1, 1923. While
amendments attached to the Ohio acts
reflected some of the concerns
of the program's opponents,
Sheppard-Towner supporters had suc-
cessfully persuaded Ohio politicians that
efforts to save the lives of
mothers and babies were worthy of such
an experiment.23 The Ohio
Sheppard-Towner program was designed to
reduce the state's maternal
20. Ibid.; See also Minutes of the
Executive Board of the Cincinnati League of
Women Voters (CLWV), April 2, 1923, Mss
qL434, box 18, folder 1, Cincinnati
Historical Society (CHS); Peters,
"The Sheppard-Towner Act in Ohio," 9.
21. Minutes of the Executive Board of
the CLWV, January 22, 1923, Mss qL434 box
18, folder 1, CHS.
22. The other female members of the Ohio
legislature included Nellie B. Loughead
(Senate: R-Cincinnati), May M. Van Wye
(House: R-Cincinnati), Lulu T. Gleason
(House: R-Toledo), Adelaide Ott (House:
R-Mahoning County), and Nettie M. Clapp
(House: R-Cuyahoga County); "Ohio's
Female Legislators," OWV, 1 (February, 1922),
no.8, 1-2.
23. Amendments adopted in Ohio also
reflected the concerns of the program's
opponents. Similar to a condition
attached to the federal law, Section 2 of Ohio 1237
declared that "no official, or
agent, or representative, in carrying out the provisions of
this act shall enter any home or take
charge of any child over the objection of the parents,
or either of them or the person standing
in loco parentis or having custody of such child."
Furthermore, Section 4 specified that
"[N]othing in this act shall be construed as
authorizing, or permitting, the
expenditure of any public moneys to provide medical or
nursing attendance or service."
"Policies Formulated for Application of Sheppard-
Towner Maternity and Infancy Provisions
in Ohio," OSMJ, 19 (June, 1923), 448; "The
Seven Years History," 564; R.G.
Leland, "Ohio Sheppard-Towner Activities," (Colum-
bus: State Department of Health,
November 22, 1924), CBP, RG #102, Box 251, 11-0-1,
NA; H.E. Kleinschmidt, M.D.,
"Administration of Sheppard-Towner Act in Ohio,"
OSMJ, 22 (August, 1926), 697.
114 OHIO HISTORY
and infant mortality rates by promoting
the "welfare and hygiene of
maternity and infancy."24
Accomplishing this task was the responsi-
bility of the State Department of
Health.25
Designing Ohio's Program
In 1921, the Ohio State Department of
Health consisted of eight
divisions, each responsible for a
separate aspect of public health:
Administration, Communicable Disease,
Sanitary Engineering, Labo-
ratories, Vital Statistics, Industrial
Hygiene, Public Health Nursing,
and Hygiene. The provisions of the
federal act required that each state
have a separate office of child or
maternal and infant hygiene to
administer the Sheppard-Towner program,
so a separate Division of
Child Hygiene with Roscoe G. Leland,
M.D., as head was installed.26
After the Ohio legislature funded
Sheppard-Towner, State Director
of Health Monger formed a state advisory
committee of physicians,
nurses, and representatives from some of
the state's health organiza-
tions to formulate a maternity and
infancy health program. These
individuals met in Columbus on May 11,
1923, with officers of the State
Department of Health and the Public
Health Council. The group
recommended that the "entire
program of activity under the provisions
of this law should be educational and
preventive including the educa-
tional work to be carried on under the
State Department of Health
jointly with the approval and
cooperation of the local profession [and]
should be limited to instruction and to
demonstrations accruing as
benefits to the entire community and not
as personal service to
individuals." It maintained that if
"in exceptional cases or in emer-
24. The state's 1922
infant mortality rate was 72 per 1,000 live births, placing it
twelfth of thirty-one
reporting states. The maternal mortality rate was 66 deaths per
10,000 live births
ranking thirteenth; "Promotion of the Welfare," CB pub. No. 203,
132-37.
25. An Ohio State
Board of Health was established in 1886. In 1917, the Board was
abolished and the
State Department of Health created by the Hughes-Griswold Health
Law. This legislation
required that each of Ohio's 93 cities and 88 counties establish
departments of health
headed by medical professionals. Both physicians and nurses
served as district
health officers. Prior to 1917, there were approximately 2,150 city and
township health
departments headed by medically and non-medically trained political
appointees. The 1917
law also created the positions of Ohio Commissioner and Assistant
Commissioner of
Health, and a four member Public Health Council. In 1921, the
Commissioner of Health
position became the Director of Health. H.G. Southard, M.D.,
Ohio Department of Health, An
Historical Review: Its Powers, Duties, and Organiza-
tion, (Columbus, 1933).
26. Ohio had
established a Division of Child Hygiene on October 1, 1915, but on July
1, 1919, this separate
division became a part of the Division of Hygiene. Thirty-first
Report of the Department of Health, (Columbus, 1930), 197.
Saving Mothers and Babies 115 |
|
gency any [medical] service is to be provided, . . . such service should only be at the request and under the direction of the attending physician." Furthermore, the program was to "in nowise disturb the professional relationship between the physician and his patient." Monger explained that legislative "acceptance of the terms of the Sheppard-Towner Act places on the Director of the State Department of Health a heavy responsibility, and being a firm believer of the efficacy of the combined judgment of persons directly interested .... he wanted the input of a number of individuals.27 However, while the program directly interested the women of Ohio, the state's physicians did not want "lay" women or their organizations to participate in the policy-making process. And interestingly, there is no evidence that women's organizations demanded such participation even though their lobbying efforts had been an essential ingredient at both the national and state level. As the Ohio State Medical Associa- tion desired, the specifics of the state's Sheppard-Towner program were set forth by physicians and health professionals.
27. "Policies Formulated for Application," OSMJ, 19 (June, 1923), 448; Ibid., 448-49; "Sheppard-Towner Work Begins in Ohio," OWV, 2 (November, 1923), no.5, 9. |
116 OHIO HISTORY
By including members of the State
Medical Association in the
planning stages, Monger was able to gain
the cooperation of many Ohio
doctors. In a memo summarizing the
state's earliest Sheppard-Towner
work, he concluded that Ohio already had
many of the necessary
programs and facilities needed to begin
to combat the unnecessary
deaths of mothers and babies, but he was
especially pleased to have
"that most powerful of allies, a
well organized and devoted medical
profession."28 According
to the OSMJ, the Ohio law which "properly
limited" state programs to
educational and diagnostic work was a
necessary "safeguard,"
designed to eliminate from the work possible
abuses of the program and made
cooperation by many physicians
possible.29
The state advisory committee, with
Monger as chairman, outlined
three programs for spending
Sheppard-Towner funds. First, the Health
Department would conduct research
programs about three problems: a
statewide survey of the causes of infant
and maternal mortality; a study
of hospital reporting procedures in an
effort to standardize statistical
records; and a statewide study of
midwives practicing in Ohio. Second,
create a series of "district
demonstrations" which would "show the
application of practical, specific
health education in which every
agency in the community is invited to
take part." Third, set up a series
of conferences run by pediatricians,
orthopedic surgeons, or other
specialists designed to "interest
the public in regular, periodic health
examinations for expectant [sic] mothers
and children as well as the
presumably normal adult and to enlist
the complete sympathy, under-
standing and cooperation of the medical
profession." Monger stated
that another part of this effort was to
"exert a definite part of our
energy in the direction of immunizing
the preschool child against
smallpox, diptheria and typhoid
fever." He again noted that it "should
be kept in mind that this entire work is
solely educational and
diagnostic in nature."30
Monger wanted to combine the support of
physicians, nurses, and
women volunteers to make the Ohio
Sheppard-Towner program a
success. Although he did not choose to
include non-medically trained
women on the state's advisory committee,
he argued that "to none is
28. "Ohio Sheppard-Towner
Activities," undated memo (summer, circa 1923) from
John E. Monger to the Children's Bureau,
CBP, RG #102, Box 251, 11-37-1 1-2, NA.
29. "The Sheppard-Towner Act,"
OSMJ, 22 (March, 1926), 203.
30. Ibid., 1-2, and "Policies
Formulated for Application," OSMJ, 448; Dr. Monger
believed that the support of the
organized medical profession was necessary if he was
successfully to reduce Ohio's maternal
and infant mortality rates under the Sheppard-
Towner program, and he continually
declared that all levels of the state program
preserved the "professional
relationship between patient and physician." 4.
Saving Mothers and Babies 117
the interest greater, nor should it be,
than to the women of the state,
wherever they may be found, or in what
circumstance of life." He
concluded that "there is no phase
of public health administration and
work that does not touch the home and
woman who is the center of the
home."31
In cooperation with Monger, the OLWV urged
its members
to participate in the organization of
local health conferences for the
public and "to become active in
assisting both the local and central
[health] department[s] in the
furtherance of their work." Women
volunteers, under the direction of the
local health director, could help
with well baby and child health conferences
across the state.32
One aspect of the Ohio plan for general
health educational activities
appeared opposed to the Children's
Bureau's instructions directing
that state Sheppard-Towner programs deal
exclusively with maternal
and infant health care, yet Ohio's
general health plan was deliberately
designed so that none of the
Department's nurses would be restricted
to maternal and infant matters. Leland
explained that Ohio's proposed
program took into consideration the fact
that "for a number of years
we have struggled to establish
throughout Ohio a system of generalized
public health nursing and at the present
time this form of public health
nursing is accepted as the most
desirable, efficient and productive."
The Children's Bureau's Dr. Anna M. Rude
wrote Leland that
"allowing a general health
program would absolutely defeat the
purpose" of the Sheppard-Towner
Act. But, she continued, "I agree
with you entirely that it is not
possible in rural areas to do specialized
public health nursing and consequently
it will be possible for you to
continue upon a general nursing program,
paying only for so much of
the nurse's time as is spent
specifically for maternity and infancy from
Federal or State funds used in
matching."33 The Ohio Department of
Health accepted this practical
expedient.
In an August 20, 1923, letter Grace
Abbott told Monger that all
phases of the Ohio plan for fiscal 1923
and 1924 except the goal to
"emphasize those general public
health measures which are essential
to the success of any personal or public
health program" had been
approved. Abbott explained that both
state and federal matching funds
"must be used for specific
maternity and infancy activities," not
general health work.34
31. John E. Monger, M.D., "From
Before Birth to Death: State Department of
Health Protects Ohioans," OWV, 5
(January, 1927), no.7, 7.
32. "Sheppard-Towner Work
Begins," OWV, 2 (November, 1923), no.5, 9.
33. Letter from Dr. R.G. Leland to Anna
M. Rude, August 9, 1923, CBP, RG #102,
Box 251, 11-37-1, NA; According to Rude,
this expedient was followed by other states
which used from one-sixth to one-half of
a nurse's time. Letter from Anna M. Rude to
R.G. Leland, August 14, 1923, CBP, RG
#102, Box 251, 11-37-1, NA.
34. Letter from Grace Abbott to Dr. John
E. Monger, copy to Dr. Leland August 20,
118 OHIO HISTORY
The Ohio Program at Work
The first Ohio Sheppard-Towner project
was a survey of approxi-
mately fifty midwives practicing in the
state during 1922. In this survey,
midwives were divided into three groups:
those licensed and practic-
ing, those unlicensed but practicing and
those licensed but not prac-
ticing. Another such study was done in
1923. The names of midwives
who delivered babies during these two
years were taken from birth
certificates and checked against a
roster of midwives registered with
the Ohio State Medical Board, the state
licensing body. At the time, all
midwives practicing in Ohio were
required to qualify before the State
Board of Medical Examiners and were
licensed by the State Medical
Board. The names of midwives found in
this study were grouped by
county and sent to district health
commissioners. Efforts to regulate,
and in many cases to eliminate, midwives
had been part of the health
reform movement in the United States
since the mid-nineteenth
century. Many physicians and women's
health reformers argued that
midwives contributed to the nation's
high maternal mortality rates.35
By the 1920s, at least in urban areas,
the goal to eliminate the midwife
from obstetrics was largely successful.
In Cincinnati in 1880, for
example, 71 percent of all births in the
city were attended by midwives,
each of whom delivered an average of 70
babies per year. During 1924,
midwives attended only 2.8 percent of
the births in Cincinnati. This
meant that eleven practicing Cincinnati
midwives assisted an average
of only 22 deliveries each.36 Midwives
continued to practice in greater
1923, CBP, RG #102, Box 251, 11-37-1,
NA: Abbott's letter officially opened the way for
the institution of specific projects
designed by the Ohio State Department of Health as
addressed by the State Advisory Committee and the
Public Health Council. The Ohio
Department of Health Divisions of Vital Statistics and
of Public Health Nursing
cooperated with the Division of Child
Hygiene in implementing the state's Sheppard-
Towner program. The Division
of Child Hygiene directed the work with its eleven-
member staff. The Division's staff included
director Leland, one part-time physician,
two staff nurses and seven "Sheppard-Towner nurses," one nutritionist, one vital
statistics clerk, one individual in
charge of publicity, one financial clerk, two movie
projector operators, and one lecturer. For
a general summary of the early Ohio
Sheppard-Towner Activities, see
"Ohio Sheppard-Towner Activities," (circa 1926) an
undated and unsigned report, CBP, RG
#102, Box 251, 11-37-1, NA; and Kleinschmidt,
"Administration of," 697-700; The
Ohio Department of Health's official report for the
entire period (1923-29) appears in Thirty-first
Report, (1929).
35. See Frances E. Kobrin, "The American Midwife Controversy: A Crisis of
Professionalization," in Judith
Walzer Leavitt, ed., Women and Health in
America:
Historical Readings, (Madison, 1984), 318-25; Charles Edward Ziegler, "How Can We
Best Solve the Midwifery Problem?" American
Journal of Public Health, 12 (May,
1922), 405-13.
36. "The Midwife in
Cincinnati," Cincinnati's Health, (October 14, 1925), 9.
Saving Mothers and Babies 119
numbers in states where either few
physicians were available or high
numbers of immigrant or black
populations lived.37 In Ohio, like most
areas of the country, the number of
midwives continued to dwindle. By
1931, midwives delivered only 1,131 Ohio
babies, a mere 1.1 percent of
state births.38 The Ohio
midwifery studies undertaken with Sheppard-
Towner funds were an example of the
desire by many physicians and
other health reformers to restrict and
eliminate midwives from the
obstetrical profession. A Department of
Health report on the first two
years of Sheppard-Towner program in Ohio
lamented that "[t]hou-
sands of mothers of Ohio pass through
pregnancy and labor alone or
attended only by incompetent
midwives."39 Many, if not most, Ohio
physicians must have shared this
sentiment.
A second research project, done by the
Department of Health's
Division of Vital Statistics, gathered data
pertaining to maternity and
infancy. These were used to compile
tables showing maternal, infant,
and stillborn death rates by city,
county, ethnicity, and age. Another
set of tables was assembled showing the
major causes of death for both
infants and mothers. The results of this
project demonstrated that the
incidence of preventable infant deaths
was declining. They also showed
that Ohio's black babies died at three
times the rate of white infants.
The research identified three major
causes of death for mothers:
puerperal septicimia, toxemia, and
"accidents of pregnancy." The first
was especially disturbing because
septicimia infection was preventable
through simple sanitary techniques.
Moreover, it was largely through
the carelessness of birth attendants,
most often physicians, that the
deadly infection was spread from one
woman to another. Physicians
were more often guilty than midwives
because they frequently attend-
ed patients sequentially. This was
especially true in hospitals. The
second highest cause of death to
pregnant women was toxemia, also a
largely preventable cause of death.
Maternal deaths caused by toxemia
were usually a result of poor prenatal
care. The third category,
37. For an instance of successful use of
midwives to help save the lives of rural
women and babies, see Nancy Schrom Dye,
"Mary Breckinridge and the Frontier
Nursing Service, and the Introduction of
Nurse Midwifery in the United States,"
Leavitt, ed., Women and Health in
America, 32744; for a discussion of Sheppard-
Towner and Midwives in southern states
see Molly Ladd-Taylor, "
'Grannies' and
'Spinsters': Midwife Education Under the
Sheppard-Towner Act," Journal of Social
History, 22 (Winter, 1988) no.2, 255-76.
38. Ohio State Department of Health,
"Summary of Statistics for Deaths and Births,
1930, 1931 and 1932," (Columbus:
State Department of Health Division of Statistics),
mimeographed report, 24. The
Sheppard-Towner reports on Ohio Midwives have not yet
been found.
39. Kleinschmidt, "Administration
of," 697-98.
120 OHIO HISTORY
"accidents of pregnancy,"
included criminal abortions, complications
caused by syphilis, and accidents which
occurred during labor which
could have been caused by an incompetent
birth attendant. Some
critics attributed the rise in death due
to accidents in labor to the
growing tendency by physicians to use
instruments to aid or hasten
labor. Dr. H.E. Kleinschmidt, Ohio's
Chief of the Division of Child
Hygiene after Leland's resignation in
1925, claimed that it was the use
of new obstetrical techniques by the
"less apt" that resulted in many
deaths. This Sheppard-Towner project was
continued by Ohio after the
federal act expired.40
The third research project gathered
information about Ohio's mater-
nity homes and hospitals with maternity
beds. This was an especially
important task due to the increasing
number of babies being born in
hospitals during the 1920s and 30s. In
Cincinnati, for example, in 1910
a small minority (estimated at fewer
than 15 percent) of babies were
delivered in hospitals. By 1922 that
percentage had increased to 42.3
percent; it would reach 90 percent by
1939. This phenomenon was part
of a national trend.41 The
Ohio Department of Health found that by
1925 there were 198 maternity homes and
hospitals in the state which
provided 2262 maternity beds.
Sheppard-Towner funds made annual
inspection and licensing possible.42
The second program instituted during the
first two years of Ohio
Sheppard-Towner work was the
establishment of four "district dem-
onstrations." Instead of spreading
the "meager" funds appropriated
under the Sheppard-Towner Act "all
over the state, the Director of
Health decided upon four demonstrations,
one each in a mining
settlement, a rural district, a small
town community and an urban
center."43 A state report explained
that many "factors determined the
placing of a district demonstration but
since these were to be used to
show local communities practical methods
of saving the lives of
mothers and babies, one of these
determining factors was a high
maternal and infant death rate."
Sheppard-Towner funds paid for
"eight Ford coupes" purchased
for use by the Department's public
40. Ibid., 698; The Department of Vital
Statistics included these numbers in its yearly
annual report.
41. Cincinnati Department of Health, Cincinnati
Sanitary Bulletin, (January, 1923);
By 1939, 90 percent of all Cincinnati
babies were born in hospitals; Neal Devitt, "The
Transition from Home to Hospital Birth
in the United States, 1930-1960," Birth and the
Family Journal, 4 (Summer, 1977), no.2, 47-58.
42. The Department's count included both
maternity homes and hospitals; "Ohio
Sheppard-Towner Activities," CBP,
Box 251, 11-37-1, 5.
43. "Cincinnati's Participation in
Sheppard-Towner Work," Cincinnati Sanitary
Bulletin, 8 (September 10, 1925), no.3, 6.
Saving Mothers and Babies 121
health nurses. Ultimately, public health
nurses performed the bulk of
the work in the first four district
demonstrations and established the
pattern followed in all subsequent Ohio
Sheppard-Towner demonstra-
tion projects. The first four projects
were established in Belmont,
Richland, and Athens counties, and in
Cincinnati.44
The Belmont County, Ohio, demonstration
began in September 1923
and continued for thirty-five months.
Like the other three demonstra-
tion sites, Belmont was chosen because
of its high maternal and infant
mortality rates, "there being many
mining villages of foreigners and a
large colored population," and
"because the health agencies are
especially interested."45 Both
the county health department and the
county medical association were anxious
to participate. Dr. Monger
explained to the Belmont County Medical
Society that work in all
Sheppard-Towner demonstrations with
expectant mothers would en-
courage "the necessity of securing
early and competent medical
attention . . ." and "after
the work was well under way and the plan
'sold' to the districts, the state would
gradually withdraw and allow the
work to continue under local
auspices." Dr. Leland described Belmont
as "an agricultural and mining
county of large area" with "energetic
but over-worked health department
personnel."46 Two nurses from the
State Department of Health were added to
the county health depart-
ment's staff of three public health
nurses. Under the plan devised by
the Ohio Department of Health and the
state advisory committee, the
work done in the demonstration in this
county was general public
health nursing. But since the combined
Federal-State funds supplied
salaries for two nurses, it followed
that to satisfy federal requirements
each of the five nurses was expected to
devote at least two-fifths of her
time to the welfare and hygiene of
mothers and babies, as provided for
in the agreement with the Children's
Bureau.47 This pattern of
Sheppard-Towner nurse use was generally
followed statewide.
44. "Ohio Sheppard-Towner
Activities," CBP, 6.
45. "Sheppard-Towner Work Begins," OWV, 9-10; "Infant Hygiene in Belmont
County," OSMJ, 19 (August,
1923), 609. From 1919-1922 the county's infant mortality
rate was 99.4 and the maternal mortality
rate was 72, as opposed to state wide figures of
76 and 68; The Promotion of the
Welfare and Hygiene of Maternity and Infancy: Fiscal
Year Ended June 30, 1928, (1929), CB pub. No.186.
46. "Infant Hygiene," 609;
Monger met with the County Medical Society on July 10,
1923: "Progress of the State
Department of Health in Maternity and Infancy Work,"
OWV, 2 (March, 1924), no.9, 15.
47. "Ohio Sheppard-Towner
Activities," CBP, p.6; Kleinschmidt, 699. The first
public nursing service in Ohio was
provided by the Cincinnati Maternity Society
beginning in 1882. See Kriste
Lindenmeyer Dick, "The Silent Charity: A History of the
Cincinnati Maternity Society," Queen City Heritage, 43 (Winter, 1985), no.4, 29-33.
A
state Bureau of Public Health Nursing
was established in 1913.
122 OHIO HISTORY
The second demonstration was in Richland
County in northcentral
Ohio. Again, two state nurses were added
to the county's staff of three.
In 1922, prior to Ohio's acceptance of
the federal Maternity and
Infancy Act, the National Child Health
Council had begun coordinating
a "Child Health Demonstration"
in Mansfield, the county seat. The
Council, made up of representatives from
the American Child Hygiene
Association, American Red Cross, Child
Health Organization, Nation-
al Organization for Public Health
Nursing, and the National Tubercu-
losis Association, set aside $200,000 to
be spent over five years to
encourage coordination of children's welfare
organizations in "a
typical American community."
According to the project's director, Dr.
Walter H. Brown, the "chief purpose
was to select a city and county
which would be fairly typical of the
average of American life, the city
to have a population of between 20,000
and 30,000 and the rural area
surrounding it an equal number."
The plan included some other
specific requirements:
... that a normal percentage of the
population should be engaged in manufac-
turing; there should not be any striking
predominant racial stocks; there should
be a variety of industries; the
surrounding area should be an agricultural
territory; the community should be
located in the birth registration area and
vital statistics should be fairly
complete; the mortality of infants and children
should not be strikingly abnormal.
Finally, and most important of all, the
[local] medical, dental, and social
organizations ... would welcome the
opportunity of cooperating in such a
Demonstration.48
After "a long and careful study of
approximately eighty communities
which applied for the
Demonstration," the Child Health Council
decided Mansfield and Richland County
"most nearly met the require-
ments." Only the project director,
Walter Brown, was sent by the
Child Health Council. Local health
professionals and social workers
formed the project's staff. Funds from
the Council established a
primary health clinic in Mansfield and
secondary centers throughout
the county. To avoid attack by medical
conservatives the project's
director denied that it was a form of
"State Medicine" or a violation of
the "rights and privileges of the
physician in the field." By March 1924
the Child Health Council had helped
local Richland and Mansfield
officials to coordinate a plan for a
joint city and county health
department, and the Council began to
taper off its own direct partici-
pation in the project.49
48. Walter H. Brown, M.D., "Child
Health Demonstration Conducted in Mansfield
by National Child Health Council and
Cooperating Agencies," OSMJ, 18 (September,
1922), 629.
49. Ibid., 630; "Progress of the
State Department of Health," 15.
Saving Mothers and Babies 123
Later that year the Ohio Department of
Health sent two Sheppard-
Towner nurses to assist the three
Richland County staff nurses. From
1924 to 1926, there were 442 live births
and seven stillbirths to mothers
who received prenatal instruction under
the combined state and county
health demonstration. None of the women
receiving prenatal care died.
During the same period, there were 795
live births and 28 stillbirths to
Richland County women who received no
prenatal instruction, and five
of these mothers died. In the supervised
group, the infant mortality rate
was 22.6 (deaths of children under one
year of age per 1,000 live
births); it was 84.6 in the unsupervised
group. Thus stillbirths were less
than half as frequent among mothers with
prenatal care (1.6 percent as
opposed to 3.4 percent) and the infant
mortality rate was 235 percent
higher among babies whose mothers were
not included in the project.50
The third demonstration was in Athens
county, a rural area in
southeastern Ohio. One Sheppard-Towner
nurse was sent "to do some
intensive work in maternal and infant
hygiene" from 1924-1926.
Mining was the primary industry in the
county. In the three years prior
to the beginning of work by the state's
Sheppard-Towner nurse
(1921-1923), Athens county had a
maternal mortality rate of 85 per
10,000. During the two years of work
under the Maternity and Infancy
Act. the maternal mortality rate dropped
to 67.51 Again, the same type
of instructional and diagnostic program
was delivered to the women of
Athens County as in the two previous
examples.
The fourth demonstration took place in
Cincinnati. It differed from
the other three projects because it took
place in an urban area
(population approximately 414,000) and
was specifically focused on
saving the lives of only one group:
black mothers and babies. The city's
1920 population was 81.8 percent
native-born white, 10.7 percent
foreign-born white, and 7.5 percent
black. A study of the city's health
services in 1926 found that the maternal
death rate for black women in
Cincinnati was 143 per 10,000 live
births while for white women it was
102. The infant mortality rate for black
babies was 133 per 1,000 live
births and 69.7 for white.52 With
an appropriation of approximately
50. "Promotion of the," CB pub. No. 186; These figures
do not include statistics from
the cities of Mansfield and Shelby. The
combined city and county health department was
not fully in place until
after the close of the project.
51. "Progress of the
State Department of Health," 15; "Promotion of the," CB pub.
No.186: No separate statistics for women
who received prenatal and infant care
supervision are available,
but maternal mortality rates before and during the
implemen-
tation of Sheppard-Towner work are obtainable.
52. Although after Sheppard-Towner work in Cincinnati,
the most specific maternal
mortality rates for Cincinnati women
during the 1920s are in An Appraisal of Public
Health Activities in Cincinnati, Ohio for the Year 1926, (New York and
Cincinnati, 1927),
58-60.
124 OHIO HISTORY
$6,500 the State Department of Health
purchased some equipment for
two Cincinnati Department of Health
clinics, sent two of the state's
eight "Ford coupes" there, and
paid the salaries of two black nurses
hired to perform maternity and infant
care in Cincinnati's downtown
basin and West End neighborhoods where
68 percent of the city's black
population lived. These women worked
with three black nurses already
on the city's staff. This
Sheppard-Towner project began in late 1923
and continued until June 30, 1925.53
The "primary object was to secure,
as far as possible, medical care
of mothers and babies before, at, and
after birth" by maintaining a
roster of all black babies born in
Cincinnati from the beginning of 1923
to the end of the project. From this
roster the nurses made home visits
and encouraged new mothers to bring
their infants to health clinics
established at Frederick Douglass and
Harriet Beecher Stowe schools
located in the area. Clinics were open
daily during the summer and one
afternoon per week the rest of the year.
Seven hundred thirty-eight
different children were brought to the
stations for "physical examina-
tions, advice, and observation."
One of the nurses also made daily
visits to the St. Andrew's Day Nursery.
The importance of the nurses'
home visits and inquiries in the
neighborhood which identified expect-
ant mothers was recognized by the
Cincinnati Department of Health
when it reported that there "were
times when but for the intervention
of the nurse we might have lost babies
and mothers.... 54
In one case, reported in typically 1920s
social work terms, a "girl
barely sixteen years old [was] taking
care of a sick father, two little
brothers shut in the house becauses of
measles, doing the washing for
her illegitimate baby, all in one room
with the only facility for heating
water a bucket placed on the coals in a
grate." A Sheppard-Towner
nurse directed the girl to the city's
clinics where six months later with
"her baby shining and spotless, her
own clothing clean; how proud she
was when the nurse complimented her on
the beautiful care she gave
her baby." During the period of
Sheppard-Towner work in Cincinnati,
839 prenatal, 5,118 infant care, and
2,064 preschool nursing visits were
made.55
Another part of the Cincinnati program
was a series of lectures for
the "colored doctors"
sponsored by the pediatric department of the
University of Cincinnati College of
Medicine, the Cincinnati General
53. Special attention from government
health officials had been directed at the
specific health problems of Cincinnati blacks in an
article of the city's Department of
Health publication, the Sanitary Bulletin, (July 10, 1919), 1.
54. Ibid., 1.
55. "Cincinnati's
Participation," 6-7.
Saving Mothers and Babies 125
Hospital (the city's municipal
hospital), and the State Department of
Health during the observance of Negro
Health week in spring, 1924.
The city's Department of Health also
held a "Better Babies Contest"
in conjunction with this event.
Cincinnati was awarded "first prize for
the best observance in the United
States" by the National Negro
Business League.56 This was
the only effort focused solely on black
mothers and babies undertaken with
Sheppard-Towner funds in Ohio.5-
After the precedent of these first four
projects, State Department of
Health nurses were lent to county and
city Departments of Health
throughout the life of the Sheppard-Towner
program. Local health
departments supervised these women, but
their salaries were paid by
the State Department of Health. Home
visits to instruct mothers about
maternal and infant care were an
important part of the tasks performed
by these nurses. They were considered
extremely valuable because
they gave the nurses "an
opportunity to see the living conditions of the
family," and to make demonstrations
"with the equipment which the
home affords." In theory, as soon
as the State Department of Health
judged that "funds [were] provided
for their permanent continuance
[by the local community], the
federal-state funds [were] diverted to
assist other communities."58
In another example of the use of
Sheppard-Towner funds for public
health nursing, two State Department of
Health nurses were assigned
to arrange examination clinics in
communities under the auspices of the
local health department with the
assistance of local civic groups.
Mothers were invited to bring their
children to a specified place for a
56. Cincinnati Council of Social
Agencies, Public Health Federation Bulletin,
(January-February, 1923), 3; Cincinnati
first observed Negro Health Week in 1922; see
the same publication February-March,
1922, 14-15; For a further discussion of health
programs for blacks in Cincinnati see
Andrea Tuttle Kornbluh, "Metropolitan Plural-
ism," (Ph.D. dissertation,
University of Cincinnati, 1988).
57. Public Health Federation
Bulletin, (January-February, 1923), 6;
There is no
readily apparent evidence of reaction
from blacks in Cincinnati, but Cincinnati Depart-
ment of Health director, Dr. William H.
Peters, spoke about the city's Sheppard-Towner
activities for black mothers and babies
at the National Interracial Conference which met
in Cincinnati in March, 1925; Toward
Interracial Cooperation: What Was Said and Done
at the First Interracial Conference, (Cincinnati, 1925). Reprint edition, (New York,
1969).
58. Thirty-first Report, 199-200;
Kleinschmidt, 699; "Policy Regarding Nursing
Service in Ohio Under
Sheppard-Towner," OSMJ, 19 (December, 1923), 888; Athens
County (34 months), Belmont County (35
months), Cincinnati (40 months which involved
more than the district demonstration),
Columbus (36 months), Coshocton County
(1 month), Darke County (22 months),
Gallia County (23 months), Geauga County
(13 months), Highland County (14
months), Hocking County (17 months), Lawrence
County (13 months), Miami County (9
months), Perry County (17 months), Preble
County (22 months), Richland County (17
months), Wayne County (14 months);
Thirty-first Report, 198; "Progress of State Department of
Health," 15.
126 OHIO HISTORY
free diagnostic examination by a
community pediatrician who was paid
for this service by the State Department
of Health. In January 1925
Dr. O. L. Baldwin of Columbus was added
to the State Department of
Hygiene's staff to oversee these
clinics. In the presence of the mother
and the family physician (if it could be
arranged) the child was
"carefully examined" by a
doctor paid for his services with Sheppard-
Towner funds.59 No treatment
was prescribed or given, but the mother
was "urged to visit her private
physician for treatment" of the child if
that was necessary, and "if not,
for periodic checking-up of the child's
health." Local physicians were
interviewed by the nurses several days
in advance and invited to come to the
clinic. The clinics were limited to
children under six years of age and were
usually held in a school. In
connection with these clinics, an
afternoon or evening was set aside for
a meeting to which mothers and older
girls were invited. A movie on
pregnancy and child care was shown and a
baby was examined by a
pediatrician before the audience. Under
all of these arrangements the
Sheppard-Towner nurses did not
"engage in so-called case work; their
efforts were not bedside nursing, but
instructional."60 The educational
work done by these nurses provided the
bulk of Ohio's third phase of
the Sheppard-Towner program:
"general education."
Another often-used educational tool was
the health exhibition. "The
Ohio exhibit," explained a State
Department of Health report, consists
of "charts, posters, a model
layette, a baby's bed, articles necessary
for the baby's bath and simple home
equipment for the care of
infants." This exhibit was carried
around the state in an automobile
called the "Gypsy." A nurse
accompanied the exhibit to county fairs
or other public gatherings where the
display could be used. The State
Department of Health also used a
"Health Mobile" truck which
traveled the state equipped with a
generator, tent, movie projector,
health films, and literature promoting
good health care.61 Films pro-
duced by both public and private health
care organizations on cancer,
child hygiene, communicable diseases,
care of eyes, problems of pests,
milk, public health nursing, prenatal or
maternal care, smallpox,
venereal disease, teeth, and
tuberculosis were frequently shown. Ohio
Department of Health physicians and
nurses who accompanied this
Department's exhibition and "Health
Mobile" placed special emphasis
59. "What the Divisions Are
Doing-Field Notes," Ohio's Health, (January 1,
1925), 3.
60. Kleinschmidt, 699-700; Children's
Conferences," Ohio Health News, (November
15, 1925), 4.
61. "Health Education by
Truck," Ohio Health News, 1 (December 1, 1925),
no.23, 2.
Saving Mothers and Babies 127 |
|
on good maternal and infant care practices. The Department's staff lecturer was the vehicle's most frequent user and gave 5,939 talks before 895,704 people from her hiring on April 1, 1919, through 1929. Audiences included women's groups, youth groups (4-H clubs, high school and grade school audiences, camps, etc.), men's service clubs (the Rotary, and Kiwanis, etc.), church groups, student nurses, and farmers' and teachers' institutes in conjunction with the Agricultural Extension Service and Ohio State University. The "Health Mobile" traveled to county fairs each summer season, and made week long county visits in cooperation with the county health commissioner throughout the year. During 1929 alone, the "Health Mobile" and "Gypsy" visited thirteen county fairs and reached 5620 individuals. Dr. H.E. Kleinschmidt, Chief of the Ohio Division of Child Hygiene, described his experience working with the Department's "cargo of health" in a 1926 article appearing in the AMA's "lay" journal, Hygeia. He described audiences of children with "mouths agape and ... eyes shining." According to Kleinschmidt, rural Ohioans were "starved for a bit of amusement and thirsty for health knowledge." He also reported some of the trials he encountered on the road, including snow storms, "windy" co-speakers, mechanical difficulties, and audi- ences which failed to materialize.62
62. Ibid., 2; Thirty-first Report, 201, 205, 386-8; Kleinschmidt, 700; Promotion of the, CB pub. No.186; H.E. Kleinschmidt, "Leaves from the Diary of a Healthmobile," Hygeia, (March, 1926), 141. |
128 OHIO HISTORY
Sheppard-Towner nurses also conducted
educational classes in
which infant care techniques were taught
to seventh and eighth grade
girls. These "Little Mothers'
Leagues" were retitled "Health Build-
ers' Leagues" in 1927 when boys
were included in the program.
Instruction covered the care of the baby
and the preschool child,
bathing, dressing and feeding the baby,
"regulation of his habits,"
methods of preparing formulas, diet of
the preschool child, "social
hygiene" (which involved the
prevention of venereal disease), and the
prevention of communicable diseases. The
Division of Child Hygiene
prepared a handbook for leaders of these
groups.63
In addition to health instruction, the
League booklet reinforced
popularly held beliefs concerning the
"nature" of women. It claimed
that the "urge to live, protect and
guide the young is a natural attribute
of all normal women" and that the
"little girl's fascination for her doll
is an early manifestation of the
motherhood instinct." But, the booklet
warned, the "high infant mortality
rate of Ohio is a sad commentary on
the intelligence of our people. For want
of knowledge our babies die."
According to the booklet, "Little
Mothers' Leagues afford the oppor-
tunity to train the oncoming generation
of mothers in mothercraft."
The Division recommended that these
classes be led by a public health
nurse, meet weekly for fifteen weeks,
and include no more than twenty
individuals.
Concern that Sheppard-Towner type
programs might constitute state
interference with parental authority was
evident in a note cautioning
instructors against encouraging members
of the class to assume "the
responsibility of appearing to instruct
their own mothers .. . ," but, it
concluded that in instances where it
seemed "advisable," the mothers
could be invited to the meetings and
perhaps benefit from the instruc-
tion. Despite this possible conflict,
the benefits of Little Mothers' and
Health Builders' groups outweighed such
concerns for 1920s reformers
because they perpetuated the important
ideal that "the responsibility
for the health of her children lies with
the mother" in the next
generation of parents.64
The distribution of literature
concerning the prevention of maternal
and infant mortality and morbidity was
another important aspect of the
63. Thirty-first Report, 200;
Little Mothers' Leagues were first proposed by Dr. S.
Josephine Baker of the New York State
Department of Health. Ohio Department of
Health, Division of Child Hygiene,
"Little Mothers' Leagues: A Handbook for Lead-
ers," undated pamphlet (ca.1926)
located in Ohio Health Department files at the State
Library of Ohio, in Columbus.
64. Ibid., 2-12; also sees the 1927 and
1930 revised versions of the booklet entitled
The Care of Baby, provided to Health Builders' Leagues, Ohio Department
of Health,
Division of Child Hygiene, (Columbus,
1930).
Saving Mothers and Babies 129
state's educational program. These
pamphlets were largely prepared
by the U.S. Children's Bureau and the
Ohio Department of Health and
were "perhaps more far-reaching
than any other [effort] in its educa-
tional effect." Literature was
distributed at conferences and other
meetings. And, according to a Department
of Health report, "[s]carce-
ly any home was too isolated for postal
service." Significantly,
materials were sent to local health
departments for distribution in order
to insure that local officials and
physicians retained control over the
program. The number of materials
dispensed increased yearly, rising
from 100,000 pamphlets in 1925 to
242,000 in 1929.65
A similar type of program mailed
"prenatal letters" to expectant
mothers at the request of their doctors
or local health department.
These letters included prenatal health
care advice and emphasized "the
need of keeping in close touch with the
doctor." As in the case of all
efforts undertaken in Ohio with
Sheppard-Towner funds, this program
did not "replace the functions of
the physician, but rather create[d] a
demand for such medical service."
Women who did not have a private
physician were sent letters encouraging
them to select one.66
Physicians were also the targets of
maternity and infancy educational
work. The state's Director of Health and
the Chief of the Division of
Child Hygiene addressed doctors through
lectures and publications.
They urged higher standards of
obstetrical and child care, "in the hope
that slipshod, inadequate methods which
are still in vogue in some
localities will give way to a higher
class of medical service." They also
urged doctors to use only state licensed
and inspected maternity
hospitals for their patients.67
Over the seven years of the act's
existence, mothers and infants in
82 of Ohio's 88 counties benefited from
Sheppard-Towner activi-
ties.68 The infant mortality
rate fell from 75 per 1,000 live births in 1921
to 68 in 1929, and the maternal death
rate dropped from 72 per 10,000
live births to 62. During this period
approximately 906,782 babies were
born in Ohio, and the State Department
of Health claimed that it
reached 10 percent of the state's
expectant mothers.69 Federal funds
totalling $150,978.75 were spent, but
this was only 42 percent of the
possible $359,897.63 actually available
to Ohio. In combined state and
65. Thirty-first Report, 201.
66. Kleinschmidt, 700.
67. Ibid., 700; "Standards for
Maternity Hospitals," OSMJ, 107-08.
68. Available State Department of Health
records do not show which six counties
failed to participate in the Ohio
program.
69. Ohio Department of Health,
"Birth Rates by County, report #877; Thirty-first
Report, 389; "Promotion of," CB pub. No.203, 132-37; Historical
Statistics, 57; U.S.
rates were: 1921 I.M. 75.6, M.M. 68.2;
1929 I.M. 67.6, M.M. 69.5.
130 OHIO HISTORY
federal funds, $289,849.01 were spent to
save the lives of Ohio's
mothers and babies during the seven
years of Sheppard-Towner's
existence.70
State Health Director Monger wanted
local communities eventually
to take on the responsibility for
programs started with Sheppard-
Towner funds. This was realized in only
nine Ohio counties and two
cities: Athens, Geauga, Hocking, Perry,
Richland, Wayne, Preble,
Darke, and Miami counties and Columbus
and Cincinnati. Private,
municipal, and county agencies combined
to continue maternity and
infancy work in these areas. The state
legislature did continue state
appropriations at roughly the same
level, but since there were no longer
federal matching funds, the amount of
money spent on maternity and
infancy work in Ohio was cut in half
after June 30, 1929.71
Throughout the years of the federal
Sheppard-Towner Maternity and
Infancy Act the Ohio Department of
Health continued to develop its
decentralized health program established
under the state's 1917
Hughes-Griswald Act. In addition, the
Sheppard-Towner Act almost
exclusively involved diagnostic and
educational programs. The only
exceptions were a program immunizing
children against diphtheria and
another project which distributed silver
nitrate to prevent blindness in
newborns.72 These efforts did
not cause a conflict with the OSMA
because it appears that such measures
were not viewed as medical
treatment. They were defined in the same
context as accepted govern-
mental responsibilities for providing
clean water, pure milk, and
sewers. The diagnostic and educational
policy followed by the Depart-
ment of Health was formulated largely
under the influence of Ohio
physicians. But ironically, the OSMA
continued to condemn the
Sheppard-Towner program. OSMJ editorials
denounced extension of
the program, and its criticism continued
until the act's expiration on
June 30, 1929, and beyond. The OSMJ argued
that it was "interested
in the reduction of unnecessary maternal
and infant mortality ... "
but it was not able to support a federal
maternity and infancy program
due to its "sound opposition to
federal centralization; impersonal and
detached supervision; unnecessary
expenses; duplication of activities
... [and] the possible development from
'education' to actual 'care and
treatment.' "73
70. U.S. Children's Bureau, The
Promotion of the Welfare and Hygiene of Maternity
and Infancy: Fiscal Year Ended June
30, 1929, (1931), CB pub. No.203, 2-3;
"Promotion
of the," CB pub. No.203; "The
Seven Years History," 564.
71. Thirty-first Report of, 390;
"The Seven Years History," 566.
72. Thirty-first Report of, 566-67.
73. "Maternity and Infancy
Developments, 886.
Saving Mothers and Babies 131
At first it appeared to Sheppard-Towner
supporters that the success
of the Maternity and Infancy Act would
enable an extension to pass
easily.74 However, the
program's opponents were better organized by
1926 when the act was due for renewal. A
compromise not only
extended the program for two years, but
also terminated it on June 30,
1929. Efforts to sway physicians to
support a federal maternity and
infancy bill had not only failed, but
backfired.
Saving Mothers and Babies?
The Sheppard-Towner program in Ohio was
probably not exception-
al, although no definitive statement may
be made until we have some
studies of other states. It is difficult
to quantify the program's
successes. One important result of the
program, however, is clear.
Public awareness concerning the value of
preventive prenatal and
infant health care was significantly
increased, so that Ohio efforts
designed to save the lives of mothers
and babies never returned to
pre-Sheppard-Towner levels.
The state's lower infant mortality rate
cannot be attributed to
Sheppard-Towner alone. The infant death
rate had been declining
steadily for a number of years. In 1914,
99 Ohio babies died for every
1,000 live births in the state. By the
close of 1922, the number had
decreased to 74 and by the end of the
Sheppard-Towner program had
fallen to a rate of 66 per 1,000.75
A similar but less dramatic decline in
the state's maternal mortality
rate occurred. In 1917, (the first year
state wide maternal mortality
rates are available, and the year Ohio
joined the United States
Birth-death registration area), 71 Ohio
mothers died of causes associ-
ated with pregnancy for every 10,000
live births. By the close of 1928,
the maternal mortality rate declined to
64.76 Admittedly, while both the
infant and maternal mortality rates
simply reflect a continuing trend,
the efforts of the Ohio Department of Health
under the Sheppard-
Towner program must have contributed to
this decline.
The data reported by the Ohio Department
of Health show the extent
of Sheppard-Towner influence. From July
1, 1928, to June 30, 1929,
74. For example see Julia Lathrop,
"Mothers and Babies First!" Woman Citizen,
7 (December, 1926), 41.
75. Ohio Division of Vital Statistics, Summary
of Statistics for Deaths and Births
1930, 1931 and 1932, 23; the infant mortality rate did show a slight
increase in 1929 to 68,
but again resumed its decline in 1930 to
61.
76. U.S. Children's Bureau, Promotion
of the Welfare: Fiscal Year Ended June 30,
1929, CB pub. No.203, 137.
132 OHIO HISTORY
alone, 4,528 children were examined in
118 infant and preschool health
conferences (clinics). Department of
Health nurses made 219,064 home
visits. Of the individuals visited,
6,181 were pregnant women, 3,215
were postnatal women, and 32,725 were
infants and preschool chil-
dren. The Department claimed to have
reached by either literature or
a visiting nurse 17,118 (ie., 10
percent) of the infants born during that
period, and a similar percentage of the
state's expectant mothers
received prenatal instructions.77
Another contributing factor to the
decline in Ohio infant and
maternal mortality was generally
improved health care provided for
women and children either directly or
indirectly as a result of Sheppard-
Towner programs. Prior to 1918 no public
child health work was
carried on in any rural territory in
Ohio, although a small amount was
done in a few cities. By the expiration
of Sheppard-Towner in Ohio,
23 percent of the nursing service
directed by local health departments
in rural counties included child
hygiene. In the cities, 51 percent of
similar nursing time was devoted to
children's health care. Improved
standards in maternity homes and
hospitals providing maternity care
were a direct result of the state's
Sheppard-Towner inspection pro-
gram. During 1928, 192 hospitals and
maternity homes were inspected.
There were 35,527 infants born in Ohio
hospitals and maternity homes
during that year (29 percent of all Ohio
births).78 Another significant
impact of Sheppard-Towner was the fact
that the Ohio Department of
Health's Division of Child Hygiene
remained intact after the act's
expiration. Efforts to promote the
welfare of mothers and babies in
Ohio which had begun in 1915 became a
permanent and discrete part of
the Ohio Department of Health's public
health care program. Howev-
er, the withdrawal of federal funding
for maternity and infancy work
cut the state's total expenditure for
that purpose in half.
The controversy over the beginning of
Sheppard-Towner contributed
to the atmosphere of concern over the
country's unnecessarily high
rate of mother and infant deaths. As
part of this concern some Ohio
doctors, especially obstetricians and
gynecologists, began to call for
better maternal and infant care.79 The
increasing use of instruments,
77. Thirty-first Report, 388-89.
78. Ibid., 388-90.
79. L.R. Fast, M.D., "A Plea for
Better Obstetrics," OSMJ, 17 (January, 1921),
23-25; other OSMJ articles:
William D. Fullerton, M.D., "The Care of the Pregnant
Woman," 17 (January, 1921), 25;
Arthur H. Bill, M.D., "Anesthesia in Obstetrics,"
17 (April, 1921), 613; William H.
Gillespie, M.D., "Relief of Pain in Labor,"
17 (October, 1921), 669.
Saving Mothers and Babies 133
caesarian sections, and anesthesia was
demanding a professionalization
(and hospitalization) of medical care.80
Historian Clarke Chambers has discussed
the growing trend toward
professionalism in America during the
1920s.81 Medicine was especial-
ly susceptible to this phenomenon. The
1910 Flexner Report served as
the chief catalyst for standardizing
medical education in the United
States. The AMA aggressively lobbied
states to allow only physicians
and nurses graduated from
"standardized" medical and nursing schools
to treat illness or teach preventive
health care.82 Even members of the
Children's Bureau increasingly placed
the ultimate responsibility for
saving the lives of mothers and babies
with physicians. But, it was
through the phenomenon of
professionalization that physicians outside
the Children's Bureau began to take
control of maternal and child
health. A 1923 advertisement for infant
formula in the OSMJ clearly
illustrates the changing position of
physicians and infant health care.
The advertisement declared:
THE DOCTOR IS THE PILOT-The life-saver
of the infant-
BRING ON THE PILOT
It's time for the infant to come into
its own
It's time that the doctor should roll up
his sleeves
and take infant feeding into his own
hands.
It's time to establish the doctor in the
eyes of the
citizenship-that he is the first man in
the community.
It's time to have mothers point out
strong, healthy,
happy babies fed by the family doctor.
SUCCESS. Put infant feeding where it
belongs-in the
hands of the doctor.83
This trend toward professionalization
placed the well-established
OSMA in a strong position to insure that
the Ohio Sheppard-Towner
program would remain purely educational
and diagnostic in nature.
The founders of the national program
envisaged state maternity and
80. See Judith Walzer Leavitt, Brought
to Bed: Birthing Women and Their Physi-
cians, 1750-1950, (New York, 1986), Chapter 5; Leavitt, "Birthing
and Anesthesia: The
Debate Over Twilight Sleep," Signs:
Journal of Women in Culture and Society,
6 (Autumn, 1980), no. 1, 147.
81. Clarke A. Chambers, Seedtime of
Reform: American Social Service and Social
Action, 1918-1933, (Minneapolis, 1963); Robert W. Wiebe, The Search for
Order,
1877-1920, (New York, 1967).
82. Paul Starr, The Social
Transformation of American Medicine, (New York, 1982);
James G. Burrow, AMA, (1963);
Ellen Corwin Cangi, "Principles Before Practice: The
Reform of Medical Education in
Cincinnati Before and After the Flexner Report,
1870-1930," (Ph.D. dissertation,
University of Cincinnati, 1983).
83. Advertisement for Mead's infant
formula, OSMJ, 19 (July, 1923), 550.
134 OHIO HISTORY
infancy programs being run by and for
women. But, in the final
analysis, the Ohio Sheppard-Towner
program failed to set such a
course for maternal and infant care.84
Two important assumptions, ultimately
proved false, were held by
the designers of the Sheppard-Towner
Act. First, Julia Lathrop and
Florence Kelley (who developed the idea
for such a program to be
administered through the Children's
Bureau as early as 1916) expected
that the women's movement would remain
strong and that women
would vote as a bloc. Instead, as
historian J. Stanley Lemons main-
tains, women, although politically
active, did not vote as a bloc and
"social feminism" entered the
"famine years" during the 1920s.85
Second, the Sheppard-Towner advocates
assumed that health care for
mothers and babies would be managed by a
strengthened women's
movement. Instead, trends toward
professionalization, a more conser-
vative political atmosphere, and an
already falling infant mortality rate
combined to create a climate of opinion
in which ending a federal act
designed to "promote the welfare
and hygiene of maternity and
infancy" could be countenanced.
In 1935, Children's Bureau Chief
Katharine F. Lenroot (Abbott's
successor in 1932) wrote that the
maternity and infancy section of Title
V of the Social Security Act covered
essentially the same efforts (and
more) and had the same general purposes
as the earlier Sheppard-
Towner Act.86 Some scholars
have argued that this fact is the most
significant aspect of the
Sheppard-Towner Maternity and Infancy
Act.87 Others have focused on
the program as evidence of progressiv-
ism and women's political power in the
early 1920s.88 But, neither of
these approaches confronts the strengths
and limitations of the pro-
gram itself. The major accomplishment of
the first Maternity and
Infancy Act was its ability to raise the
public's consciousness about
preventing the deaths of mothers and
babies. The act's chief weakness
lay in its limited "education
only" approach. An analysis of the
historical significance of
Sheppard-Towner should not focus merely on
its ability or inability to blaze a path
for the future or as evidence of the
political power of its supporters, but
should also consider what it
contributed to saving and improving the
lives of mothers and babies.
84. In 1922, forty-five of forty-eight
state directors of child welfare were women. By
1939, three quarters of these positions
were held by men. S. Josephine Baker, Fighting
for Life, (New
York, 1939), 201, cited by Ladd-Taylor, Raising A Baby, 32.
85. Lemons, The Woman Citizen, 228-47.
86. Letter from Katharine F. Lenroot to
Senator Morris Sheppard, June 19, 1935,
CBP, RG #102, Box 613, 13-0-1, NA.
87. Chepaitis, "The First Federal
Social Welfare Measure,"; Schlesinger, "The
Sheppard-Towner Era,"; Siefert,
"An Exemplar of Primary Prevention,"; Ladd-Taylor,
Raising A Baby.
88. Lemons, The Woman Citizen, 228-47.
KRISTE LINDENMEYER
Saving Mothers and Babies: The
Sheppard-Towner Act in Ohio,
1921-1929
In 1985 (the year for which the latest
statistics are available), 10.6
American babies died for every 1,000
live births in the United States.
This is a dramatic improvement over the
country's 1921 infant mortal-
ity rate of 76 per 1,000, but as in
1921, the United States' rate continues
to compare poorly with many other
industrialized countries. In 1921,
the United States rate ranked
seventeenth out of twenty "modern"
nations.1 The 1985 rate
placed the U.S. eighteenth, and a Children's
Defense Fund report contends that,
contrary to popular opinion, infant
mortality is actually worsening in some
categories. Dr. Marsden
Wagner, director of the World Health
Organization's maternal and
child health program, maintains that
"infant mortality is not a health
problem ... [but] ... a social
problem" which should be addressed
through "more social education for
families" and by insuring that the
"basic level of financial and
social support ... be provided to families. "2
But, his is not a new idea. In 1921, the
United States Congress passed
legislation designed to attack the
country's high infant mortality rate by
"promoting" better prenatal
and infant care.
The Sheppard-Towner Maternity and
Infancy Act was passed in 1921
as the first federal health care
legislation to "promote the welfare" and
prevent unnecessary deaths of mothers
and babies in America.3
Kriste Lindenmeyer is a Ph.D. candidate in
history at the University of Cincinnati.
1. For a comprehensive
list of
the nations cited in the
1921 Congressional Hearing
on
Sheppard-Towner, see Promotion of the
Welfare and Hygiene of Maternity and Infancy:
The Administration of the Act of
Congress of November 21, 1921, Fiscal Year
Ended June 30, 1929, (Washington,
D.C., 1931), Children's Bureau Publication
(CB pub.) No. 203, 139.
2. Associated Press, "High Infant-death
Rate in U.S. Blamed on Skimpy Social
Help," Cincinnati Enquirer, 3
February 1988, sec. B, p.8; see also Children's Defense
Fund, A Children's
Budget: An Analysis of Our Nation's Investment in Children,
(Washington, D.C.,
1988), 61-62.
3. The Sheppard-Towner Act passed the
U.S. Senate by a vote of 63-7 on July 22,
1921. An amended version passed the
House on November 21, 1921, by a vote of 279-39.