The Promotion of the Welfare and Hygiene of Maternity and Infancy Act, more commonly known as the Sheppard–Towner Act was a 1921 U.S. Act of Congress that provided federal funding for maternity and child care. It was sponsored by Senator Morris Sheppard (D) of Texas and Representative Horace Mann Towner (R) of Iowa, and signed by President Warren G. Harding on November 23, 1921.
The Sheppard–Towner Act was the first venture of the federal government into social security legislation and the first major legislation that came to exist after the full enfranchisement of women. This marked the political and economic power of women’s issues since the bill was passed due to pressure from the newly formed Women's Joint Congressional Committee. Before its passage, most of the expansion in public health programs occurred at the state and local levels. Many factors helped its passage including the environment of the Progressive Era.
The act was a response to the lack of adequate medical care for women and children, including reports from Department of Labor's Children's Bureau that found 80% of all expectant mothers did not receive any advice or trained care. The Bureau also investigated high rates of infant and maternal mortality rates. After examining 23,000 infants, they concluded that the infant mortality rate was 111.2 deaths per 1000 live births, which was higher than most other industrialized countries. The problems were usually preventable and were attributed to the lack of infant care knowledge.
For example, rural women had limited access to medical care. Less than half the women in a rural area in Wisconsin were attended to by doctors, and even then, the doctors sometimes arrived post-birth to cut the cord. The study also found a correlation between poverty and mortality rate. If a family earned less than $450 annually, one in six babies died within the first year; between $640–850, one in ten; over $1250, one in sixteen.
Representative Horace Mann Towner (R-Iowa) and Senator Morris Sheppard (D-Texas) introduced in 1920 the bill that was modeled after a similar bill presented by Representative Jeannette Pickering Rankin (R-Montana) in the previous session. The Senate passed the bill in December 1920 after debates about funding and administration. The House however did not vote on the bill since the hearings were held at the end of December. The American Medical Association and the Women Patriot Corporation opposed the bill. AMA feared that government intervention would lead to non-medical provisions of medical services. Woman patriots were anti-suffragists who also opposed the bill fundamentally. President Harding endorsed the bill in April 1921 and it was reintroduced to congress. The House passed the bill 279 to 39, and the Senate passed it 63 to 7.
Appropriation of $1,480,000 for fiscal 1921-1922 and $1,240,000 for the next five years ending in June 30, 1927 were made for the Act. Of the funds, $5000 would go to each state with a dollar for dollar matching up to an explicit cap determined by the state’s population. Costs of administering the program would not exceed $50,000. This program was administered by Children’s Bureau, though the states could decide how to utilize the money themselves. The act, however, also provided a guide to the instruction of hygiene of maternity and infancy care through public health nurses, visiting nurses, consultation centers, childcare conferences, and literature distribution called "prenatal letters".
The Sheppard–Towner Act led to the creation of 3,000 child and maternal health care centers, many of these in rural areas, during the eight years it was in effect. The United States Children's Bureau worked extensively with state-level departments of health to advise them on how to use Sheppard-Towner funding.
The overall U.S. infant mortality rate in 1922 was 76.2 deaths per 1000 live births. By the time that Sheppard-Towner was repealed in 1929, the infant mortality rate had fallen to 67.6, with a net decrease of 9.6 deaths per 1000 live births. There was already a downward trend in infant mortality during the 1920s; not all of the decrease was due to Sheppard-Towner.
States that spent one standard deviation of money on "child-life", or approximately $27, reduced infant mortality on average by 2.8 deaths per 1000 live births. States that spent one standard deviation of money on health and sanitation, or approximately $188, reduced infant mortality on average by 6.27 deaths per 1000 live births. Home nurse visits reduced infant mortality on average by 1.8 deaths per 1000 live births. One standard deviation increase of the number of health centers decreased infant mortality on average by 2.25 deaths per 1000 people. An increase in 30 “prenatal letters”, letters that provided information on prenatal and well-child care, decreased infant mortality on average by 0.2 deaths per 1000 live births.
There were different effects on white and non-white populations of states that decided to participate in Sheppard-Towner. For whites, one standard deviation of spending on child life reduced 1.5 deaths per 1000 live births, and one standard deviation of spending on health and sanitation reduced infant mortality by 3.8 deaths per 1000 live births while for non-whites both had no statistically significant effect on reductions. Nursing visits reduced white infant mortality by 1.2 deaths per 1000 live births while non-whites with the same nursing visits had 8.7 decrease in infant mortality. With the health centers that were constructed, 1.9 deaths per 1000 live births were reduced for white infant mortality and 8.4 deaths per 1000 live births were reduced for non-white infant mortality. Finally for prenatal letters, white infant mortality was reduced by 0.2 deaths per 1000 live births and non-white infant mortality reduction was not statistically significant.
Overall mortality rate would have been 0.7 and 1.9 deaths per 1000 births higher without Sheppard-Towner. That would make up 9 and 21 percent of the decline of infant mortality during the enactment of the Act. Aggregate effect of Sheppard-Towner was driven primarily by the non-white populations. White infant mortality rate would have been 0.15 to 1.0 deaths higher whereas non-white rate would have been 9.9 to 13 deaths higher.
Federal appropriation for Sheppard-Towner was $776,676.54, suggesting that one infant death could be prevented for between $118 and $512 in federal expenditures.
End of the Act
Massachusetts, Connecticut and Illinois never participated in the program. Participation in the program varied depending on states. The Act was due for renewal in 1926, but was met with increased opposition. Hence, Congress allowed the act's funding to lapse in 1929 after successful opposition by the American Medical Association, which saw the act as a socialist threat to its professional autonomy. This opposition was in spite of the fact that the Pediatric Section of the AMA House of Delegates had endorsed the renewal of the act. The rebuking of the Pediatric Section by the full House of Delegates led to the members of the Pediatric Section establishing the American Academy of Pediatrics. The Act was held unconstitutional by the Supreme Court in 1922 but the Act continued to be in force until 1929.
- Text of the Act
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