1921

Passage of Sheppard-Towner Maternity and Infancy Act, “women’s legislation”: government provides states with matching funds to establish prenatal and child-health centers, to be administered by the Children’s Bureau. Its passage was orchestrated by the Bureau’s head, Julia Lathrop, who mobilized the states’ child hygiene divisions that were created under the Women’s Committee of the Council of National Defense during the war and harnessed the lobbying power of the Women’s Joint Congressional Committee (WJCC) organized in 1920 and initially representing 10 national women’s organizations (Muncy, 101ff.). The Children’s Bureau administered the act; it recommendations re the acceptability of state programs were rubber-stamped by the special Board of Maternity and Infant Hygiene set up under the act: “Passage of the Sheppard-Towner Maternity and Infancy Act, then, expressed women’s power at this unique juncture to determine federal child welfare policy even despite the legal ability of a male Congress to prevent it, and success was due in large part to the professionalization and institutionalization of the female movement for child welfare reform. . . . [By 1927, only three states remained outside the Shepard-Towner fold, so] The Maternity and Infancy Act thus legalized the previously unofficial relationship between the Children’s Bureau and analogous agencies in the states” (196, 107). An annual average of 750 nurses worked around the country as home visitors, driving “health cars” loaded with films, charts, posters, and pamphlets; they preached the behaviorist canon of “habit formation.” S-T opposed by AMA as “un-American” and was allowed to lapse in 1929 (M-S, 301-302; Stevens, 143-144; Sealander, 226-234), owing, inter alia, to fractionation of female voting bloc, marginalization of activist female reformers (“Bolsheviks”), and capitulation of congressional democrats to governmental inactivism following Coolidge’s election in 1924 (Muncy, 128-131). In both the Children’s Bureau (which administered the act) and the state maternity and infancy programs, “women also ran the show” (108). Other S-T activities included health conferences, birth registration, training midwives in 31 states; 40 of 89 full-time docs in state child health bureaus that relied on S-T funding were women. Failure to renew S-T in 1929 owed, inter alia, to AMA, which criticized S-T as harboring “communistic” sympathies and characterized its clinics as second-class clinics run by second-class docs. It was also opposed by clinical (but not academic or research) pediatricians, who viewed it as a challenge to private practice. Its nonrenewal signified the marginalization of public health during the “private practice” response to S-T to promote for first time “periodic health exams” for children and adults (More, 155-158). For AMA leadership, it was all about money and the “hoarding” of professional knowledge: “. . . leaders in the AMA understood rightly that the professional code embodied in the Sheppard-Towner Act clashed utterly with their own: while public service values were central to the professionalism of women in the child welfare dominion, profits were central to that of the AMA leadership” (Muncy, 139). In Appalachia, “private physicians eventually moved to limit the boundaries of public health as well as the parameters of acceptable nonprofessional involvement in advocating and financing medical care . . . If doctors rejected the concept of educating lay midwives and elevating nurse-midwives to a professional level, they were equally wary of the increased autonomy of public health nurses” (Barney, 134, 137). “As independent field nurses, public health educators, and school inspectors, these women gained legitimacy and furthered their professional maturity. . . .Public health nurses . . . were both unwilling and unable to accept the absolute authority of the medical community. . . . many doctors feared the presence of public health nurses (Barney, 138, 139). Conservatism of late 20s  replacement of independent women’s organizations by women’s auxiliaries of state and local medical societies: “Physicians helped develop these dependent auxiliaries into the perfect propaganda machines” (150).