Sheppard Towner Act

Being the first social welfare program that was federally funded, the Sheppard Towner Act of 1921 laid the foundation for maternal and infant care. Causing the establishment of almost 3,000 prenatal care clinics, over 3,000,000 travelling nurse visits and 180,000 infant healthcare courses, the effectiveness of the Sheppard Towner Maternity Act of 1921 cannot be argued against.

So, how was the Sheppard Towner Act passed, and why was it not renewed?

The Sheppard-Towner Act of 1921

The Sheppard Towner Act of 1921 was first passed in the Senate, but on 19 November 1921, officially passed the House of Representatives by a landslide vote of 279 to 39. As a part of the 'Scientific mothering' movement, the 1921 Sheppard Towner Act wished to apply a scientific approach to the education and care of mothers and infants.

The Act provided healthcare and education to mothers and families that were in the lower classes as the act provided federal funds which were used to set up infant welfare and prenatal programs. The Act's funding was planned over a five-year course, in 1927 the Act was extended two years and was repealed in 1929.

Sheppard Towner Maternity Act

Morris Sheppard and Horace Towner introduced the National Maternity and Infancy Protection Act to congress in 1921 as Senate Bill 1039. In summary, the Sheppard Towner Act successfully helped to distribute information on hygiene and nutrition, provided training in the midwifery sector of healthcare, rapidly grew the nurse visits for new mothers and pregnant women and set up health clinics for infants and women where some nurses and physicians could care for and educate those who visited.

Fig. 1 Prenatal Care Illustration

• The bill requested appropriations: $10,000 per state.
• A federal matching grant system would then enact four million dollars to be given annually.
• Programs to educate women on prenatal health and the proper care of infants would be funded by the $10,000 grant.

• State funding would be reimbursed by the four million dollars of federal funds outlined by the Act.

• The Children’s Bureau would be in charge of the ongoings of the Act. This meant that state officials would report the progress of the programs within their states to the Children's Bureau.

• In July 1921, the bill passed in the Senate and then in the House of Representatives four months later. The amount of money per state was decreased to $5,000 and the matching federal funds were reduced to $1.2 million.

• States’ involvement was also made voluntary.

History of The Sheppard Towner Act

One of the influences of the Sheppard Towner Act was that during the time of its formation, the second leading cause of death for females was childbirth. Around 20% of infants in the US would die before they reached two, with a further 33% dying within five years. Statistics such as this highlight the dangers of pregnancy and childbirth and the high mortality rates of children during this period, signifying the importance of the Act.

Fig. 2 The Roaring Twenties Lobby Card

Sheppard Towner Act Timeline

Although only seen in action between 1912 and 1929, the Sheppard Towner Act marks the beginning of federal healthcare for pregnant women and children, and its importance on the development of the safety of childbirth still radiates today.

The Sheppard Towner Act Support and Opposition

Supported by the social reformers, the progressives and the feminists, the Sheppard Towner Act was believed to be the change that was needed to curb the drastically high US infant mortality rate during this period. Alongside this, the Sheppard Towner Act is a perfect example of how the life of women in the 1920s was rapidly changing.

Fig. 3 Rally of women voters 1920

• The 19^th Amendment was added to the constitution on 26 August 1920, recognising women as people and giving them the right to vote in political matters.
• Birth control was created on 14 March 1920 by the American Control League.
• Women were given access to further education, allowing them to attend the University of Carolina on 9 September 1921.
• The Era of Flappers in 1922 spiked the idea of modernism and the status of women started to be altered.
• Nellie Tayloe Ross was the first woman to be elected as a US governor on 11 January 1925.
• Women competed in field events for the first time during the 1928 Amsterdam Olympics.

Julia Lathrop and the US Children's Bureau

Feminist and member of the US Children's Bureau, Julia Lathrop, drafted the language of the Sheppard-Towner Act for Jeannette Rankin to bring to Congress in 1919. Although Rankin was not in Congress when the Act was passed in 1921, Rankin attended the House of Representatives whilst they debated on the bill. Another supporter of the Act and its contributions to the progressive movement was President Warren G. Harding.

Fig. 4 Julia Lathrop

American Medical Association and The Supreme Court Challenge

Opposition to the Sheppard Towner Act included the AMA. Groups such as this feared that the Act would create a sector of socialist medicine and healthcare, the AMA's documents on paediatrics describe the Sheppard-Towner bill and the programs that it created as 'socialistic'. Other critics and opposing groups used the rights of state and community autonomy to support their belief that the Act was impeaching parent-child relationships and their privacy.

Effectiveness of the Sheppard Towner Act

Just how effective was the Sheppard-Towner Act? Historian Molly Ladd Taylor writes that "indication of the program's success was the significant decrease in infant mortality during the Sheppard-Towner years".¹ Carolyn M. Moehling and Melissa A. Thomasson come to the conclusion that with the increase in one-on-one contact between patient and nurse, and the follow-up care that the Act provided, its effectiveness was inevitable.

Sheppard Towner Act Significance

The Sheppard Towner Act and its significance for the advancements in federal contribution to the healthcare sector of the pregnant, recent mothers and infants are vast. With the Act being the first federally funded social welfare program that addressed the essential needs of women and children during this time, it is significant in the development of female protection.

Fig 6 Anti-Feminist Poster

• The Sheppard-Towner Act was challenged by the Supreme court; the challenge failed.
• Female activists Jeannette Ranking, Grace Abbot and Julia Lathrop, considered the Sheppard-Towner Act to be a part of a bigger movement for the feministic enhancements of rights in the Roaring Twenties–like women's suffrage–and it helped to prove women's activism power.
• The Act provided evidence that introducing education and science to the application of preventive care would have a large impact on infant and maternal mortality rates.

End of The Sheppard Towner Act

29 August 1929 brought with it a change in the political climate, vast financial failures and most importantly the Great Depression. This meant that when the Sheppard Towner Act expired, there was no longer the economic means for the state to provide matching grants to support the healthcare programs that had been set up.

The consequences of this were that the Sheppard-Towner Act was no longer ongoing and the majority of maternal and infant care clinics were closed. The opposing group of the American Medical Association was also an influencing factor that caused the defunding of the Act, although there was a divide in opinion among the group by 1929. The American Medical Association of Delegates fought to overrule the Paediatric Section of the Medical Association as, by this time, the Paediatric sector had been convinced of the effectiveness of the Act, supporting its renewal.