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. 

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Table of contents

    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 The Act's funding was planned over a five-year course, in 1927 the Act was extended two years and was repealed in 1929.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.

    Sheppard Towner Act Prenatal Care Illustration StudySmarterFig. 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.

    Did you know?

    Two years earlier, Sheppard and Towner had introduced and passed a similar bill called Senate Bill 3259 which failed in the House of Representatives.

    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.

    What about the future of the Sheppard Towner Act?

    Many states continued to fund the programs that were already established through the Sheppard Towner Act. This did not last long, as federal funding had been stopped, and the 1930s saw the beginning of financial ruin during the Great Depression.

    Sheppard Towner Act The Roaring Twenties Lobby Card StudySmarterFig. 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.

    1912Establishment of the US Children's Bureau.
    1913-1915Mortality rate studies carried out by the US Children's Bureau.
    1917The US Children's Bureau's annual report suggested a federal program to the Secretary of Labour.
    December 1920Bill 3259 passed the Senate but failed the House of Representatives.
    July 1921Bill 1039 passed the Senate and the House of Representatives.
    23 November 1921Warren Harding, the US president, signed bill 1039 into law.
    1922A total of 41 states had access to the Sheppard Towner Act funds.
    1925Over 500 prenatal clinics had been established.
    1927A bill that would have ensured the renewal of the Sheppard Towner Act was not passed by US Congress, instead, a two-year extension was approved.
    19283 million home visits to women with infants by around 3,000 public nurses had been achieved.
    30 June 1929The Sheppard Towner Act expired.
    August 1935The Social Security Act was signed into law by President Roosevelt.

    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.

    Sheppard Towner Act Rally of women voters 1920 StudySmarterFig. 3 Rally of women voters 1920

    • The 19th 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.

    Sheppard Towner Act Julia Lathrop StudySmarterFig. 4 Julia Lathrop

    The Progressive Movement

    A political movement that aimed to improve human conditions through its enhancement of science, social organisation, the economy and technology through its reforms.

    US Children's Bureau

    Established in 1912, the US Children's Bureau was the federal department that was issued with the responsibility for any arising issues that concerned the health of children. Julia Lathrop, the Bureau's chief, focused the first year of the Bureau's investigations on infant mortality, something that was drastically high during the 20th century. A number of studies were conducted from 1913 to 1915. They found:

    • Areas impacted by poverty and low education were prone to a higher number of infant deaths.
    • Pregnant women in rural areas were at high risk of medical issues.

    Sheppard Towner Act US Children's Bureau StudySmarterFig. 5 US Children's Bureau

    In 1917, Julia Lathrop in her annual report of the Children's Bureau suggested to the Secretary of Labour that creating a federal program that focused on improving the hygiene, health and education surrounding mothers and children would prove beneficial. Lathrop promoted her idea and gathered support over the next year such as the National Women's Trade Union and General Federation of Women's Club. This support proved essential in the progression of the Sheppard-Towner Act.

    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.


    American Medical Association.


    System of the collective, based on public ownership and its control over providing services and distributing commodities.

    Did you know?

    Alice Robertson, Oklahoma's representative and the singular woman in congress during the Sheppard-Towner Act, opposed the bill.

    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.

    Overall, we estimate that Sheppard-Towner activities can account for 9 to 21 percent of the decline in infant mortality over the period.2

    - Carolyn M. Moehling and Melissa A. Thomasson

    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.

    Sheppard Towner Act Anti-Feminist Poster StudySmarterFig 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.

    Social Security Act of 1935

    Providing federal grants to states to support health programs for infants and mothers, the Social Security Act of 1935 was directly influenced and inspired by the former Sheppard-Towner Act. This acts as proof of the significance of the Sheppard-Towner Act as it continued to shape later legislation on welfare.

    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.

    Did you know?

    This split in opinion in the AMA over the Sheppard Towner Act resulted in a group of mostly male paediatricians leaving the AMA and forming the AAP, the American Academy of Paediatrics.

    Sheppard Towner Act - Key takeaways

    • The Sheppard Towner Act of 1921 provided federal funds to the states which chose to participate to set up programs that would provide care and education surrounding prenatal health and infants.
    • The Sheppard-Towner Act was successful in its goal with over 3,000 prenatal care clinics and 180,000 educational programs being established.
    • As Julia Lathrop claimed, the Sheppard Towner Act did reduce mother and infant deaths, Carolyn M. Moehling and Melissa A. Thomasson (2012) argue that it decreased infant mortality by 9-12%.
    • The US Children's Bureau, progressives, feminists and social reformers all played a huge role in the success of the Sheppard-Towner Act. The opposition that prevented its continuation was the upcoming Great Depression and the AMA (American Medical Association).
    • The Sheppard-Towner Act significantly influenced later legislation around prenatal care, the Social Security Act of 1935 is proof of this.


    2. Ladd-Taylor, Molly. (1988). “‘Grannies’ and ‘Spinsters’: Midwife Education under the Sheppard-Towner Act.” 255- 275
    3. Susan Amsterdam,(1982). “The National Women’s Trade Union League.” The Social Service Review 56: 259–272
    4. Sheppard-Towner Maternity and Infancy Protection Act of 1921,(1921) 42 U.S.C Section 161–175
    5. Katherine Madgett, (2017) "Sheppard-Towner Maternity and Infancy Protection Act (1921)

    Test your knowledge with multiple choice flashcards

    When was the Sheppard Towner Act passed?

    What does the term 'Scientific Mothering' mean?

    Fill in the blank.The Sheppard Towner Act originally planned to provide funding for ____ years.

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