Peggy West PhD MSW
October 19, 2012
Significance
 Oldest Federal/State Partnership
 First federally-funded social welfare
program
 Since 1935 has been continuously funded
 Significant role of women activists
 Addresses needs of women and children
directly at the federal level
 Block Grant to States since 1981
What happened relevant to maternal
and child health in each year below?
 1912
 1921
 1935
 1965
 1977
 1981
 1998
 2012
Roots began 100 years Ago in1912
 The Children’s Bureau is the first federal agency within the U.S.
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Government—and in fact, the world—to focus exclusively on
improving the lives of children and families. Since its creation by
President Taft in 1912, the bureau has tackled some of our nation’s most
pressing social issues, including:
Infant and maternal death
Child labor
Orphanages
Child health and recreation
Delinquency and juvenile courts
Family economic security
Abused and neglected children
Foster care
Sheppard-Towner Act of 1921
 Also called the “Maternity Act”
 Purpose was to “reduce maternal and infant
mortality”
 In 1921 childbirth was the second leading cause of
death for women and 20% of children in US died
in first year of life and 33% in first five years.
 Low income was an important factor in these
mortality rates.
Sheppard-Towner Act funded
programs such as
 Health clinics for women and children, hiring MDs
and nurses to educate and care for pregnant women
and their children
 Visiting nurses
 Midwife training
 Distribution of nutrition and hygiene information
Sheppard Towner Act significance
 Unsuccessful challenge in Supreme Court (Frothingham v.
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Mellon and Mass.v Mellon (1923)
Addressed needs of women and children at federal level
Role of women activists (Jeannette Rankin, Julia Lathrop,
and Grace Abbott) & League of Women Voters
Demonstrated that education and preventive care at could
have a significant effect on maternal and child mortality.
Not funded after 1929 due to political pressure
Groups including the American Medical Association
(AMA) and its Section on Pediatrics labeled the program
"socialistic" and opposed its passage and opposed its
funding in subsequent years.
MCH/Title V of Social Security Act
 Passed in 1935
 Ensures health of women, children and youth
including Children with special health care needs
 Converted to Block grant in 1981
 States required to match $4 to $3
 30% for CSHCN
 30% for preventive and primary care for women and
children
 Limit of 10% administrative costs
Where we are today
 MCH is located in HRSA in HHS
 Provides Block Grants to 59 states and territories
 MCH Mission
The mission of the Maternal and Child Health Bureau
(MCHB) is to provide leadership, in partnership with
key stakeholders, to improve the physical and mental
health, safety and well-being of the maternal and child
health (MCH) population which includes all of the
nation’s women, infants, children, adolescents, and
their families, Including fathers and children with
special health care needs.
Goals of MCH
 Assure access to care for low income women and
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children
Reduce infant mortality
Ensure comprehensive prenatal and postnatal care
Increase health assessments, diagnosis and tx for kids
Ensure access to preventive, and rehab services
Assure family-centered, community-based systems of
coordinated care for CSHCN
Toll free hotlines for assistance in applying for services
for eligible to Title XIX. (Medicaid)
MCH Pyramid of Health Services
Discretionary Grants
 900 Discretionary Grants, SPRANS and CISS from 15%
set aside
 Includes Training Grants: Adolescent Health, Autism,
Communication Disorders, Dev/Beh Peds, Genetics,
Leadership, Leadership Education in
Neurodevelopmental and other disabilities, Public
Health, Nursing, Nutrition, Pediatric Dentistry, and
Social Work
Coordination with Medicaid/Title
XIX
 Passed in 1965 as part of the Social Security Act
 Expansions of services and populations impacts MCH
shifts
 MCH emphasis on ensuring access to Medicaid and
help with gaining information about enrollment.
 Allows MCH to shift its small resources away from
direct care payment to building infra structure
MCH impact In 2009, MCH reached
 *2,513,320 pregnant women were served by the MCH Block Grant and
an additional 118,258 served, mostly through Healthy Start
 *4,134,329 infants were screened through the Title V Block. Services
were provided to an additional 62,125 infants through Healthy Start and
early identification services through such programs as LEND
*27,611,884 children were served through the MCH Block Grant and
an additional 89,654 mostly through Healthy Start and LEND
*1,944,766 children with special health care needs received services
through the MCH Block Grant and an additional 148,761 mostly
through LEND.
*3,132,908 women and men were served through the MCH Block
Grant and an additional 485,809 mostly through the first Time
Motherhood/New Parents
What happened relevant to maternal
and child health in each year below?
 1912 Children’s Bureau Created
 1921
Sheppard-Towner Act Passed
 1935
Social Security Act, Title V (MCH) passed
 1965 Title XIX of Social Security Act passed (Medicaid)
 1977
First LEAH programs funded by MCHB
 1981
MCH funding to states becomes a Block Grant
 1998
MCH implements performance measures for reporting by
states
 2012
LEAH funded at UW (after an absence of 10 years)
Questions and Discussion