UNITED STATESDEPARTIV1ENT
OF LABOR
V.
N. DOAK,
Secretary
CHILDREN'SBUREAU
CRACE ABBOTT. Chief
YEARS
THESEVEN
OF THE
ACT
ANDINFANCY
MATERNITY
I
No.20J
fromPublication
Separate
of the Welfareand Hygieneof Maternity
The Promotion
and Infancy,FiscalYearEndedJune30,1929
U.\-ITEDSTATES
GOIER.\\IL\T PRINTING OFFICE
S A S H I N C T O Nl 9: l l
MCH
Collection
Provided by the Maternal and Child Health Library, Georgetown University
THE SEVEN YEARSOF THE MATERNITY AND
INFANCY ACT
SEVDNYEARS'WORK OF TIIE COOPERATINGSTATES
UNDDR THE ACT
ACTIVITIESUNDERTAKEN
Though the details of the work under the maternity and infancy
act havi diflered in the different States, the aim in all has beei
fundamentally educationall and, because the large cities already
have hospitals, physicians, nurses, and health departments, the
rrork has been primarily for mothers and babiesliving in the smaller
cities and in rural areas. All the States have soueht to teach the
public horv better care of mothers and babies will save lives and
improve health and to stimulate such local and individual interest
in the program that the work, once initiated, will be carried on by
the local community itself.
The types of activities that the States have carried on u'ere, in
q
- e n c l a l ,t h e I o l l o u ' i n g :
1. Instruction o{ ihc Lndividual as to the care of the mother and
child throueh(a) Health cbnferencesconducted by physicians and nurses
,
directly under State auspices.
(D) Permanent health centers^ofiering the same kind of instnrctionbut condrrctedunder loial auspicesand financed
at ieast in ullt, bv local funds.
(c) Yisits to nrotliers ir their hornesby public-health nurses.
(d) Demonstrations in the home in infant and maternal care.
2. lnstruction of groups through(a) Classes(i) In infant care for adolescentgirls.
,'
(2) In infant care and prenatalcarefor tnothers.
(3) In infant rarc arrd-lxenatal care for teachers,.toprepare thenr to include maternity and infancy instruction in thcir classwork.
(4) For midwives.
:
(D) Graduate coursesfor nursesin maternity and infanc5rwork
:
through State or rcgional conferencesor institutes.
I
(c) Graduate coursesin pediatricsand obstetricsfor physicians
i
(usually conducted in conjunction with State or county
f
I'
medical societies).
(r/) Lectures, motion pictures, slides, charts, and exhibits.
3. Instnrction through distribution of literature prepared by the
Statt' or Federal Governmenton maternal and infant cale and
hvgit'ne,cliild care and management,and other subjects.
It is not possibieto give an exact numerical summary of the States'
, activities of these various types for the sevenyears in which the act
s as in operation. Only approximate results can be shown by figures
reported by the States, as the figures available fall short of actual
Provided by the Maternal and Child Health Library, Georgetown University
2
THE
\\-ELFARN
accomplishrnents.
;;;i^;il;;:"iitr,
N\D
HYGIENE
OF ITATER\ITY
A\D
I\FA\C
I
of factors influencing .the tievelop-
A number
to the
in the stateshave conr,ributed
"f1t "-.i.orL
uistlttilll*,$'it";T"'1"11:";'i"'1.?i'''*,*,ff,;:tx?;
the materiii" !t"i* i*." i" u po.ition to atc_eptthe full benefitsof
created
Stltes
"ti-ttor-gn
l'ou'
legi.lntu.e=.
1t-rei.
..t
irrlancy
-bu,'.*u.
urrd
nitv
passage
tlte
year"of
the
lgZt,
in"
;hiid:h;-i;;c .l"iui.ionso,
su'n";,*il1'f:
established
;f iii. i,Et,o"dl0 States
frl;ilTJiglff;
yeal to y
Thet'e was also an increase from
il;il;;s';;d;;-l[-pro"i*1u"i'
not .ntii 1e27that the
It.tu'
benefitsof the act' In
the
accepted
States to."oofi"tute
last, tu'o
"Siu;"io'i"tito" necessa'ly .\&'asconsumedin organizing the
;;"h
'-iT-,lJ;;5it.u,a1{':*":ili,l",sl:';ry.ill},Loil*'",:
;
i*f
and
secondarv
rv-as
kee'ing
'''"oid
;v;;;'; ;i
iilin .i*,-a;
"";;;,t
r#"|1'""trPi"X*;tt*:1;ililli;""-#T."iil:li*fi!:
Ai;;";;;.-oi stut" bureausrvas-hel4in 1923that
frrrt
homogeneous Sbate progr&ms were inaugurated'
more """t"i""d-;f
r'vas not
Jt
figuresfrom
t;"t 1e24that coilparable
on a ferv points
iiiltii ir'"'i,13."
urruilubl" td ut y extent, and data
the States *-".""l-tr'.'il;J
not obtaineduntil 1925and 1926'
'
u,'ere
'i.f-,"t"t"i ,rutnb"t oi h"otlh
at which expectantmothers
"o"t"tences
as
reportedby.the.cooperatphysiciatts,
by
.*o*irred
urrd.chilclren*
"."
*.",*ul"'.'Lt,tt*.i'iiii.".Llni:it':G*i'1;lJ{;.*i$ffi
n.mbcr of
rvas gir.en or. *u,"^uT';;,1 ;hiid .are brought^th-e^total
permanent
cen2,978
of
total
A
183,252.
to
cooOuctecl
conferences
prenatal
and'combincd
prenatal,
;;;;;;;;*ti;ts
"f "ii1,a-1,ourtrt,
*tt" L"iut'Iished' The number of classes
;;}i ;i]i1d-h"uTtrt
"""i"tt
inciucling classcsfor girls in infarrt care,
Tn, n.t.u"-tio",
;l;ili
'"]i1i"T:1:
;i;-.;.'i;;;;th.;.i;-ili;'t;"dniateInal.cTi';ffi
X-:13f
fiv.e
last
the
during
I
19,723
rvas
;i;.i,
nradeby oublicVi.il.'t" fi"".* i" tfr",iii?"t".i li "-tit"is and babies
u-tntul of
liealtl nursesduri'g the last six 1'earsiiih"";;t;.""it"tithe act showed
of
five
Years
R"iro.t,.";;";i;;
;;iii,br6'.
th;"l"'t
or'Ui.tot"rr! oistrib'ted. D.rine the last four years
preccrs
22.030,4S9
weredistiibr'rted' The State
of tlre act 176,733..;;,i;;"';Jull"tt"tt
infants
rlloretiran 4,000,000
that
.tt"*'.a
fo,,t:1-i,"t.
in.t
the
for
re'or.ts
expectant,rnothers
700,000
*r,p*.'rir'ateh'
;ffi,'r",i u"ii
;;ili';;;:;i,;;i
nl: .on," io.* o i i h,' I naI eri'it.v,andin f a'c.r's_orli .
;,:;;"',;;h;j
i' tiunr1ersin a. *ctivily dit^rilS
It should U" ,rot.i-til""T; l;;;";.
rath.r tha. a climinution of the
iolorL
year
means-"';il;"g;i.
a si'en
cts itiuerant clemonstration
fon,lr
si
ut"
;
;ilff
;3.i:" F;;.;;;pt.;
a m'ch.larger nunr6erof
repcrts
3;L;'it
tli'";;i;
over
confcre'ces
than
cliildren-rcnt'het"
and
i"ottters
.
oi
l-,.]a oni
conferences
it tr:,si.tsi' the
"i"ri.
ticne,
iri
rvo'k
this
rvhcn, after
d;.;;l^;;;;."tiu,,ul
st:pt:t-'rit'tit'eritt'rs' \\'ircri the
ot p.tilJ"t;-l;i;;ii];
cler,eloi-.'tent
bv the
l,ri" lreettrtssrlttrc'd
1]',.''t'etrtcri,r
*"i"iuiuitg
fn.
respo.sibilit-"
it >1ltc' nctivity'
iis
' " - - ltitlscr
1 r t t , l l , lci:rrt'tctl
,t.
I,t.irl contmrinity, tl',";r:;;L i.-tio
' , - l t l " ' * - r t l i i q i r ' t i i t ' a t e di n
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s . n r e a c t i r - i t i c s ,a s i h . i r t . . " " . . . i r i t l ^ t r i s t r i l r r i t i t ' l L
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Provided by the Maternal and Child Health Library, Georgetown University
3
SEVEN YEAHS, W'ORK OF THE COOPERATINGSTATES
Table 6 suntmarizcs tlie activities under the maternity_and-in{ancy
u"fJ""i"n'the period 1924 to 1929, inclusive, as rcported by the cooperatine Sip.tesrrrd the Territor'.v ol Harvaii.
r l t t r i n ' c .t h e
T- ',itns r f, r i ( i . - S v p l n i o r ! l r . 4 ' a c t i t i i i t s l t t : ( i t t i h e r n a t r : t r t i t 1 1u ! t ! l i t t l o t t ( l J o c t
4l t s n n d T e r r i . t o r y
t i . . l t t r t r so . f i i r , r 1 r r , , t r i l i , rous, r e p . ) t l t - i b y l l t r e t u , i t r , 1 1 1 111\2l n
of Huuaii. 192.i 1929
conductc(l
C
- onferclctrs
5J:pir1-sk'iaus
!,::l:' p":iil;l
l,i,t;
,g;:
lllfr
.' :pT
^ ,. .' "l l,
,i.iiir
estrrlrlishr:d
clil.l
l,rn-
"'',t'
tttt'''
t,..iirl ' ri"',r nuri5,:
hculth
{
I:'-
'. 1l l ,l .] ': , ] ' t " l ,, itl,l uj : r r L l
rijlll;i.
I
,
i;Bilti9l 'iii lii
l:lii li:3lll
'-.-.-'-.--ll39':t"::----,----.
lil
i!
t9:
,H.
r,:r+t re,b4u
__
- ___t
---i 7,;r+r
li z,uur
1q'81q
?'99?1l'?lg . 9:l
?g?
1i
-------____
re28re28_
1929,---------
- ,]
0 ,1 9 8.
1 6 '9 3 3
2'352
Classesconductcd
i6:?i| ,,ili
i;i
1e
I
S0ts of preIJome Yisits natal letters
made
] distributed
Picces o[
literature
distributed
22,030,489
(1)
2, 195,000
3, 192,919
4, 403,218
6,176,232
6,063,120
Public knowledge of the health problems of the infant and the
h;; l".r"ur.E, and those in immediate charge of child.ren. and
"hiiJ
mother.s
ale better informed about infant and maternal hygtene.
their
T h c i m p o r . t a n c eo f a d e q u a t ep r e n a t a lc a r e i s b e i n g g r n d r r a l l yl e a r n e d .
f - n " . a i u " r a g c s o f b r e a s t f e e d i n gh a l e b e e n s t r c s s e ds o f r e q u e n t l y b y
infant-rvelfarE u-orkers that the'slogan printed on the stationcry of
ih" b.,."u.. of child health of Virginia,- "The best-fed bab,v is the
f,."n.t-i"a baby," has become an'-accepted standard for thc State
*"a infant-ivelfare rvorkers in general. Simpler and more
.t.ti.
..i.irtifi. iormulas for feeding the bottle-fed lrahy have contributed
to his liealth ancl chance of lii'ing. A greatel demand has deYelo.ped
i.,,' iir. siLpc.ti..ionof infants by cbmpetent pediatricians arrdspecialists
i n i n t ' a n tl c e c l i n g .
: t r r n ( l r r r ' ( l so f ' p r c n a t a l c a t ' eh a v e b e e n f o r m u l a t e d w i t h g r e a t c a r e
l - , t r , , 1 , ' , , t t , t , i t t t ' e ' tl,cf a c l i t r go l r s t e t l i c i a n s f r o m v a i ' i o u s p a r t s , o f t h e
o l g t r n i z t ' t lI ' o l t h r r t p i t t '' 1
Tlhoessacet t h e l c q u e s t , ' f t h e f - r r i t c t l S t a t c s
"donui tna,rt i' 'r",.- , i ] , , . o , , , , i n 1 { t 2 { . 1
s t a n d a r t i s h a v e r e i r t ' } i c t lo t h e r
( i i r l , i r tr : : l l u r r l u I ' u l ' l i c B t i o n
Provided by the Maternal and Child Health Library, Georgetown University
TIiE
TI-ELFARE
AND
I{YGIENE
OF }IATERNII'Y
A\D
INFANCY
obstetricians, ha\-e been incorpolated in obstetrical coursesin medical
. o l t . o . . . a n d t r r e p a r t o f t h e ' g e n c r a l k n o u - l e d g eo { m a t e n t a l - s c l [ n r ' "
*lork-"r.. Thcir effect scems1o bc le{lected in the lou-er mo|trlitl'uiu tro* p'erperal eclarnpsia and con'ulsiols, al!.lrough the maternal
mortality i'atcs frorn cert,ain ,other puerperal conditions not so e.rsillinfluencdtl br. prenatal care have not declined. Exlrectant mothct'-.
o.i pt'cnrrt"tlcrlre'
clertrandand"uriercccivinl'1a hiSlier t1-1lc.
S t u t " p l o g r . { r n }fso r . l l r e 1 r r . r ' e u t i o n - o l ' t l i s c n sicns c h i l d r c n t h r ' o r r c h
vaccination'and irtrmunization against discasesfc;r rvhich preventive
-"u"rr"r have becn accepted andplovetl ellecrtir-char-ebeen extended
throuqh the assistan.e oi the natelnity and infancl- stl{Is. . -{. loler
inci<leiice of such diseascshas been shorvn in areas n'lielc itlttnsive
'p r e v c n t i v e $ o l k h a s b e e n d o n e .
The rnenacc of tlie untrained, ignorant, antl rinclcan rnidwife has
l ?l :rntl19!9 throrrgh
b e e n g r . e a l l yl c . s s c n t ,ddu l . i n g t h c \ . e a | sL , t ' t r , , c o li 0
.
r
t
p
t
'
;
r
' i s i , ' ta
t .t r r li n s t t r r c t i o n .
r
e
g
i
r
i
a
t
i
o
n
r
c
g
i
s
t
r
a
t
i
o
i
.
i
n
i
h
e
i
r
'p t o g , ' i . u
\ i u n r S t n t e s h n ' v e r r s c t lm a r i ' r . 1 j l y a n d i n f a n c y f r r r r d si o u . s s i : ti n
the rnanufacturc and distribtrtion ol ampules ol nitrrrte of siiver for
use in the eyes of the ne$bc_rrninfail_t(to prevent ophthalmia neonaiorum). Ttese States reported in thc last yeals of opera.tion of the
act an'inclea-sein the nr,rribe. of reclnestsfotJtiic amltr.riesfloln llhysicians and mid$.ives--especiaily the latt_er'. In several States no case
of ophthalmia neonatori,ttr tt,o rcported dtrring the past year. That
ier.l6r babies are blind from this ci,.,.e .eerncd to be the corrclusion of
other.States in their repolts subrnitted at the erpiration of the rnaternitv and in{ancv act.
'il*
Stoto. uhd th" United States Chiidren's Bureau ]rave made
s t u d i e s a n d s u r v e y s o f f a c t o r s c o t t l r i h t r l i n : t 1 . ot h o r r r o r . b i t i i t 5a' "n d
m o r t a l i t y o f m o l h r . r s a n d b a b i e s . T h e n c c e s s i t ; 'o f o b t a i n i n g l ' u l l e r
and mor"eaccrrratefig1 res and of collecting more_unilol'Ind.atashorl ed
i h . i ^ p o r t r n c e o f c o " m p l e t i n gt h e h i l t h a n d d o a t h r e g i s t r a l . i o n l r e a si n
t h e U r i i t e d S t a r e s . I r i f g Z f t l r c D i s t r i c i o f C o l r r n r l r i ial n d 2 7 S t a t e s
\rere in the LTnited States birth-registration area. By the close of the
fiscal year lg2g,45 Statcs ancl tli6 District of Columbia \\'cre in the
birth-iesistration area. In i921 the flnited States death-registration
areu con"tuirred34 Statcs, the District of Coiumbia, and the Territory
of Hawaii. In 1929 the death-registration area included 45 states,
the Djstrict of Columbia. and the Te|ritor;'.of Hurvaii. I\Iaternity
a n d i n f a n c y $ o r k c r s h u r e g i v c n c o n s i d e t ' a b l ea s s i s t a n c ei n S t a t e
camoaisns i'or improved resistration of births and deaths.
Giea[er attenti,on to thelhealth of the p'eschool child markcd the
c i o s i n g v c a r . so f t h c m a t e r . n i t y a l r d i n f a n c l ' a c l . P l e v c n t i o n o l ' c o m m u n i c " a E l ed i s e a s e sf o r r v h i c hh c a n s o f p l e r - e u t i o na r e k n o * n , p e r i o d i c
examinations of preschool children, t!r1 "qgmm-er- round-up" oj P.reschool children who will enter school in the f all, and the correction during
the summer of defects found in these children in health conferences
in the spring or early summer have been d.evelope{^i1 lalge measure
since 1gl1 aiid huve [rown to larger proportions in 1929,'rvith_resulting
health for chfldren at thi beginning of their school life.
better
th. inclease in the trained personiel emfloyed in the promotion of
maternal and infant health in tgZS as compared with 1921 and the
irnprovement in standards and methods of work also reflect the progrei" made durins the operation of the maternity and infancy act.
Provided by the Maternal and Child Health Library, Georgetown University
SEVEN YEARS,STORK OF T}IE COOPERATING STATES
5
DEVELOPMENT OF ORGANIZED STATE AGANCIES FOR PROVIOTING
THE WELFARE OF SIOTHERS AND CHILDREN
ORGANIZED
BURTAUS IN STATE DDPART\TDNTS
OF HEAI,TH
A number of States anticipatcd liie passageof thc me"ter.nityand
ilrfancry act lvhile it was peuding in Clonglesi aurl created nraternit.v
and childltvgiene burcaus or divisions td tdirriristel tlre funtls under.
the act if the5r should beconte available. Thiltv-tlir.cc sricli Stllte
age-ncieswere in existence at the beginnine of i{.}:1. During l$21
a n d 1 9 2 2 , 1 4 m o r e u ' e r e c r e a t e c l ; a r r d i l 1 9 2 i , a 1 ' t e le s t r r i s i , t n ' o f t h e
benelits of tjre e"ct,to l{awaii. tlrrt 1[rlritolr esta]rlislrcclrr tlivi-.iotr
o { n r a t e r n i t y n r r , li r r f a r r c r ' .
. Ry June 30, 1929, mate'rnity arrti cliilcl-hr-gicrrcliurearrs c,i. tlivi-*iols had bcen r:r'ca.tecialrd ri'ere functioniirg irr the Telriiorr,,- of
I l r r v n i i a n r i i r r r , l l t h c S t a t e se . r c t , p\t- c l r n r , r r t u, j r i c h r l i t i r r o t c s t r i , l i s h
'ol'r.r
a s c p a r a t ed i v i s i o n o r b t t t ' r . o ut o r , 1 , ' , ' t
t l r r , l ' c r l c l l l j r r r r t l sh u t
has carried on the u-orll untler'1l:c iriiriierlirte riirertion of tlic State
health officer. Not orrlr. tr-ercsuch ue*- agelcies ct'eelcil, but those
aircady existing'were able,to esplntl tiuou!:h tbe gralling'o{ I,'ccicral
funds to the States that accepted tlie provisioli oi tiri: rct,. flhe
States that did not accept the Federal fund-. secured lalqer aJri)r'r)priations for maternal and child irvgicnc from thci-r legislalurcs rintl
'q'ere stimulatcd to gt'eater activities.
pARENrs tN (.llrLD AND NfATttRNAL
PERMANDNTLocAL AGENCTES
FoR
"il;?#il"
The directors of State clir.isions and bureaus of ma.ternitv rnd
child hygiene. had as a,lr objectivc tlie develop;nent of permanent
local interest in the care of mothers ancl childlen and thc assumt)tion
of local responsibility for such care.
Even in the first 5"ears of operation of the act rlian]- rtrirectors
regarded the itinelant health conferences that thcv cori,lLrcteclfor
the local conirrnrnities as <lemotrstralions rr-bicli n-et? trr irave thc
w a y f o r t h e c s t a b l i s l i n r e n to f s i m i l a l f a c i l i t i r : s f o r . c l i l t l , . a r e o n a
permanent basis and ri-itli lccal suirl;ort. This poliiv resulteclin
t l t e t ' . t a b l i s h n r o noti ' 2 , 1 1 1l -{ t, 1 ' l } r r t n { ' l l t - c l r i l , l - i r l r r l r l r ' ,l.r,.' or 'rtr,1
r. i0' -3 4
t o 1 9 2 9 , i r r c l r r s i v ea, l s o 3 1 1 p c . r t r r a n t n t , l ' e t l i r t l r(i f n t ( ' t ' s . u r i ( 13 7 8
p e r m a n e n t c o n r b i t r e c-lp r c n a t a l a n t i c h i l d - h c r r l t l l ( . r l l t c l s - s { r t i l e , q u p p o r t e d f r o r n l o c a l f u n c l s ,o t h e r s s o s t r p p o r t e c il n l t r t ' t .
THE \IATERNTTY AND rNFAN{y pRLoOcRAM
ril;'it""
D_EvELOp}rDNT O}- c.ouN.ry AND
Nurses paid in full or in part from nraternit..' and in{ancv fun<ls
liar-e been detailed to countibs, communities, of cities, scrnetirnes to
u o r k u ' i t h a n e s t a b l i s h c dc o u n t . v h e r l t n i r n i t o r o t h e r o f l i c i n l h c r t t h
agency, sometimes to conduct nursing demonstrations for the purp o s e, o f d e v e l o p i n g p r r b J i ci n t e r e s t i n a p e r r n a n e n t i o ( , a l r r r r r s i n go r
h e a l t h s e r v i c e . N o t i n f r e q r r e n t l l ' a n u r s e w o r k i r r -a
g a l o r r ei n r e o i r n t v
aflorded a starting point for the developnrent of
fuli-tiurc, corirrtr
health denartment
The esiablishrnent and extension of local health rvot'k *'clt' tiromoted b5 the use of maternitv and in{ancy frrnrls to }rc}p p,-rrj{tr
Io<'al nialernity arrd infanc5 ri-orii iri iriol);r'ti1)u ir_r1|'. riruirrLirtof
titrtc spent b5r the nlrrses in such rr'orli. Sinte tire iicginirirrg of the
Provided by the Maternal and Child Health Library, Georgetown University
6
TIIE \TELFARE AND HYGIE}IE OF }IATERNITY AND INFANCY
operation of the act 161 counties and 13 comrnunities have assull)e(l
i*=nonsibilitr- for maternity and infrncr rvorlt begun br- the
"tlii."
r r s e o f r n a t e r n i t v a n d i n f a n c y f u n d s . . _. O t h e r c o u n t i e s a n d e o t r t l r t t t nities hrr-e assrlmed partial"responsibility for such. work. or $'r're
* r . i y t o c s s u m e i t a i t h c e x p i r a t i o n o f t h e m a t e r n i t y u n d i n f r r n ,v
act.
THE TREND IN INFANT MORTALITY
The value of rnatemity and infancy rr-ork is reflected in the decrease
in inlant and mater.nal'death ratcs"in 1928 as comparcd rvith tho'.e
in 1921.
AlthouEh the seneral death late for all ages for the cxilrrtrcl.irrg
l i i r h - . e g i l t r a r i o n a r c a u ' a s s l i g h t l y h i e h e r i n 1 9 ? St l r n n i r r 1 0 1 1 .t l i e
i " i r n t f r o r t a J i t y r a t e w a s l o u i r , a i c o r r l i n g t o f i g u r e so f t h e B u r e a u o I
tir tgZt in this area, consisting of 27 States and the Dis'nu, C""*.,..
p o p r r l a t i o t t;
J
C
o
t
r
n
i
b
i a , t h e g e n e r a ld e ni h r a t c 1 ' a s t t 7 _ p e r1 . , 0 0 0
i.i.t
o f 4 4 S t a t c sa n d t l i e D i s l r i c t o f c o i r r n r i n l g 2 g . i n t l r e a r e a c o i s i s t i n" g
nearly
3 pcr ce1t, The infall tnortalitv
1 2 ,r r n i n t , r e a s e . , f
bir,li;;,
livc hirths)for
r"li'f,r."ir'.-it-li'r"tt. ;;J;; i-i-;"i 6i ns" pcr 1,000.
of 9 per
a clecrease
areawas 70 in lSlt and 69-in 1_928,
lii" eipu".ling
'tt,i.
E..t.or* rvas obtaincd despite the fact that a nnnrbel
"""t.
oi-Stuter uamitted to the area since 19t1 h&d high inlant mortali.ty
rates. 'Ihe 1928 rate (67) for the states that, have bee[ in tire
Lliih-resistration atea.iuting the entire period 1921 to 1928 is 11
Der
' - l f cent"lowerthatr the 1921rate (75) for this area'
t h e s a t n ei n f a n t r t r o r t a i i l vr a t e s h r d p r c v a i l e dt h r o u g l r t l r e
ut't as.irr1921,
rnd itrfrrtr.'5se\-envearsof opelutiorrof the riral.errrity
in their first
died
ha're
who
survived'ir-ould
i""t"- tiro" 60.000babies
-fn"-"*.talitv
of life.
vear
"
rate for white infants in 1921w9s 72,,as contpared
,r-itir^6til-igtb; for coloredinfants it r.as 108 in 1921 and 106 in
1gtS. In r.rrbariareasthe moltality rrte for infants was 78 in 1921
o"a-OSin 1928;in rrral areasit tr-ai 74 in 1921and 68 in 1928'
for the States
Tlfrunr&pson page 7 show the infant mortaljty_rat_es
in tii. it"itua Siaies birth-registration arL'a i'l. 1921 and for these
sameStatesin 1928.
'iiit""i i"o.tali6' has shorvn a downrvard trend throughout' the
ncriod of the cooperationof the Statesunder the maternity and irtt ' r o n l 1 .o u e v o n r u - e .tsl r el a t e h i g h e ' tr. h a ni n L 9 2 l : t l t a t
i;,,;;."i.
i l , i * i t : , , nI g 2 3 . t . h c r rt l r e r . a t er v a s7 7 , a s c o t t r p a t ' eud' i t h 7 6 i n i 1 ) 2 1 .
vear'
{iuctuations}rar.eoccrtrtedfrorn -vearto :fo1
lStiqht
'li-;";;;;tl"
irr int".t rnortalitl' 6r''carrses the Statc'sarid the
Di.,ri;t;l aoirimbia in tlie bilth-r:egistrationarea of 1921 (exclusive
of :outh carolina) shows that thc rates.f-ront the irnportant- grottp
i,*,i...-ii.r" loner in 1g28than in 1921,ivith the exceptionof the rate
i.oiri ,'.rr;ratorr. diseases,$.hich was'higher. Thc Iater months of
i ^ r , j . , , . , ' 1i , , - * r t . a ' b vo . " i i o , , s i n f l r r e n zFap i d e m i c , ^ u ' i tr sh a t t e n d a n t
The increasein tlre infant mortality rate
ie.1,ir,,toLr"orrrplications.
h 1927to 67 in 1928was undoubtedly
84
itn"r
igZi
n ifi. a'ea of
the mortala,," i" tlrc itr.reasein tt-redeathsfrom respiratorydiseases,
(12:9)
than in
1928
in
higher
per
cent
25
bcing
itv rrrtel'or tlre erorrp
l e 2 ; 1 t 1 . 3 ) .r T a b l e7 , p . 8 . )
Provided by the Maternal and Child Health Library, Georgetown University
SEVEN YEARS,WORK OF THE COOPER,{.TI^\G
STATES
I
The rates from gastrointestinal diseasesshorv a definitc dorvnlvard
trend from 1921 to 1928. In 1928 the rate from these causes(7.9)
was 47 per cent less than in 1921 (14.8). This group sho*'s & greetcr
. fnfant mortality rates in 1921 in the birth-registration States of 1921 (deaths ,
of infants under 1 year of age per 1,000 live births)
reduction than any other group of causes. Although the rates from
natal and prenata,Icauses,rihich have their origin lar[ely in the mother
during pregnancyand confinement,do not show the definite downward
&!rcer
u I Oure@ofthe
Infant mortality rates in 1928 in the birth-registration States of 1921 (deatbs
of infants under 1 year of a,geper 1,000 live births)
trend shown by the rates from gastrointestinal diseases,
theserates
have ner-erthelessdecreasedduring the period. As Table 7 shows,
the rate from natal and prenatalcausesfor the 1921arearras33.9in
38349-31-2
Provided by the Maternal and Child Health Library, Georgetown University
8
TEE ITTLFARE AND IIYGIENE OF MATERNITY A.I\D INFANCY
l92E as compared rvith 36 in 1921. Reduction in infant mortalityfrom
gastrointestinal diseasesreflects the work done in disseminating inforination orr the importance of breast, feeding ald the proper preparation of simole formulas of cow's milk, the value of good routine in
t h e c a r e o f ' t h e b a b y , s u n s h i n c ,f r e s h ' a i r , a n d t l r e i n t r o d u c t i o n i n t o
the infant's dietary of the right foods at the right time. Reduction
in mortality-offrom-natal and prenatal causes also reflects the rvider
the care of the baby, the prenatal care the mother
knov-ledge
receives,"anda greater attention to care at-time of childbirth.
groupsof causes,
in the UnitedStatee
specified'
Trarn 7.-Infant mortalityrates',by
of SouthCarolina; 1921-1928|
areaas of 1921,exclusiue
birth-registrati,on
lsource: United States Bureau of thc Census]
Crusc of dcstb
\ r l a l a n d p r o o a l a l. r l t s c s
G a s t r ( , i n l o si n
l a l d i s t ' r r ss' r - - .
R e s n i r a l o r l ' d i " o r r s pt s- . . - E p i d e m i r 'a n r l c o m m t t n i c r l , l Pd i s e r s c s
l : r t c r n , r l ( ' a u s n s-. \ l l o t h e r c a u s p 6s - .- - . . .
-- ------Unknown or ill{lefined Ciseasesr' r uIncluding
lruurrrS
catifornia, Connecticut, Delaware, Indiana, Kamas, K_entuq\y, l\Iaine, Irlaryla-nd., MassaYork, North
Nortb
New Jrrscy,
J€rsey, New Yor.k,
Elampshire, Now
Nebraska. New
New Eampshire,
Nlinnesota, Xtississippi,
xlississiooi, Nebraska,
ureiii. Michigan,
Michisan. Miirnesota.
ctruieiis,
Rhode island, Utab, \'ermonl, \ irginia, \l'ashingtoD, \'isconsin,
i".niina. Ohio."Oreeon. Pennsvlvania,
"Thesedre
States
r e tthe
heS
t e t e sthat
t h a l ,werb
w e r ein
i n the
t h e bbiith-regiltration
i r t h - r e g i s l r a l i o narea
a r c aesery
e Y e ryear
y y e afrom
rfrom
m a t nttre
e Diriiiiici
i s t r i c i o toiC-olumtia.
C-otuinUia. Tbesca
ani
1928.. Rates
for the
the
reinstaled in
in 1928-.
Rates are
are for_
in 1925
1925and
and reinstaled
from the
area in
was tlroppeal
dropped from
tbe area
fgZA. South
South Carolina
Carolina was
igZt io
tgt
to 1gZA.
oiiioa tszt-tSzS because 1921immcdi;t-ely precedcd the €nactment of the maternity and infancy act 8nd the
latest asailable.
available. ,
28 flnres
flgures are the
the latest
i9z8
-.
, todia"s pii-uiure
birth, congenital debility, injuics at birth, other diseasesoI early infancy, congenitsl
e la
anus.
nus.
ma
alformatio;rs.
l f o r m a t i o i r sssvnhilis.
. v n h i l i s . tte1
a Includes
dysentery.
enteritis, dysentery.
diarrhea and enteritis,
oI the stomach,
stomach, diarrhea
Includes dileds-es
dileds-esof
pneumonia, influcn-za.
{ IDcludes
influcnza.
hronchopneumonia, pneumonia,
Includes broochitis,
bronchitis, hronchopneumonia,
m-eningococcusmeningitis,
! Includes
6
u'hooping eough,
eryl
cough, diphtheria,
diphtheria, erysip^elas,
scorlet fer:er,
fever, u'hooping
measles, Scarlet
Includes measles,
berculosisof tho respiratory systcm, tuberculosistoI tlle meDiDges,ol trer torms oI [uberculosls.
tuberculosis
6 Includs convulsions aod other causesof dcath.
Infant, mortality rates for the year 1927^are.availablefor 29.foreign
countries and foi the vear 1923 for 13 foreign eountries. In 1927
(Australiir.
(Australil,,
Norway,
Zealand, Norway
New Zealand,
countries
the
!lr9
lNetherlands,
Netherlands.
\suulrrouuDt
countries
uulrulrub
ssix
t.)! u
\f\uD!louot
Santo Domingo, and Switzerland)had lou'er rates than the United
l /
States birth-reqistra,tion are&. X'ive of the 13 countries whose rates
are ava,ilable for 1928 (England and Wales, Irish X'ree State, the
Netherlands, Neu' Zealand,-and Su-itzerland) ha{ lou-er rates than
the United State. birth-registration area. Nerv Zealand, u'hich for
nany years has had a lower infant mor-tality rate- than. any other
.ounirv. had in 1928 a rate of 36. The States in the United States
r&[e .41?
Lrregor
trrls rate
neafly approaching
approacnlng this
are& most nearly
birth-rigistration
brrth-regrstra,tron area,most
-are Oregon
sith a r:ate of 47, Washington with a iate of 48, Iowa and Nebraska
with ratesof 53.
The infant mortalitv rate of 1928 u'as lov'er than that of 1921 in
tbe L nited States and in each of the 12 foreign countries for which
rates for hoth 1921 and 1928 are available. These eountries a,re
-lustria. Cliile, En-eland and Wales, Germ-any,Irish X'ree S-tatg,
Japan. the \eiherlands, New Zealand,Northern Ireland, Scotland,
SGtzerland,and ['ruguay.
Provided by the Maternal and Child Health Library, Georgetown University
SEVITNYEARS, WORK OF TIIE COOPERATINGST.{TES
9
THE TREND IN MATERNAI, MORTALITY
During the period of the operation of the maternity and infancy act
slisht fluctuations in the maternal mortalitv rates have occun'ecl from
year to lear', according to the figures report"d by the Unitcd States
Bureau of the Census, but no material decrease has been effected,
cxcept for eertain causes. The rate for the birth-resistration area
of t0Zt, rviiich consisted of 27 States and the Distliciof Cohrmbia,
w'as 68 cleaths from causes associated with nreEnancv and childbirth
per 10,000 ]ive bir:ths as cornpared w.ith 69 iir tgZS iri the alea,which
consisted of 44 States and the District of Colurnbia. Tl'ris increase
in the expanding area is due primarily to adrnission of States that
ha'r.e large negro populations and high matelnal mortality.
It is
notervolth.r' that a decreascoccurred in the &r'eaas of 1{i21,exciusive
of South Carolina, the i921 r'atcbeing 67 and the 1928rate ti4.
Under thc matcrnity ald infancy act the contacts riith crpcctant
rnothers har.e usuall-vbeen outside the large urban centels. The efiect
of tliis x-ollr, therefore, should be re{lccted in lorvered rnaternal nrortalitv rates in thc'nillll ai'r,,as. The rurrll rate for thc 27 States and
thc Distric-r oI Columbia in the legistration area ol 1921 u-as 59 per
10,000 iive births. The rate in lglS n'ls 56 for the sarne area.
The maternai death rates for thc 26 States and the District of
Columbia in the birth-registratir-rn area from 1921 through 1928
shos- a dorrnrrard trend throushout the nelicd. In lg2E ihe rate
f r o r n n l l p r r c r ' p c l a(l' e l l s ( ' si l r s 6 l p c l i 0 . O d t ti i v e I ' i r ' h
1s r s c c r r r p a r e d
with 67 in 192f . ilhcr rates frorn puerperel hemolliraqc, liuerpcral
septicemia, and puerperal albuminuria and convulsions u'cre lower
in 1928 than in 1921. (Table 8.) It may be reasonably concluded
that, althoush the maternal rnortaiity rates show no-substantial
d e c t ' e a s ersl i r i n g t h e p e r i o d o f t h e m a t e r n i t y a n d i r r f a r r c l 'a c t , l h e
lives of nranv mothers have been saved in lural areas as a result of
the educationul programs in regard to the need of prcnatal care.
T h e m a p s o n p a g e s1 0 a n d l l s h o r v t h e m a t e r n a l r n o r t a i i t v l a t e s i n
the States in the Unitccl States birth-reeistlation area in 1921 and in
t h e r u r a l a r c a s o f t i r e s eS t a t e s . a l s o t h c l r t e s i n t h e s e s l r n i e S t l i t e s i n
19 2 S ,
T - r e L r 8 . - - 1 1 ' r t t r n a l n t r t r l o l i t t l r a t e s ,b r yc a u s e t t . ft l t ' t t h . i n l h r ( ' t L i i , ' l , S l a l c s b j r l h r t g i s { r a l i o r t a r e e o s o f 1 9 2 1 , e r t l u s i t e o J ' b o t t t l L( ' r t r o l i r t a : 1 t ! 1 - 1 9 2 5 |
ISource:Lnited ,qtatcsBureauof thc Ccnsus]
D c a l h s o f m o t h p r s f r n r n . a u : c j n s c ' . ' i r l ' r l $ i l l t n r e -g .
D a n c . v a n d c h i l d U i r r h p c r 1 o , { j ^ Ul i \ e l , j r r h i
Ca[se of dcattl
tgzz i re:a] roz+] iozs ro:o roz:J ro:s
-l
or.l i
9.9
o.o
i
65.8 i 64.0 i 64.3 6{.6
62.3) 64.2
6.8
6 . 0 | f r . 9 7 . 0 5 .I j 0 . 9
6 . 6 6 . 6 1 6 . 6 7 . 0 t i . 9i 7 . 0
/.o
7.6 6.717.I
1-.5 7.0r 7.8
2 3 . 6 2 5 . O 2 4 . 0 | 2 4 . 2 2 : J . 6 2 . 1I. 2 3 , 5
1 78. 1 6 .1 1 7 . 0 i 1 7 .I 1 6 .2 1 5 .r
1 5 .r i
3 . 4 3 . 6 3 .t i i 3 . 5 3 . 3 3 . , 1 3 .3
\Iainr', )Irtr1'Ltn,l. \Ils:rt-i Inclilding California, Cornecticut,. Delaware, Indiana, Kansas, Kentnchv,
\_lichigan, l{inresota,-\Iississjl]pi,
cbuatts,
Nehraska, Nerv Ilampshirc,
\eir
.trrsel', \r \i \'.rk.
\onh
C u o l i n r - r l h i n . t , r . g ' ) n , P e n n s i l r ' l r r i a . R l l u d r t " l : r r r i l , i I r l r . \ p r n t ; , r , t . \ i r ,. ,i ,\ j\ , l : , . - . , r , . \ \ i . , , , . . ; r r ,
l)istrictof Columbirr. TllesearetheSl,aic-qtliat\.,'ere intlle biith-rrilistratiorlr,
sn,ilhf
:i (,\rf\ rr,lrfronr
l 9 3 l ' , ' 1 9 . 5 . s o u t l l ( a I O l i n e l t a S d r o p p e d f l i l r n r l r o t r O t i n l J . . ] ;i l t : , i r e i t . j t : r l . , r r r . j , _ . . l t : r , . - . , r , . i . r t l , e
1i 0 n t o f t h e r ] r r , i { ' i l t i t l ' i t l 1 i l i l : r r r } : l (l t [ t l t i j e
; t r l , l l ! 1 1 - l g f E b e c a u s e 1 9 2 1i m m e d i a t e l J ' p r c c e d f i l t h e e r r 3 ( , n
;:+ ::ir:rrs ire the latest available,
I-----
Provided by the Maternal and Child Health Library, Georgetown University
t0
TBE FEI.F.TRE A\D
ETGIENE
oF IIATER\II'Y
A\D
I-\F'INCY
Comparisonof maternal mortality ratcs of the United Statesbirththose of foieign
-thecountries giyes th"e {--nited
."jJ;aii;;-uiou
"ittr position than
comparisonof infant mor3iitn. a less favorable
(deaths
f N'Iaternal mortalitv ,u,", i" 1921 in the birth-registration- sta,tesof 192I
associateawith pregriancv and childbirth per 10'0001
H^;i;;h;;;i;;;".;;;;
5* live births)
tality rates. The maternal mortality rate for the Ilnited States in
tg2f rcS per 10,000live births) was-higher than that of- any of tho
clountribsfor rvhich rates are aiailable;in 1928the rate (69)
iO ott
",:
S.J.cc: u 5 3ureau of tho census
JIatcrnel rnortality rates in 1928 in the birth-registrationstat-es of 1921 (deaths
,,f tlrit|ers from causesassociatedrvith pregnancy and cirildbirth per 10,000
livebirths)
esceeclecl all blt
one of the 9 other countlies
repor.tingfigures.at
this
'f
lrt countr-v$-ith a rate most nearly app{o4ryil_tngthat,of the
iir"".
iti,li",t .*t"t"-. ri as Scotland,rvhichhad a iatebf 64 in 1927and 70 in
Provided by the Maternal and Child Health Library, Georgetown University
SEVEN YEAIIS'WORK
OF THE COOPERATING STATES
11
I 928. N{ost of the other countrieshad rates considerablylower. The
.countrywith thelowestratewasuruguay(22iL|grz ;ria-i+i" rszsl.
bource. u.5 8ureau of the censu6
Ilaternal mortality rates,in 1921 in rural areas of the birth-registration states
i lof lgzt (degths o! mothers f.o* caus"s
i'iiii ijr"gi.r.i""""a
.r,ilabirth per 10,000 live births)
"r.*iii"ii
jFigures_for both 1g21 and rg2z are available for 1g foreign countries. In 7 the rate for 1927$'ashigher than that for tszi;'in z the
1927rate was the sameas the 1g21rite; and in the united siates and
solrce, u.5 Su.eauolthe
C€nsus
Jlaternal mortalitl' rates in 1928 in rural areas of the birth-registration states
o.! mothers from .u"ru. u.ro"iui"d;"ith;;;;;u".i""""O
g{ 1.92I (d_ryt^hs
.rrila_
birth per 10,000 ti.r'ebirths)
I other countries the rate v'as lower. The foreign countries shorving
1927rates lorverthan thoseof 1921nerc chile, ezechoslovatiia,
-i*f""d,
nin?
l.and, I_rish-tr'ree State, Japan, Nerv Zeala"h, Xbiit
Su-itzerland,and Uruguay.
"i."
Provided by the Maternal and Child Health Library, Georgetown University
T2
THE WTLFARE AND HYGIENE OF MATER}IITYA\D INFA\CY
In the cspanding lJnited States birth-registr-ation area thc lllS
maternal mdrtalit5irate was 69 as compared with 68 in 1921. Tlie
rates of a constant a'rea (such as that of the States in the t-nitt'tl
States birth-reeistration aroa from 1921 to i928) are, horvel-cl'.
more comparable rvith those of foreign countries, rvhic! are generalllconstant in sizc, than the rate of the erpanding United States birthregistration area. The rate for such an area composed of the States
in-the United States birth-registration area during the entire period
from 1921 to 1928 shou.s a decreasefrom 67 in 1921 to 64 in 1928.
The 1927 rate for this alea was 62. The tendency torvard higher
, s ti of thc U I'oreign
r a t e s i n 1 9 2 8i s a l s o a p l l a l e n t i n f o r e i g n c o t t n l t ' i e s a
countries for ri-hich i'g:S rates are"available (trngland and \fale-",
Irish l'ree State, tlie Nethellands, Northern Ireland, Scotland, and
Umsuay) had hieher rates in 1928 than in 1927. The rates for Japan
and\eir- 7:ealand rvere the sarne fol both ycars, and that for Chile
rvas lon'er.
The phase of the x'orli dealing with the irnportance of prenatal care
fol both mother and child has been well begun. Good prenatal care
is a f actor in preventing puerperal albuminuria and convulsions; and
the dorvnward trend in the rate of deaths from this cause of maternal
mortality driring the operation of the rnaternity and infancv _act has
been noted. The number of u'omen seeking such care is still relatively
srnall, and nuch more education of the public as to the importance of
early and regular medical supervision of the erpectant mother is
needed. Enc"ouraging featurei ale thc increased lnterest shon'n by
womcn in seeking"ui.l bt physicians in giving such care arrd tlte
recognition of the"servicei of the maternitli and-infancy nurse as the
most effective means of reaching expectant mothers.
PUBLIC INTEREST IN THE PROMOTION OF TTIE WELFARE AND
HYGIENE OF MATERNITY AND INFANCY
Great interest on the part of the public was aroused in the rvelfare
and hvgiene of maternity and infancy as a,resttlt of the passage of the
maternitl' and infancy act. The regular work of the State agcncies
and the llnited States Children's Bureau in the adrninistration of the
act has provided additional stimulation of this interest, which has
developed quite outside of the actual information clisseminated concernin$ mafiernal and infant care. Newspapers and magazin_eshave
carried colurnns on the care of mothers and babies. The public has
been informed about t'he essentials of proper care for mothers and
babies by rnaterial frorrr these uno{ficial sourc,es,which have heen
based laigely on ofiicial inforrrration. Editorials har-e been written,
In 1921 it was still
both pro and con, on the Sheppard-Torvner lct.
a rnoot question whether child h1-giene and tnatelnal hygiene were
necessarf divisions in a goorl Str.te puhlic-health program_andwhether
thcl- belbnged in a dise"ase-prevettfionprogran]. I{bw, however, the
general publie, as well as official St'at'eagencies,recognizethe necessity
bf inclu,ling in public-health programs the prevention of morbidity
and mortalitr- of mothers and babies.
Obstetrical procedures and the feeding and care of babies are topics
on nietlicrrl-soiicty programs much more frequently than before the
and
pE-i-i:lseof the rrraterni[y and infancy act, and section_s_on_infant
ihild hrgient. contribute to the growing interest of public-health profrranrs iintl nrct'tinqs. Tlie welfare of the child and the mother is a
Provided by the Maternal and Child Health Library, Georgetown University
SEYEN YEARS,WORK
OF THE COOPERATING STATES
13
topic of increasinginterest at conferencesof public-health nursesand
socialworkers also. The active support of the great organizationsof
larl,groups that have sponsoredthe maternity and infancy act from its
inception continues and is not confined solely to .women'sorganizations. Some loss of public interest may be expected,however, as a
result of the curtailment of the work through the lack of appropriation of n'ederalfunds.
CONTINU.4,I,ION OF MATERNITY
AND INFANCY WORK
\Till the States carry on this ioint work unaided bv the n'ederal
Government so that there will be no loss to the motheis and babies?
Can we expect the expansionof programson the basisof the demonstrated successes
of the last few yearswithout tr'ederalassistance?
Nation-wide interest in this problem of the health of mothers and
babies has been almost as irnportant in promoting the work as the
money contribution, but funds are essentialif gains that have been
made-areto be conservedand extended. When t-heX'ederalmaternity
and infancy act cameto an end every effort was madeby its supporteis
to secureState appropriationsequaling at,least the combinedX'ederal
and State funds that were expendedin the fiscal year endedJune 30,
1929. This effort for increascdappropriations was made in order to
continue the work that n'as being done and also becausein the event
of the enactrnent of a law continuing Federal cooperation the increasedappropriation u'ould nrake possiblean expansionof activities
along thB lines that experiencehad indicated were desirable.
At the expiration o-f the maternity and infancy act 16 States and
the Territory of Hawaii reported that their legislatureshad appropriated an amount equaling or exceedingthe combined X'ederaland
State funds availablefor the previousyear. These States are: Delaware, Maine, l'faryland, Michigan, Missouri, New Hampshire, Nerv
Jersey, New Mexico, New York, North Carolina, North Dakota,
Pennsylvania, South Dakota, Tennessee,\rermont, and Wisconsin.
fn some of these the appropriation was made becausethe wonen of
the State requestedit, in such overwhelminEnumbers th.at refusal
seemedimposiible. In Florida the support for the work comesfrom
a millage tax for the health department, and the State reported that
it expectedthe returns to enableit to expend an amount equal to the
State and tr'ederalfunds for maternitv and infancv work of 1929.
In five States--California, Indiana, Minnesola, Montana, and
Texas--the legislatures had made appropriations that represented
large increasesorrer those for the previous year but did not, quite
eaual the amount of combined State and Federal funds w-hich the
Sfateshad under the maternity and infancv act. The leeislaturesof
seven States-Georgia, Kans'as, Ohio, Oklahoma, Rho'de Island,z
\Test Yirginia, and \4'yoming-had made appropriai;ions that representedincreasesover State appropriationsfor 1929 but were considerably less tharr the combined State and X'ederalfunds for 1929. In
six States-Arkansas, Colorado, Iowa, Nebraska,Oregon,and South
Cnrolina-the appropriations made were the same or less than the
State appropriationsfor 1929,so that the work had to be greatly curtailed. Iu Arizona, where the legislature rnade an increasectState
I In Rbode Island the 1930legislature appropriated an amount equaliDg the combined Iederal and State
furds that the State had under the maternity and infarcy aci.
Provided by the Maternal and Child Health Library, Georgetown University
14
TEIE \vELF-IRE A-\D HycrENE
oF I\IATERNTTY AND TNFANoY
appropriation, and in Utah, lvhere tho appropriation was the same a-r
iti itrr previous year, the Siate funds migtrt Ue spent only if Federal
funds riere avaiiable. In Idaho no Stat6 funds might be spent after
December31, 1929,unlessFederal funds should be available.
Two States-Nevada and Washington-made no appropriationsfor
carryinE on the work. The legislatures of Alabama, Kentucky,
Louisiaia, Mississippi,and Virginia did not, meet in 1929.3
The threat of withdrawal clearly acted as a trvo-edgedsword, stimulating sonie States to greater expendituresand influencingothers to
reduce"the work if the I'ederal Government withdrew. In a third of
the cooperatingStates the money a,ppropriatedwas suffi.cientto continue the present activities; in the others physiciansand nurseshad
to be dismissedand cooperativeauangementswith countiesand local
communities curtailed rvhen the lrederal Government failed to continuc promoting the health of mothers and babiesthrough somesharing
of the e*petrse'involved. Even the Statessecuringai appropriation
equaling the combinedState and Federal funds rcported a drop in
the inte'restin the program since July l, 1929. In-other wordsf the
participation of the X'ederalGovernment contributed something else
as lmporta,nt as money.
3 In Alabama the State board of health allotted from its appropriation the sum of $74,U3 for "child
bygiene and public-health nursing " in 1929. In Kentucky and Virginia the l9S0 legislatures made approoiiations eoualinc the combined Federal and State funds the States had under the maternity and infancy
ict. In thd intcrim tho work in Keltucky has been carried on with funds raised by private subsoiption.
ths 1930legislature appropriated a sum equal to the State approfiriation for tho previous
In Misisippi
biennium, In Louisiana the 1930legislature made no appropriation for maternity and infancy work,
Provided by the Maternal and Child Health Library, Georgetown University
OF THE CHILDREN'StsUREAUUNDERTHE ACT
SERVICES
A rnaternitr- ancl infant-hr n'icnc division of tire Children's Bureau
rvas organizcri in 192:l to airrliirristel the maternitv ancl infancy act.
The ciisting t'liild-bvgicrre division of the bLrleriu continueri its
tesea.rchin the generai field of child health but hari no rcsponsil.iiity
1,.-rlthe atlministration of the act. To the nratclnitv lnll infancv
division, after appror aI of the State plans anC budgcis sirbrnittccl t-o
the n'ederal Boarcl of X{aternitv and Infant HvEiene I rrelc irrtrusted
the details of the lietkrlal administration of the aci. Its wolli includecl
aurlitinq anriuailr tirr,State nccorintscoverinE the Fecleraland mntched
funds allottetl to tire Strites underr the ac't.il:ccl,ing financial reuorts
a n d r c p o l t s o l ' r v o t ' sl ;r. r l r r r r i t t t 'l r lr -i h e S t n t c sr i i t l r t l r c i r p l r l n sa n d b r r d g ets, c:ompiling annual rcporis of the joint rvorli o{ the State and the
Fecleral Gor-crnmentsin this field, cstabii-"hing contacts ryith the
States through advisory visits nrnde b1'the adrninistratir-e and field
stnfls of the rlir-ision, and condtictitrg srtrvevsct"esigned
to plornote the
plu'llosesof tlie trrt.
The visits to the Stares bv tire rlirector, the other physicians, and
the t'onsulting nul'-celiept thi brrrearr inforrued of theit-"p"*, amount,
anti ciralacttr of lhe u'oi'ir in tlie States. To tire States thcse soecialists ]rt'ought ln oritsiilo poirrt of liclr'<lf t]'.c rvorli thcrl-rvcrc doiirg and
rr'.rr;lrntsof u-hrrt otlier States lirlle lrncling heipfrrl. Sornetimes an
oirr-iousneecllol slrtiiai ltelsonrrrrlri-asnotecl, and this resulted in tire
Ienriing oI personncrifi'onr the Chilciren's Bureau for dernonstration or
sonrt'other special rvolli in thc States. In eddition to its adrninistratir-i, ri'olli tho rurrternitv altl infant-hlgiene division served as a
cleriring horrse lrir inforiil*tiori on nratciial and infant care for ihe
priblic-r.-hich inciiirled rriothels. aritliols, scientists, social wor-kers,
Iilli'-qes.and othcr grollrJS.
Through this dir:ision fielcl str:tlir.slelating to nraternity ancl infancy
rrere tlilectecl. 'I'ht chiidhvsierLe dilision also conduc,tedstudies and
t'eserrch lclating to the irifiint ancl the child, and both divisions
assisti'd in the preparatio:r o{ publications, films, and other educatiotral niatotial lelatins to rnatelual ancl child ryelfare issued bv the
trulcarr.
THU ST.{F'F0F TE{N }{ATI'NNITY AND INT'A\T-HYGIENE DIYISION
lior tho plrlpos('sof ritlninistlation $50,00Cu'as allottecl annuall5 to
tlic Children's Ilrrlt rrtr 1'r'r'rrr
thc rrLa1,:mitvanti infnncy funcl fot iC23
- i1 T i r , ' l r f t r i 1 , j i r r i l l f l 'ssl n f l ' o f
f l l i l i l 0 l 4 l n r l $ ; t t , ; i ; l i ' r ' o r rl rl r j . ; 1 o 1 1 1 : 1
t , h e r n a t e r r i t r - a r r d i n { r r r r t - l r r - g i t ' r rdci v i s i o n r l r r t ll i r e n i r n r b c r o f c i t h c r
p c l ' s o n sr c g u l a r l r e n i p l , t l ' 1 , ,uf t , r ' r ' l i r ' 1 r t , t t i i r r r . i n i n i r t r n . T h i s p o l i c v
l e f t a v a i l a b l e s u l ' [ i t r i e nftr r n t l s f o l c c r t r r i n s t r l r i i t : a n t i t ] e t n o n s t r e t i o n s
and for thc lending of spcciallv tl'rrinetl pclsor',rielto r1o spc<'iallield
s-orii for short periods. Tltc herrdtluartcls strrtl u-rs a ilrir'lr' c'oti-staut
group consisting of the director (a phr-siciant, rrn assistant tlilector
o r a s p e c i a l i s t i n c h i l d h 5 ' g i e n e ( a i s o a p h 1 - s i c ' i a n \1. h t ' a c c o u n t a n t ,
r Seenraternitl and infanct act, secs.3 an(l 8 (,\ppcndix -\, I)p. 12?,1:8
I S c e t h c m a t c r n i t t ' a n i l i n l a n c l ' a c t , s e c .5 ( , \ p l r c n d i x - { , p . l l t ) .
15
F*_
Provided by the Maternal and Child Health Library, Georgetown University
16
TEE IMELFARE AND TIYGTENE ol
MATERNTTY .\)iD rNl"\NCr
who in addition to auditing tbe expenditures of n]-atemitv rin,i
i " t " . " u i u n a . i n t h e S t a t e s a i s o a c t e d a s a c c o r r n t a n ta t - h e a d q r l a l ' 1 , ' r i .
u-.o"rttury, and t!r-o clerks. The lield sta{ changed. in type anti
*orkers and in the services rendered as occasion demandeti
*
"f types of work developed.. In 1929 this stafi incl*ded 1l
""-t
u"J
". ""* 2"nurses, and 1 other rvorlier.
phvsicians,
ASSISTANCETO STATNS
Fronr 1922 to 1929 the director of the maternitr- rnd infarrt iil'gieut"
oi tii" cooperating States ind the Territor'1..of
ai"irl"" iisited
of the State.. reieivecl ieveral of these.ach'isolyvisits.
Hui,;"ii. \lon1- """5
nurse nrade advisory visits to appro.rirnatel5 rll tire
tfr"
"""..,liingS?trtes,an{ the rrccolitant rnritle iirnual visits to the
"""p".r*ti"S
S
- tates to audit accounts.
i h ; n u a r r = " o I t l r e r r r at e y n i l r - a n r l i t t f a n e r -a e t l ) r o l l l l c c , li t l t i i r t - a a i " t * a a L r i n n df . , r . t r . r r i r r e ,rJ* i o r l e r ' . , r v l r i c h * r r s i n e \ e o s s c f t l r p
(}f
i " " o t i : . - { r t h e r o q t r e s l, , f t l r e S t a t o st h e c o t t s l r l t i r rsgt u l f l u i r s e t i r e
e'rc
c
]
r
i
l
d
n
n
d
n
t
r
t
i
e
t
'
t
r
r
l
i
n
i
r
r
s
t
r
u
c
t
i
o
n
I
c
o
t
t
t
'
s
c
,
a
u
i
r
a
n
q
e
d
Li,'i'li*.t,
of n,rscs. Betrveen Decenrin" ,rior.., luiiich she gave lrefr,re gr*ils-institntes
for nrirses rvere lelrl
U"t l, f gi'2, ancl Jrine'30, 1!i23, s-uclr
in 16 Statcs.
tire servicesof ph1-siciansfroln the Cliildlerr's
-riemonstration
NIanr. States requestecl
child-healtir or prenatal eonfert"' .""a"6t,
B.i;;;
r 0 ( . u t . ( . [. 1
' | 1 s. r i t . l rr rt , tl i l t r , l s p t ' t - e ,l 'l o i ' t ' r t i ' ' ' i l : ' J
P l t i . s i c i : r r r \s1( . I . C
"pn; iai ,""rl.. i n ' K e n t u c l i v ,
\fontana, North Carolina. Nortli I)rrhuta,
Carolina.
South
and
Oregon,
grollps lrresented needs.fol sp'eciailvorhers fol intplovettient
-i.iaii:li."s.'The
R-acial
negro niduir-es bf the South ofiered a special
of
p r o b l e m i n c o n n c e t i o n r v i t h t h e l o r v e r i n g o f t h e d e a t h -r a l . g .i n t h e
'''f
5;,,ii';;" States. -{t llre request of thc Strrte }rerrltlroflieers
Delarvare, Georgia, Tenncssee,-Texas,.andYirgini,r. tlie negto $'olllttll
r r h i . i . i r n ' o n t l i e s 1a f f r , f t h r . r n l t c r n i t r - a n d i r r f , r r r . t - l l v g i e n e . , l i v i s i , , n
p r o t r t o t e tIIr i r t h r c g i s l I ' n t i o l r
5"ii-i r.l".itnctnrof negrornirlriivesnnd
c
o
n
f
e
r
e
n
c
e
s - i nc ( ) n r l e c t i o r *r i t h l r e a l t h
h
e
l
t
l
S
h
e
r
l
s
o
i
;
;
;
;
.
i; fi;"
and industrial inst'itute at
nonnal
State
the
of
u1''ttr" ]rospital
'
"1..[
p
u
b . l i c - l e a l t l r _n r t l s e . o n . . t l t e
S
p
a
n
i
s
h
s
p
e
r
l
i
i
n
g
i;;L"s"".- .fio. 1.ne
s t a f f a i d e di n i n s t l r r c t i n g - m i d $ i v cisn \ e $ \ f e s i e o . l ) e m o I ] s t l ' r r l I { J l l s
attd infaniy r-orh rvere conductecl in sevcral States at
;i-;;i;ilav
For severol months one of the pubiic-liealth nulses on
ih"it t.qrr..i.
the Federal staff conductecl a demonstrati')n nul'sing plogranl 1Ii.
cere in four counties of L'itah: follorving 1,hissire
u"a
-"t*""i
"nla
prog'ain in care- _of .the. presch,ol cliild iu
e""" ;.-a;";nsiration
Nebraska, then a denronstratign o-I-a publtc heall,lI llul'slng pr'og_Idll}
i" i[.-i"io.est of mothers and babies-in \\-yoniing. Pach of these
demonstrations awakened local interest and'stimula'red local activities for improving maternal and child hygiene.
pro\-es.for 11)I
Consideiable aisistance was given to State.carrrp.nign
are
the
statistics
vital
Good
death regist"ration.
-tou"aotio"
-*i
oi nitlh
for""dgood p.blic-health_ progranrs. Thel- furnish the
eomp{tssbr- u-hich prrblic-health rvork is guide.d. \\ithrttt thettr att.v
the
nublic-heaith prosranr is more or lesstrneertain. Ilealizing this,
conducting
*'ere
tlat
States
B"i"ui itur easer to assist,
bhlia;;;t;
themielres into the tlnited States birth and
t;-b.i"g
;;;;ic^
death resistration areas.
Provided by the Maternal and Child Health Library, Georgetown University
sEI'tlrcESol rr{E CHTLDIiEN'sgrnnru
uNDEri THE -{cr
1;
ro i0 States the lr..eau gave sp.ecialassistancein their campaigns
to secure more complete rqqistraiion.: Arkansas, Colorado, Georgia.
I d a h o L o u i s i n n a , N . ' a d r , i ( ' e * - r I e s i e o ,o i r , i l d r , , , s o u i t , ' c a r o l i n a .
a n t l ' l ' e . r r s . T h e r l j r e c t ' , r o I t ] r e n r r i t - e , r ' n i t ro-n , t i n t " n i - h r - g i e n e
division also se'r-etlas a 'rcr'ber of tiic Natitinai G;"rift;;
to Aid
completion of the Regi-"t.atior A.en bcf.rc 1930. Both tte birth and
d e u t h r t g i s l l ' r i 1 i . l ri r l c i r s i r r . or r ( ) \ \c r ) r n l i l { , i .l,' , , i ., . ; ; , ; i i : , ; , ; ; * J ' l ' n i t e t l
D t l l e > \ \ ' l 1 . tl lt l c { , \ c c j ) l l O rl lr l S o U t l iD r r j i , r l i irt r r r l' i ' r , r r r s .
,, Tlie sPecialists,i-n-child h1-gieneancl obstetri,.*,r11,c,ri,er.con ihe
t i r e "s t a f l ' r i s s p e c i a l c o n s r r l t a l i t sg a v e p a l t - t i r n e s e r . r . i c e ,. , , , , , * , , , , , , . 1
a.res.
* l.ls1
, o r r t ' . s p e c i a l iisnt r . l r i i t Il r y g i e n cg n r . ee d ' r c , , i i , , , , ,i,-ti i . . i , ,
U a J t l n r i r t ,L . o l u t ' i r t iJr '.,o r r i s i i r nN
a ,l i c h i g x l l , : i n d\ \ , - e s\t- i r g i n i l I i ; l i ' i j ; g 1 ,
r \ - B Si c n l 1 o g r r e .( ' r , l r r s eis, c l r i l d h v g i e n c t o p l r y s i c i r n si n I l . r r l r . n i i .
j \ e \ - { i ( i n ,a n < l U k i a j r o t n a . - \ S p e c i i r J i S. ut l r o 1 - a s
e r , n < 1 l 1 r a ,i+n o b _
stetrics conducted cour.sesin obstetrics for Ph1,si,:ir;l;.K;ntuckr
and olilaho*a a'd ga'e some etl'caiio.rr'tilks
i"-r1"n"i"".'^l
member of the o bstet ric al_?dr-isoryconrmittee conclucte J-si,.ii-. uu..o*
in ( ier,r'gin
a n t . lF l o r i d a . T h e b r i r e a r ig a v e s p e c i , , .i i r i i . i i " r t * s s i s l , , n c e
1 1 Il l l o R l l a l )s l s o l n t r t t e r t t a ln n t . li n l : r r r 1n. r o l t t lj i t r r l r t n i n L i c l r t rar r o ,
rndrai*r, I'entrichv.. \{aryland, tr'!'chigan, Neiv Ilarnpsirire, New
Je'se1',
\e* I o.rtt,'\-orihirrntinr,.Ohi":p;;"*li;."i;;'R'i;;i.'I.1,,,.,;,
'r,;i";:;al
\:irginia. anrl \\-isc',nsin.,\n rralr-sisof infairi ;il
'ro.j
biditv and mortaiit'in Idaho was:req'estud t[; ia;i; beparrby
menf of F'blic \\-6Hare, an<r a .tltiiti"io"
ii.o"r-1r." rrii.i,, ,o,u*
assigneclto the State for th-estud5'. At the rcquest-of r"rror."o ,,
s t a t i s i . i c i nr rna s , a s s i g r tr oe d
t h l t S t a t ct o m a k ea . i l , a " n r " o n n n t a oi n , l
maternalrnoltalitv in relationto the attendantat birth, in six counties.
CONFERENCES OF STATE DIRECTORS
I'i'e rnnual conferencesof directorsof state bureausand dir-isions
administerilLgthe Federal maternity and infancy
t**-["la
in ttru
".i
children's Bureauin \\'ashingtonduring the serlen
J-"rr. ;ith; operatjon of the act.- .(No eonference\\.ash-eldin rCiz",ifie dr.t-v"r, oI
the opcrqtronof lhe act,.an-([
nonein rg2g,the last )'earof its operation.) The attendanceinchrdednot onll"the dircciorsfrnriipr,,ctithe cooperatingStates,a number"of;*oqi"t;;;;t"r;,
super_
_{]]r
vrilngitlnurses, and other rnenrbers of the child_hygieneo.' .hil.l_
selfare bulearrsand dir..isions
but also state health 6fri.;;; frorr,."reral of the Statos. Representatir.esfronr the three, no"*op"ruti"g
states also attendcd some of the confere'ces Tt; ail:*"tor.Tu.ia"E
upon the time jg' holding
the conferenccsand the iopic. to te dis'Rrireari
cussed. The childlen's
arranged for trlans'poiltationancl
details in relation to thc pl.ogram,inciuding ,..lrt"I-oi--sp"eal.ers.
Representativesfror* prir-ate brganizatiorrr rilho.. ari.i oi'irrdir""t
purpos-eis the {urtheranceof ririiternalor.child u,elfar.eor hygiene,
as,r"ellas specialists
in pedJatlics,
obstetlics.nirtritio", un,t ,utot.a
sllDJcets,
\4-ere
among
those
w'ho,aplreared.on
the conference
progfanrs.
'r'fiese
confe-rences
made poss-ible
thc exehangeof experiences
by
" the
state directors and pro'eh of great practical iah,e tri;h;i;.-"
Provided by the Maternal and Child Health Library, Georgetown University
lttr- \\-ELF.\Iiu,\Nr) lrrGIE\E oF fr'\TERNITY '\\rr r\F-\\c\
18
ADYISORY COMNIITTEES
rll olr'i''tt'iT,,r-oadi-isorv comriritteesrone of pediatricians and one
rlre'rlrct's
The
ttre.btrreatl.
t6
"f
.io"., ,=",.i".o{ .:*l,r$te so.-ices
are tliiti'grrishe4 in thcir special fields. The pcdiit*""'.-'r"rittees
.oir.ist. of_tirree nicrnbers, one named li1'
;T;i" ;ir-i;;ii'-'r*ritio.,
"iitto"-iog
or.ganizrtion.: Th_e_-\tnericanPediatric Societl"
"ftn
"".,f-r
sectioir ,,t-ltt" -\mclican ]It'dical Issociation, and the
iii. nnaintnic
Issociation. The rr,ii'ector oi the chiid:i;;,J;i;.;"Afrif,i'g.,,iit
the L'hilL]rerr'sRureatt ttrcets ri-ith this commit"ee.
1""-i.""',ii."i-r-io{
'iiffi;;i;i".."",i,i"i;tr3
by
\\e'c {orrrrtrlatt'd
.trit.i-6."lthcontere'ces
e ic t t r o r l t t i re t ' i t . n . r t i , , t ' " c. r l r - i . , , 1 ]c' , r t t t t t t i l { t 'ue' .i t h t h e a s s i s t a r r o
ancl
triaternit't'
of
clirecto'
Statc
a
ancl
;i;;',;;i;;;;i
rr*tti"i'i..
child
ancl"
care
;nfant
lxi
,rri-.,iir;;ti,r;;T'"iut"tiul
ili1,";i,"';r;,t.]
;;;:;, i.'.,r;at'fi tir.l,,ti.".,i i. *"b"rittecl to this conrniittee{or a.pproval
or
'"i'h.
rcvision.
;ilietricai aclyisorvcortirnitteeg'as t,i'ganized"atth,r',retltlest'
of chllti !1-gleue'
of the 1924conferenccof state directorsof lriu'ear.rs
l
.
r
e
a
.
p
p
o i n t ctdo . d r a u ' u p
c
o
m
t
l
i
t
t
e
e
I
t
l
r
n
t
r
i
r
a
t
l
e
h
c
i
n
,
l
Ihosrrcqcstiol
f " , ' t h c r t s co f l r h l s i c i a n sn 1 e l i n i c sa r ' d
;i;,ij;;i.';i'pi"'iti.r
"n,.
rror.k. The Chil,lrcn's Bttttttt aecc;ttctl tltc sttqgcs:li.; '"
Dr.ir.ltc
the l'rrea* reqrLestedan obitetricia* rvho is
;i,;;,';#'';fr"iiri"i-"t
of the T{arr.ard \Iedical school to form
fairiltv
ttre
of
;il;';';l;;b"r'
T-he.it"it-tbers, lvho rt'present diflerent geographsuch a comlrittee.
flrrttt
i c r l " s " . t i " n l . , f r l r c c o L I I r t l 5 ,i n c l r d r ' i n s t t ' u c t o l s i n o l r s t e t l ' i ' ' s
in{antancl
rnaternity
the
..iioot... The director of
;;;-;;;i;ii;di";i
f"ri-oii"" ,liti,"inn of tlre Cliild.en's Bru'cart rueets u'ith this cortrt'ittee'
.iiil- ;;-;;iii"u
f*,tr.,tated standards of prenatal cnre fo' p6ysicirtrs,
f1'the Chilclren's.Buteau in 1925 as one of its
;"itilh i;;;;o,ltti.n"a
been aclopted b-v several nredical schools for
b,;'il".il;;i*rri.i..-r-t"i:;
The cornrnittee continrred to
itrstruction.
use in their co,trser'-of
also has
=ui.'-"-trt" r'"reart iIt tt'-tttltlitntl' capacity-' qrrd its chairman
nll the
like
x-?ichCare,
Prenatal
i,,,li.ii"
t5" bu..uiii*
,""riti""
s r r t h i s s r r h j e c t\ \ n s n , p p l ' o r e thl . v l . h c1 ' t ' r ' r r r i t t e o
iitit"."t= pi,blicati,rno
i r e t b r c i t w r t s i s s l t c d. l T h e = " o i e a n d c h a l a c t c l o I i l r e i ' r a f e t ' t t a l buleau
i,.rtofit" stuch. matie bv 15 States in cooperation rvith the
cornmittee'
this
by
,r:.t=
-Th;;e"d'"ttttined largcly
g:real
h",r-.,"^tnitt"es are not merely no'rinal; the-v*rencler
looli
to
rvho
directors
State
and
parents
to
..,.-l* io the br,re.u'and
infant,
tlie bureau fo. D,ateiliul on tlie sribject of adequate tnaternal,
'itrtl child care
suRvnys AND sruDIES
'f
n
i r t , ( ' l r i l . . l r . e r i 'l sJ r t t ' i . r r tclo r ) p p r n t c , Ii p 3 r 1 . 1 ' r - t t' rn' '=! . s t : l ' l i c s i n
li,rirrirer.(]f Strites. Lisrrllly the cooperation includcd the assigntDent
,,i'i,,,,',..,i i,.i."onr"l inr ih"" plllpose'of collcctinq data in.the States,
t t , , , i i , f , , , , " r i r t i o i ro b t a i l e i t o ' b e c o m p i l e d , e d i t e d , a n d p u b l i s h e t l | i t e r
!'r- lht' I'ttLt'rttt
su*v'y
oF MATERNIT' HoMEs
i , r " n i r i t c r ' l l l ( ' l l r r : s l l g ( o' f t h e m a t e r n i t v a n d , i r r f a n c r -a c t a n s t t r v e Yo f
Penlrs;'ll : . r t e r "r r i'3,.'ili'tr,'"Ltti-,rnil
t \ - l t r r l r r r , *<, , s ' - r ! , , r , 1i"n c o o p c r l t i o n u ' i t h t h e S t a t e c t I
;..;i-
socialaspectsrvereinvestigated,a physician
=-
Provided by the Maternal and Child Health Library, Georgetown University
sER\-rcras()1-TttII CHTLDRENtssunplu
uNDEri TIIE ACT
19
ancl a social xor'lier ireing assigned fronr the bru'cau for tile stridv.
#ur exienderl to X4innesota, and still lat-er
tn" i"r-"iiis"tlo"
iri.t
a sulYe\r o{ rlaternity honies ancl a phVsician rvas
\{ontnla r.e,tltrested
a-*sigriedto rnalie the survef in that State.
STUDY
OF STILLBIRTHS
AND
NEONA
AL DEATHS
An investieation of stillbirths and neonntal dcaths $.as begun at
the Llnii-ersiil- of \{innesota in ]923 for the maternit;i and infanthvsieler dir-ision of the children's Rureau. Thc stutl1' related to
facjors I'est)onsil)lefor the deaths before. drrling, ancl after birth and
inclucled a study of etiology, pathology, and plevention, -based on
about 1.000 stilibirths antl deaths of infants under 2 rveelis of age.
The tabul&tions ar.ein process of analysis hy bulear,rstatisticians.
STTTDY OT' NEONATAL
MORBIDITY
AND
I}IORTALITY
In 192E the child-hvqiene division of the bureau began a stud-y of
the causes of neonatai inorbidity and mortalily, in cooperation rvith
the Yale tlnir-ersitv School of N{edicine. Infants werc eramined on
the first, third, tenth, fourteenth, and-fort5'-secold days of life, and a
n a t h o l o e i c a ls i u d l u ' a s m a d e o f n n v w h o d i c d b e f o l e t h e f o r t y - s e c o n d
t-h" inforriration regarding i,001 case. to be included in the
h"v.
rerlort of the study u'ill folliox- certain general lines relating the natal
and neonatal history of the child to the prenatal and natal history of
the nrother. Special analvsis q'ill be made of thc history of the premature infants; and the history of those 'vho were stillborn or who
died u.ithin the first nronth after birth will be given special attention
1,odetermine so lar as possible l,he cause of death. The findings in
these special studies atrd in the autopsies made will be considered in
llith the information available for the whole grollp.
"otrn..iiotr
il1;"rtechairmanorthe
Amaternat-,'"..J#J".r:lJil'.*:llffi
b u r e a u ' s o b s t c t l i c a i a d r i s o r v e o m m i t t e e a t t h e 1 9 2 6 c o n f e r e n c eo f
State directors of rnaternity and inlancy u-ork, and.srreha study was
aDprovcd bv the confclenee. A plan of rvorh, schedrrles.and rnstructions co.-cring tit'tails of the $'ork $-ere prepared rvith the assistence
of the bureau's obstetr.ical advisory cbmmittee. Every maternal
death registerecl u-ithin tlic ca,lt'ndar )'ears 1927 and 1928 u'as investigatecl in''t3 Statcs uricl e\elv such <leath i'egistelerl in 102S in these
Stut". aucl trvo aclditiorial States. Thcse 1ir States rvcre the followi n e : A l a b a n r a , C a l i l ' o r n i a ,I i e n t t r c k . r ' \, l n l r l a r r d ' \ l i c j L i g n n ,M i n n e s o i a . N e b r a s k a . N c t \ . H a r r r D s h i l e ,^ \ t , t ' t h D , t k o t a , O l i l u l r o m a ,O r c g o n ,
Rhode Island, Virginia, \Tashington, and \tr-isconsin.
The inr-estigatio"nsurade by tlie physicians included the selection of
data from birih and death certificate.s, and r-isits to attendants, ph_ysicians, midwives, or others I'ho at,tentled t'he v-oman who died' The
hosoitil record rvas obtained for all of these worlcn who had had hosn i t u ' l c a r e . T h c C h i l d r e n ' s B u t e a u l e n t p h y s i c i a n s1 o n i n e S t a l e . t o
inake the investigations. Six States suppiied physicians fronr tlieir
ox,n st,affst,o rnaf,e the visits to attcndanls,,'nlv atlr-is,'tr-iltr(l othcr
occasional service bcing rendcred thesc sjx Stltes |v tlrt' ltLtretttl.
of
X'acts in the bit'th and iiea,th certificatt-s liled itr 1hc Strrte brtt'catl-s
r.ita,l stntistics aflolclcrl the ltreliniinarS tlrrtrt. IrrLt'thct'iufor'tttrrtion
was obtaincd b1-tltc metlicul inr-estigrrtolsin theil intcrvien-s u-itli the
physician, nritlivift, or.othe.r'attcnclJnt at birtli for eIcrl- rvonran rvho
Provided by the Maternal and Child Health Library, Georgetown University
20
sErivicEs oF Trrn cHTLDRENts etrREAU UNDER TFIE -{cr
died in childbirth within the period of the study. The dtt,r i'rom the
7,537 schedulesobtained in the 15 States came to the Chiltiren's
Bureau to be tabulated and analyzed.
In the 13 States in which all maternal deaths of 1927 (3,234)were
investisated 797 of. these deaths were due to albuminuria and convulsionl. Reports on the prenatal care received were obtained for
728 of these deaths. I\{ore than half the women (375) received no
prenatal care. Of the 355 who had some prenatal care, 192 had
u'hotty inadequate care. Sixty-four had fair care beginning someasgood
rvhatlate in pfegnancy,and 76 receivedcare t'hat was_negarded
thouEh below tlie requfuementsin the bulletin, Standar*dsof Prciatal
comnritteeoi the ChilCarel prepared by the obstetricaladvisory
-Only
,lrenis'Burearl an[ issued by the bureau.
20 mothers had the
Erade of care "excellent" recommendedin this bulietin. In 3 cases
[he care could not be Eraded.
It should be borne in mind that the statement of the amount and
kind of prenatal care given relatesonly to B,grolrp of women u'ho died
from albuminuria and convulsionsl a suryey of care given mothers
surviving childbirth might show a larger proportion of women
receiving proper prenatal care.
Of the 3,234 puerperal deat'hsin 1927in 13 States, 1,278 (40 per
cent) were due to puerperal septicemia. One of the objects of the
study has been to determinethe underlying causesof the deathsfrom
sepsis,which form a large proportion of the puerperallosses. It was
found that abortions preceded45 per cent of the deaths from septicemia. Of a total of 570 abortions 309 r,vereindr.rced,154 'were
spontaneous,19 were therapeutic, and for 88 the type was unlinou'n.
Thus abortions known to be induced were responsiblefor about onefourth of the deaths from sepsis.
A study of 796 casesin the sepsisgroup for which prenatal care\tras
reported showedthat nine-tenths of the women had had inadequate
c'Te or no care'
sruDY oF RI.KET'
Someof the work of the child-hygienedivision of the bureau rvasof
direct value in promoting the purposesof the maternity and infancy
act-in particular a study of rickets made by that division !n cooperation with the Yale University School of Medicine and the New
Haven Department of Health. A district consistingof three wards
of New Haven was selectedfor the demonstrati n part of the study,
which covered approximately three years. During this period
clinical and X-ray exarninations\l'ere made of the children receiving
treatment,and of a control group. Sociai and economicdata having
a bearing on the development of rickets in New Haven also were
coilectedl Tabulations were made showinEthe relation of the Nerv
Haven rickets diasnosesin each3-month peiiod to the amount of codof fanningof the skin, the rate
liver oil taken,the diet, the presence
of grow-th,and the deviation from averagerveight for height and age,
nof only in the period under considerationbut also in contiguous
.i. f:9,#
periods.
A study of approximately 600 Porto Rican infants alsov'as made to
furnish firrthef itandards for interpreting the Nerv Haven findings.
The study covered,in addition to data on rickets, not only certain
aspectsof health but also material on social and economicconditions
in-the fanriliesof the children. diets, and suchlocal conditions as \rere
Provided by the Maternal and Child Health Library, Georgetown University
sErivrcEsoF Trrll cHrr,DREN'sBLRE^ruuNDERTttE ^{cr
2I
;rertinent to the studv. The health oi the children as indicated bv
inorbiditv and rnortaiity statistics r-as considerecl,their growth, and
their generaiph1-sical
condition. The report of this study will include
of the incidence of rickets, eviclencesof the
a detailed discr.rssion
diseasefound in rontgenograrnsof the arrn bones and at physical
examination, and the relation of these evidencesto various other
factors.
In addition to the rickets studies in Nev- Haven and Porto Rico
a study r-as made of rickets in children in the District of Coiumbia.
Both clinical and X-ray data v-erecollectedin this investigation, and
attention was given also to the nutrition of the children.
PREPARATION
OF NTATERIAL
FOR DISTRIBUTION
r\lthough the St,atesthemselvesprepare popular publications on
child care and maternal care for distribution to the public, most
of them also receive regular quotas of certain popular bulletins
on child and maternal care issued bv the Children's Bureau, rvhich
thev distribute to their public. Ser:eralnew folders were prepared
during the period when the bureau and the States were conducting
this cooperative program and rvere widely distributed by State
directors.
A nunrber of bureau publications have been preparedfor the information of physicians and nurses conducting child-health u.ork, for
scientists, and for research workers. Included in this group of
publications are Standardsfor PhysiciansConducting Conferencesat
Child-Health Centers, Standards of Prenatal Care-an outline for
the use of physicians,Prenatal Letters (preparedfor the use of State
bureaus or divisions of child hygiene), Referenceson the Physical
Grou-th and Der-eiopment of the Normal Child, Posture Clinics,
PostureExercises,Habit Clinics for the Child of PreschoolAge, Milkt,heIndispensablelrood for Children, and \Yhat Is Malnutrition?
In the grant of funds to the States the maternity and infancy act
assisted directlv in the nromotion of the u'elfare and hvEiene of
maternit5r and infancy. The surveys and studies of the Ofrildren's
Bureau, ihe lending of membersof the X'ederalstafi who are specialists
in child hygiene ind obstetrics, the conferencesof State directors,
the assistancegiven by national advisory committeesof pediatricians
ancl obstetricians,and the popular bulletins publishedby the bureau
aiso pla1-edan irnportant part in this joint undertaking of the State
and FederalGovernments.
o
Provided by the Maternal and Child Health Library, Georgetown University