The Fight To Save Mothers And Babies—And What It Can Teach Us About The Politics Of Health Care

Government control over medical care . . . a violation of states’ rights . . . the first step down the path towards socialized medicine . . . unfairly burdens taxpayers . . . expands the government bureaucracy . . . promotes contraception . . . violates the U.S. Constitution . . . the government shouldn’t be involved in health care.  

Critics of the Affordable Health Care Act rattle off these objections as if they were reading from a script—a script written 90 years ago. In 1921 these same criticisms were voiced by individuals and groups opposed to the Maternity and Infancy Protection Act, groundbreaking legislation that signaled a radical change in how Americans viewed the role of government in responding to public health crises. The history of the law’s passage and its subsequent repeal on June 30, 1929 provides important lessons on the politics of health care in the United States. 

The Maternity And Infancy Protection Act

The early years of the 20th century were marked by alarming rates of infant mortality in the United States. For more than two decades activists among social workers, nurses, public health workers, government officials, philanthropies, immigrant societies, and pediatricians lobbied at the federal and state level for the implementation of programs to improve the health of mothers and babies. In 1921 legislation to provide federal funding for women’s and children’s health programs was introduced into the Senate by Senator Morris Sheppard, a Democrat from Texas and the House by Representative Horace Mann Towner, a Republican from Iowa. 

The Maternity and Infancy Protection Act passed the House and Senate and was signed into law by President Harding in the fall of 1921. Commonly known as the Sheppard-Towner Act, the law provided a federal grant of $5,000 and matching funds to participating states for infant and maternal health programs. Beginning in March 1922, Sheppard-Towner funds, which were limited to education and diagnosis, were used to pay the salaries of visiting nurses and establish educational programs and 3,000 free diagnostic clinics for young children and pregnant women. 

The Most Powerful Lobby In Washington

Despite tremendous opposition from the American Medical Association, anti-suffragist politicians and organizations, and some newspapers, the proposed legislation easily passed in both the House, (279 to 39) and the Senate (63 to 7). Congress’ overwhelming support for Sheppard-Towner stemmed from lawmakers’ fear that women would vote as a bloc.

In The Political Economy of Saving Mothers and Babies: The Politics of State Participation in the Sheppard-Towner Program, authors Carolyn Moehling and Melissa Thomasson note that with the passage of suffrage in 1920, Congress feared the women’s vote. “Women’s magazines published numerous articles in favor of Sheppard-Towner. The League of Women Voters supported the bill, and the Women’s Joint Congressional Committee (WJCC), which claimed to speak for 20 million members, lobbied strongly for its passage and generated significant grass-roots support.”*

Created in 1920 by former suffrage leaders to coordinate efforts to achieve reforms supported by women, the WJCC was an umbrella group that included almost every major national women's organization of its time, including the League of Women Voters, the Women's Trade Union League, and the National Consumers' League. In The Women's Joint Congressional Committee and the Politics of Maternalism, author Jan Doolittle Wilson states that the WJCC “evolved into a powerful lobbying force for the legislative agendas of more than twelve million women. As such, the WJCC was recognized by critics and supporters alike as ‘the most powerful lobby in Washington.’ The committee's early achievements spurred a business-led retaliation that challenged and ultimately limited the programs these women envisioned.” 

The fear of Senate members was acknowledged by Senator Kenyon, who confessed in the April 1922 issue of the Ladies Home Journal, “If the members could have voted on that measure secretly in their cloak rooms it would have been killed as emphatically as it was finally passed in the open under the pressure of the Joint Congressional Committee of Women.”

Legislators’ fear of the women’s vote is supported by other evidence. Moehling and Thomasson point out that “suffrage coincided with immediate increases in state government expenditures for functions women generally supported, such as education, sanitation and hospitals. Suffrage also generated more liberal voting patterns among federal representatives.” 

The Opposition

Despite its laudable goal of reducing infant mortality, the Maternity and Infancy Protection Act generated fierce opposition from the ultra-conservative American Medical Association, anti-suffragist politicians and organizations, and some major newspapers. The AMA viewed Sheppard-Towner as an attempt by government to intervene in medical care, arguing that the legislation was the first step down the path towards socialized medicine. Pediatricians within the AMA publicly disagreed with the group’s position and actively supported the bill’s passage. The Medical Women’s National Association also supported Sheppard-Towner.

Anti-suffragist politicians and organizations joined the AMA in opposing Sheppard-Towner.  The Woman Patriots, formerly known as the National Association Opposed to Woman Suffrage, condemned the law “as a communist and feminist plot.” Moehling and Thomasson conclude the opposition of the Woman Patriots and many anti-suffragist politicians “reflected the general anti-suffragist opposition to government expansion into issues they felt should remain within the home and family.”

The Chicago Tribune denounced Sheppard-Towner in editorials as a “dangerous and evil precedent” that promoted “the centralization of government, the development of bureaucracy, and the weakening influence of paternalism.”

But most opposition to Sheppard-Towner rested on the argument that the federal program violated states’ rights. The states of Massachusetts, Connecticut and Illinois refused to participate in the program, claiming that the federal government had no right to intervene in matters of state policy. The Commonwealth of Massachusetts filed suit against Treasury Secretary Andrew Mellon, asserting that the Act infringed on the state’s sovereignty. Another lawsuit was filed by Harriet A. Frothingham, president of the Woman Patriots, who maintained that as a taxpayer she was unfairly burdened by the Act. The U.S. Supreme Court dismissed the Massachusetts’ lawsuit and affirmed the dismissal of the Frothingham suit in a lower court, determining that Mrs. Frothingham’s injury was not serious enough to warrant a lawsuit. 

Although Connecticut and Massachusetts declined to participate in Sheppard-Towner, both states were eager to take other forms of federal aid. The appropriations committee of the Connecticut General Assembly refused to take federal aid under Sheppard-Towner as a matter of principle, but then voted to accept federal aid for an airplane squadron. According to Moehling and Thomasson, “At the same time Massachusetts was suing to preserve its rights under Sheppard-Towner, it was accepting federal money under 22 other programs. The inconsistencies of these states' behavior regarding other federal grant programs and their stated opposition to Sheppard-Towner suggests that ‘states' rights’ may have been just a convenient excuse to vote against a program that was unpopular with politically influential groups.”

The political battles over Sheppard-Towner grew in intensity when supporters attempted to extend the law’s authorization in 1926. The same groups that opposed the bill in 1921 lobbied even harder to defeat the law’s reauthorization. The AMA again was one of the principal opponents, describing the program as socialized medicine. The Catholic Church also opposed Sheppard-Towner’s reauthorization because the church’s leadership feared that the educational programs would include instruction on birth control. 

Perhaps a more important factor than the lobbying of the groups opposed to Sheppard-Towner’s reauthorization were the results of the 1924 and 1926 elections which indicated that women did not vote in blocs on issues, but rather split along party lines. The election results suggested that members of Congress had no reason to fear the women’s vote.

While the reauthorization easily passed in the House, a filibuster led by conservative anti-suffragist Senator Lawrence Phipps of Colorado prevented a vote in the Senate. Under a compromise worked out between supporters and opponents in Congress, Sheppard-Towner funding was extended for two years in exchange for the automatic repeal of the law on June 30, 1929. 

From Private Tragedy To Public Responsibility

Despite its repeal in 1929, the Maternity and Infancy Protection Act was a success story. The health care programs implemented under the Act and even the contentious debates surrounding its passage and reauthorization raised public awareness and resulted in expanded funding both at the state and federal level for programs to improve the health of babies and mothers. Even in Illinois, which refused to participate in the program, the focusing of public attention on children's health helped increase public spending and lower the state's infant mortality rate by 50 percent between 1920 and 1930. 

Sheppard-Towner and other measures to reduce infant deaths such as milk programs and the development of vaccines came about because activists envisioned an America where children did not die before their second birthday.  It was the vision of healthy children that became the ground on which activists stood.  Over time, the vision began to gain ground in the American public’s imagination until it eventually was translated into broad public support for children’s health programs, whether at the state or federal level. After the passage of Sheppard-Towner, the private tragedy of a baby dying from an infectious disease would become a matter of public conscience and public responsibility.

Sheppard-Towner offers important lessons for those who believe that affordable health care is a fundamental right of every American. It demonstrates that the passage of the Affordable Health Care Act of 2010 and the controversy surrounding its passage and implementation may be helpful in focusing public attention and slowly building support for its goals. 

The striking down of the Affordable Health Care Act by the U.S. Supreme Court, in whole or in part, may be only a temporary defeat for supporters. There are already renewed calls for a single payer health care system from physicians’ and nurses’ groups, including National Nurses United and the powerful California Nurses Association. And significantly, President Obama continues to enjoy an 11-point advantage over his Republican rival in his personal favorability rating among women voters.

The ultimate lesson of Sheppard-Towner is that if activists persevere—if they continue to stand their ground and articulate their vision of affordable health care for every American—public support will eventually broaden to the point where the vision will become a reality.    

*In The Women's Joint Congressional Committee and the Politics of Maternalism, author Jan Doolittle Wilson puts the number of members of the WJCC at 12 million. 

Note about the photograph:

The photograph was taken in New York City in 1912. The caption reads: Mrs. Guadina, living in a rear house at 231 Mulberry St., a dirty poverty-stricken home, and making a pittance by finishing pants. On the trunk is the work of four days. She was struggling along, (actually weak for want of food) trying to finish this batch of work so she could get the pay. There seemed to be no food in the house and she said the children had had no milk all day. The father is out of work (sells fish) on account of rheumatism. Three small children and another expected soon. Credit: Library of Congress.  

Sources: 

The Political Economy of Saving Mothers and Babies: The Politics of State Participation in the Sheppard-Towner Program, Carolyn M. Moehling and Melissa A. Thomasson, Rutgers University, Miami University and National Bureau of Economic Research, 2009. 

For the Welfare of Children: The Origins of the Relationship Between U.S. Public Health Workers and Pediatricians, Howard Markel, M.D., PhD, American Journal of Public Health, 2000. 

The Women’s Joint Congressional Committee and the Politics of Maternalism, 1920-30, Jan Doolittle Wilson, 2007. 

Children and the Law, Encyclopedia of Chicago, Chicago Historical Society and Newberry Library, 2005.