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MSU II An Afflnnativo ActioNEqual Opportunity imtituion
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”-9.1

 

NETWORKS OF PUBLIC AND PRIVATE ORGANIZATIONS:
BUILDING MATERNAL AND CHILD HEALTH PROGRAMS
1N MICHIGAN, 1910-1930

By

Kristi Ann Rutz-Robbins

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF ARTS

Department of History

1997

ABSTRACT

Networks of Public and Private Organizations:
Building Maternal and Child Health Programs in Michigan, 1910-1930

By

Kristi Ann Rutz-Robbins

In Michigan’s towns and rural communities a network made up of women’s
voluntary organizations, the Michigan Bureau of Child Hygiene and Public Health
Nursing, nurses and private physicians, enabled local communities to open maternal and
child health clinics before the passage of the Sheppard- Towner Maternity and Infancy Act.
These clinics expanded in number during 1923-1929 when federal fimds were available to
support maternal and child health programs. Clinics continued to function after the funds
were withdrawn. The Board of Health of the City of Detroit operated separately from the
Michigan State Board of Health and did not received support from the Sheppard-Towner
funds. Nonetheless, here also a network of public and private organizations enabled the
Detroit Urban League to establish a Baby Clinic prior to the Sheppard—Towner Act, to

expand its services from 1923-1929 and continue operating after 1929.

ACKNOWLEDGMENTS

Without the assistance and support of numerous people I would never have
completed this thesis. I thank the staff at Bentley Historical Library, the Michigan State
Public Library, and the Michigan State University Library for the time they gave me. I
thank Dr. Maureen Flanagan, a member of my thesis committee and professor in whose
research seminar this project was begun, for her sincere interest in my work and invaluable
comments and suggestions. My thanks go to Dr. Richard Thomas, another member of my
thesis committee, whose encouragement and support have meant so much to me. I also
thank Dr. Lisa Fine who has advised and guided me throughout my master’s program.
She read multiple drafts and offered valuable criticism, I thank her for the careful attention
she paid towards improving my scholarship.

My eternal gratitude goes out to my family whose loving support has been the
foundation of all that I have done: to my parents and sisters for their firm belief in me and
for the hours they patiently listened as I worked through this project; and finally to Dan, my
husband, who has given his time, criticism, editing abilities and love, enabling me to

complete this project.

TABLE OF CONTENTS
INTRODUCI‘ION.......................1
CHAPTERl Building Popular Support for

MaternalandChildHealthPrograms. . . . . . . . . . .9

CHAPTER 2 Sheppard-Towner Maternity and Infancy Act:
Federal Maternal and Child Health Policy ........ 21

CHAPTER 3 Women's Voluntary Organizations and the Michigan
Bureau of Child Hygiene and Public Health Nursing:
Creating Clinics in Michigan's Rural Communities and Towns . 30

CHAPTER 4 Maternal and Child Health in Detroit: A Case Study of the
Baby Clinic run by the Detroit Urban League
and the Detroit Board of Health ............ 45

CONCLUSION.......................63

BIBLIOGRAPHY......................67

iv

INTRODUCTION

Molly Ladd-Taylor observes that “scholars have as yet paid little attention to the
history of women’s health and public policy, but it is a promising area for research in
which much work needs to be done. Women played a key role in the creation of the
American public health system as activists, health professionals, and the primary
consumers of health care. However, the separation between women’s history and
scholarship on public health has left historians with only a partial explanation for the
development of the public health system.”1 This thesis explores the development of child
and maternal health programs in Michigan during the first three decades of the twentieth
century. Focusing largely on the Michigan Department of Public Health yearly reports has
allowed me to piece together the operational structure of Michigan’s early public child and
maternal health clinics. Admittedly, the voices of the women served are missing; this is
yet another unexplored piece of the puzzle for historians of public health and women’s
history to uncover. Even without these voices the documents explored herein give
evidence to the importance of the cooperative networks among public agencies and private
organizations during this period. Largely due to these networks, Michigan developed
maternal and child health care programs that continued to serve women at a time when
twenty-seven other states’ maternal and child health programs disappeared. These
organizational networks were heavily indebted to the networks developed by the growth of
women’s associations in the late 19th century and of black community associations in the

early 20th century.

 

lMolly-Ladd Taylor “Women’s Health and Public Policy,” W
. . . . ed. Rima D. Apple (New York & London, 1990).

2
If current maternal and child health programs are a product of the New Deal and the

following decades, the essential shape and orientation of these programs is the result of
early twentieth century concerns and solutions to infant and maternal mortality.2 To
understand the roots of our current system and thus the subsequent changes that occurred,
scholars need to closely examine this period. In the second half of the nineteenth century,
fifteen to twenty percent of all infants born in the United States died before their first
birthday. In large cities and industrial towns these numbers probably soared to thirty
percent.3 Richard Meckel writes, “Of all the health revolutions that have taken place in the
United States since 1850, the reduction of infant mortality is arguably the most dramatic
and far-reaching.” No other modern reduction of mortality in sheer numbers and the
concentration of those numbers in a single year of life has come close to comparing with
the reduction of infant mortality.4

Scholars consider women volunteers to be the principal campaigners for the
expansion of public maternal and child health and welfare programs nationwide during this
period.5 Every year new research appears on the role women’s organizations played in

developing welfare policy.6 Recent historical work focuses primarily on national politics,

 

2Richard Meckel, _ .
Press, 1990) 4.

3Ibid, p. 1

4mm, 1). 1

5Molly Ladd-Taylor, u . ,l - . '
(Chicago: University of Illinois Press, 1994) 2. Alisa Klaus, MW
.10 .9 0 U. u ..... i ,I 11.1 c'...'1ic ii i i y -i ox. 1,
(Ithaca, New York: Cornell University Press, 1993) 5. RObyn Muncy, W
W (New York: Oxford University Press 1991);
Kriste Lindenmeyer, “Saving Mothers and Babies; The Sheppard-Towner Act in Ohio,”

9111211131911 (June 1990) 107.

6 Noralee Frankel and Nancy S Dye eds W
W (Lexington: The University Press of Kentucky 1991); Muncy, 9mm
Won; Meckel,S_a1e_the_B_abjes; Linda Gordon, “Black and White Visions of
Welfare: Women’s Welfare Activism, 1890-1945” WW
(September 1991); Linda Gordon, “Social Insurance and Public Assistance: The Influence

 

(Baltimore and London: The Johns Hopkins UniverSity

 

3
leading activists and their national networks, the Children’s Bureau, and the rise and

decline of national support for the Sheppard-Towner Maternity and Infancy Protection Act,
the first national welfare measure. Little work has been done on state level structuring of
maternal and child health policy; this may be due in part to the relatively recent interest in
women’s influence on the formation of the welfare state as a research topic. In addition,
historic limitations of the definition of “political,” as well as modern feminists’ rejection of
motherhood and matemalism as incompatible with female emancipation have contributed to
the scholarly neglect of this research area.7 In the last decade significant changes have
been made in how historians look at political participation, especially that of women and
minorities. Rather than limit politics to voting and political office holding, new definitions
expand the realm of the political to encompass social activism in both its private and public

forms.8

 

of Gender in Welfare Thought 1n the United States, 1890-1935” WW
ELL“ (Febmrary1992); Klaus W; Linda Gordon PitiedBuLNut

(New York: The Free
Press, 1994); Ladd-Taylor, W; GNwendolyn Mink, W
W, 1917- 1942 (Ithaca and London: Cornell University Press,
1995); Theda Skocpol,m§91¢ezs_and_Mgthers(;l992) Seth Koven and Sonya
Micheledsq 110.50: W100 Uzueu '0 cur 01.4.0 A -
States (New York and London: Routledge, 1993).

7Koven and Michel. Mahmud. p. 2.

8 Paula Baker “The Domestication of Politics: Women and American Political Society
1780-1920” WW, Linda Gordon, ed. (Madison Wisconsin. The
University of Wisconsin Press, 1990) 76; Skocpol, W, p. 3,
10. Maureen A. Flanagan, “Gender and Urban Political Reform: The City Club and the
Woman’s City Club of Chicago in the Progressive Era,” WW
(October 1990) 1033; Sara M. Evans, “Women’s History and Political Theory. Toward a
Feminist Approach to Public Life ” YlubiflumeLNLEssuxsunAmeumAsnm
Suzanne Lebsock and Nancy Hewitt, eds. p. 121; Katheryn Kish Sklar, “Hull House 1n
the 18905: A Community of Women Reforrners, ” WW
second edition, Vicki L. Ruiz and Ellen Carol DuBois, eds., (New York: Routledge, 1994)
109-121; Nancy A. Hewitt, “Politicizing Domesticity: Anglo, Black, and Latin Women m
Tampa’ s Progressive Movements,”

E1 Frankel and Dye, eds. (Lexington: University of Kentucky Press 1991); Kathryn
Kish Sklar, “The Historical Foundations of Women’s Power in the Creation of the
American Welfare State 1830-1930,” MW Koven and Michel eds.,
(New York and London: Routledge 1993) 43-93. Eileen Boris, “The Power of
Motherhood: Black and White Activist Women Redefine the ‘Political’,” W
m, Koven and Michel, eds.

4
State and local studies can help to follow the course of sociopolitical activism,

exposing the continuity of private, non-govemmental organizations’ participation in
American political and public life and the consequences of their work on social policy
accomplished through networks of individuals and organizations. Kriste Lindenmeyer has
done a state level study of the Sheppard-Tower programs in Ohio. Presently no other state
level studies have been published. A distinctly different development of state Sheppard-
Towner programs occured in Ohio from what occurred in Michigan. According to
Lindenmeyer, Ohio’s Sheppard-Towner programs were headed by a male physician
strongly opposed to the federal act. Women’s organizations in Ohio were not involved in
the decision making process nor in the implementation of Ohio’s programs.9 Ohio, like
Michigan, formed an advisory committee but the Ohio committee consisted of physicians,
nurses, and representatives from some of the state’s health organizations. Thus, Ohio’s
Sheppard-Towner programs were formulated by Ohio State Medical Association physicians
and other health professionals. This contrasts sharply with Michigan, where a female
physician, strongly connected to state and national level women’s organizational networks,
headed the Bureau in charge of overseeing the state’s program. A committee made up of
heads of women’s organizations concerned and already involved with infant health and
welfare advised the Michigan Bureau of Child Hygiene and Public Health Nursing in
aiding their organizations in providing health education and clinical care to communities
across the state. Thus, women’s organizations played on important role in creating and
implementing Michigan’s Sheppard-Towner programs. This may partially explain the
different programs and organizational structure of maternal and child health care programs
between the neighboring states. The comparative strength of the state medical associations
and women’s organizations between the two states also may have been a factor in the

differing structure and survival of the programs.

 

9Lindenmeyer, p. 115.

5
The Ohio advisory committee with the State’s Director of Health as chair outlined

three programs for spending the Sheppard-Towner funds. The first was a set of research
programs, similar to research done in Michigan at the same time: a statewide survey into
the causes of infant and maternal mortality, a study of hospital reporting procedure in an
effort to standardize statistical records, and a statewide study of midwives practicing in
Ohio. The second program, where the difference between the two states is most acute, was
the creation of a series of “district demonstrations” which would “show the application of
practical, specific health education in which every agency in the community is invited to
take part.” Michigan’s Bureau ran traveling clinics throughout the state, but more
importantly aided local county committees and women’s clubs in setting up maternal and
child health clinics widely distributed across the state. The third Ohio program was a series
of conferences run by specialists intended to “interest the public in regular, periodic health
examination for expectant [sic] mothers and children as well as the presumably normal
adult and to enlist the complete sympathy, understanding and cooperation of the medical
profession,” as well as an immunization campaign.10 Michigan’s Bureau was, likewise,
heavily concerned with enlisting the aid and support of Michigan’s medical professionals;
however, the lectures and educational programs were directed primarily at women’s groups
and other non-professional organizations interested in maternal and child health care.

The Ohio Director of Health set up four demonstration districts in the state: one in a
mining settlement, one in a rural district, one in a small town community and one in an
urban center. A key determining factor in the selection of the demonstration district was
evidence of high maternal and infant death rates. Public health nurses performed the bulk
of the work in the demonstration districts. While the demonstration districts did not solely
focus on maternal and infant health, but rather general health as well, nurses were expected
to devote at least 2/5ths of their time to the welfare and hygiene of mothers and babies as
Ohio. This was the agreement Ohio’s Director of Health had made with the Children’s

 

lOIbid, p. 117.

6
Bureau when his program was approved.11 This raises another distinction between Ohio

and Michigan. Michigan’s programs were entirely focused on maternal and child health
and did not combine community health in general with maternal and child health work.
While the three chosen districts predominantly served white native and immigrant
communities, the Cincinnati district, focused on saving the lives of black mothers and
babies whose death rates were much higher than white women. This district demonstration
ran from late 1923 through June 30, 1925. As in other minority communities, black nurses
were hired to work in the district. The nurses made home visits and held clinics in two area
schools. A series of lectures for ‘colored doctors’ was also sponsored by the pediatric
department of the University of Cincinnati College of Medicine, the Cincinnati General
Hospital and the Ohio State Department of Health during the observance of Negro Health
Week in the spring of 1924. Lindenmeyer writes, “this was the only effort focused solely
on black mothers and babies undertaken with the Sheppard-Towner funds in Ohio.”12
Ohio may be an anomally in respect to targeting the black population in the state for
receipt of Sheppard-Towner programs. In other welfare activitiy, pension programs for
mothers specifically, half of the black mothers in the country receiving pensions lived in
Pennsylvania and Ohio. While black mothers accounted for only 3 percent of the recipient
population in 1931, Pennsylvania and Ohio, in contrast with other states, made significant
efforts to address the needs of their black population. Michigan did not use Sheppard-
Towner funds to address the health of black mothers and babies in the state. This neglect
rose due to the several interrelated issues. The Sheppard-Towner funds were given to the
state department of health. The Michigan State Department of Health did not oversee, do
research or run programs in Detroit. The Board of Health of the City of Detroit had

complete autonomy from the state department of health. Detroit held the majority of

 

llrbid, p. 120-123.
12mm, p. 124-125.

7
Michigan’s black population and so cooperated with the Detroit’s board of health rather

than the state department of health which received the funds. Also, Detroit was the largest
urban center, but underrepresented politically at the state level and thus was not in position
to influence the spending of the maternity and infancy funds. In addition, the racial and
ethnic makeup of the Detroit left large segments of its population outside national and state
political structures which made policy and allocated resources. Furthermore, Sheppard-
Towner funds were directed predominantly at rural communities and that combined with
the autonomy of Detroit in health matters, left the Detroit black community, along with the
rest of the Detroit population, on its own during the Sheppard-Towner years. However,
this did not mean that the city’s inhabitants went without maternal and child health care.
Detroit had its own organizational networks that ran maternal and child health care
programs throughout the city. The Detroit Black community, through the work of the
Detroit Urban League was a part of this network.

Thus on numerous grounds the development of the child and maternal health
programs in Michigan differed from that of Ohio. In Michigan, professional and non-
professional white and black men and women, working in networks made up of voluntary
organizations, public organizations, nurses and private physicians, actively used public
resources, as well as private resources, to improve maternal and child health in their
communities before 1923. Significantly, this structural difference the administration of
Sheppard-Towner programs Ohio and Michigan allowed Michigan to maintain child and
maternal health programs after the repeal of the Sheppard-Towner Act, where as Ohio’s
programs declined. The continuity in Michigan’s programs before 1922 and after 1929
points to the centrality of organizational networks to the success of Michigan’s child health
programs, showing that these networks were able to successfully continue the work they
had begun before the Sheppard-Towner Act after the federal funds were withdrawn. While
public and private networks, such as those in Michigan, are not new to historians, they do

add weight and a local dimension to the work historians have done on the national

8
networks created by women reformers in the early twentieth century. The existance of

these networks also reinforces a gender distinction in the way white men and women
participated in public policy making. In addition, the networks seen in Michigan show that
white women activists and black activists (both men and women) participated in a similar
mode. Working outside conventional politics, both groups created networks linking public
with private organizations which provided for the health care needs of women and children

in their communities. ‘3

 

l3For readings on matemalist networks: Mink, WW; Klaus,

' Li n; Koven and Michel, eds., W51; Ladd-Taylor,
mm; Meckel, mm; For readings on race and gender in connection
with the formation of the welfare state see Mink, WW; Koven and
Michel, eds. Medic on bf New Wefld; Ladd-Taylor, Wk; Meckel, 81%
Babies, Gordon, “Social Insurance and Public Assistance: The Influence of Gender in

Welfare Thought in the United States 1890-1935, ” WW (February
1992) 19-54; Gordon, “Black and White Visions of Welfare: Women’s Welfare Actisim.

11390-1945”: Frankel and Dye eds W512:
Eta.

CHAPTER 1
Building Popular Support for Maternal and Child Health Programs

In 1921, the Michigan Public Health Department asserted the obligation of society
to preserve the lives of its infants stating, “All babies have a right to live; a right to the best
there is. They come into the world without their consent, and society is inhuman when it
neglects or refuses to provide for them.”14 This sentiment often expressed in the Miehigan
WM grew out of Progressive Era activism of women’s voluntary
organizations working to remedy what they identified to be social injustices towards
women and children.15 Women activists believed that women had a unique role to play in
the public realm, one that focused on the improvement of the family and the protection of
women and children. Women’s moral vision, compassion, and capacity to nurture became
linked with motherhood, these private qualities became central to the public discourse
scholars now identify as matemalism. Matemalism upheld women’s domesticity at the
same time it legitimated women’s public ‘domestic’ role. As Koven and Michel write,
“Using political discourses and strategies that we have called ‘matemalist,’ they
transformed motherhood from women’s primary private responsibility into public

policy.”16

 

14 J. P. Sedgwick, MD. and E. C. Fleischner, M.D. “Breast Feeding in the Reduction
of Infant Mortality,” Bubiieflealih (May-April, 1921) 117.

15 Paula Baker, “The Domestication of Politics,” WW,
Linda Gordon, ed. (Madison Wisconsin: The University of Wisconsin Press 1990) 63.

16 Koven and Michel eds., MW, p. 2. For more on matemalism
and women’s emerging public role and the developement of public health and welfare in

the late 19th and early 20th century see: Skocpol,Em1melmens_andem:s, p. 349',

9

10
The ethic of matemalist reform can be traced to the early nineteenth century when

women in American began to organize to promote social reform and moral purity. Within a
newly defined domestic sphere of activity drawn from an domestic ideology that stressed
the difference between men and women, white, middle class women began to work in the
public sphere in efforts to provide the civic moral reform they believed industrializing
America needed. In 1874, the formation of the Woman’s Christian Temperance Union

(W CI'U) put women’s volunteerism into a larger arena of political activism. Not limited to
temperance issues, the WCTU moved into openings created by the American tradition of
limited government and members generated a wide range of needed social services. As
Koven and Michel write, “The WCTU created new opportunities for middle-class women’s
social activism in a social environment that was absorbing massive numbers of recent
European immigrants and a political environment where municipal, state and national
governments offered little if any assistance to needy men, women, and children.17
Increased access to higher education contributed to women’s new public role. By 1880,
one out of every three undergraduates was female.18 The social sciences by this time were
gendered so that women predominated in three of the five departments of the American
Social Science Association - education, public health and social economy.19 College-
trained women reformers thought of themselves as policy experts and used social science
tools in their work. A group of educated reform leaders turned to settlement work among

the immigrants communities in America’s cities, such as, Jane Addams’ Hull House in

 

353' Regina Morantz, “Making Women Modern: Middle-Classs Women and Health

Reform 1n Ninetenth-Century America,” W ed., Judith Walzer
Leavitt, (Madison, Wisconsin: The University of Wisconsin Press 1984) 348- 349' Klaus,

.For imormation on domestic ideologies of the 19th century see: Linda
A.,Kerber IIIIII'i‘IIWI‘a 1.9!".4l’x’0 roofing"! :(New
York and London: W .W. Norton & Company, 1986) Chapter 5.

”Koven and Michel, 14mm, p. 61.
”mm, p. 62.
19Ibid, p. 65.

1 1
Chicago. Beyond the reform leadership, by the 1890’s tens of thousands of urban middle-

class women put their educations to use in the women’s club movement. The General
Federation of Women’s Clubs (GFWC), drew together after 1890, a vast network of local
women’s organizations and channeled women’s energies into concerted political action.

The movement for maternal and child health rose as women’s political activism
grew. Concern over infant mortality developed alongside sanitary reform in America’s
urban centers in the late 19th century. Reformers sought first to reduce infant mortality by
improving the general public health through sanitizing the environment. The Pure Milk
campaign began when statistics showed that the greatest proportion of infant deaths were
due to digestive and nutritional disorders and when bacteriology emerged as a science.20
By the 1890s, cities established milk stations, especially in tenement districts, in efforts to
reduce infant deaths due to poor quality or contaminated milk. By 1913, 297 milk stations
chiefly operated by private agencies, existed in thirty-eight cities.21 While milk reform
addressed the nearly one third of infant deaths that were due to diarrhea, infant mortality
rates remained high, as respiratory diseases and infectious diseases killed sizable numbers
of infants. Believing that educating mothers on rules of infant hygiene and management
could lower infant mortality rates still further, new reform work defined infant mortality as
a problem of motherhood and reformers turned their attention towards improving mothers
abilities to carry, bear and raise healthy infants.22

Voluntary agencies formed the core of the campaign against infant mortality. In the
19103, organized women ran infant health clinics staffed by hired or volunteer physicians

and nurses. They examined, weighed, and measured children and instructed mothers on

 

20“Introduction” and “Historical Foundations of Women’s Power,’ ’Mgmemgfl‘lm

M. Koven and Michel eds.; Meckel, Sa_e_me_Babies, p. 5-6; John Duffy,_'[he
' .11- 1 (U rbana and Chicago: University of

 

Illinois Press 1990) Chapter 12. A

21Mecke1. 511mm. p. 79.
221bid, p. 6, 94-124.

12
nutrition and hygiene.23. By 1915, hundreds of private agencies, in almost 300

Americans cities and towns, conducted some form of educational infant welfare work.“
While voluntary agencies formed the core of the campaign against infant mortality,
few of those involved in the campaign believed volunteerism alone was sufficient to meet
the vast array of social and economic problems common to industrial society. Reformers
concerned about child health and welfare argued that only government had the authority,
resources and centralized bureaucratic organization to pursue and coordinate effective
reform and regulation. Women’s organizations, at the local, state and national levels,
finding their own funds inadequate to meet the great demand for health care, lobbied the
government for publicly funded child health and later maternal health services.” Local
concern supported a growing national coalition of women’s organizations and professional
reformers who worked to pass their voluntary work to the government as they campaigned
for mothers’ pensions, minimum wage regulations and the creation of the US. Children’s
Bureau in 1913.25 Support from local women’s organizations, the social settlements, the
National Conference of Charities and Corrections, the General Federation of Women’s
Clubs, the Mothers’ Congress, and local child welfare societies was central to the
establishment of the Children’s Bureau 27 Skocpol argues that the campaigns led by female

 

23Ladd-Taylor Mgihexflqflgp. 51 and Meckel, W95, p. 113-114.

24Mecke1. magnum p.129.

25Molly Ladd-Taylor, '
W, (New Brunswick: Rutgers University Press, 1986) 152.
Meckel, S_ay_e_the_Babies, p. 112-114.

26Paula Baker, “The Domestication of Politics,” p. 76., Skoc pol, Wm

auiMuthersp 310; Mink W p 13: Weckel.SaxetheBabies,
Chapter5,

27 Skocwl Wrap 3 10 Most scholars recognize the

centrality of women’s organizations to the establishinent of the Children’s Bureau. For
other accounts read: Linda Gordon, W, p. 70-80. She presents the
campaign for welfare 1n terms of a white women’s network. This networking style of
organization was vital to Michigan’s maternal and child health programs that were later
formed. For a more through discussion of women’s campaign for maternal and child health

soc also Ladd-Taylor Mather-flux Muncy.§2realing.a£emale_129miniom Skocpol

 

l 3
professionals “would not have succeeded without the locally rooted women’s federations

already engaged in child welfare work and other civic activities.28

It took eleven proposed bills before the Children’ Bureau was signed into law on
April 9, 1912. Housed in the Department of Commerce and Labor, the Children’s Bureau
was intended to be a research agency to “‘investigate and report" .upon all matters
pertaining to the welfare of children and child life among all classes of our people.”’29 As
the first federal agency headed and staffed primarily by women, the Children’s Bureau
focused national attention on maternal and child welfare and coordinated the disparate
activities of voluntary women’s organizations into a powerful nationwide campaign.30
Working with leaders of the public health nursing profession, women’s voluntary
organizations and other voluntary organizations, the Children’s Bureau worked to foster,
inspire and guide an independent infant health movement by providing models, information
and limited material assistance,.31 Local studies directed by the Children’s Bureau quickly
became associated with women’s groups and therefore established the primacy of women
in child welfare work.

Historian Molly Ladd-Taylor writes of the Children’s Bureau, that “the spotlight it
placed on maternal and child welfare made many women feel they had a stake in politics for
the first time.”32 Volunteers from all over the country promoted the Children’s Bureau and
its work towards reducing infant mortality. Women’s clubs asked the Children’s Bureau

for direction on how to reduce infant mortality in their communities. These voluntary

WM; Meckcl Weber and Alisa Klaus Emflhrlda

.WIIIMIIIUIL 1111 .I'I 1_1

1W, (Ithaca and London: Cornell University Press, 1993) Chapter 3

zsskocpoummashmrermmahm p. 2. 482.
29Muncy. Won p. 46-47;

30 Ibid, p. 38; See also Ladd-Taylor, Marin-11911;, Chapter 3.
31 Klaus, When. p. 210-211.

32Ladd-Taylor. Mather-lam. p. 74.

 

14
women’s organizations functioned as active partners in the Bureau’s work by forming child

welfare committees in state and national women’s organizations. The national chair of
child welfare then worked directly with the Bureau and sent orders down to her state
chairs, who directed the activities of local branches.33 Commenting on the widespread
recognition of the power of organized women and the Children’s Bureau, historian Robyn
Muncy writes, “State health officials and legislators knew that if they wanted an immediate
force of lobbyists on behalf of better birth registration laws, they need only write to [Julia]
Lathrop, [head of the Children’s Bureau] and the lobby would materialize.”34 Pressure
from organized women and the publicity generated by the Children’s Bureau prompted
state health officials to back the child hygiene movements and to ask the Bureau for help in
achieving higher birth registration rates. The legislative victories of the alliances between
the Children’s Bureau and local women’s organizations exposed the potential power of
even a small, federal agency without the legal right to prompt states or individuals into
action. This power lay primarily in the networks of public and private agencies in the
Progressive era.35

Enthusiasm for child welfare programs at the local, state and national level was
boosted by US. engagement in W.W.I.36 Congress created the Council of National
Defense in 1916 to study the country’s economic capacity for war. In June of 1917, the
Council of Defense Special Committee for Child Welfare recommended “that the Council of
Defense call upon all communities to see that there is no abatement, but on the contrary a
decided increase in their activities along the lines of maternal, infant and child welfare; this

to apply to all public and private agencies.” The Council further recommended that “the

 

33Muncy.creanngal=_emalermln1en p. 61.
34Ibid, p. 58-60.
35Ibid, p. 60-62.

36For readings on the connection between WW1 and the infant health movement see:
Mink. W Chapter 3 and Meckel, mm. P- 200-

15
Council of National Defense through the several state councils of defense, cooperate with

local organizations interested in maternal, infant and child welfare, and establish an agency
or appoint an existing agency to secure information as to the specific needs of each
community and to show how these needs can be adequately met.” 37 This attention to
child welfare was due in part to the large number of young men rejected from military
service for defects at least a third of which could have been recognized and treated in
infancy. During the war, 29.1 percent or 730,000 young American men were declared
physically unfit for military service. Most of the defects appealed to be the result of early
childhood diseases such as, scarlet fever and rickets.38

Reformers read the army data as proof of the social and human costs of ignorance,
illiteracy, poverty and cultural isolation. Maternalist leaders used this evidence to lobby
government for more generous and more systematic social investment in motherhood and
child health and to included organized women and the Children’s Bureau into the campaign
when the Council added a Woman’s Committee after the declaration of war to coordinate
the voluntary, war-related activities of men and women in the states it named Dr. Anna
Howard Shaw, former NAWSA president, chair of the Woman’s Committee.39 She
immediately established ten departments, each with a national chair and chair in every state,
directed state chairs to act as child welfare agents for the Children’s Bureau and to assume

the responsibility for implementing the Bureau’s war time program.40 Setting up the

 

37Margaret Hughes, “Building Up Our Last Line of Defense,” Wealth (April
1918) 1 10.

38Muney. W p 97; Meekel .SaxellreBables. p; 201 for

statistics; Paul Starr ln I1 ' , ._
Summauflufesauuandrhemmsmufalasundum (Basic Books 1982) 193 He
presents slightly different figures: He reports of 3, 760, 000 men examined, about 550, 000
were rejected as unfit; and of the 2. 7 million called into service, about 47 percent were said
to have physical impairments.

39Mink. W. p. 23.

40Muncy. Qteauugafiemalenorniniuu. p. 97 and Skocpol. W
lumen. p. 496.

 

16
Woman’s Committe in this way, Shaw replicated long established women’s cooperative

associational methods. The establishment and work of a Woman’s Committee tied
women’s social and political roles together and placed greater responsibility on the state for
child welfare.

The Children’s Bureau’s wartime program, a publicity campaign called Children’s
Year, began April 6, 1918.41 The publicity of Children’s Year and rising popular
sentiment, caused many communities to establish permanent health clinics funded and
administered by local governments working in cooperation with the Children’s Bureau.42
During the war the Children’s Bureau and the State and National Councils of Defense,
cooperating with Federated Clubs, Health Departments and all organizations interested in
child welfare, began a drive to save 100,000 children, designating each state a quota of
babies to save. 43 Women’s organizations were key to the success of this drive. Bina
West, Chair of the Michigan Child Welfare Department wrote, “No greater problem than
this exists in the world today. While nations are destroying the manpower and the natural
resources of the world in the carnage and devastation of war, organized women are called
upon to help make good that waste by the conservation of child life for the future.”44

The baby saving campaign generated state involvement.45 Success of Michigan’s
campaign to meet its quota of 2,808 babies, depended on the work of voluntary
organizations in the state. The April 1918 edition of the Michigan Public Health
Department magazine, Will. explained that state and federal agencies, either

official or voluntary, “can make plans and offer suggestions, but each community must

 

41"Child Welfare Campaign,” W (April 1918) 98.

42Ladd-Taylor, MM“. P. 89-90.

43Margaret Hughes, “Building Up Our Last Line of Defense,” p. 113.

“Elm M. West, “Child Welfare,” W111 (April 1918) 106.

45For more on the Better Baby movement see Klaus, When, Chapter 4.

17
bear its full share of responsibility in making the campaign a success.”46 The Women’s

Committee recommended lending aid to already existing organizations working for child
welfare and advised readers of hibiieflealih to get in touch with parent teacher
associations.47 Arguing for the importance of local women’s organizations to child health
in writing, Bina West wrote that “The work of this Department [State Child Welfare
Department] covers the welfare of all children, and it affords an excellent opportunity for
women’s clubs, societies and organizations of all kinds in Michigan to cooperate in a
general plan of work which will benefit the children of the state who need this help.”“8

The wartime nationalistic rhetoric apparent in public health literature such as Bublie
Healih also helped to propel support for maternal and child health and welfare programs.
The April 1918 isse included articles asking, “Is there any greater patriotic duty for the
civilian population than to safeguard the welfare of the Nation’s Children?” and stating that
“National Liberty rests upon national vitality. The health and strength of the people are,
therefore, fundamental factors in national defense?“9 The essay, “Building up Our Last
Line of Defense,” by Margaret Hughes, Director Child Welfare Division from Helena
Montana, asserted that “there is not greater patriotic service than fitting the children of today
to physical and mental efficiency, for the heavy burdens that will rest upon them as the
citizens of tomorrow.”50 Wests article'further emphasized community responsibility
towards children by arguing that “Although the United States now lacks the machinery for
such Federal Aid as England has enabled to grant to local work it has power enough locally
to make a very credible showing, and, it may be hoped, to pave the way for such

 

46West, “Child Welfare Work,” p. 122.
47Ibid, p. 106.

431bid, p. 105.

49Ibid, p. 98 and 108.

50Hughes, mullahs-aim. p. 109.

l8
Governmental provisions as will enable the United States to show that even greater salvage

which its unexhausted condition makes possible.”51

After World War I, the statewide and local child and maternal health campaign drew
upon this momentum. The 1920 April issue of flibfiefiealm, featuring child welfare
exclusively, opened with a cartoon of a baby on a pedestal flanked by a soldier and a
worker in overalls holding a mallet. The Pedestal read, “The Baby-To him we look for
reconstruction and the future strength of all nations.” The caption below read, “The
Biggest thing to have come out of the war.”52 The first article titled, “Killing America’s
Babies,” stated, “Fifty thousand American soldier were killed in the great world war in
Europe the past two years. Dreadful. But 300,000 babies were killed in the United States
only last year.... As a matter of fact, 600,000 children under the age of six years are buried
in the United States annually.”53 The author urged women voters to inform themselves for
the purpose of saving American babies arguing, “Woman must enter the domain of
sociology, of politics, of political economy. To neglect these fundamental sources of
knowledge and power is to be responsible for this dreadful slaughter of the innocents.”54

Attention turned increasingly to maternal health. Dr. Josephine Baker, Chief of the
Child Hygiene Bureau in New York City wrote that “for every soldier killed a mother died
in childbirth, and for every soldier killed six babies died at childbirth , and all because the
social and theeconomical conditions are so poor.”55 In May 1919, the Children’s Bureau

wrote standards for public protection of maternity at the Children’s Bureau Conference on

 

51Wesr, “Child Welfare Campaign,” p. 100.

52W (April 1920) 153.

531bid, p. 155. Even with the baby saving campaign, U.S. child and maternal mortality
rates were still high compared to European rates.

54Judson Grenell, “Killing America’s Babies,” mm (April 1920) 155.

55Ann Wilson, “Development of the U. 8. Federal Role ln Children’s Health Care: A
Critical Appraisal,” ' -., ed. Loretta M.
Kopelman and John C. Moskop (Boston, London, Dordrecht: Kluwer Academic
Publishers 1989) 39.

 

19
Standards of Child Welfare that stressed the need for education on hygiene, having a

complete physical examination by a physician, and the availability of adequate maternity
and prenatal care to all women.-"6 Public support was vital to the Children’s Bureau’s
vision, “Laws alone will not make people civic or healthy. They must spring out of a
public sentiment, and be backed by public sentiment, or else they will be like so many
laws that are only occupying book space.”57

Through the 1920’ 8 public sentiment would support maternal and child health
programs. mbhefleaiih continually reaffirmed the neccessary role of the state in lowering
infant mortality. The April-May issue of 1921 opened with a graphic featuring a map of
Michigan broken into counties with a smiling baby pasted over the state. The caption below
read, “11,041 Babies under one year of age died in Michigan in 1920. What are you doing
in your community for the Babies?” It ended by asking, “Do You Know that the boys and
girls of today are the mothers and fathers of tomorrow and it is up to you to keep them
well?”58

The publicity generated in the early 19105 and 19205 led many communities to
established permanent health clinics funded and administered by local governments,
philanthropic or social service agencies working in cooperation with state departments of
health and the US. Children’s Bureau.59 These state divisions owed no allegiance to the
Children’s Bureau legally; yet, they took advice from the Children’s Bureau and submitted
regular reports on budgets, legislation and programs in their states. After World War I the
Council of National Defense was dismantled and the Woman’s Committee transferred its

work to newly created state agencies or to permanent women’s organizations.60 These

56 W (April, 1920) 155.

57W (April, 1920) 159.

58W (May-April 1921).

59Ladd-Taylor Mothetflork. p. 89-90; Meckel Wear). 141.
5°Mmcy.crea11nz_al~:emals_psm1m9h. p. 101.

 

20
agencies and organizations advocated for the creation of maternal and child health programs

during the post war years and their support would ultimately lead to the passage of the
Sheppard-Towner Act.

CHAPTERZ

The Sheppard-Towner Maternity and Infancy Act:
Federal Maternal and Child Health Policy

The Children’s Bureau and its supporting voluntary organizations actively pushed
for more maternal and child health initiatives from national government reinforcing the
points that maternity care was a public responsibility and that local funds were not adequate
to reverse the limited availability and underconsumption of quality obstetric services thet
were responsible for America’s high maternal mortality rates. They cited statistics that
every year 17,000 mothers died and that, since 1900, no decrease has been seen in the
maternal mortality rate although other death rates had been reduced.61 Reminding readers
that the US. maternal mortality rate was higher than fourteen other countries, the
Children’s Bureau cited the need for state and national aid to provided borth the education
and health services neccessary to lower these rates. Federal support and funding for
maternal and child health programs thus became the goal of the Children’s Bureau.

The campaign to secure the passage of the Sheppard-Towner Maternity and Infancy
Act brought concerns about infant and prenatal care into the world of politics.“32 Women’s
organizations across the country lobbied in support of the bill. The Charter members of the

Women’s Joint Congressional Committee, established in 1920, unanimously voted to make

 

61 Judson Grenell, “Killing America’s Babies,” Bibliefleahh (April 1920) 155.
Meckel, SayeiheBabies, presents Meigs 1916 maternal moralty study p. 202.

52 Ladd-Taylor, Mp. 168. For Sheppard-Towner History see also Meckel,
Chapter 8, Wilson, “Development of the U. S. Federal Role 1n Chilren’ s

W.
Health Care A Critical Appraisal” Larld-Taylor. W
pp. 24-32.

21

22
passage of the Sheppard—Towner Maternity and Infancy Bill its primary goal.“3 (gm

Housekeeping. Ladieaflumeluurual. Wanamegompauiuu and Mugalls urged
women to write their congressmen and provided petitions to circulate and sign.64
Thousands of women wrote congressmen and senators urging the passage of the bill.
Other women joined an organized lobbying effort what was described by many in
Washington as the most intensive campaign to influence the vote on a single bill they had
ever seen65 Signed into law by President Harding on November 23 ,1921, state
legislatures still needed to vote acceptance of the Act. The Federation of Women’s Clubs,
League of Women Voters, and other women groups led lobbies in state capitols. By June
30 1922, all but six of the 48 states had accepted the Sheppard-Towner Act.‘56 Ultimately
only three states refused to do 50. Illinois and Connecticut established their own maternal
and infant health programs. Massachusetts did not and challenged the constitutionality of
the Sheppard-Towner Act. The Supreme Court dismissed their suit.‘57

The Sheppard-Towner Act “provided federal matching grants to states for
information and instruction on nutrition and hygiene, prenatal and child health clinics, and

visiting nurses for pregnant women and new mothers. It furnished no financial aid or

 

63Muncy, W, p. 104. The charter organizations were: the
General Federation of Women’s Clubs, the National Consumers’ League, the National
League of Women Voters, the National Women’s Trade Union League, the National
Congress of Mothers and Parent-Teacher Associations, The American Association of
University Women, The Women’s Christian Temperance Union, the National Federation
of Business and Professional Women’s Clubs, the National Council of Jewish Women,
and the American Home Economics Association.

64Ladd-Taylor, MW, p. 170.
65Mecke1.8ays_1hs_uahies p. 210; Mink. WM. Chapter 3;

Ladd-Taylor, “My Work Came Out of Agony and Grief ’: Mothers and the Making of the
Sheppard-Towner Act,” WW, Koven and Michel eds., Chapter 9.

66Muncy. mummies. p. 107.
67Meekel. W. p- 211-

23
medical care, and limited appropriations to a period of five years?“8 The grants, available

from 1923-1929, supported a marked increase in child and maternal health activities in the
states. The Southern and Western states, where prior to the Sheppard-Towner Act
maternal, infant, and early childhood health programs had been all but non-existent,
particularly benefited from the Act.69 Almost every state used Sheppard-Towner funds to
hold health conferences, make home visits, promote birth registration, and distribute
literature. A number of states also ran mobile health clinics, organized training programs
for midwives, immunized children against diphtheria and smallpox, and encouraged the use
of silver nitrate to prevent blindness in infants. Some funded research into maternal and
infant mortality and investigated local hospitals, maternity homes, and day nurseries.7O
Even though it was not intended to finance medical care, a number of states also ran mobile
health clinics, and immunized children against diphtheria and smallpox.

Not all communities benefited from the Sheppard-Towner Funds. For example,
the Detroit black community operated a Baby Clinic run by the Detroit Urban League and
the Board of Health of the City of Detroit that remained untouched by the federal program.
This is due in part to the rural emphsis of the Sheppard-Towner Act. The Children’s
Bureau had first concentrated its investigations on urban areas assuming the problem of
infant mortality was essentially an urban one, but then it shifted its work by 1920’s to a
largely rural focus. According to Meckel, in 1917, as maternal mortality became an
increasing concern, lack of rural obstetrics care redirected the Children’s Bureau focus
from urban centers to rural regions. Though he argues it recognized that urban mothers
died more frequently in childbirth and from pregnancy complications than the rural mother,

 

68Ladd-Taylor, W3, p. 168-169.

69Meckel.$.a1e_the_Babies. p. 211.

7oLard-Taylor. Melherflorlr. p 177 Raymond Devries. W
W W(Philadephia: Temple University Press 1985) 38.

24
it continued to pursue rural programs.71 Lloyd C. Taylor attributes this shift to the work of

Dr. Frances Sage Bradley of the Children’s Bureau rural medicine program.72 Ladd-
Taylor argues that the first maternity and infancy bill introduced in 1918 specifically
targeted rural areas, where mortality was thought to be highest. Thus the subsequent
Sheppard-Towner Act reflected this early emphasis.73

Aside from conflicting beliefs about rural and urban mortality there are other
explanations for the uneven distribution of programs across racial and ethnic lines.
According to Alisa Klaus, the Children’s Bureau had chosen to work in smaller cities and
in the rural communities where the grass-roots strength of the women’s infant health
movement was concentrated to avoid competition with already established service groups,
located in larger cities like Detroit. Consequently, this was where Sheppard-Towner
programs were later developed.74 Ladd-Taylor , who also maintains that Sheppard-
Towner programs chiefly benefited white farm women even though statistics showed
higher death rates in urban areas, argues that the decision to concentrate on rural areas was
made partly to avoid conflict with health agencies already established in a number of cities,
but also because this promised less conflict with the medical profession, since the
specialists who dominated the AMA had less influence in rural areas. Ladd-Taylor also
suggests that the rural focus may be due in part to the large correspondence between
Lathrop and her staff and the white farm women who were the main audience for the
Bureau’s pamphlets.” Historical racial and ethnic inequality left black and ethnic

minorities outside of networks of political power whose middle-class members formed

 

71Meckel, Measures. p. 204.

72Lloyd C- Taylor. IbeMedicaiBmfessiunandSoeialRefunn. 1885-1945 (New
York: St. Martin’s Press 1974) Chapter 5.

73Ladd-Taylor, “My Work Came Out of Agony and Grief,” p. 328.

74KlauS.E1enL_Child_aLi9n. p. 210-212.
75Ladd-Taylor, “My Work Came Out of Agony and Grief,” p. 337-338.

25
public policy, and the Sheppard-Towner Act itself, which allowed states and localities to

determine their own programs, contributed to the focus on a white rural population.
Southern and border states developed infancy protection measures either for whites only or
on a Jim Crow basis. In northern cities de facto segregation reinforced the white ethnic
bias of matemalist reform.76 This is in part why Detroit operated uneffected by the funds.
Ladd-Taylor argues that despite this racial and ethnic bias the federal Children’s Bureau
worked to reduce infant and maternal mortality in all racial and ethnic groups, hiring black
physicians and nurses to work in black communities, Spanish-speaking nurses to work
among the Mexicans and Native Americans to work on reservations.” Ultimately, the
states had control over the spending and direction of their programs and no single factor
can be identified as the determinant of who the recipients would be; as in the cases of
Michigan and Ohio these programs could vary greatly as well as the recipients. In the case
of Michigan another factor also must be considered. The historical separation of Detroit’s
Board of Health and the Michigan State Department of Health, combined with active
involvement of grass-roots, white, women’s organizations across the state in getting
maternal and child health clinics established in their own communities, led to the de facto
white bias in Michigan’s Sheppard-Towner programs.

Some physicians opposed federal maternal and child health programs, others
supported federal involvement in maternal and child health issues although they pushed for
the creation of programs under the public health service. Believing that the medical
profession should be in charge of health bureaus across the nation, rather than ‘lay’ women
associated with the Children’s Bureau, physicians supported federal involvement, but
along different lines that defined by the women of the Children’s Bureau. Taliaferro Clark
(Surgeon, US. Public Health Service) read a paper before the Homeopathic Medical
Society of Pennsylvania on Sept. 21, 1920 discussing the needs in child hygiene. Clark

76Mink. W p. 67458.
77Ladd-Taylor “My Work Came Out of Agony and Grief,” p. 331.

 

26
heavily emphasized the importance of prenatal care of the mother across the country.

Citing the 1910 census data, he noted, that children aged birth to fourteen made up 32 % of
the population.78 Two-thirds of these deaths were due to causes that current child hygiene
programs did not address, (namely prenatal sources of death).79 He criticized state
departments of health for leaving the creation of a bureaus of child hygiene to the last. He
further criticized the departments of health for placing nurse or lay women in charge of the
bureaus. This was a concern in common with many in the medical field. He claimed that a
proper child hygiene program must have a foremost place in the public health organization
including in the budget, and stressed that even trained women or men from the medical
profession and public health profession would be challenged to oversee such a program.80
He wrote, “There is no lack of child hygiene programs. Practically every civic organization
has one and virtually all of them are directed to one-third of the baby deaths, with the
exception of pubic health organizations providing prenatal supervision in a limited way.
The great need is to pull all these organizations together, and to give them scientific
direction under centralized administrative control. The combined support of private
organizations behind well-directed public health education as to the real needs of the
Divisions of Child Hygiene would enable health departments to establish them on an
adequate basis successfully to attack some of the more fundamental problems relating to
child health.” 31

Despite the apparent success and wide spread support of Sheppard-Towner
programs, opposition to renewing the Sheppard-Towner Act was almost immediate. The
American Medical Association began its campaign against renewal of the Act with an

editorial in mammalian, in February, 1921. The AMA perceived the
73211111121112.1111. (April-May 1921) 122.
79mm, p. 124.
801bid, p. 130.
8lrbid, p. 130.

 

27
Sheppard-Towner Act as a threat to male doctors incomes and control over the health care

system. The AMA argued on three grounds against renewal of the Act: “it made a political
issue of women’s and children’s health; it expanded the social welfare function of the state;
and it increased professional women’s authority over public health and welfare
programs.”82 At the heart of the AMA’s oppostion was a perceived challenge to male
authority. Doctors questioned the ability of the “lay” women on the Children’s Bureau
staff to administer maternity and infancy programs, overlooking the fact that a female
physician headed the Maternity and Infancy Division of the Children’s Bureau. Medical
leaders urged that, if passed, the maternity bill should be administered by the Public Health
Service run by male doctors, rather than by the (female) “social workers at the Bureau”.33
Sheppard-Towner opponents also argued that the act was fiscally irresponsible, that it
violated states rights, that it endangered private medicine and declared it socialistic, in
addition to objecting to an agency staffed by “spinster feminists.”84

Since the Sheppard-Towner Act had initially been funded for five years ending June
30, 1927, proceedings for the extension of the funds were initiated in 1926.85 The Act
passed in the House 218-44, but it was blocked in the Senate by the conservative wing and
a compromise had to be reached. Sheppard-Towner was extend for two years after which
it automatically was repealed. Many women assumed that the well-organized women’s
movement would cnrsh the Opposition, as Anna Rude told Michigan Director of the Bureau
of Child Hygiene and Public Health Nursing, Blanch Haines in 1922, “‘With the women
of your state well organized, one does not have to take their [doctors’] action too

seriously.” Yet two years after thirty thousand Michigan women signed petitions and

82Ladd-Taylor, Mama-mm, p. 171-173.
83Ibid, p. 171-173.

84Moclrcl.sai111-.rllauahiea p 209 See Taylor. IbeMerlicaLEmfcsslcnauasoclal
Reform, p. 107-111 for brief summary of support and opposition to the Sheppard-Towner

Act.

 

85Muncy. Emanufiemalanuminiun. p- 125-

28
succeeded in getting their state to accept Sheppard-Towner funds, Haines facing another

round over appropriations complained, “If any thing has made me want to get out of my
job it is facing the situation.”86 Organized women were no longer able to push the funds
through Congress.

After the funds were repealed, twenty-one states tried to continue maternity and
infancy work.87 Michigan, through state and local funding, successfully continued child
and maternal health work. The Michigan legislature, in 1929, amended the 1927 law
which established county health departments and allowed the payment of $3,000 per year
to every county health department to meet the requirements of the State Department of
Health.88 The establishment of the Children’s Fund of Michigan trust in 1929 also
ensured that child welfare work continued in Michigan.89

The Children’s Fund was created in April 1 1929, by Michigan Senator, James
Couzens, with a 10 million dollar gift. According to We, Couzens
believed “that each generation is capable of taking care of its social needs and that other
generous persons will constantly make equally generous gifts, so that there is no need for
endowments of this kind in perpetuity.” 9° The trust money, used over twenty-five years,
to promote child welfare was intended to “promote the health, welfare, happiness and
development of the children of Michigan primarily, and elsewhere in the world.”91 Its
Child Health Division, one of three divisions created by the trustees, gave grants to
independent health nursing services, such as the Visiting Nurse Association of Detroit, as

86 Ladd-Taylor, W. P. 85.
871bid, p. 190.

 

  

' , Michigan Department of

 

Health 1929, p. 10
89"The Children’s Fund of Michigan,” Michiganfllziiefleairh XXII (July 1934) 128.
90“The Children’s Fund of Michigan” IheMiehigmNmse 3, (April 1930) 1.

91Children’s Fund of Michigan Reference File, Bentley Historical Library; University
of Michigan, Ann Arbor Michigan i.

29
well as, to the Michigan State Department of Health, and to the Detroit Urban League for its

Green Pastures Camp, a program that took black children out of the slums.92 The
Children’s Fund and continuing support from other private organizations enabled maternal
and child health programs to continued at the state and local levels in Michigan. Programs
begun on Sheppard-Towner initiatives were maintained and new programs added, in
addition, programs that had not received Sheppard-Towner funds benefited from this
Fund.

Even though the Sheppard-Towner funds were repealed in 1929, the program’s
existence, even if brief, had made a lasting national impact. Women of all social and
economic groups read baby books, women’s magazines, and child care bulletins published
by the federal Children’s Bureau. At the end of the 19205, according to Ladd-Taylor,
“women from virtually every social and economic group had begun to look outside their
female support networks to new sources of expertise on child care...and turned
increasingly to physicians and to the childrearing advice found in government pamphlets
and women’s magazines for information and encouragement that had once been handed
down informally.”93 The act raised individual women’s expectations for their children’s
health and made them more knowledgeable about prenatal and well-baby care. Physicians
responded by incorporating preventative health education into their private practices and
worked to improve obstetrical training in medical schools.94 Today all fifty state health
departments have departments of maternal and child health.95

 

92 Children’s Fund of Mlchigan Reference File, 1; Richard Thomas, Wis
- - a. , (Bloomington and

 
 

Indianapolis: IndlanaUnlverslty Press, 1992) 76.
93Ladd-Taylor, Matherflprk, p.17, 33.

94Ibid, p. 189.

95Marshall w Raffel. and Norma K Raffel MSW
Emefigns, third edition (New York. John Wiley & Sons 1989) 267. All fifty departments
reported having environmental health, helath education and nursing departments.

CHAPTER 3

Women’s Voluntary Organizations and the Michigan Bureau of Child Hygiene and Public
Health Nursing: Creating Maternal and Child Health Clinics in Michigan’s
Rural Communities and Towns, 1920-1930

Professional and non-professional Michigan women, working in a network of
women’s voluntary organizations, the Michigan Bureau of Child Hygiene and Public
Health Nursing, other health organizations and private health care professionals actively
sought public resources and private resources to improve maternal and child health in their
communities before and during the Sheppard-Towner years. These women remained
active and rrraintained maternal child health programs they had run locally after the repeal of
Sheppard-Towner funding.

The Michigan Bureau of Child Hygiene and Public Health Nursing was created
during a period of heightened public concern over health and sanitation across the nation.
By the end of the nineteenth century a majority of states had a state board of health.915
However, at the beginning of World War I, relatively few communities had infant welfare
stations or public funding for milk stations. The communities that did have these services
were predominantly large cities. Forty-three percent of the nations 551 infant welfare
stations and forty-nine percent of the visiting nurses were located in eight large cities.
Detroit’s Board of Health began focusing attention on the welfare of children, founding its
first “Mothers’ Clinic” in January 1 1910. Its purpose was “instructing mothers in the care

 

95 Wilson G. Smillie, a- 1 ,, , - . .. ' . ; ,(New York.
McMillian 1947) 16. In 1872 the American Public Health Association was formed.
Massachusetts and California had already formed a state boards of health m 1869 and
1870. Virginia and Minnesota followed in 1872. Michigan was the fourth in 1873,
followed by Delaware and Alabama in 1875 and Wisconsin in 1876.

 

30

3 l
of their babies with a view to reducing the unnecessarily great infant mortality.”97 Three

years later, in 1913, Detroit’s Board of Health founded its Child Health Department.98
The Board also ran Infant Welfare Stations and Prenatal Clinics 99 During the 19105 and
19205 many other local communities established permanent health clinics funded and
administered by local governments, philanthropic or social service agencies working in
cooperation with state departments of health and the US. Children’s Bureau.100 Still in
1914, only four states and eighteen cities had bureaus of child hygiene in their state
departments of health.101

Between 1918 and 1920, with pressure from the Children’s Bureau, women’s
organizations and members of the medical community, twenty-eight other states created
bureaus of child hygiene By November of 1920, thirty-five states had created child
hygiene divisions in their Departments of Health; by 1924 only one state had not done so.
These state divisions owed no allegiance to the Children’s Bureau legally; however, they
took advice from the Children’s Bureau and submitted regular reports on budgets,
legislation and programs in their states.102 The creation of these state divisions aided in
establishing maternal and child health programs outside of major urban areas.

Michigan formed its Bureau of Child Hygiene and Public Health Nursing as part of
the Michigan Department of Health on September 15, 1920. Miss Harriet Leck R.N.,
formerly superintendent of the nurses of Grace Hospital in Detroit, was named the first

 

 

100Load-Taylor. Mutherflmk. p. 89-90; Meckel, marbles. p. 141-

101Klaus, W, p. 209. Tennessee had been the first to create a child
hygiene bureau in 1912.

102Muncy. W. p. 100-101.

32
Director of the Bureau.103 Hope Romani, another nurse, was one of her assistants. Leck

credited her with having “blazed the trail” for the Bureau of Child Hygiene.104 Two
assistant salaries were paid by the State Anti-Tuberculosis Association and by the American
Red Cross.105 In February 1921, Leek published an article in New discussing

the purpose and plan of the Bureau. The aims were:

“To follow up the work begun during the war in the Children’s Year
Campaign, which demonstrated to the people of the state the need for child
health work. To emphasize the importance of improving the health of
children and the value of keeping children well. To secure one-hundred per
cent birth registration. To encourage breast feeding of babies. To enroll
mothers and young girls in health study groups, so that all women maybe
informed on the care of mothers and infants. To encourage the women of
local communities to establish Health Centers and to place scales in rural

schools with proper charts for keeping records.”106
During its first year, the Michigan Bureau “concentrated on perfecting an organization
which will assist in lowering the infant mortality of the state and aiding communities in
their public health nursing service.”107

The Michigan Bureau of Child Hygiene and Public Health Nursing worked in
cooperation with local women’s groups. Local women’s groups, connected through state
and national federations had long been involved with child hygiene in the state and had
been key to the success of Children’s Bureau Baby Saving Campaign in Michigan. Across
the country, national federations of local women’s clubs worked for maternal and child

health and welfare campaigns lead by the professional female reformers. These campaigns
would not have succeeded without the locally rooted women’s federations already engaged

 

103Richard M. Olin, M.D., "1'6 Michigan Nurses,” W (February 1921) 37.
10421112111113.1111 (April-May 1921) 108.; W (February 1921) 42.
105W (February 1921) 41.

106W (February 1921) 43.

 

_ - . , Michigan Department
of Health (Lansing, Michigan 1921 & 1922) 97.

33
in child welfare work and other civic actives. 108 This interdependence of professional

women with lay women characterized the early years of the development of state social
policy.109 Dr. Clark of the US. Public Health Service observing the increased child
welfare work wrote in 1921, “There is no lack of child hygiene programs. Practically
every civic organization has one and virtually all of them are directed to one-third of the
baby deaths, with the exception of pubic health organizations providing prenatal
supervision in a limited way.” “0 Although recognizing women’s activity, he obviously
did not value women’s organizations work in this area, the Michigan Bureau of Child
Hygiene did. During the Michigan Bureau’s first year, Leek specifically addressed
women’s clubs, outlining for them how women’s clubs could aid child and maternal
health.1 11 She urged women of local communities to establish Health Centers so that the
work of the county nurse could be more easily extended.1 12 The Bureau worked in
cooperation with women’s clubs, nurse’s associations, and medical doctors to provide

maternal and child health screening and health education to their communities.113 On the

 

1085kocpol. Wars. p- 2. 482.
1°9Muney.9rsatina_a£emale_120mini9n. p. 58.
11W (April-May 1921) 130.

1 1 1Ibid, p. 121. She advised women’s clubs to set up a committee which would find
rooms for baby clincis to be held and for the publicizing the baby clinic in the local
newspaper, movies and churches. Next a physican was to be secured for examination of
the babies and a nurse to weigh and measure them. She also gave advise on what type of
room should be found an what equipment would be neccessary.

112W (February 1921l43.

113 In that first year, the Bureau of Child Hygiene and Public Health Nursing reported
‘Baby Conferences” and clinics being run across the state. Permanent “Baby
Conferences” were held in four counties and three permanent Centers were started in three
counties. Temporary “Baby conferences” were held and centers were started in several
counties. Permananet centers were started in Lapeer, Sanilac, Berrien and Isabella and
permanent baby conferences were held in Lapeer, Sandusky and St. Josheph counties.
Temporary Baby Conferences were held in Baton, Gratiot, Saginaw, Ingharn, Jackson,
Manistee and Otsego counties. Centers were started in Manistee, Midland, Presque Isle,
Jackson and Otsego counties. Sixty-seven talks were given to women’s clubs, Grange,
Parent-Teacher’s Clubs, Schools etc. during the first year of the Bureau June 30 1920-June

34
local level women’s groups organized, ran and often found the funding for infant health

clinics staffed by hired or volunteer physicians and nurses. Nurses and doctors examined,
weighed, and measured children and instructed mothers on nutrition and hygiene.l ‘4
Early clinics, like these served as models for prenatal and well—baby clinics later funded by
the federal government under the Sheppard-Towner Act.115

The creation of the Central Clearing House Committee further stresses the
importance of women’s organizations to the development of Michigan’s early maternal and
child health programs. The committee was formed early in 1921, when Miss Elizabeth
Parker of the Michigan Anti-Tuberculosis Association called together representatives from
the M.A.C. Domestic Science Department, Michigan Department of Health, Red Cross,
University of Michigan, State Federation of Women’s Clubs and “others interested in rural
health programs.” The Central Clearing House Committee was created with the intent that
each organization making up the Committee would “be informed of the programs and
workers of the others and all pull together in a community for better health.”1 15 This
committee played a vital role in establishing maternal and child health programs in

 

30 1921. In the first two years, prior to July 1, 1922, thirty-four mother and baby health
centers had been formed or were started through agencies other than the Bureau of Child
Hygiene and Public Health Nursing. As of July 1923, thirty-four centers were organized
by the Bureau bringing the total number of centers up to 68. These figures exclude Detroit
and Grand Rapids which had their own health departments that worked ‘seperately, for the
most part, from the Bureau. , ' .

   

Department of Health (Lansing, Michigan 1923) 65. A

114Ladd—Tay1or. Muthenflurk. p. 51.
115Ladd-TaylonM91hflflflQl’k. p. 52.

116 Harriet Leck, R. N., “Brief Summary of Work Accomplished,” W,
(May-April 1921) 118. In Michigan, each district was made up of several counties and each
county had at least one nurse. Nurses brought difficult problems to the district supervisors,
“who, by advice and counsel, in close touch with the office of the bureau, is helping to
bring about a greater cooperation and greater harmony among the different officials and
organzation doing public health work in the distritct.” Leek wrote, “There is scarcely a
county in the state which has not at least three or four permanent baby clinics held weekly
to which the mothers for miles around bring their babies- not because they are ailing but
because their mothers have been educated in prevention— the most modern campaign in
public health.” Harriet Leck, “Response,” W (February 1921) 42.

35
Michigan. The 1923 Commissioners Report recognized that “the force of this committee

has been seen repeatedly in promoting the field work in organizing county committees and
health center committees, also when the acceptance of the federal aid for the two years from
July 1, 1923 to July 1, 1925, was pending in the Legislature of 1923.”117

The Sheppard-Towner Funds available from 1923-1929 supported a marked
increase in child and maternal health activities in Michigan. Due to the additional funds
available after July 1, 1922, the Michigan Bureau of Child Hygiene and Public Health
Nursing reorganized and expanded to handle the increased work. The Bureau staff jumped
from 2-3 to 13 people.118 The staff then consisted of: “1 Director, a physician; 1 Assistant
Director, registered nurse; 2 Associate physicians, clinicians; 1 speaker and organizer; 5
Nursing Directors, registered nurses; 1 clinic Nurse, registered nurse; 1 Secretary and
Stenographer; 1 Research Worker and Clerk, college graduate.”1 19 Dr. Blanche M.
Haines assumed the position of Director of the Bureau, June lst 1922, replacing Harriet
Leck R.N.120 This was consistent with the trend toward a national “female dominion,” as
noted by Muncy, female professionals led seventy-five percent of the bureaus and divisions
that directed state Sheppard-Towner programs. 12‘ In addition to working with the
Children’s Bureau in Washington DC, the Michigan Bureau reaffirmed its past
relationship with local women’s organizations stating, “the fostering of local interest and
local responsibility with a minimum of state supervision might be said to be the premise
upon which all the activities of the bureau have been based.”122

 

    

12. I“ ._ ' . i‘IAO| O i' 5,‘!'1-_.1

121Muncy. Won p- 103-

 

36
Women’s voluntary organizations played an active role in the implementation of

Sheppard-Towner Act programs across the nation. Almost all states reported cooperative
work with some of the women’s organizations in their state, many inviting them to serve
on state advisory boards overseeing maternal and infant health work. As Muncy wrote,
“Volunteers lobbied for state and local funding, publicized child health conferences,
provided transportation and lodging for public health nurses, rented facilities for clinics,
aided doctors and nurses during the conferences and canvassed their communities to find
children and expectant mother who might use the services.” Sometimes they even funded
local health programs themselves when public officials refused to. 123 Ladd-Taylor also
argues “the implementation as well as passage of the Maternity and Infancy Act depended
on the unpaid services of women activists...The Children’s Bureau also depended on
volunteers to conduct prenatal and child health conferences, publicize Sheppard-Towner
programs and research local health conditions.” 124 She reports that in 1929 of the twenty
states plus the Territory of Hawaii which kept records 700 nurses, 1,614 physicians, and
4, 683 “lay persons” worked on the programs voluntarily. The Bureau also reported that in
42 states the PTA gave assistance, in 30 states the Federation of Women’s Clubs assisted,
and in 18 states the American Red Cross and the League of Women’s Voters helped. She
argues that Sheppard-Towner programs had a “tremendous impact in states where child
helath was politicized and the Children’s Bureau worked effectively with activists women
and physicians.”125 In line with this national picture, local level support from Michigan
women’s organizations was very important to the success of the Michigan Bureau of Child

Hygiene and Public Health Nursing Sheppard-Towner programs.
123Muncy, W, p. 120. In 1927, thirty-one states reported

cooperation with parent-teacher associations and twenty-five with states women’s clubs. At
least twelve states cooperated with Red Cross chapters and twelve cooperated with state
tuberculosis societies. Eight worked with the Women’s Christian Temperance Union and
two reported aid from the Amercian Association of University Women.

124Ladd-Taylor, Mother-flour. p. 178.
1251bid, p. 178.

 

37
The cooperation during the Sheppard-Towner years between the women’s

organizations and the Bureau of Child Hygiene and Public Health Nursing resulted in an
increase in maternal and child health clinics run across the state. Prior to July 1, 1922,
thirty-four mother and baby health centers had been formed or were started through
agencies other than the Bureau of Child Hygiene and Public Health Nursing. By July
1923, thirty-four centers were organized by the Bureau bringing the total number of centers
up to sixty-eight.125 The development of permanent mother and baby centers “maintained
by community funds” continued throughout the Sheppard-Towner years. ‘27 Lay
committees sponsored the centers providing rooms and equipment. None of the centers
were ever financed by the Bureau; however the Michigan Bureau distributed record
blanks, report forms and literature to the centers in return for monthly reports of the work
done. Thirty-one Mother and Baby Health Centers existed in June 1922 when the Bureau
was organized, by 1926, with the help of local organizations the number had expanded to

seventy.128

 

 

exclude Detroit and Grand Rapids Which had their own health departments that worked
seperatly for the most part from the Bureau of Child Hygiene programs. This number
excludes Detriot and Grand Rapids. In the second year of Sheppard-Towner funding,
eighteen more mother and baby health centers were organized bringing the number up to
86. Growth continued through 1925, with nine new centers established in Hastings,
Ludington, Grayling, Harntramck, Lansing, Grand Haven, Marshall, Ecorse and Plymouth
bringing the total number of centers to 80 who reported 28,037 infants and preschool
children had been examined and had performed 1,580 prenatal examinations.

" ' .-;p65-66Ihe_5.3rd

- ' ' t- , Michigan Department of Health
(Lansmg, Michigan, 1925) 125. If the Bureau organized the center the local committees
were “advised. to pay each physician for his services at the clinics.” This shows that the
Bureau, while it coordinated clinic activity, did not fund it.

 

 

 

. ' . . ‘ ' .1, Michi ganDepartment
of Health (Lansing, Michigan, 1926) 135. Nine new Mother and Baby Health Centers
were organized 1n the 1925- 26 year. This brought the total to seventy-seven, all supported
by local funds (some having become inactive). Since the centers began reporting in March
1923, 82,064 infants and preschoolers were seen, 4,884 prenatal cases advised and

112, 254 home visits were made. In addition to sponsoring clinics and funding the medical
staff, local communities also sponsored Little Mothers’ leagues which were begun 1n
October 1923. A manual of 12 lessons was prepared by the Michigan Bureau. Local

38
The Bureau also reorganized and renamed its Central Clearing House Committee.

The Bureau invited the state presidents or representatives from the women’s organizations
which had promoted the Sheppard-Towner bill in Congress to meet in order to form a
Cooperating State Health Committee.129 The next year the Cooperating State Health
Committee members were increased to fourteen. The Michigan Bureau reported that this
committee “assisted materially” in carrying on the work of the Michigan Bureau.”0

After the creation of the Cooperating Committee, the Bureau of Child Hygiene and
Public Health Nursing and its representatives organized County Health Committees in
counties having no preexisting health committees (such as Tuberculosis, Red Cross or
Welfare Committees). Representatives from the women’s organizations in each county and
often county supervisors, superintendent of schools, probate judges, physicians or others

made up the members of the health committees. 131 The Bureau suggested activities to the

 

school, county and bureau staff nurses ran a total of 249 classes. Little Mothers’ Leagues
continued m 1925 with 5 ,799 girls attending. Little Mother’s Leagues continued to grow
in 1926 and demand exceeded the supply of nurses available to conduct them. They
continued to grow through 1928. By 1929, every county had had at least one series of
classes.

 

- ° °.p63 DrR1chardM
Olin, Michigan Health Commissioner appointed Mrs. William Alvord (President of
Michigan State Federation of Women’s Clubs), Mrs. F. C. Aldinger (President, Michigan’s
League of Women Voters), Mrs. E. L. Calkins (President, Woman’s Christian Temperance
Union of Michigan), Miss Bina West (Commander, Woman’s Benefit Association of the
Maccabees, who had been Chairman of Child Welfare Division during the War and had
written articles in Public Health supporting child welfare programs), Mrs. Frances Burns
(Commander, Ladies of the Maccabees), Mrs. Louise Campbell (State Home
Demonstration Leader, Michigan Agricultural College), Mrs. E. W. Kiefer (President,
Congress of Mothers and Parent-Teacher Association of Michigan). Later Mrs. L. Victor
Seydell (State Regent, Daughters of the American Revolution), Miss Fandira Crocker
(State President, American Association of University Women), Mrs. Burton Browne
(President, Michigan Child Conservation League), and Mrs. Dorian Russell (succeed Mrs.
Alvord as State President of the Michigan State Federation of Women’s Clubs).

 

,, . . ' ' ‘ ,Michigan Department
of Health (LanSing, Michigan, 1924) 73. The additional members were Miss Alice Lake
(Legislative Chairman of the State Nurse’s Association), Mrs. Dora Stockman (of the State
Grange), Mrs Edna Kimball Wilcox (Worthy Grand Matron of the Order of the Eastern
Star), and Mrs A. D. Wallace (Legislative Chairman of the Detroit Federation of Women’s
Clubs).

 

- - =_ ' ‘ p.64. Eighteen county
health committees were organized as of July 1,1923 by the Bureau. Gogebic, Houghton,

39
county health committees who then carried out the activities they chose. The activities

suggested were: promoting county nursing service, establishing mother and baby health
centers, sponsoring the department’s Health Institute, encouraging occasional infant and
prenatal clinics and clinics for preschoolers, holding mothers classes and Little Mothers’
Leagues.”2 The health committees then organized, sponsored and ran what they
considered important for their community. Dr. Moores wrote in the Michigan Public
Health about his county health unit: “Publicity was carried by talks at the County Medical
Society, the various luncheon clubs, Parent-Teacher Associations, the Chamber of
Commerce, the Board of Supervisors, etc.”‘33 He reported that the Parent-Teacher
Association sponsored preschool clinics with local physicians volunteering their services.
134 The groups involved in county activities of the 1927 Child Health Day bear further
witness to the involvement of women’s organizations in child health programs. In Dewitt,
“Woman’s Clubs [put] on a May Day program,” in Iron Mountain a preschool clinic was
sponsored by the Woman’s Club, in Grand Haven women’s clubs paid doctors and
furnished clerical help for a county-wide preschool clinic, and in Cadillac, the article
reported “Women’s Clubs and Board of Education and Medical Society Cooperating”.135

 

Menomienee, Delta, Alger, Emmet, Charlevox, Leelanau, Benzi, Manistee, Montmorency,
Oscada, Clare, Isabella, Newaygo, Muskegon, St. Joseph and Branch.

 

. - , p. 73. Eighteen
Cooperating County Health Committees were organized in Arenac, Gladwin, Chippew,
Dickinson, Mackinac, Saginaw, Livingston, Iron, Baraga, Ontonagon, Ogemaw, Calhoun,
Ottawa Missaukee, Roscommon, Kalkaska, Otsego and Lake counties. .11

, p. 64. The next year saw an increase in
organization of health committees in the counties and increased women’s clubs support of
its activities. The organization of county committees also continued into 1925 with the
organization of twelve new county committees in Lenawee, Eaton, Alcona, Iosco, Presque
Isle, Hillsdale, Genesee, Van Buren, Ionia, Cass, Barry and Cheboygan.

 

1338. C. Moore, M. D., “Some Experiences in the Organizations and Administration of
a County Health Unit,” Wm, XVIII (September 1929) 201.

134mm, p. 203.
135“May Day Suggestions,” W, XVI ( March 1928) 61-63.

40
After the federal funds were repealed twenty-one states continued matemity and

infancy work.135 Michigan, through state and local funding, successfully maintained its
maternal and child health programs. The Michigan legislature in 1929 amended the 1927
law which established county health departments and allowed the payment of $3,000 per
year to every county health department that met the requirements of the State Department of
Health.137 The establishment of the Children’s Fund of Michigan trust in 1929 helped
ensure that child welfare work continued.138 Governor Fred W. Green support also
contributed to maintaining Michigan’s programs. On April 6, 1929, he declared May Day
as official Child Health Day in Michigan. He stated, “Designating Child Health Day is but
a part of the nation-wide and world-wide movement for proper care of children. It serves
to remind us of the seriousness of the responsibility that we have so lately recognized.”139
May Day Child Health Day activities for 1930 were planned by organizations who were
interested in child welfare. County May Day committees were formed with county nurses
as chairs. The March issue of W advocated, “Parades, pageants, plays- one of
these may be developed under direction of a special community group such as the Parent-
Teacher Association, the General Federation of Women’s Clubs, the director of physical
education and reactions of the shcools, or whoever in the community is willing and able to
direct such a celebration?”0 This suggests that across the country similar networks
existed at the local level. The 1930 Commissioners report reviewed the success of Child

Health Day stating, “Immunization campaigns, clinics, physical inspection in schools,

 

136Ladd-Taylor. mm. p. 190.

 

_ - ; , Michigan Department
of Health (Lansing, Michigan, 1929) 10.

138 “The Children’s Fund of Michigan,” W XXII (July 1934)
128.

 

140American Child Health Association, “Suggestions for Celebrating May Day Child
Health Day” WW XVIII (March 1930) 60

41
health talks and health plays in schools, as well as the more spectacular May pole, pageants

and parades all made May Day in Michigan a day of definite value to children.”1

The network established between the Bureau, women’s organizations, nurses and
physicians was vital to the maintenance of Michigan’s maternal and child health programs
after 1929. An article from May, 1930, advocated the importance maintaining the network
strategy: “a statisfactory prental and maternal care program depends upon cooperation on
the part of physicians, public health nurse and expectant mothers, together with the
assistance rendered frequently by local women’s organizations. This is also true of an
infant welfare program and the care of the preschool child.”142 The Bureau continued to
supply the centers with Record blanks and literature and the majority of the centers made
monthly reports back to the Bureau.143 In 1932, the Bureau reported an increase in
attendance for the Women’s Classes. The 1935 Commissioners’ Report casually stated,
“Health centers established and financed locally reported their activity as usual to this
bureau. These centers are provided with literature and record forms by the bureau, but the
examinations are made by local physician?”4 This reaffirms the importance of local level
of involvment in maternal and child health and the fact that the state did not fund these
chnics.

In 1947, Wilson Smillie in his book on Public Health Administration in the United
States recognized the work done by voluntary organizations when explaining the Child

 

 

, - .._ -- , Michigan Department
of Health (Lansing, Michigan, 1930) 20.

142W, xvm, (May 1930) 105.

 

' ' - ,p. 19. Approximately
70 centers sent back records to the Michigan Bureau. In 1930 28,706 infants were
examined at the centers and 28,134 home visited were made.

 

. ° ° _ - ,Michigan Department
of Health (Lansing, Michigan, 1935) 391. Reports from these centers stated that there
were 1,077 clinic days held, 14,133 babies examined, and 19,371 home visit made by
local public health nurses. The reports are incomplete, not all centers reported regularly to
the Bureau.

42
Hygiene programs of the Public Health Service “Supplementary to the general health

activities that affect all age groups are certain health activities that are aimed specifically
toward promotion of the health of the child. Often these special functions have been
initiated by voluntary organizations, or by private enterprise, rather than by official health
agencies?”5 The Child Hygiene programs he describes correspond surprisingly with
Michigan’s programs during the years of this study. The structure of Michigan’s program
from 1910-1935 may be similar to other state programs, and Smillie may be recording a
dominant trend across many states.

A potentially large number of states’ maternal and child health programs may have
been structured similarly to Michigan’s. Since seventy five percent of the state divisions of
child health were initially headed by women, it is possible they depended on networks
similar to those seen in Michigan. However, without close studies of other states during
these years an satisfactory explanation for why Michigan succeeded when more than half of
the states maternal and child health programs failed after the repeal of Sheppard-Towner
funds remains conjecture. A comparison between Michigan and Ohio’s programs suggests
a combination of factors led to the two states differening program structures. First, the
involvment and opinion of the two state’s health department heads constrasted starkly. In
Ohio, in 1923 the new director, John Emerson Monger, M.D.,“was hesitant about, if not
antagonistic to, the federally assisted maternity and infancy plan.”145 Monger chaired the
committee which outlined Ohio’s Sheppard-Towner programs. 147 In Michigan, State
Commissioner of Health, Richard Olin left control of Michigan’s Sheppard Towner
programs with Bureau of Child Hygiene and Public Health Nursing head, Blanche Haines,
M.D. She supported the Children’s Bureau work and later become the Director of the
Division of Maternity and Infant Hygiene for the Children’s Bureau in Washington DC.

l45wnson Smillie, W p. 262.
146Lindenmeyer, p. 108.
1471bid, p. 116.

 

43
A second important distinction between the two states is the organizational structure of the

administration of the Sheppard-Towner programs. Ohio’s maternal and child health
program administration was organized hierarchically and shows the differences between
men and women’s organizational structure. This hierarchical structure left Ohio’s women’s
organizations out of the decision making process and separated women’s organizations
from the maternal and child health work done by the state. The advisiory committee
Monger formed was made up of health professionals and excluded women’s
organizations.148 Michigan’s program , headed by a female physician who had close ties
with the states women’s organizations, was organized representatively. The Cooperating
Committee which assisted in creating and adnrinistering the Sheppard-Towner programs
gave women’s organizations across the state a voice in the creation of the state’s maternal
and child health programs. Thirdly, the strength of the Ohio State Medical Association in
opposition to the Sheppard-Tower Act in contrast to that of the Michigan State Medical
Association probably influenced the structure of the programs in the states. Nationally the
AMA was the strongest opponent to the Sheppard-Towner Act. The Ohio State Medical
Association ‘was the most vocal state organizations which helped shaped the national
organizations’ official anti-Sheppard-Towner policy.”149 Fourthly, differing activity levels
of women’s organizations between the states may have contributed to the difference
between the two states. As Lindenmeyer points out, “the state’s physicians did not want
‘lay’ women or their organizations to participate in the policy-making process. And
interestingly, there is no evidence that women’s organizations demanded such participation
even though their lobbying efforts had been an essential ingredient at both the national and
state level.”150 These differences between Ohio and Michigan help explain why Ohio’s

Sheppard-Towner programs, created and run without local initative and cut off from the

 

148mm, p. 114-115.
149Ibid, p. 110.
150mm, p. 115.

44
network of women’s voluntary organizations, dwindled in contrast to those in

Michigan.151 Significantly, this comparision shows the importance of public and private
networks to the maintenance of maternal and child health programs in the early 20th
century. Further state level studies can shed more light on the factors contributing the

success or failure of the Sheppard-Towner programs across the nation.

 

151Ibid, p. 130. Ohio State Health Director, Monger, wanted local communities to take
over the responsiblity for programs started with the Sheppard-Towner funds, but in
only nine counties and two cities did private, municipal, and county agencies combine
to continue these programs.

CHAPTER 4

Maternal and Child Health in Detroit: A Case Study of the Baby Clinic Run by the Detroit
Urban League and the Detroit Board of Health, 1900-1930

Creating networks among public and private organizations was not only a strategy
of white communities across the state of Michigan; a similar network strategy can be see
used by communities in Detroit. The Board of Health of the City of Detroit operated
autonomously from the Michigan State Department of Health, consequently the clinics run
in Detroit were unconnected to the State Department of Health and must be studied
seperately from a state level study. Beginning child health work in 1910, ten years earlier
than the State Department of Health, Detroit’s Board of Health worked in cooperation with
private organizations in the city to establish child health clinics. One such organization was
the Detroit Urban League (DUL). Working with the Detroit Board of Health, the DUL ran
a Baby Clinic in the Detroit black community which remained unaffected by the Sheppard-
Towner Act and its repeal. Since the Board of Health of the City of Detroit was
unnconnected to the State Department of Health, it did not receive allocations of the state’s
Sheppard-Towner funds fi'om the Michigan Bureau of Child Hygiene and Public Health
Nursing, therefore its clinics relied and grew on local funds. Thus, as seen on the state
level, a network of public and private organizations, white and black, concerned with child
health and welfare played a critical role in establishing and maintaining an infant health
clinic in the Detroit black community.

A number of factors lay behind the autonomous functioning of the Board of Health
of the City of Detroit from the Michigan State Department of Health. First, in 1837, nearly

45

46
all of Michigan’s population lived in rural areas and Detroit was the only city in the

state.”2 In 1890, Michigan, still predominantly rural, had a rural population double that
of the state’s urban population. In the late 1910s a dramatic demographic shift occurred,
the urban population caught and exceeded the rural population.153 The Michigan Bureau
of Child Hygiene and Public Health Nursing was established before the 1920 census
figures showed this shift and understandably the Bureau’s initial program focused on the
rural population of the state. Later attention to rural problems during the Sheppard-Towner
years reflects this early design. 8

By 1930, however, 68.2 % of the people of Michigan lived in urban areas of 2,500
or more. Detroit alone held 43% of the state’s population.154 This population shift left
Detroit underrepresented in the state government. This is a second contributing factor to
the seperation of Detroit’s Board of Health from the State Department of Health. One
scholar reflecting on rural and urban representation in the state goverment writes, “It is very
apparent that under the old system of apportioning senatorial and representative districts in
Michigan many urban dwellers did not have the representation in the legislature to which
their numbers and the constitution entitled them. This was because the representatives of
the overrepresented rural areas were unwilling to surrender their control of the legislature
despite the fact that they were forced to violate the constitution in order the regain control.”

The senatorial districts were redrawn in 1925, if senate seats had been distributed roughly

1521"'loyde C. Fischer. Ihefismmrentnfmhim (Chicago: Allyn and Bacon,
Inc., 1965) 101.

153Daniel S. McHargue, WWW, (Ann Arbor: University of
Michigan Press, 1961) 4-5. In 1890 Michigan had approximately 1.3 nrillion rural and
.6 nrillion urban people. In 1900, approximately 1.4 million lived in rural regions and
.75 million lived in urban areas. By 1910, the population of the urban areas had
increased significantly to 1.25 million, while the rural p0pulation remained the same at
1.41 million. The 1920 census marked the shift in the balance of the rural to urban
population of the state. Michigan now contained 2.25 urban dwellers, while its rural
population remained at 1.4 milllion. By 1930, the urban population had grown by one
million to 3.25 milhon; the rural population remained approximately the same.

 

 

154Richard T. Ortquist. W (New York:
Garland Publishing Inc., 1982) 1.

47
on a population basis the eight most populous counties would have been entitled to 60 % of

the 32 seats.155 Rural control over the Michigan house and senate left Detroit with little
power in influencing state policy to its advantage. V

A third factor contributing to the autonomous operation of Detroit’s Board of Health
may have been the shifting makeup of the urban population in the early 20th century. In
1910 33.6% of the Detroit population was foreign bom.155 In 1925 the foreign born
population was comprised half the population of Detroit. 157Also, from 1910—1920 the
black population in Detroit jumped from 1% to 4%. 153 By 1925, blacks made up 6.5%
of the Detroit population.159 The 1918 electoral reform in Detroit gave Detroit a non-
partisan govemment with officials elected by the voters at large, rather than through ward
elections. A mayor, nine councilmen, a city clerk and city treasurer now governed the
city.”0 This represented a rather dramatic change, as one historian writes: “what had been
a rather ethnically balanced political elite at the century outset was by 1920 more solidly
Anglo Saxon.”161 Inside Detroit the white population gained control over city politics. A
1922 history of Detroit remarked, “The automobile industry has resulted in a great influx of
immigrants from Europe. Probably no other city in the United States has had forced upon it

1551140ng116 Miszhiganfioxemmtiafitid p- 245-

156Clarence Burton, William Stockling and Gordon Miller, eds. '
(Detroit and Chicago. The S. J. Clarke Publishing Company,

 

1922) 1508.
157Me1vin G. H6111, ed. gem; (New York: New Viewpoints 1976) 21.

1581021 D Aberbach and Jack Walker. W
W (Boston: Little Brown and Company, 1973) 7. The
black population was 5, 741 in 1910 and by 1920 had risen to 40, 838. The white
population in 1910 was 460,025 and in 1920 was 952,840.

159116111 ed., 12211911 9. 123.

160Dorothy Ketcham, “A Manual of the Government of Detroit,” mum
(Detroit Bureau of

Governmental Research Report no. 163, 1942) 13.

161Martin Margcr WW (Joumal of
University Studies-Ethnic Monograph Series, vol. 10, no. 5, Winter 1974) 53- 54.

48
the problem of assimilating and Americanization of the so-called foreign element as had

Detroit. The city has been a veritable ‘melting pot.’ As a result, perplexing problems of
health and sanitation have arisen.”162 These perceived ‘perplexing problems of health and
sanitation” which were “forced” on Detroit by the influx of immigrants, as this 1922
history described, likely were not something the dominant rural population wanted to
channel state money into, thus constituents would have supported maintaining Detroit’s
separate municipal functions.

And lastly, considering the history of Michigan, the autonomous operation of the
board of health of its largest city comes with little surprise. Detroit has a long history of
local government. In 1815, “ as the result of a protest demanding that the control of local
affairs be restored to the people, Governor Lewis Cass approved an act of the Territorial
legislature which granted a new charter to Detroit, thus restoring local government.” 153
In 1837, during the third session of the legislature of the new state of Michigan, a new
charter was provided for Detroit. Government of the city was divided into six wards with
two aldermen from each on the common city council. The mayor was elected yearly. This
allowed Detroit to maintain local government. Twenty years later, in 1857 a new charter
enlarged the powers of the common council. In 1908, the Home Rule City Act permitted
cities in Michigan great freedom in choosing the type of government which would fit local
needs. Cities could choose the form of government, the number of department needed, the
officers needed to carry out municipal responsibilities the city council and how it would be
elected.154 One report explains, “Home rule cities operate under a broad grant of authority.
They may exercise all municipal powers in the administration and management of municipal
property and government whether the powers be enumerated or not and may adOpt

resolutions and ordinances relating to their municipal concerns subject to the constitutions

 

162Burton, Stockling and Miller, eds., p. 1179.
163Ketcham, “A Manual of the Government of Detroit,” p. l.

154Fischer.1h2_Q9_v2nun2nt9f_Michigan p. 102.

49
and laws.”"55 Another text further explains, “The home rule enabling act, passed by the

state legislature in 1909, made it possible for the electors of all cities and villages in
Michigan to frame, adopt, and amend their charters, or to amend an existing charter
previously granted by the legislature, and to pass all laws and ordinances relating to strictly
internal affairs and municipal concerns, subject to the constitution and the general laws of
the state.” 166 For example, Detroit had “its own supervision of midwives” when midwife
inspection and supervision was initiated throughout the state in 1927 by the Bureau of
Child Hygiene and Public Health Nursing.167 Detroit’s long history of independent
government and “home rule charters,” allowed for legal autonomous operation of the city’s
Board of Health.

The Board of Health of the City of Detroit was established in 1895. However, this
does not mark the beginning of health work in the city, the earliest report of the Board of
Health of Detroit dates to 1882 according to a 1922 publication.168 Only the Board of
Health records for the years 1910-1915 can now be located in the Michigan State Public
Library, the Bentley Historical Library, the Detroit Public Health Department and the
Detroit Public Library. However, these records chronicle the beginnings of maternal and
child health care in Detroit. Clues on its later expansion come out of the Detroit Urban
League records. The Detroit Urban League’s records concerning its Baby clinic offer
detailed information on the establishment and operation of this clinic run in cooperation
with the Board of Health of the City of Detroit. Further research is needed to assess the

operation of other clinics in Detroit.

 

l65Citizens Research Council of Michigan, WW
MenomlitanfiuuthcastMichigan (Detroit Mempolitan Fund Inc 1965) 20

166Ketcham,A.Manual.9£th2_®y2mm2m_9f.mtr911. p. 2-

 

168131111011, Stockling, Miller, eds., p. 1508.

50
Detroit’s Board of Health began to focus attention on the welfare of children in

January of 1910 with the founding its first “Mothers’ Clinic.” The purpose of the clinic
was to instruct “mothers in the care of their babies with a view to reducing the
unnecessarily great infant mortality.”169 The Visiting Nurse Association “gave” the
services of a nurse, Miss E. E. Gilmour, to attend to the clinics and make home visits. A
“well-known woman of this city who requested that her name be withheld from
publication” contributed “enough” money to provide the babies with milk and to purchase
the necessary equipment for the clinic. The physician in charge of the clinic, Dr. Francis
Duffield, volunteered his services. Similar to clinics that would later be run across the state
in connection with the Michigan State Department of Health, various individuals and
organizations in Detroit worked together to establish and run a clinic. The Board of Health
reported that “the results obtained from this experimental work have been so satisfactory
that the Board of Health has decided to enlarge upon the work,” Five nurses who did
school work in the winter were assigned to the baby clinic over the summer.170

Three years after the opening of this first clinic, in 1913, the Board of Health
founded its Child Health Department.171 That same year prenatal clinics were established
with the Board reporting that “These clinics have prospered and are destined to assume a
prominent part in the solution of the infant mortality problem in Detroit, and the
improvement in vitality of coming generations”172. Two infant welfare stations for
educating mothers and caring for sick babies had already been established prior to 1914,
one at the Board of Health building and the other at the Children’s Free Hospital. Another

two infant welfare stations. located at 1257 Dubois Street and 578 Weston Ave., were

 

 

51
opened between June 1914 and June 1915. The Wesson Ave. Health Center, located in the

Polish section of Detroit, represented the Board of Health concem’s with the presence of a
rapidly growing immigrant population.173 By 1922 the number of clinics, according to the
Detroit Urban League Board Meeting minutes, were “twelve or fifteen” distributed across
the city. 174 While clinics served the surrounding populations and thus remained largely
segregated in practice, this segregation was not legally mandated, “mothers were permitted
to use the clinics nearest them regardless of color.”175

Just as the immigrant population-growth declined with the restriction of
immigration at the beginning of World War I, the Detroit black community expanded in the
wake of migration from the South to northern industrial centers. Over the course of
fourteen years one of the largest redistributions of population in this country’s history took
place. From 1916-1930, over one million blacks left the southern states for northern urban
centers of Detroit, Pittsburgh, New York and especially Chicago. In the first two years
conservative estimates place the number of migrants at 400,000, at an average rate of
16,000 per month or 500 a day. 176 The majority of the 500,000 southern blacks who

 

 

174M1nutes for the DUL Board Meeting, April 1922; DUL-MHC Box 11.

175Minutes for the DUL Board Meeting, April 1922; DUL-MHC Box 11.

176Carole Marks, -_ t 1 = . '
(Indiana University Press: Bloomington and Indianapolis, 1989) 1. see also Richard
Thomas, W11, Chapter 2. For other books on Detroit see:
Sidney Glazer, W(New York: Bookman Associates,
Inc., 1965) For other books on black Detroit see:
13199199292111 (Detroit: The Detroit Urban League 1987);Iku9111_8392_and_11ney_2n
W (Philadelphia: Temple University Press, 1987) For books .on the Great
Migration see: Joe William Trotter jr. ed.,

 

(Indiana University Press, 1991); Joe
WilliamTrotter,Jr.,31-.. u w. It ain't 0-1 011-1 1 311-. - ‘A.
(Urbana: University of Illinois Press, 1985); Peter Gottlieb, ' '
WW (Urbana University of
Illinois, Press, 1987); Kenneth L. Kusner,A_G11_e;tg_’[&e§_S_hap§_,_Blgck_C1e2e1an9,
131021239, (Chicago: The Universtiy of Chicago Press, 1967), Homer C. Hawkins and
Richard W Thomas. eds Wm (Lansing: Michigan
History Division, 1979), Florete Henri, '

(New York: Doubleday, 1976); James R. Grossman, WW

52
relocated northward came in two major migration waves: one in 1916-1917 in response to

the increasing demand for labor, and the other in 19244925 when the full effect of
decreased foreign immigration due to the Immigration Act of 1921 was felt.177 An
increase in jobs available at Ford, Dodge, Chrysler, Chevrolet and Packard automobile
plants served also as a major pull factor.178

In 1910 the Detroit black population was 5,741. By 1920, the population had risen
to 40,838, a startling net increase of 35,097 (611.3 percent). The percentage growth rate
for Detroit exceeds by nearly double the next closest contender for percent increase,
Cleveland, Ohio whose black population increased by 307.8 percent. By 1930, 120,066
blacks resided in Detroit. Rapid population growth along with job opportunities at the
lowest rungs of the work force, poor housing, segregation and overcrowding combined
with hard work, long hours and insufficient food, clothing and rest to magnify health
problems in the community. 179

The Detroit black community, seveme challenge by the rapid growth and change
during these years and after survived and progressed through what historian, Richard
Thomas, calls the “process of black community building.” In this process of black
community building certain individuals, classes, institutions and organization played key
roles at various stages of the community building process. 130 Denied government

solutions because traditional access to political power remained in the control of the white

 

W (Chicago. University of Chicgo Press, 1989); George
W Grohn. Wm (New York Weybright

and Alley, 1972); Darlene Clark Hine, “Black Migration to the Urban Midwest. the Gender
Dimension, 1915-1945,”
Joe William Trotter, jr. ed. (Indiana University Press, 9911).

177 Thomas. W11. p. 27; Hine, ‘Black Migration to the
Urban Midwest,” p. 128.

l73Marks, mu, p. 122; Hine, “Black Migration to the Urban Midwest,” p. 128.
”Marrow. p. l4el47; Thomas. Wilma. Chapter 4.
180 Thomas. W p. xii

53
male middle- and upper-classes, black welfare activity, especially before the New Deal

consisted to a great extent of private black institutions providing for black people in their
communities what the white state did not.

While black men headed most organizations and played leadership roles denied to
women, black women also played a important role in the community building process.
Black women matemalists concentrated their efforts on race uplift work directed at men,
women and children, rather than solely on women and children.131 Working in hotels as
cooks and waitresses, in the new steam laundries as ironers, in garment and lampshade
factories and in food processing and meat packing plants as common laborers and more
commonly as personal servants and domestics working black women contributed vital
financial support to black families and by extension to the black community. 132 As
Thomas argues, since black women tended to be the mainstay of black churches, their
meager wages contributed greatly to the growth and development of those institutions that
formed the heart of the community building process in black Detroit.133 Darlene Clark
Hine also argues for the importance of black women in sustaining black communities: “A
study of the history of the early twentieth century black women’s club movement is
essential to the understanding...the critical roles they played in creating and sustaining new
black social, religious, political, and economic institutions.” Black women’s considerable

contribution to the founding and development of the Urban League is one such example.134

 

18 loordon, W29. p. 141; Boris, “The Power of Motherhood: Black
and White Activist Women Redefine the Political,” p. 213-246; Evelyne Brooks
Higginbotharn, “African-American Women’s History and the Metalanguage of Race,’

Signs 17 (Winter 1992) 271; Gordon, “Black and White Visions of Welfare: Women’s

Welfare Activism, 1890-1945, ” p. 559-590; Mink, mm.

182mm, “Black Migration to the Urban Midwest,” covers the gender differences in
migration and employment patterns of blacks during the Great Migration.

183Ibid, p. 28, 34.
184Hine, “Blacks Migration to the Urban Midwest,” p. 130.

54
The National Urban League was founded in New York City in 1911 through the

merger of three related organizations: The Committee on Urban Conditions Among
Negroes in New York, the National League for the Protection of Colored Women, and The
Committee for Improving Industrial Condition Among Negroes. Black men and women
worked together for racial uplift in this organization. Detroit founded its local chapter of
the Urban League in 1916 in response to the influx of southern black migrants. Although
established and run by black men and women to serve the needs of the Detroit black
community, the Detroit Urban League was supported by a network of white and black
organizations. The Association Charities, a collaboration of Catholic and Protestant ethnic
self help agencies, gave financial assistance in establishing the DUL. The Employers
Association of Detroit paid the salary of the employment secretary. The vast majority of
black workers who arrived in Detroit received their first jobs from those firms in the Detroit
business community which worked with the DUL. The Jewish Welfare League also '
assisted, agreeing to allow the DUL to use a building they owned for just the cost of
maintenance as a community center. The Detroit Recreation Commission operated the
building. These supporting organizations represented white-controlled resources who
work across racial and ethnic lines.

Aid also came from black community organizations. The Detroit Study Club, a
group of 25 middle class black women and the Willing Workers, a relief society of middle
class black women assisted the DUL. More substantial aid came from four of the largest
black churches in Detroit, such as the Second Baptist Church. Other organizations, like the
Young Negro Progressive Association and the Colored Mothers Club, cooperated with the
DUL. With the help of this network of white and black organizations, the DUL found jobs
and housing for migrants, set up programs like the Domestic Training School to prepare

55
nrral black women for domestic employment in Detroit, established community centers, a

children’s summer camp, ran health programs and a baby clinic.185

The Detroit black community obtained its infant clinic in much the same way as
white communities around the state later would: through networks of people from different
organizations working together for the purpose of improving maternal and infant health.
Even before the founding of the DUL, the black community had already established a
connection with the Detroit Board of Health to address the health needs of its community.
The Detroit League on Urban Conditions Among Negroes reported in 1916, that Dr.
Vaughn of the Board of Health was collecting the vital statistics for the black population in
Detroit.135 That same year the Director of the Joint Committee of the Detroit League on
Urban Conditions Among Negroes enlisted the aid of the nurses of the Board of Health.
Miss Ross, Chief Nurse of the Board of Health, “promised their active cooperation in
health among the colored people to the Director.”137

Later, the Detroit Urban League maintained and expanded this link between the
Board of Health and the black community. With death rates in black communities
consistently higher than those in white communities across the country, health was always

a top concern of the DUL 133 In 1910, the white death rate was 14.5 per 1000; the non

1853ee Thomas, W Chapter 3. For books on the NUL
see: Guichard Parris and Lester Brooks, ist N

Iggy; (Boston: Little, Brown, and Company, 1971); Nancy J. Weiss, M91121

W (New York: Oxford University Press, 1974). For books on the

DUL see: John C. Dancy, Jr. W

(Detroit: Wayne State Univsity Press, 1966), John M. T. Chavis and William McNitt, A
(Ann Arbor: Michigan Historical Collection,

 

1971).

186“Monthly Report of Detroit League on Urban Conditions Among Negroes” June
1916, DULP-MHC, Box 11.

187“Report of Director to Monthly Meeting of Joint Committee of Detroit League on
Urban Conditions Among Negroes” December 12, 1916, DULP-MHC, Box 11.

183 Marks. Emil. p. 146-147; Thomas. W. p. 104;
Dancy “History of National and Local Urban League” Historical File Detroit Urban League
Papers, Michigan Historical Commission, Ann Arbor Mich. (Here after cited as DULP-
MHC) Box 69.

56
white 21.7. In the 1920, the white rate was 12.6; the nonwhite 17.7 per 1000. Children,

especially infants were worse off than their parents. Between 1915 and 1919, 92.8 white
babies died per 1000, while 150 black babies per 1000 died before their first birthday.189
With high infant death rates between 1915 and 1919, (149.7 black infants died compared to
92.8 white infants) the improvement of infant health in the black community was a prime
focus of the DUL from its inception.190

When the DUL established its settlement house in 1919, later named the Columbia
Community Center, its first proposed activity was a “Clinic and Day Nursery?”1 The
clinic, which opened in July, was operated in conjunction with the Board of Health as the
1919 minutes suggested, “The Children’s Clinic which was planned by the Board of
Health held its first session today at which time one mother and child presented
themselves.”192 A later history, written by John Dancy, further clarified this relationship.
He reported, “A community center was organized on Columbia Street with a Baby Clinic
under the direction of the Board of Health.” 193 The rapid expansion of the infant clinic,
seen in the Community Center and DUL Board meeting reports, further verifies the
importance placed on improving infant health in the black community. This follows the
state trend of increased infant welfare activity during this period. That first month, the
physician and two nurses in the clinic cared for 53 babies.194 The minutes of the
Columbia Community Center board meeting reported in September of 1919, that “The
clinic has registered 164 babies during the month of August. Since this feature was added

 

189Marks. Ewell .p. 146-147. Thomas. W. p. 104-

1901homas. W11. p. 104.
191“Minutes of Settlement Board Meeting,” June 13, 1919, DULP—MHC, Box 8.

192“Meeting of Settlement House Committee,” July 11, 1919, DULP-MHC, Box 8.

193 Dancy, “History of National and Local Urban League,” Historical File DULP-
MHC, Box 69. '

194 “Minutes of Settlement House,” July 13, 1919, DULP-MHC, Box 8.

57
the Board of Health has found it necessary to add another colored nurse on its staff, it now

having three colored nurses.” At this time the clinic ranked 10th out of fifteen clinics in the
Detroit area in number of attendance. 195 By March of 1920, less than a year since the
clinic was begun, the Board reported that “The Clinic is growing so rapidly that the Board
of Health has petitioned to use the place every day during the week instead of the three days
they now have. We are having daily attendance averaging twenty-five babies.”196 By
October, the Clinic operated every day, and with “very fine results.”197 By March of
1921, the large number of babies coming in each month necessitated the addition of another
physician and nurse at which point the Baby Clinic now operated with two physicians and
three nurses.”8

Like so many other infant clinics in the state operated by private voluntary
organizations at this same time, the DUL bore the cost of running the clinic. The DUL
received its funds through the Employers Association and the majority of their funds from
the Community Union. 199 From the initial proposal for a clinic, the board worked on
funding the clinic as the 1919 Settlement Meeting minutes suggested when they reported
that “the Director is to see Dr. Ross in re to the expense.” 200 During the first year of
operation the Board of Health “asked that we secure a new stove for the kitchen so as to

increase the heating in that room. The present gas stove cannot adequately keep the room at

 

195 “Columbia Community Center Minutes,” September 25, 1919, DULP-MHC, Box 8.

196 “Columbia Community Center Board Meeting Report” March 25, 1920, DULP-
MHC, Box 8.

197 “Report of Urban League,” October 14 1920 DULP-MHC, Board of Directors
Minutes and Reports, Box 11. _

198 “Report of the Community Center,” March 24, 1921, DULP-MHC, Box 8.
199 “Special Urban League Board Meeting,” November 3 1919, DULP-MHC, Box 11.
200“Minutes of Settlement Board Meeting,” June 13, 1919, DULP-MHC, Box 8.

58
the temperature best suited for the babies.” 201 The House Committee in May of 1922

requested a teachers table for the clinic at a cost of $18.00. Dancy was consulted and
agreed with the purchase.202 That same year Mr. Dancy requested the House Committee
place new shelves in the Baby Clinic, which they provided at a cost of 85.50203

The DUL clinic continued to run in this manner during the Sheppard-Towner years.
When the Sheppard-Towner Maternity and Infancy Act was signed into law November 23,
1921, unlike the white small town and rural communities of Michigan which experienced a
boost in growth of clinics aided by the expanded Bureau of Child Hygiene and Public
Health Nursing, the Detroit black community saw no changes which could be attributed to
the Sheppard-Towner funds directly. As Lindenmeyer’s study showed, Ohio used
Sheppard-Towner funds to address maternal and infant health in the Cleveland black
community. Michigan did not do so.

Even without assistance from Sheppard-Towner funds the DUL continued to expand
its maternal and child health programs and clinic. In addition to establishing and running
the Baby Clinic in cooperation with the Detroit Board of Health, the DUL held other
activities to promote improved infant health in their community, such as open houses at the
Community Center at which the clinic ran demonstrations on infant care as part of the
Annual Negro Health Week 1920- 1923.204 In July 1923, the DUL bought the Chestnut
Street house and moved its community center to the new building. The health clinic was
still of central importance and was one of the first of the DUL Community Center activities
resumed. The committee reported, “Baby Clinic and several activities are now in operation,

but before all clubs and organizations can function in the new building some decorating and

 

201“Columbia Community Center Board Meeting Report,” November 18 or December
4, 1919 DULP-MHC. Box 8.

202“ch01-1 of House Committee” May 11, 1922, DULP-MHC, Box 8.
203”Report of House Committee,” September 14 1922, DULP-MHC, Box 8.
204“Director Reports,” DULP-MHC, Box 8 and Box 11.

59
minor repairs will have to be made.”205 Throughout the Sheppard- Towner years the clinic

saw over 1,000 babies each year.206 In 1925 1,432 babies made over 6,000 visits to the
clinic.207 By 1927, the clinic expanded its hours of operation to six days a week.
The Baby Clinic in the Chestnut Street Community Center, like many clinics across

the state, continued unaffected by the repeal of the Sheppard-Towner Funds in 1929.208
In 1930 the center’s annual report stated: “Our Community Center has gone along in the
even tenor of its way. It has served not only the neighborhood, but the city at large...” The
center enabled the education department of the Board of Health to provide nurses to lecture
to black mothers on child care and to expectant mothers on prenatal care. 209 Minutes from
the “Detroit Urban League Board of Trustees” reported in 1933 a near record number of
babies; 1500 had visited the clinic.210 The clinic was still in operation in 1936 when
Dancy wrote a history of the Detroit Urban League, having at that point cared for over
20,000 children.211

While Detroit black community’s infant clinic and infant clinics in Michigan’s towns
and rural communities were organized and funded by local organizations with the support
of public health departments, important distinctions must be made. The Board who

 

205”House Committee Report” 1923 DULP-MHC, Box 8.

206“Annual Report of Director of Detroit Urban League” 1924-1934, DULP-MHC,
Box 11.

207 “Annual Report of Director of Detroit Urban League” January 14, 1926, DULP-
MHC, Box 11.

203“Annual Report of Trustees of Detroit Urban League,” 1929-1935, DULP-MHC,
Box 11.

209”Minutes of the Detroit Urban League Board Meeting," May 14, 1929; Annual
Report for 1929; DULP-MHC, Box 11.

210 “Annual Report of Trustees of Detroit Urban League” January 29. 1934, DULP-
NIHC BOX 11.

211 Dancy, “History of National and Local Urban League,” DULP-MHC, Historical
File Box 69.

60
governed the Columbia Community Center and arranged the DUL infant clinic consisted of

men and women?12 The Board, while headed by males, was also made up of women. In
the following three years other women’s names appeared and reappeared on the Board
members lists, in addition to the original six?l3 These women were actively involved in
the functioning of the community century. For example, for the 1919 open house, a
committee made up of Miss Lee, Miss Postales and Miss Holgate with Mrs. Hunton and
Mrs. L. B. Johnson made the arrangements. They “decided that the Clinic put on some
sort of demonstration for baby care, that the music school have a musical program, and that
the Domestic Training school add some program in keeping with their work.”214 Even
though the Community Center Board was a mixed group of men and women, in contrast to
the women’s clubs who arranged the clinics in the white communities, both the board and
the women’s clubs drew on networks of people in private and public organizations to
appropriate community resources for maternal and child health work. Both groups
established networks to effect change from outside the traditional power structure.

Another important distinction, the Detroit Clinic unlike the maternal and child health
clinics in the white communities did not provide maternal health care. In 1927, the Detroit

Board of Health urged the DUL to operate a prenatal clinic so “that some of the pressure

 

212“Minutes of Settlement Board Meeting” June 13, 1919, DULP-MHC, Box 8. In
1919, the Settlement Board Meeting, after electing Mr. Butzel as Chair, Mr. Talliaferro as
Vice Chair and Mr. Dancy as Secretary, proposed the founding of a children’s clinic in its
new settlement house. Miss Gulley, Mrs. Hosner, Miss Westrnorland, Mrs. Graine, Miss
Postle, Mrs. DuPorte along with Dr. Lundy, Mr. Butzel, Mr. Johnson made up the present
members of the fust Settlement Board meeting, as must have Mr. Talliaferro and Mr.
Dancy as mentioned above.

213“Minutes of Settlement Board Meeting” June 13, 1919,Columbia Community
Center Minutes Sept. 25 1919; Minutes of the Columbina Community Center Board
Meeting October 23, 1919, Minutes of Community Center Board Meeting February 24,
1921, DULP-MHC, Box 8. New names appearing were: Mrs. Hunton, Miss Holgate,
Mrs. Lee, Mrs. Bakeman-Johnson, Miss Henderson, Mrs. Cary, and Mrs. Krolik.

214“Minutes of the Columbia Community Center Board Meeting,” October 23, 1919,
DULP-MHC, Box 8.

61
might be taken off its downtown central station.”?15 Not willing to increase attention to

health at the expense of other programs this request for more Space in the Community
Center building was rejected. The House Committee feared that expanding the clinic would
force out other activities and turn the Community Center into a settlement house?16 The
DUL did not take on the added responsibility of a prenatal clinic, so the pregnant women of
the black community must have continued to seek care at the downtown central station
prenatal clinic run by the Detroit Board of Health. How this decision was reached is
unclear from the minutes. Undoubtedly the existance of a prenatal clinic which black
women had access to lessened the Board’s concern about this issue. Other factors
undoubtedly contributed to this decision. One, the mixed gender of the Board members of
the Community Center would lead to less focused concern over solely female health issues.
Two, black women during this period concentrated their reform efforts on race uplift rather
than primarily on concerns of women, such as prenatal care?17 This racial difference
between Black and white women reformers is important to consider and adds further
weight to the importance of the racial difference between the members of the Board
governing the Baby Clinic and the white women’s clubs who organized local clinics
outside of Detroit. The Board worked for racial uplift and consequently directed work for
the improvement of health of men, women and children in their communities, in
comparison to white women’s clubs who worked addressed largely women and children’s

health issues.

 

215”Minutes of DUL Meeting,” September 21 1927 DULP-MHC, Box 11.
216“Minutes of DUL Meeting,” October 21, 1927 DULP-MHC, Box 11.

217Gordon, 12111211.]291111911191111211. p. 141; Boris, “The Power of Motherhood: Black
and White Activist Women Redefine the Political,” p. 213-246; Evelyne Brooks
Higginbotharn, “African-American Women’ S History and the Metalanguage of Race’
Signs 17 (Winter 1992): 271; Gordon, “Black and White Visions of Welfare. Women’s
Welfare Activism, 1890-1945, ” p. 559-590.

62
While these distinctions are important, the similarity between the organizational

Structures behind the clinics run across the state is most striking. The cooperation of the
DUL with the Board of Health, and the DUL’S work with other white and black
organizations points to the importance of establishing networks of people among public and
private organizations as a strategy to serve the health needs of the Detroit black community
women and children. This network was an important part of the community building
process in black Detroit and provided needed education and care for black mothers and their
children in Detroit from 1919-1930.

CONCLUSION

The Depression brought concerns over maternal and child health to public policy
debates again and as Muncy argued, “women in the child welfare corps were ready with the
suggestions they had carried across the hostile terrain of the 1920s.”218 The Social
Security Act of 1935 included each of the programs suggested by the Abbott-Lenroot team
of the Children’s Bureau and much of their broader agenda. Title V of the Social Security
Act restored the Children’s Bureau’s Maternity and Infancy health work and allowed the
Children’s Bureau to expand through programs for crippled children and those neglected
by their parents. In addition, the Social Security Act established Aid to Dependent
Children, old-age pensions and unemployment insurance?19 However, Aid to Dependent
Children was put under the new Social Security Board, a federal program unconnected to
the network of organizations throughout the country working on infant health and welfare,
rather than under the Children’s Bureau, the unofficial head of this informal network. In
addition to circumventing the established networks, Aid to Dependent Children focused on
and benefited only those in poverty and, as a result, did not attempt to benefit all women
and children as the Children’s Bureau programs had?20 These two Significant changes
marked a new era in child and maternal health in the United States, and the decline of

community networking.

 

213Muncy. Wm. 13- 150.
219Muncy, W, p. 152; Ladd-Taylor, W, p. 190.
22°Mttney.Cnatln2_a.E2ma12Mmini9n. pp- 153-154-

63

64
Scholars mark the decline of women’s organizational networks active influence on

child health programs with repeal of the Sheppard-Towner funds in 1929. However, even
after repeal of the Sheppard-Towner funding in 1929, Michigan women’s organizations
remained active and continued to cooperate with the Bureau of Child Hygiene and Public
Health Nursing. In doing so they were vital to the continuation of maternal and child health
programs begun during the Sheppard-Towner years. This demonstrates that the decline in
women’s active influence did not occur at the same rate or in the same way across the
country women’s organizations continued the work they had begun before Sheppard-
Towner after the federal funds were withdrawn.

Most importantly, this study shows the centrality of private and public networks to
the success of health programs in Michigan. White women’s voluntary organizations
worked with the Michigan State Department of Health to establish successful maternal and
child health programs across Michigan outside of Detroit. Similar networks operated
within Detroit as seen used by the DUL. People from various public and private
organizations, black and white, working together contributed to success of the DUL Infant
Clinic. These networks gave politically marginalized groups, white women and black men
and women, a means to address health needs in their communities.

This study leads me to a number of areas for future research. The success of the
informal networks constructed by white women and also by black men and women may be
one reason that support for the continuation of Sheppard-Towner Act waned and warrants
further study. The degree to which the Director of the Michigan Department of Health
supported the work of the Bureau of Child Hygiene and the Children’s Bureau in
comparison to the dynamics of this relationship in other states may shed light on the
resulting organizational differences between states. Further comparison of women’s club
activity among States and their connection to the expanding roles of the state public health
department is needed. Comparisons between community efforts to improve infant health in

black urban and black rural communities will reveal valuable information concerning race

65
and public health. Studies addressing the political dynamics between the city and state

governments in regards to allocating funds for maternal and child health work will provide
further information into the politics of the development of maternal and child health policy.
Many questions arise concerning the voices of the women served by these programs and
further research using community newspapers and newsletters can shed light on their
perceptions, reactions and desires. Research on the nursing associations involvement with
maternal and child health programs, their relationship with the women they served and their
role in the rising professionalism of public health are broad topics that would important to
the development of maternal and child health policy during the early 20111 century, as is
research on the professionalization of medicine during this period. More case studies of
rural and urban communitiy clinics other that the DUL clinic are also important.

Research on Michigan’s maternal and child health programs after 1930 is
neccessary in providing insight into the creation of our current state maternal and child
health program and for pointing to directions for the future. As a society we must
readdreSS the issue of maternal and child health. Today one percent of all infants die under
the age of one.221 Yet other countries have lower rates and critics of current American
policy and programs argue that the United States has failed to reduce infant mortality
adequately and evenly because it has not adopted comprehensive national health and
maternal support systems?22 For the period between 1980-1990 a dismal decline in child
and maternal health was reported by the Children’s Defense Fund. Statistics from the
National Center for Health Statistics Show that compared with 1980 statistics, American
infants in 1990 were less likely to be born to mothers who received early prenatal care,
more likely to be born to mothers who received later or no prenatal care. In 1990 one in
four infants were born to mother who did not receive early prenatal care. Four in 10

infants born to black mothers did not receive early prenatal care. One in nine babies born to

221Meckel.59¥2_1h2_Babies. p- 1.
222Meckel. 52mm P~ 3-

 

66
black mother received late or no prenatal care, compared with one in 20 white babies. In

1990 infants were more likely to be born at low birth weight. Low-birthweight infants are
much more vulnerable to death and disability than infants born at normal weight. The
overall infant mortality rates were lower in 1990 than in 1980, but the rate of improvement
in that decade was Slower than the two previous decades. Even with this improvement, in
1991 the U.S. infant mortality rate was let compared to nations world wide, behind
countries like Canada, Hong Kong, Singapore, and Spain. And a baby born in the U.S.
was more than twice as likely to die before its first birthday as a baby born in Sweden.
U.S. black babies were more likely to die in their first year of life than a baby in 34 other
nations, including Jamaica, Cuba, and Sri Lanka?23 The U.S. must focus its attention on
caring for its mothers and infants. Ultimately understanding the past can help clarify the
issues at hand and uncover possible consequences of different courses of action and help
guide us in establishing sound, well thought out maternal and child health policy that
addresses and remedies these relatively high rates of infant and maternal morbidity and

mortality.

 

223Children’s Defense Fund. - .. -
W (March 1993) 1-3-

 

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