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The National Women's Relief Society and the U.S. Sheppard-Towner Act
Utah Historical Quarterly
Vol. 50, 1982, No. 4
The National Women's Relief Society and the U.S. Sheppard-Towner Act
BY LORETTA L. HEFNER
DURING THE 1920s THE NATIONAL WOMEN'S Relief Society of the Church of Jesus Christ of Latter-day Saints participated at the forefront of one of the country's most important pieces of social legislation. From 1921 to 1928 the Relief Society lobbied in state and federal chambers, allied itself with several noted American reformers, and became widely recognized as an important progressive leader in the cause of maternity and infant health care through its extensive efforts in support of the national Sheppard-Towner Act.
That bill, formally known as the Federal Maternity and Infancy Act of 1921, was the first social reform measure to involve federal grants-inaid to states. The measure was a vital part in a series of ideas and actions dealing with the health and welfare of children. The movement, spanning two Roosevelt administrations, began with the White House Conference on Child Welfare Standards in 1909 and ended with the Social Security Act of 1935.
In addition to its importance for maternity and infant health care, the Sheppard-Towner Act was also seen as the first major political victory for women following the adoption of the Nineteenth Amendment in 1920. Indeed, the legislation, which was supported by ten million women, was introduced by Julia Lathrop, director of the Children's Bureau. Although some health care bills incorporating federal grants-in-aid to states had been introduced in Congress by 1919, and again in 1920, it was not until after the Nineteenth Amendment had passed that the bill sponsored by Democratic Sen. Morris Sheppard of Texas and Republican Rep. Horace Towner of Iowa succeeded in winning congressional approval. On November 23, 1921, it was signed into law by President Warren G. Harding.
The goal of the legislation was to establish cooperation between state and federal governments to improve maternity and infancy health care. This was to be accomplished by creating health centers and prenatal clinics, by holding child health conferences, by giving examinations in schools to screen for medical and dental problems, and by distributing literature about a variety of subjects relating to mother-child care.
The Sheppard-Towner Act authorized an appropriation of over a million dollars a year, beginning in 1923 and ending in 1927. Each state adopting the act would receive $5,000 and an additional $5,000 if matching funds were provided. The remainder would be distributed according to population percentage and matching funds. The administration of the Maternity and Infancy Act was handled by the Division of Child Hygiene and Maternity Health within the U.S. Children's Bureau.
The Relief Society's initial involvement began during the summer of 1921. The women's organization had previously received permission from the First Presidency and the Presiding Bishopric to go ahead with their plans to build a maternity home in Salt Lake City to augment existing health care facilities. The confinement home (as the women called it) was to be financed with the interest accrued from the Relief Society's wheat fund. On July 28, 1921, as the General Board members were reviewing the project, Amy Brown Lyman, general secretary and director of the Social Services Department of the Relief Society, suggested "that a movement to establish a maternity home in Salt Lake City be considered as a movement in the interest of maternity and motherhood throughout the Church." She went on to suggest that other institutions be established on a smaller basis, that trained nurses work in these facilities, and that such a program be announced to the women of the church at the next General Relief Society Conference in October.
This broadened proposal was discussed by the General Board and was unanimously approved. Even though the Sheppard-Towner Act was in the midst of a critical debate in Congress in which conservative groups suggested that it was part of a Communist Bolshevik plot to gain control over the children of the country, the Relief Society joined the nation's progressive leaders from the U.S. Children's Bureau, National Conference of Women, the Red Cross, and the National Conference of Social Workers to reduce what they believed to be the extraordinarily high infant and maternity morbidity and mortality rates in the United States.
The revised program was submitted to and approved by both the First Presidency and the Presiding Bishopric. On the opening day of the organization's conference, General Relief Society President Clarissa S. Williams announced to the several hundred women attending the meetings that the Relief Society would embark upon a drive to improve the health of the church's women and children. After President Williams delivered her address, she asked for comments on the proposal from the attending representatives. The local leaders were enthusiastic about the Relief Society's plans and related many accounts of poverty and poor health conditions in the less populated areas of the western states.
During the next year many of the program's details were worked out. The leaders of the Relief Society used their positions, their magazine, and a strong grassroots organization to educate their own members as well as the local priesthood and community members at large about the nature of the Sheppard-Towner work and what they hoped to accomplish through it. In letters sent out from the Presiding Bishopric and the General Relief Society Presidency, local leaders were instructed to "cooperate with state and federal officials in carrying out the provisions of the recently enacted maternity bill." Several months later at another conference, President Williams said:
In 1923 the executive committee of the Relief Society, consisting of the president, her two counselors, and general secretary, began meeting with Dr. Theodore B. Beatty, state director of Public Health, May Muckley, state director of the Bureau of Child Hygiene and Public Nursing, and Hyrum Young Richards, director of the Maternity and Child Welfare Department. The Relief Society and the state officers cooperated very closely during the remainder of the Sheppard-Towner work.
The Relief Society executive committee encouraged the Utah State Health Department to work with the local Relief Society women in every city and town in the state. Beatty, Muckley, Richards, and their colleagues were given permission to send literature about the Sheppard-Towner work to stake and ward presidents and to call upon that leadership to direct and organize local clinics and classes and to improve health care delivery. In return, the Relief Society augmented its efforts by utilizing public health nurses, physicians, dieticians, and medical practitioners. With the state's ability to pay competitive fees for medical personnel to attend conferences, teach classes, and conduct clinics to examine mothers and children, the Relief Society was more than willing to publicize the event as well as to make the local wardhouse or Relief Society hall available for local meetings. In the end, their mutual cooperation made it possible for both groups to accomplish more than either one could have done alone.
In 1923, at the first session of the Utah State Legislature to be held after the passage of the Federal Maternity and Infancy Act of 1921, the Relief Society lobbied for the adoption of the Sheppard-Towner Act so that the state would become eligible for federal grants. Amy Brown Lyman, who originally advocated the Relief Society's support of the Sheppard-Towner Act, was also a member of the House of Representatives and sponsored the measure. Her bill, HB 88, passed both House and Senate without a single dissenting vote. Shortly thereafter, the enacting legislation was also passed which allowed Utah the fullest amount possible of federal grants-in-aid to underwrite the work.
Within eighteen months after the Sheppard-Towner work was proposed to the Relief Society General Board, nearly every ward and stake in the Intermountain West had participated to some degree in the cause. The work involved the distribution of literature on proper prenatal care to expectant mothers; examinations by physicians and public health nurses of mothers, infants, and children; conferences to instruct women in nutrition, hygiene, medicine, and child care; examinations of infants and children for deformities, chronic health problems, and immunization, as well as dental examinations. For many who lived in rural areas and for those who did not have access to good professional health care in the larger towns and cities, these services provided the first opportunity for diagnosis and treatment of this kind.
Because it realized the wide variety of needs throughout Utah's twenty-nine counties and in the surrounding Intermountain states, the General Board decided to encourage local stake Relief Society leaders to design their own health care programs. This way, the program would be responsive to the needs of a particular area and could draw upon what governmental funds were coming to that community. The only guidelines established by the Relief Society General Board related to the use of various Relief Society funds, the building of maternity hospitals (which required the approval of the Presiding Bishopric), and the careful and thorough study of the needs of a local area before taking formal steps to acquire aid. Stake Relief Society presidents were asked to survey the health care facilities already in existence, to take note of the area's birthrate and socioeconomic background, and to let those two factors play an important part in formulating their proposal. Finally, the women were told that whatever course they pursued, they should work with only the most reputable doctors and should maintain the highest standards in facilities and equipment.
The autonomy of local leaders proved to be a great benefit for the work. Shortly after the program was announced stake leaders began submitting plans to the General Board for review, and in time virtually every stake in the western United States was participating to some degree.
During the legislation's seven-year span local women enthusiastically devised, promoted, and mobilized health care delivery for thousands of women and children. The reporting years of 1925 through 1929 show that in Utah alone 52,925 infants and children were given examinations at some 2,203 health conferences; 133 health care centers were established; 274 dental health clinics were sponsored where 5,491 children were checked; and 3,766 women attended mothers' classes where they were instructed in prenatal health, nutrition, and child care. In addition, public health nurses visited 13,675 homes where women and children were given special medical attention. Over four thousand untrained volunteers — the overwhelming number of which were Relief Society members — assisted public health officials with physical examinations and made the local arrangements for conferences. Members of the health and medical profession delivered over nine hundred lectures throughout the state on maternity and child care, while a number of traveling exhibits were displayed in community centers to inform the general public of various related aspects of the Sheppard-Towner work.
Each year the State Health Department initiated a special program to combat particular health concerns. In 1926 the program focused on diphtheria immunization and the prevention of goiter. In 1927, 1928, and 1929, as part of the "May Day as Child Health Day Observance," examinations were given to preschool children. Also during those years intensive efforts were made to immunize children against smallpox.
In 1923 the General Board, with the advice and counsel of the State Health Department and the Red Cross health nurses, suggested that each ward and stake make available to expectant mothers and attending physicians and nurses at least one of three maternity outfits: a maternity bundle, a loan chest, or a baby layette. The purpose was to provide sanitary articles for delivery to new mothers and babies in communities where such items were frequently unobtainable.
The maternity closets worked very well in Utah as they had elsewhere throughout the country. For little or no charge physicians, midwives, mothers, and newborns were provided with a convenient supply of necessary instruments, bandages, and clothing for the very critical time of delivery.
In another aspect of the Sheppard-Towner work, seventeen different stakes established maternity health centers that ranged in sophistication from two available sanitary beds with the care and attention of nontrained volunteers to entirely furnished buildings equipped with outstanding delivery facilities and personnel. Stakes proposing such hospitals were Utah, Box Elder, Parowan, South Sevier, Kanab, Granite, Union, Blackfoot, Roosevelt, Franklin, Oneida, Blaine, Panguitch, Garfield, North Sevier, Deseret, Liberty, and Cottonwood.
The most successful and well known of the maternity homes existed in the Cottonwod Stake. In 1924 the stake Relief Society president, Amanda Bagley, asked the Presiding Bishopric for approval and financial support in purchasing an older home in south Salt Lake County for $6,000. The women of Cottonwood Stake believed they could maintain the hospital themselves after the Presiding Bishopric acquired the building, remodeled it, and obtained the essential equipment and supplies. Within a week after the proposal was submitted, Presiding Bishop Charles W. Nibley sent an affirmative answer to President Bagley. By mid-October the hospital was ready to receive patients. The Relief Society Stake Presidency supervised the hospital with the advice of a board made up of local physicians, public health care officials, community business people, and church leaders. As for the services, a fee of $40.00 furnished a woman the use of the delivery room, articles from maternity bundles, layettes, three meals a day, and the professional care of a licensed nurse for a period of two weeks.
Even though most of the other facilities were much smaller in size and did not grow into major medical complexes like the Cottonwood Maternity Hospital, the fact that some place was set aside for examinations, prenatal care, delivery, and confinement and that midwives and physicians had access to a clean, quiet environment with sterile equipment had a significant impact on the maternity and infancy mortality and morbidity rates.
After only two years of Sheppard-Towner work in Utah, the General Relief Society Executive Committee reported great success. President Clarissa S. Williams stated in the April 1925 General Relief Society Conference:
The Relief Society did continue assisting in the Sheppard-Towner program, and the conditions did continue to improve. By 1929, seven years after the work had begun, the general maternity mortality rate for Utah Was about 8 percent lower in 1928 (9.6 per one thousand) than in 1921 (10.4 per one thousand). The infant mortality rate was considerably lower in 1928 than in 1921 as the following table sfiows.
DEATHS OF INFANTS UNDER ONE YEAR OF AGE PER1,000 LIVE BIRTHS IN UTAH*
If the 1921 infant mortality rate had prevailed in 1928, 14 more infants would have died for every 1,000 born alive. Given the 1928 birthrate, this meant a total saving of 182 infant lives. If the maternal mortality rate had prevailed in 1928, there would have been 94 deaths from puerperal causes instead of 63.
The reduction in maternal and infant mortality rates made Utah one of the five lowest states in the nation for maternity- and infancy-related deaths. Indeed, the U.S. Children's Bureau published several reports stating that Utah had achieved the greatest reduction in the maternity death rate of any state in the union. In fact, Utah's successes attracted Grace Abbott, chief of the U.S. Children's Bureau; her sister, Edith Abbott, the famous social worker and educator; and their colleague Sophonisha Breckinridge. These noted reformers and social work leaders met with the Utah State Board of Health as well as with Amy Brown Lyman and several members of the Relief Society General Board to congratulate them on the efforts.
In spite of the successes of Sheppard-Towner work in Utah and elsewhere, national "biennial squabbles over appropriations required that reform associations remain eternally vigilant." This required the continual support of all groups that originally worked for the measure, including the Relief Society. In 1926, when the U.S. Children's Bureau defended its request for more appropriations, the Relief Society began its campaign to raise the political consciousness of its members.
At the October 1926 General Relief Society Conference, two addresses were given that advocated extending the legislation and continuing the appropriations. Julia F. Lund, General Board member, defended the use of federal aid — a major point of disagreement with opponents :
Amy Brown Lyman then cited her admiration for Grace Abbott and described the historical development of the U.S. Children's Bureau and the Sheppard-Towner Act. She further stated:
Three months later, Grace Abbott solicited the help of the Relief Society, in particular Amy Brown Lyman, in securing the extension of the Sheppard-Towner legislation. Abbott desperately needed help in dissuading the most vocal critic of the legislation and the agency — Democrat William H. King. Utah's junior senator, King was completing his second term in a congressional career that would span twenty-four years. He was an outspoken advocate of states' rights and the decentralization and limitation of the federal government.
In an attempt to change his mind, Lyman sent King telegrams, letters, reports on what the Relief Society and Utah had accomplished under the provisions of the act, and visited him personally, but to no avail. On January 13, 1927, King delivered a decisive blow to the Sheppard- Towner Act. While supposedly discussing a foreign policy matter on the floor of the Senate, King turned his attention to the Maternity and Infancy Act and filibustered for several hours. He referred to the people supporting the measure as ". . . neurotic women, . . . social workers who obtained pathological satisfaction in interfering with the affairs of other people, ... and Bolsheviks who did not care for the family and its perpetuity."
During the filibuster King made it clear that he did not intend to give up the floor until legislation was passed ending the Sheppard-Towner Act. After several hours, Senator Sheppard, an original cosponsor of the bill, whispered to King that "an amendment to the pending bill had been prepared which would permit the passage of the bill with little further discussion." That night the amendment was summarily read, discussed, agreed to, and passed.
Because of the sudden pressure of King's filibuster, coupled with the mounting strength of the conservative lobbying caucuses of the American Medical Association, Women Patriots, and the Daughters of the American Revolution, as well as the immediate need for funds to cover operating expenses, Senator Sheppard and other proponents were forced to accept a compromise bill that would renew appropriations for two more years but automatically terminated the original legislation on June 30, 1929. Hoping that the next Congress would be more supportive of their efforts, proponents voted in favor of the compromise bill. These hopes proved to be fruitless. In 1928 a new bill that retained the original provisions and renewed appropriations was introduced in Congress. However, Senator King and the same conservative lobbyists who were so effective in 1927 were once again victorious. The Sheppard-Towner Act expired June 30, 1929.
Despite Congress's repeal of the Sheppard-Towner Act, forty-five states, including Utah, continued their own efforts in providing maternity and infancy health care programs until the federal government became involved once again in 1935. In Title V of the Social Security Act, "the Children's Bureau was authorized $5,820,000 for maternity and infancy protection, $3,870,000 for crippled children, and $24,750,000 for aid to dependent children." Thus, after a fifteen-year struggle for acceptance and legitimacy, the national reformers finally saw their hopes realized: needed health care during pregnancy and infancy became a permanent fixture in the social welfare apparatus.
Throughout the 1920s and long after the rescinding of the Sheppard- Towner legislation in 1929, the Relief Society maintained its involvement in maternity and infancy health care as well. In the 1920s it proved itself to be one of the most progressive social welfare organizations in the country. While leading the way in Sheppard-Towner work, the women's group also received its child adoption and placement license in 1922, was a vital force in creating the American Fork Training School for mentally retarded children, distributed milk to poor children in Salt Lake City, temporarily placed malnourished children in homes where they would be given better diets, and played an active role in resolving problems in Utah's juvenile courts.
Even after the demise of the Sheppard-Towner Act, the Relief Society made effective use of the Relief Society Magazine to provide its readers with a significant source of information and editorial direction that both supported and advocated persistent social welfare reform. The interest from the wheat fund was used by local units to finance various health programs until the early 1940s, and the numerous maternity hospitals continued to receive patients. Indeed, the Cottonwood Maternity Hospital continued under the direction of the Cottonwood Stake Relief Society until 1963.
In this period, traditionally treated as a time devoid of activism, the Relief Society demonstrated its belief that even though the Ninetenth Amendment had passed, a great deal more needed to be done in behalf of women. As an organization it would support Carrie Chapman Catt, Jane Addams, Grace Abbott, and other reformers in working for protective legislation for women; but it did not choose to support Alice Paul's campaign for equal rights.
In addition to saving the lives of many mothers and infants and helping thousands more live free from disease and chronic health problems, the Relief Society's involvement in Sheppard-Towner work resulted in other dividends as well. With the publicity brought about by its great success in helping Utah reduce the infant mortality rate more than any other state in the union, and through the praise of Grace Abbott and other reformers lauding it as an important lay women's group, the Relief Society received national recognition for its social intelligence, extensive grassroots organization, and political effectiveness while firmly establishing itself as a primary force in child welfare reform.
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