History of Maternal and Child Health in the

History of Maternal and Child Health in the U. S. Peggy West Ph. D MSW October 19, 2012

Significance Oldest Federal/State Partnership First federally-funded social welfare program Since 1935 has been continuously funded Significant role of women activists Addresses needs of women and children directly at the federal level Block Grant to States since 1981

What happened relevant to maternal and child health in each year below? 1912 1921 1935 1965 1977 1981 1998 2012

Roots began 100 years Ago in 1912 The Children’s Bureau is the first federal agency within the U. S. Government—and in fact, the world—to focus exclusively on improving the lives of children and families. Since its creation by President Taft in 1912, the bureau has tackled some of our nation’s most pressing social issues, including: Infant and maternal death Child labor Orphanages Child health and recreation Delinquency and juvenile courts Family economic security Abused and neglected children Foster care

Sheppard-Towner Act of 1921 Also called the “Maternity Act” Purpose was to “reduce maternal and infant mortality” In 1921 childbirth was the second leading cause of death for women and 20% of children in US died in first year of life and 33% in first five years. Low income was an important factor in these mortality rates.

Sheppard-Towner Act funded programs such as Health clinics for women and children, hiring MDs and nurses to educate and care for pregnant women and their children Visiting nurses Midwife training Distribution of nutrition and hygiene information

Sheppard Towner Act significance Unsuccessful challenge in Supreme Court (Frothingham v. Mellon and Mass. v Mellon (1923) Addressed needs of women and children at federal level Role of women activists (Jeannette Rankin, Julia Lathrop, and Grace Abbott) & League of Women Voters Demonstrated that education and preventive care at could have a significant effect on maternal and child mortality. Not funded after 1929 due to political pressure Groups including the American Medical Association (AMA) and its Section on Pediatrics labeled the program "socialistic" and opposed its passage and opposed its funding in subsequent years.

MCH/Title V of Social Security Act Passed in 1935 Ensures health of women, children and youth including Children with special health care needs Converted to Block grant in 1981 States required to match $4 to $3 30% for CSHCN 30% for preventive and primary care for women and children Limit of 10% administrative costs

Where we are today MCH is located in HRSA in HHS Provides Block Grants to 59 states and territories MCH Mission The mission of the Maternal and Child Health Bureau (MCHB) is to provide leadership, in partnership with key stakeholders, to improve the physical and mental health, safety and well-being of the maternal and child health (MCH) population which includes all of the nation’s women, infants, children, adolescents, and their families, Including fathers and children with special health care needs.

Goals of MCH Assure access to care for low income women and children Reduce infant mortality Ensure comprehensive prenatal and postnatal care Increase health assessments, diagnosis and tx for kids Ensure access to preventive, and rehab services Assure family-centered, community-based systems of coordinated care for CSHCN Toll free hotlines for assistance in applying for services for eligible to Title XIX. (Medicaid)

MCH Pyramid of Health Services

Discretionary Grants 900 Discretionary Grants, SPRANS and CISS from 15% set aside Includes Training Grants: Adolescent Health, Autism, Communication Disorders, Dev/Beh Peds, Genetics, Leadership, Leadership Education in Neurodevelopmental and other disabilities, Public Health, Nursing, Nutrition, Pediatric Dentistry, and Social Work

Coordination with Medicaid/Title XIX Passed in 1965 as part of the Social Security Act Expansions of services and populations impacts MCH shifts MCH emphasis on ensuring access to Medicaid and help with gaining information about enrollment. Allows MCH to shift its small resources away from direct care payment to building infra structure

MCH impact In 2009, MCH reached *2, 513, 320 pregnant women were served by the MCH Block Grant and an additional 118, 258 served, mostly through Healthy Start *4, 134, 329 infants were screened through the Title V Block. Services were provided to an additional 62, 125 infants through Healthy Start and early identification services through such programs as LEND *27, 611, 884 children were served through the MCH Block Grant and an additional 89, 654 mostly through Healthy Start and LEND *1, 944, 766 children with special health care needs received services through the MCH Block Grant and an additional 148, 761 mostly through LEND. *3, 132, 908 women and men were served through the MCH Block Grant and an additional 485, 809 mostly through the first Time Motherhood/New Parents

What happened relevant to maternal and child health in each year below? 1912 Children’s Bureau Created 1921 Sheppard-Towner Act Passed 1935 Social Security Act, Title V (MCH) passed 1965 Title XIX of Social Security Act passed (Medicaid) 1977 First LEAH programs funded by MCHB 1981 MCH funding to states becomes a Block Grant 1998 MCH implements performance measures for reporting by states 2012 LEAH funded at UW (after an absence of 10 years)

Questions and Discussion