The Sheppard-Towner Act — America’s Early Foray into Social Security
November 23rd marks a century since the milestone Sheppard-Towner Maternity and Infancy Protection Act was signed into law by President Warren G. Harding. Originally sponsored in 1918 by Representative Jeannette Rankin, a Washington State suffragette and the first woman to serve in the United States Congress (representing Montana), the legislation was carried to completion in 1921 by Senator Morris Sheppard and Representative Horace Mann Towner after Rankin’s departure from the House. The Act provided federal grants to participating states to fund maternal and infant health programs. Despite the demise of the Act in 1929, the Sheppard-Towner era stands as an important precedent in the advent of social security in the United States.
The Sheppard-Towner act emerged from a confluence of forces. The U.S. Children’s Bureau was established in 1912 to investigate and report on issues of child welfare throughout the country, and more specifically on the problems of infant and maternal mortality and child labor. The new focus on child welfare had the backing of President Woodrow Wilson as evidenced by his administration’s 1918 campaign known as The Children’s Year. Additionally a 1917 Children’s Bureau report found that “[i]n 1913 in this country at least 15,000 women, it is estimated, died from conditions caused by childbirth.” Soon after, the 19th amendment was ratified, granting (some) women the right to vote. This emboldened groups of women activists to push for child welfare legislation. Their members of Congress took notice and passed the legislation by wide margins in both the Senate and House.
The legislation established the first federally funded grant program to the states for health services. Julia Lathrop, the first chief of the Children’s Bureau, wrote the legislation and modeled it on the 1914 Smith-Lever Act that provided federal matching grants-in-aid for agricultural education and outreach to rural America. Edward R. Schlesinger, M.D. explains in The Sheppard-Towner Era: A Prototype Case Study in Federal-State Relationships, “[Lathrop] called for a nationwide program that would provide public health nurses for service and health instruction, instruction in schools and universities, and through different forms of extension teaching on hygiene for mothers and children, well child conference centers, adequate confinement care, and hospital facilities for mothers and children.”
While the Sheppard-Towner Act has been credited with reducing maternal and infant mortality and promoting advancements in prenatal care in states that accepted the grants, it has also been criticized for “reflecting and reinforcing hierarchies of race and socioeconomic class as well as contributing to the decline of midwifery in the United States.” Congress allowed the law to expire in 1929 despite the fact that forty-five states, including Washington (Laws of 1923, ch. 127, p. 346), had accepted the funding provided by the Act. The American Medical Association had mounted opposition to the law and other parties opposed it as a violation of states’ rights and an intrusion into the parent-child relationship. The law had also been challenged, albeit unsuccessfully, in the U.S. Supreme Court.
Arguably, the Act’s most important legacy is the role it played as a precursor to the 1935 Social Security Act passed in the wake of the Great Depression. In fact, Title V, Part One of the Act provides for federal matching grants to states for infant and maternal welfare and was modeled on the Sheppard-Towner Act. In Washington State, this meant the same Division of Child Hygiene established to administer Sheppard-Towner funds would go on to administer the grants provided by the Social Security Act.
Today Washington uses these grants, among other things, to continue maternal mortality work with the goal of remedying racial and socioeconomic inequities, to curb opioid use by pregnant women, and to respond to the current COVID-19 public health crisis. Read the U.S. Health Resources & Services Administration Washington State Snapshot report (November 2021) to see the true measure of the Sheppard-Towner Maternity and Infancy Protection Act’s legacy in our state.
For Further Reading:
U.S. Capitol Visitor Center Exhibit, Protecting Mothers and Infants
The Embryo Project Encyclopedia, Sheppard-Towner Maternity and Infancy Protection Act (1921)
The Children’s Bureau Legacy: Ensuring the Right to Childhood by the Children’s Bureau, U.S. Department of Health & Human Services
United States House of Representatives, History, Art & Archives, The Sheppard–Towner Maternity and Infancy Act post in Historical Highlights
The Social History of the American Family: An Encyclopedia, chapter on Sheppard-Towner Maternity and Infancy Protection Act of 1921
The Sheppard-Towner Era: A Prototype Case Study in Federal-State Relationships, 57 American Journal of Public Health and the Nations Health 1034 (1967)
ThoughtCo., The Sheppard-Towner Act of 1921: This breakthrough social legislation was also called the Maternity Act
CB and the Sheppard-Towner Act of 1921, Children’s Bureau Centennial Series post in Children’s Bureau Express (April 2012)
Shots Health News from NPR, Parenting Advice From Uncle Sam
Rutgers School of Arts and Sciences, Jeannette Rankin and the Passage of the Sheppard-Towner Act
National Bureau of Economic Research Working Paper Series, Saving Babies: The Contribution of Sheppard-Towner to the Decline in Infant Mortality in the 1920’s
Conference Paper, Southern Conference on African American Studies, February 2014, The Midwife Problem: The Effect of the 1921 Sheppard-Towner Act on Black Midwives in Leon County
Children’s Bureau publication, The Promotion of the Welfare and Hygiene of Maternity and Infancy: The Administration of the Act of Congress of November 23, 1921 (1926)
Social Security Administration, Social Security History
Speech by Thomas H. Eliot (one of the principal drafters of the Social Security Act), The Legal Background of the Social Security Act (February 3, 1961)
Virginia Commonwealth University Libraries Social Welfare History Project, Social Insurance & Social Security Chronology: Part II — 1900s — 1920s
Social Security Board publication, Why Social Security? (1937)
Governor Louis Hart’s veto of portions of Washington’s 1923 legislation accepting Sheppard-Towner Act provisions (SC)
