On a recent episode of the HBO series Boardwalk Empire, set in Atlantic City in the Prohibition Era, the wife of the city's boss, Enoch "Nucky" Thompson, was speaking with a physician and a nun about a women's health clinic she founded. Reviewing the language of the materials to be distributed, the nun objects to the word menstruation. Mrs. Thompson responds, "The Federal Children's Bureau has already published a series on prenatal care and 'menstruation' is what they used." A shout out to the show's writers for acknowledging the work of this largely unknown agency (actually called the United States Children's Bureau) on its 100th birthday.
Founded in 1912 and housed in the Department of Labor, the Children's Bureau was the first federal agency to be run by women - and the first time the federal government committed to efforts on behalf of children's health and welfare. The bureau had a broad mission: reducing infant and child mortality, improving child health, abolishing child labor and advocating for those with special needs, including the orphaned, abandoned, disabled, and delinquent. It also had a limited mandate: investigating and educating, while leaving intervention and services to the states.
Public support for the bureau's work might surprise contemporary critics of federal health programs. The bureau received about 125,000 letters each year from 1915 to 1932, a huge number of them from mothers requesting advice about caring for their offspring. "Infant Care" was published in 1914, the year after "Prenatal Care" became the government's best-selling publication of all time, with the 25 millionth copy distributed in 1942. When the bureau investigations of infant and child health in various cities and rural communities became public, civic leaders asked the agency to send agents to their towns to undertake investigations and to sponsor health demonstration programs. City and state health departments reprinted advice from the Children's Bureau, and voluntary organizations looked to it for help with their educational endeavors, such as "baby week."
The Children's Bureau extended its reach and impact following passage of the Maternity and Infancy Care Act (known as Sheppard-Towner) in 1921. The bureau distributed Sheppard-Towner funds to cooperating states for education programs, prenatal and child health clinics, and midwife training. Sheppard-Towner reached 4 million infants and children and 700,000 pregnant women, resulting in a significant decline in infant mortality. (Congress ended the program in 1929 under pressure from the American Medical Association, which feared that the health clinics siphoned off paying patients and that the program opened the door to socialized medicine.)
Working with other federal agencies during the Great Depression, leaders of the Children's Bureau crafted legislation that was incorporated into the Social Security Act of 1935 as Title IV (providing grants to states for dependent children) and Title V (providing grants to the states for maternal and child welfare). During World War II, the bureau distributed Title V funds under the Emergency Maternity and Infant Care program that paid for prenatal, delivery, and postnatal care for servicemen's wives in the lowest military pay grades.
Success did not guarantee survival. After 1946, administrative reorganization pushed the Children's Bureau down a notch in the federal hierarchy, ultimately curtailing its funding and mission. Thereafter it became a vagabond moving among different federal departments. It now operates under the Administration for Children and Families within the Department of Health and Human Services, distributing funds to programs focused on strengthening families and protecting children.
Today, no single federal agency has the resources and mandate to address issues such as child poverty, high rates of illness among children, and a stagnant infant mortality rate that reflects dramatic disparities by race, ethnicity and income. So, let's not celebrate the centenary of the Children's Bureau; let's ask when the nation will once again have a robust, well-funded agency with the power to act on behalf of the health and welfare of children.