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4458 1919

HYGIENE OF MATERNITY AND INFANCY.

COMMITTEE ON LABOR,
HOUSE OF REPRESENTATIVES,

IVashington, D. C., January 15, 1919. The committee met at 10.30 o'clock a. m., Hon. James P. Maher (chairman), presiding.

The CHAIRMAN. The committee will hear Miss Rankin in connection with H. R. 12634, which is as follows:

(H. R. 12634, Sixty-fifth Congress, Second Session.] A BILL To encourage instruction in the hygiene of maternity and infancy, and to extend proper care for

maternity and infancy; to provide for cooperation with the States in the promotion of such instruction and care in rural districts; to appropriate money and regulate its expenditure, and for other purposes. .

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled. That there is hereby annually appropriated, out of any money in the Treasury not otherwise appropriated, the sums provided in section two of this act. to be paid to the several States for the purpose of cooperating with the States in promoting the care of maternity and infancy in rural districts; to provide instruction in the hygiene of maternity and infancy, and the sum provided in section five for the use of the Chief of the Children's Bureau Department of Labor, for the administration of this act and for the purpose of making such studies, investigations, and reports as will further the efficient administration of this act.

SEC, 2. That for the purpose of paying the expenses of said cooperative work in providing the services and facilities srecified in this act, and the necessary printing and distribution of information in connection with the same, there is permanently appropriated out of any money in the Treasury not otherwise appropriated, the sum of $480,000 for each year $10 000 of which shall be paid annually to each State, in the manner hereinafter provided: Provided, That there is also appropriated for the use of the States, subject to the provisions of this act, for the fiscal year ending June thirtieth, rineteen hundred and nineteen, an additional sum of $1.000,000; for the fiscal year ending June thirtieth. nineteen hundred and twenty, the sum of $1,200,000; for the fiscal year ending June thirtieth, nineteen hundred and twenty-one, the sum of $1,400,000; for the fiscal year ending June thirtieth, nineteen hundred and twentytwo, the sum of $1,600 000; for the fiscal year ending June thirtieth. nineteen hundred and twenty-three, the sum of $1,800.000; for the fiscal year ending June thirtieth, nineteen hundred and twenty-four, the sum of $2 000 000; and annually thereafter the sum of $2,000,000: Provided further. That no payment out of the additional appropriations herein provided shall be made in any year to any State until an equal sum has been appropriated for that year by the legislature of such State for the maintenance of the services and facilities provided for in this act.

So much of the appropriation apportioned to any State for any fiscal year as remains unexpended at the close thereof shall be avialable for expenditures in that State until the close of the succeeding fiscal year. Any amount apportioned under the provisions of this act unexpended at the end of the period during which it is available for expenditure under the terms of this section shall be reapportioned, within sixty days thereafter, to all the States in the same manner and on the same basis, and certified to the Secretary of the Treasury and to the State boards of maternity and infant hygiene in the same way as if it were being apportioned under this act for the first time.

SEC. 3. That in order to secure the benefits of the appropriations provided for in • section two of this act, any State shall, through the legislative authority thereof, accept the provisions of this act and designate or authorize the creation of a State board of maternity aid and infant hygiene, which shall have all necessary power to cooperate as herein provided, with the Chief of the Children's Bureau, Department of Labor, in the administration of the provisions of this act; the members of the State board shall

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be appointed by the governor and shall consist of the following persons: The governor, ex officio, who shall be chairman of the board; a representative of the State board of health, who shall be a physician; a representative of the nursing profession, who shall be a graduate nurse, and in States where registration obtains shall be duly registered; a representative of the teaching profession, who shall be selected from the State university or the State college of agriculture. The first meeting of said board shall be called by the governor, at such time and place as he may direct; the board shall elect a vice chairman and a secretary, and shall notify the chief of the Children's Bureau, Department of Labor, of the assent of the State to the provisions of this act and shall state the name and address of the officer authorized to conduct the correspondence of the board.

In any State the legislature of which does not meet in nineteen hundred and nineteen the governor of that State, so far as he is authorized to do so, shall accept the provisions of this act and d signate or create a State board of not less than three members to act in cooperation with the Chief of the Children's Bureau, Department of Labor. The Chief of the Children's Bureau shall recognize such local board for the purposes of this act until the legislature of such State meets in due course and has been in session sixty days.

Sec. 4. That the Chief of the Children's Bureau, under the direction and control of the Secretary of Labor, shall have charge of all matters concerning the administration of this Act, and shall have power to cooperate with State boards in carrying out the provisions of this act. It shall be the duty of the Chief of the Children's Bureau, under the direction or with the approval of the Secretary of Labor, to make or cause to have made, such studies, investigations, and reports as will further the efficient administration of this act.

Sec. 5. That so much, not to exceed five per centum of the appropriation for any fiscal

year made by or under this act, as the Chief of the Children's Bureau, with the approval of the Secretary of Labor, may estimate to be necessary for administering the provisions of this act, shall be deducted for that purpose, available until expended. Within sixty days after the close of each fiscal year the Chief of the Children's Bureau, under the direction or with the approval of the Secretary of Labor, shall determine what part, if any, of the sums theretofore deducted for administering the provisions of this act will not be needed for that purpose and apportion such part, if any, for the fiscal year then current in the same manner and on the same basis, and certify it to the Secretary of the Treasury and to the State boards of maternity aid and infant hygiene, in the same way as other amounts authorized by this act to be apportioned among all the States for such current fiscal year. The Secretary of Labor, after making the deduction authorized by this section, shall apportion the remainder of the appropriation for each fiscal year among the several States in the proportion which the rural population of each State bears to the total rural population of all the States as determined by the next pr ceding Federal census.

Sec. 6. That out of the appropriations made by or under this act, the Secretary of Labor, upon the recommendation of the Chief of the Children's Bureau, is authorized to employ such assistants, clerks, and other persons in the city of Washington and elsewhere, to rent buildings outside of the city of Washington, to purchase such supplies, material, equipment, office fixtures, and apparatus, and to incur such travel and other expense as he may deem necessary for carrying out the purposes of this act.

SEC. 7. That within sixty days after the approval of this act the Secretary of Labor shall certify to the Secretary of the Treasury and to each State board of maternity aid and infant hygiene the sum which he has estimated to be deducted for administering the provisions of this act, and the sum which he has apportioned to each State for the fiscal year ending June thirtieth, nineteen hundred and nineteen, and on or before January twentieth next preceding the commencement of each succeeding fiscal year shall make like certificates for such fiscal year.

Sec. 8. That any State desiring to avail itself of the benefits of this act shall, by its board of maternity aid and infant hygiene, submit to the Secretary of Labor detailed plans for carrying out the provisions of this act. These plans shall include the provisions made in the State for the administration of the act; the provision of instruction in the hygiene of maternity and infancy through public health nursing, consultation centers, and other suitable methods; and the provision of medical and nursing care for mothers and infants at home or at a hospital when necessary, especially in remote

If the Chief of the Children's Bureau finds the same to be in conformity with the provisions and purposes of this act, the same shall be approved under the direction of the Secretary of Labor.

Sec. 9. That in order to provide popular, nontechnical instruction to the residents of the various States, particularly to those to whom such facilities are not accessible, on

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the subject of the hygiene of infancy, hygiene of maternity, and related subjects, the State board of maternity aid and infant hygiene is authorized to arrange with the State university, land-grant college, or other educational institution for the provision of extension courses by qualified lectures: Provided, That not more than twenty-five per centum of the sums granted by the United States to a State under this act may be used for this purpose.

Sec. 10. That in order to receive the benefits of the appropriations provided under this act the State shall, through the legislative authority thereof, appoint as custodian for said moneys its State treasurer, who shall receive and provide for the proper custody of such money and its disbursement on rquisition of the State board of maternity aid and infant hygiene.

Sec. 11. That the facilities provided by the State board of maternity aid and infant hygiene under the provisions of this act shall be available for all residents of the State, but the State board may require persons receiving specified services to pay a fee for the same under regulations approved by the Secretary of Labor: Provided, That moneys collected under this section shall be turned over to the State treasurer and deposited in the fund used for the purposes and expenses of carrying this act into effect.

SEC. 12. That the Chief of the Children's Bureau, Department of Labor, shall every three months ascertain the amounts expended by the several State boards of maternity aid and infant hygiene in the preceding quarter year. On or before the first day of January and quarterly thereafter the Secretary of Labor shall certify to the Secretary of the Treasury the amount to which each State is entitled under the provisions of this act. Upon such certification the Secretary of the Treasury shall pay to the State treasurer as custodian the amounts so certified.

Sec. 13. That the State board of maternity aid and infant hygiene shall make such reports concerning its operations and its expenditures of funds as shall be prescribed by the Chief of the Children's Bureau, with the approval or under the direction of the Secretary of Labor. If the Secretary of Labor determines that any moneys provided under this act are not being expended for the purposes and under the conditions of this act, he may decline to approve any further allotments to such State.

Sec. 14. That if any portion of the moneys received by the treasurer of any State as custodian under this act shall, by any action or contingency, be diminished or lost, it shall be replaced by such State, and until so replaced no subsequent allotment under this act shall be paid to such State. No portion of any moneys appropriated under this act for the benefits of the States shall be applied, directly or indirectly, to the purchase, erection, preservation, or repair of any building or buildings or equipment, or for the purchase or rental of any building or lands.

Sec. 15. That the receipt by any person of aid under this act shall not be construed as the receipt of charitable relief, and shall not in any way affect unfavorably the legal status of such person.

SEC. 16. That the Secretary of Labor shall include in his annual report to Congress a full account of the administration of this act and of the expenditures of the moneys herein provided.

STATEMENT OF MISS JEANNETTE RANKIN, REPRESENTA

TIVE IN CONGRESS FROM THE STATE OF MONTANA.

Miss RANKIN. I have prepared a little synopsis of the bill. Section 1 of the bill provides for an appropriation of money to be paid to the States for the purposes of cooperating with the States in promoting the care of maternity and infancy in rural districts; and to provide instruction in the hygiene of maternity and infancy.

Section 2 calls for the sum of $480,000 to be permanently appropriated each year, $10,000 of which shall be paid annually to each State; also an added sum of $1,000,000 for the first year, this sum to be increased $200,000 each year until it reaches the sum of $2,000,000. These supplementary allowances must be equaled by State appropriation. The allotments to States are to be made on the basis of relation of the rural population of State to total rural population of United States by l'ast preceding Federal census. Any unexpended State apportionment at the close of the fiscal year shall be available for the State until the close of succeeding fiscal year. If still unexpended, it shall be reapportioned within 60 days to all the States as if it were being apportioned for the first time.

Section 3 provides that to secure the benefits of the act the State legislature must accept its provisions and authorize the creation of a State board of maternity aid and infant hygiene, with power to cooperate with the Chief of the Children's Bureau, Department of Labor, in its administration. The State board is to be appointed by the governor, of which he is to be ex-officio chairman, composed of a physician from the State board of health, a registered nurse, a teacher from the university or agricultural college. I want to offer an amendment later providing for three women on that board. The board is to elect its vice chairman and secretary, and notify the Chief of the Children's Bureau of the assent of the State. Where the legislature does not meet within a year of the passage of the act, the governor shall accept the provisions and create a board to cooperate with the Chief of the Children's Bureau. The Chief of the Children's Bureau shall recognize such board until the first legislature has been in session 60 days.

Section 4 provides that the Chief of the Children's Bureau shall have the administration of the act and shall cooperate with the State boards; shall also make studies, investigations, and reports that will further its effective administration.

Section 5: The cost of Federal administration is not to exceed 5 per cent of the total amount appropriated during a given year. The allotments to the State shall be made on the basis of the relation that the rural population of each State bears,to total population of the United States by the last preceding Federal census.

Section 6: The Secretary of Labor is authorized to employ assistants, and so forth, in the city of Washington and elsewhere, to rent buldings, purchase supplies, and so forth, and to incur other necessary expenses.

Section 7 provides that within 60 days of the approval of the act the Secretary of Labor shall certify to the Secretary of the Treasury and to each State board of maternity aid and infant hygiene the sum he estimated to be apportioned to each State.

Section 8: States desiring to avail themselves of the act shall submit to the Secretary of Labor detailed plans for work. These plans shall include the provisions for administration, for instruction in the hygiene of maternity and infancy, for medical and nursing care for mothers and infants, especially in remote areas.

In section 9, that extension courses may be arranged for in educational institutions, but not more than 25 per cent of sum granted to State to be so expended.

Section 10: That the State, through legislative authority, shall appoint the State treasurer custodian of the funds.

Section 11: That a fee may be required for the facilities provided, but it must be turned into the fund.

Section 12: That the Chief of the Children's Bureau shall report money spent in each State every three months.

Section 13: That the State board shall report, and if the Secretary of Labor determines money is not properly expended he may decline to approve further allotments.

Section 14: That the States shall be held responsible for the money given them, and no money is to be used for buildings, equipment, or rent.

Section 15: That the act is not a charity.

Section 16: That the Secretary of Labor shall include in his annual report to Congress a full account of the administration of the act.

Miss Fleming, the assistant chief of the bureau, is here and has prepared a brief which she desires to read to the committee.

STATEMENT OF MISS CAROLINE FLEMING, CHILDREN'S

BUREAU, UNITED STATES DEPARTMENT OF LABOR.

Miss FLEMING (reading):

BRIEF FOR MATERNITY AND INFANCY BILL.

INTRODUCTION.

As a

The maternity and infancy bill would place with the Secretary of Labor and the Chief of the Children's Bureau the responsibility for its administration, so far as the Federal Government is concerned. The Department of Labor is a department to promote human welfare, one of whose duties it is to ascertain adequate standards of life. The Children's Bureau, in the bill establishing it in 1912, was assigned by Congress the whole field of child welfare, and no other branch of the Government is concerned with child welfare as a whole. During the six years of its existence it has been making a careful study of infant and maternal mortality, of the most successful. methods of carrying on infant welfare work, of obtaining for mothers proper prenatal supervision and instruction, and the possibility of adequate obstetrical care. result of these studies it has published many bulletins and leaflets, which have increased the general interest in these vital matters and widened the realization of the importance of maternal and child welfare to the Nation.

Many communities throughout the United States have been led by these studies to consult the Children's Bureau as to the best way of starting and developing infant and prenatal work.

Special surveys made by the Children's Bureau in rural communities have furnished knowledge of the actual conditions existing in many types of rural districts in different parts of the country, and through these investigations the bureau has awakened the public to the urgent need of rural work for mothers and children. Information obtained from these careful studies of rural conditions has prepared the Childrens' Bureau for the task of making plans for the administration of the proposed measure. A summary of the important points which prove the need for this Federal measure for protection of maternity and infancy follows:

1. At least 16,000 women die every year in the United States from childbirth, and uncounted thousands suffer impairment of health from causes related to maternity.

Approximately one-quarter of a million babies die every year within 12 months of birth. At least one-half of these deaths occur within the first six weeks after birth.

2. From the last available figures maternal death rates are apparently higher in the United States than in 13 other principal countries and show no decrease from year

Of the maternal deaths in the United States about 7,000 are assigned to childbed fever, a disease almost entirely preventable, and about 9,000 are assigned to other conditions which may frequently be prevented or cured.

3. Infant mortality rates are higher in the United States than in 10 other principal countries. Within the first year after birth we lose 1 in 10 of all babies born; New Zealand loses 1 in 20.

While almost one-fourth of the infant deaths in the United States are ascribed to gastric and intestinal diseases, which result from improper care and feeding of the baby, over two-fifths are due to prenatal and natal conditions.

4. Considerably more than one-half of the babies in the United States are born in rural areas, and these show the same high infant mortality that is found in cities from causes related to the cure and condition of the mother.

The infant mortality rate from other causes is slightly less in rural areas than in cities, but in the rural areas of the United States it is far greater than the corresponding rate for New Zealand as a whole.

5. The Children's Bureau studies in rural areas in different States have revealed (a) High maternal mortality rates, above the average for the United States as a whole.

(6) That a majority of mothers have received no advice or trained care during pregnancy, and may have had no trained attendance of any kind at confinement.

to year.

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