The death of a young child was a very real and emotional experience for many families during the American Progressive Era. However, at the dawn of the twentieth century many Americans came to expect a better outcome in the life expectancy of their children. In the new age of industrial capitalism with rapidly changing technology, medical professionalization, and increasing wealth, America could have had the lowest percentages of child and infant deaths out of all industrializing nations. This was not the case, however. In 1900 America ranked 10th among principle nations in infant mortality. The estimated national infant mortality rate was 100 per 1,000 live births resulting in over 230,000 infant deaths per year. The maternal mortality rate was 15,000 per year. The actual numbers were probably much higher as official data was never exact. The United States did not have a uniform system in place to register births. And just to put this in perspective, in 1900 there were 76 million people in the United States, now we have 323 million people living in the U.S. So these infant mortality numbers were significant in 1900. Subsequently, the pain of the loss of a child was an element that touched almost every American living in the early 20th century.
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Transcript for: The United States Children’s Bureau: An Attempt to Curb Infant Mortality
Researched and written by Elizabeth Garner Masarik
Produced by Elizabeth Garner Masarik and Marissa Rhodes
Elizabeth: The death of a young child was a very real and emotional experience for many families during the American Progressive Era. However, at the dawn of the twentieth century many Americans came to expect a better outcome in the life expectancy of their children. In the new age of industrial capitalism with rapidly changing technology, medical professionalization, and increasing wealth, America could have had the lowest percentages of child and infant deaths out of all industrializing nations.
Marissa: This was not the case, however. In 1900 America ranked 10th among principle nations in infant mortality. The estimated national infant mortality rate was 100 per 1,000 live births resulting in over 230,000 infant deaths per year. The maternal mortality rate was 15,000 per year. The actual numbers were probably much higher as official data was never exact. The United States did not have a uniform system in place to register births. And just to put this in perspective, in 1900 there were 76 million people in the United States, now we have 323 million people living in the U.S. So these infant mortality numbers were significant in 1900. Subsequently, the pain of the loss of a child was an element that touched almost every American living in the early 20th century.
Elizabeth: This series we are taking the opportunity to share with our listeners what each of us researches and writes about. Today it’s my turn (Elizabeth) to talk a little bit about what I’m focused on historically and what my research and writing is about. So get ready for a discussion of women’s political organizing in the late 19th and early 20th century in the face of high infant mortality rates.
I’m Elizabeth Garner Masarik
And I’m Marissa Rhodes
And we are your historians for this episode of Dig.
Marissa: Because the United States did not have a system in place to adequately register births, the numbers of infant deaths were never exact. In fact, the chief statistician of the government board of Vital Statistics deplored the inadequate birth registration efforts of the United States. There were pockets in America, like New York City, that were working towards more accurate birth records but the majority of states had no systematic programs to gather the data. Rural rural areas in the U.S. were the least accounted for. On one hand this was a result of federalism. Each state had different systems, or none at all, in determining accurate infant birth and death rates. Another reason infant mortality was not accurately tracked was that there was no central organizing board to do such calculations. The Census Bureau counted the population every ten years but did not implement protocols for registering every infant birth between censuses. Alternatively, by the 1910s, numerous industrialized countries had already enacted programs to document and prevent infant and maternal mortality.
Elizabeth: Regardless of the statistical data, millions of women lost their babies within the first year of life during the early 20th century. This acted as a motivating factor for many women to organize around infant and maternal mortality and the deeply gendered aspects of this problem. The issue of child welfare gained prominence in the late 19th century. Building upon the antebellum voluntary women’s’ activism in the abolition, temperance, and suffrage movements, a cadre of female reformers built a network of women focused on child welfare. Many of these reform minded women founded charity-based organizations to help alleviate poverty among immigrants and the poor. Many also focused on women’s issues and the issues of child health and mortality.
Marissa: The movement to create a national agency that would collect and disseminate information regarding the welfare of children was spearheaded by two reformers with roots in the Settlement House movement. Lilian Wald was the founder of the Henry Street Settlement in New York City and led the campaign to establish the New York City Bureau of Child Hygiene. She was a lifelong advocate for access to medical care for the rich and poor alike and actually developed the concept of public health nursing. Florence Kelly, a labor rights and children’s rights advocate who founded the National Consumers League in 1909 lived and worked in Chicago’s Hull House settlement before moving to New York city and joining the Henry Street Settlement.
Elizabeth: In 1903 Wald and Kelley enlisted the aid of Edward T. Devine, a longtime political associate of President Theodore Roosevelt, to introduce the idea of a federal children’s bureau to the president. Roosevelt famously replied, “Bully, come down and tell me about it.” Wald, Devine, Jane Addams, and Mary McDowell, another former Hull House resident, met with the President to argue their case. What was needed, they argued, was a physical bureau in Washington that could coordinate information pertaining to child welfare.
Marissa: Numerous charity organization across the country were involved in programs to alleviate infant mortality, child working conditions, and family poverty but there was no central agency to bind their efforts together. The States and private organizations were not capable of enacting real changes on their own, they needed a central organizing authority backed by federal dollars to organize child welfare efforts. The Children’s Bureau would become a clearing-house in which spatially separated studies and programs could be analyzed, organized, and acted upon under one roof. Roosevelt privately endorsed the idea but declined to publicly endorse the program until years later.
Elizabeth: Many advocates for small government felt that the government had no authority to distribute persuasive data, or propaganda as they called it, regarding health and child welfare. Homer Folks, Secretary of the State Charities Aid Association of New York believed that it would be a mistake for the “federal children’s bureau to take on many of the things that would be extremely proper and extremely desirable for a voluntary association to undertake.” James E. West, Secretary of the National Child Rescue League argued that “it is not the function of a government body to do promotional work.” Instead they wanted to see some kind of governing board that was organized on a voluntary basis. Proponents of the federal bureau however, saw federal action as the only means of systematically collecting and distributing the enormous amounts of data that needed to be collected and analyzed. Individual states and scattered charity organization had thus far not been able to collect data that could be utilized for national purposes. Therefore, a centralized federal bureau was the only option that viewed as a workable solution.
Marissa: Women were largely behind the organizing efforts for creating a federal children’s bureau. A web of women’s voluntary organizations including the National Consumers League, General Federation of Women’s Clubs (GFWC), National Congress of Mothers, Daughters of the American Revolution (DAR), and many others finally created enough public momentum and interest to get Congress to pass a bill creating the U.S. Children’s Bureau.
Elizabeth: Yet there were still some charity reformers and politicians who were opposed to the formation of the Bureau. Some of these opponents, citing fears of government bureaucracy, large salaries, and infringement on states’ rights, editorialized in the New York Times and other such platforms about the “dangerous” scheme. They feared the Bureau would “invade rights which have existed since the foundation of the National Government and are by its Constitution entrusted to the individual states.”
Marissa: However, there were many who were glad to see the formation of the bureau. The New York Times published an article applauding the formation of the Children’s Bureau, which highlighted the need for a unified front aimed at children’s welfare. Up until the formation of the Bureau, reform efforts geared towards children had been piecemeal or as the Times stated, “split up into bits, and has therefore, been insoluble.” As much as charity organizations had previously devoted to the alleviation of poverty and suffering they had thus far not been able to gather significant statistical information to make real, nationwide change in the health and wellbeing of children.
Elizabeth: Thousands of letters poured in to the Children’s Bureau after its formation chronicling women’s fears over the proper care of their children. Thousands more wrote in describing their grief and pain over the loss of a child or the paltry gynecological health they lived with because of inadequate postnatal care. A cursory look at a study commissioned by the Charity Organization Department of the Russell Sage Foundation in 1910 of 985 widows and their families showed that almost half of the mothers surveyed experienced the death of a child.The death of children, especially infants, was a visceral reality to many American women.
Marissa: The first major effort undertaken by the Children’s Bureau was a focus on curbing infant mortality. The bureau investigated health and hygiene, milk supply, economic conditions, and all sanitary conditions concerning children under one year old within designated areas of study. Additionally ,the Bureau enacted a door-to-door campaign to collect birth records. Thousands of women connected with the network of voluntary women’s organizations and took on “government” work as volunteers for the Bureau. Women from the National Congress of Mothers, the GFWC, DAR, and other such organizations prepared committees to knock on doors with copies of standardized birth certificates. The director of the Bureau, Julia Lathrop, stated the women volunteers “carefully filled them out for a certain number of babies in their neighborhoods they then compare these records with those in the local registrar’s office.” These records were then sent to the Children’s Bureau for analysis.
Elizabeth: This massive collection of data allowed the Bureau to create regions where they knew the birth, and subsequent death rates of children in particular areas. Over three thousand club women participated in the registration effort in 1915, designating ten states and the District of Columbia as “birth registration areas” where there was an accurate birth and death record of all babies born; by 1933 this included all States. The majority of this foot-work was performed by volunteer members of women’s clubs across the country. These women physically went neighborhood to neighborhood and door to door to collect data. As they traveled through these landscapes they spoke with women in their communities about the importance of birth registration. They helped spread consciousness pertaining to infant mortality, something that so many women had previously faced alone or within their insulated families. These women’s’ voluntary efforts to collect this data and speak with other women about their experience with infant health and mortality is the perfect example of making the personal political. So much of women’s experience was relegated to the private sphere, this was bringing it out into the public.
Marissa: But the Children’s Bureau did not rely on volunteer labor alone, but employed a cadre of female social workers and statisticians. The Bureau conducted eight intensive studies between 1912 and 1918 that focused on the infant mortality rates in cities ranging from 24,000 people to one half million. Bureau employees, almost exclusively women, conducted these sociological field studies by traveling to the respective cities of study. A study in Montclair, NJ found that overall the infant death rate in Montclair in 1915 was 84.6 per 1,000, whereas the national rate was estimated at 124 per 1,000 live births for 1910. So a little closer right? On closer inspection however, the Fourth Ward area of town which housed the most tenement dwellers and low income families had an infant mortality rate of 134 per 1,000 live births! This was one of many such studies that linked poverty with higher infant mortality rates. The report concluded “a low income frequently must involve undesirable housing accommodations, an overworked mother, insufficient nourishment for mother and child, and lack of competent medical advice.” The report wasn’t linking infant mortality to a lack of medical care per se, but the unequal access to the resources necessary for raising healthy offspring. This type of Bureau field study was conducted in cities and towns across the nation and usually accessed the expertise of local public health nurses for each locality.
Elizabeth: Many Children’s Bureau reports showed that poverty had a direct correlation to infant mortality, but it was not the sole determining factor. Middle and upper class women also suffered from infant death or poor maternal health after delivery. Women across the country participated in the Children’s Bureau reform efforts by actively requesting and reading pamphlets printed by the Bureau. Roughly 1.5 million copies of Prenatal Care (1913) and Infant Care (1914) were distributed widely between 1914 and 1921. Letters written to the Children’s Bureau from mother’s requesting the pamphlets or asking clarifying questions regarding the pamphlets proved their popularity. These letters show that mothers of every class and level of education were reading the pamphlets and engaging in the dissemination of government sponsored scientific literature.
Marissa: Some letters written to the Bureau asked very specific medical questions that the writer either did not want to speak to her male doctor about or were sent to the Bureau because it was the only place she could acquire medical advice. One woman wrote, “My babys eyes have been sore but no one worried but myself, and I did only because I had read of the danger of blindness in your books…. No one here ever saw a Dr. do any thing for a newborn baby’s eyes [sic].” Through reading and sharing Children’s Bureau pamphlets many women circumvented their physical landscape that might be devoid of physicians or openly hostile to modern scientific ideas on childrearing.
Elizabeth: In fact, some of the letters written to the Children’s Bureau showed the anger that women felt over the death of children, which they felt was entirely preventable. A well-off women from Boston wrote about the death of her baby son and the inadequate medical advice she received.
“My baby was sacrificed through mere ignorance. This happened in the capital of Illinois and money or efforts were not spared to save him. I soon found that not only mothers of large families knew nothing about the scientific care of babies, but the best Doctors in the city knew less. I could not nurse my baby, and he just faded away, never gaining, or rather losing weight all the time on the many foods which the different Doctors tried.” This grieving mother, along with thousands of others, became mobilized through their own experiences and those of their friends and acquaintances. They bemoaned the lack of trustworthy medical advice regarding pre and post-natal care even from their own doctors. They were looking for a way to excerpt some political authority over the care and management of children and maternal health in the United States.
Marissa: In fact in 1965, the Department of Health, Education and Welfare estimated that one copy of Infant Care (continuously published since 1914) had been distributed for every three babies born in the past fifty years accounted for the vast reach of the Children’s Bureau into individual homes. The relationship between women that consumed Bureau publications and the women who ran the Bureau exponentially spread consciousness to women across the American landscape that maternal and infant health were important and worthy of state protection.
Elizabeth: As important as the dissemination of knowledge became, scientific studies performed by the Children’s Bureau showed in stark numerical detail that infant mortality in America was appallingly high. For a country that prided itself on its wealth and high standard of living a soaring infant mortality rate was unacceptable as it reflected a general lack of care for the poor and women and children in general. Lathrop was quoted as saying in a speech at the end of World War I, “we cannot help the world toward democracy if we despise democracy at home; and it is despised when mother or child die needlessly.”
Marissa: Much of women’s voluntary organizing focused on “private sphere,” or domestic concerns –issues that were perceived to be part of the women’s domain, like maternal and child health, childrearing, nutrition, and education. But these issues inevitably drew women into partisan politics in the late nineteenth century as the lines between the private and the public “sphere” blurred. Matters that were once perceived as private family concerns morphed into issues of public health and national concern as Progressive Era discontent with social ills grew. Women began lobbying in larger numbers for federal oversight of issues like health, education and sanitation; issues women had previously taken care of on a voluntary basis. Nonetheless, women’s political activism spread further to include issues of anti-lynching, labor activism, birth control, civil rights, and other important problems.
Elizabeth: It is important to keep in mind that “women” was not an all-encompassing term. Women’s political organizing focused on many different aspects of American life and some women’s political organizing did not benefit other women. The historiography of women’s reform and politics is vast. Additionally, contemporaneous ideas about health, fitness, and eugenics were all linked to ideas surrounding motherhood. So my research explores women’s reform work concerned with the politicization of motherhood. It probes how women reformers from distinct demographics politically organized to address the health and vulnerability of women and children.
Marissa: Women’s reform work is part of a broader study of women’s political movements during the Progressive Era. Reform work for maternal and child health allowed many women opportunities to enter official channels of government, like women working in the U.S. Children’s Bureau. Other notable exceptions were Florence Kelly and the labor movement, Jane Addams and the settlement house movement, and Ida B. Wells and the anti-lynching, civil rights movement. Simultaneously and often overlapping was the women’s suffrage movement.
Elizabeth: Women’s reform work and the fight for suffrage are often treated as separate movements when in reality they were closely related. For example, women’s suffrage and the abolition movement were connected from their earliest beginnings. Other reform movements also overlapped with suffrage, namely the Woman’s Christian Temperance Union (WCTU) support of women suffrage in the late nineteenth century. Women’s political action through reform work and the fight for suffrage are often treated as different types of “politics” in much of the literature. However, many reform organizations whose main priority was not woman suffrage either supported or condemned women’s enfranchisement as a way to push forward their primary reform goal. Even without the vote, the very act of reform work in charitable and voluntary organizations allowed women to enter the political sphere.
Marissa: Statistically speaking, infant mortality for American women as a whole has fallen dramatically since the early twentieth century, but there is shocking disparity when broken down by race. Nationally, black infants die at much higher rates than white infants in the U.S. Although the Children’s Bureau did investigate infant mortality based on race, their primary findings were that populations with higher rates of poverty had a greater percentage of infant mortality. This correlation between poverty and infant mortality still stands today, but examining the relationship between race and poverty is further highlighted in the disparate numbers between white and black infant mortality rates in America today. Nationally, 11.1 black infants died per 1,000 live births in 2013, compared to 5.96 deaths for white babies in the same period. That means black babies were dying at a rate 2.2 times higher than white babies. For example, in Ohio the rate of black infant mortality in 2013 was 13.57 per 1,000 births, the second highest nationally. The disparity in the Ohio numbers mirror the national average, where more than twice as many black babies die than white. According to the CDC, in the 39 states where this information could be calculated, nowhere was infant mortality equal among black and white babies.
Elizabeth: So in summation, as a historian I’m interested in the intersection of child health and mortality with women’s reform work and the entrance of women into public and political roles on account of those issues. And on a grander scheme I’m interested in how the American welfare state began to form in the early 20th century, and the multitude of female reformers who were behind that push. And honestly, I first became interested in this topic when I myself was on welfare. It was right after the crash of 2008 and the company I worked for shut down. I was seven months pregnant. Didn’t get a severance package or anything. Just showed up for work one day and they were turning everyone away at the door. My husband had lost his job two weeks earlier. So um, life really sucked there for a while. And I was so angry about how I was treated, as a malingner, I was repeatedly questioned about my financials and cars that I had owned years previous but no longer owned and just all this nonsense. And I completely understood that I was experiencing this really shitty treatment, and this was in Texas just to be clear, they were doing everything they could to keep me from getting any welfare benefits even though we had no income and not savings, but I was struck how hard the process was to get some help. And how all the gazillions forms I had to fill out confused me to no end. And I was thinking, here I am navigating this with my white privilege and my college education and all the benefits I have going for me, and this is the most confusing, intimidating, confounding web of bullshit I have every experienced. And I couldn’t even fathom how shitty this would be if I didn’t have all of these things going for me. And I got really angry and yeah, I got more involved politically. And yes, I fully admit that this was something I never batted an eye about until I had to experience it myself, which is shitty and privilege of me, and I fully acknowledge that. Andyway, A year or so after all of this I read a book by political scientist Eileen McDonagh about why America lags so far behind other democracies in our percentage of women in elected office. And that book introduced me to the term maternalist or maternalism, which in reference to politics is the care-work people need after they are born, especially the young, elderly, ill or disabled – so maternalist in a political sense is the working towards state sponsored support of that needed care-work. And um, then I entered grad school and now I’m able to geek out about all this stuff all the time. And just to throw out a few books that were really integral to pushing me further down this path, here are a few faves: Gwendolyn Mink, The Wages of Motherhood, Theda Skocpol, Protecting Soldiers and Mothers, Robyn Muncy, Creating a Female Dominion in American Reform, Michelle Mitchell, Righteous Propagation and although not a book that is directly tied to this topic but is just a book that I’ve found very influential as a graduate student is Thomas Sugrue’s, The Origins of the Urban Crisis.
Marissa: So thanks for listening. Please don’t forget to leave us a five star review on iTunes, Stitcher or wherever you get your podcasts.
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Gwendolyn Mink . The Wages of Motherhood: Inequality in the Welfare State, 1917-1942. Ithaca: Cornell University Press, 1996.
Michele Mitchell. Righteous Propagation: African Americans and the Politics of Racial Destiny after Reconstruction. The University of North Carolina Press, 2004,
Molly Ladd-Taylor, ed. Raising a Baby the Government Way: Mothers’ Letters to the Children’s Bureau 1915 1932. New Brunswick: Rutgers University Press, 1986.
Robyn Muncy. Creating a Female Dominion in American Reform, 1890-1935. New York: Oxford University Press, 1994.