State of the Union. We are at the present time getting the kind of information that the committee would like to have. I am sorry we just have not had enough time to develop that, but we will make available for the committee the kind of information which we think is first-hand information and which might be helpful.

Senator LEHMAN. I would appreciate it very much if we could have that.

Mr. SCHIFF. Yes. We are concerned about the general lack of health and welfare facilities throughout the country as they relate to the kind of problem we are considering, particularly, Mr. Chairman, as they relate to the lowest grades of our military personnel. We think there is a morale factor there that cannot possibly be stressed

too much.

Senator LEHMAN. When you say the "lowest grades," do you include the seven grades?

Mr. SCHIFF. Yes, sir. That is right.

Senator LEHMAN. Under S. 2337, the scope of the program has been enlarged from the four grades, as was the case in World War II, to seven grades.

Mr. SCHIFF. We consider it part of our responsibility to develop responsible information and statistics and case records.

Senator LEHMAN. Are many of your people settlement workers? Mr. SCHIFF. Among our people are settlement workers, institutional workers, people who work in public agencies and private agencies. I would say they cover the gamut of the field of the social-work profession.

Senator LEHMAN. So they would probably know from their community contacts quite a lot about the need?

Mr. SCHIFF. Yes; and I might say to you that as we have studied the bill dealing with public-health units on a local level, we have developed similar types of information which we would like to make available to the committee.

Senator LEHMAN. Thank you very much.
Mr. SCHIFF. Thank you, sir.

STATEMENT OF THE AMERICAN ASSOCIATION OF SOCIAL WORKERS, REGARDING
S. 2337 AND S. 1245

The American Association of Social Workers is the largest professional membership association in the field of social work. It has about 12,000 members living in all parts of the United States and its Territories. They are employed in public and voluntary local, State, National, and international agencies. Its 120 chapters are located in practically every State and in Hawaii and Puerto Rico. An annual conference attended by delegates chosen by each chapter provides the chief means of formulating membership opinion on health and other national problems.

For the past 20 years the American Association of Social Workers has stood squarely for all bills that would extend health resources to the American people. We have had a particular concern for measures which would enable the low- and middle-income groups to secure medical and hospital services. Because of our long and continued interest in these basic problems and in the field of health, we want you to know that we support the proposals in S. 2337 and S. 1245 and shall work toward the passage of these bills or of other legislation which the Health Subcommittee might recommend to meet the problems of maternity and infant care and hospitalization for the dependents of enlisted members of the Armed Forces.

The health of the citizens is a basic asset to our country. While we are engaged in a protracted struggle abroad to defend our democratic way of life, it is imperative that we organize and maintain those resources-such as m'aternity and infant care and hospital care for dependents of enlisted personnel in the Armed Forces-which contribute to the morale of our fighting men and the well-being of their families. We believe that it is the responsibility of the Federal Government to initiate, develop, and finance these essential health services which would be provided by the States through State and local health departments. To do less is to fail in the national defense.

We understand that the Department of Defense is expecting a total strength of more than 3,000,000 enlisted members of the Armed Forces in 1952. It is estimated that there will be approximately 200,000 births to wives of enlisted men in 1953. Care can be provided for about 70,000-75,000 births in military hospitals, but this leaves 100,000-125,000 births for which military facilities will not be available.

In addition to the maternity problem, enlisted men are concerned over medical care for their children. We understand that 64 percent of the married men in the Army are under 30 years of age and thus have not had the opportunity to acquire great economic stability or to lay away savings to meet emergency medical needs. More than half of the married enlisted men have children and these average two per family. Seventy percent of these children are under 6 years of age. These figures bring us to the conclusion that medical care for young children is a grave problem for our enlisted personnel.

The quarters allowance for a man in the lowest pay grade who has two dependents or more is $85 a month plus the $40 that he contributes or $125 a month for the care of his family. We social workers know that this amount is inadequate for a minimum standard of decent living. Unless some provision is made for maternal and infant care and hospital care, the family of such an enlisted man will have to depend on charity to meet medical needs. The realization that an enlisted man in the first pay grade cannot provide the necessary medical care for his family in time of emergency will inevitably keep married men from enlisting and thus retard the defense effort.

Permit us to point out, also, that an enlisted man in the highest pay grade would receive a quarters allowance of $85 a month and would contribute an additional $80, thus totaling $165 a month for the care of two or more dependents. One hundred and sixty-five dollars a month or $1,880 a year is still an amount so low that a family of three would be living below a subsistence level.

In addition to the maternity and infant care provisions of the bills under consideration, we favor strongly title II, the hospital care provision of S. 2337 for dependents of enlisted members of the Armed Forces. The sudden need for hospital care can strike a blow at the economic security of any citizen in as low an income bracket as that of our enlisted personnel. It is our patriotic duty to provide this type of security for the dependents of persons serving the country in the Armed Forces.

When we recall our experience under the emergency maternity and infant care program of World War II, we believe that the Congress can do several things to improve on the operation of the former program. Substantive legislation is needed rather than appropriation bills alone in order to put the program n and to define the responsibilities of the Federal Security 'e health agencies. Also, time to prepare for any new prowed before the program goes into operation. The Federal State health agencies will need administrative funds during program begins so that general policies and State plans can

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many, we neartily approve of title I, section 102 (a) (7) and title II, section 202 (a) (6) of S. 2337, pertaining to establishment of standards designed to safeguard the quality of care furnished under these plans. We believe that the quality of care is the cornerstone of a sound maternity and infant care and hospital care program. We owe this protection to the dependents of servicemen who will benefit by the program.

We are convinced that the families of enlisted members of the Armed Forces need maternity, infant, and hospital care. We urge the Congress to meet this need by appropriate legislation such as S. 2337 and S. 1245.

Senator LEHMAN. The next witness is Dr. Dorothy Ferebee.

STATEMENT OF DOROTHY B. FEREBEE, M. D., MEDICAL DIRECTOR OF THE UNIVERSITY HEALTH SERVICE, HOWARD UNIVERSITY, AND PRESIDENT, NATIONAL COUNCIL OF NEGRO WOMEN ́

Dr. FEREBEE. Senator Lehman and the committee, I am Dr. Dorothy B. Ferebee, a practicing physician in the District of Columbia, and a former participant in the emergency maternity and infant care program of the last war. I wish to speak for myself and for 800,000 members of the National Council of Negro Women in support of the provisions for an effective and efficient program of maternity and infant care and of hospital care for the dependents of enlisted members of the Armed Forces in the seven lowest-pay grades, as outlined in titles I and II of S. 2337. This will assure most desirable and greatly needed services to wives and children of enlisted men.

During the war years, when a great deal of mobility among servicemen resulted in the migration of their families from one community to another, the emergency maternal and infant care program was a boon to young mothers and fathers. Harassed not only by the anxieties of an approaching birth, but also by the uncertainties of the medical services available to them, and of the financial means for obtaining them, they found some needed security under that program. The emergency maternal and infant care program is acutely needed now. Enlisted men and their wives are at the peak of the child-bearing age. In fact, it is estimated that about 200,000 babies will be born to wives of these men over the period of 1 year. Slightly more than one-half of the married men have children, predominantly in the preschool years. The military hospitals and personnel are unable to care for all the expected births. It is currently possible to provide care for approximately 75,000 of these births. But even if the military facilities were available, many wives are so far removed from the hospital sites, that extended travel would prove hazardous.

The quarter allotment is inadequate for current living expenses, not to mention the additional cost of the pregnancy, which has doubled along with all other living costs since 1945. Servicemen are often inducted at a pay lower than their civilian salary. They are often required to make commercial loans or to borrow from others in order to cover even basic maintenance costs. Or even worse, in many cases no financial resources are available to them at all.

Under this circumstance, no service may be available thus projecting the patient into conditions which are hazardous to the lives of both mother and baby. At best, their health may be menaced by neglect. Most certainly we should not want it upon our consciences that any mother or baby had been lost or their health impaired by the exigencies of military service.

An effective program of good maternal care as proposed here in S. 2337, for example, is designed to carry a mother through her period of pregnancy with a minimum of discomfort and distress; to assure her of a safe delivery and a healthy baby.

The lack of such care often results in serious complications and disastrous mishaps. There are, for instance, the untreated and uncontrolled blood pressures which may result in toxemia and convulsions, and death. There is the danger of hemorrhages and untreated infections, many of which could be detected and controlled under good

prenatal care. Nutritional deficiencies or undiscovered infections in the mother are often reflected in the babies, and a large percent of babies born under such adverse conditions fail to reach their first birthday.

The many problems of the serviceman and his family do not end with the birth of the child. Postnatal care is equally as essential as prenatal. This is often severely curtailed by financial stress, aggravated by the costly period of pregnancy and delivery. At the very time that proper food, protective clothing, and other needs are most important to the infants and growing children, the serviceman's family is often faced with the multiple obligations accumulated during pregnancy.

May I address myself for a moment to title II of this bill providing for the furnishing of hospital services to dependents of members of the Armed Forces, as bed patients. Hospitalization is too often an unexpected and consuming expenditure. The same financial problems that face the enlisted man in trying to provide for his wife during the period of pregnancy and confinement are inherent in securing adequate hospital care for any dependent he might have. Providing bed patient care is a logical extension of maternity and infant care.

As a physician, I have seen the devastating effects of worry, anxiety, insecurity, and depression upon the serviceman, his wife and his family. Military service should not require such undue sacrifice. The least we can do is to assure to our enlisted men that their fundamental needs be provided for. This was recognized in World War II and those who now man our defense should have a like guaranty. It is inconceivable that a great and prosperous nation should deprive men of the privilege of caring for their families, without seeing to it that adequate care is made a certainty, in return for a just and honorable service. Then there is the right of the child according to the children's charter "to be well-born." This is the right he should not be deprived of, just because his father happens to be a member of the Armed Forces. It would seem then that the services envisioned in this bill are the very least that our Nation should underwrite for the wives and families of its defenders.

Senator LEHMAN. Dr. Ferebee, I believe that you are a medical director?

Dr. FEREBEE. Yes; I am at Howard University.

Senator LEHMAN. You have a maternity ward?

Dr. FEREBEE. We do not have one at the university, but at the affiliated Freedmen's Hospital.

Senator LEHMAN. You are familiar with that?

Dr. FEREBEE. Oh, yes.

Senator LEHMAN. I paid a visit to it at the beginning of last year, and even at that time my impression was that the maternity ward of the hospital was already very much overcrowded.

Dr. FEREBEE. Yes; it still is.

Senator LEHMAN. To what extent can you care for the cases that have applied to you for admission to the maternity ward?

Dr. FEREBEE. Formerly mothers used to be kept in the hospital from 5 to 7 days, but because of the overcrowded condition and the present demands for beds we are now able to hold them only for 3 days. The turn-over is pretty rapid, and in this way we are able to take care of a greater number of patients.

Then, too, we have emergency provisions of setting up extra beds in an overcrowded section. It is not ideal, of course.

Senator LEHMAN. That was very evident, more than a year ago, when I was out there. Suppose you have a prospective mother for confinement; what care would she get in the District of Columbia, if your hospital and other hospitals were so overcrowded that they could not take care of these cases, which I am sure must be a fact from time to time? What recourse would that mother have?

Dr. FEREBEE. It would make a very difficult problem for both the patient and the hospital. The hospitals usually have a communicating system of calling around, inquiring for beds, thus helping each other by appropriating or allocating some of their services for mothers that are emergency cases.

Now, in the instance where all hospital beds are taken, it may mean that the mother would have to be delivered at home. We do not like it, of course, because facilities are not adequate, but very often we do have to return to the home delivery service.

Senator LEHMAN. You say you keep the mother there for 3 days? Dr. FEREBEE. Yes.

Senator LEHMAN. What care, if any, do you give the mother in the way of prenatal care?

Dr. FEREBEE. We like to get the mother as soon as she thinks she is pregnant. If that is true, she may know at 212 months. From 212 months through the whole period of 9 months, prenatal care consists of one visit a month for the first 7, and two visits a month for the next 2. Of course, if there are intervening or intercurrent conditions that will require more frequent service

Senator LEHMAN. Is that given in the clinics or the out-patient

service?

Dr. FEREBEE. In the out-patient service.

Senator LEHMAN. Are you able to take care of all applications for prenatal care?

Dr. FEREBEE. No. Physicians must give some of that in their own offices. As a participant of the old EMIC program, I took care of many of the prenatal cases in my own office, because the prenatal services were so crowded that a mother would go early in the morning and sit through a whole day on hard benches, and then perhaps at 4 o'clock might not have been examined or treated.

Senator LEHMAN. Or might not get in at all?

Dr. FEREBEE. That is right.

Senator LEHMAN. You try to give prenatal care to some extent, To what extent can you say the need for postnatal care exists?

Dr. FEREBEE. That is also given in the postnatal clinic at the hospital, where the mother returns at the end of 6 weeks for a complete examination, and for follow-up and instruction. If the doctor has done it as a private case, she returns to the doctor's office at the end of 6 weeks, and is given a thorough examination, and further instructions for her own care and the care of the baby.

Senator LEHMAN. Suppose she does not have money to pay for the private doctor?

Dr. FEREBEE. If she does not have money to pay it, she must go to a free clinic, if she is eligible for District care. The wife of a nonresident enlisted man is not eligible for the services.