Thirty-five State health agencies included in their 1937 budgets funds for the payment of local practicing physicians on a part-time basis for conducting prenatal or child-health conferences. This has meant during the current year a considerable extension of these conference services into towns and rural areas where they did not exist before and has insured the participation of a large number of physicians in the maternal and child-health program. Many States and communities now recognize that the payment of physicians for this type of service is as important in rural areas as it is in cities, where this plan has long been followed. In 28 States a total of 54 dentists were employed on the State staff, as well as 38 dental hygienists and 4 dental-health instructors. There is a growing tendency toward the employment of dentists on the staff of the State health agency, either in the division of maternal and child health or in a coordinate dental-hygiene division. The State health officers again recognized in the 1937 State plans the basic importance of the service rendered by the public-health nurse in the maternal and child-health program. The State agencies are encouraging the employment of public-health nurses, usually with the county or the local governmental unit bearing a considerable proportion of the cost. Nursing service at time of delivery was planned in 21 States. Nurses participating in such service have special training and experience in obstetric nursing. Maternitynursing institutes have been held in four States. Many nurses have been awarded stipends enabling them to study public-health nursing and also maternity nursing. Plans are being made to develop further facilities for courses in maternity nursing, combining experience in hospital- and home-delivery service. Effort is being directed toward the inclusion of preparation for service to infants during the neonatal period. Continuous supervisory service through the preschool period is being encouraged, so that upon entering school the child's physical defects will have been corrected. The content of school nursing service is receiving attention in many of the States. There has been a distinct advance in the employment of nutritionists by State health agencies. Under the 1937 State plans 12 State health agencies employed a total of 23 nutritionists, of whom 20 are attached to maternal and child-health divisions. Seven State health agencies employed health educators—a total of 11. Forty-one States conducted postgraduate courses in obstetrics or pediatrics for local physicians during the fiscal year ended June 30, 1937. As instructors for such courses, the State agencies are taking great care to obtain obstetricians and pediatricians who are qualified to teach local general practitioners and to discuss their problems. Eight States had a total of 12 such instructors as full-time employees on the staff of the maternal and child-health division; 14 States engaged lecturers residing in their own State only; 13 States engaged out-of-State lecturers only; 6 States engaged both local and out-of-State lecturers. Such instructors are available at the request of local medical societies for consultation and demonstration clinics. The State agencies are receiving many requests for the extension and improvement of the program for postgraduate instruction of physicians. Reporting to the Children's Bureau by the State agencies of current statistics of maternal and child-health activities began with the quarter July 1 to October 31, 1936. (See p. 38.) Some State agencies could not send in complete reports at the start because it was necessary to readjust the local reporting systems in order to obtain data in the form requested. It was expected that by July 1, 1937, every State would be in a position to assemble and send in comparable data on maternal and child-health activities. For the first year State reports were requested only from areas where Federal maternal and child-health funds were being expended. For the fiscal year beginning July 1, 1937, reports are to be requested covering all local areas, with the intention of securing as soon as possible complete reports of maternal and child-health activities for each State. Separate entries will be requested for the areas in which the State health agency is conducting maternal and child-health demonstration services. In January 1937 a 2-day conference was held at the Children's Bureau, with representatives of State health agencies present, to discuss medical and nursing record forms for maternal and child-health services. Subsequently the Children's Bureau prepared tentative forms for maternity-service records and for infant and preschool-service records. These were sent to the State agencies for comment. When the final form for each record is agreed upon copies will be printed for optional use in the States. One outstanding fact revealed by the experience of the first year of operation of the maternal and child-health program is that although there has been marked extension of child-health and prenatal services, the State agencies have not been able with the funds available to provide to any extent for better care of the mother and infant at the time of birth. A number of State agencies have inquired as to the feasibility of including in their State plans provision for paying local physicians, on a case basis, to provide obstetric and pediatric care or consultation service for patients otherwise unable to obtain such service. The costs of such service and the funds so far available for the whole program have made it apparent that such expenditure can be undertaken only in a few small areas. The year's experience has made it increasingly evident, however, that there is urgent need in many areas for the provision of more adequate maternal care, including pre natal, natal, and postnatal care and care of newborn infants, by qualified local physicians, assisted by public-health nurses with special training. Inability to obtain such care is due to many factors, among them low economic status of the family, distance from physicians and hospitals, poor transportation facilities, and the inadequate undergraduate and graduate obstetric training of many practicing physicians. In recognition of this need the general advisory committee on maternal and child-welfare services (Apr. 7 and 8, 1937) made recommendations to the Chief of the Children's Bureau and the Secretary of Labor proposing the extension of the maternal and child-health program under the Social Security Act by the provision of public funds to make available (1) increased and improved maternity care and care of the newborn and (2) training in these fields for physicians and nurses. The recommendations proposed provision of resources for: (1) Maternal care, to be given locally by qualified general practitioners and public-health nurses to women who could not otherwise obtain such care, (2) expert obstetric and pediatric consultation service to aid general practitioners in areas where such service is not otherwise available, and (3) delivery care in hospitals for women who because of medical, social, or economic reasons should be so cared for. In the development of such an extended program the committee recognized the right of the patient to select her own physician. The recommendations proposed also the establishment of centers of postgraduate education to teach urban and rural physicians and nurses the principles of complete maternal and infant care. Similar recommendations were approved by the conference of State and Territorial health officers April 9, 1937, in adopting a joint report of its committee on maternal and child health and the child-hygiene committee of the Conference of State and Provincial Health Authorities of North America. This report also included a recommendation that the Children's Bureau send a questionnaire to the States on present facilities and resources for maternal and child health. Services for Crippled Children. For the fiscal year ended June 30, 1937, State plans for services for crippled children were approved for 42 States, Alaska, Hawaii, and the District of Columbia. (For States receiving grants see fig. 2 and table 8.) Every State has designated an official agency for administering these services. The question of what State agency was best equipped to conduct them was considered by 1937 legislatures in many States, and in some the services were transferred from one agency to another. In Maryland the responsibility for the services was transferred from the board of State aid and charities to the State department of health, TABLE 8.-Federal funds available to States, Federal funds budgeted by States, and payments to States, for services for crippled children under the Social Security Act, title V, part 2, fiscal year ended June 30, 1937 Total_ Alabama.. Alaska. 28, 915. 51 8, 252.28 20, 663. 23 Arizona $3,527,675.98 $678, 615. 474 $2,849,060.51 81, 020, 000 $1,829,060.51 82,681,350.92 $2,011,606.04 35, 328. 18 9, 855.78 25, 472. 40 20,000 18, 878.95 28, 982.46 71, 816. 62 20,000 Colorado. 5, 472.40 25, 331. 51 51,816. 62 34, 461.00 21, 662. 74 88,920. 57 Connecticut_ 20,000 29, 262.85 53, 476.46 61, 500.00 20,000 Delaware 17, 753. 35 31, 956. 98 District of Columbia 20, 000 34, 216. 74 Florida 20, 000 Georgia 20,000 85, 412. 32 Hawaii. 20, 000 35, 436. 56 Idaho. 20,000 5,017. 24 34, 642.70 8, 975.82 25, 666. 88 Illinois 20,000 5, 666. 88 141, 239. 94 19, 724. 16 41, 525. 89 99, 714. 05 20,000 Indiana 78, 349. 38 23, 035.84 33, 731. 23 48, 794. 60 663. 32 57, 494.66 4,993. 75 15, 816. 03 18, 216. 52 4,900.00 55, 313. 54 Iowa 68, 500.00 67, 390.97 26, 411. 65 Kansas. 20,000 27, 576.94 58,776, 94 48, 998. 96 58, 776.94 Kentucky 83, 620. 26 1, 309. 39 82, 310. 87 Louisiana 20,000 62, 310. 87 67, 469. 13 83, 310. 87 82, 267. 04 Maine. Maryland.. 54, 022. 09 25, 465.72 Massachusetts. 36, 033. 56 68, 722. 53 Michigan.. 20,000 48, 722. 53 100, 284. 49 84, 676.00 61, 591.71 Minnesota 20,000 95, 161.00 99,999.99 Missippi. 65, 997. 05 95, 161.00 Missouri. 20,000 27, 961. 78 15, 246. 89 67, 970. 44 12, 606. 40 Montana 20, 000 32, 735.95 53, 629. 83 20,000 Nebraska.. 6, 259.48 59, 355. 55 22, 309. 77 18, 869.93 20,000 Nevada... 16, 163. 92 46, 163.92 29, 555. 22 16, 552. 38 20,000 24, 894.46 New Jersey. 20, 000 115, 715. 35 21, 210. 11 94, 505. 24 New Mexico. 20,000 33, 244.00 6, 530. 45 26, 713. 55 New York. 180, 160. 50 20,000 North Carolina_ 127,056. 50 98, 118.00 103, 942. 72 18, 554. 72 74, 162.72 79, 563. 28 North Dakota_ 20,000 59, 563. 28 98, 118. 00 41, 393. 19 72, 789. 71 Ohio 164, 120. 80 11, 728. 44 Oklahoma. 61, 804. 10 Oregon 20,000 Pennsylvania. 20,000 189, 243. 24 Rhode Island. 20, 000 20,000 20,000 20, 000 20,000 152, 730. 02 152, 730. 02 20,000 77,550.00 4, 252.75 21, 947.75 152, 717. 75 29,999.99 12, 217. 40 73, 297.25 Washington 20, 000 53, 297.25 77, 550.00 67, 196. 47 73, 297. 33 12, 123. 98 55, 072.49 West Virginia. 20,000 43, 923.40 Wisconsin 61, 747.97 62, 350. 65 Wyoming.. 58,412.00 32, 419.99 9, 772.92 49, 508.55 22, 647. 07 20,000 2, 647.07 23,000.00 6, 124. 15 1 The term "State" includes Alaska, Hawaii, and the District of Columbia. Includes remainder of 1936 allotment in the Treasury of the United States and unexpended balance of Federal funds in State treasury June 30, 1936. 3 The amount allotted to any State remaining unpaid at the end of each fiscal year is available for payment to such State until the end of the second succeeding fiscal year. 4 Of $2,850,000 authorized for allotment, $939.49 was not allotted. |