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Recommendation VII. Education and training of administrative personnel

(a) Education and training of administrative personnel should be encouraged financially and technically, especially for those who may serve as administrators of the medical-care program, for hospital and health-center administrators, and for nursing supervisors.

(0) State health departments should utilize those funds that may be available to train personnel in such technics as administration of health and medical services, and hospitals. Such a training program may contribute more than any other single activity to the future role of the official public-health agency. corollary, the attention of schools of public health is directed to the importance of establishing the necessary training courses. Recommendation VIII. Expansion of research

(a) Increased funds should be made available to the United States Public Health Service and to other agencies of government (Federal, State, and local), and for grants-in-aid to nonprofit institutions for basic laboratory and clinical research and for administrative studies and demonstrations designed to improve the quality and lessen the cost of services.

(b) T research agencies and those responsible making grants-in-aid should be assisted by competent professional advisory bodies to insure the wise and efficient use of public funds.

EXHIBIT 37

THE AMERICAN DIETETIC ASSOCIATION,

Chicago 11, III., June 25, 1946. Hon. CLAUDE PEPPER, Senate of the United States,

Senate Office Building, Washington, D. C. DEAR SENATOR PEPPER: The American Dietetic Association is indeed pleased to express the views of our organization concerning the bill S. 1318. You will find attached a prepared statement signed by Mrs. Bessie Brooks West, president of the association. We trust that the statement will be included in the record. Our best wishes for success for this important legislation. Sincerely yours,

GLADYS E. HALL,
Executive Secretary.

THE AMERICAN DIETETIC ASSOCIATION,

Chicago 11, III., June 25, 1946. Our association has always supported further extension of maternal and child health and welfare services and crippled children's services through the Children's Bureau. The object of the American Dietetic Association is to improve the nutritional status of human beings; to bring about closer cooperation among dietitians and nutritionists and workers in allied fields; to raise the standards of dietary work.

The community nutrition section of the association is concerned with imparting sound nutrition information to the public. Members of the association who are especially active in the work of this section are employed as consultants in public and private welfare or health agencies, as nutrition specialists in State agricultural extension services, and as teachers of nutrition in colleges and in outpatient clinics.

We strongly endorse Senator Pepper's bill, S. 1318, providing Federal grantin-aid to the States for comprehensive, preventive, diagnostic, and curative services for all mothers and children who elect to participate. This legislation must be passed immediately, for the persons concerned need care now. The Children's Bureau should be guaranteed continued support whether it remains in the Department of Labor or is transferred to the Federal Security Agency. In light of the valuable services it will render to the health of our Nation, the $100,000,000 appropriation which the bill provides is more than justified.

THE AMERICAN DIETETIC ASSOCIATION,
Mrs. BESSIE BROOKS WEST, President.

EXHIBIT 38

TOWN OF WEST BRIDGEWATER,

September 21, 1945. Senator CLAUDE PEPPER,

Washington, D. C. DEAR SIR: We are using the Child Welfare Service which is a part of the Social Security Federal program in our town and would like to have you know how much good it is doing in this community. We appreciate this service and would like to have it continue. We are back of you 100 percent in the broader program represented in Senate bill 1318. Yours very truly,

WILLIAM W. NOYES, Chairman, Board of Selectmen.

EXHIBIT 39

NATIONAL COUNCIL OF JEWISH WOMEN, INC.,

New York 23, N. Y., June 24, 1946. Hon. CLAUDE PEPPER, Subcommittee on Health, Senate Committee on Education and Labor,

Senate Office Building, Washington, D. C. SIR: I am enclosing a statement which expresses the position of the National Council of Jewish Women on maternal and child-care legislation.

I would appreciate it if you would include this statement in the record of your hearings on S. 1318. Sincerely yours,

MILDRED G. WELT,
(Mrs. Joseph M. Welt),

National President.

TESTIMONY IN SUPPORT OF MATERNAL AND CHILD CARE LEGISLATAION BEFORE SUB

COMMITTEE ON HEALTH, SENATE COMMITTEE ON EDUCATION AND LABOR I am writing in the name of 65,000 members of the National Council of Jewish Women concerning our stand on expanded maternal and child-care services as proposed in S. 1318. In 1935, the National Council of Jewish Women passed the following resolution :

“Whereas proper prenatal, maternity, and infancy care should be assured all of the people of our country: Therefore be it

Resolved, That the National Council of Jewish Women endorses such legislation as seeks the secure better maternal, prenatal, and infancy care."

Our sections throughout the country have for many years taken a particular interest in community services for mothers and children. Our sections have sponsored services such as well-baby clinics and special programs for handicapped and convalescent children.

Through participation in these activities, our members have become intimately acquainted with the very great and immediate need for expansion of health and welfare services for mothers and children in all parts of the United States. They have seen the distress and tragedy caused by lack of proper care for women in childbirth or their babies.

By expanding its maternity and infancy services, our country can for the first time in its history assure adequate health service and medical care for all mothers in childbirth, for all new-born infants, and for children during the preschool and school years.

In addition, as mother of families, our members understand how much care is needed to enable a child to grow up into a well-balanced citizen. They have seen, too, the preventable tragedies caused by lack of community facilities to care for children in trouble and for those who are physically handicapped. They strongly support, therefore, expanded welfare facilities for the care of these children.

And finally, our members, belonging to sections situated throughout the country, have seen that maternal and child-care services offered by other States. They believe that every child, regardless of the State that he is born in, is entitled to the best possible care. Additional legislation, therefore, must be enacted to enable States, and communities to develop these indispensible services more fully than is now possible under the present limits in the social-security law.

For these reasons, the National Council of Jewish Women strongly endorses the establishment of maternal and child-care services as proposed in S. 1318. patients in the obstetric and pediatric services.

EXHIBIT 40

MATERNITY CENTER ASSOCIATION,

New York 21, N. Y., June 21, 1946. Hon. JAMES E. MURRAY, Chairman, Senate Committee on Education and Labor,

Senate Office Building, Washington, D. O. MY DEAR SENATOR MURRAY: May I ask that the enclosed statement regarding S. 1318, the Maternal and Child Welfare Act of 1945, be incorporated into the record of the hearings on that bill to be held June 21 and 22. Sincerely yours,

HAZEL CORBIN, General Director. Enclosure.

STATEMENT SUBMITTED BY HAZEL CORBIN, GENERAL DIRECTOR OF THE MATERNITY

CENTER ASSOCIATION, INC., ON THE PROPOSED MATERNAL AND CHILD WELFARE ACT OF 1945, S. 1318, BEING HEARD BY THE SENATE COMMITTEE ON EDUCATION AND LABOR, JUNE 21 AND 22, 1946

There is one word which epitomizes maternity care throughout the United States. That word is discrimination. Sometimes facilities in a community discriminate against the poor, because they cost more than the poor can pay. In some communities the rich and poor receive the best that is available, the rich by paying the highest prices and the poor through free or low-cost services. The middle class is discriminated against because they cannot pay the prices the rich can afford, and they are not eligible for the clinic care provided for the poor. They must take whatever care they can pay for, even though they know that it is of a lower standard than that provided for the poor.

In the United States maternity care is truly a patchwork quilt. In community A there is a hospital but no prenatal clinic. The mothers are dismissed with their babies from 24 to 48 hours after delivery. In community B there is no hospital. Most mothers are cared for by general practitioners with no access to specialists. These doctors do their best, and often their best is excellent. Too frequently, however, there is needless death, injury, or suffering, because when abnormalities and difficulties arise there is no expert consultation available. In community C there is marvelous prenatal care-consultation with tuberculosis, heart, and related services—but after the baby comes, the mothers are dismissed from the hospital to whatever they call home, where no household help is available. In community D there is no hospital, no doctor, no public-health nurse.

Because of the excellent maternity care that is provided to many American mothers, the maternal death rate has fallen precipitously during the past two decades—from 8.0 per 1,000 live births in 1920 to 2.3 in 1944. This good progress is high-lighted even more dramatically by the number of maternal deaths. In 1920, when the population of the birth-registration States was 63,597,307, there were 1,508,874 births and 12,058 maternal deaths. In 1944, the population of the birth-registration States rose to 138,083,449, wih 2,794,800 births and only 6,369 maternal deaths. Thus, when the number of births doubled, the number of maternal deaths was halved.

I should like to call to your attention, however, that last year nearly 200,000 women had no care from any qualified medical attendant whatsoever when their babies were born. The maternal death rate in many communities and in some States is as high as the worst national rate ever recorded in our history. The latest Census Bureau statistics—that is for the year 1943—show that New Mexico, Arizona, Colorado, and other States have maternal death rates far in excess of our national death rate in 1936, which was then considered by statisticians as the highest among the civilized countries with which we drew comparisons.

Census Bureau figures released on May 10, 1946, indicate also another serious discrepancy. The maternal death rate for white mothers has been reduced to 1.9 per 1,000 live births. For nonwhite mothers, it was 5.1.

In Mississippi, New Mexico, and Texas, in 1943, the Negro maternal death rate was double that for the whites. In Virginia and New Jersey, it was three times the white rate. These figures cannot be construed as evidence that Negro mothers are more prone to death in childbirth. On the contrary, in New York City during 1944, where 99 percent of all mothers were hospitalized, the maternal death rate for white mothers was 1.7 per 1,000 live births. For Negro mothers it was 2.1. When good care is provided to Negro and white mothers alike, the end result can be nearly alike. In one southern county during 1944 the maternal death rate was 8.4 per 1,000 live births. One-third of all the mothers in the county—the poorest third-a large majority Negro—were delivered by the nurse-midwives of the county health department. These nurse-midwives are public health nurses who have special training in obstetrics. The maternal mortality for this group of mothers was exactly zero. The stillbirth rate for the county was 45.9 per 1,000 live births. For cases attended by nurse-midwives, the stillbirth rate was only 14. What additional proof do we need to point out the obvious fact that when every American mother and baby receive good care, many lives can be saved and needless sickness can be prevented.

It is my opinion that the enactment of the Maternal and Child Welfare Act of 1945, S. 1318, can make good care available to every mother and baby on the basis of their medical need. Here follow reasons why we believe this bill would provide the care which is so necessary to the health and welfare of every American mother and baby :

1. It would provide care to all mothers and children on the basis of their need.

If this bill is enacted and put into full operation in every State, no expectant mother ever need be concerned about maternity care. Whether she needs plain everyday good obstetric care or special tests or consultation or special hospitalization or special diet or ambulance service or blood transfusions or a Caesarean section or what have you, she would be entitled to it. Her economic status no longer would matter. The time and attention of doctors, nurses, hospitals could be focused on the woman with the need.

2. It would give each patient the right to select the doctor, hospital, nurse, and dentist of her choice.

The tried and true relationship of doctor and patient is not disturbed. If the Government pays her bill, then it would be paid according to a scale of fees agreed upon at the State capitol and hy the State health department-not at Washington-after consultation with an advisory board of doctors, dentists, nurses, etc. If the patient does not like the care she is receiving, she can change doctor or hospital just as she may under the present system when she pays for her care.

3. It would give each doctor, nurse, hospital, and dentist the right to select patients.

All can determine whether or not they want to be paid by the Government for those patients who elect care under this plan. Doctors who do not wish to provide care under the plan would not in any way be obligated to do so and would continue their practice on the same basis as at present.

4. The patient would come first-professional protocol after.

If too few doctors in a community agree to care for patients under the provisions of the bill, then other, perhaps younger doctors, who will take Government funds, may be attracted to that community to provide the care. Or else local health authorities may be authorized to employ competent doctors, nurses, and dentists to care for those patients on a salary basis.

5. It would give to doctors, nurses, hospitals, and dentists assurance of payment for care..

Today every doctor has his charity list, every hospital its group of patients who pay little or nothing. Under this proposed law, as it now stands, expectant mothers and children up to 21 may all be pay patients. The economic position of doctors and hospitals may thus be improved. It might be possible for doctors to settle in some communities which were formerly too poor to support a physician, It might also be possible for many hospitals, formerly providing low-standard services in clinics and wards, to improve their services because they would be paid at a reasonable rate for all obstetric and pediatric care.

6. It would protect the right of each State to plan how it would care for the mothers and children within its boundaries.

States as widely different as Pennsylvania and Wyoming or New York and Nevada can best meet their own needs on their own home ground. They understand their own problems and can best work out their own solution to those problems. States' rights has been a lively issue ever since the First Continental Congress. This bill fits into the pattern of States' rights.

7. It would follow a plan already tested and found satisfactory.

The maternity and child health aspects of the bill follow in detail the EMIO plan. It satisfactorily provided good maternity care during a national crisis in communities where facilities were available.

8. It would be in step with the times throughout the world.

Every country throughout the world is accepting responsibility for the provision of certain basic human rights. Good health with good medical, hospital, and nursing care, is one of those rights.

9. It would be the direct result of shifting public opinion which recognizes that the health and vitality of our next generation is a national necessity.

10. It would improve the education of doctors, nurses and allied workers in the field of obstetrics and pediatrics.

The bill provides for needed additional facilities for teaching doctors, nurses and allied workers in the field of maternal and child welfare. At the same time, the quality of the teaching would improve because it would not be limited to the care of the medically indigent. There would be no medically indigent patients in the obstetric and pediatric services.

Students would no longer get the impression that there are two kinds of care for two kinds of people one kind for free patients, another for those who pay their way.

EXHIBIT 41

SPOKESMEN FOR CHILDREN, INC.,

New York 21, N. Y., June 27, 1946. Senator CLAUDE PEPPER,

United States Capitol, Washington, D. C. DEAR SENATOR PEPPER: Spokesmen for Children has testified before the Senate Committee on Education and Labor in favor of title I, part B of the National Health Act of 1945, S. 1606, as amended by Senator Pepper. (See Congressional Record.) Our testimony was accepted as endorsing the Maternal and Child Welfare Act of 1945, S. 1318.

We believe that the provisions for maternal and child health and welfare in these two bills are among the most essential services ever proposed for the mothers and children of America. We urge you to act favorably on this legislation at this session of Congress. Sincerely yours,

Mrs. THEODOR OXHOLM, Chairman.

EXHIBIT 42

PARENTS' FEDERATION OF GREATER BOSTON,

Jamaica Plain, Mass., June 22, 1946. The Honorable JAMES E. MURRAY, Chairman, Senate Committee on Education and Labor,

Washington, D.O. SENATOR MURRAY: We approve most heartily introduction by Senator Claude Pepper and nine other Senators of the Maternal and Child Welfare Act of 1945, S. 1318.

This sorely needed legislation will represent a broad and forward-moving step toward the objective that this Government of the people may truly function for the people, so that our children of today may grow up to be the strong and healthy citizens which the world of tomorrow will demand.

We sincerely urge you to hold hearings on both this bill and the National Health
Act of 1945, S. 1606.
Yours faithfully,

ELLA FIRGER,
(Mrs. Harry Firger.)

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