ACTION TO BE TAKEN WHEN OPERATION NOT IN CONFORMITY WITH APPROVED 13 STATE PLAN

ADDITIONAL RESPONSIBILITIES OF THE CHILDREN'S BUREAU IN THE ADMINISTRATION OF THESE ACTS

APPROPRIATIONS TO CHILDREN'S BUREAU

14 This is a typographical error in sec. 126 of S. 1606. Reference should have been made to compliance with the sections setting forth conditions of approval of a plan.

15 S. 1606, sec. 218; S. 1318, secs. 402 and 403.

16 S. 1606, sec. 130; S. 1318, sec. 403.

PROCEDURE IN FORMULATION OF GENERAL POLICIES, FEDERAL ADVISORY COMMITTEES, 17 AND RULES AND REGULATIONS

REPORTS TO CONGRESS

The Secretary of Labor shall include in his annual report to Congress a full account of the administration of this part.

CHIEF OF THE CHILDREN'S BUREAU AUTHORIZED AND DIRECTED TO MAKE AGREEMENTS

EXHIBIT 74

TEN YEARS OF SERVICES FOR CHILDREN UNDER THE SOCIAL SECURITY PROGRAM

August 1935 to August 1945

PART I-MATERNAL AND CHILD HEALTH

This summary of the work done toward the betterment of the health of mothers and children during the first 10 years of the social security program is one of a series of three covering those activities in which the Children's Bureau, United

17 S. 1606, sec. 128; S. 1318, secs. 105, 205, and 501.

18 S. 1606, sec. 129; S. 1318, sec. 502.

10 S. 1606, sec. 128.

States Department of Labor, has a special responsibility. Part II of this summary deals with the work done on behalf of crippled children; Part III deals with the aid given in establishing and extending child-welfare services. These programs are all administered by State agencies under plans approved by the Children's Bureau.

This report is intended for use as background material by newspaper editors and feature writers; radio program directors; and by organizations interested in the welfare of children. The national story, in each instance, can be related to the work done in the States and the localities.

MATERNAL AND CHILD HEALTH UNDER THE SOCIAL SECURITY ACT, 1935-45

"Somewhere out on the prairies, in isolated mountain districts, scattered over the desert, down along the swamps, on the border, up hill and down dale, off beaten paths were the children for whom a paragraph of legal language created a mechanism whereby government would attempt to provide a greater measure of opportunty."-Children's Bureau.

THE AUTHORITY

Title V, part 1, of the Social Security Act, as amended:

"For the purpose of enabling each State to extend and improve, as far as practicable under the conditions in such State, services for promoting the health of mothers and children, especially in rural areas and in areas suffering from economic distress, there is hereby authorized to be appropriated for each fiscal year, beginning with the fiscal year ending June 30, 1936, the sum of $5,820,000. The sums made available under this section shall be used for making payments to States which have submitted, and had approved by the Chief of the Children's Bureau, State plans for such services."

By this appropriation the fact was recognized that Federal participation was vital to the success of any comprehensive effort to better the health of the mothers and children of this country.

What was provided was a limited program. Neither by the language of the act nor the amount of the appropriation was complete coverage of the country contemplated, even in rural areas where most of the work was to be done. What has been done, therefore, can only be regarded as a beginning, but a beginning that has already affected the well-being not of thousands, but of millions, everywhere in the United States.

THE BENEFICIARIES

The people of the United States-for what benefits children benefits all. Direct beneficiaries of this particular part of the Social Security Act are, for the most part, mothers and children who live in the rural areas of the United States. Many of them did not ordinarily see a doctor except in times of serious illness or disaster, for doctors are few and far between in many parts of this country. Health services, including prenatal clinics, child-health conferences, public-health nursing, school health examinations, and the like, that in some parts of the country have long been taken for granted, were scarcely known to many of these people prior to the start of this program, and in some places, such services are still nonexistent.

In the days before social security, many, if not most, of the women who are now being reached through prenatal clinics would have had no medical care whatsoever prior to their baby's birth. Death, under such circumstances, frequently took the mother—a human loss to be reckoned not only in terms of the individual, but in the count of broken homes and of children left motherless.

And the children-many of them, like their mothers, were seldom seen by a doctor or by a nurse. They "took sick"-and were "ailing"-they died, as if that were the natural order. As in the case of their mothers, mortality rates were high, 1 out of 10 in some groups dying in the first year of life..

Those who survived grew up, and many are still growing up, not the robust lot one pictures as being typical of American youth. They are more apt to be hollow-eyed boys and girls, with bodies marked by malnutrition-youngsters with bent shoulders, spindlelegs-the group from which came the young men who were rejected in such great numbers when called up by Selective Service.

These, then, are the mothers and children for whom health services under the Social Security Act were specifically intended, and among them are thousands and tens of thousands who for the first time are being seen by doctors and nurses, and who for the first time are benefiting from the medical and health knowledge of which their country has great measure. Not all of these women and children, nor even a considerable part of those in need of medical care and health services, have as yet been reached-a fact that must be kept in mind when gains made under the social security program are set forth in impressive figures such as those cited in this report.

WHAT HAS BEEN DONE FOR THESE MOTHERS AND THEIR CHILDREN UNDER THE SOCIAL SECURITY ACT

In these 10 years, because of the assistance to the States made possible by the use of social security funds, a basis has been laid for State-wide health services to mothers and children through the establishment and strengthening of maternal and child-health divisions of State health departments, and the strengthening, too, of local health agencies.

At the time the Social Security Act was passed, almost half the States bad no special funds or less than $10,000 for maternal and child health. Fourteen spent less than $3,000 a year or nothing at all for this work. Today, all of the States have maternal and child-health divisions in their departments of health. Altogether in 1945 the States now budget at least $4,800,000 of their own and local money for maternal and child-health services in addition to the money they get from the Federal Government.

In the period approximating that in which maternal and child-health programs have been in operation under the social-security program, the infant mortality rate has been reduced nearly one-third; the maternal mortality rate more than one-half.

Among women in the 15- to 44-year age group, the childbearing years, in 1935, death from causes related to childbirth ranked second, only tuberculosis accounting for a larger number. In 1942, the last year for which these statistics are available, puerperal causes ranked fourth on the list, preceded by tuberculosis, diseases of the heart, and cancer. In 1935, some 12,000 women died from causes related to childbirth; in 1942, the number was 7,000. Then, some 56 babies out of every 1,000 died within their first year of life; today, 40 out of 1,000 die.

Not all the credit for that remarkable record, of course, goes to the socialsecurity program, but it undoubtedly has been an important contributing factor. Significantly, the greatest decline has taken place in those States in which the work done under the social-security program broke new ground-the States that before there was a social-security program had the greatest health problems and had been able to do the least about them; the States, broadly speaking, with a large rural population and relatively little money with which to reach their people with health services.

WHAT IS BEING DONE

In a single year (1942), under this program of health services, made possible with the use of social security funds, more than 160,000 mothers received prenatal care. One hundred eighty-five thousand babies and some 300,000 young children were given health check-ups at medical conferences.

More than 1,600,000 school-age children were examined by physicians. More than 2,000,000 children were vaccinated against smallpox; more than 1,600,000 were immunized against diphtheria. Public-health nurses gave care to some 1,500,000 mothers and children.

HOW THE WORK IS DONE

Funds made available for maternal and child-health services by the Social Security Act are administered by State health departments under plans approved by the Children's Bureau, United States Department of Labor.

A large portion of the Federal money is allotted to the States on the grantin-aid principle. That is, the States match the funds. Part of the Federal allotment, however, is granted solely on the basis of need, and this part of the funds is not matched by the State.

The procedure is this: Each year the State agency submits to the Children's Bureau a plan of operation, setting forth what services will be provided. The Children's Bureau reviews the plan to make sure that it is in accord with the over-all objectives set in the Social Security Act and that standards for services are satisfactory. Upon approval of that plan, Federal funds are granted to the State. Programs provided in a State plan are administered by the maternal and child-health division of the State health departments.

HOW THE STATES USE THE MONEY

Most of the money granted to the States under the social security program is used, through the State health department, to pay for the services of physicians, dentists, public-health nurses and nutritionists, to people living, for the most part, in rural areas.

These people are being reached through prenatal clinics and well-baby conferences held in centers easily accessible to large numbers of mothers and children. Others are reached through home visits by public-health nurses. Some few mothers and children are given medical and hospital care, but the program has been primarily one of providing health services rather than actual medical or hospital care.

Through these various programs mothers are being taught better ways for caring for their own health and that of their children and these mothers in turn teach others: a significant contribution to better health for the entire Nation.

Nursing care is provided through the services of public-health nurses in clinics and schools, and by home visits. Examinations of school children by doctors and nurses are an important part of the program.

Besides the day-to-day work carried on by doctors and nurses in the community, special projects are undertaken.

Part of the money is used, too, to pay the salaries of consultants on the staffs of State health departments, and of the Children's Bureau. For example, for a considerable period a Negro pediatrician on the Children's Bureau staff worked with State health departments in improving the care being given Negro groups.

Funds are also available for postgraduate courses for medical, dental, and other personnel. For example, thousands of physicians have attended "refresher" courses of obstetrics and pediatrics. The use of social security funds has also made possible the training of nurse-midwives, this training being given in four specially selected centers: Tuskegee, Ala.; Santa Fe, N. M.; Hyden, Ky.; and New York City. These women, in turn, work as members of the State and local health department staff in improving the care given to the thousands of women who must, under present circumstances, depend upon a midwife's service at delivery.

In some instances, these nurse-midwives train and direct the nonprofessional midwives. In others, they themselves assist in the delivery, as is the practice in Kentucky, Maryland, Indiana, and Florida.

CARE OF SERVICEMEN'S WIVES AND BABIES

An unforeseen outgrowth of this program has been the care given to servicemen's wives and babies during the war. When the need of public provision for the maternity care of wives of men in the armed forces and care for their sick infants became apparent in the early days of the war, the experience gained in administering the maternity and child-health program was heavily drawn upon in framing the emergency maternity and infant-care program. Since 1943 Congress has provided special funds for this program which is administered by State health departments through their maternal and child-health divisions, in accord with plans approved by the Children's Bureau. As a result, medical, hospital, and nursing care has been provided for nearly a million wives and infants of servicemen (September 1945).

HOW WELL IS THE NEED MET?

Impressive as the work has been under the social-security program, it is recognized as far from adequate. Although infant death rates for the Nation are now at the lowest level ever reported, only 1 in 25 babies dies before the end of the first year of life, wide variations exist in States and in racial and language