Maternal and Child Health Care

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MATERNAL AND CHILD HEALTH CARE

MATERNAL AND CHILD HEALTH CARE. The story of maternal and child health care in America parallels major changes not only in medical science, but also in society at large. Colonial Americans continued European practices of obstetrics and midwifery, while child health care remained largely undifferentiated from adult treatments. Complications from childbirth were the leading killers of young women, and infant and toddler mortality was high. In 1789, 40 percent of all deaths were among children under age five. Infants frequently succumbed to dysentery, diarrhea, and cholera, while epidemics of smallpox, scarlet fever, typhoid, yellow fever, and diphtheria often killed older children.

Maternal health was threatened by postpartum bleeding as well as by deadly ailments such as puerperal ("childbearing") fever, a bacterial infection contracted during childbirth. Labor pain went largely untreated until 1853, when Queen Victoria of England demanded chloroform while delivering her eighth baby. The smallpox inoculation was introduced to America in 1721, and a greatly improved smallpox vaccination became available in 1800; still, infant and child mortality rates remained high well into the mid-nineteenth century.

By 1850, nearly 17 percent of deaths nationwide were among infants, although they accounted for less than 3 percent of the total population. Cities were particularly deadly: between 1854 and 1856, children under age five accounted for more than 60 percent of New York City's deaths. Yet the roots of pediatrics and obstetrics were taking hold. In 1825, William P. Dewees of the University of Pennsylvania published the first comprehensive treatise on children's health. Philadelphia opened the first children's hospital in 1855, and in 1860, Dr. Abraham Jacobi, who became known as the "father of pediatrics," was appointed to head the first children's clinic at the New York Medical College. Before long, the American Medical Association had departments devoted to obstetrics and pediatrics, and in 1888 the American Pediatric Society was formed.

Meanwhile, the problem of child labor was reaching a crisis point. In 1870, some 764,000 children—about 13 percent of the nation's 10- to 15-year-olds—were working in America's factories, mines, and fields. Within 30 years, the child workforce had mushroomed to 1.75 million. Child labor abuses, however, also spawned child welfare programs. In 1874, the Society for the Prevention of Cruelty to Children was founded, modeled after the Society for the Prevention of Cruelty to Animals, which had been established in 1866. By the end of the century, the "sanitary milk movement" had become a powerful force in combating diarrheal diseases brought on by spoiled milk, the leading cause of death among young children at the time. The advent of pasteurization further aided the cause, allowing for wide distribution of safe milk to fight disease and malnutrition.

As the Progressive Era ushered in the new century, reform movements such as the "crusade for children" promoted a range of maternal and child health issues. Public schools took an active role in preventative care by introducing school nurses and instituting general health and eye exams for students. New York City piloted programs that became national models, including, in 1908, the first public school lunch program, as well as the establishment of the first Bureau of Child Hygiene. In 1909, President Theodore Roosevelt hosted the first White House Conference on Children. He called for the establishment of what, in 1912, became the Federal Children's Bureau. Its mission: to "investigate and report upon all matters pertaining to the welfare of children and child life among all classes of our people."

The 1921 Maternity and Infancy Care Act provided health services funding for mothers and children, particularly in rural communities. The act, though not renewed in 1929, inspired the 1935 Social Security Act Title V maternal and child health care funding programs. Later in the century, federal legislation and programs for maternal and child health care ranged from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), permanently established in 1974, to the Family and Medical Leave Act (FMLA) of 1993.

In the private sector, the National Easter Seal Society (formed originally as the National Society for Crippled Children in 1921; the first such association was the Ohio Society for Crippled Children, formed in 1919) and the March of Dimes Birth Defects Foundation (created as the National Foundation for Infantile Paralysis in 1938) were among the many organizations formed to promote maternal and child health through prevention and treatment.

One of the century's most significant medical advances was Dr. Jonas Salk's introduction of the polio vaccine in 1952. Salk's fame also paved the way for a new breed of superstar doctor, including pediatricians-turned authors Dr. Benjamin Spock and, a generation later, Dr. T. Barry Brazelton. Best-sellers written by and for women, including Our Bodies, Ourselves (first published in 1970) and the "What to Expect" series, gave women a common, personal point of reference on reproductive health and child rearing.

The evolution of women's roles in society also had a significant impact on maternal health care in the twentieth century, with reproductive health issues sparking frequent national debate. Early in the century, women's rights advocates such as the Planned Parenthood founder Margaret Sanger fought to overturn the nineteenth-century Comstock laws (named for anti-vice crusader Anthony Comstock), which banned contraceptives and related information as obscene materials. In 1936, a U.S. Circuit Court of appeals ruling liberalized the interpretation of the Comstock laws as they applied to contraceptives; a year later, the American Medical Association officially recognized the importance of birth control in medical education and practice. The patenting of the birth control pill in 1960, which quickly became women's birth control method of choice, kicked off the sexual revolution. The 1960s and 1970s also spawned natural childbirth and Lamaze movements, which gave fathers a more prominent role during delivery.

The most bitter war over reproductive rights stemmed from the 1973 Supreme Court decision in Roe v. Wade, which effectively legalized first and second-trimester abortions in the United States, using the same privacy standard the court had applied in overturning Griswold v. Connecticut (1965), which dealt with state bans on contraceptives. Roe set off a firestorm between "pro-life" abortion opponents and "pro-choice" advocates of a woman's right to end a pregnancy.

Medical science also stretched toward the other end of the spectrum near the end of the century with the advent of fertility treatments such as in vitro fertilization and other methods of assisted reproductive therapy. As the twenty-first century began, the ethical debates about everything from prenatal gene therapy to human cloning hinted at a new century of cutting-edge science and social discourse about maternal and child health care.

BIBLIOGRAPHY

American Pediatric Society/Society for Pediatric Research. Web site http://www.aps-spr.org.

King, Charles R. Children's Health in America: A History. New York: Twayne, 1993.

Kotch, Jonathon B., ed. Maternal and Child Health: Programs,Problems, and Policy in Public Health. Gaithersburg, Md.: Aspen, 1997.

Luker, Kristin. Abortion and the Politics of Motherhood. Berkeley: University of California Press, 1984.

McCann, Carole R. Birth Control Politics in the United States,1916–1945. Ithaca, N.Y.: Cornell University Press, 1994.

Meckel, Richard A. Save the Babies: American Public Health Re-form and the Prevention of Infant Mortality, 1850–1929. Baltimore: Johns Hopkins University Press, 1990.

Quiroga, Virginia Anne Metaxas. Poor Mothers and Babies: A Social History of Childbirth and Child Care Hospitals in Nineteenth-Century New York City. New York: Garland, 1990.

Wollons, Roberta, ed. Children at Risk in America: History, Concepts, and Public Policy. Albany: State University of New York Press, 1993.

Laura A.Bergheim