Peggy West PhD MSWOctober 19, 2012

SignificanceOldest Federal/State PartnershipFirst federally-funded social welfare

programSince 1935 has been continuously

fundedSignificant role of women activistsAddresses needs of women and

children directly at the federal levelBlock Grant to States since 1981

What happened relevant to maternal and child health in each year below?1912 1921193519651977198119982012

Roots began 100 years Ago in1912The Children’s Bureau is the first federal agency within

the U.S. Government—and in fact, the world—to focus exclusively on improving the lives of children and families. Since its creation by President Taft in 1912, the bureau has tackled some of our nation’s most pressing social issues, including:

Infant and maternal deathChild laborOrphanagesChild health and recreationDelinquency and juvenile courtsFamily economic securityAbused and neglected childrenFoster care

Sheppard-Towner Act of 1921

Also called the “Maternity Act”Purpose was to “reduce maternal and

infant mortality”In 1921 childbirth was the second leading

cause of death for women and 20% of children in US died in first year of life and 33% in first five years.

Low income was an important factor in these mortality rates.

Sheppard-Towner Act funded programs such asHealth clinics for women and children, hiring

MDs and nurses to educate and care for pregnant women and their children

Visiting nursesMidwife trainingDistribution of nutrition and hygiene

information

Sheppard Towner Act significanceUnsuccessful challenge in Supreme Court

(Frothingham v. Mellon and Mass.v Mellon (1923)Addressed needs of women and children at federal

levelRole of women activists (Jeannette Rankin, Julia

Lathrop, and Grace Abbott) & League of Women Voters

Demonstrated that education and preventive care at could have a significant effect on maternal and child mortality.

Not funded after 1929 due to political pressureGroups including the American Medical Association

(AMA) and its Section on Pediatrics labeled the program "socialistic" and opposed its passage and opposed its funding in subsequent years.

MCH/Title V of Social Security ActPassed in 1935Ensures health of women, children and youth

including Children with special health care needs

Converted to Block grant in 1981States required to match $4 to $330% for CSHCN30% for preventive and primary care for

women and childrenLimit of 10% administrative costs

Where we are todayMCH is located in HRSA in HHSProvides Block Grants to 59 states and territoriesMCH MissionThe mission of the Maternal and Child Health

Bureau (MCHB) is to provide leadership, in partnership with key stakeholders, to improve the physical and mental health, safety and well-being of the maternal and child health (MCH) population which includes all of the nation’s women, infants, children, adolescents, and their families, Including fathers and children with special health care needs.

Goals of MCH Assure access to care for low income women and

childrenReduce infant mortalityEnsure comprehensive prenatal and postnatal

careIncrease health assessments, diagnosis and tx

for kidsEnsure access to preventive, and rehab servicesAssure family-centered, community-based

systems of coordinated care for CSHCNToll free hotlines for assistance in applying for

services for eligible to Title XIX. (Medicaid)

MCH Pyramid of Health Services

Discretionary Grants900 Discretionary Grants, SPRANS and CISS

from 15% set asideIncludes Training Grants: Adolescent Health,

Autism, Communication Disorders, Dev/Beh Peds, Genetics, Leadership, Leadership Education in Neurodevelopmental and other disabilities, Public Health, Nursing, Nutrition, Pediatric Dentistry, and Social Work

Coordination with Medicaid/Title XIXPassed in 1965 as part of the Social Security

ActExpansions of services and populations

impacts MCH shiftsMCH emphasis on ensuring access to

Medicaid and help with gaining information about enrollment.

Allows MCH to shift its small resources away from direct care payment to building infra structure

MCH impact In 2009, MCH reached*2,513,320 pregnant women were served by the MCH Block

Grant and an additional 118,258 served, mostly through Healthy Start

*4,134,329 infants were screened through the Title V Block.  Services were provided to an additional 62,125 infants through Healthy Start and early identification services through such programs as LEND

*27,611,884 children were served through the MCH Block Grant and an additional 89,654 mostly through Healthy Start and LEND

*1,944,766 children with special health care needs received services through the MCH Block Grant and an additional 148,761 mostly through LEND.

*3,132,908 women and men were served through the MCH Block Grant and an additional 485,809 mostly through the first Time Motherhood/New Parents

What happened relevant to maternal and child health in each year below?1912 Children’s Bureau Created

1921 Sheppard-Towner Act Passed

1935 Social Security Act, Title V (MCH) passed

1965 Title XIX of Social Security Act passed (Medicaid)

1977 First LEAH programs funded by MCHB

1981 MCH funding to states becomes a Block Grant

1998 MCH implements performance measures for reporting by states

2012 LEAH funded at UW (after an absence of 10 years)

Questions and Discussion