“Save 100,000 Babies”: The 1918 Children’s Year and Its Legacy

Abstract

In April 1918, President Woodrow Wilson, alarmed at the high draftee rejection rate, proclaimed the second year of American engagement in World War I as “Children’s Year.” The motto of the nationwide program was to “Save 100,000 Babies.” Children’s Year represented a multipronged child welfare campaign aimed at gathering data on best practices regarding maternal and child health promotion, documenting the effects of poverty on ill health, reducing the school drop-out rate, ensuring safe play spaces for children, and addressing the unique needs of targeted populations such as orphans and delinquents. Thousands of communities across the country participated in Children’s Year, which was overseen by the Children’s Bureau and the Woman’s Committee of the Council of National Defense. The 1919 White House Conference on Children’s Health synthesized all of the Children’s Year findings into concrete recommendations. But in an effort to minimize conflict with organized medicine and those who feared governmental intrusion into family life, stakeholders accepted a series of compromises. By so doing, they inadvertently helped enshrine the means-tested, class-based, fragmented approach to child well-being in the United States that persists to this day.

In April 1918, the US Children’s Bureau (USCB) and the Children’s Welfare Department of the Woman’s Committee of the Council of National Defense together announced that the second year of American engagement in World War I would be marked by a “determined Nationwide [sic] effort on behalf of childhood.”¹ Shocked by the extraordinarily high draftee rejection rate for what were considered preventable health conditions, civic leaders united behind the issue of child well-being. They proclaimed 1918 the Children’s Year with the goal of saving 100 000 babies and, in the language of former President Theodore Roosevelt, called for a “Square Deal” for children. Knowing that most people were aware of the high rates of war-related morbidity and mortality, local leaders used the conflict to enhance concern about infant mortality and build support for Children’s Year. As the Chicago, Illinois, Health Commissioner observed: “The number of men killed in war is not so serious an index of loss as is the high infant death rate.”² President Woodrow Wilson offered concrete support for Children’s Year by supplementing the USCB appropriation with $150 000 from his War Emergency Fund.³

Children’s Year Poster, Francis Luis Mora, Courtesy of the Library of Congress.

The creation of the USCB in 1912 followed the 1909 White House Conference on the Care of Dependent Children. The first federal agency in the world to focus solely on improving the lives of children, it concentrated on investigating youngsters’ health, labor, and legal status and on disseminating advice about childrearing. Between its creation in 1912 and the American entry into World War I, the USCB conducted studies of infant mortality, which, from the beginning, uncovered the correlation between poverty and ill health. The Bureau also sponsored Baby Week campaigns that joined women’s groups and state and local government agencies in educational outreach efforts.⁴

Children’s Year programming built on this foundation and encompassed a wide range of interventions, galvanizing citizens to come together around a popular population: children. Initiatives included promoting access to maternity and infant care, improving recreational opportunities for children, new attention to the health of preschool children, and enforcing child labor laws in tandem with efforts to encourage adolescent workers to return to school. Children’s Year initiatives also meshed with ongoing drives against infectious disease: “Henceforth every year must be a Children’s Year,” trumpeted one tuberculosis journal describing the ways in which the two public health efforts shared a common aim.⁵

CHILDREN’S YEAR INITIATIVES

In many respects, Children’s Year enabled the USCB to move beyond its initial work of data gathering and education and to demonstrate the agency’s importance through community-based programs. However, the new efforts were heavily circumscribed, hemmed in by a continuing need to avoid overstepping state and local authorities as well as the need to save costs wherever possible.⁶ The USCB’s leaders similarly sought to refrain from antagonizing physicians who feared that public support for health programs augured impending socialized medicine. Working within these limitations and attempting to maintain strategic alliances, the USCB and its partner organizations succeeded in reaching approximately 17 000 rural and urban communities with the assistance of 11 million women volunteers.

Health promotion activities included the distribution of more than six and a half million weighing and measuring cards used to obtain the height and weight of every preschool-aged child with examinations conducted in schools, city halls, and clinics. Thousands of examinations by physicians ultimately revealed the extent of uncorrected pediatric physical defects. For example, physician Adelaide Brown, writing about Children’s Year in California, reported that 541 physicians signed national weighing and measuring cards for more than 53 000 children. She noted that, of the thousands of California children examined, more than 46% were diagnosed with physical defects. Brown’s article, published in the California State Journal of Medicine, also included data on children with abnormal tonsils and adenoids, those below height and weight norms, and those with defective teeth. In response to the problems uncovered, mothers received pamphlets about diet, dental hygiene, and maintaining infant and children’s health. Maternal education and frequent medical examinations were seen as the answers to the problems revealed by the Children’s Year work in California and elsewhere, rather than a more focused attack on their underlying structural causes of morbidity and mortality as suggested by the Bureau’s previous infant mortality studies.⁷

Advocates understood that child health promotion was only one component of what they called “child welfare work.”⁸ As part of Children’s Year, the USCB worked with the Playground and Recreation Association of America, the Department of Agriculture, and other groups to promote the importance of healthy, safe play spaces. “Clean amusement and vigorous outdoor play,” they believed, would uplift children both “physically and morally.”⁹ During “Patriotic Play Week” in 1918, for example, the New York City Mayor’s Committee of Women on National Defense welcomed citizens to athletic carnivals, a Boy Scout parade, and other games and activities, with the motto “A child without a playground is like a man without a job.”¹⁰

Children’s Bureau leaders and their allies believed that, although men should be employed, youngsters did not belong in the labor force. To stem the tide of school leaving, which wartime opportunities exacerbated, reformers kicked off a “Stay-in-School” campaign in 1919 after the armistice with the slogan “Children Back in School Means Soldiers Back to Jobs.” In Ohio, for example, all sixth-, seventh-, and eighth-grade children wrote essays on “Why go to high school?” A poster issued by the USCB and the Council of National Defense Child Conservation Section proclaimed “Boys and Girls: The more you learn, the more you’ll earn: Stay in School! Back-to-School Drive.”¹¹

Local newspapers helped publicize Children’s Year activities by reprinting articles issued by the USCB and reporting on community efforts. Each state and, in turn, individual communities received quotas from the USCB of the number of infant lives they were responsible for saving. In Klamath Falls, Oregon, for example, the Evening Herald quoted USCB director Julia Lathrop explaining “In the last analysis, every community must save its own babies if they are to be saved at all,” underscoring that critical child welfare work had to take place at the local level.¹²

In another community, Morgan City, Louisiana, an animated group of determined women identified 300 children for weighing and measuring, reflecting the Bureau’s investment in applying standardized growth metrics. In Morgan City, mothers were instructed to bring their children to City Hall on May 28th and 29th for “weighing test day.”¹³ Volunteers, described as “woman power” by economist Jessica B. Peixotto, executive chairman, Child Welfare Department, Woman’s Committee, Council of National Defense, provided the labor.¹⁴

RACE, HEALTH, AND CHILDREN’S YEAR

Reflecting the era’s norms, one Mississippi newspaper carried a brief announcement under the headline “United States Government Order” from the chairman of the local Children’s Year campaign. It gave the date for a weighing and measuring day for children aged up to 6 years and concluded, “A date will be arranged for the colored people.”¹⁵ Racial variations in child health interested the USCB, but they took no concrete steps to address the problem. For instance, the report on the measurements taken as part of Children’s Year in 167 024 categorized White children by then-contemporary standards of race into groupings such as “British and Irish parentage,” “Scandinavian,” “Italian,” and “other racial stocks.”¹⁶

Despite weighing and measuring African American children during the campaign and the participation of the National Urban League, which conducted education campaigns and established child health clinics, the USCB excluded African American children from their official height and weight charts without explanation. Just as the leaders of the USCB sought to avoid conflict with organized medicine and political conservatives worried about federal encroachment into family life, so, too, did both groups shy away from challenging existing racial norms and presumptions. Like other Progressive Era reformers, those working in the USCB sought to apply knowledge gained from social science and biological studies to problems that arose from an urban industrializing nation that had welcomed many immigrants. However, they could not escape the eugenic and racist beliefs that shaped understandings of human difference.¹⁷ The USCB and other federal agencies largely left it to private organizations to propose solutions and develop programs to improve African Americans’ health.¹⁸ Relying largely on their own resources, African American organizations addressed the problem of health disparities. Under the auspices of National Negro Health Week, which began in 1915, baby clinics and health clubs for mothers joined the educational and public health outreach campaigns in many communities.¹⁹

LEARNING FROM CHILDREN’S YEAR

Publication of the 1919 White House Conference report Standards of Child Welfare served as the concluding event of Children’s Year. The meeting began in Washington, DC, and was followed by conferences around the country including New York City; Cleveland, Ohio; Boston, Massachusetts; Chicago, Illinois; Denver, Colorado; Minneapolis, Minnesota; San Francisco, California; and Seattle, Washington. In each setting, participants analyzed the findings from the thousands of Children’s Year projects, seeking to forge a template that could be used to define standards for well-being in the American child. This had been part of President Wilson’s original charge when he approved Children’s Year, which he hoped would “successfully develop as to set up certain irreducible minimum standards for the health, education, and work of the American child.”²⁰

The final report not only called for a national commitment to children; it also offered a broad philosophical manifesto regarding what America owed its youngsters. Significantly, issues related to child health, education, and protection from abuse were encapsulated in an expansive concept participants called “child welfare.” Discussions of health in the document incorporated serious attention to poverty and the need for adequate housing, quality child care, and parental employment. Conference attendees believed that Children’s Year programs demonstrated the way forward: “No longer can it be said that the knowledge concerning how to safeguard childhood is lacking. The data are available.”²¹ Their optimism would prove unfounded.

Standards of Child Welfare acknowledged the “economic and social basis” that influenced Americans’ health, what we today call health disparities, and it directly engaged with race. One presenter, Kelly Miller, a Howard University professor, proclaimed “The Negro child is born into an environment of economic and social depression which is calculated to crush the just aspiration of humanity. The stress of economic pressure falls heaviest upon the black race, and is felt most acutely by the black child.”²² While USCB director Lathrop won praise as a friend of the “colored race” and spoke before groups such as the National Urban League, her personal activities did not translate into a programmatic effort by the USCB to address the particular problem of African American infant mortality.²³

Standards of Child Welfare did, however, enumerate the health services that should be available to every American mother and child, no matter how poor. Pregnant women, for example, were entitled to prenatal care and, in an era in which most babies were born at home, “Daily visits through [the] fifth day, [after giving birth] and at least two other visits during the second week from a physician or nurse.”²⁴

While the Children’s Year programing focused on outreach and education to improve school attendance, Standards of Child Welfare proposed a more robust approach: a federal mandate that would keep children in school until age 16 years. Conference attendees evidently viewed this recommendation as necessary because of the previous Supreme Court ruling overturning the Keating-Owen Child Labor Act of 1916. With federal action on child labor foreclosed, mandatory school attendance laws appeared to them to be the most viable means of keeping youngsters out of the workplace.²⁵

Yet another chapter of Standards of Child Welfare focused exclusively on children in need of “special care,” broadly defined by categories such as delinquents and children born out of wedlock. Acknowledging that it was in the best interests of some children to be removed from their home, the document nevertheless extolled the nuclear family as “the highest and finest product of civilization.” As such, the report called on “private and governmental agencies . . . to supplement the resources of the family wherever income is insufficient.”²⁶

In one area, the report called for an initiative that would ultimately develop decades later. It recommended “one public health nurse for average population of 2,000” so that mothers and infants could benefit from regular home visits. While in the home, nurses could educate mothers, assess for unsafe conditions, and, if necessary, refer children to “available clinics for dentistry, nose, throat, eye, ear, skin, and orthopedic work; and for free vaccination for smallpox and typhoid.”²⁷ Today, a modern version of a program aimed at providing support, education, and care coordination to vulnerable, at-risk families through an intensive nurse home-visiting model is trademarked as the Nurse–Family Partnership.²⁸

LEGACIES

The momentum of Children’s Year, expanding awareness of the needs of mothers and children highlighted in Standards of Child Welfare and passage of the 19th Amendment giving women the right to vote led to the 1921 Promotion of the Welfare and Hygiene of Maternity and Infancy Act, better known as the Sheppard–Towner Act (Pub L No. 67-97). The law provided matching federal funds to states for maternal and infant health care initiatives. As part of Sheppard–Towner, an army of physicians and public health nurses taught mothers prenatal care, screened children for preventable diseases, and weighed and measured them. Its successes and the political opposition it roused from the American Medical Association have been well documented, as has the support of the program by pediatricians, a group of whom founded the American Academy of Pediatrics. Pediatricians’ support and that of others was not sufficient, especially after elected officials learned that newly enfranchised women were not voting as a bloc. When funding expired in the late 1920s, the Act was not reauthorized.²⁹

Sheppard–Towner was the best known and most politically successful (at least temporarily) follow-on to the Children’s Year, but it was not the only legacy of this wartime program. Well-child care became the centerpiece of pediatrics, in part as a result of the weighing and measuring campaign and the clinics held during Children’s Year. More substantially, the programming stimulated state and local governments to expand their work with infants and children. After Children’s Year, 23 states passed legislation creating child-hygiene divisions, and, in 24 states, newly hired public health nurses strengthened existing programs.³⁰

Although Standards of Child Welfare suggested the need for broad-based integrated programs for children and families, underlying fissures between and among professionals and voluntary groups as well as resistance to federal oversight prevented that unified vision from taking hold. Many voluntary organizations developed focused missions. For instance, the Child Welfare League of America, an umbrella organization representing agencies focused largely on poverty and children who needed out-of-home care, set as their charge enforcing the 1919 conference guidelines for institutions, foster homes, adoption, child neglect, and supporting the work of juvenile courts. The League did not see health care as falling within its purview.³¹ The National Child Labor Committee, likewise, had a narrow focus that did not include health. Health care providers, in turn, increasingly focused on the biomedical needs of individual children.

With child well-being policy and practice splintering into separate health and welfare domains, any potential for a coherent national approach to children and their well-being evaporated. The 1935 Social Security Act (Pub L No. 74-271) codified these divisions by addressing poverty in Title IV, Aid for Dependent Children, and health in Title V. This provided a rationale for creating Social Security programs for children that were largely means-tested, establishing a class-based approach to child well-being that persists to this day. During World War II, the federal government gave a special appropriation to the USCB to support services to the wives and infants of servicemen in the lowest four pay grades of the armed forces. Known as the Emergency Maternity and Infant Care Act, this program gave a new mandate to the USCB, but funds flowed through it and on to state health agencies, much as Medicaid and Children’s Health Insurance Program dollars flow from the federal government to the states today. After the war, the USCB was, in the words of one historian, “dismembered.”³² Children’s health and welfare programs no longer reside in a single federal agency dedicated to their well-being.

ONE HUNDRED YEARS LATER

The 1919 White House Conference synthesized all of the Children’s Year findings into the Standards of Child Welfare recommendations; however, participants never took a formal stand on who was responsible to meet children’s needs, perhaps to avoid political controversy. In the end, five core principles became the foundation of the American approach to child well-being. First, it would be assumed that parents were primarily responsible for the health and welfare of their children rather than seeing child welfare as, at least in part, a shared civic responsibility. Second, efforts on behalf of children were understood as best undertaken by or in partnership with private organizations. Third, the longstanding pattern of federal funding to state-based and state-run programs would serve as the model for future efforts to support child well-being. Fourth, rather than federal funding that guaranteed equal support for all children, means-tested programs became the preferred model. The Children’s Year promoters never set out to enshrine these principles; they accepted them as a necessary accommodation to the existing system of government social welfare. Finally, reformers proved reluctant to engage with race and class disparities in child well-being. One hundred years later, these ideas and political constraints still animate American policy.

Children’s Year is worth remembering today because of the lessons it provides about the origins of current dilemmas and the examples of past attempts to create a holistic approach to the needs of children and families. Early 20th century reformers documented the ways race, class, and the laissez-faire capitalist state shaped the lives, health, and well-being of what they often referred to as America’s most vulnerable future citizens. But these same reformers accepted incremental change and prioritized cost-neutral solutions as the only practical means of winning support for more investments in children. It is notable that they selected “Save 100,000 Babies” as the centerpiece of their crusade because it engendered no opposition, whereas tackling child labor, a guaranteed family income, or mandating better housing challenged powerful and entrenched political interests. So, too, today’s researchers document the social determinants of health, but government policy focuses largely on individual parental and family responsibility, not structural change. Activities such as weighing and measuring children and distributing health education pamphlets provoked little opposition during Children’s Year; calls to make health care a right for all children would have been far too controversial in 1918 and, sadly, it remains so in 2018.