MCH History

MCH/Title V History: Beyond Legislation, Bold Leaders, and Bright Legacies

Injustice and cruelty to children are as old as the world. We have made some progress. We see the ways more clearly now than in the past, and with clearer vision, we can do more, go further. Without apology, then, I ask you to use courageously your intelligence, your strength, and your goodwill in the removal of the barriers which have [hindered] children in the past. There will, I warn you, be discouragement and disappointments. New standards of what constitutes social justice will develop, but the cause of children must triumph eventually. The important thing is that we should be on our way. Perhaps you may ask, “Does the road lead uphill all the way?” And I must answer, “Yes, to the very end.” But if I offer you a part in a long, hard struggle, I can also promise you great rewards.

—Grace Abbott, Chief of the Children’s Bureau (1921-1934) and one of "America’s Twelve Greatest Women"

Introduction. The passage of Title V of the Social Security Act on August 14, 1935 signaled the commitment of the federal government to promote the health and welfare of all women and children. It began a public health movement that emphasizes leadership, performance, and accountability to tap into the best parts of those involved to work toward the best outcomes: the elimination of disparities in health status outcomes, the highest quality of family-centered, community-based, coordinated care, and continuous access to that care for those who need it most.

Maternal and child health (MCH) has evolved significantly over the last eight decades. The commitment signed into action in 1935 still holds and is evident in past and current legislation, leadership, and programmatic legacies of HRSA's Maternal and Child Health Bureau (MCHB).

This history page — a collaboration of the National Center for Education in Maternal and Child Health's MCH Digital Library (a component of the Strengthen the Evidence for MCH Programs initiative) and the MCH Navigator — is a celebration of nearly a century's worth of accomplishments.

Beyond Legislation presents the legal framework and a decade-by-decade milestones showing the federal response in supporting mothers, children, families, and communities.
Bold Leaders offers an overview of federal MCH leaders and their signature projects.
Bright Legacies provides insights and resources then and now as seen through the lens of current population/conceptual domains that highlight the diversity and history of MCH initiatives.

A Resource for Our Time. This resource was compiled during unprecedented times as the coronavirus pandemic challenged the nation to address one of the worst public health emergencies in a generation and while the call for more equitable systems for Black, Indigenous, People of Color (BIPOC) has been raised to address systemic racism spanning generations. This page serves as a reminder of our nation’s capacity to engage in challenging, meaningful work to equip mothers and children with the necessary resources and support to lead meaningful, healthy lives.

Looking Back, Moving Ahead...

The history of MCH can be used as a guidepost in planning for the future. Check out these recent articles on the of the MCH program in the US and the MCH Library.

Over a Century of Leadership for Maternal and Child Health in the United States: An Updated History of the Maternal and Child Health Bureau (Michael Warren and Laura Kavanaugh)
Navigating the Future Through the Past The Enduring Historical Legacy of Federal Children's Health Programs in the United States (Jeff Brosco)
The MCH Library: Leveraging Learning to Leadership (Sarah K. Riehl, Olivia K. Pickett, Rochelle Mayer, and John Richards)

Read HRSA's Celebratory Announcement. August 14, 2020.

Join MCHB in Celebrating the 85th Anniversary of Title V

Like, Retweet & Share our 85th Anniversary posts on Twitter and Facebook today!

Today marks 85 years since President Franklin D. Roosevelt signed the Social Security Act, which included “Title V—Grants to States for Maternal and Child Welfare.” Since August 14, 1935, Title V has formed the foundation of the public health system for mothers, children and families in the United States.

This is a perfect time to celebrate the history and achievements of the Title V program, especially as we’ve seen it nimbly and extensively support our nation’s most vulnerable populations during the current COVID-19 pandemic.

Title V Through the Years

The Social Security Act codified work that began 23 years earlier with the founding of the Children’s Bureau, and built upon the early federal/state partnerships funded under the Sheppard-Towner Maternity and Infancy Protection Act. The broad reach of Title V originally included “maternal and child health services,” “services for crippled children,” “child welfare services,” and “vocational rehabilitation.”

In 1981, Title V converted to a block grant, providing funding to all 59 states and jurisdictions. The Maternal and Child Health Services Block Grant operates as a federal-state partnership, and comprises about 85 percent of all Title V funding.

In addition to these State Block Grants, today’s Title V also supports special projects of regional and national significance (SPRANS) and community integrated service systems (CISS). In 2010, the Title V legislation expanded to include the Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program.

While Title V has evolved over the years, its commitment to mothers and children, including the prominent callout for children and youth with special health care needs, has endured. Over the past eight decades, Title V has contributed to notable improvements in:

Reducing infant mortality, and maternal mortality and morbidity;
Preventing child and adolescent deaths and injuries;
Increasing access to quality care for pregnant women, post-partum women and children, including those with special health care needs;
Improving access to family mental and behavioral health supports and promoting strong caregiver-child bonds to foster healthy child development;
Advancing universal newborn metabolic and hearing screening and providing timely follow-up;
Increasing the number of children who receive health assessments, immunizations, and follow-up diagnostic and treatment services;
Collecting national survey data on children’s health, including data on adverse childhood experiences;
Developing a skilled and adequately trained public health workforce prepared to improve health outcomes and advance health equity;
Promoting guidelines for child health supervision from infancy through adolescence and for well-women care; and
Ensuring that care provided to the maternal and child health population is family-centered, community-based and coordinated.

Today, Title V programs touch nearly every U.S. family. In FY2018, the Title V federal/state partnership served 99% of infants, 91% of pregnant women, and 54% of all children, including children with special health care needs.

Success Stems from Title V’s Flexibility

Part of why Title V has been so successful is because it allows states and jurisdictions the flexibility to address specific needs and priorities. Every five years, each recipient conducts a comprehensive needs assessment and designs an action plan to respond to these state-specific needs. Funds from the Block Grant support direct, enabling and public health services and systems.

Balanced with this flexibility is accountability. States must also provide financial, program and performance reporting annually.

You Can Help Shape The Future of Title V

Fifteen years from today, we will celebrate the 100th anniversary of Title V. What will be the needs of mothers and children in 2035? What progress will we have made in resolving perennial MCH challenges, including infant and maternal mortality, and marked inequities across many maternal and child health outcomes? Title V will undoubtedly play a role in accelerating progress on these challenges as well as emerging MCH issues that we may not even recognize yet.

To achieve that progress, we must prepare now. The Maternal and Child Health Bureau is developing a strategic plan to help us advance our vision of an America where all mothers, children, and families are thriving and reach their full potential. We welcome you to join us. Please share your vision and priorities for MCH by emailing them to [email protected].

Whether you hold a position in federal, state or local government, academia, research, a community organization or another MCH entity, each of you plays a critical role in shaping the future.

On this special day, HRSA’s Maternal and Child Health Bureau recognizes the contributions of Title V leaders and myriad other MCH partners across the country (and across decades), and looks forward to continuing to work alongside you to improve the health and well-being of America’s mothers, children and families.

Read more about the history of Title V at the MCH Digital Library and the MCH Timeline.

Image source: Library of Congress, Prints and Photographs Division, NYWT&S Collection Reproduction number LC-USZ62-123278 https://www.loc.gov/pictures/item/00649636/

Beyond Legislation

“The story begins in August 1935, in the midst of the Great Depression. Federal health programs are experiencing cutbacks and the health of mothers and children is in decline. President Franklin Delano Roosevelt signs into law new legislation to promote and improve maternal and child health nationwide. Title V of the Social Security Act is born. Title V was created as part of broad social, rather than [narrowly] health, legislation. The legacies of Title V programs are deep and widespread.”¹ 85 years later, Title V remains the longest lasting social and public health legislation in our Nation’s history. The timeline below highlights MCH milestones; explore our rich history in the sections that follow.

Image depicting a timeline that is described below

Note: If you would like to suggest resources to add to this list and the MCH Digital Library in general, please suggest a resource.

The Legislation. Careful Planning Paves the Way.

In 1996, MCHB worked with the National Center for Education in Maternal and Child Health (NCEMCH) at Georgetown University to research and publish the Legislative Base: Maternal and Child Health Services Block Grant. It is a ready reference in the administration of Title V and is a rich source of historic legislation and documents in the history of child health and welfare. In addition to Title V, this publication includes other relevant provisions of the Social Security Act., Public Health Service Act., CMI Rights Act, and many related child health and welfare laws.

When the Title V program was converted to a block grant as part of the Omnibus Budget Reconciliation Act of 1981 (OBRA '81, PL 97-35), seven categorical programs were consolidated: maternal and child health and services for children with special health needs; supplemental security income for children with disabilities; lead-based paint poisoning prevention programs; genetic disease programs; sudden infant death syndrome programs; hemophilia treatment centers; and adolescent pregnancy prevention grants. Sweeping amendments enacted under the Omnibus Budget Reconciliation Act of 1989 (OBRA '89), PL 101-239, introduced stricter requirements for the use of funds and for State planning and reporting. Congress added a separate Abstinence Education program to Title V as part of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Additional funding for abstinence education projects was initiated in 2000.⁵

In 2010, the Patient Protection and Affordable Care Act (ACA) brought about sweeping health reform, including three new sections of the Title V legislation (Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, grants for Services for Individuals with Postpartum Conditions and Their Families, and Personal Responsibility Education Grant Program). And in 2015, Title V MCH Services Block Grant to States Program Transformation enhances the ability of States to document the impact and value of this investment towards improving MCH outcomes within the State as well as to tell a national story about the impact of Title V funding across the country.

Beyond Legislation. Diving into a Rich History.

Beyond legislation, Title V represents a future America in which “the right to grow to one’s full potential is universally assured through attention to the comprehensive physical, psychological, and social needs of the MCH population.” It’s history throughout the decades – and its future – strive for a society” where children are wanted and born with optimal health, receive quality care, and are nurtured lovingly and sensitively as they mature into healthy, productive adults… [Title V] seeks a Nation where there is equal access for all to quality health care in a supportive, culturally competent, family and community setting.”⁶

MCH Milestones. A Decade-by-Decade Timeline of Progress.

Use the short summaries below to learn more about the milestones of Title V history.^7,8,9You can also access additional timelines and histories for a broader understanding of MCH throughout the years:

MCH Timeline. Developed by HRSA's Maternal and Child Health Bureau.
History and Evolution. The Roots and Evolution of Title V. Developed by the Association of Maternal and Child Health Programs (AMCHP).
Children's Bureau Timeline. Developed by the Child Welfare Information Gateway.
Leadership and Legacy: Oral Health Milestones in MCH. Developed by the National Maternal and Child Oral Health Resource Center.
The History of Nutrition in MCH. Developed by the Association of State and Territorial Public Health Nutrition Directors.

MCH Milestones

1900s-1930s. Historic legislation passed through efforts of bold leaders.

At the beginning of the 1900s, America faced many maternal and child health challenges. Poverty. Malnutrition and food insecurity.¹⁰ The average life expectancy in the United States from 1900-1902 was 49.2 years. One in five children would die before reaching their fifth birthday. In some U.S. cities, up to 30 percent of infants died before reaching their first birthday.¹¹ The maternal death rate in the early 20th century was one mother’s death per every 150 living births.¹² A series of hard-won social victories were achieved through the “early mothers” of maternal and child health.

Historical Highlights:

1909 First White House Conference on the Care of Dependent Children.
1912 Children’s Bureau created by Congress (The Act of 1912; PL 62-116), placed in Department of Labor.
1912 Julia C. Lathrop named chief of Children’s Bureau, Department of Commerce and Labor (1912-1921).
1913 Prenatal Care published by Children’s Bureau, first-ever pamphlet on topic.
1914 Infant care published by Children’s Bureau.
1915 Establishment of a Birth Registration Areas (10 States and the District of Columbia)
1916 Keating-Owen Child Labor Act limited the working hours of children and prohibited the interstate sale of goods produced by child labor.
1918-1919 Worldwide influenza (the “Spanish Flu”) killed an estimated 20 to 50 million people, more than were killed in World War I. Children and young adults were particularly susceptible to transmission and disease.
1921 Grace Abbott, PhM, named head of Children’s Bureau, Department of Commerce and Labor (1921–1934).
1921 Sheppard-Towner Act established national policy that the people, through their Federal, State, and local governments, share responsibility for helping to provide community services that children need for a good start in life.
1929 Sheppard-Towner Act lapses/repealed due to significant opposition from the Catholic Church, the Public Health Service, and the American Medical Association.
1930 Dissident group of pediatricians resign from AMA in protest and form the American Academy of Pediatrics.
1930 White House Conference produces “Children’s Charter,” which outlined the specific rights of children.
1933 Birth Registration Area includes all States.
1934 Katharine F. Lenroot named to lead Children’s Bureau, Department of Commerce and Labor (1934–1951).
1934 Department of Labor’s Annual Report recommends 3 major programs: (1) aid to dependent children, (2) welfare services for children needing special care, and (3) maternal and child health services for crippled children.

August 1935. Title V is signed into law.

In the face of the Great Depression, cutbacks in Federal health programs, and declining health for mothers and children, President Franklin Delano Roosevelt signs into law new legislation to promote and improve maternal and child health nation-wide. Title V of the Social Security Act is born. Eighty-five years later, Title V remains the longest lasting public health legislation in our Nation's history. Created as part of a broad-sweeping social rather than health legislation, the legacies of Title V programs are deep and widespread.

Historical Highlights:

1935 Recommendations 2 and 3 (welfare services for children needing special care, and maternal and child health services for crippled children; Department of Labor Report) were enacted into law as Title V of the Social Security Act, administered by Children’s Bureau, Department of Labor.

1935-40. First ongoing medical care programs funded by Federal grants-in-aid.

Title V provides programs for maternity, infant, and child care, and a full range of medical services for children, including children with congenital disabilities. By 1938, every State but one has a Crippled Children's (CC) Program aimed at the social and emotional, as well as the physical needs of these children. They represent the first medical care programs supported on a continual basis with Federal grants-in-aid money.

Historical Highlights:

1938 March of Dimes founded (Originally the National Foundation for Infantile Paralysis).
1939 Original food stamp program enacted by President Roosevelt in response to the Great Depression.

1940s. From war-time to the most extensive public medical care program of an era.

The Emergency Maternity Infant Care Program (EMIC), administered by the Maternal and Child Health Bureau and the State Title V agencies, establishes a service delivery system that provides free and complete maternity and infant health care for the wives and infants of the four lowest grades of servicemen. At the time of its implementation, EMIC represents the most extensive public medical care program in U.S. history.

Historical Highlights:

1943 Emergency Maternity and Infant Care enacted (PL78-156).
1944 An association of directors of maternal and child health programs (AMCHP) founded to provide both a framework and a focal point for state and national efforts centered on mothers, children and families. AMCHP has since provided a forum for state directors of programs for MCH and CYSHCN to work with a wide range of partners to improve the health of families nationwide.
1946 Children’s Bureau transferred to the Federal Security Agency, Social Security Administration.
1946 National School Lunch Act passed.
1946 Hill Burton Act passed to modernize hospitals.
1946 The United Nations Children’s Fund (UNICEF) established to provide food, clothing and health care to children facing famine and disease.
1946 Centers for Disease Control and Prevention (CDC) founded to combat malaria.
1949 United Cerebral Palsy founded by parents of children with cerebral palsy.
1949 Linus Pauling makes critical discoveries regarding sickle-cell disease.

1950s. Shifting demographics stagnation in child health lead to public health changes.

New program initiatives are developed to respond to new information about infant mortality rates and risks and information that points to the movement of health care providers away from the cities and rural areas toward suburban areas. In addition, this decade sees the beginning of special funding for projects targeting "mentally retarded" children, later referred to as MR funds.

Historical Highlights:

1951 American Congress of Obstetricians and Gynecologists (ACOG) formed.
1951 Martha M. Eliot, MD, named to lead Children’s Bureau, Social Security Administration (1951–1956).
1953 Federal Security Agency becomes the Department of Health, Education, and Welfare.
1954 Mental retardation became a Title V program priority.
1955 Dr. Jonas Salk produces a vaccine for polio.
1956 Social Security Disability Insurance (SSDI) passed to provide income to people who are unable to work because of a disability.
1956 Katherine B. Oettinger named to lead MCH Service, Public Health Service (1956–1967).
1958 A Technical Advisory Committee to the Children’s Bureau recommends screening for Phenylketonuria (PKU). PKU was the first metabolic disorder for which a screening test was developed.
1959 Training of Professional Personnel Act (PL 86-158), which helped train leaders to educate children with mental retardation.

1960s. Changing social structures lead to unprecedented program and policy advances.

The Maternal and Infant Care Programs (MIC) and Children and Youth Programs (C&Y) provide comprehensive child and reproductive health care services to millions of low-income women and children. The services developed by the programs for prenatal care, well-baby care, and family planning become models for the country.

Historical Highlights:

1962 Significant amendments to the National School Lunch Act enacted.
1962 National Institute on Child Health and Human Development (NICHD) established to investigate the broad aspects of human development as a means of understanding developmental disabilities and the events that occur during pregnancy.
1962 Migrant Health program established.
1963 Children’s Bureau transferred to the Welfare Administration, Department of Health, Education, and Welfare.
1963 Maternal and Child and Mental Retardation Planning Amendments (MR Programs, MIC Projects, Research Program) enacted.
1964 Economic Opportunity Act passed.
1965 Neighborhood Health Centers established.
1965 Head Start launched, serving more than 560,000 children and families across America.
1965 Social Security amendments (Children and Youth Projects, Training Program, Dental Projects) enacted.
1965 Medicare and Medicaid enacted.
1967 Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program is enacted, but not published until 1972.
1967 Social Security amendments (Family Planning Services and Projects, Intensive Newborn Projects) enacted.
1968 Title V-supported research program on mental retardation established.
1969 Title V moved to Public Health Service.
1969 Arthur J. Lesser, MD, MPH named to lead MCH Service, Public Health Service (1969–1973).

1970s. Looking at health disparities through a modern lens.

The Improved Pregnancy Outcomes Program (IPO) promotes greater access to appropriate levels of care for pregnant women and infants in chosen geographic regions. The 34 States that participate in this program – including 13 that have very high rates of infant mortality – experience greater rates of decline in infant mortality than does the rest of the country.

Historical Highlights:

1970 Reauthorization of the Developmental Disabilities Act authorized funding for State Developmental Disabilities Councils (DD Councils) in each state and territory. State and Territorial DD Councils work to improve the quality of supports and services for individuals with developmental disabilities and their families.
1970 Family Planning Services and Population Research Act (Family Planning Act) enacted.
1972 Sickle Cell Anemia Control Act allots government health funds for screening, research and treatment programs.
1973 Maternal and Child Health Service split between Bureau of Community Health Services and the Office for Maternal and Child Health Service.
1974 The Special Supplemental Food Program for Women, Infants, and Children (WIC; PL 92-433) established as a 2-year pilot program. By the end of 1974, WIC was operating in 45 States.
1974 Child Abuse and Prevention Treatment Act (CAPTA) signed into law.
1975 Education for All Handicapped Children Act (PL 94-142) passed—later amended as Individuals with Disabilities Education Act (IDEA) in 1997.
1976 SSI Program for Children enacted.
1976 Health Research and Health Services Amendments provide for a national program of research, training, testing, counseling and education programs for genetic diseases, including sickle-cell and Cooley’s anemias, Tay- Sachs diseases, cystic fibrosis, dysautonomia, hemophilia, retinitis pigmentosa, Huntington’s chorea and muscular dystrophy.
1977 Vince Hutchins, MD, MPH named to lead Office of MCH (later Division of MCH (1982), Bureau of MCH and Resources Development (1987), Maternal and Child Health Bureau (1990)), Bureau of Community Health Services (later Bureau of Health Care Delivery and Assistance), Health Services Administration (later Health Resources and Services Administration), Department of Health and Human Services (1977–1992).
1977 The Food Stamp Act enacted the program as we know it today, expanding participation and eliminating the process of purchasing food stamps.

1980s. Block Grants and budget reforms redefine MCH and increase accountability.

The Maternal and Child Health Services Block Grant is created in 1981, consolidating under Title V seven former categorical child health programs into a single program of formula grants to States supported by a Federal special projects authority. States adopt injury prevention as a public health issue. The Emergency Medical Services for Children (EMSC) program is created in recognition of the fact that children have special needs when they are critically ill or injured. The program provides training and education in pediatric emergency health care, and influences the development of pediatric emergency equipment and standards.

Historical Highlights:

1980 Department of Health, Education, and Welfare split into Department of Health and Human Services and Department of Education.
1981 Omnibus Budget Reconciliation Act (OBRA) converted Title V-funded programs to a single Title V Block Grant to States, combining seven categorical programs: MCH/CSHCN, SSI, lead screening, hemophilia treatment centers, Sudden Infant Death Syndrome, genetic diseases, and adolescent programs.
1984 Emergency Medical Services for Children (EMSC) enacted to improve the availability of child-appropriate equipment in ambulances and emergency departments; support hundreds of programs to prevent injuries; and provide thousands of hours of training to EMTs, paramedics, and other emergency medical care providers. Watch this video on the Beginnings of EMSC from the EMSC Innovation and Improvement Center's EMSC University.
1987 Surgeon General report on Children and Youth with Special Health Care Needs (CYSHCN) kicked off a campaign to improve the lives of CYSHCN and their families through family-centered, community- based care.
1988 Institute of Medicine (IOM) published Future of Public Health.
1988 Pediatric AIDS projects developed in Title V set-aside.
1989 SSA amendments – accountability of State Programs increased.
1988 CityMatCH formed.
1989 OBRA SSA amendments increased accountability of state programs.

1990s. Women’s health combines with welfare and education reform to bring change.

The Maternal and Child Health Bureau and its partners remain dedicated to improving the health of all the Nation's women and children. Significant amendments to Title V in 1989 and adoption of the Government Performance Results Act (GPRA) of 1993 usher in an era of greater sophistication in assessing unmet service needs and improved accountability in measuring program performance and strengthening an already close Federal-State partnership. State data on health status and services are collected electronically and made available nationally via the Title V Information System. Major new child health legislative initiatives-Healthy Start in 1991 and the State Child Health Insurance Program (SCHIP) in 1997-target long-standing national concerns over infant mortality and uninsured children, drawing heavily on MCH professional expertise and organizational support. Abstinence Education is added to Title V as a categorical program separate from the Block Grant in 1996.

Historical Highlights:

1990 Maternal and Child Health Bureau (MCHB) established within HRSA to administer Title V and other MCH work federally.
1990 Introduction of the Bright Futures program.
1990 National Institute of Health (NIH) opens Office of Research on Women’s Health.
1991 Healthy Start enacted.
1992 Audrey H. Nora, MD, MPH named to lead Maternal and Child Health Bureau, Bureau of Community Health Services (later Bureau of Health Care Delivery and Assistance), Health Resources and Services Administration), Department of Health and Human Services (1992–1998).
1992 National Parent Resource Center survey documented family participation.
1992 Family Voices established.
1994 Back to Sleep campaign launched to address SIDS.
1996 Welfare Reform enacted.
1996 Abstinence Education Program added to Title V.
1997 State Children’s Health Insurance Program (SCHIP) created to help uninsured children.
1997 A Life Course Approach to Chronic Disease Epidemiology published.
1997 IDEA amendment passed.
1998 Peter van Dyck, MD, MPH, MS, named to lead Maternal and Child Health Bureau, Health Resources and Services Administration), Department of Health and Human Services (1998-2011).
1998 Title V Information System (TVIS) established by MCHB.

2000s. MCH Block Grant recognized as effective model as other MCH programs are launched.

The Maternal and Child Health Bureau assumes responsibility for new legislative programs to support Newborn Hearing Screening and Poison Control Centers. Major new funding for community-based abstinence education is added to SPRANS.

Historical Highlights:

2000 Oral Health in America: A Report of the Surgeon General calls for access to oral health care for all Americans, especially the disadvantaged and minority children found to be at greatest risk for severe medical complications resulting from minimal oral care and treatment.
2002 The Program Assessment Rating Tool (PART) is developed to help assess the management and performance of federal programs.
2006 CDC publishes Recommendations to Improve Preconception Health and Healthcare.
2008 The Title V MCH Block Grant received the highest rating possible on the White House Office of Management & Budget’s Performance Assessment Rating Tool (PART). Programs such as the MCH Block Grant that receive the highest PART rating of “effective” clearly show ambitious goals, achieve results, are well managed and improve efficiency.
2008 The Newborn Screening Saves Lives Act enacted.
2009 SCHIP reauthorized.
2009 The American Recovery and Reinvestment Act enacted.

2010s. Title V transforms as the nation addresses health reform.

The decade began with sweeping health reform through the Patient Protection and Affordable Care Act (ACA) that includes expanding Medicaid eligibility, subsidizing insurance premiums, providing incentives for businesses to provide health care benefits, prohibiting denial of coverage or claims based on pre-existing conditions, establishing health insurance exchanges, and support for a range of new preventive health services. Programmatic drives to address childhood obesity, bullying, autism, developmental delays, women’s preventive services, and the Zika virus epidemic combined with the transformation of the Title V MCH Services Block Grant Program to lessen burden on State applicants, maintain State flexibility in addressing unique MCH priority needs, and improve program accountability at both Federal and State levels.

Historical Highlights:

2010 The Patient Protection and Affordable Care Act (ACA) passes. Specific to MCH, the ACA creates three new sections of the Title V legislation: Section 511 authorizes the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, Section 512 authorizes grants for Services for Individuals with Postpartum Conditions and Their Families, and section 513 authorizes the Personal Responsibility Education Grant Program. These new sections of Title V acknowledge the state and territorial leadership role in addressing pressing MCH problems and provide a vehicle for states and territories to link their existing MCH programs.
2010 The White House Task Force on Childhood Obesity is established.
2010 The Federal Partners in Bullying Prevention is convened at the same time the U.S. government launches the annual Federal Partners in Bullying Prevention Summit.
2011 Michael Lu, MD, MS, MPH, named to lead Maternal and Child Health Bureau, Health Resources and Services Administration (2011–2017).
2014 CDC’s autism prevalence report concludes that the prevalence of autism had risen to 1 in every 110 births in the United States and almost 1 in 70 boys. The Autism Collaboration, Accountability, Research, Education and Support (CARES) Act is signed into law.
2015 Title V MCH Services Block Grant to States Program Transformation enhances the ability of States to document the impact and value of this investment towards improving MCH outcomes within the State as well as to tell a national story about the impact of Title V funding across the country.
2016 Women's Preventive Services Guidelines are established to ensure that women receive a comprehensive set of preventive services without cost sharing and account for the unique needs of women throughout the life course.
2016 CDC begins responding to Zika outbreaks in the Americas amid increased reports of birth defects. MCHB makes addressing the Zika epidemic a top priority as research found that infection during pregnancy can cause serious birth defects, especially affecting the neurological and nervous systems.
2018 Michael Warren, MD, MPH, FAAP, named to lead Maternal and Child Health Bureau, Health Resources and Services Administration), Department of Health and Human Services (2018 –present).

2020 and Beyond. MCH and the nation face global pandemic and calls for racial equality.

The COVID-19 pandemic, potentially the most serious public health emergency in a generation, has required a fully-engaged response from MCH professionals, the larger public health field, government and private coordination, and the American people. At the same time and building son decades of systemic racism, the call for the creation of more equitable systems for Black, Indigenous, People of Color (BIPOC) challenges MCH to continue the struggle against racism and the aim for health equity for all women, infants, children, adolescents, and youth with and without special health care needs, their families, and the communities that support them.

Highlighted Hopes for the Future:¹³

Today many historical legacies of Title V thrive as key components of local and State systems of care.
Title V remains the only Federal program that focuses solely on improving the health of all mothers and children. It does this through (1) improving access to quality health care and services; (2) strengthening the health workforce; (3) building healthy communities; (4) improving health equity; and (5) strengthening program operations.¹⁴
Title V remains a partnership with State Maternal and Child Health (MCH) and Children with Special Health Care Needs (CSHCN) programs, reaching across economic lines to support such core public health functions as resource development, capacity and systems building, population-based functions such as public information and education, knowledge development, outreach and program linkage, technical assistance to communities, and provider training.
Title V makes a special effort to build community capacity to deliver such enabling services as care coordination, transportation, home visiting, and nutrition counseling.
Title V funds support programs for children and youth with special health needs to facilitate the development of family-centered, community-based, coordinated systems of care.
Special projects target underserved urban and rural areas with efforts at the community level that promote collaboration between public and private sector professionals, leaders, and health care providers.

Bold Leaders

Over the last 85 years, HRSA's Maternal and Child Health Bureau (MCHB) has been organized under different structures, but has always addressed the needs of MCH populations. The work of eleven directors has been critical to the health of the nation and essential to the evolving needs of the individuals they aimed to serve.

Explore their stories before, during, and after serving as the federal leader in support of MCH. You’ll learn about a wide range of topics, including support for children with disabilities, the value of prevention over intervention, and the utility of effective performance measurement. The timeline below shows a summary of those who led MCH for the past century; explore their accomplishments in the sections that follow.

A map showing the federal leaders below

Note: If you would like to suggest resources that document MCH leaders to add to the MCH Digital Library, please suggest a resource.

Federal Leaders During the Children's Bureau Era. 1912-1956.

Julia C. Lathrop (1912–1921). From Hull House to first female U.S. Bureau chief.

Julia C. Lathrop (1912–1921)

From Hull House to first female U.S. Bureau chief

Children’s Bureau Era, under the Department of Commerce and Labor

Biographical Information

Born in Rockford, Illinois in 1858, Julia Clifford Lathrop attended Rockford College before going to Vassar, from where she graduated in 1880. After spending some time working at her father’s law firm in Rockford, she became a resident of Hull House, a settlement home in Chicago for immigrants and the poor. While at Hull House, she conducted surveys of the living conditions, which were compiled into “Hull House and Papers.” This work was notable as it earned her an appointment to the Illinois Board of Charities in 1892. Serving in this capacity, Lathrop visited and inspected public institutions, such as poorhouses, mental health organizations, orphanages, and shelters, in Chicago and around Illinois.

In 1912, President Taft appointed Lathrop to be the first chief of the newly created Children’s Bureau, established within the Department of Labor. Lathrop was the first woman to be appointed chief of any bureau in U.S. history. Under her leadership, the Bureau focused on issues of infant mortality, nutrition, child labor laws, juvenile delinquency, mothers’ pensions, and treatment of the mentally ill. Additionally, Lathrop and the Bureau were involved in lobbying for the Sheppard-Towner Act, which gave federal funds to states to create programs for maternity care and was passed by Congress in 1921. Lathrop resigned as Chief in 1921 and was succeeded by Grace Abbott.

For more information on Lathrop and her life, visit the following links:

Primary Documents from the Children's Bureau National Archives Collection

Published Works

Lathrop, J.C. (1895) “The Cook County Charities.” In Hull-House Maps and Papers. Retrieved from https://archive.org/details/hullhousemapspap00newy/page/n6/mode/2up.

Findings and observations from visits to the institutions maintained by Cook County (infirmary, insane asylum, hospital, detention hospital, and the county agency). Details the conditions in each facility

Lathrop, J.C. (1905). Suggestions for Visitors to County Poorhouses and to Other Public Charitable Institutions. Retrieved from https://images.socialwelfare.library.vcu.edu/items/show/298.

A guide for those who are conducting investigations of county poorhouses, public hospitals, insane asylums, homes for children, and “homes for wayward boys and girls.” Proposes some fixes for common problems (bedbugs, roaches, etc.) and suggests the need for standards by which to evaluate these institutions.

Lathrop, J. (1921). Standards of Child Welfare. The Annals of the American Academy of Political and Social Science, 98, 1-8. Retrieved May 18, 2020, from www.jstor.org/stable/1015037.

Article summarizing the standards of child welfare in the United States that were laid out in the Minimum Standards for Child Welfare, adopted by the Washington and Regional Conferences on Child Welfare in 1919.

Lathrop, J. (1902). Women in the Care of the Insane. The American Journal of Nursing, 2(6), 430-434. doi:10.2307/3402212.

Discusses the conditions for those who work in insane asylums – wages, training, - and poses some suggestions on how they should be improved, how training for working in insane asylums is not and should not be the same as the training for working in a hospital

Lathrop, J. (1912). The Children's Bureau. American Journal of Sociology, 18(3), 318-330. Retrieved May 18, 2020, from www.jstor.org/stable/2763380.

This article discusses the role of the Federal Children’s Bureau, standards it will abide by, and argues for why there is a need for a federal agency of this sort.

Lathrop, J., Lounsbery, H., Parsons, S., Mackenzie, E., Foelker, E., Laurance, M., & Gaule, M. (1902). Letters to the Editor. The American Journal of Nursing, 3(2), 146-152. doi:10.2307/3402207.

A letter to the editor clarifying a remark Lathrop made in an address to the National Nurses Association that a correspondent seems to have misrepresented in an article.

Lathrop, J. (1917). Shall This Country Economize For or Against its Children? The Journal of Education, 86(6 (2142)), 146-147. Retrieved May 18, 2020, from www.jstor.org/stable/42825958.

Lathrop’s thoughts on child labor laws in relation to war and increased access to education for children.

Lathrop, J.C. (1908). A Visit to Stirling Asylum. JAMA. 1908;L(22):1774–1777. doi:10.1001/jama.1908.25310480012001c.

Recounting her time visiting the Stirling Asylum in Scotland in 1907. Discusses the conditions and treatment of those at the asylum.

Lindsay, S., Furse, K., Moorhead, H., Martin, W., Snow, W., & Lathrop, J. (1926). Discussion: International Social Welfare Problems. Proceedings of the Academy of Political Science in the City of New York, 12(1), 424-432. doi:10.2307/1180412

Transcript of a Round Table conversation on the welfare of children around the globe.

Lathrop, Julia. (1912). The Appeal of the Insane to the Nursing Profession. AJN, American Journal of Nursing, 12(11), 908-919. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=ovfta&NEWS=N&AN=00000446-191208000-00009.

In this article, Lathrop argues for the use of nurses in the public institutions that care for the insane. Lathrop argues that with the growth in number of trained nurses, hospitals have grown and their ability to care for patients has grown as well. Thus, trained nurses should receive training in this area and be placed in the institutions for the insane, should they choose so.

Lathrop, J. (1918). Provision for the Care of the Families and Dependents of Soldiers and Sailors. Proceedings of the Academy of Political Science in the City of New York, 7(4), 140-151. doi:10.2307/1172209

A speech given to the Academy of Political Science in 1917 where Lathrop discusses the provisions of the Military and Naval Insurance Act that led the government to provide service members and their families with insurance and compensation in the case of death or disability in war (the United States just became involved in WWI at this time).

Lathrop, J. (1926). International Child Welfare Problems. Proceedings of the Academy of Political Science in the City of New York, 12(1), 418-423. doi:10.2307/1180411

Lathrop’s reflections on the meeting of the Advisory Child Welfare Committee as part of the League of Nations; discusses the work and focus of the Committee

Lathrop J. C. (1919). Income and Infant Mortality. American journal of public health (New York, N.Y.:1912), 9(4), 270–274. https://doi.org/10.2105/ajph.9.4.270

Lathrop discusses the correlation between low wages, mothers who are obligated to work, and poor housing conditions on infant mortality. The information and facts Lathrop cites in this article comes from studies and reports undertaken by the Children’s Bureau on infant mortality prior U.S. involvement in World War I.

Lathrop, J. (1917). The Children's Bureau in War Time. The North American Review, 206(744), 734-746. Retrieved May 20, 2020, from www.jstor.org/stable/25121688

Lathrop discusses how the government should deal with the children of men sent abroad to fight in the war. Provides an overview of what other governments of countries involved in the war (England, France, Germany, Austria, Russia, Italy) are doing (or not doing) for the children.

Lathrop, J. (1925). Federal Safeguards of Child Welfare: Child Welfare Has Become a World Concern-What Is the Share of the United States? The Annals of the American Academy of Political and Social Science, 121, 96-107. Retrieved May 20, 2020, from www.jstor.org/stable/1015584

Lathrop discusses the role of the U.S. federal government (and thus the Children’s Bureau) plays in protecting and improving child welfare. She compares it to other nations (Germany, Estonia, Poland, Lithuania, Austria, Czechoslovakia) and how these other nations have included child welfare in their constitutions but the primary role of the Children’s Bureau in the United States is to research and report on child welfare.

Lathrop, J. (1910). Pension the Mothers. The Journal of Education, 72(14 (1800)), 376-376. Retrieved May 20, 2020, from www.jstor.org/stable/42817298

Lathrop argues that state governments should be providing some form of child support for mothers instead of separating her child/children from her when she is struggling to provide for them.

Abel, E. (1993). Correspondence between Julia C. Lathrop, Chief of the Children’s Bureau, and a working-class woman, 1914-1915. Journal of Women’s History, 5(1), 79. https://doi.org/10.1353/jowh.2010.0289.

This article provides background on and presents the correspondence between Lathrop and a white working class woman, Mrs. C, while Lathrop was Chief of the Children’s Bureau.

Children’s Bureau Reports

United States. Children's Bureau. (1917). Child Labor in Warring Countries: a Brief Review of Foreign Reports. Washington: Govt. Print. Off. Retrieved from https://link-gale-com.proxy.library.georgetown.edu/apps/doc/AXETZL312751123/NCCO?u=wash43584&sid=NCCO&xid=54a997e1.

A report on the status of child welfare and labor in countries involved World War I.

United States. Children's Bureau. (1919). Laws Relating to "Mothers' Pensions" in the United States, Canada, Denmark, and New Zealand. Washington: Govt. Print. Off. Retrieved from https://link-gale-com.proxy.library.georgetown.edu/apps/doc/AXEUAI329518003/NCCO?u=wash43584&sid=NCCO&xid=b6f2d0c7.

Compilation of laws on government assistance to mothers (“mothers’ pensions”) in the United States (state laws in 41 states), Canada, Denmark, and New Zealand.

United States. Children's Bureau. ([1917]). Saving Mothers. Washington: [Govt. Print. Off.]. Retrieved from https://link-gale-com.proxy.library.georgetown.edu/apps/doc/AXOWDA934681029/NCCO?u=wash43584&sid=NCCO&xid=be106fd2.

Discussion of maternal mortality in the United States and the need for maternity care to improve outcomes.

United States. Children's Bureau. (1914). New Zealand society for the health of women and children: An example of methods of baby-saving work in small towns and rural districts. Washington, D.C.: Govt. Print. Off. Retrieved from https://hdl.handle.net/2027/hvd.hl4ixt.

An account of New Zealand’s efforts through the Society for the Health of Women and Children to lower the infant death rate and how the United States might benefit from implementing a similar model.

United States. Children's Bureau. (1917). Fifth Annual Report of the Chief, Children’s Bureau to the Secretary of Labor. Washington, D.C. Retrieved from https://hdl.handle.net/2027/coo.31924069796674.

Annual report on the activities of the Children’s Bureau regarding the enforcement of U.S. Child Labor Act; infant welfare; child welfare; and the impact of war on the welfare of infants and children.

United States. Children's Bureau. (1914). Baby-sitting campaigns: preliminary report on what American cities are doing to prevent infant mortality. Washington, D.C.: U.S. G.P.O. Retrieved from https://hdl.handle.net/2027/hvd.hl37kb.

Summary of findings from U.S. cities regarding work cities are doing to prevent infant deaths.

United States. Children's Bureau. (1913). Handbook of federal statistics of children: part I, number of children in the United States with their sex, age, race, nativity, parentage and geographic distribution. 2nd ed. Washington, D.C.: Govt. Print. Off. Retrieved from https://hdl.handle.net/2027/hvd.hl3l0z.

A report on the demographics of children based on information collected in the 1910 census. This report is part 1 and is focused on “the number of children, their age, sex, race, nativity, parentage, and geographic distribution” (7).

Hunter, E. B., United States. Children's Bureau. (1918). Infant mortality: Results of a Field Study in Waterbury, Conn. Based on Births in One Year. Washington: Govt. Print. Off. Retrieved from https://hdl.handle.net/2027/uc1.c095002487.

One report in series on infant mortality. This report is based on field work in Waterbury, Connecticut in the years prior to and at the start of World War I.

United States. Children's Bureau. (1913-1924). Annual Report of the Chief, Children’s Bureau to the Secretary of Labor. Washington: U.S. Govt. Print. Off. Retrieved from https://hdl.handle.net/2027/uc1.$b797169.

The first through twelfth annual reports of the Chief of the Children’s Bureau. Reports on the activities of the Bureau during the prior fiscal year.

United States. Children's Bureau. (1921). Administration of Child-Labor Laws, Part 4: Employment-Certificate System, Wisconsin. Washington: U.S. Govt. Print. Off. Retrieved from https://hdl.handle.net/2027/uc1.c070968094.

This report, the fourth report in a series on the administration of child labor laws in the United States, focuses on child labor laws in Wisconsin and how the administration in that state differs from others.

United States. Children's Bureau., West, M. (1915). Prenatal care. 4th ed. Washington: Govt. Print. Off. Retrieved from https://hdl.handle.net/2027/uc1.b4330262.

A study conducted on prenatal care and presented to help mothers improve the care they receive while pregnant. This is the first in a series on child care.

Sumner, H. L., Merritt, E. A., United States. Children's Bureau. (1915). Child labor legislation in the United States: Separate No. 1 – Analytical Tables. Washington. Retrieved from https://hdl.handle.net/2027/hvd.32044112555321.

Report presents child labor legislation across the 50 states using tables.

United States. Children's Bureau., Routzahn, M. Swain., Meigs, G. Lynde. (1915). Baby-week campaigns: suggestions for communities of various sizes. Washington, D.C.: Govt. Print. Off. Retrieved from https://hdl.handle.net/2027/hvd.hl37k6.

A report for executing a baby-week campaign to educate communities on how to best care for their babies in communities of different sizes across the United States.

United States. Children's Bureau. (1916). Birth-registration test. 2d ed. Washington: Govt. Print. Off. Retrieved from https://hdl.handle.net/2027/mdp.39015074865885.

A guide for communities and community groups to conduct birth registration tests which test how complete the birth registration statistics are in counties, cities, and towns. The aim in conducting this assessment is to be better able to enforce the new national child labor law and protect the rights of children.

Sumner, H. L., Merritt, E. A., United States. Children's Bureau. (1915). Child labor legislation in the United States. Washington: Govt. Print. Off. Retrieved from https://hdl.handle.net/2027/nyp.33433010709107.

Report presents child labor legislation across the 50 states using tables and the text of the legislation in each state.

United States. Children's Bureau., United States. Federal Board for Vocational Education. (1921). Child care and child welfare: outlines for study. Washington, D.C. [Washington]: Govt. Print. Off. Retrieved from https://hdl.handle.net/2027/wu.89042008870.

A report for teachers of home economics to use to create lessons and instructions around child care.

United States. Children's Bureau., Williamson, M. (1915). Infant mortality Montclair, N. J: A study of infant mortality in a suburban community. Washington: Govt. Print. Off. Retrieved from https://hdl.handle.net/2027/uiuo.ark:/13960/t3421zf86.

One report in series on infant mortality. This report is based on field work in Montclair, New Jersey in 1912.

United States. Children's Bureau. (1920-29). [Miscellaneous publications]. Retrieved from https://hdl.handle.net/2027/uc1.c055928877.

Various publications on infant and neonatal mortality, midwifery, federal aid for mothers and infants, legislation, and regulation.

United States. Children's Bureau. (1917). Rules and regulations made by the board consisting of the attorney general, the secretary of commerce, and the secretary of labor for carrying out the provisions of an act to prevent interstate commerce in the products of child labor, and for other purposes, approved September 1, 1916: Issued August 14, 1917. Washington, D.C.: U.S. G.P.O. Retrieved from https://hdl.handle.net/2027/hvd.hl280e.

Summary of rules and regulations for the implementation and enforcement of a law preventing interstate buying and selling of products made using child labor.

United States. Children's Bureau., United States. Council of National Defense. Field Division. Child Conservation Section. (1919).

Information on how to handle the change in the workforce as men return from war and children who are already in the workforce continue to want to be employed and working.

United States. Children's Bureau. (1920).

Standards agreed upon at the Children’s Bureau Conference on Child Welfare Standards, held on May 5-8, 1919 in Washington.

United States. Children's Bureau., Hunter, E. Belle. (1922). Office administration for organizations supervising the health of mothers, infants, and children of preschool age: with special reference to public health nursing agencies. Washington: Govt. Print. Off.. Retrieved from https://hdl.handle.net/2027/mdp.39015063516036.

A report for public health organizations to better supervise the health of preschool-aged children.

Grace Abbott, PhM (1921–1934). Leading labor and literacy reforms.

Grace Abbott, PhM (1921–1934)

Leading labor and literacy reforms

Children’s Bureau Era, under the Department of Commerce and Labor

Biographical Information

Grace Abbott was born in 1878 in Grand Island, Nebraska in a family that valued education and political involvement. After graduating from the Grand Island Baptist College, Abbott was unsure of her purpose. Until she was twenty-nine, she lived at home with her parents and taught at the local high school. In 1907, she left Nebraska to study law at the University of Chicago, but ended up developing an interest in social work. She completed her degree in Ph.M. in 1909. The year before, she had taken up residency at Jane Addams’ Hull House and become director of the Immigrants’ Protective League (IPL), working to improve the quality of life for immigrants. She served in this role until 1917. At the IPL, specific results of her advocacy included devising a state plan to enforce compulsory school attendance for immigrant children and persuading President Taft to veto an act of Congress that mandated literacy tests for entry into the country. As well, Abbott taught for several years at the University of Chicago and the Chicago School of Civics and Philanthropy, and was an active participant in the labor movements by joining the Women’s Trade Union League. In 1917, she became director of the Industrial Division at the Children’s Bureau. She developed enforcement plans for the first child labor laws enacted by Congress in 1916, and led the inspection for compliance of all of the major shipbuilding plants on the Atlantic Coast, the Gulf of Mexico, and the Great Lakes. Abbott then briefly returned to Chicago to serve as executive secretary to the Illinois State Immigrants’ Commission and then chair of the child labor section, Illinois State Children’s Commission.

In 1921, she went back to Washington, D.C. when President Warren G. Harding appointed her as chief of the Children’s Bureau. In this role, she saw the passage of the Sheppard-Towner Act, which provided the first federal grants to aid the social welfare of children and authorized government cooperation with states that promoted maternal and child health. She championed the use of sociological data to guide the lawmaking process, calling for the collection and incorporation of research on child labor, juvenile delinquency, and dependency. During her term, the Bureau helped fund more than 100 social research investigations including “Maternal Mortality in 15 States,” “Children in Agriculture,” and “Children in Street Work.”

In response to the Depression in 1929, Abbott advocated for federal relief aid by collecting and distributing relief reports from 203 cities to national agencies. From 1922 to 1934, Abbott also served as official representative of the U.S. on the League of Nations’ advisory committees on trafficking of women and on child welfare. She served as President of the National Conference of Social Work, and even supported the organization of the first Conference on Social Work in Paris in 1928. After resigning in 1934, Abbott held a professorship at the University of Chicago’s School of Social Service Administration and was editor of the Social Service Review. Additionally, she remained politically engaged through chairing labor conferences and state committees on child labor, supporting causes such as women’s rights, participating in President Franklin Delano Roosevelt’s council on economic security, and helping to draft the Social Security Act. She died in 1939.

For more information on Abbott and her life, visit the following links:

Grace Abbott : An Introduction (YouTube video; 4:22 minutes)
https://socialwelfare.library.vcu.edu/organizations/childrens-bureau/abbott-grace/
https://www.britannica.com/biography/Grace-Abbott
http://www.ssa.uchicago.edu/grace-abbott
Good Housekeeping article, One of America’s 12 Greatest Women: http://www.ssa.uchicago.edu/grace-abbott-one-americas-12-greatest-women

Primary Documents from the Children's Bureau National Archives Collection

Published Works

Abbott, G. (2010). The Treatment of Aliens in the Criminal Courts (Report of a Sub-Committee of Committee G of the Institute). The Journal of Criminal Law and Criminology (1973-), 100(2), 331-344. Retrieved May 29, 2020, from www.jstor.org/stable/20753697.

Article describes how immigrants were treated by the legal system in Chicago.

Abbott, G. (1933). The Child. American Journal of Sociology, 38(6), 880-888. Retrieved May 29, 2020, from www.jstor.org/stable/2767396.

Article summarizes the impact of the depression and unemployment on children and maternal health so far.

Abbott, G. (1932). The Child. American Journal of Sociology, 37(6), 949-955. Retrieved May 29, 2020, from www.jstor.org/stable/2767007.

Summary of census figures relating to children in the United States, as well as summaries of studies and legislation relating to maternal and child health in 1931.

Abbott, G. (1930). The Federal Government in Relation to Maternity and Infancy. The Annals of the American Academy of Political and Social Science, 151, 92-101. Retrieved May 29, 2020, from www.jstor.org/stable/1016982.

Article discusses how the establishment of the Children’s Bureau has impacted maternal and child health and has contributed to increased attention on issues of maternal and child health.

Abbott, G. (1915). The Midwife in Chicago. American Journal of Sociology, 20(5), 684-699. Retrieved May 29, 2020, from www.jstor.org/stable/2763409.

Article discusses the presence and use of midwives for birth and the lack of training and regulation the profession receives. The article presents some suggestions, such as licensing and examination, to improve the quality of midwifery.

Abbott, G. (1908). The Chicago Employment Agency and the Immigrant Worker. American Journal of Sociology, 14(3), 289-305. Retrieved May 29, 2020, from www.jstor.org/stable/2762712.

This article presents the findings of an investigation into the employment opportunities immigrants receive through the Chicago Employment Agency, how the immigrant may be exploited, and what laws are necessary to protect immigrants against this exploitation.

Abbott, G. (1917). The immigrant and the community. New York, NY: J. S. Ozer. Retrieved from https://hdl.handle.net/2027/mdp.39015010848763.

A book on the immigrant experience in the United States at the time, a discussion of how policy has not adequately provided for immigrants, and how policies may be better adapted to better reflect the immigrant experience.

Children’s Bureau Reports

United States. Children's Bureau. (1923). Eleventh Annual Report of the Chief, Children's Bureau to the Secretary of Labor. Washington, D.C.: U.S. G.P.O. Retrieved from https://hdl.handle.net/2027/mdp.39015029392878.

Annual report on the activities of the Children’s Bureau regarding the administration of the Maternity and Infancy Act, maternal mortality, and birth registration, among other activities of the Bureau.

United States. Children's Bureau. (1930). Juvenile-Court Statistics. Washington, DC: Children's Bureau. https://hdl.handle.net/2027/umn.31951000839280y.

Fourth annual report on statistics from juvenile courts, focusing on delinquency, dependency and neglect, and other subjects of children’s cases in juvenile court.

United States. Children's Bureau. (1925). What builds babies?: The mother's diet in the pregnant and nursing periods. [Washington: U.S. Government Printing Office]. Retrieved from https://hdl.handle.net/2027/uc1.$b172003.

An educational pamphlet to educate pregnant mothers on proper nutrition so they birth healthy babies.

United States. Children's Bureau. (1929). Out of babyhood into childhood, 1 to 6 years ... [Washington]: U.S. Govt.Print. Off. Retrieved from https://hdl.handle.net/2027/uc1.b3120016.

An educational pamphlet for parents on how to create a healthy living environment and good habits so their babies grow up healthy.

United States. Children's Bureau., Steele, G. (1923). Maternity and Infant Care in a Mountain County in Georgia. Washington: Govt. Print. Off. Retrieved from https://hdl.handle.net/2027/miun.adz0777.0001.001.

A report from a series on child welfare in rural areas. This report comes from fieldwork conducted in rural Georgia.

United States. Children's Bureau. (1922). Illegitimacy laws of the United States passed during the years 1919 to 1922, inclusive. Washington: Govt. Print. Off. Retrieved from https://hdl.handle.net/2027/mdp.39015015368627.

A compilation of illegitimacy laws that were passed in the United States during 1919 through 1922.

United States. Children's Bureau., Legg, C. Ella., Crowder, G. Lynde (Meigs)., Rude, A. Elizabeth. (1922). Physical status of preschool children, Gary, Ind.. Washington: Govt. Print. Off. Retrieved from https://hdl.handle.net/2027/uc2.ark:/13960/t1fj2m72x.

A report on the physical conditions of children in Gary, Indiana, conducted through examinations of children under the age of 7. This report was conducted to accompany the studies of infant mortality and of the preschool child in Gary.

United States. Children's Bureau., West, M. (1922). Child care: the preschool age. Washington. Retrieved from https://hdl.handle.net/2027/uc2.ark:/13960/t9183j50b.

An educational report discussing the care of children between the ages of 2 and 6. This report is targeted to mothers.

United States. Children's Bureau., Woodbury, H.S. (1922). The Working Children of Boston: A Study of Child Labor Under a Modern System of Legal Regulation. Washington, DC: Children's Bureau.

A report focusing on children under the age of 16 who work in Boston, MA and the conditions they face in the workplace.

United States. Children's Bureau. Physical Standards for Working Children. Washington: Govt. Print. Off. Retrieved from https://hdl.handle.net/2027/uiug.30112033477545.

A report on the conditions of working children in the United States, as well as the changes in child labor legislation that have happened since the first report on standards for working children.

Katharine F. Lenroot (1934–1951). Serving as MCH Ambassador to the World.

Katharine F. Lenroot (1934–1951)

Serving as MCH ambassador to the world

The Children’s Bureau Era, Under the Department of Commerce and Labor

Biographical Information

Katharine F. Lenroot was born in Superior, Wisconsin on March 8, 1891. She attended University of Wisconsin, Madison, from which she graduated in 1912 with degrees in economics and sociology. After college, she began her career as a deputy at the Industrial Commission of Wisconsin as an assistant to Emma O. Lundberg. In 1914, Lundberg was appointed as the first director of the Social Service Division of the United States Children’s Bureau so Lundberg and Lenroot moved to Washington, D.C. There, Lenroot served as a special investigator in the division until being promoted to Assistant Director. She largely focused her work on juvenile courts and issues affecting unmarried mothers and their children. Lenroot rapidly ascended the ranks of the Children’s Bureau, becoming the Director of the Editorial Division (June 1921) and then the Assistant Chief of the Bureau (November 1922).

When Grace Abbott retired as Chief in 1934, President Franklin Delano Roosevelt appointed Lenroot as the Bureau’s third Chief. The Bureau’s responsibilities expanded substantially under the FDR administration. During her term, Lenroot worked on the design and advocacy for Title IV (Aid to Dependent Children), and Title V and VII of the Social Security Act (1935). She also led efforts to address child labor, maternal and infancy health concerns, expanded services for disabled, neglected, and dependent children, aid for soldiers’ wives and children, and international children’s welfare. During her term, she was the United States representative on the executive board of UNICEF, helping to set the new organization’s agenda. Martha May Eliot succeeded Lenroot as chief of the Bureau in 1951. Meanwhile, Lenroot continued to work with UNICEF. She also remained active in child welfare work particularly in collaboration with the Child Welfare League of America, and the International Union for Child Welfare. She died in 1982.

For more information on Lenroot and her life, visit the following links:

Primary Documents from the Children's Bureau National Archives Collection

Published Works

Lenroot, K.F. (1942). Children in the World for Which We Strive. World Affairs, 105,3, 163-169. https://www.jstor.org/stable/20663741.

Lenroot addresses the window the end of the War presents as a chance to improve the conditions under which children are raised and equip them to be be citizens of democratic institutions. She discusses the rights and opportunities of childhood, and the stakeholders and strategies needed to promote and maintain these.

Lenroot, K.F. (1935). Children of the Depression: A Study of 259 Families in Selected Areas of Five Cities. Social Services Review, 9,2,212-242. Retrieved from https://www.jstor.org/stable/30010450.

Lenroot describes brief studies of several cities to characterize the impact of the Great Depression on child welfare. She characterizes the families selected and details the cities’ characteristics with respect to their economic situation, public relief, health services, and educational/recreational opportunities. To determine the impact of the Depression on families, she reports the effect on their financial resources and standards of living and family life, and underscores current needs of these families and problems of youth. She ultimately calls for manners in which to address these needs such as more accessible and available health services or more adequate relief (especially on the basis of employment).

Lenroot, K.F. (1944). Youth and Government. Annals of the American Academy of Political and Social Science, 236,1,161-168. Retrieved from https://doi.org/10.1177/000271624423600121.

Lenroot characterizes the current state of and ideal relationship between youth and government. She argues that all citizens must be aware of youth’s needs in the postwar world, and collaborate with youth to ensure they are met.

Lenroot, K.F. (1946). What the 79^th Congress Did for Children’s Services. The Compass, 28,1,13-16. Retrieved from https://www.jstor.org/stable/23704857.

Lenroot reports on measures passed in the 79^th Congress that directly and indirectly served children. She discusses Public Law 719 (which amended Title V), matching by state and local funds for maternal and child health grants, states’ use of new funds, emergency maternity and infant care, the National Mental Health Act, federal aid for school lunches, the Hospital Survey and Construction Act, child welfare services, and the National Commission on Children and Youth.

Lenroot, K.F. (1937). Twenty-Fifth Anniversary of the Children’s Bureau, United States Department of Labor. California and Western Medicine, 46,5, 355-357.

Lenroot describes progress made over the last twenty-five years in maternal and child health. She then proposes new goals for the next twenty-five years that acknowledge current problems to be solved and needs to be met, such as reducing the infant death rate and eliminating child labor.

Lenroot, K.F. (1935). The Welfare of Children. American Journal of Sociology, 40,6, 746-754. Retrieved from https://www.jstor.org/stable/2768342.

Lenroot discusses the current state of child welfare with respect to issues including child labor, juvenile delinquency, and nutrition. She argues that the proposed social security program will promote normal health, and welfare of mothers and children.

Lenroot, K.F. (1942). The Significance of the Children’s Charter in Wartime. ALA Bulletin, 36,11(1), 613-618. Retrieved from http://www.jstor.com/stable/25691518.

Lenroot outlines the impact of war conditions and the role of community agencies in collaboration with parents/other adults in the family circle on child welfare in her address to the Division of Libraries for Children and Young People. She gives specific suggestions on how libraries and library associations can help.

Lenroot, K.F. (1949). The Mid-Century White House Conference and Social Workers. Social Work Journal, 30,3,135-137. Retrieved from https://www.jstor.org/stable/23706512.

Lenroot outlines the rationale for holding and subsequent potential impact on child welfare in the future of the Mid-Century White House Conference and Social Workers. She describes needs to be discussed during the conference and possible deliverables from these discussions.

Lenroot, K.F. (1937). The Health-Education Program of the Children’s Bureau, with Particular Reference to Negroes. The Journal of Negro Education, 60,3, 506-512. Retrieved from https://www.jstor.org/stable/2292298.

Lenroot describes the purposes and organization of the Children’s Bureau, its maternal and child activities, and the specific health needs of and extension of services to black children. She notes that black individuals encounter specific economic and social challenges, underscoring the value of federal and state initiatives at meeting the needs of this vulnerable population

Lenroot, K.F. (1949). The Community and Its Children. American Journal of Nursing. 49,11,685-686. Retrieved from https://www.jstor.org/stable/3467889.

Lenroot calls for the expansion and improvement of all professional services related to children in order to support their optimal growth and development. She specifically highlights the need for high-quality, accessible medical care for all children, research on child development (physical, emotional, social) and service provision (e.g. child care, social work, etc.), and special topics (e.g. preparation for parenthood, social security, education, more training for professionals who serve children and youth).

Lenroot, K.F. (1944). The Children’s Bureau and Libraries. ALA Bulletin, 38,1, 26-27. Retrieved from https://www.jstor.org/stable/25691765.

Lenroot details the set-up of the Children’s Bureau and its relation to libraries. She argues that the library is a critical means through which the Children’s Bureau is able to stimulate community action for children’s welfare.

Lenroot, K. (1921). Social Responsibility for the Protection of Children Handicapped by Illegitimate Birth. The Annals of the American Academy of Political and Social Science,98, 120-128. Retrieved from jstor.org/stable/1015053.

Lenroot presents illegitimacy in the context of child welfare, outlining its background, prevalence in the United States, hazards to the children, relation to dependency and delinquency, and standards of legal protection. She argues that the existence of illegitimate children requires action to protect their rights and ensure that the child’s, parents’, and society’s needs are met.

Lenroot, K.F. (1933). Reviewed Work(s): The Children’s Judge. Frederick Pickering Cabot by M.A. DeWolfe Howe. Social Service Review, 7, 1, 142-143. Retrieved from https://www.jstor.org/stable/30010011.

Lenroot reviews Howe’s account of the personality and work of Frederick P. Cabot, judge of the Boston Juvenile Court. She describes it as ‘more than a biography,’ instead an account of an individual who had dedicated himself to understanding and addressing the needs of others.

Lenroot, K.F. (1933). Reviewed Work(s): A Working Manual for Juvenile Court Officers. Social Service Review, 7, 1, 143-144. Retrieved from https://www.jstor.org/stable/30010012.

Lenroot reviews Ralph Riley’s manual for social workers, students, and candidates for positions at the court preparing for an examination. She notes that this booklet is not only locally important, but also a critical resource for understanding the general legal framework of a juvenile court’s typical functions.

Lenroot, K.F. (1927). Reviewed Work(s): Juvenile Courts in the United States by Herbert H. Lou. American Bar Association Journal, 13, 12, 734. Retrieved from https://www.jstor.org/stable/25707314.

Lenroot reviews Herbert Lou’s volume on juvenile courts in the United States in which he outlines the background of the court, its structure, and its current practices with special reference to certain issues (e.g. institutional care, probation). She commends his clear attention to detail and care to ensure that the work is up to date and accurate.

Lenroot, K.F. (1929). Reviewed Work(s): El Huérfano (The Orphan) by Ismal Valdés Valdés. Social Services Review, 3, 1, 136-137. Retrieved from https://www.jstor.org/stable/30009297.

Lenroot reviews Valdés’ account of modern methods of prevention of and treatment for child dependency. She cites Valdés’ expertise on social problems in South America, and describes areas of need and related recommendations for ‘orphans’ and child welfare in general.

Lenroot, K.F. (1934). Regional Conferences on Juvenile Delinquency. Social Service Review, 8, 2, 370-371. Retrieved from https://www.jstor.org/stable/30010233.

Lenroot reports on two regional conferences held by the Children’s Bureau, U.S. Department of Labor, and the Bureau of Prisons, U.S. Department of Justice. She describes attendees, subjects discussed (e.g. juvenile court organization, state and community efforts to address problem children, probation service), and resolutions and committee reports adopted. Agreements reached included the condemnation of jail detention of children, the request for adequate resources for detention care, and a call for the development of community-wide programs to prevent and treat juvenile delinquency.

Lenroot, K.F. & Myers, R.J. (1940). Population Trends and Future Problems of Child Welfare. The Milbank Memorial Fund Quarterly, 18, 3, 198-213. Retrieved from https://www.jstor.org/stable/3347879.

Lenroot outlines population trends and their significance in relation to the child population as well as to the aims of families, communities, and the nation as a whole. She highlights social interest in children as our primary concern over population policy, and notes specific trends in child populations. She then discusses population trends in the context of family life, community services to children, and state and national planning for children.

Lenroot, K. F. (1935). National Aspects of the Social Security Program as They Pertain to the Children's Bureau. American journal of public health and the nation's health, 25(12), 1327–1333. Retrieved from https://doi.org/10.2105/ajph.25.12.1327.

Lenroot gave this address during a Special Session at the Health Officers Section of the American Public Health Association’s (APHA) 64^th Annual Meeting in 1935. She outlines the national activities of Social Security in which the Children’s Bureau is involved, and calls for counsel and assistance from the APHA in their execution. She underscores the value of these activities as tools for supporting the optimal development of children and strengthening communities and families.

Lenroot, K.F. (1936). Maternal and Child Welfare Provisions of the Social Security Act. Law and Contemporary Problems, 3,2, 253-262. Retrieved from https://www.jstor.org/stable/1189394.

Lenroot describes the intent and impact of the maternal and child welfare provisions in the Social Security Act in this article. She begins by addressing the rationale for the specific MCH provisions in a broad economic program and outlining the conditions that made these provisions necessary. She then summarizes the parts of the Act administered by the Children’s Bureau.

Lenroot, K. F. (1947). International children's emergency fund. Social Security Bulletin, 10(4), 7-10.

Lenroot, then serving as the United States representative on the International Children’s Emergency Fund, calls for the organization of a cooperative, international effort to extend aid to children in war-torn areas. She also discusses potential barriers to this aid should the Fund be implemented that year.

Lenroot, K.F. (1943). Inter-American Co-Operation for Child Welfare and Its Meaning for the Post-War World. Social Service Review, 17,4, 393-407. Retrieved from https://www.jstor.org/stable/30014153.

Lenroot describes the beginning of inter-American cooperation, specifically reflects on a visit to South America that year to attend the International Council of the American International Institute for the Protection of Childhood, underscores the significance of inter-American experience for the post-war world, and discusses how to strengthen this cooperation for the protection of children worldwide. She also notes her observations on professional training in different South American countries and establishes the current state of social service and child welfare across the continent.

Lenroot, K.F., Daily, E.F., Glasser, M.A. (1950). Health and the Child. Public Health Reports (1896-1970),65, 46,1525-1528. Retrieved from https://www.jstor.org/stable/4587543.

In this report on health resources in defense of the nation, Lenroot notes that children present a greater challenge than ever to public health workers. She highlights advances being made as the population of children grows rapidly. She also emphasizes that policies and funding must ensure that these advances can adequately support the optimal development of children.

Lenroot, K.F. (1939). Health Security for Mothers and Children. Annals of the American Academy of Political and Social Science, 202, 1, 105-115. Retrieved from https://doi.org/10.1177/000271623920200114.

Lenroot outlines how Title V of the Social Security Act (1935) supports health security for mothers and children through stipulations such as grants-in-aid to states and the expansion and improvement of health services for mothers and children. She describes Parts 1 and 2 of Title V, and their implications for administration at the federal, state, and local levels and scope and type of services provided. She also discusses the National Health Program and its potential benefits for mothers and children.

Lenroot, K.F. (1946). Europe’s Children Need Help Now. World Affairs, 109, 1, 38-43. Retrieved from https://www.jstor.org/stable/20664253.

In this report, Lenroot emphasizes to all Americans the importance of restricting food consumption so Europe may receive adequate shipments to feed its population. She argues that Europe currently faces the tremendous undertaking of rebuilding in the wake of World War II, and it has never been so critical to support children in this process.

Colcord, J.C., Lenroot, K.F., Shulman H.M., and Maller, J.B. (1932). Discussion of ‘Are Broken Homes a Causative Factor in Juvenile Delinquency?’ Social Forces, 10, 4, 525-533. Retrieved from https://www.jstor.org/stable/2569900.

Lenroot reviews an article by Dr. Shaw on the role of family factors in social maladjustment (in this case, juvenile delinquency). She acknowledges the significance of this topic, but disagrees with Shaw’s argument for broken homes as the central cause of juvenile delinquency, instead preferring a more holistic approach to understanding the multiple factors driving delinquency.

Lenroot, K. F. (1936). Children in the social security program. National Municipal Review, 25(4), 200-204.

Lenroot describes the supplemental appropriations made for maternal and child health services, aid to crippled children, and child welfare to be allocated during the fiscal year 1936. She structures her report around the background for the funding, aid to dependent children, maternal and child health services, crippled children, and administration.

Lenroot, K.F. (1933). Child Welfare at Geneva. Social Service Review, 7, 2, 320-321. Retrieved from https://www.jstor.org/stable/30010041.

Lenroot reports on the 1933 annual session of the Advisory Commission for Protection and Welfare of Children and Young People. She describes the members of the committees, the subjects discussed, the aims outlined, and the resolutions adopted.

Lenroot, K.F. (1940). Child Welfare 1930-1940. The Annals of the American Academy of Political and Social Science, 212, 1-11. Retrieved from http://www.jstor.com/stable/1024416.

Lenroot offers a comprehensive overview of child welfare from 1930 to 1940, characterizing its evolution as one toward a broadened concept of child welfare that relates it to the fundamental social and economic issues of the U.S. and aims to meet the needs of all children. In her review, she examines child welfare’s record over the decade in maternal and child health, education, social welfare, control of child labor, and provision for leisure-time activity, recreation, vocational guidance, and opportunity for useful employment.

Lenroot, K.F. (1936). Annual Meeting of the League of Nations Advisory Commission for the Protection and Welfare of Children and Young People. Social Service Review, 10, 3, 517-520. Retrieved from https://www.jstor.org/stable/30010723.

Lenroot reports on the 1936 annual meeting of the League of Nations Advisory Commission for the Protection and Welfare of Children and Young People. She details the representatives present, issues discussed, plans for reorganization and future meetings, and specific examination of preliminary reports on certain issues.

Lenroot, K.F. (1936). Advancing the Health and Welfare of the Nation’s Children through Federal and State Cooperation. The Milbank Memorial Fund Quarterly, 14, 2, 132-143. Retrieved from https://www.jstor.org/stable/3347781.

Lenroot discusses the approval of ten state plans for maternal and child health services through the Social Security Act. She discusses allocation of funds, expectations for states, role of the Children’s Bureau, and specific programs for vulnerable populations. She concludes with summaries of approved plans for maternal and child health services, crippled children’s services, and child welfare services.

Lenroot, K.F. (1934). Reviewed Work(s): Juvenile Detention in the United States by Florence M. Warner. Journal of Criminal Law and Criminology (1931-1951), 24, 6, 1131-1134.

Lenroot reviews this volume of the Social Service Monographs by Florence Warner on a field study of official treatment of juvenile delinquency, a critical glimpse into the need for states and communities to improve their approach to the issue. She summarizes the study’s findings, and contextualizes them with the general juvenile court movement. She calls for greater attention to alternative methods of detention care and more resources on best practices in juvenile delinquency.

Lenroot, K.F. (1950). Child welfare: A Challenge to Both Private and Public Agencies. Social Service Review, 24, 1, 1-7. Retrieved from https://www.jstor.org/stable/30018393.

Lenroot presented this paper at the 66^th Annual Meeting of the Illinois Children’s Home and Aid Society. She discussed past advances in child welfare over the first half of the twentieth century, and necessary areas for improvement and action in the second half. She calls for passionate, evidence-based, organized, and collaborative efforts to care for children across the globe.

Lenroot, K. (1925). The Place of the Juvenile Court in a Community Program for Child Welfare. The Annals of the American Academy of Political and Social Science,121, 60-69. Retrieved from jstor.org/stable/1015580.

Lenroot discusses the role of the juvenile court in a community program for child welfare by exploring the initial aims of the first children’s courts, the extent to which those purposes are being fulfilled, and the court’s place in relation to other agencies.

Lenroot, K.F. (1923). The Evolution of the Juvenile Court. The Annals of the American Academy of Political and Social Science, 105, 213-22. Retrieved from http://www.jstor.com/stable/1015198.

Lenroot presents a history of the juvenile court, beginning with its English precedents and initial existence in the United States. She outlines its first laws, theory underlying its procedures, development since 1910, and other aspects such as the socialization of court procedure and probationary supervision. She also highlights the national movements for standardization of juvenile court work, suggesting potential next steps for the juvenile court’s evolution.

Lenroot, K.F. (1949). The Children’s Bureau and Health Education. The Journal of Negro Education, 18,3,388-397. Retrieved from https://www.jstor.org/stable/2966146.

Lenroot discusses the role of the Children’s Bureau in health education, a topic she argues exists in every phase of the services the Bureau provides. She discusses and cites examples of education combined with services and/or in a health center, publications for parents, and education in the context of services for MCH and/or crippled children. Finally, she cites May Day as a holiday specifically dedicated to health education and children.

Martha M. Eliot, MD (1951–1956). Establishing programs based on social medicine.

Martha M. Eliot, MD (1951–1956)

Establishing government programs based on an understanding of social medicine

The Children’s Bureau Era, Under the Social Security Administration

Biographical Information

Martha May Eliot was born in Dorchester, Massachusetts on April 7, 1891. She attended Radcliffe College and worked in the Social Service Department at Massachusetts General Hospital the year after graduating. She then went on to graduate from Johns Hopkins University’s medical school in 1918. After medical school, Eliot taught in the Department of Pediatrics at Yale University from 1921 until 1935 while directing the National Children’s Bureau Division of Child and Maternal Health from 1924 until 1934. In the 1930s, she conducted epidemiological field studies on rickets in Puerto Rico and New Haven, Connecticut, and on the therapeutic utility of sunlight and vitamin D in the disease’s prevention and treatment.

She became Chief of the Bureau in 1951. Her work with the Bureau focused on the establishment of government programs based on her understanding of social medicine. Specific initiatives under the leadership of Director Lenroot included the legislation and policies for Title V of the Social Security Act (1935) and the creation and implementation of the Emergency Maternity and Infant Care Act during World War II. As Chief, she continued to facilitate the effective implementation of these programs and worked to increase resources for children in rural areas and disabled children. She also served in leadership roles in the World Health Organization and UNICEF. Eliot resigned from Chief in 1956 and was replaced by Katherine Oettinger. In 1956, Eliot became Department Chairman of Child and Maternal Health at Harvard University’s School of Public Health before retiring in 1959. She died on February 14, 1978.

For more information on Eliot and her life, visit the following links:

Primary Documents from the Children's Bureau National Archives Collection

Published Works

Eliot, M. (1926). The New Haven Demonstration of Community Control of Rickets. The Public Health Journal, 17(3), 114–116.

This study details the New Haven Demonstration, which aimed to control rickets in a community through the regular use of cod liver oil and sunbaths. Among babies that received these interventions, the disease was fully controlled such that babies only developed the ‘slightest evidence’ of rickets.

Eliot, M. (1934). Child health 1933–1934. The Journal of Pediatrics, 4(6), 817–837. https://doi.org/10.1016/S0022-3476(34)80097-2.

In this review, Eliot presents information on the Great Depression and its impact on child health and health services. She then details efforts taken to shed light on some of these issues in an attempt to protect children’s health in the future.

Eliot, M. (1936). Consumer demand for vital statistics: The Need of the Child Hygienist. American Journal of Public Health and the Nations Health, 26(5), 493–496. https://doi.org/10.2105/AJPH.26.5.493.

Dr. Eliot read this before the Vital Statistics section of the APHA annual meeting in 1935, underscoring the value of vital statistics (mortality figures by state with information on deaths in urban/rural areas by race, age, cause, etc.) in planning and implementing community programs. Moreover, she argues that this information would illuminate significant systemic problems.

Eliot, M., Nelson, E., Barnes, D., Browne, F., & Jenss, R. (1936). A study of the comparative value of cod liver oil, viosterol, and vitamin D milks in the prevention of rickets and of certain basic factors influencing their efficacy. The Journal of Pediatrics, 9(3), 355–376. https://doi.org/10.1016/S0022-3476(36)80028-6.

The authors describe a series of studies to illuminate the relative efficacy of different forms of vitamin D at different dosage levels at preventing rickets during the winter months of 1933-1936 in Detroit, Michigan. These different treatments were intended to equip physicians and other public health officials with practical tools to protect infants at home from rickets.

Eliot, M. (1936). Progress in Maternal and Child Welfare Under the Social Security Act. American Journal of Public Health and the Nations Health, 26(12), 1155–1162. https://doi.org/10.2105/AJPH.26.12.1155.

In this report to the Child Hygiene Section of the American Public Health Association, Dr. Eliot discusses relevant progress in maternal and child welfare in the eight months since the passage of Title V under the Social Security Act in August 1935. She also presents a case for stronger coordination for and cohesive provision of services to support maternal and child health and welfare via this component of Social Security.

Eliot, M. (1937). Concerning May Day--Child Health Day, 1937. California and Western Medicine, 46(4), 280–281. http://search.proquest.com/docview/1774969510/.

Dr. Eliot writes to the editor asking that the journal emphasize the importance of “Health protection for every child” in connection with May Day-Child Health Day, 1937. She hopes the journal will enclose suggestions on observance of the holiday with notice of the event in this state’s medical journal.

Eliot, M. (1937). Maternal Care—The Principles of Antepartum, Intrapartum and Postpartum Care for the Practitioner of Obstetrics. American Journal of Public Health and the Nations Health, 27(11), 1184–1186. https://doi.org/10.2105/AJPH.27.11.1184-b.

Dr. Eliot reviews a manual for maternal care intended for the family physician. She underscores its value, highlights some of its content, and discusses its implications for maternal and child health.

Eliot, M., Bierman, J., & Van Horn, A. (1938). Accomplishments in maternal and child health and crippled children services under the social security Act. The Journal of Pediatrics, 13(5), 678–691. https://doi.org/10.1016/S0022-3476(38)80159-1.

Dr. Eliot outlines specific accomplishments in maternal and child health and crippled children services under the Social Security Act’s provision of federal grants to states for maternal and child welfare. She describes administrative procedures, briefly discusses ongoing programs by the states, the qualifications and training of personnel, and cooperative approaches by key stakeholders.

Eliot, M. (1939). Subject: “May Day”--Children’s Bureau of United States Department of Labor. California and Western Medicine, 50(3), 239. http://search.proquest.com/docview/1774977357/.

Dr. Eliot writes to the editor on suggestions for May Day-Child Health Day, 1939. She underscores the importance of medical care for all children and nutrition guidance, and notes that the execution of this holiday will depend on state choices.

Souther, S., Eliot, M., & Jenss, R. (1939). A Comparison of Indices Used in Judging the Physical Fitness of School Children. American Journal of Public Health and the Nations Health, 29(5), 434–438. https://doi.org/10.2105/AJPH.29.5.434.

The authors, members of a partnership between the US Children’s Bureau, the Institute of Human Relations, and the Department of Pediatrics at Yale University School of Medicine, report findings on their comparison of indices to evaluate a child’s health (regarding child’s general nutritional condition and annual rate of gain in weight). The four indices used, the Baldin-Wood index, the ACH and Nutritional Status Indices of Franzen, and the Pryor Width-Weight index, were applied to 713 7-year-old children observed for 19-20 months in New Haven, CT during 1934 to 1936. The indices did not successfully capture the significant proportion of children who were malnourished and/or had not gained a satisfactory amount of weight.

Eliot, M. (1941). Protection of Children in Great Britain in Wartime. American Journal of Public Health and the Nations Health, 31(11), 1128–1134. https://doi.org/10.2105/AJPH.31.11.1128.

Dr. Eliot addresses how children were protected during World War II in Great Britain. She then uses this to highlight a gap in American preparation for war, noting that we lack a critical set of supports for maternal and child health nationwide and particularly in smaller towns and cities. This unpreparedness led to the establishment of an interdepartmental committee on the health and welfare components of civilian evacuation to study the issue and determine appropriate protocols.

Eliot, M. (1941). Children in the defense program. The Journal of Pediatrics, 19(6), 740–747. https://doi.org/10.1016/S0022-3476(41)80100-0.

In this article, Dr. Eliot summarizes health and welfare services for children in the defense program. She highlights the need for more services for children in ‘defense’ regions and beyond; presents what has been done to address this need; and details ongoing planning should the ‘defense situation’ become a more acute emergency.

Eliot, M. (1941). New Frontiers of Health and Welfare. Social Service Review, 15(4), 636–650. https://doi.org/10.1086/633718.

Dr. Eliot presents an account of health and welfare in the United States, highlighting specific areas of growth and progress alongside disparities and inequities. She then argues that the ‘frontiers of health and welfare’ will remain open until there is true equal opportunity for all citizens to have enough food, appropriate housing, accessible education, and adequate health care.

Eliot, M. (1942). The Effect Of War And Civil Defense On Children: The British Experience. Social Service Review, 16(1), 1–36. https://doi.org/10.1086/633831.

Dr. Eliot presents a comprehensive review of the impact of war and civil defense on children in Great Britain through examining the effect on various facets of society and how society has responded. She examines a diverse array of impacted components of society for children including social services, physical and mental health, food availability, and youth recreation centers.

Eliot, M. (1944). Experience with the Administration of a Medical Care Program for Wives and Infants of Enlisted Men. American Journal of Public Health and the Nations Health, 34(1), 34–39. https://doi.org/10.2105/AJPH.34.1.34.

This study discusses Congress’ appropriation of $18.6 million for emergency maternity and infant care for the wives and infants of enlisted men in specific pay grades in the armed forces. She notes the purpose of this program to be to keep the soldiers’ wives from worrying about getting necessary care for themselves and their children and to reassure the men that their families are cared for in their absence. She details the value of this program, its principles of implementation, the challenges with the initiative, and the role of the Children’s Bureau.

Eliot, M. (1944). The Children’s Bureau, EMIC and postwar planning for child health. The Journal of Pediatrics, 25(4), 351–367. https://doi.org/10.1016/S0022-3476(44)80081-6.

Dr. Eliot discusses the intent and interests of the Children’s Bureau in serving children during wartime and in postwar planning. Regarding wartime services, she describes the Emergency Maternity and Infant Care Program’s design, implementation and impact, and the role of the Children’s Bureau. For postwar planning for child health, the statement outlines why and how the Children’s Bureau will build a more expansive, evidence-based peacetime program to serve mothers and children.

Eliot, M. (1945). PII: S0022-3476(45)80159-2. The Journal of Pediatrics, 27(2), 198–201. https://doi.org/10.1016/S0022-3476(45)80159-2.

This letter to the then-President of the American Academy of Pediatrics, Joseph S. Wall, is a response to Dr. Wall’s correspondence on the Post-War Planning Committee’s plans to study child health postwar. Dr. Eliot also thanks Dr. Wall for sharing with her the Executive Board’s discussions on expansion of MCH programming based on the Children’s Bureau Steering Committee on Health Services and the report by the National Commission on Children in Wartime. She then elaborates on the value of this study for the development for future MCH initiatives, calls for data transparency, highlights some issues around services for ‘crippled children,’ and underscores the need for both standardization and more state-specific recommendations.

Eliot, M., & Heseltine, M. (1947). NUTRITION IN MATERNAL AND CHILD HEALTH PROGRAMS. Nutrition Reviews, 5(2), 33–35. https://doi.org/10.1111/j.1753-4887.1947.tb04100.x.

Dr. Eliot outlines nutrition in maternal and child health programs by discussing the critical importance of nutritional requirements for children and their application. She discusses the theory behind and implementation of nutritional interventions, and addresses critical limitations in the provision of nutrition services in MCH programs.

Eliot, M., & Freedman, L. (1947). Four Years of the EMIC Program. The Yale Journal of Biology and Medicine, 19(4), 621–635.

This article refers to the Emergency Maternity and Infant Care program approved in April 1943, the first appropriation for maternal and infant care for wives of enlisted men in the U.S. armed forces. The authors discuss the gap EMIC filled, its principal purpose, its implementation, and the scope of its impact thus far.

Eliot, M. (1948). Child Feeding in Europe Under the International Children’s Emergency Fund. American Journal of Public Health and the Nations Health, 38(1_Pt_1), 1–7. https://doi.org/10.2105/AJPH.38.1_Pt_1.1.

Dr. Eliot addresses the Food and Nutrition Section of the American Public Health Association at their 1947 Annual Meeting to persuade members collectively and individually to support the work of the International Children’s Emergency Fund. She reviews the situation that led to the creation of the Fund, and then outlines current activities and future plans for it.

Eliot, M. (1948). Cultivating Our Human Resources for Health in Tomorrow’s World. American Journal of Public Health and the Nations Health, 38(11), 1499–1507. https://doi.org/10.2105/AJPH.38.11.1499.

This is the Presidential Address delivered by Dr. Eliot to the American Public Health Association at their 76^th Annual Meeting in Boston, Massachusetts. Dr. Eliot calls for cultivating resources for health by focusing on action for the nation’s children to equip them for successful futures. She tasks her audience with working to gain ‘time for peace,’ and to realize their full potential in supporting health for all, especially for children.

Eliot, M. (1950). Advisory Services Of The World Health Organization. The British Medical Journal, 1(4661), 1027–1032.

Dr. Eliot outlines the means by which the World Health Organizations grants aid to governments to support health services sustainably. She discusses aspects of the WHO’s approach to international aid such as types of services provided, expert committees, fellowships, scientific information, demonstration projects.

Eliot, M. (1952). New Horizons for Child Health: The Children. Public Health Reports (1896-1970), 67(2), 169–171. https://doi.org/10.2307/4588023.

In this profile of child health in the United States, Dr. Eliot begins with noting the significant nationwide reduction in infant mortality between 1915 and 1950. However, she underscores the disparities in various components of child health evident upon a closer look, and addresses the current state of and potential next steps for health services for children, handicapped children, and regional programs. She then highlights the role of the Children’s Bureau in facilitating effective initiatives that address the ‘health and welfare aspects of this business of growing up’ at the local, state, and federal levels.

Eliot, M. (1953). Report on Child Health and Welfare. Public Health Reports (1896-1970), 68(2), 183–187. https://doi.org/10.2307/4588386.

Dr. Eliot reports on the disproportionate increase in children and its implications for health, welfare, and education nationwide. She addresses disparities in health needs and outcomes among states and counties, underscores the importance of collaboration, and specifically highlights topics of significance on which the bureau is focused such as infant prematurity and the health of the children of migrant workers.

Eliot, M. (1953). Health Services and Juvenile Delinquency. Public Health Reports (1896-1970), 68(6), 572–577. https://doi.org/10.2307/4588484.

Dr. Eliot discusses the work of the Children’s Bureau on improving treatment for juvenile delinquents. She highlights the connection between child health and child welfare, and between health services and social services.

Eliot, M. (1953). A New Start on an Old Problem: Juvenile Delinquency Project. Juvenile Court Judges Journal, 4(1), 32–34. https://doi.org/10.1111/j.1755-6988.1953.tb00506.x.

Dr. Eliot presents the issue of juvenile delinquency and its relevance to the Children’s Bureau. She details the current campaign and project by the Bureau to acquire information on the topic, increase public awareness, improve practices (including prevention) in addressing the issue, and promote collaboration among federal, state, and local agencies.

Eliot, M. (1954). Child Health Programs: Federal-State Funds and Current Problems. Public Health Reports (1896-1970), 69(1), 66–72. https://doi.org/10.2307/4588704.

In this report, Dr. Eliot gives an update on the current state of the Children’s Bureau regarding child health issues, current progress, federal-state funding and collaboration, and future endeavors. Specific issues highlighted include mental retardation; juvenile delinquency; migratory workers’ children; and premature births.

Eliot, M. (1955). Child Health Problems: Juvenile Delinquency; Black Market in Babies. Public Health Reports (1896-1970), 70(3), 284–288. https://doi.org/10.2307/4589046.

Dr. Eliot provides a description of significant topics in child health, including juvenile delinquency, the ‘black market’ in babies, mental retardation, children of migrants, retrolental fibroplasia, and services for crippled children. She addresses current needs and efforts and/or future plans to address them.

Eliot, M. (1955). Twenty Years of Progress for Children. Social Security Bulletin, 18(8). http://search.proquest.com/docview/1310462081/.

Dr. Eliot describes the state of child health from the initial funding of Title V in the Social Security Act (1935) until 1955. She discusses legislative changes, program developments, and services for child welfare and maternal and child health over these twenty years.

Eliot, M. (1955). The Problem of Juvenile Delinquency. Challenge, 4(1), 36–41. https://doi.org/10.1080/05775132.1955.11468148.

This is an interview with Dr. Eliot on juvenile delinquency. She answers questions on the function of the Children’s Bureau, its relationship with states and local entities, the role of the Division of Juvenile Delinquency Service, perceptions and understandings about juvenile delinquents, and the value of behavioral modeling and support from parents.

Eliot, M. (1956). Current Trends in Child Health. Public Health Reports (1896-1970), 71(1), 33–37. https://doi.org/10.2307/4589353.

Dr. Eliot discusses the year’s activities in child health as a means to reflect on accomplishments and identify areas for improvement or new programming. She cites specific topics including helping crippled children; school health services; the school lunch program; incidence of prematurity; poison control centers; mental retardation; migratory workers; protecting adoptions; and juvenile delinquency. She also underscores the value of community collaboration among state and local agencies with federal support in these endeavors.

Eliot, M. (1956). The family today: Its needs and opportunities. Pastoral Psychology, 7(4), 23–32. https://doi.org/10.1007/BF01564749.

Dr. Eliot delivered this address at a meeting of the Family Service Association of America. She acknowledges that needs across society must be met before all children can be raised with ‘healthy personalities,’ discusses concepts related to child growth and the role of parents, describes the Children’s Bureau’s campaign to improve services to juvenile delinquents, and argues that the opportunity of the family is to strive to provide a destination for the world’s children that is ‘clearer and more certain.’

Eliot, M. (1956). Strategy for Children. Social Work, 1(4), 3–11. https://doi.org/10.1093/sw/1.4.3.

Dr. Eliot discusses how and why to support child development. She acknowledges children’s needs, the growing population, certain advances in the economy and social patterns, and areas for potential improvement. She focuses on the growth of the economy and the shift from helping children through emergencies to helping them to realize their potential through greater parental knowledge, stronger families, preventive efforts, expansion of workers for children, and more research.

Eliot, M. (1957). Perspectives in Child Health. Public Health Reports (1896-1970), 72(1), 28–32. https://doi.org/10.2307/4589679.

In this article, Dr. Eliot provides an update on the Children’s Bureau’s activities in the last year. Specific areas of focus include support for professional workers; radiological health; child health programs; and a shift in pediatric work. She notes that these activities are an investment in the future of the world.

Bierman, J., & Eliot, M. (1958). WHO Contributions to Child Health. Public Health Reports (1896-1970), 73(5), 402–411. https://doi.org/10.2307/4590139.

Bierman and Eliot laud the accomplishments of the World Health Organization and UNICEF as a ‘sound beginning’ during the first decade of this partnership, beginning with describing the contributions of the WHO to child health since its start. They highlight the collaborations between the WHO and UNICEF to support maternal and child health, discussing the scope of programming, MCH assistance to match development; growth in national MCH units; and potential for future collaboration.

Eliot, M. (1960). Report of the Chairman of the Technical Development Board to the Governing Council 1958-1959. American Journal of Public Health and the Nations Health, 50(4), 561–573. https://doi.org/10.2105/AJPH.50.4.561.

This report describes to the American Public Health Association the work of its Technical Development Board in areas including research, local public health initiatives, public health in clinical care, greater awareness of events affecting public health, and attention to the broader spectrum of health and morbidity. The Board outlines specific examples of efforts taken along these areas of action, including the establishment and actions of a Child Health Committee.

Hilleboe, H., Mattison, B., Dixon, J., Easlick, K., Eliot, M., Perkins, J., & Poole, B. (1962). Committee on Public Policy and Legislation. American Journal of Public Health and the Nations Health, 52(3), 514–516. https://doi.org/10.2105/AJPH.52.3.514.

This report by the American Public Health Association’s Committee on Public Policy and Legislation provides an update on their work from 1960 to 1961.

Eliot, M. (1962). The Children’s Bureau: Fifty Years of Public Responsibility for Action in Behalf of Children. American Journal of Public Health and the Nations Health, 52(4), 576–591. https://doi.org/10.2105/AJPH.52.4.576.

Dr. Eliot uses the 50^th Anniversary of the Children’s Bureau to reflect on its progress and look forward to its next endeavors and challenges. She describes the Bureau’s broad concern for children, their needs, and how to meet them; the impact of the Bureau’s initiatives on policy; certain principles that guide its programming; the Bureau’s effectiveness in evidence-based, collaborative, high-quality work; and potential next steps to ensure the future wellbeing of children.

Teague, R., Mattison, B., Dixon, J., Eliot, M., Knutson, J., Perkins, J., & Poole, B. (1963). Committee on Public Policy and Legislation. American Journal of Public Health and the Nations Health, 53(3), 492–496. https://doi.org/10.2105/AJPH.53.3.492.

This Report of the Chairman of the Committee on Public Policy and Legislation at the American Public Health Association annual meeting details legislation proceedings for 1963. It had been a productive year despite a relatively low number of bills. Regarding child health, the National Institute on Child Health was established, and amendments to the Maternal and Child Health and Crippled Children’s programs did not pass.

Teague, R., Mattison, B., Cherasky, M., Eliot, M., Pelton, W., Sheahan, M., & Thompson, M. (1966). Committee on Public Policy and Legislation: Report to the Governing Council, 1964-1965. American Journal of Public Health and the Nations Health, 56(3), 525–528.

In this annual report to the Governing Council, the Committee on Public Policy and Legislation outlines Congressional activities related to health. Specific issues addressed include Medicare; disease (heart disease, cancer, stroke); air pollution (solid wastes); cigarette smoking; water pollution; and family planning. Other efforts mentioned include more funding for vaccinations and schools of public health and the removal of epilepsy as grounds for exclusion from immigration.

Federal Leaders Guiding the Transition to MCH. 1956-1992.

Katherine B. Oettinger (1956–1967). Serving as the voice for children with developmental challenges.

Katherine B. Oettinger (1956–1967)

Serving as the voice for children with developmental challenges

Transformation to MCH, MCH Service, Public Health Service

Biographical Information

Katherine Brownell Oettinger was born in Nyack, New York in 1903. She received her bachelor’s degree in Sociology from Smith College in 1925, and completed her master’s degree from the Smith College School for Social Work in 1926. She served as a caseworker with the Charity Organization Society in New York City until 1929, supervising students from the future Columbia University School of Social Work. In 1929, she became a mental health consultant in the Visiting Nurse Association in Scranton, Pennsylvania. There, she met her husband, began to raise her two sons, and ultimately was appointed chief of the Division of Community Service in the Bureau of Mental Health of the Pennsylvania Department of Welfare in 1950. She administered the first National Mental Health Act funds in Pennsylvania. Then, Oettinger moved to Boston to serve as Dean of the School of Social Work at Boston University. In 1954,

President Dwight Eisenhower appointed her chief of the Children’s Bureau in the Department of Health, Education, and Welfare. Oettinger was most known for her work for children with developmental challenges. She believed strongly that these children could be cared for at home rather than institutionalized. She led a six-fold increase in the bureau’s budget and spearheaded efforts on important maternal and child health issues such as child abuse, juvenile delinquency, and day care.

She also served as secretary of the 1960 White House Conference on Children and Youth, and as chair of the Interdepartmental Committee on Children and Youth. Oettinger also held several international roles, including U.S. representative on the UNICEF executive board (1957-1961) and chair of the U.S. delegation to the 11th Inter-American Congress on Children (1959). At the end of her time as bureau chief, she became a fierce advocate for family planning. She was the first public official to speak out in its favor in 1965, leading to her appointment as Deputy Assistant Secretary for Population and Family Planning in the Department of HEW in 1968. However, she struggled to keep this a priority with presidential appointees in the Nixon administration. She retired from federal government in 1970. After her retirement, Oettinger consulted on topics related to population and family planning for organizations such as the International Association of Schools of Social Work and the Inter-American Dialogue Center, and lectured at colleges and universities. She died in Carmel, California on October 15, 1997.

For more information on Oettinger and her life, visit the following links:

Primary Documents from the Children's Bureau National Archives Collection

Published Works

Oettinger, K. (1932). A Newer Concept of Weaning. The American Journal of Nursing, 32(2), 169–171. https://doi.org/10.2307/3410773.

Oettinger outlines a more novel view of weaning that sees it not as a ‘tearing away from dependency.’ She argues that, instead, it must be understood as a normal, happy part of growing up. She discusses the connotations of this shift in understanding for child development and the relationship between mother and child.

Oettinger, K. (1935). Teaching Tools: Suggestions for Private Duty, Public Health, and Institutional Nurses. The American Journal of Nursing, 35(11), 1012–1016. https://doi.org/10.2307/3413021.

This report provides suggestions for private duty, public health, and institutional nurses as educators. She describes how nurses can strengthen their patients’ autonomy and sense of responsibility through a discussion on integrating laws of learning into actual casework, the new emphasis on repetition, the role of praise, and the spirit of the educator.

Oettinger, K. (1939). Toward Inner Freedom. The American Journal of Nursing, 39(11), 1224–1229. https://doi.org/10.2307/3413472.

This article outlines the professional identity formation of a nurse as a journey toward ‘inner freedom and independence.’ Oettinger discusses valuable attitudes and practices for nurses in this process.

Oettinger, K. (1943). Mental Hygiene and the Nurse. The American Journal of Nursing, 43(12), 1091–1094. https://doi.org/10.2307/3456376.

This article discusses the role of nurses in their patients’ mental health. Oettinger discusses aspects of nursing that make this profession uniquely suited to practicing mental hygiene. She also details particular challenges nurses may face such as identifying too closely with a patient.

Oettinger, K. (1958). Children in a Changing World. Public Health Reports (1896-1970), 73(1), 30–34. https://doi.org/10.2307/4590033.

This report presents current trends and initiatives in children’s health and welfare (on topics such as rehabilitation, home-based care, mental health in families, specialized foster family homes, definition of the role of a social worker in adoption). Oettinger outlines this information in the context of global changes such as increasing health care costs and a younger population, and notes the role of the Children’s Bureau in tackling certain issues.

Oettinger, K. (1959). Some Factors in the Closer Coordination of Health and Welfare Services. American Journal of Public Health and the Nations Health, 49(5), 579–584. https://doi.org/10.2105/AJPH.49.5.579.

This report outlines the interconnected nature of health and welfare. Oettinger draws on her personal experience with this to discuss the coordination and joint planning of these two domains. She calls for more research, greater transparency, effective leadership, multidisciplinary joint planning, and citizen involvement.

Oettinger, K. (1960). A Springboard For The Next Decade. Juvenile Court Judges Journal, 11(1), 5–9. https://doi.org/10.1111/j.1755-6988.1960.tb00037.x.

This report reflects on the original White House Conference on Children, progress made in children’s health, and future topics to tackle in the upcoming White House Conference on Children and in the decade to come.

Oettinger, K. (1960). Title V of the Social security act: what it has meant to children [1935-60]. Social Security Bulletin, 23, 39–50. http://search.proquest.com/docview/59136664/.

This report commemorates the 25^th anniversary of the Social Security Act, using it as an opportunity to reflect on the rationale for and progress in children’s programs under Title V. Oettinger discusses child welfare services prior to the Act’s enactment, the Act’s role in guiding maternal and child health initiatives for the last two-plus decades, and characterizes the current state of issues and action in MCH as of 1960.

Oettinger, K. (1962). CHILDREN AND COURTS. Juvenile Court Judges Journal, 13(1), 2–4. https://doi.org/10.1111/j.1755-6988.1962.tb00303.x.

This report discusses present-day philosophy on juvenile courts and how it has come to be. Oettinger outlines the close working relationship between judges of the juvenile courts and the Maternal and Child Health Bureau, provides court statistics, describes 502 Juvenile Courts reports, raises concern about child abuse, and speculates about future steps on giving children a fair chance at optimal development.

Oettinger, K. (1962). Services to unaccompanied Cuban refugee children in the United States. Social Service Review, 36, 377–384. http://search.proquest.com/docview/59209323/.

Oettinger highlights the long-lasting American traditions of freedom of thought and religious belief and caring for orphaned or unaccompanied children as rationale for supporting unaccompanied Cuban refugee children. She characterizes Cuban refugees, describes the current federal program for these individuals, and details special needs and issues.

Oettinger, K. (1971). Pregnancy Detection: A Critical Service Link. Family Planning Perspectives, 3(4), 15–18. https://doi.org/10.2307/2133871.

This report underscores the value of centers at which women may access fertility-related services and pregnancy detection as a critical bridge that links these services. She highlights the policy and cultural background for this topic, specifically speaking to the growing nationwide demand, the increasing number of options for pregnant women, and key obstacles. She proposes that education is an impactful means of building social consensus toward comprehensive fertility services for women that emphasize prevention.

Arthur J. Lesser, MD, MPH (1969–1973). Leading through scholarship and personal conviction.

Arthur J. Lesser, MD, MPH (1969–1973)

Leading through scholarship and personal conviction

Transformation to MCH, MCH Service, Public Health Service

Biographical Information

Arthur Lesser was born in 1909. He worked in the Children’s Bureau for 28 years, and was Deputy Chief when he left the Bureau. In 1965, he received the Martha May Eliot Award by the American Public Health Association for his outstanding achievements in the field of maternal and child health. He became Director of the Maternal and Child Health Service in 1969 when the child health grants were transferred to the Public Health Service. He retired from government service in 1973 in protest of the Nixon administration’s budget cuts to the program. Until his death in 2005, Dr. Lesser continued to serve as an advocate for issues related to maternal and child health by joining the National Research Council for two years, giving guest lectures at Harvard School of Public Health, and serving as a Reagents Lecturer at UC Berkeley.

For more information on Lesser and his life, visit the following links:

Primary Documents from the Children's Bureau National Archives Collection

Published Works

Lesser, A. J. (1952). Emotional problems, associated with handicapping conditions in children. Washington, D.C.: U.S. Government Printing Office.

This report was prepared for the Technical Committee on Fact Finding of the Midcentury White House Conference on Children and Youth. The authors highlight emotional issues in children with disabilities. They characterize the parent-child relationship, the reactions of the child, and society’s reactions to the child. The authors also highlight the child’s distinct issues with achieving independence, feeling inadequacy, and achieving identity as they come of age.

Lesser, A.J. (1953). State Programs for the Care of Crippled Children. Exceptional Children, 20(3):132-137. https://doi.org/10.1177/001440295302000307.

This report outlines why and how states can support the care of ‘crippled children.’ Dr. Lesser defines ‘crippling,’ the responsibilities of the state, funding sources, and other components of this topic. He also calls for a comprehensive program that would support children in realizing their potential.

Lesser, A. (1953). The School Health Program and the Handicapped Child. American Journal of Public Health and the Nations Health, 43(8), 1023–1029. https://doi.org/10.2105/AJPH.43.8.1023.

This report was presented to a Joint Session of the American School Health Association and certain sections of the American Public Health Association at the eightieth annual meeting. Dr. Lesser presents school supports for children with cerebral palsy, deafness, and epilepsy.

Lesser, A., & Hunt, E. (1954). The Nation’s Handicapped Children. American Journal of Public Health and the Nations Health, 44(2), 166–170. https://doi.org/10.2105/AJPH.44.2.166.

This report characterizes the nation’s population of ‘handicapped children.’ The authors report the number of children who fall into this category and their chief disabilities to characterize the burden of physical handicaps in childhood. They also call for more research and supports to better meet the needs of this population.

Lesser, A.J. (1956). Periodic examinations for physicians. JAMA,162(15):1414. doi:10.1001/jama.1956.02970320062020.

In his letter to the Editor, Dr. Lesser endorses the recommendation of routine examinations for physicians. He argues that this is a means of modeling the same behavior we expect from patients and maintaining their health.

Lesser, A. (1958). New Program for Mentally Retarded Children. American Journal of Public Health and the Nations Health, 48(1), 9–14. https://doi.org/10.2105/AJPH.48.1.9.

Lesser discusses current efforts to support mentally retarded children in the context of a recent movement to better meet the needs of this population. He describes the nature of these initiatives, their aims, and their problems.

Lesser, A.J. (1960), National Needs and Resources In Newborn and Maternity Care. Bulletin of the American College of Nurse‐Midwifery, 5: 49-58. doi:10.1111/j.1542-2011.1960.tb00538.x.

In this report, Dr. Lesser details significant changes in public health, medicine, and the population and their implications for newborn and maternity care. He underscores the need for the nation to respond to the needs of a growing child population, significant sociological changes in public health, increasing costs of medical care, and changes in practice of medicine and public health. He also notes the need for more funding and more personnel working on relevant issues in public health, medicine, and the population in general.

Lesser, A.J. (1964). Mental retardation and the Maternal and Child Health Amendments of 1963. Pediatrics, 33(1). 3-4.

Lesser describes the amendments to Title V of the Social Security Act that will improve the Children’s Bureau’s ability to address mental retardation. He highlights specific components of this legislation, their significance, and their alignment with the recent charge from the United States President to take national action against mental retardation.

Lesser, A. J. (1964). Health of children of school-age. Washington, D.C.: U.S. Government Printing Office.

In this report, Lesser discusses health-related topics for children of school-age. Issues highlighted include gaps in child health supervision in the preschool years and their impact on child readiness to begin education; overcrowding of urban well-baby clinics and hospital outpatient departments; and unmet healthcare needs among children from low-income families. He calls for specific interventions to address these issues, such as greater support for health needs assessments in schools and renewed emphasis on overcrowding for healthcare in urban settings.

Lesser A. J. (1965). Closing the gaps in the nation's health services for mothers and children. Bulletin of the New York Academy of Medicine, 41(12), 1248–1254.

This report was presented in a panel discussion, Today’s Gaps in Health Care and Barriers to Service, as part of the 1965 Health Conference of the New York Academy of Medicine. Lesser underscores the widening gap between a growing population reliant on public and voluntary medical resources and the healthcare system’s ability to meet that need. He discusses some of the reasoning behind this gap, discusses current efforts to address this disparity, and highlights next steps in the context of maternal and child health using a project-grant method with recent maternity care amendments.

Lesser, A.J. (1966). A tribute to the first lady of public health (Martha M. Eliot). IV. Concepts and content of maternal and infant care projects from a national viewpoint. American Journal of Public Health and the Nations Health, 56:725-733. https://doi.org/10.2105/AJPH.56.5.725.

Dr. Lesser discusses the movement to improve quality of medical care among low-income families. He describes the underlying theory and evidence for this work, and discusses specific initiatives in this effort. He characterizes this moment as an opportunity to develop and implement comprehensive preventive services and medical care for mothers and children.

Anderson, H., & Lesser, J. (1966). Maternity Care in the United States: Gains and Gaps. American Journal of Nursing, 66(7), 1539–1544. https://doi.org/10.2307/3420127.

This report outlines changes in maternal and infant care in the United States over the past fifty or so years (1915-1966). They discuss disparities between potential achievements and actual accomplishments in the field on issues such as maternal mortality, infant mortality, and prenatal care.

Vince Hutchins, MD, MPH (1977–1992). Developing standards to strengthen state-federal partnerships.

Vince Hutchins, MD, MPH (1977–1992)

Developing standards to strengthen state-federal partnerships

Modern MCH, Office of MCH (later Division of MCH (1982), Bureau of MCH and Resources Development (1987), Maternal and Child Health Bureau (1990)), Bureau of Community Health Services (later Bureau of Health Care Delivery and Assistance), Health Services Administration (later Health Resources and Services Administration), Public Health Services

Biographical Information

Vince Hutchins was born on January 1, 1928 in Otter Creek, Iowa. He attended medical school at the University of Iowa, graduating in 1952. He spent one year as an intern at Edward Sparrow Hospital in Lansing, Michigan before he was drafted to serve on Navy transport ships at the very end of the Korean War. After finishing his tour in 1955, he completed his Pediatrics residency at the University of California Medical School, San Francisco where he served as Chief Resident from 1957-1958. He then worked in private practice for a decade before obtaining his MPH at the University of California, Berkeley in 1968. He felt a calling to serve people’s health needs by integrating the work he did in private practice with public health. In 1968, he moved to Philadelphia to run the Children and Youth project at Women’s Medical College of Pennsylvania. He was also Assistant and then Associate Professor of Pediatrics, and taught at the college.

He entered federal service in 1971 when he was appointed Regional Medical Director for the Maternal and Child Health Service Region III office that had just been moved to Philadelphia. Hutchins learned to manage financial and administrative responsibilities to serve the regional MCH programs, preparing him well for his growing career in civil service.

In 1977, he became Director for the Office for Maternal and Child Health. He guided it through various administrative identity changes before ultimately emerging as the Maternal and Child Health Bureau. During his nearly two decades in the role, he was proudest of his work on the development of national standards for prenatal care, out-of-home child care, and health supervision guidelines; and the development and strengthening of state-federal partnerships. Hutchins was known for his commitment to mentorship and ability to maintain good relationships with political appointees and members of Congress.

After retiring from the MCHB in 1992, he became Executive Director of the National Ready to Learn Council, and joined the National Center for Education in Maternal and Child Health in 1994 as a Distinguished Research Professor. He also was the Chair, Division of Policy, NCEMCH, Georgetown Public Policy Institute, Georgetown University. Hutchins received many awards from the federal government and MCH community. He also was a prolific writer and lecturer on public policy in the context of MCH issues.

For more information on Hutchins and his life, visit the following links:

Mayer R, D L Mullins DL, Anastas J. Memorial tribute to Vince L. Hutchins, MD, MPH, 1928-2001. Matern Child Health J . 2001 Sep;5(3):141-4. doi: 10.1023/a:1011379732174.
Theakston K (ed.). "Dr. Vince Hutchins and Maternal and Child Health (MCH)." Bureacracy and Leadership. St. Martin's Press. 2000.
Program and Newsletter, November 17, 1983. The Center for Developmental and Learning Disorders, The University of Alabama in Birmingham. Guest Lecturer: Vince L. Hutchins, M.D., M.P.H., Director, Division of Maternal and Child Health Bureau of Health Care Delivery and Assistance Health Resources and Services Administration.

Published Works

Hutchins, V. (1996). Salute to Tebben. Public Health Reports (Washington, D.C. : 1974), 111(3), 186–186.

Dr. Hutchins honors Marian Tebben for her work at Public Health Reports, including 23 years as editor. He highlights her impact on public health, compliments her character, speaks highly of her work, and describes her life since retiring.

Hutchins V. L. (1977). New policies in school health. The Journal of school health, 47(7), 428–430. https://doi.org/10.1111/j.1746-1561.1977.tb01106.x.

Dr. Hutchins contextualizes current school health policies with those dating back to 1945. He discusses specific considerations of needs over the years and characterizes trends in school health services. He then outlines the Bureau of Community Health Services’ current strategy to meet the health needs of school-age children.

Gephart, J., Egan, M. C., & Hutchins, V. L. (1984). Perspectives on health of school-age children: expectations for the future. The Journal of school health, 54(1), 11–17. https://doi.org/10.1111/j.1746-1561.1984.tb08747.x.

This report was developed by MCH staff as background information for a conference on “Health of School-Age Children.” They characterize the population of concern, its needs, current interventions, and future priorities for action.

Hutchins, V., & Walch, C. (1989). Meeting Minority Health Needs Through Special MCH Projects. Public Health Reports, 104(6), 621–626. http://search.proquest.com/docview/230140563/.

This report discusses grants for special projects of regional and national significance (SPRANS) in the context of minority health needs. They cite minority population trends and then describe specific MCH initiatives.

Hutchins, V., & Mcpherson, M. (1991). National Agenda for Children With Special Health Needs. American Psychologist, 46(2), 141–143. https://doi.org/10.1037/0003-066X.46.2.141.

This report discusses trends in the needs of children with special health needs and the current national agenda for this population. Specific target areas for advancement must be tackled both by Congress and through private sector activities with the U.S. Public Health Service. Services for children with special health needs should be family-focused, based in home communities, and coordinated to promote accessibility and responsiveness.

Hutchins, V. (1994). Community Pediatrics From the Federal Government’s Perspective. Pediatric Annals, 23(12), 684–689. https://doi.org/10.3928/0090-4481-19941201-09.

This report discusses community pediatrics, its challenges and their relevance in discourse on healthcare reform, and its future. He notes that the federal view of most health issues is through the perspective of health-care reform.

Mayer, R., & Hutchins, V. (1998). District of Columbia Family Policy Seminar: A Tool for Devolution. Maternal and Child Health Journal, 2(1), 59–62. https://doi.org/10.1023/A:1021849710515.

This report describes the District of Columbia Family Policy Seminar, an opportunity to learn the value of customizing policy analysis to the local level. The authors discuss its mission, benefits, implementation, and effects

Grason, H., Aliza, B., Hutchins, V., Guyer, B., & Minkovitz, C. (1999). Pediatrician-led community child health initiatives: Case summaries from the evaluation of the Community Access to Child Health Program. Pediatrics, 103(6), 1394–1419. http://search.proquest.com/docview/228364625/.

The authors characterize and evaluate 12 community-based, physician-led programs to advance children’s health supported by the Community Access to Child Health program of the American Academy of Pediatrics. They reviewed documents and conducted multiple in-person interviews to determine the effectiveness of CATCH.

Hutchins, V., Grason, H., Aliza, B., Minkovitz, C., & Guyer, B. (1999). Community Access to Child Health (CATCH) in the historical context of Community Pediatrics. Pediatrics, 103(6), 1373–1383. http://search.proquest.com/docview/228336578/.

The authors evaluated CATCH to retrospectively identify the chronology of activities undertaken through CATCH and their antecedents within the American Academy of Pediatrics. They characterize a decade of change beginning in the late 1980s and its relevance to CATCH’s design and implementation.

Minkovitz, C., Grason, H., Aliza, B., Hutchins, V., Rojas-Smith, L., & Guyer, B. (1999). Evaluation of the Community Access to Child Health Program. Pediatrics, 103(6), 1384–1393. http://search.proquest.com/docview/228346568/.

The authors describe the Community Access to Child Health Program, a program led by the American Academy of Pediatrics to support and fund pediatricians’ endeavors to promote child health in their communities. They retrospectively evaluate the initiative using case studies and in-person interviews, concluding that CATCH established/enhanced child health services and underscoring the need for more opportunities for similar programs.

Federal Leaders in Modern MCH. 1992-Present.

Audrey H. Nora, MD, MPH (1992–1998). Launching initiatives to strengthen services and systems.

Audrey H. Nora, MD, MPH (1992–1998)

Launching national program initiatives to strengthen MCH public health services and systems

Modern MCH, Maternal and Child Health Bureau, Bureau of Community Health Services (later Bureau of Health Care Delivery and Assistance), Health Resources and Services Administration), Department of Health and Human Services

Biographical Information:

Audrey Hart Nora was born on December 5, 1936 in Picayune, Mississippi. She attended the University of Mississippi for her bachelor’s degree (1958) and her medical degree (1961). She completed her Pediatrics residency at the University of Wisconsin-Madison Hospital in 1964. From 1964-1966, she subspecialized in hematology/oncology through a fellowship at Baylor University, Texas Children’s Hospital. After finishing her fellowship, Dr. Nora became an associate clinical professor in pediatrics at the University of Colorado School of Medicine, Denver. From 1970 until 1978, she was the director of genetics at Denver Children’s Hospital. She received the Virginia Apgar award in 1976 for her work on the well-being of neonates.

In 1978, Dr. Nora entered public service, becoming a consultant in maternal and child health for the United States Public Health Service in Denver. In 1983, she became Assistant Surgeon General, and a regional health administrator for the United States Public Health Service. She served in this role until 1992 when she was appointed Director of the Maternal and Child Health Bureau. She also served on the advising committee for the National Institutes of Health from 1975 until 1977, the advisory board for Metronet Health, Inc. since 1986, and the Colorado Association of Commerce and Industry since 1985. She was a fellow in the American Academy of Pediatrics and a member of the American Public Health Association, Commissioned Officers Association, American Society for Human Genetics, Teratology Society, and the Western Society for Pediatric Research.

For more information on Nora and her life, visit the following links:

https://prabook.com/web/audrey_hart.nora/3644084

Published Works:

Holton, C., Lonsdale, C., Nora, A., Thurman, W., & Vietti, T. (1968). Clinical study of daunomycin (NSC‐82151) in children with acute leukemia. Cancer, 22(5), 1014–1017. https://doi.org/10.1002/1097-0142(196811)22:5%3C1014::AID-CNCR2820220517%3E3.0.CO;2-F.

The authors report the findings of their study on the effect on daunomycin in the management of advanced acute leukemia in children. They conclude that this drug has low-grade activity for inducing remission in children with advanced acute leukemia, and that the response rate could be increased through combination with prednisone.

Nora, J.J., Nora, A.H., Toews, W.H. (1974). Lithium, Ebstein’s Anomaly, and Other Congenital Heart Defects. The Lancet. 304(780), 594-595. https://doi.org/10.1016/S0140-6736(74)91918-7.

This letter responds to a recent report from the “Register of Lithium Babies” that failed to emphasize the presence of congenital cardiovascular disease in several of the infants. The authors note the implications of this information on the scientific consensus on the teratogenicity of lithium.

Nora, J. J., Nora, A.H., Sinha, A.K., Spangler, R.D., & Lubs, H.A. (1974). The Ullrich-Noonan Syndrome (Turner Phenotype). Archives of Pediatrics & Adolescent Medicine, 127(1), 48. https://doi.org/10.1001/archpedi.1974.02110200050007 .

The authors reviewed recent genetic, cytogenetic, and clinical findings of the Ulrich-Noonan syndrome in 81 patients. They discuss diagnostic criteria, the frequency of anomalies, and disabilities, noting their implications for cardiovascular abnormalities and recurrence risks particularly in the context of genetic counseling.

Nora, J.J. & Nora, A.H. (1975). The Pediatric Roots of Coronary Heart Disease. Chest, 68(5), 714-718. https://doi.org/10.1378/chest.68.5.714.

This report discusses the three main risk factors (lipid levels, hypertension, cigarette smoking) of predisposition to coronary heart disease in the context of heredity and the environment. The authors provide a clinical example and describe how to best identify infants and children at risk.

Nora, A., & Nora, J. (1975). A syndrome of multiple congenital anomalies associated with teratogenic exposure. Archives of Environmental Health, 30(1), 17–21. https://doi.org/10.1080/00039896.1975.10666626.

The authors report their findings on a study of 19 patients with multiple congenital anomalies known as VACTERL to identify their etiology. They found that the mothers had been exposed at a vulnerable period of embryogenesis to a progestogen/estrogen compound or progestogen alone, and call for greater care with verifying the absence of pregnancy prior to starting oral contraception and discontinuance of hormonal agents as pregnancy tests.

Nora, J., & Nora, A. (1976). Recurrence risks in children having one parent with a congenital heart disease. Circulation, 53(4), 701–702. https://doi.org/10.1161/01.CIR.53.4.701.

This article contains the findings on and implications of a study on recurrence risks to offspring of parents with seven common and significant congenital heart lesions. The authors report a range of risk of 2.5-4.3%, depending on the lesion.

Winkler, R., Nora, A., & Nora, J. (1977). Familial congenital complete heart block and maternal systemic lupus erythematosus. Circulation, 56(6), 1103–1107. https://doi.org/10.1161/01.CIR.56.6.1103.

This article describes the investigation of the relationship between infants with congenital heart block (CHB) and the presence or later development of maternal systemic lupus erythematosus or other connective tissue disease (CTD). The authors found that one in three mothers who deliver babies with CHB have or will develop CTD, an association potentially explained by the placental transfer of a maternal antibody.

Nora, J., & Nora, A. (1977). Contraceptive hormones and congenital heart disease. Teratology, 15(3), 331–331. https://doi.org/10.1002/tera.1420150317.

This letter to the editor agrees with a previous study’s call for prospective study on the relationship between congenital malformations and maternal exposure to progestogen/estrogen. The authors point out specific errors in the aforementioned study, describe their own current work, and emphasize the dangerous problems in this investigation of the teratogenicity of hormonal contraceptives.

Nora, J., & Nora, A. (1978). The evolution of specific genetic and environmental counseling in congenital heart diseases. Circulation, 57(2), 205–213. https://doi.org/10.1161/01.CIR.57.2.205.

This report summarizes the development of guidelines starting in 1968 of specific genetic and environmental counseling in congenital heart disease.

Nora, J., Lortscher, R., Spangler, R., Nora, A., & Kimberling, W. (1980). Genetic-epidemiologic study of early-onset ischemic heart disease. Circulation, 61(3), 503–508. https://doi.org/10.1161/01.CIR.61.3.503.

The authors conducted a genetic-epidemiologic study of white Colorado patients with a history of myocardial infarction to determine the efficacy of a risk index. They integrated family history into a preliminary risk index for use in a clinical setting, and found that it was logistically feasible to identify patients at high risk using similar indices to this one.

Nora, J., & Nora, A. (1984). Teratogenicity of progestational agents: Comments on Dr. Ferencz’s paper. Teratology, 29(1), 133–134. https://doi.org/10.1002/tera.1420290116.

This Letter of the Editor notes ‘fundamental errors that invalidate ‘Dr. Ferencz’s’ findings,’ and call for the authors to address certain questions to ensure the appropriate, safe interpretation of the findings.

Nora, J., & Nora, A. (1987). Maternal transmission of congenital heart diseases: New recurrence risk figures and the questions of cytoplasmic inheritance and vulnerability to teratogens. The American Journal of Cardiology, 59(5), 459–463. https://doi.org/10.1016/0002-9149(87)90956-8.

The authors review eight studies of offspring of parents with congenital heart disease (CHD) to characterize the risk for all defects. They acknowledge the lack of statistical significance due to case numbers, hypothesize the reasons for the higher rate of maternal transmission, and note the implications of their findings for genetic counseling.

Nora, J., & Nora, A. (1988). Update on counseling the family with a first-degree relative with a congenital heart defect. American Journal of Medical Genetics, 29(1), 137–142. https://doi.org/10.1002/ajmg.1320290117.

This article contains updated recurrence risks figures to inform the genetic counseling of families who have a first-degree relative with a congenital heart defect. They call for risk projections based in the genetic and teratogenic history in the family and pregnancy.

Nora, J., & Nora, A. (1988). Familial risk of congenital heart defect. American Journal of Medical Genetics - Seminars in Medical Genetics, 29(1), 231, 233–233.

This Letter to the Editor responds to a previous article on a population-based epidemiological study on the familial risks of congenital heart defect. The authors call for further investigation into this topic as a means of providing more data for recurrence risk counseling and gaining greater insight into the implications of diagnosis categorization.

Standards for pediatric immunization practices. Recommended by the National Vaccine Advisory Committee. (1993). MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports, 42(RR-5), 1–10.

This report outlines eighteen standards for pediatric immunization practices. The Committee discusses the value of immunization, address potential barriers and obstacles, and describes the process through which standards were developed.

Nora A. H. (1994). Information related to the Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration, and the United States government contained in your editorial on the Baby Friendly Hospital Initiative. Birth (Berkeley, Calif.), 21(2), 118–119. https://doi.org/10.1111/j.1523-536x.1994.tb00249.x.

In this letter to the Editor, Dr. Nora corrects and clarifies the information recently published on the Baby Friendly Hospital Initiative to give greater insight into the significance of this global endeavor.

Kessel, W., Kiely, M., Nora, A., & Sumaya, C. (1995). Early Discharge - In The End, It Is Judgment. Pediatrics, 96(4), 739–742.

This article offers recommendations for the length of hospital stay after birth based on studies of postpartum discharge policies, expert discussions, and review of the academic literature. Ultimately, the authors do not recommend a specific length of time. Instead, they call for discharge with a specific follow-up plan when the mother and child are medically stable, newborn screening tests have been done, and appropriate maternal education has been provided.

Fishman, M., Kessel, W., Heppel, D., Brannon, M., Papai, J., Bryn, S., Nora, A., & Hutchins, V. (1997). Collaborative office rounds: continuing education in the psychosocial/developmental aspects of child health. Pediatrics, 99(4), E5. https://doi.org/10.1542/peds.99.4.e5.

This article describes the Collaborative Office Rounds (COR) Program as a means of improving collaboration on the mental health aspects of pediatric care. The authors report experiences with COR that underscore its utility for addressing psychosocial issues in primary care, and propose its continued use and potential expansion.

Schonberg, S., Anderson, S., Bays, J., Duncan, P., Felice, M., Frader, J., Heyman, R., Katcher, M., Miller, P., Wolraich, M., Ziring, P., Francoeur, E., Nora, A., Perez, L., & Widome, M. (1998). The role of home-visitation programs in improving health outcomes for children and families. Pediatrics, 101(3), 486–489. https://doi.org/10.1542/peds.101.3.486.

This article reviews the history and current research regarding home-visitation programs. The authors also outline recommendations for the pediatrician’s role in supporting and implementing home visitation.

Peter van Dyck, MD, MPH, MS (1998-2011). Linking performance measurement to MCH systems.

Peter van Dyck (1998-2011)

Establishing performance measurement to evaluate the pyramid of essential MCH public health system components

Modern MCH, Maternal and Child Health Bureau, Health Resources and Services Administration), Department of Health and Human Services

Biographical Information

Peter van Dyck began his career in Utah as State Maternal and Child and CSHCN director, and as a faculty member at the Department of Pediatrics at the University of Utah Medical Center. He also supported international health efforts, serving as chief of pediatrics for an army hospital in Germany and as a pediatric consultant for the Red Cross in Jordan. In 1995, he was appointed the first permanent director of the Maternal and Child Health Bureau’s Office of State and Community Health. For this position, Dr. Van Dyck set the organizational focus for administering the states’ MCH block grant program. He also managed the State System Development Initiative and devised legislation on abstinence education. He served as executive secretary of the Secretary’s Advisory Committee on Infant Mortality and worked on initiatives for immunization, health care reform, managed care, and Healthy Start.

In 1998, he became acting associate administrator of Maternal and Child Health in the U.S. Department of Health and Human Services Health Resources and Services Administration. In 1999, he became the associate administrator and served in this role until 2011. In this role, he designed and implemented a data collection and performance measurement system to allow for dynamic evaluation of grantees’ ability to deliver care. Throughout Dr. Van Dyck’s career, he prioritized the improvement of systems of care for MCH populations both nationally and internationally through policy, outreach, evaluation, and innovative financial strategies.

For more information on van Dyck and his life, visit the following links:

Legacy of a Leader Before retiring as the Associate Administrator for Maternal and Child Health at the Health Resources and Services Administration on July 29, 2011, Dr. Peter van Dyck offered three gifts to the MCH Community, three videotaped presentations: (1) Career Choices: Public Service Pathways; (2) Maternal and Child Health: History to Remember; and (3) Leadership Lessons: Making a Difference
https://issuu.com/berkeley_health/docs/spotlight
http://www.welfareacademy.org/conf/papers/van_dyck_bio.shtml

Published Works

Buehler, B. A., Gortatouski, M. J., Scow, G., Hoogasian, A. C., & Van Dyck, P. C. (1983). Thyroid screening in the newborn: Utah experience. Annals of clinical and laboratory science, 13(1), 5–9. PMID: 6404213.

The authors present findings from a three-year screening of infants for hypothyroidism by the State Department of Health Laboratory of Utah. They report that the incidence of normal infants is generally less than one percent, and, in this case, the incidence was 1 per 3,800 live births. They emphasize the value of newborn screening of infants for thyroid disease.

Frost, F., Wells, T., Glasheen, K., & van Dyck, P. (1984). Epidemiology of SIDS in Utah. Pediatric Research, 18(S4), 183A–183A. https://doi.org/10.1203/00006450-198404001-00539.

This summary refers to the first five years of the Utah State SIDS program, which aimed to document demographic and epidemiological factors for each SIDS case. They report certain variations in risk factors among the 366 documented cases, but note that these victims are similar to SIDS victims outside Utah.

Van Dyck, Peter C. (1991). Use of Parental Fees in P.L. 99-457, Part H. Washington, D.C. Special Education Programs (ED/OSERS). (ERIC Document Reproduction Service No. ED334781).

In this paper, Dr. van Dyck proposes the use of parental fees and private insurance as funding sources for early intervention services under the 1986 amendments to the Education of the Handicapped Act. He cites relevant legislative authorities, discusses sources of payment (especially private insurance), presents the calculation of familial financial responsibility, and offers options for implementation of payments according to six progressive levels.

Sosin, D., Keller, P., Sacks, J., Kresnow, M., & van Dyck, P. (1993). Surface-specific fall injury rates on Utah school playgrounds. American Journal of Public Health, 83(5), 733–735. https://doi.org/10.2105/AJPH.83.5.733.

The authors describe their effort to estimate surface-specific rates of fall injuries on school playgrounds using injury reports from 1988 to 1990 from 157 Utah elementary schools. Asphalt injury rates were the highest, followed by mats, gravel, grass, and sand. These findings demonstrate that impact-absorbing surfaces do not reduce fall injuries on playgrounds better than grass.

van Dyck, P., Mcpherson, M., Strickland, B., Nesseler, K., Blumberg, S., Cynamon, M., Newacheck, P., & van Dyck, P. (2002). The national survey of children with special health care needs. Ambulatory Pediatrics : the Official Journal of the Ambulatory Pediatric Association, 2(1), 29–37. https://doi.org/10.1367/1539-4409(2002)0022.0.CO;2.

This article outlines the plan for and design of the National Survey of Children with Special Health Care Needs, a new telephone survey to be implemented by the National Center for Health Statistics with funding and policy direction from the Maternal Child Health Bureau.

van Dyck, P. (2003). A history of child health equity legislation in the United States. Pediatrics, 112(3 Part 2), 727–730.

Strickland, B., Mcpherson, M., Weissman, G., van Dyck, P., Huang, Z., & Newacheck, P. (2004). Access to the medical home: results of the National Survey of Children with Special Health Care Needs. Pediatrics, 113(5), 1485–1492. http://search.proquest.com/docview/71899095/.

This article contains the findings of the National Survey of Children with Special Health Care Needs regarding parent perceptions of the extent to which CSHCN have access to a medical home. The authors report that, although some components of the medical home have been achieved for most CSHCN, most do not have receive care through a comprehensive care model associated with a medical home.

Mcpherson, M., Weissman, G., Strickland, B., & van Dyck, P. (2004). Implementing Community-Based Systems of Services for Children and Youths With Special Health Care Needs: How Well Are We Doing? Pediatrics, 113(5), 1538–1544. http://search.proquest.com/docview/228419693/.

This study offers a baseline measure of the proportion of children in the United States who meet the MCHB’s core outcomes for children with special health care needs. The authors report success rates greater than 50 percent for 5 of the 6 core outcomes, with transition to adulthood being the least successful. This study underscores the need for working toward success at all these outcomes.

van Dyck, P. C., Kogan, M. D., McPherson, M. G., Weissman, G. R., & Newacheck, P. W. (2004). Prevalence and characteristics of children with special health care needs. Archives of pediatrics & adolescent medicine, 158(9), 884–890. https://doi.org/10.1001/archpedi.158.9.884.

The authors present national estimates of the number of children with special health care needs (CSHCN) and their characteristics, including an assessment on how well their needs are met. About 12.8 percent of US children are CSHCN, with higher rates among certain subgroups. About one-third (33.5%) of CSHCN lacked critical elements of family-centered health care, and almost one-fifth (17.7%) had unmet health needs.

van Dyck, P., Kogan, M., Heppel, D., Blumberg, S., Cynamon, M., & Newacheck, P. (2004). The National Survey of Children’s Health: a new data resource. Maternal and Child Health Journal, 8(3), 183–188. https://doi.org/10.1023/B:MACI.0000037693.09847.f6.

This article characterizes the National Survey of Children’s Health, a state and national survey jointly completed by the Maternal and Child Health Bureau and the National Center for Health Statistics. The authors note its significance, and discuss its implementation and potential impact.

Kogan, M., & van Dyck, P. (2005). Editorial: The National Survey of Children With Special Health Care Needs: Using State-Level Data to Improve Systems of Care for Children. Maternal and Child Health Journal, 9(S2), S1–S2. https://doi.org/10.1007/s10995-005-4917-z.

In this editorial piece, the authors discuss how the National Survey of Children with Special Health Care Needs will address the existing dearth of information on state-specific care systems and outcomes for CSHCN. This article served as an introduction to a series of 11 state-specific studies on issues ranging from the ease of using community-based systems of care to the identification of children without access to adequate care.

Puryear, M., Weissman, G., Watson, M., Mann, M., Strickland, B., & Van Dyck, P. (2006). The regional genetic and newborn screening service collaboratives: The first two years. Mental Retardation and Developmental Disabilities Research Reviews, 12(4), 288–292. https://doi.org/10.1002/mrdd.20121.

This article outlines efforts initiated by the Maternal and Child Health Bureau to address access to genetic specialty services to improve equity. The authors provide background information, characterize the landscape on the issue, discuss regional collaboratives, present critical program accomplishments, and describe future goals and challenges.

van Dyck, P. & Edwards, E. (2006). A look at newborn screening: today and tomorrow. Pediatrics, 117(5 Pt 2), S193–S193. https://doi.org/10.1542/peds.2005-2633A.

This article introduces a supplement to Pediatrics on newborn screening, underscoring the importance of the topic in the context of comprehensive care. The articles in the special issue outline specific activities implemented by the Health Resources and Services Administration and the Maternal and Child Health Bureau with the American Academy of Pediatrics.

Alexander, D. & van Dyck, P. (2006). A vision of the future of newborn screening. Pediatrics, 117(5 Pt 2), S350–S354. https://doi.org/10.1542/peds.2005-2633O.

This article discusses the evolution of newborn screening and explores potential next steps. The authors note issues of inequity on the topic, and specific areas for improvement to improve the quality of and expand access to and use of newborn screening.

Lloyd-Puryear, M., Tonniges, T., van Dyck, P., Mann, M., Brin, A., Johnson, K., & Mcpherson, M. (2006). American Academy of Pediatrics Newborn Screening Task Force recommendations: how far have we come? Pediatrics, 117(5 Pt 2), S194–S211. https://doi.org/10.1542/peds.2005-2633B.

This article describes the activities of the American Academy of Pediatrics Newborn Screening Task Force since its establishment in 1998. The authors also note future goals to ultimately reach a high-quality, coordinated care system for children with positive newborn screening results, their families, and the health professionals who care for them.

Sweetman, L., Millington, D., Therrell, B., Hannon, W., Popovich, B., Watson, M., Mann, M., Lloyd-Puryear, M., & van Dyck, P.. (2006). Naming and counting disorders (conditions) included in newborn screening panels. Pediatrics, 117(5 Pt 2), S308–S314. https://doi.org/10.1542/peds.2005-2633J.

In this article, the authors propose a system of nomenclature for newborn screening disorders that aligns with the screening panel recommended by the American College of Medical Genetics, the screening analyte, and accepted standardized nomenclature. The goal of this system was to eliminate ambiguity and better standardize the naming and counting of newborn screening disorders.

van Dyck, P. (2007). Final commentary on the special volume of articles from the National Survey of Children’s Health. Pediatrics, 119 Suppl 1, S122–3.

This article serves as a reflection on the special Pediatrics supplemental issue on findings from the 2003 National Survey of Children’s Health (NSCH). The commentary highlights specific findings and their implications for policy and practice, overarching themes, and expectations for future data from the NSCH.

Kemper, A., Boyle, C., Aceves, J., Dougherty, D., Figge, J., Fisch, J., Hinman, A., Greene, C., Kus, C., Miller, J., Robertson, D., Therrell, B., Lloyd-Puryear, M., van Dyck, P., & Howell, R. (2008). Long-term follow-up after diagnosis resulting from newborn screening: Statement of the US Secretary of Health and Human Services’ Advisory Committee on Heritable Disorders and Genetic Diseases in Newborns and Children. Genetics in Medicine, 10(4), 259–261. https://doi.org/10.1097/GIM.0b013e31816b64f9.

This article outlines expectations for long-term follow-up after diagnosis via newborn screening. Specific features mentioned include the guarantee and delivery of high-quality chronic disease management, condition-specific treatment, and age-appropriate preventive care across the lifespan. The authors also note four critical components to achieving long-term follow-up: care coordination through a medical home, evidence-based treatment, ongoing quality improvement, and novel research.

Singh, G., Kogan, M., & van Dyck, P. (2008). A Multilevel Analysis of State and Regional Disparities in Childhood and Adolescent Obesity in the United States. Journal of Community Health, 33(2), 90–102. https://doi.org/10.1007/s10900-007-9071-7.

This article contains an analysis of state and regional disparities in child and adolescent obesity prevalence and the impact of individual and area factors on prevalence using data from the 2003 National Survey of Children’s Health. Obesity prevalence varied significantly across geographic areas, and was partially explained by individual characteristics (e.g., race/ethnicity, socioeconomic status, neighborhood social capital, and physical activity), and area poverty rates.

Kogan, M. D., Strickland, B. B., Blumberg, S. J., Singh, G. K., Perrin, J. M., & van Dyck, P. C. (2008). A national profile of the health care experiences and family impact of autism spectrum disorder among children in the United States, 2005-2006. Pediatrics, 122(6), e1149–e1158. https://doi.org/10.1542/peds.2008-1057.

This article presents an analysis of the 2005-2006 National Survey of Children with Special Health Care Needs (CSHCN) to understand the care experiences of children with autism spectrum disorder (ASD) and the impact of ASD on the family. The authors reported that CSHCN with ASD were more likely to have unmet needs and issues accessing care, and that their families face greater financial, employment, and time burdens than those of other CSHCN. They also noted that receipt of primary care in a medical home can ameliorate some of these issues.

Therrell, B., Buechner, C., Lloyd-Puryear, M., van Dyck, P., & Mann, M. (2008). What’s new in newborn screening? Pediatric Health, 2(4), 411–429. https://doi.org/10.2217/17455111.2.4.411.

This article presents an overview of newborn screening at the time of publication. The authors discuss general considerations in existing systems, relevant policies and pertinent conditions, state-specific practices, education for pediatric health professionals and parents, and system-wide evaluation. They also highlight possible next steps in newborn screening.

Singh, G., Kogan, M., Siahpush, M., & van Dyck, P. (2008). Independent and joint effects of socioeconomic, behavioral, and neighborhood characteristics on physical inactivity and activity levels among US children and adolescents. Journal of Community Health, 33(4), 206–216. https://doi.org/10.1007/s10900-008-9094-8.

The authors used 2003 National Survey of Children’s Health data to conduct an analysis of the independent and joint associations between several socioeconomic and behavioral characteristics and physical activity and inactivity prevalence. They report significant variation in prevalence of physical activity by socioeconomic and behavioral characteristics, calling for targeted interventions for certain subgroups including older, female adolescents, children from socially disadvantaged households, and those living in urban areas.

Singh, G., Kogan, M., Van Dyck, P., & Siahpush, M. (2008). Racial/ethnic, socioeconomic, and behavioral determinants of childhood and adolescent obesity in the United States: analyzing independent and joint associations. Annals of Epidemiology, 18(9), 682–695. https://doi.org/10.1016/j.annepidem.2008.05.001.

The authors examined independent and joint associations between several socioeconomic, demographic, and behavioral characteristics and obesity prevalence using data from the 2003 National Survey of Children’s Health. They report that race/ethnicity, SES, and behavioral factors are independently related to childhood and adolescent obesity, and highlight joint effects by gender, race/ethnicity, and SES.

Singh, G. K., Strickland, B. B., Ghandour, R. M., & van Dyck, P. C. (2009). Geographic disparities in access to the medical home among US CSHCN. Pediatrics, 124 Suppl 4, S352–S360. https://doi.org/10.1542/peds.2009-1255E.

The authors analyzed geographic disparities in medical home access among US children with special health care needs using data from the 2005-2006 National Survey of Children with Special Health Care Needs. They identified individual-level sociodemographic and state-level health policy variables as predictors of access, and noted significant geographic disparities irrespective of these individual or policy-based factors.

Singh, G., Kogan, M., Siahpush, M., & van Dyck, P. (2009). Prevalence and correlates of state and regional disparities in vigorous physical activity levels among US children and adolescents. Journal of Physical Activity & Health, 6(1), 73–87. https://doi.org/10.1123/jpah.6.1.73.

The authors describe their analysis of the 2003 National Survey of Children’s Health to identify state and regional disparities in vigorous physical activity level among school-age children. They found that individual (e.g., race/ethnicity, socioeconomic status, social capital) and area-level (e.g., poverty, income inequality, violent crime) factors were important predictors of physical activity, and that there was significant geographic variation in activity levels.

Kogan, M.D., Blumberg, S.J.,…van Dyck, P. (2009). Prevalence of Parent-Reported Diagnosis of Autism-Spectrum Disorder among Children in the US, 2007. Pediatrics, 124(5), 1395-1403. https://doi.org/10.1542/peds.2009-1522.

This article is an analysis of 2007 data from the National Survey of Children’s Health to quantify the prevalence of parent-reported diagnosed autism spectrum disorder (ASD) among children aged 3 to 17 years in the United States. The authors found that more children (approximately 673 thousand) had ASD than previous US estimates indicated, underscoring the need for more inclusive survey questions and improved population awareness.

Krotoski, D., Namaste, S., Raouf, R., El Nekhely, I., Hindi-Alexander, M., Engelson, G., Hanson, J., Howell, R., Al Hait, S., Al-Hassnan, Z., Bensalah, A., Chaabouni, H., Dhondt, J., El Nekhely, I., Hannon, H., Hanson, J., Howell, R., Raouf, R., … Van Dyck, P. (2009). Conference report: second conference of the Middle East and North Africa newborn screening initiative: Partnerships for sustainable newborn screening infrastructure and research opportunities. Genetics in Medicine : Official Journal of the American College of Medical Genetics, 11(9), 663–668. https://doi.org/10.1097/GIM.0b013e3181ab2277.

This report describes the second conference of the Middle East and North Africa newborn screening initiative, of which the primary outcome was to develop country plans of action for implementation or expansion of newborn screening. Aspects such as needs assessments of countries, national plans, and recommendations for further action are mentioned.

Kogan, M., Newacheck, P., Blumberg, S., Ghandour, R., Singh, G., Strickland, B., & van Dyck, P. (2010). Underinsurance among children in the United States. The New England Journal of Medicine, 363(9), 841–851. https://doi.org/10.1056/NEJMsa0909994.

The authors evaluated whether insurance sufficiently met children’s needs across the United States using data from the 2007 National Survey of Children’s Health. They found that the number of underinsured children exceeded the children without insurance for all or part of the year in question, and that uninsured and underinsured children were more likely to face issues with health care access and quality.

Van Dyck, P. (2010). Celebrating 75 years of Title V (Maternal and Child Health) and re-exploring our roots. Maternal and Child Health Journal, 14(6), 817–821. https://doi.org/10.1007/s10995-010-0674-8.

This commentary piece describes the history of Title V (Maternal and Child Health) of the Social Security Act from its roots in the formation of the Children’s Bureau in 1912 to current projects such as the recent establishment of a Life Course Research Network.

Singh, G. K., Kogan, M. D., & van Dyck, P. C. (2010). Changes in state-specific childhood obesity and overweight prevalence in the United States from 2003 to 2007. Archives of pediatrics & adolescent medicine, 164(7), 598–607. https://doi.org/10.1001/archpediatrics.2010.84.

This article is a temporal cross-sectional analysis of the 2003 and 2007 National Survey of Children’s Health Data to identify changes in state-specific obesity and overweight prevalence among U.S. children and adolescents. The authors found significant geographic disparities in childhood obesity and overweight, and noted a higher prevalence in certain states in 2007.

Downs, S., van Dyck, P., Rinaldo, P., Mcdonald, C., Howell, R., Zuckerman, A., & Downing, G. (2010). Improving newborn screening laboratory test ordering and result reporting using health information exchange. Journal of the American Medical Informatics Association, 17(1), 13–18. https://doi.org/10.1197/jamia.M3295.

This paper describes efforts taken on by the American Health Information Community to improve the capture, coding, and communication of newborn screening information. This initiative was intended to promote the reliable, safe multidirectional transfer of patient information among data users and protect its availability as the patient grows.

Strickland, B., van Dyck, P., Kogan, M., Lauver, C., Blumberg, S., Bethell, C., & Newacheck, P. (2011). Assessing and Ensuring a Comprehensive System of Services for Children With Special Health Care Needs: A Public Health Approach. American Journal of Public Health, 101(2), 224–231. http://search.proquest.com/docview/847329551/.

The authors reported the proportion of children with special health care needs (CSHCN) receiving care in ‘high-quality systems of services.’ These systems were measured by attainment of 6 essential system elements based on findings from the National Survey of Children with Special Health Care Needs. Just 17.7 percent of CSHCN received services in a system that met all quality indicators.

Kenney, M., Kogan, M., Toomer, S., & van Dyck, P. (2012). Federal expenditures on maternal and child health in the United States. Maternal and Child Health Journal, 16(2), 271–287. https://doi.org/10.1007/s10995-011-0745-5.

This study estimates federal maternal and child health expenditures and identifies their sources to provide a broad perspective on MCH funding appropriations and inform a discussion of optimal allocation of said funding. The authors reported identifiable funding in fiscal year 2006 to approach $57.5 billion, with funding sources concentrated within the United States Department of Health and Human Services but spread across different agencies. This fragmentation raises questions regarding the potential impact of a more integrated MCH infrastructure.

Michael Lu, MD, MS, MPH (2011–2017). Transforming the MCH Block Grant with comparative, national data.

Michael Lu, MD, MS, MPH (2011–2017)

Transforming the MCH Block Grant to a performance measure-based framework through Collaborative Improvement and Innovation Networks (CoIINs)

Modern MCH, Maternal and Child Health Bureau, Health Resources and Services Administration

Biographical Information

Michael Lu received his bachelor’s degrees in political science and human biology from Stanford University, master’s degrees in health and medical sciences and public health from UC Berkeley, and a medical degree from UC San Francisco. He then completed his residency training in obstetrics and gynecology at UC Irvine. After finishing residency, Dr. Lu went on to serve as an obstetrician at UCLA, attending more than a thousand births and being honored as one of the Best Doctors in America since 2005. There, he was a lead investigator for the National Children’s Study and led a project to monitor and improve the quality and safety of maternity care in California. He was known for his research on racial-ethnic disparities in birth outcomes. He also taught obstetrics and gynecology at the David Geffen School of Medicine at UCLA and maternal and child health at UCLA School of Public Health, receiving many awards for his teaching and recognition for his leadership on life course.

Before his tenure as director of the Maternal and Child Health Bureau, Dr. Lu chaired the HHS Secretary’s Advisory Committee on Infant Mortality, and served on two Institute of Medicine committees and the Centers for Disease Control and Prevention Select Panel on Preconception Care. As Director of the Maternal and Child Bureau, Dr. Lu worked tirelessly to advance health equity in maternal and child health and prioritized evidence-based strategies. Initiatives included the transformation of Title V programs to a performance measure-based framework and the conceptualization and launch of the Collaborative Improvement and Innovation Network (CoIINs), an initiative intended to reduce infant mortality and improve birth outcomes.

He received the Hubert H. Humphrey Award for Service to America by the Department of Health and Human Services for his work on CoIINs. He also led the expansion of the Maternal, Infant, and Early Childhood Home Visiting Program. After stepping down from the Bureau, he served as professor and senior associate dean for academic, student, and faculty affairs at the Milken School of Public Health at George Washington University. Since 2019, he has been dean of UC Berkeley School of Public Health.

For more information on Lu and his life, visit the following links:

Published Works

Lu, M. (1992). Cowboys in White: Individualism and Compassion in American Medicine. https://escholarship.org/uc/item/5bb0g4r4.

Lu wrote the culture of individualism’s impact on compassion in American medicine for his master’s thesis. He argued that self-concern about success, self-interest, and freedom limit compassion among physicians, and spoke with a number of physicians, medical students, and faculty to inform this research.

Lu, M., Lin, Y., Prietto, N., & Garite, T. (2000). Elimination of public funding of prenatal care for undocumented immigrants in California: A cost/benefit analysis. American Journal of Obstetrics and Gynecology, 182(1), 233–239. https://doi.org/10.1016/S0002-9378(00)70518-7.

The authors compared perinatal outcomes and costs of undocumented women with and without prenatal care and inferred the impact of denial of prenatal benefits on 970 undocumented immigrants in California through a retrospective review of delivery records. They concluded that the elimination of public funding of prenatal care for these individuals could pose a significant detriment to infant health (low birth weight, prematurity) and result in significant postnatal costs.

Agustines, L., Lin, Y., Rumney, P., Lu, M., Bonebrake, R., Asrat, T., & Nageotte, M. (2000). Outcomes of extremely low-birth-weight infants between 500 and 750 g. American Journal of Obstetrics and Gynecology, 182(5), 1113–1116. https://doi.org/10.1067/mob.2000.105386.

The authors conducted a retrospective cohort study to characterize morbidity, mortality, and developmental outcomes among extremely low-birth-weight infants (500-750 grams). They found significant rates of morbidity, mortality, and developmental delay.

Stein, J., Lu, M., & Gelberg, L. (2000). Severity of Homelessness and Adverse Birth Outcomes. Health Psychology, 19(6), 524–534. https://doi.org/10.1037/0278-6133.19.6.524.

The authors evaluated the predictors and prevalence of adverse birth outcomes among 237 homeless women at shelters and meal programs in Los Angeles. The study found that African Americans and Hispanics reported worse outcomes than those found nationally, and African Americans reported the worst outcomes. Of note, severity of homelessness was significantly correlated to low birth weight and preterm births beyond its relationship with prenatal care and other risk factors.

Gelberg, L., Leake, B., Lu, M., Andersen, R., Wenzel, S., Morgenstern, H., Koegel, P., & Browner, C. (2001). Use of contraceptive methods among homeless women for protection against unwanted pregnancies and sexually transmitted diseases: prior use and willingness to use in the future. Contraception, 63(5), 277–281. https://doi.org/10.1016/S0010-7824(01)00198-6.

This article describes a study on the use of contraceptive methods by 746 homeless women in Los Angeles. The authors report that age-related factors and ethnocultural perceptions may keep some women from using contraception, and gaps between realized use and willingness to use may represent missed opportunities for protection against unwanted pregnancies and sexually transmitted diseases.

Prentice, J., Lu, M., Lange, L., & Halfon, N. (2002). The Association Between Reported Childhood Sexual Abuse and Breastfeeding Initiation. Journal Of Human Lactation, 18(3), 219–226. https://doi.org/10.1177/089033440201800303.

This study investigates the relationship between self-identified childhood sexual abuse and breastfeeding initiation in a nationally representative sample of 2017 parents with children under three years of age. The authors report that self-identified childhood sexual abuse was associated with an increased likelihood of breastfeeding initiation and called for future research on this correlation.

Lu, M. & Prentice, J. (2002). The postpartum visit: risk factors for nonuse and association with breast-feeding. American Journal of Obstetrics and Gynecology, 187(5), 1329–1336. https://doi.org/10.1067/mob.2002.126848.

This study focused on use of the postpartum visit among 9953 US women of different social and ethnic backgrounds, specifically looking to characterize risk factors of nonuse and to determine the relationship between postpartum care and breastfeeding duration. The authors found that 15 percent of respondents had not made a postpartum visit within six months of delivery, no prenatal care was associated with greater likelihood of nonuse of postpartum care, and the postpartum visit was not significantly associated with breastfeeding duration.

Gelberg, L., Leake, B., Lu, M., Andersen, R., Nyamathi, A., Morgenstern, H., & Browner, C. (2002). Chronically homeless women’s perceived deterrents to contraception. Perspectives on Sexual and Reproductive Health, 34(6), 278–285. https://doi.org/10.2307/3097746.

This study describes a survey of 974 Los Angeles women, of whom 229 were chronically homeless and at risk for unintended pregnancy, to characterize their reproductive health and use of contraceptives. The authors found that the women reported substantial deterrents to contraceptive use, including not knowing how to use contraceptives or which method to use, underscoring the need for more comprehensive, evidence-based reproductive health services.

Lu, M. & Halfon, N. (2003). Racial and ethnic disparities in birth outcomes: a life-course perspective. Maternal and Child Health Journal, 7(1), 13–30. https://doi.org/10.1023/A:1022537516969.

This article contains a synthesis of two longitudinal models of health disparities, considers traditional prenatal risk factors through these frameworks, and discusses the limitations and implications of the life course perspective. The authors outline a model for health disparities in birth outcomes in which disparities are the consequences of differential developmental trajectories determined by early life experiences and cumulative allostatic load over the lifespan.

Lu, M., Prentice, J., Yu, S., Inkelas, M., Lange, L., & Halfon, N. (2003). Childbirth education classes: sociodemographic disparities in attendance and the association of attendance with breastfeeding initiation. Maternal and Child Health Journal, 7(2), 87–93. https://doi.org/10.1023/A:1023812826136.

The authors examined sociodemographic disparities in attendance at childbirth classes, and evaluated the relationship between attendance and breastfeeding initiation among a nationally representative, cross-sectional sample of 1540 mothers. They found significant sociodemographic disparities in attendance, with attendance varying by race, education, household income, and marital status.

Lu, M. & Chen, B. (2004). Racial and ethnic disparities in preterm birth: the role of stressful life events. American Journal of Obstetrics and Gynecology, 191(3), 691–699. https://doi.org/10.1016/j.ajog.2004.04.018.

This article describes a retrospective cohort analysis of 33,542 women across the country who delivered a live-born infant in 2000 to characterize the relationship among racial-ethnic disparities, stressful life events, and preterm birth. The authors found that, though there were significant racial-ethnic disparities in the experience of stressful life events before and during pregnancy, stressful life events were not significantly associated with racial-ethnic disparities in preterm birth.

Lu, M., Fridman, M., Korst, L., Gregory, K., Reyes, C., Hobel, C., & Chavez, G. (2005). Variations in the incidence of postpartum hemorrhage across hospitals in California. Maternal and Child Health Journal, 9(3), 297–306. https://doi.org/10.1007/s10995-005-0009-3.

This study uses linked birth certificate and hospital discharge data from more than 507 thousand births in California in 1997 to examine variability in postpartum hemorrhage and related risk factors (eg., obstetrical trauma, chorioamnionitis, protracted labor) across hospital types and hospitals in California. The authors found significant variation in postpartum hemorrhage and other related risk factors across hospital types and hospitals in California, highlighting a need for greater investigation into the relationship between these variations and processes of care.

Korst, L., Gregory, K., Lu, M., Reyes, C., Hobel, C., & Chavez, G. (2005). A Framework for the Development of maternal quality of care indicators. Maternal and Child Health Journal, 9(3), 317–341. https://doi.org/10.1007/s10995-005-0001-y.

The authors collaborated with the California Department of Health Maternal and Child Health Branch to form a working group to identify potential clinical indicators to guide decision-making regarding maternal health care. This process resulted in 24 final indicators from several categories, health status and access; preconception and interconception care; antenatal care; and postpartum care. These indicators represent a foundation for reaching consensus and ascertaining methods for maternal care quality assessment.

Korst, L., Fridman, M., Friedlich, P., Lu, M., Reyes, C., Hobel, C., Chavez, G., & Gregory, K. (2005). Hospital rates of maternal and neonatal infection in a low-risk population. Maternal and Child Health Journal, 9(3), 307–316. https://doi.org/10.1007/s10995-005-0006-6.

This article describes a study on the variability of maternal and congenital neonatal infections in more than 308 thousand California mother-newborn pairs delivered in 1997 across different types of hospital ownership (not for profit, government) and to determine if rates of infections could serve as criteria for quality indicators proposed by the Agency for Healthcare Quality and Research. The authors found that these research methods and calculated infection rates were consistent with AHRQ methods and criteria. As well, this approach effectively identified hospitals with particularly high rates of infectious morbidity.

Lu, M., Kotelchuck, M., Culhane, J., Hobel, C., Klerman, L., & Thorp, J. (2006). Preconception care between pregnancies: the content of internatal care. Maternal and Child Health Journal, 10(5 Suppl), S107–S122. https://doi.org/10.1007/s10995-006-0118-7.

The authors define the contents of internatal care and outline priority areas on the topic, aiming to begin a dialogue around internatal care. Internatal care is the package of healthcare and ancillary services a woman and her family receive between the birth of one child and the next, and its specific priorities relate to risk assessment and health promotion for the mother and the family.

Lu, M. (2007). Recommendations for preconception care.(Clinical report). American Family Physician, 76(3), 397–400.

Dr. Lu outlines the rationale behind, the contents of, and the means for provision of preconception care. He argues that all women of reproductive age capable of becoming pregnant are eligible, and underscores the value of this care in both preventive and management interventions.

Huang, J., Lee, T., & Lu, M.(2007). Prenatal programming of childhood overweight and obesity. Maternal and Child Health Journal, 11(5), 461–473. https://doi.org/10.1007/s10995-006-0141-8.

The authors review scientific evidence on prenatal programming of childhood overweight and obesity to inform its implications for MCH research, practice, and policy. They found that their systematic review of observational studies on prenatal exposures and childhood overweight demonstrated support for prenatal programming of childhood overweight and obesity, and there is a need for MCH efforts to consider pregnancy a critical period during which to address these health issues.

Gelberg, L., Lu, M., Leake, B., Andersen, R., Morgenstern, H., & Nyamathi, A. (2008). Homeless women: who is really at risk for unintended pregnancy? Maternal and Child Health Journal, 12(1), 52–60. https://doi.org/10.1007/s10995-007-0285-1.

This article describes the investigation of correlates of failure to use contraception among 974 homeless women in Los Angeles County of whom 457 were at risk for unintended pregnancy. The authors report findings that underscore the need for integrated services including education, regular medical care, and encouragement for contraception for homeless women.

Mendelson, S., Mcneese-Smith, D., Koniak-Griffin, D., Nyamathi, A., & Lu, M.(2008). A community-based parish nurse intervention program for Mexican American women with gestational diabetes. Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGN, 37(4), 415–425. https://doi.org/10.1111/j.1552-6909.2008.00262.x.

This article describes a randomized controlled trial on the effects of a Parish Nurse Intervention Program on maternal health behaviors, glycemic control, and neonatal outcomes among 100 Mexican-American women with gestational diabetes. The authors reported significant improved self-reported health promoting behaviors among study participants who received the nursing intervention, but did not observe differences between groups based on glycemic control, macrosomia, or days of maternal or neonatal hospitalization.

Frey, K., Navarro, S., Kotelchuck, M., & Lu, M. (2008). The clinical content of preconception care: preconception care for men. American Journal of Obstetrics and Gynecology, 199(6), S389–S395. https://doi.org/10.1016/j.ajog.2008.10.024.

The authors describe the critical components to optimizing preconception health status of men. They call for consensus on service delivery of said care, and underscore the need for further research on the theory and implementation.

Klerman, L., Jack, B., Coonrod, D., Lu, M., Fry-Johnson, Y., & Johnson, K. (2008). The clinical content of preconception care: care of psychosocial stressors. American Journal of Obstetrics and Gynecology, 199(6), S362–S366. https://doi.org/10.1016/j.ajog.2008.08.042.

This article details psychosocial stressors women may encounter in the period before conceiving and outlines how to acknowledge and address these factors into preconception care. Specific risk types considered are inadequate financial resources; inability to easily access healthcare; and intimate partner/other types of violence.

Dunlop, A., Jack, B., Bottalico, J., Lu, M., James, A., Shellhaas, C., Hallstrom, L., Solomon, B., Feero, W., Menard, M., & Prasad, M. (2008). The clinical content of preconception care: women with chronic medical conditions. American Journal of Obstetrics and Gynecology, 199(6), S310–S327. https://doi.org/10.1016/j.ajog.2008.08.031.

This article reviews medical conditions associated with adverse pregnancy outcomes for women and their offspring. The authors discuss particular preconception treatments and approaches to mitigate the effects of these conditions on birth outcomes, and present contraceptive considerations specific to the medical conditions in question.

Coonrod, D., Jack, B., Stubblefield, P., Hollier, L., Boggess, K., Cefalo, R., Cox, S., Dunlop, A., Hunter, K., Prasad, M., Lu, M., Conry, J., Gibbs, R., & Hogan, V. (2008). The clinical content of preconception care: infectious diseases in preconception care. American Journal of Obstetrics and Gynecology, 199(6), S296–S309. https://doi.org/10.1016/j.ajog.2008.08.062.

This article outlines infectious diseases for inclusion in clinical preconception care. The authors make their recommendations based on their characterization of each disease’s respective burden of suffering, level of detectability, efficacy of current treatments, impact of preconception care, and recommendations by other groups.

Lu, M., Kotelchuck, M., Hogan, V., Jones, L., Wright, K., & Halfon, N. (2010). Closing the Black-White gap in birth outcomes: a life-course approach. Ethnicity & Disease, 20(1 Suppl 2), S2–62–76. http://search.proquest.com/docview/733979578/.

This article proposes a 12-point plan to reduce black-white disparities in birth outcomes via a life-course approach. The authors assert that this approach would both address early life disadvantages and cumulative allostatic load.

Lu, M., Jones, L., Bond, M., Wright, K., Pumpuang, M., Maidenberg, M., Jones, D., Garfield, C., & Rowley, D. (2010). Where is the F in MCH? Father involvement in African American families. Ethnicity & Disease, 20(1 Suppl 2), S2–49–61. http://search.proquest.com/docview/733979576/.

This article provides a review of the historical context for and current profile of father involvement in African-American families, acknowledges barriers to and supports for involvement, evaluates the effectiveness of specific father involvement programs, and suggests next steps for research, programs, and policies. The authors call for a multi-level, life-course approach to strengthening the capacity of African-American men in promoting greater involvement in pregnancy and parenting.

Jones, L., Lu, M., Lucas-Wright, A., Dillon-Brown, N., Broussard, M., Wright, K., Maidenberg, M., Norris, K., & Ferré, C. (2010). One Hundred Intentional Acts of Kindness toward a Pregnant Woman: building reproductive social capital in Los Angeles. Ethnicity & Disease, 20(1 Suppl 2), S2–36–40. http://search.proquest.com/docview/733979569/.

This article provides the background for, program description, and lessons learned during the development of One Hundred Intentional Acts of Kindness toward a Pregnant Woman. This initiative was an innovative community-based program intended to increase reproductive social capital for pregnant women in Los Angeles communities.

Lu, M. (2010). We can do better: improving perinatal health in America. Journal of Women’s Health (2002), 19(3), 569–574. https://doi.org/10.1089/jwh.2009.1415.

This article contains Dr. Lu’s examination through a life course perspective and via the ecological model of how the United States can do better in perinatal health. He argues for an expanded approach to improving perinatal health that incorporates risk reduction, as well as health promotion and optimization across the lifespan, and provides specific recommendations for expanded healthcare access, stronger families and communities, and more research.

Halfon, N. & Lu, M. (2010). Gestational weight gain and birthweight. Lancet (London, England), 376(9745), 937–938. https://doi.org/10.1016/S0140-6736(10)61024-0.

This comment emphasizes the relationship between gestational weight gain and birthweight by highlighting recent research on the topic and its implications for preconceptional health and lifelong weight trajectories. The authors call for greater investigation into how to support mothers in attaining and maintaining healthy weights before and during pregnancy.

Korst, L., Fridman, M., Lu, M., Mitchell, C., & Gregory, K. (2011). 587: Trending elective preterm deliveries using administrative data. American Journal of Obstetrics and Gynecology, 204(1), S234–S234. https://doi.org/10.1016/j.ajog.2010.10.607.

This article discusses a methodology for identifying and analyzing elective preterm births with administrative data, and applies it to California data on nearly 1.4 million singleton deliveries. The authors aim to offer an analytical framework with which to explore potential rationales for early delivery and propose potential strategies to prevent preterm ‘elective’ birth.

Heinrich, J., Lu, M., Macrae, J., Morris, T., Hopson, D., Somsak, J., & Spitzgo, R.(2012). Foreword from Associate Administrators of the Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services. Journal of Health Care for the Poor and Underserved, 23(3 Suppl), 2–2. https://doi.org/10.1353/hpu.2012.0133.

This is the foreword to the special themed issue on quality improvement initiatives within the safety net for the Journal for Health Care of the Poor and Underserved. The authors are all Associate Administrators of the Health Resources and Services Administration.

Singh, G., Kenney, M., Ghandour, R., Kogan, M., & Lu, M. (2013). Mental Health Outcomes in US Children and Adolescents Born Prematurely or with Low Birthweight. Depression Research and Treatment, 2013(2013), 570743–570743. https://doi.org/10.1155/2013/570743.

This article discusses the significant effects of prematurity and low birth weight on mental health outcomes among US children using data on 95,677 parent responses from the 2011-2012 National Survey of Children’s Health.

Dolbier, C., Rush, T., Sahadeo, L., Shaffer, M., Thorp, J., Vance, M., Minkovitz, C., Sankofa, N., O’Campo, P., Schafer, P., Wagenaar, K., Shalowitz, M., Clark-Kauffman, B., Adam, E., Duncan, G., McKinney, C., O’Connell, R., Schoua-Glusberg, A., Jones, L.,…Lu, M., Yñiguez, M. (2013). Relationships of race and socioeconomic status to postpartum depressive symptoms in rural African American and non-Hispanic white women. Maternal and Child Health Journal, 17(7), 1277–1287. https://doi.org/10.1007/s10995-012-1123-7.

This article describes a study on the potential racial disparity in postpartum depression (PPD) symptoms among non-Hispanic white and African-American women, accounting for the impact of socioeconomic status (SES). The authors report that the most significant and consistent predictor of PPD was subjective SES, emphasizing the need for further investigation on the topic alongside PPD screening and evidence-based intervention.

Wakeel, F., Witt, W., Wisk, L., Lu, M., & Chao, S. (2014). Racial and ethnic disparities in personal capital during pregnancy: findings from the 2007 Los Angeles Mommy and Baby (LAMB) study. Maternal and Child Health Journal, 18(1), 209–222. https://doi.org/10.1007/s10995-013-1256-3.

This article presents findings from the 2007 Los Angeles Mommy and Baby Study on the existence of racial and ethnic differences in personal capital during pregnancy and the impact of these differences in maternal sociodemographic and acculturation characteristics. The authors found that the risks associated with low socioeconomic status, single motherhood, and low acculturation contribute to low personal capital for many pregnant women, underscoring the value of addressing these factors to reduce disparities in personal capital that impact maternal and child health outcomes.

Chao, S., Wakeel, F., Herman, D., Higgins, C., Shi, L., Chow, J., Sun, S., & Lu, M.(2014). The 2007 Los Angeles Mommy and Baby Study: a multilevel, population-based study of maternal and infant health in Los Angeles county. Advances in Preventive Medicine, 2014(2014), 293648–293648. https://doi.org/10.1155/2014/293648.

The article details the 2007 Los Angeles Mommy and Baby Study. The authors outline the conceptual frameworks for the project, highlight the successful collaboration between a research institution and a public health department, discuss the unique characteristics of their methodology, and describes the study’s implications for research.

Dibari, J., Yu, S., Chao, S., & Lu, M. (2014). Use of postpartum care: predictors and barriers. Journal of Pregnancy, 2014(2014), 530769–530769. https://doi.org/10.1155/2014/530769.

This article describes the use of survey data from the 2007 Los Angeles Mommy and Baby Study to identify predictors and barriers to postpartum care use. The authors call for the use of these findings to inform future interventions directed at subgroups at risk for not obtaining postpartum care.

Guardino, C., Dunkel Schetter, C., Bower, J., Lu, M., & Smalley, S. (2014). Randomised controlled pilot trial of mindfulness training for stress reduction during pregnancy. https://escholarship.org/uc/item/89v7s8z9.

This article reports the findings of a randomized controlled trial of a six-week mindfulness intervention in 47 pregnant women experiencing high levels of perceived stress and anxiety. The authors observed some evidence of the effective reduction of pregnancy-related anxiety and worry through mindfulness training, and outline some potential dilemmas with this strategy and next steps for researchers interested in mind-body interventions of this sort during pregnancy.

Lu, M., & Johnson, K. (2014). Toward a national strategy on infant mortality. American Journal of Public Health, 104(1), S13–S16. https://doi.org/10.2105/AJPH.2013.301855.

This editorial is a summary of the recommendations to the Health and Human Services Secretary for the national strategy on infant mortality. The Secretary’s Advisory Committee on Infant Mortality applied a life course perspective to their proposed approach, and set strategic priorities to guide next steps.

Lu, M. (2014). Improving maternal and child health across the life course: where do we go from here? Maternal and Child Health Journal, 18(2), 339–343. https://doi.org/10.1007/s10995-013-1400-0.

This commentary on maternal and child health highlights major advancements in the development of the life course theory and its application to MCH research, practice, and policy and their implications for next steps in the field. Dr. Lu calls for a move beyond discovery to intervention in research, isolated to collective impact in practice, and paying for remediation in investing in capacity formation in policy.

Hirai, A., Sappenfield, W., Kogan, M., Barfield, W., Goodman, D., Ghandour, R., & Lu, M. (2014). Contributors to excess infant mortality in the U.S. South. American Journal of Preventive Medicine, 46(3), 219–227. https://doi.org/10.1016/j.amepre.2013.12.006.

The authors conducted an analysis of National Center for Health Statistics Period Linked Birth/Infant Death Files to quantify the components of excess infant mortality in the U.S. South by maternal race/ethnicity, underlying cause of death, and gestational age. Their findings highlighted the need for comprehensive strategies to address sudden unexpected infant death and preterm birth among both non-Hispanic black and white infants, with state-level information to guide state-specific efforts.

Coller, K., Chao, S., Lu, M., & Strobino, D. (2014). Unintended births among adult immigrant and U.S.-born Mexican women in the Los Angeles Mommy and Baby (LAMB) survey. Women’s Health Issues : Official Publication of the Jacobs Institute of Women’s Health, 24(4), e365–e372. https://doi.org/10.1016/j.whi.2014.03.005.

This article describes a study of unintended births and their predictors among 1214 adult Mexican women in Los Angeles County. The authors found that women’s background and psychosocial characteristics were critical to explaining unintended birth among immigrant women, but were less indicative for U.S.-born Mexican mothers. They called for initiatives to improve birth intentions that acknowledged not only the role of effective contraception but also that of social determinants.

Lu, M. & Jones, J. (2014). A new way forward: improving maternal and child health in America. Maternal and Child Health Journal, 18(7), 1558–1559. https://doi.org/10.1007/s10995-014-1568-y.

This report is the summary of Dr. Lu’s keynote address to the 2012 Cohosted 18^th Maternal and Child Health Epidemiology Conference and 22^nd City MatCH Urban MCH Leadership Conference. The address, entitled ‘We Can Do Better,’ outlines his vision for improving MCH through addressing access, quality, integration, accountability, and equity.

Korst, L., Fridman, M., Lu, M., Mitchell, C., Lawton, E., Griffin, F., & Gregory, K. (2014). Monitoring childbirth morbidity using hospital discharge data: further development and application of a composite measure. American Journal of Obstetrics and Gynecology, 211(3), 268.e1–268.e16. https://doi.org/10.1016/j.ajog.2014.03.011.

This article details a study on the use of a childbirth composite morbidity indicator for monitoring childbirth morbidity at hospital and regional levels in California. The authors applied it to nearly 378 thousand eligible deliveries, determining that the childbirth composite morbidity rate and its sub-measures met the criteria for quality indicator evaluation as specified by the Agency for Healthcare Research and Quality.

Lu, M., Lauver, C., Dykton, C., Kogan, M., Lawler, M., Raskin-Ramos, L., Watters, K., & Wilson, L.(2015). Transformation of the title V maternal and child health services block grant. Maternal and Child Health Journal, 19(5), 927–931. https://doi.org/10.1007/s10995-015-1736-8.

This paper outlines the transformation of the Title V Maternal and Child Health Block Grant to improve the ability of states to provide a coherent, compelling narrative about Title V’s impact with a reduced reporting burden and continued flexibility. The authors describe its history, current state, the rationale behind its transformation, and the means by which it was updated.

Kogan, M., Dykton, C., Hirai, A., Strickland, B., Bethell, C., Naqvi, I., Cano, C., Downing-Futrell, S., & Lu, M. (2015). A new performance measurement system for maternal and child health in the United States. Maternal and Child Health Journal, 19(5), 945–957. https://doi.org/10.1007/s10995-015-1739-5.

The authors describe the development of a new performance measurement system for maternal and child health by the Maternal and Child Health Bureau. The new system met the MCHB workgroup’s goals to give states more flexibility without a greater reporting burden; to improve accountability in order to better characterize Title V’s impact; and provide a multifaceted system to evaluate all domains of MCH.

Lu, M., Highsmith, K., de La Cruz, D., & Atrash, H. (2015). Putting the “M” back in the Maternal and Child Health Bureau: reducing maternal mortality and morbidity. Maternal and Child Health Journal, 19(7), 1435–1439. https://doi.org/10.1007/s10995-015-1665-6.

The authors describe the efforts of the Maternal Health Initiative (MHI) to improve maternal health in the context of increased maternal morbidity and mortality and the general initiatives of the MCH community. The public-private partnership of MHI takes a comprehensive approach by focusing on the priority areas of women’s health; quality and safety of maternity care; clinical and public health systems of maternity care; public awareness and education; and surveillance and research.

Zhao, Y., Kershaw, T., Ettinger, A., Higgins, C., Lu, M., & Chao, S. (2015). Association Between Life Event Stressors and Low Birth Weight in African American and White Populations: Findings from the 2007 and 2010 Los Angeles Mommy and Baby (LAMB) Surveys. Maternal and Child Health Journal, 19(10), 2195–2205. https://doi.org/10.1007/s10995-015-1734-x.

This article looks at the association between life events stressors during pregnancy and low birth weight among African Americans and Whites using data from mothers with singleton births who participated in the 2007 and 2010 LAMBs. The authors observed a differential impact of financial stressors during pregnancy on racial disparities in LBW.

Park, H., Harwood, R., Yu, S., Kavanagh, L., & Lu, M. (2016). Autism and Other Developmental Disabilities Research Programs of the Maternal and Child Health Bureau. Pediatrics, 137(2), S61–S66. https://doi.org/10.1542/peds.2015-2851C.

The authors detail information and HRSA/MCHB initiatives regarding the characterization and clarification of autism-spectrum disorder, its causes and potential treatments, and other developmental disabilities. These efforts were spurred by the Combating Autism Act of 2006.

Liu, J., Whitaker, K., Yu, S., Chao, S., & Lu, M. (2016). Association of Provider Advice and Pregnancy Weight Gain in a Predominantly Hispanic Population. Women’s Health Issues : Official Publication of the Jacobs Institute of Women’s Health, 26(3), 321–328. https://doi.org/10.1016/j.whi.2016.01.004.

The authors report findings from the 2007 Los Angeles Mommy and Baby Study to determine if women’s report of gestational weight gain advice from their provider was consistent with Institute of Medicine (IOM) guidelines, and to characterize the association between provider advice and women’s weight gain during pregnancy. The study underscored a need for more consistent provider advice and improvement in provider education on gestational weight gain and IOM guidelines.

Ghandour, R., Flaherty, K., Hirai, A., Lee, V., Walker, D., & Lu, M. (2017). Applying Collaborative Learning and Quality Improvement to Public Health: Lessons from the Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality. Maternal and Child Health Journal, 21(6), 1318–1326. https://doi.org/10.1007/s10995-016-2235-2.

The authors report the findings from the process evaluation of the Collaborative Improvement and Innovation Network model of collaborative learning, quality improvement, and innovation to reduce infant mortality across 13 southern states. The article also contains lessons learned and information from original organizers and participants on the model’s development and implementation.

Lu, M. (2018). Place matters to birth outcomes: A life-course perspective. Paediatric and Perinatal Epidemiology, 32(5), 420–422. https://doi.org/10.1111/ppe.12498.

In this article, Lu comments on the impact of racial-ethnic disparities in birth outcomes via a life-course perspective. He highlights biological and epidemiological evidence to support this relationship, and compares risk and protective factors women may encounter during pregnancy.

Lu, M. (2018). Reducing Maternal Mortality in the United States. JAMA, 320(12), 1237–1238. https://doi.org/10.1001/jama.2018.11652.

Lu characterizes the significant problem of maternal mortality in the United States, and calls for necessary change. To address the issue, he calls for learning from each death, ensuring quality and safety of care, and improving women’s health across their life span to address.

Kogan, M., Vladutiu, C., Schieve, L., Ghandour, R., Blumberg, S., Zablotsky, B., Perrin, J., Shattuck, P., Kuhlthau, K., Harwood, R., & Lu, M. (2018). The Prevalence of Parent-Reported Autism Spectrum Disorder Among US Children. Pediatrics, 142(6). https://doi.org/10.1542/peds.2017-4161.

The authors used the 2016 National Survey of Children’s Health to estimate the national prevalence of parent-reported autism spectrum disorder diagnosis among US children aged 3 to 17 years, and characterize their treatment and health care experiences. They found the estimated prevalence to be 1 in 40 US children, with rates of treatment usage varying by sociodemographic factors and co-occurring conditions.

Lu, M. (2019). The Future of Maternal and Child Health. Maternal and Child Health Journal, 23(1), 1–7. https://doi.org/10.1007/s10995-018-2643-6.

Lu uses this commentary to begin national discourse on the future of maternal and child health, noting emerging opportunities and hazards for MCH and potential strategies for moving forward. He argues that the future of MCH relies on discourse, research, training of the future MCH workforce, and necessary social and political change.

Perrin, J., Lu, M., Geller, A., & Devoe, J. (2020). Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity. Academic Pediatrics, 20(2), 160–162. https://doi.org/10.1016/j.acap.2019.11.019.

The authors outline a roadmap for integrating the neurobiological and sociobehavioral sciences to guide necessary change toward health equity for children and families. They propose a broad, multisectoral, collaborative approach that incorporates coordinated transformation across the investment of human capital, parent/family support, health care, and early child education.

Michael Warren, MD, MPH, FAAP (2018 –present). Leading MCH to Accelerate Upstream Together.

Michael Warren, MD, MPH, FAAP (2018 – present)

Leading MCH to Accelerate Upstream Together

Modern MCH, Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services

Biographical Information

Michael Warren graduated Summa Cum Laude with honors in Psychology from Wake Forest University. He then received his medical degree from the Brody School of Medicine at East Carolina University. He completed his pediatrics residency, Chief Residency, and fellowship in Academic General Pediatrics at Vanderbilt. He also obtained a Master’s in Public Health at Vanderbilt. He is a board-certified pediatrician, and a fellow of the American Academy of Pediatrics. Upon completing his training, he went on to serve as an Assistant Professor in the Department of Pediatrics at Vanderbilt and as Medical Director in the Governor’s Office of Children’s Care Coordination.

Dr. Warren then joined the Tennessee Department of Health, serving as the Assistant Commissioner for Family Health and Wellness, the Director of Maternal and Child Health, and Deputy Commissioner for Population Health. As Deputy Commissioner, he led various offices and divisions including Family Health and Wellness (which includes Title V/Maternal and Child Health). As well, Warren served on the Oversight Committee for the Tennessee Initiative for Perinatal Quality Care and the President for the Association of Maternal and Child Health programs.

In 2018, Dr. Warren became Associate Administrator of the Maternal and Child Health Bureau. His work aligns with the overall mission of the MCHB, to improve the health and well-being of America’s mothers, children, and families. Specific issues he has targeted include maternal mortality, emergency medical services for children, and access to pediatric mental health care.

For more information on Warren and his life, visit the following sites:

Published Works

Warren, M. D., Pont, S. J., Barkin, S. L., Callahan, S. T., Caples, T. L., Carroll, K. N., Plemmons, G. S., Swan, R. R., & Cooper, W. O. (2007). The effect of honey on nocturnal cough and sleep quality for children and their parents. Archives of pediatrics & adolescent medicine, 161(12), 1149–1153. https://doi.org/10.1001/archpedi.161.12.1149.

The authors review a randomized, partially double-blinded study by Paul et al. on the efficacy of honey compared to dextromethorphan or no treatment for nocturnal cough and sleep difficulty in children with upper respiratory infections. They specifically consider validity of results, size and precision of treatment effect, and applicability to clinical practice. They conclude that honey is a reasonable therapy for children with a cough due to its low cost, low adverse effect profile, and potential benefit.

Warren, M. D., & Cooper, W. O. (2008). Honey improves cough in children compared to no treatment. The Journal of pediatrics, 152(5), 739–740. https://doi.org/10.1016/j.jpeds.2008.02.023.

The authors review the Paul et al. study on the effect of a single nocturnal dose of buckwheat honey or dextromethorphan on cough and sleep among children with nocturnal cough and sleep difficulty. They describe its design, setting, participants, intervention, outcomes, main results, and conclusions. They categorize the study as well-designed and valid, commenting on its overall findings and potential next areas of investigation.

Warren, M. D., Bryant, T., Agan, M., & Aligne, C. A. (2008). Pediatrics in the community: a smoking ban in the heart of tobacco country.

Deis, J. N., Smith, K. M., Warren, M. D., Throop, P. G., Hickson, G. B., Joers, B. J., & Deshpande, J. K. (2008). Transforming the Morbidity and Mortality Conference into an Instrument for Systemwide Improvement. In K. Henriksen (Eds.) et. al., Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 2: Culture and Redesign). Agency for Healthcare Research and Quality (US).

The authors discuss an effort to promote patient safety within their institution through a monthly interdisciplinary morbidity, mortality, and improvement conference to focus on systemic issues. They describe its implementation and characterize attendance and participation at sessions, content of information discussed, and the conference’s resultant action items. They deem a MM&I conference to be an effective means of discussing adverse events and subsequently guiding informed efforts to address systemic problems.

Warren, M. D., Arbogast, P. G., Dudley, J. A., Kaltenbach, L., Ray, W. A., Wang, W. C., & Cooper, W. O. (2010). Adherence to prophylactic antibiotic guidelines among Medicaid infants with sickle cell disease. Archives of pediatrics & adolescent medicine, 164(3), 298–299. https://doi.org/10.1001/archpediatrics.2009.286.

In this ten-year retrospective cohort study, the authors characterize adherence to prophylactic antibiotic guidelines in a cohort of Tennessee Medicaid infants with sickle cell disease and examine risk factors for non-adherence. They report that 60 percent of eligible infants failed to fill a prophylactic prescription in the recommended time period, with certain sociodemographic factors increasing likelihood of non-adherence. These findings underscore the need for further investigation of rationale for non-adherence and the implementation of targeted interventions to address this.

Barkin, S. L., Heerman, W. J., Warren, M. D., & Rennhoff, C. (2010). Millennials and the World of Work: The Impact of Obesity on Health and Productivity. Journal of business and psychology, 25(2), 239–245. https://doi.org/10.1007/s10869-010-9166-5.

The authors used existing evidence in the literature to develop an economic model to predict the impact of obesity on aggregate lifetime earnings for Millennials (deemed individuals born between 1982 and 1993) and implications for employers and employees. They also offer case reports on successful business strategies relevant to classic attributes of Millennials.

Warren, M. D., Miller, A. M., Traylor, J., Bauer, A., Patrick, S. W., & Centers for Disease Control and Prevention (CDC) (2015). Implementation of a statewide surveillance system for neonatal abstinence syndrome - Tennessee, 2013. MMWR. Morbidity and mortality weekly report, 64(5), 125–128.

The authors present initial findings on surveillance of neonatal abstinence syndrome in Tennessee. They report its prevalence and characterize factors associated with NAS (e.g. maternal exposure source, maternal county of residence). These findings highlight the value of near real-time surveillance data on NAS to inform policy and programming.

Patrick, S. W., Dudley, J., Martin, P. R., Harrell, F. E., Warren, M. D., Hartmann, K. E., Ely, E. W., Grijalva, C. G., & Cooper, W. O. (2015). Prescription opioid epidemic and infant outcomes. Pediatrics, 135(5), 842–850. https://doi.org/10.1542/peds.2014-3299.

The authors conducted a retrospective, longitudinal cohort study using 2011 Medicaid data on mothers and infants in Tennessee to identify neonatal complications associated with antenatal opioid exposure and to establish predictors of neonatal abstinence syndrome. They reported that prescription opioid use during pregnancy was common and significantly linked to neonatal complications and found greater risk of NAS to be associated with antenatal cumulative prescription opioid exposure, opioid type, tobacco use, and selective serotonin reuptake inhibitor use.

Warren, M., Dooley, S., Pyle, M., & Miller, A. (2015). Use of Competency-Based Self-Assessments and the MCH Navigator for MCH Workforce Development: Three States’ Experiences. Maternal and Child Health Journal, 19(2), 335–342. https://doi.org/10.1007/s10995-014-1549-1.

The authors conducted three case studies to evaluate varied state implementations of maternal and child health workforce development initiatives using the online MCH Navigator resource. They report quantitative and qualitative data on staff perceptions of using self-assessments and the MCH Navigator for workforce development, underscoring the value of these methods and the significant variation in implementation across states.

Patrick, S. W., Bauer, A. M., Warren, M. D., Jones, T. F., & Wester, C. (2017). Hepatitis C Virus Infection Among Women Giving Birth - Tennessee and United States, 2009-2014. MMWR. Morbidity and mortality weekly report, 66(18), 470–473. https://doi.org/10.15585/mmwr.mm6618a3.

The authors characterize prevalence of hepatitis C virus infection among women giving birth in Tennessee and the United States between 2009 and 2014 using data from the National Vital Statistics System and the Tennessee Department of Health. They found that maternal HCV infections nearly doubled among reporting states nationwide but varied significantly state to state, and that certain social determinants of health and comorbidities significantly increased the odds of infection. They call for more HCV screening and treatment of women of child-bearing age, and monitoring of HCV-exposed infants.

Heitmann, R., Nilles, E. K., Jeans, A., Moreland, J., Clarke, C., McDonald, M. F., & Warren, M. D. (2017). Improving Safe Sleep Modeling in the Hospital through Policy Implementation. Maternal and child health journal, 21(11), 1995–2000. https://doi.org/10.1007/s10995-017-2334-8.

The authors evaluated policy-based efforts to improve safe sleep practices by health care providers in hospital settings in Tennessee. They report that statewide implementation of this intervention resulted in significant reductions in infants found in unsafe sleep situations and that the most common risk factors for sleep-related infant deaths can be modeled in hospitals.

Marcewicz, L. H., Clayton, J., Maenner, M., Odom, E., Okoroh, E., Christensen, D., Goodman, A., Warren, M. D., Traylor, J., Miller, A., Jones, T., Dunn, J., Schaffner, W., & Grant, A. (2017). Parental Refusal of Vitamin K and Neonatal Preventive Services: A Need for Surveillance. Maternal and child health journal, 21(5), 1079–1084. https://doi.org/10.1007/s10995-016-2205-8.

The authors conducted a retrospective chart review of children whose parents had refused injectable K for their infants at Nashville-area hospitals for 2011-2013 and Tennessee birthing centers for 2013. They also interviewed parents on their reason for refusal. They report that refusal was more common among families choosing to give birth at birth centers and related to refusal of other preventive services. The findings of the study underscore the need for greater surveillance of vitamin K refusal to inform tailored mitigation efforts.

Mullen, S., Marshall, A., & Warren, M. (2017). Statewide Breastfeeding Hotline Use Among Tennessee WIC Participants. Journal of Nutrition Education and Behavior, 49(7), S192–S196.e1. https://doi.org/10.1016/j.jneb.2017.04.024.

The authors examined the use of the Tennessee Breastfeeding Hotline according to WIC participation. They identified variation in use of the hotline by WIC enrollment, maternal/infant age, race, ethnicity, preterm delivery, caller type, and exclusive breastfeeding. The authors suggest that the use of this resource highlights the need for initiatives beyond clinic practice for breastfeeding support among WIC participants.

Fill, M., Miller, A., Wilkinson, R., Warren, M., Dunn, J., Schaffner, W., Jones, T., & Fill, M. (2018). Educational Disabilities Among Children Born With Neonatal Abstinence Syndrome. Pediatrics, 142(3). https://doi.org/10.1542/peds.2018-0562.

This study aimed to characterize the need for special educational services among infants born with neonatal abstinence syndrome (NAS). The authors conducted an analysis of Tennessee Medicaid and birth certificate data linked to Tennessee Department of Education special education data during early childhood. They report that children with a history of NAS are significantly more likely to have a subsequent educational disability.

You may also want to check out these other resources on MCH leaders:

MCH Academic Legacy Project. A collaboration between the Association of Teachers in Maternal and Child Health (ATMCH), the HRSA/MCHB funded Centers of Excellence in Maternal and Child Health (CoE-MCH), and the MCH Navigator. Through recorded oral interviews, this project documents the unique paths and trajectories of MCH leaders in public health academe and their relationship with the larger public health Maternal and Child Health enterprise including Title V.
MCH Oral Histories. Interviewees discuss MCH in schools of public health, the MCH Block Grant, and the evolution of family partnerships.
Developing a Repository of Excellence in Maternal and Child Health (MCH): Past, Present and Future Voices. Interviews with Dr. Donna Petersen.
AMCHP Legacies in Leadership Video Series:

Bright Legacies

The work of the Maternal and Child Health Bureau is ongoing. No issue it tackles has a perfect fix. To understand significant advances in MCH for the past 85 years, it is useful to understand how thinking has changed.

Progress can be viewed through the six domains in which Title V agencies annually report their financial, programmatic, and performance measure data. Five of the six domains are broken down by MCH population group, which includes Women/Maternal Health, Perinatal/Infant Health, Child Health, Children with Special Health Care Needs (CSHCN), and Adolescent Health. The sixth domain, Cross-cutting/Systems Building, addresses program capacity and/or the systems-building needs of a state or jurisdiction. The image below shows a representation of the MCH domains; explore changes and access resources in each domain in the sections that follow.

This image of MCH domains is described in the content below

Note: If you would like to suggest resources to add to this list and the MCH Digital Library in general, please suggest a resource.

Women/Maternal Health. From Pregnant Women and Safe Birth to Women's Health.

Women/Maternal Health initially focused on prenatal well-being with the Bureau’s work in this topic centered around prenatal care, maternal mortality, and birth-related health and hygiene guidelines. From publishing booklets to educate the public on these topics to advocating for increased access to care in rural communities, the Bureau led critical initiatives in this domain. Over time, MCHB has expanded its focus to promoting women’s health beyond pregnancy and birth to a holistic life course perspective

Resources To Explore:

Then: Pregnant Women/Safe Birth. Some examples include:

Maternal Mortality from all Conditions Connected with Childbirth in the United States and Certain Other Countries. This 1916 report was compiled by Dr. Grace Meigs, the head of the Children’s Bureau hygiene division, and published by Secretary of Labor William Wilson and Chief of the Children’s Bureau Julia Lathrop. It characterizes the state of maternal childbirth-related mortality using U.S. census data and information from selected other countries.

Now: Women’s Health. Some examples include:

Well Woman Chart. This resource outlines preventive services recommended by the Women’s Preventive Services Initiative, U.S. Preventive Services Task Force, and Bright Futures according to age, health status, and risk factors. It also provides recommendations from the Advisory Committee on Immunization Practices for immunizations and Clinical Summary Tables detailing clinical practice considerations, risk assessment methods, and the age at and frequency with which to deliver services.
Safety Bundles (Maternal and Non-Obstetric). Safety bundles are concise, clear sets of evidence-based practices to improve patient outcomes. Examples include ‘Obstetric Hemorrhage,’ ‘Enhanced Recovery after Gynecologic Surgery, ‘Reduction of Peripartum Racial/Ethnic Disparities,’ and ‘Obstetric Care for Women with Opioid Use Disorder.’
A Comprehensive Approach For Community- Based Programs To Address Intimate Partner Violence And Perinatal Depression.This toolkit supports community-based programs in addressing intimate partner violence and perinatal depression concurrently and improving their evaluation, diagnosis, and connection of women to needed services.

Perinatal/Infant Health. From Infant Mortality to Early Experiences with Long-Term Developmental Outcomes.

Perinatal/Infant Health initially focused on infant mortality, noting the high census statistics on infants dying of preventable diseases and accidents. As the United States confronted challenges such as World War II and a growing gap between the rich and the poor, the work of the Bureauembraced a more comprehensive view of infant health. In 2000, the seminal publication From Neurons to Neighborhoods illuminated the critical role early experiences played in the long-term development of children and spurred further expansion of the Bureau’s work to ensure that children had a safe, supportive start to life.

Resources To Explore:

Then: Infant Mortality. Some examples include:

The Sheppard-Towner Maternity and Infancy Act. This federal act was signed into law by President Warren G. Harding in 1921. The landmark social welfare legislation addressed elevated mortality rates among mothers and newborns by granting $1 million annually in federal aid over a five-year period to state initiatives for mothers and babies. The Act paid special attention to prenatal and newborn care facilities in rural states. For more information, see here.
Safe to Sleep Campaign. Originally, the Back to Sleep Campaign, this public health education initiative began in 1994 with the goal of educating caregivers on ways to reduce the risk of Sudden Infant Death Syndrome (SIDS) and other sleep-related causes of infant death. It has evolved throughout the years to include multiple guidelines in addition to placing the baby on his or her back.

Now: Early Experiences with Long-Term Developmental Outcomes. Some examples include:

Maternal, Infant, and Early Childhood Home Visiting Program. This partnership of the Maternal and Child Health Bureau with the Administration for Children and Families allocates funding to states, territories, and tribal entities to design and implement evidence-based voluntary programs to meet their communities’ needs regarding birth to kindergarten. Funding goes to provide regular, planned home visits by health, social service, and child development professionals to families, educating parents on topics ranging from breastfeeding and infant care to developmental milestones.
American Academy of Pediatrics Newborn Screening Task Force Recommendations: How Far Have We Come? This report was compiled at the request of HRSA/MCHB to ensure leadership by pediatricians in fully evaluating the newborn screening system. This includes acknowledging the important connection to medical homes. The document both acknowledges the commitment by MCHB to early, effective identification of health issues and highlights the collaborative relationship between HRSA/MCHB and the American Academy of Pediatrics.
The Newborn Screening Story: How One Simple Test Changed Lives, Science, and Health in America. This report marks the 50^th anniversary of newborn screening. When we consider how far the MCHB has come, we can see here how longtime priorities evolve with new insights, technological advances, and other changes. In this case, this resource highlights how newborn screening guidance has expanded and adapted to align with the current science and new understandings of what to test for and what the results’ implications are.
A Compilation of Actions taken by Fetal and Infant Mortality Review in the United States, 2016. One of the MHCB’s initiatives for fetal/infant health is its National Center for Fatality Review and Prevention. This Center also examines deaths in children and adolescents. This report highlights the actions of states and counties to address fetal and infant mortality as of 2016.

Child Health. From Infectious Disease and Child Welfare to Addressing Physical, Emotional, and Behavioral Health.

Child Health has always been at the forefront of the Bureau’s work. Over time, its focus has transitioned from an emphasis on child welfare and infectious disease to a more comprehensive approach to children’s well-being that encompasses physical, emotional, and behavioral health. From initiatives to reduce non-fatal injury admissions to efforts to extend insurance coverage to more children, MCHB sets the field's priorities to reflect a growing awareness of the social and environmental factors that impact child development.

Resources To Explore:

Then: Infectious Disease and Child Welfare. Some examples include:

Child Welfare News Summary. The Children’s Bureau published their first periodical in 1919 for dissemination to the Bureau’s staff. Over time, the mailing list was expanded to include state and local partners (as many as 1,200 people). It was issued three times a month from 1921 to 1932, and irregularly between 1932 and 1935 before being replaced by the Child in 1936.
Child Welfare 1930-1940. Then-Director of the Bureau Katharine Lenroot compiled this comprehensive overview of child welfare from 1930 to 1940, characterizing its evolution toward a broadened concept of child welfare connected to the fundamental social and economic issues of the U.S. and that aspires to meet the needs of all children. She examines child welfare’s record over the decade in MCH, education, social welfare, control of child labor, and provision for leisure-time activity, recreation, vocational guidance, and opportunity for useful employment.
Your Child from 6 to 12. This 1954 publication gives parents knowledge about a range of topics from children’s development to diseases (e.g., meningitis, tuberculosis) to which their child is susceptible. It highlights the Bureau’s commitment to education and outreach

Now: Physical, Emotional, and Behavioral Health. Some examples include:

Early Childhood Comprehensive Systems Collaborative Improvement and Innovation Network. This is a multi-year initiative to improve early childhood service systems in 12 states. The program aims to increase age-appropriate developmental skills among three-year-olds and ameliorate developmental disparities.
StopBullying.gov. This collaborative federal effort began in 2011 to engage federal and community stakeholders in various sectors (e.g., health, education, justice) in bullying prevention. The resource disseminates important research findings on the topic through different forms such as webinars, trainings, and blogs.
Bright Futures, 4th Edition: Guidelines for Health Supervision of Infants, Children, and Adolescents. This initiative and resource characterizes a system of care for children that champions health promotion and acknowledges the psychosocial factors of health with appreciation for youth and family strengths. It notes the care needs of all children and adolescents, making this a relevant tool for children and teens with and without special health care needs and from all different backgrounds. This is the fourth iteration, and the earlier editions highlight an evolving grasp of children’s health and health supervision.

Healthy Tomorrows Partnership for Children: Sustaining Community-Based Innovations. This infographic illuminates the current scope and impact of initiatives sponsored by the Healthy Tomorrows Partnership for Children Program, an initiative funded by the MCHB. The Partnership promotes maternal and child health via community-based programs that increase access to care and decrease health care costs via promotion, prevention, and early intervention.

Children and Youth with Special Health Care Needs. From a Focus on Disabilities to Holistic Well-Being.

Children and Youth with Special Health Care Needs (CYSHCN) have long been a priority for the MCHB. Once focused on caring for ‘crippled children’ often in institutions, today’s work is directed at supporting the optimal health and autonomy of children, irrespective of their special health care needs or disabilities. Varied efforts aim to acknowledge the multifaceted nature of this population’s needs and create an accessible, coordinated system of care that is family-centered and community-based. Specific initiatives include the expansion and redefinition of the population as “Children and Youth with Special Health Care Needs” to inform a life-span-oriented perspective on the topic (including transition to adult care) and the creation of the National Center for Health Insurance and Financing to support families in finding adequate, affordable coverage for their children.

Resources To Explore:

Then: Disabilities. Some examples include:

The Nation’s Handicapped Children. This 1954 report, co-authored by future Bureau chief Arthur Lesser, characterizes the nation’s population of ‘handicapped children.’ The authors report the number of children who fall into this category and their chief disabilities to characterize the burden of physical handicaps in childhood. They also call for more research and supports to better meet the needs of this population.

Now: Holistic Well-being. Some examples include:

Access to the Medical Home Among Children With and Without Special Health Care Needs. This article characterizes the medical home and its ongoing promotion by the MCHB as critical to quality care for children, especially for those with special needs. This article acknowledges areas for improvement in access to the medical home, noting that, as of 2016, 43.2% of CSHCN and 50% of non-CSHCN had access to one.
National Center for Family and Professional Partnerships. The Center supports and aids the HRSA-funded Family-to-Family Health Information Centers and other MCHB initiatives for family engagement and cultural/linguistic competence. Other duties include specific programming for CYSHCN.
National Survey of Children with Special Health Care Needs. The National Survey of Children with Special Health Care Needs aims to assess the prevalence and impact of special health care needs among children in the US, and to evaluate change over time. The survey reaches about 190 thousand households with children nationwide, identifying about 750 CSHCN in each state and DC. The Maternal and Child Health Bureau provides the primary funding for this project.
HRSA Hemoglobinopathies Programs: Sickle Cell Disease Newborn Screening Follow-Up Program (SCDNBSP) and Sickle Cell Disease Treatment Demonstration Regional Collaboratives Program (SCDTDP). This presentation describes the work of the Hemoglobinopathy Program to ensure individuals with sickle cell disease have access to comprehensive, evidence-based care in a Medical Home. It contains an overview of the medical home, desired systems outcomes for CYSHCN, treatment demonstration program successes by region, and specific program objectives.

Adolescent Health. From a Component of Children's Health to an Independent Life Stage.

Adolescent Health. Initially, the Bureau viewed this population through the lens of children and their needs. The recognition of adolescence as its own stage in the life cycle has allowed for targeted efforts to identify the unique needs of this age group and support a positive transition from childhood to adulthood. Specific endeavors to this end have included collaboration with schools to provide mental health services to teens and continued efforts to promote safety across the lifespan with awareness of the distinct dangers of activities in adolescence.

Resources To Explore:

Then: Adolescents were grouped alongside children, meaning that there were no stand-alone resources on their needs, services, etc.
Now: Adolescence is seen as a critical stage of development, not just "big kids" or "little adults." Special focus on maturation of the adolescent brain, specifically the prefrontal cortex, begins to explain behavior and social and emotional development. Transition to adult health care, both for youth with and without special health care needs, is recognized as a critical component along the life course. Some examples include:

GotTransition.org. This federally funded national resource center website contains tools and resources for youth and young adults, clinicians, and parents and caregivers on transitioning to adult health care if and when appropriate.
Leadership Education in Adolescent Health (LEAH). This fact sheet describes this unique MCHB program designed to equip trainees/fellows for leadership roles that improve youth-centered , community-based care for adolescents and young adults and also enhance the capacity of community and Title V state programs.
National Adolescent and Young Adult Health Information Center. Housed at the University of California, San Francisco, this MCHB-funded collaboration aims to strengthen state capacity to address the needs of adolescents and young adults. Its resource page linked here provides various resources on a wide range of relevant health care topics for this age group (e.g. mental health, substance use, sociodemographic disparities).

Cross-Cutting and Systems-Building. Building a Comprehensive, Multifaceted Understanding of MCH.

The Cross-Cutting/Systems Building domain is critical to the comprehensive manner in which MCHB works to promote the health and well-being of children, mothers, and families. The origins of the Bureau speak to a commitment to caring for vulnerable populations through policy and practice. This domain exemplifies a holistic approach to supporting maternal and child health that utilizes a health equity lens and acknowledges social determinants of health across the life span.

Resources To Explore:

Then: Building on a commitment to collaboration. Some examples include:
- The Children's Bureau and Its Relationships with Other Agencies. This report speaks to the lengthy history of joint work on behalf of maternal and child health. Collaboration has long occurred both among divisions of the bureau and with outside organizations (within and outside government).
Now: Comprehensive and collaborative initiatives thrive. Some examples include:

Bright Futures. This project began as partnership between the MCHB and the Medicaid Bureau of the Health Care Financing Administration. It contains health supervision guidelines to advance children’s health needs in infancy, early childhood, middle childhood, and adolescence.
Rethinking MCH: The Life Course Model as an Organizing Framework. This concept paper synthesizes the current perspective on life course theory and its implications for maternal and child health initiatives. It highlights the need for a more comprehensive, multifaceted approach to this field and the populations it serves.
Collaboration at the Federal, State, and Local Levels to Build Capacity in Maternal and Child Health: The Impact of the Maternal and Child Health Epidemiology Program. This article characterizes the Maternal and Child Health Epidemiology Program within the Division of Reproductive Health at the Centers for Disease Control and Prevention. It outlines initiatives to build capacity and expand infrastructure within states, regions, and among tribes in MCH through collaborative relations with other federal, nonprofit, private, and academic agencies.

Putting It All Together

As MCH professionals, we know that appropriate knowledge, skills, and science are needed to address the issues of today. This section highlights learning opportunities from the MCH Navigator and actionable resources from the MCH Digital Library and MCH Evidence Center to assist you in the work you do everyday to better the lives of our MCH family — mothers, infants, children, adolescents, youth, caregivers, and the communities in which we all live. Start with this video on where to find resources critical to our work today and then access additional trainings, resources, and portals below.

Moving From Knowledge to Practice. Using the MCH Navigator as a Learning Portal.

The MCH Navigator serves as the field's one-stop portal for competency-based learning. It pulls from our rich history and integrates evidence-based and emerging skill sets to equip MCH professionals with the knowledge and skills to address complex issues. Access these learning opportunities to learn more:

Start Here: Developing a Repository of Excellence in Maternal and Child Health (MCH): Past, Present and Future Voices. Interviews with Dr. Donna Petersen.

Learning MCH Building Blocks, Concepts, and Skills:

MCH 101 Learning Bundles. These bundles provide building blocks critical to an overall orientation to the field of MCH. Those who are newly entering the field may find it most helpful to tap into at least one learning resource for each of the six areas.
MCH Orientations. These bundles provide an orientation to MCH for different audiences defined by role or type of organization. Select the category that best describes your position to start your learning: for new hires; for mid-level to senior staff; for local health departments; and for community, advisory groups.
MCH Conceptual Models. This bundle contains tailored learning opportunities on the leading conceptual models utilized in the field of MCH. Participants will learn the importance of Life Course and Social Determinants Frameworks, Behavior Change theories and other models with respect to the field of MCH.
MCH Planning Cycle. This bundle provides learning opportunities to help navigate the 5 steps to program planning: assessment, program planning, program implementation, program evaluation, and policy development and analysis.

Learning How To Implement the MCH Leadership Competencies:

Keep On Learning. Additional Resources to Further Explore MCH History.

The MCH Digital Library houses a collection of historical documents and reports related to maternal and child health in the United States and health services for children and families.

A particular focus is programs of the federal government, including activities of the Children's Bureau and Maternal and Child Health MCH services under Title V of the Social Security Act as guided by the Maternal and Child Health Bureau, Health Resources and Services Administration.

MCHB Oral Histories

Interviews include Helen Wallace, MD, Merle McPherson, MD, MPH, Julie Beckett, Betsy Anderson, Patricia Thomas, and Barbara Popper.

American Academy of Pediatrics (AAP) Oral Histories

Interviews with selected pediatricians and other leaders in the advancement of children's health care are conducted and preserved as part of the center's oral history project. Recordings and transcripts of interviews provide narrative accounts of important developments in the care of children and augment the center's written, recorded, and photographic records of pediatric history.

Legislation and Program Data

Social Security History. A history of the development of social security, agency history, and links to special collections.
Title V Information System. Data from annual State Title V Block Grant applications and reports that tracks information on key MCH measures.
Discretionary Grant Information System. Abstracts of MCHB-funded discretionary grants describing project goals, methodology, and other elements.

Other Collections of Historic Materials

References. Access the Research

^1,4,5,6,13 Content was derived from numerous volumes of U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. Title V: A Snapshot of Maternal and Child Health (specifically 1997, 2000, 2004). Rockville, MD.
² U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. Title V: Caring for our National Maternal and Child Health (2000). Rockville, MD.
³ U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. Understanding Title V of the Social Security Act: A Guide to the Provisions of the Federal Maternal and Child Health Block Grant (2000). Rockville, MD.
⁷ Decade summaries have been built on through the Title V Snapshots (reference 1) and the Understanding Title V of the Social Security Act overview (reference 3).
⁸ Bulleted items have been derived primarily from Hutchins VL, "Maternal and Child Health Bureau: Roots," Pediatrics Vol. 94No. 5(November 1997), pp. 695-699.
^9,10 Note: these milestones are a combination of the Hutchins article (reference 8), Association of Maternal and Child Health Programs, Celebrating the Legacy, Shaping the Future: 75 Years of State and Federal Partnership to Improve Maternal and Child Health (2010). Washington: DC, and the MCH Timeline, with recent events drawn from the timeline.
¹¹ Preston SH, Haines M, Fatal Years: Child Mortality in Late Nineteenth Century America, National Bureau of Economic Research, Series on Long-Term Factors in Economic Development (Princeton, NJ: Princeton University Press, 1991).
¹² Meckel RA. Save the babies: American public health reform and the prevention of infant mortality, 1850-1929. Baltimore, Maryland: The Johns Hopkins University Press, 1990. [[Need to update this]]
¹⁴ U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. About the Maternal and Child Health Bureau, Approach. Website.

MCH History: Title V @ 85 — Beyond Legislation, Bold Leaders, Bright Legacies
August 2020
Authors: Hannah Todd, MPH, John Richards, MA, AITP
Reviewers: Olivia Pickett, MLS, MA, and Rochelle Mayer, EdD

MCH History

MCH/Title V History: Beyond Legislation, Bold Leaders, and Bright Legacies

Looking Back, Moving Ahead...

Read HRSA's Celebratory Announcement. August 14, 2020.

Join MCHB in Celebrating the 85th Anniversary of Title V

Title V Through the Years

Success Stems from Title V’s Flexibility

You Can Help Shape The Future of Title V

Beyond Legislation

Read More. Setting the Stage for MCH.

The Legislation. Careful Planning Paves the Way.

Beyond Legislation. Diving into a Rich History.

MCH Milestones. A Decade-by-Decade Timeline of Progress.

MCH Milestones

1900s-1930s. Historic legislation passed through efforts of bold leaders.

August 1935. Title V is signed into law.

1935-40. First ongoing medical care programs funded by Federal grants-in-aid.

1940s. From war-time to the most extensive public medical care program of an era.

1950s. Shifting demographics stagnation in child health lead to public health changes.

1960s. Changing social structures lead to unprecedented program and policy advances.

1970s. Looking at health disparities through a modern lens.

1980s. Block Grants and budget reforms redefine MCH and increase accountability.

1990s. Women’s health combines with welfare and education reform to bring change.

2000s. MCH Block Grant recognized as effective model as other MCH programs are launched.

2010s. Title V transforms as the nation addresses health reform.

2020 and Beyond. MCH and the nation face global pandemic and calls for racial equality.

Bold Leaders

Federal Leaders During the Children's Bureau Era. 1912-1956.

Julia C. Lathrop (1912–1921). From Hull House to first female U.S. Bureau chief.

Grace Abbott, PhM (1921–1934). Leading labor and literacy reforms.

Katharine F. Lenroot (1934–1951). Serving as MCH Ambassador to the World.

Martha M. Eliot, MD (1951–1956). Establishing programs based on social medicine.

Federal Leaders Guiding the Transition to MCH. 1956-1992.

Katherine B. Oettinger (1956–1967). Serving as the voice for children with developmental challenges.

Arthur J. Lesser, MD, MPH (1969–1973). Leading through scholarship and personal conviction.

Vince Hutchins, MD, MPH (1977–1992). Developing standards to strengthen state-federal partnerships.

Federal Leaders in Modern MCH. 1992-Present.

Audrey H. Nora, MD, MPH (1992–1998). Launching initiatives to strengthen services and systems.

Peter van Dyck, MD, MPH, MS (1998-2011). Linking performance measurement to MCH systems.

Michael Lu, MD, MS, MPH (2011–2017). Transforming the MCH Block Grant with comparative, national data.

Michael Warren, MD, MPH, FAAP (2018 –present). Leading MCH to Accelerate Upstream Together.

You may also want to check out these other resources on MCH leaders:

Bright Legacies

Women/Maternal Health. From Pregnant Women and Safe Birth to Women's Health.

Perinatal/Infant Health. From Infant Mortality to Early Experiences with Long-Term Developmental Outcomes.

Child Health. From Infectious Disease and Child Welfare to Addressing Physical, Emotional, and Behavioral Health.

Children and Youth with Special Health Care Needs. From a Focus on Disabilities to Holistic Well-Being.

Adolescent Health. From a Component of Children's Health to an Independent Life Stage.

Cross-Cutting and Systems-Building. Building a Comprehensive, Multifaceted Understanding of MCH.

Putting It All Together

Moving From Knowledge to Practice. Using the MCH Navigator as a Learning Portal.

Keep On Learning. Additional Resources to Further Explore MCH History.

Overview

Anniversary Celebrations

Materials in the MCH Digital Library

MCHB Oral Histories

American Academy of Pediatrics (AAP) Oral Histories

Legislation and Program Data

Other Collections of Historic Materials

References. Access the Research