“A Right to Be Safely Born”: The Quest for Health Justice for American Mothers and Children, 1890-1965 by Eden Abigail Goldman Department of History Duke University Date:_______________________ Approved: ___________________________ William H. Chafe, Supervisor ___________________________ Edward A. Balleisen ___________________________ Sherman A. James ___________________________ Robert R. Korstad ___________________________ David Rosner ___________________________ Jeffrey P. Baker Dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of History in the Graduate School of Duke University 2014 i v ABSTRACT “A Right to Be Safely Born”: The Quest for Health Justice for American Mothers and Children, 1890-1965 by Eden Abigail Goldman Department of History Duke University Date:_______________________ Approved: ___________________________ William H. Chafe, Supervisor ___________________________ Edward A. Balleisen ___________________________ Sherman A. James ___________________________ Robert R. Korstad ___________________________ David Rosner ___________________________ Jeffrey P. Baker An abstract of a dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of History in the Graduate School of Duke University 2014 Copyright by Eden Abigail Goldman 2014 Abstract Between 1890 and 1965, the ideology of government responsibility for maternal and child health represented a continuous and central goal that fueled programs and institutional networks of progressive and liberal social policy advocates. Beginning in the settlement houses of the 1890s, a cadre of female bureaucrats, social reformers, and their political allies developed an array of federally based programs. Conservative stakeholders—among them anti-feminists, representatives of the medical industry, anti- communists, and white supremacists—strenuously opposed this vision of health justice, arguing that health was a personal responsibility in which government should play no part. Despite the achievements of government-based progressive reformers in instituting their vision in urban settlement houses, under the Sheppard-Towner Act of the mid- 1920s and during the years of the New Deal and World War II, the Cold War’s approach to domestic social policy after 1947 clamped down on their vision. After this conservative turn against social democratic solutions to welfare needs, these progressive advocates shifted their attention to the international health rights movement and to community-based maternal and child health activities. My dissertation introduces the concept of health justice as an interpretive lens to trace the history of health policy progressives and their institutional networks. On the one hand, health justice reflects the communitarian premise that the health of all members of society is essential for the common good. On the other hand, health justice implies that health and health care are individual rights that government ought to protect. While communitarian arguments were often on the tip of the tongues of social reformers, a passionate belief in citizenship-based rights and redistributive and iv humanitarian ideas of social justice undergirded their policy ideas and became a more explicitly stated position during the New Deal and World War II. This justice-based approach to maternal and child health policy was consistently undermined by the prevailing counter-ideologies of individual responsibility for health, local control of public services, racial segregation in health services, and the commodification of health care. My work relies on primary evidence collected from the personal papers of key protagonists, the administrative records of the Children’s Bureau housed at the National Archives, oral histories, and the presidential papers of Harry S. Truman. Published primary materials have been culled from memoirs, professional public health and medical journals, as well as the popular press. I also draw from a body of historical and political science scholarship of the past twenty-five years to contextualize the narrative. v Dedication Dedicated to my sons, Benjamin, Eliav, and Judah Goldman. vi Contents Abstract..........................................................................................................................................iv   Acknowledgements...................................................................................................................viii   Introduction:..................................................................................................................................1   Chapter 1. The Social Crisis of Industrial Society and the Rise of Educated Middle-Class Women..........................................................................................................................................15   Chapter 2: The Work for Health Justice of Four Settlement-house women.......................28   Chapter 3: The Children’s Bureau and the Sheppard-Towner Act.....................................55   Chapter 4: Opposition to Progressive-Era Female Social Reform Engagement in Maternal and Child Health Policy.............................................................................................................83   Chapter 5: The Political and Economic Context of New Deal and Wartime Health Justice Work..............................................................................................................................................97   Chapter 6: The Great Depression, the Struggle for a National Health Plan, and the FSA’s New Deal Health Service Programs.......................................................................................107   Chapter 7: Title V and the Emergency Maternity and Infant Care Program...................142   Chapter 8: The Backlash against New Deal and Wartime Experiments in Federal Health Services.......................................................................................................................................177   Chapter 9: The Cold War and the Legacy of Health Justice at Home and Abroad.........186   Biography...................................................................................................................................256   vii Acknowledgements I am fortunate to have so many people and institutions to thank for their help in completing this dissertation. Bill Chafe has been a kind and astute mentor and committee chair. He has been with me at every stage of this dissertation. I admire his own prolific scholarship and his devotion to his students. Throughout my time in graduate school, Ed Balleisen has gently pushed me to think more analytically and made my work much better through his extensive insights. Sherman James has inspired me to read outside of my field, to learn other disciplines’ methodologies, and to approach the study of inequality and poverty head-on. Since I was nineteen, David Rosner has modeled for me the kind of scholar I hope to be, one who combines political passion and intellectual rigor. Jeff Baker’s willingness to participate in this committee has given me the resource of someone well-versed in my subject, and his involvement has helped me to understand the complex politics of pediatrics. Bob Korstad has supported me during my years at Duke and encouraged me to use the lens of health politics to understand modern American history. All of my committee members have been, without a moment’s exception, generous, kind, and supportive. This warmth, their brilliance, and their interest in understanding the issues of our time, have helped me to love this project, and to finish it. Many senior scholars have refined my skills, asked me helpful questions, honed my subject, and found relevant materials. My first marvelous history teachers were Ann Norton Green and John Wood. More recently, I have received guidance and encouragement from John Dittmer, Eric Foner, Janet Golden, Malachi Hacohen, Margaret Humphreys, Kriste Lindenmeyer, Nicole Sackley, Pete Sigal (my department’s Director of Graduate Studies), Karin Shapiro, Karen Kruse Thomas, and Eric Yellin. viii Archivists, librarians, and administrators at an array of institutions have been courteous and helpful. They include staff at the National Archives II, the Truman Library Institute, the Radcliffe Institute’s Schlesinger Library, Columbia University’s Rare Books and Manuscripts Division, Duke’s Perkins, Bostock, and Law Libraries, as well as Guy Phipps at the University of North Carolina-Chapel Hill Davis Library, and Robin Ennis, the Staff Assistant for Graduate Studies in my department. This project has received generous support from the Duke Graduate School, the Sanford School’s Levitan Fellowship, the Rethinking Regulation Project at the Kenan Institute for Ethics, the Radcliffe Institute, the Truman Library Institute, and Duke Sanford School’s Center for the Study of Philanthropy and Voluntarism. My friends from my graduate program have given me their support, enthusiasm, and suggestions. Among them are Jacob Remes, Daniel Bessner, Heidi Guisto, Elizabeth Brake, Paige Welch, Erin Parish, and Julia Gaffield. Many other close friends have patted me on the back, told me to keep at it, and helped with the kids. My gratitude to my immediate family is immense. Throughout my education, my father has asked good questions and expressed curiosity about what I study and pride in my accomplishments. My mother edited the entire thing, even the footnotes, and has supported my intellectual and creative pursuits throughout my life. My sister has believed in me and insisted that this undertaking is worth the trouble. My children, Ben, Elie and Judah, have been patient and curious, asking me what I am writing about and why it matters. I am grateful most of all to my husband, Michael Goldman. Besides his brilliant editorial feedback, he has been a source of unflagging support, friendship, and love. ix Introduction: In 1948, the American Public Health Association chose Dr. Martha May Eliot as its new president. She was the professional organization’s first female president, chosen in large part for her success in running the largest single-payer health insurance system the nation had ever seen. In her acceptance speech, Eliot insisted that the most urgent priority facing the public health professional community after World War II was the improvement of American children’s health. “What we do for the child,” she declared, “can be taken as a fair measure of social progress.”1 According to Eliot, she and her colleagues had failed the children of the nation. During the war, “three babies died for every two soldiers killed in action.” Eliot explained the irony of the situation: Although Americans believed that their “standard of living is high enough to provide not only food, shelter, clothing, education, recreation for families, but also health and medical care” to all Americans,” the statistics on the nation’s children showed quite the opposite. Eliot believed that the only way out of this dilemma was to “provide a medical care program” available to all, regardless of income level, one that would be “as freely available to mothers and children as is our public education system.”2 Although medical care was Eliot’s first priority, her ideas about how to resolve the health crisis of America’s children went far beyond a comprehensive, federally funded health care system. She believed that the improvement of children’s health 1 Martha May Eliot, “Cultivating Our Human Resources for Health in Tomorrow's World,” American Journal of Public Health and the Nations Health 38, no. 11 (1948): 1500-2. 2 For statistics of child deaths during World War II, see Committee for the Improvement of Child Health of the American Academy of Pediatrics, “Road Ahead for Better Child Health,” (1948), accessed online through digital archives of Georgetown University’s Maternal and Child Health Library on January 26, 2014, http://www.mchlibrary.info/history/chbu/20320.pdf; for Eliot’s interpretation and recommendations, see Eliot, “Cultivating Our Human Resources for Health in Tomorrow's World,” 1500-2. 1