Birthing and bureaucratic women: needs talk and the definitional legacy of the Sheppard-Towner Act

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Author: Kristin Barker
Date: Summer 2003
From: Feminist Studies(Vol. 29, Issue 2)
Publisher: Feminist Studies, Inc.
Document Type: Article
Length: 10,362 words

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I am to be a mother in July.... Are there any spacil things that i should eat? If so, what? Any what kind of exercices should i take? And how often? What kind of clothes should i buy and make for the baby and my self? And how much of everything? Will you please write down everything i need? and the baby as i would not like to buy to much because i cannot afford to pay much, I would like to buy as less things as possible. and make as much as i can at home, I will be a very young mother as i am only 17 years old.... [W]ill you please tell me why i always think that eather I or the baby will die after its birth.

--Mrs. C. Carroll to Mrs. Max West, 23 March 1921

It is wise for an expectant mother to consult a physician as early in pregnancy as is possible as much trouble later on may be avoided by the care of a physician throughout pregnancy.... If you are perfectly well and strong there is no reason at all to think that either you or the baby will not live. It is much better for both you and the baby not to let such unhappy ideas find a place in your thoughts. If you take the very best care of yourself possible, there is no reason why all should not go well.

--Florence McKay, M.D., Assistant Director, Division of Hygiene, U.S. Children's Bureau to Mrs. C. Carroll, 1 April 1921

In 1921 the Sheppard-Towner Act was signed into law, thereby establishing the first federal welfare program in the United States. The objective of Sheppard-Towner was to reduce infant and maternal mortality. One pillar of this campaign was a national educational program designed to promote the use of medical prenatal care, since, when Sheppard-Towner became law, only pregnant women with severe complications were receiving medical attention prior to the onset of labor.

In 2000, 97 percent of all pregnant women in the United States received regular medical prenatal care.1As evidenced by the widespread cultural acceptance of prenatal care, pregnancy has been medicalized (come under a medical jurisdiction) during the twentieth century. Indeed, the efficacy of prenatal care is so widely accepted that the late 1980s and early 1990s, an era otherwise characterized by harsh cutbacks in welfare benefits, witnessed an expansion in eligibility for publicly-funded prenatal care. A series of "welfare reforms" recently decoupled Medicaid from other cash assistance for poor women and children formally AFDC. Consequently, low-income women who do not qualify for cash welfare benefits can still qualify for Medicaid. This expansion of eligibility contributes to the remarkably high utilization rate for prenatal care. (1)

From the passage of Sheppard-Towner in 1921 to the maternal health policy reforms of the 1990s, the federal state has equated women's maternal health needs with prenatal care. Although recent research raises questions about the efficacy of prenatal care historically and contemporarily in terms of...

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Gale Document Number: GALE|A109023389