Table Of Content“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
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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.
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Dedication
Dedicated to my sons, Benjamin, Eliav, and Judah Goldman.
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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
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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.
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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.
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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
Description: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
