Celebrating 75 Years of Title V (Maternal and Child Health) and Re-exploring Our Roots

With roots going back to the formation of the Children’s Bureau in 1912, Title V (Maternal and Child Health) of the Social Security Act (SSA) provides a foundation for ensuring the health of our Nation’s mothers and children. Passed by Congress and signed into law by President Franklin Delano Roosevelt on August 14, 1935, Title V authorized the Maternal and Child Health Services Programs that are now administered by the Maternal and Child Health Bureau (MCHB) as part of the Health Resources and Services Administration, US Department of Health and Human Services. Seventy-five years later, Title V continues to provide leadership, performance, and accountability to ensure the delivery of health care and related services to all mothers, infants, children, adolescents, and children with special health care needs in the Nation–including those with low incomes, diverse ethnic or racial backgrounds, or isolated populations with limited access to care. The Children’s Bureau was established in 1912 and was the unit in the Federal Government created to implement Maternal and Child Health (MCH) programs. The Act states, ‘‘that the Bureau shall investigate and report...upon all matters pertaining to the welfare of children and child health among all classes of our people, and shall especially investigate the questions of infant mortality, the birth rate, orphanage, juvenile courts, desertion, dangerous occupations, accidents and diseases of children, employment, legislation affecting children in the several States and Territories.’’ The Bureau was formed to fact-find and share the findings about the interrelated economic, social, and health issues influencing the well-being of children and families in the Nation. ‘‘It is hard to realize now what a novel idea it was to establish a Children’s Bureau in a national government. When our Children’s Bureau was created by Congress, no other government—and only one of our States—had such a Bureau. Governments thought of children very much as the old painters thought of them, as pocket editions of grownups. With the creation for the Children’s Bureau, Congress first recognized what modern psychology has taught us, that a child had needs and rights quite distinct from those of adults. Wisely, Congress realized that you can’t separate one phase of child welfare from another any more than a doctor can treat one phase of a child’s health without regarding others’’[1]. In 1921, President Harding signed the first federal law, the Maternity and Infancy Care Act, better known as the Sheppard-Towner Act, providing grants-in-aid to States for human services similar to existing grants-in-aid programs for Agriculture and Vocational Training. Although the appropriation was small ($5–$10,000 per State), it established several precedents carried forward to Title V of the Social Security Act. It showed not only that the National Government could successfully fund local health services for mothers and infants, but also that it was possible and practical to distribute money to all the States. In other words it established a National policy that people in the Nation, through their federal government, share with the States and localities the responsibility for helping to provide community services that children need for a good start in life [2]. With the demise of the Sheppard-Towner Act in 1929, coupled with the Great Depression, the ability of states to continue the young MCH programs was compromised. P. C. van Dyck (&) Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 5600 Fishers Lane, Room 18-05, Rockville, MD 20857, USA e-mail: Pvandyck@hrsa.gov