1. Freda, Margaret Comerford EdD, RN, CHES, FAAN

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This editorial celebrates the 75th anniversary of Title V of the Social Security Act, the program you might know as the Maternal and Child Health Services Block Grant program. Since 1935, this program has improved the health of untold numbers of women and children. Have you ever wondered how essential programs such as SCHIP (State Children's Health Insurance Program), Healthy Start, reproductive health services for poor women, and interventions for children with developmental disabilities came to be in the United States? They all received funding because of Title V, the only federal mechanism by which the government supports state efforts for mothers and children.


And where did the idea of federal and state help to improve the health of women and children come from? You might have guessed it. It was the idea of a nurse. A simple idea, really, but a revolutionary one at the time. It was a long time ago (in 1919) when Lillian Wald, the nurse hero of many of us (and the mother of public health nursing), became concerned about outbreaks of communicable diseases throughout the country, as well as the proliferation of child labor in the United States, and wanted our country to provide protection for the most vulnerable. Sounds like a nurse, right? It wasn't easy, but through her efforts President Taft signed an Act of Congress creating something new: "The U.S. Children's Bureau," to "investigate and report on matters pertaining to the welfare of children among all classes of people" (Hutchins, 1994, p. 695). Before The Children's Bureau, we kept no national statistics on infant mortality or child health; one mandate of this new government agency was to gather statistics for the first time in the United States in order to develop interventions. The Children's Bureau also organized healthcare before birth into formalized prenatal care, taught new mothers how to care for their babies, and offered special services to disabled children. Of course, getting Congress to create The Children's Bureau wasn't easy. It was met with great resistance by some who felt that the federal government was overstepping its rights, and that only states should have the power to provide services such as these to citizens-sound familiar? We've heard these debates again in the last year about our new healthcare reform efforts as well.


For several decades, the issue of how to fund The Children's Bureau loomed large for Congress. As the population increased, more people needed help, and Congress had to continually revisit the funding issue as well as choose worthy programs. Over time, this method of funding became untenable, and it was necessary to find a more permanent way to help women and children. Fast-forward to 1935 and Franklin D. Roosevelt, who,as a part of his broad social agenda, signed the Social Security Act and then Title V, which replaced The Children's Bureau in monitoring the health of women and children. Title V is now longest-lasting public health legislation in the United States. It's hard to overestimate the good that has been done by Title V. To this day, Title V provides programs for maternity, infant and child care, and a range of services for children with congenital disabilities, supports children with special health needs, builds community capacity to provide services, and delivers prenatal services to over 2 million women and primary care to more than 17 million children. In the intervening years since 1935, Title V has added research grants, as well as outstanding programs such as Healthy Start and SCHIP to its long list of accomplishments, as well as adolescent pregnancy prevention, lead poisoning prevention, low birthweight prevention, breastfeeding promotion, and nutrition programs. Nurses have been an integral part of the history of Title V and the services it provides, as you would expect. After all, the whole thing emanated from the concerns of one great nurse expressing one good idea.




Hutchins, V. L. (1994). Maternal and Child Health Bureau: Roots. Pediatrics, 94(5), 695-699. [Context Link]