The 100-year legacy of America’s first big national investment in families

This week, as Americans debate whether to increase investment in family support programs as part of President Biden’s Build Back Better framework, we celebrate the 100-year anniversary of an earlier law that should inspire us toward action. On November 23, 1921, President Harding signed the Maternity and Infancy Act, the federal government’s first foray into family assistance. The Act allocated $1 million ($28 million in today’s dollars) to states to improve maternal and infant health care. The law became known as the Sheppard-Towner Act, named after its two male sponsors, though it was originally proposed in 1918 by Jeannette Rankin, the first woman to serve in Congress, and Julia Lathrop, the first woman to lead any federal agency.

The Act passed with overwhelming bipartisan support despite frantic opposition from the American Medical Association. The AMA’s (male) members feared competition from new health clinics and (female) social workers that would provide families with health care at subsidized rates — a “socialist threat” as they framed it for the public, which must have sounded a bit overblown to women receiving guidance about how to give their babies more hygienic milk. One male physician representing the AMA asked a congressional committee, “If you are going to save the lives of all these women and children at public expense, what inducement will there be for young men to study medicine?”

The Sheppard-Towner Act (or Rankin-Lathrop Act, if you prefer) funded thousands of new health clinics especially in underserved rural areas, ultimately assisting 4 million infants and 700,000 pregnant women. Infant mortality rates — then as now, brutally high in America compared to other democratic nations — fell significantly during the period. Undaunted, the AMA escalated its attacks. It pointed out that infant mortality rates had already been falling in decades prior to Sheppard-Towner. They claimed the program “did not develop a single new idea in the field of maternal and infant hygiene,” and had wasted public funds. They basically eyeballed some numbers without any actual analysis, but they were very confident.

And as the Great Depression kicked in the AMA’s arguments won the day. Congress defunded Sheppard-Towner in 1929 just as the Great Depression kicked into high gear. Physicians who focused on serving children were so outraged at the AMA’s handiwork that they left a year later to form the American Academy of Pediatrics.

A great tragedy of pro-family programs is that the costs occur right away, but the full benefits occur so far in the future, and in such diffuse ways, that the full picture required to evaluate success can take decades or more to emerge with any clarity. Fortunately, in recent years researchers have begun to make progress using the kinds of higher-quality data and ingenious statistical methods that recently won economists Joshua Angrist, David Card, and Guido Imbens a Nobel Prize. A full eighty years after Sheppard-Towner passed, researchers have confirmed the law likely improved infant survival and health to such an extent that it caused children to earn significantly higher incomes in adulthood. These income gains are so large that they easily paid for the program’s costs just in terms of higher tax revenue alone. From a pure fiscal perspective, Sheppard-Towner wasn’t a waste after all; it was a bonanza.

This kind of too-good-to-be-true finding is increasingly common as we learn more about the real long-term impacts of policies that support child development, many of which turn out to increase future income and tax revenue that pays back taxpayers for a significant share of program cost. In some cases, like Sheppard-Towner apparently, taxpayers actually profit. That means it’s more expensive not to provide these services than to provide them. And the best research suggests we can expect very significant long-term payouts of this nature from all the key family investments being considered as part of Build Back Better: high-quality education before age 5, paid family leave, and child tax credits.

Just like 100 years ago, opponents of these measures talk about affordability, and hypothetical harm to businesses, and of course the evergreen spector of “socialism.” And just like 100 years ago, these objections are little more than fear-mongering. Despite the fiscal hysteria engended by our nation’s bizarre focus on ten year program costs (how much money do you spend on food over ten years?), the pro-family policies in BBB amount to modest annual expenditures on wildly popular, much needed public services. And even these modest costs will be at least partially offset by the greater tax revenue generated by healthier parents and children over time.

If the fear-mongers do successfully eviscerate key pro-family elements of BBB, Sheppard-Towner offers yet another hopeful lesson. The AMA thought it had killed Sheppard-Towner in 1929, but it was wrong. Six years later in 1935, President Franklin Roosevelt restored and expanded Sheppard-Towner programs in Title V of the Social Security Act. He was inspired in part by the counsel of the first female cabinet secretary, Frances Perkins, along with other visionary female leaders who had celebrated passage of Sheppard-Towner earlier in their careers, and who gallantly carried on the pioneering pro-family spirit of their mentors. Today Title V has evolved, but continues to finance investments in maternal and infant health affecting millions of American lives every year.

So on this centennial anniversary of a watershed law, we’d be wise to remember two things: bet big on programs that help families thrive, and keep up the good fight.