In 1923 two private national organizations, the American Child Hygiene Association and the Child Health Organization of Amer ica, united under the presidency of the Hon. Herbert Hoover to form the American Child Health Association. This association was active in promoting May Day as Child Health Day, and pub lished an important survey of child health in 86 cities with a population of from 40,00o to 70,000, and many popular bulletins. On Aug. 13, 1935, this organization was disbanded.
The Federal Maternity and Infancy Act authorized for a five year period, which was extended to a seven-year period in 1927, an annual appropriation of $1,240,000, of which a sum not to exceed $50,000 was to be expended by the U.S. children's bureau for administrative purposes and for the investigation of maternal and infant mortality, the balance being divided among the States accepting the act as follows: $5,000 unmatched to each State, and an additional $5,0oo to each State if matched ; the balance to be allotted among the several States on the basis of population and granted if matched. National administration of the act was lodged with the children's bureau of the U.S. Department of Labor. This act was in effect from Nov. 23, 1921, to June 3o. 1929 though the appropriations provided did not become available until some months after the act became effective. During this entire period Grace Abbott was the chief of the children's bureau, serving from Aug. 27, 1921 until June 30, when she was succeeded by Katharine F. Lenroot. After June 3o, 1929, the children's bureau had no special appropriation for this work until the Social Se curity Act was passed by the Congress and approved by President Roosevelt on Aug. 14, 1935. While this act went into effect im mediately, the actual appropriations for grants to the States were made later and became available for distribution as of Feb. 1, 1936. The total amount of money made available by the provi sions of this act for expenditure by the children's bureau amounted to $8,150,000 divided, in purpose, as follows : Maternal and child health services, $3,800,000. Services for crippled children, $2,850, 000. Child welfare services, $1,500,000. The distribution of this money to the States is made after their programs of work have been accepted by the children's bureau and it is allocated with special reference to the extent of the rural population in each State. The amount available for maternal and child health serv
ices was increased to $5,820,000 by an amendment to the act approved by the President on Aug. 1 o, 1939. On the same date the amount authorized for grants for services for crippled children was increased to $3,870,000.
The States rapidly took advantage of this opportunity of pro moting their work for the betterment of maternal and child health and by Nov. 25, 1936, all of the 48 States, Alaska, Hawaii, and the District of Columbia had presented programs of proposed work and made the essential appropriations for matching the grants made possible by the terms of this act. Services of this nature are now available for a large proportion of the mothers and babies in the U.S. and the children's bureau is actively engaged in plans and programs to make these services more widespread and effective.
In this field of maternal and child health., definite advances have been made. Since all of the 48 States have been ac cepted into the birth registration area thus making it possible to have a more accurate basis for computation of the infant mor tality rate. In 1915, the infant mortality rate for the then birth registration area, based upon each i,000 live births, was I00; in 1920, it was 86; in 1930, the rate was 65 and in 1938 the provi sional figures of the U.S. bureau of the census gives the rate as 51. This steady and marked decrease places the U.S. in a favour able position with relation to other countries. Among the 3o countries of the world for which reports have been received and for the year 1937, the only ones which show a lower rate of infant mortality than the U.S. are: New Zealand, 31; Australia, 38; The Netherlands, 38 ; Sweden, 46, and Switzerland, 47. When the relative size of the countries and the admixture of racial groups living in them are considered, the position taken by the U.S. in this regard may be considered excellent. During 1938, the States having the lowest infant mortality rates were Connecticut and Nebraska each with a rate of 36, while the State showing the highest infant mortality rate during the same period was New Mexico, with a rate of 109.