Appropriating the Maternalist State: Rockefeller Philanthropy in the American West and the Making of County-Based Maternal and Infant Health Policy

My paper examines the relationships between health professionals charged with oversight of the Sheppard-Towner Maternity and Infancy Act in the rural west and the state-building activity of the Rockefeller International Health Board (IHB) during the 1920s.  The IHB, though not a federal agency, linked local, state, and national actors in creating public health policy and provided a template for federal-state cooperation.  A key strategy of the IHB’s success was the organization’s ability to appropriate the federal funds intended for maternity and infancy work for its own project—creating a local public health infrastructure.  The use of Sheppard-Towner monies became so critical to the operation of western county health units that congressional repeal of the Act crippled entire state health programs throughout the region.  When medical professionals in western states turned to the IHB to cover the shortfall caused by the loss of federal maternity funds, the philanthropy became embroiled in a struggle between the Hoover Administration and the Children’s Bureau over the future of national maternal and infant welfare policy—a struggle in which the IHB’s vision for county-unit based health care ultimately prevailed.

Drawing on the Rockefeller Foundation Archives, my work highlights the critical role of non-state actors in shaping national public health policy. It also places the Sheppard-Towner Act at the center of a fresh narrative suggesting that when we take region seriously, federal programs could, and did, have very different meanings in different places.  In the West, the development of maternal and infant health policies were dominated less by a nascent maternalist state, as other scholars have argued, than by the increasing power of what I refer to as “red-tape fraternities”—informal male-dominated professional networks that emerged at junctures where state, local, public, and private interests intersected with new agencies of the administrative state.