The Department of Government Efficiency (DOGE) is tearing through the federal government agency by agency, slashing programs, firing civil servants, and cutting research dollars. Polling indicates Americans may be souring on this approach, as program cuts come closer to home. Even then, some 40% of Americans believe the country could run with almost no federal employees. This reflects how disconnected Americans have become from federal agencies and the programs and services they provide.
It wasn’t always this way. The history of the U.S. Children’s Bureau, an early 20th-century federal agency, provides a helpful example of how federal agents made their work visible to Americans. They understood that citizens needed to see government in order to care about it. They focused on passing and implementing laws, while also making sure they advertised their efforts. This strategy was effective in both bolstering political support and in expanding the reach of their programs well beyond their limited capacity.
President William Howard Taft established the Children’s Bureau in 1912 to research and report on the health and welfare of American children. Julia Lathrop, the organization’s initial chief, was the first woman to run a federal bureau. Lathrop and her allies lacked established support within Washington, so they constructed a national network to conduct and advertise their work on behalf of mothers and children.
Lathrop’s first undertaking was to evaluate national infant mortality rates. But her Bureau did not have the resources to hire professional social scientists to collect the data at the scale that they wanted. Instead, they partnered with women’s magazines and federated women’s clubs to recruit local volunteers across the country to take part in data collection campaigns. Lathrop did this out of necessity, but she also understood that building out an active volunteer corps could generate grassroots political support for her agency’s programs.
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When the U.S. entered World War I, Lathrop fought to keep the plight of American infants at the center of the public discourse. She declared 1918 to be national “Children’s Year” and began explicitly connecting preventative healthcare for children to the ill-health of American draftees—one third of whom were rejected from service. Lathrop readily admitted that this was “of course…a device for arousing public opinion.”
It worked. An estimated 11 million Americans volunteered for the Children’s Year campaigns, weighing and measuring babies, promoting birth registration, and conducting health clinics and education campaigns within their communities. The Children’s Year campaigns brought millions more women in touch with local, state, and federal agencies.
Lathrop’s successful publicity drives and local engagement built a groundswell of support for her agency’s work. In 1920, Lathrop’s efforts received a major boost when states ratified the 19th Amendment, granting women the right to vote. This provided the political capital she and her allies needed as they pushed Congress to pass a national infant and maternal health bill.
Just as they had in their earlier efforts, the Children’s Bureau worked in tandem with national women’s associations and magazines in a concerted lobbying campaign. These organizations and publications encouraged women to write to their representatives in favor of the bill and many did. A Senate staff member observed, “I think every woman in my state has written to the senator.”
In 1921, their efforts succeeded, and Congress passed the Sheppard-Towner Act. The law, popularly known as the “Better Baby Bill,” provided federal funding to match state spending on infant and maternal health and welfare programs. Sheppard-Towner programs aimed to reduce the nation’s exceptionally high infant and maternal mortality rates by funding free and accessible preventative prenatal, postnatal, and pediatric care, home visit programs, birth registration campaigns, midwife training and regulation, and childrearing instructions for all interested women and girls.
The law was Congress’s first “explicit” social welfare legislation and was one of the earliest federal matching grant programs. Sheppard-Towner programs were available to all, not targeted to those deemed “needy and deserving,” as later federal maternal and child welfare programs would be. The law was underfunded and short lived, but its effects were far reaching. According to the Children’s Bureau, half of all babies born in the U.S. between 1921 and 1929 benefited from Sheppard-Towner health or education programs.
With high demand for their programs and limited resources, federal and state agents set up child health clinics, conferences, and demonstrations that would attract large groups of people—especially in rural areas. They went to state and county fairs, visited local communities, and used every technology available to widen their reach.
State and federal agents relied heavily on entertainment, publicity stunts, and gimmicks. They found a great deal of success in doing so. Traveling movie trucks, radio broadcasts, baby contests, children’s plays, and train car displays with mechanical child health exhibits attracted huge crowds. State and federal agents used these spectacles to provide services and to explain to the crowds how the federal and state bureaus functioned.
The Children’s Bureau childrearing handbook, Infant Care, first published in 1914, became “the federal government’s most popular publication.” A Children’s Bureau agent called it, “Uncle Sam’s best seller.” The booklet circulated within community networks and the government printed it in over a dozen languages.
This combination of services and publicity paid off. American women came to see the Children’s Bureau as a trustworthy and knowledgeable, if distant, ally in their efforts to raise healthy babies and to remain healthy themselves. More than 100,000 American women from every region, class, and educational background wrote to the Children’s Bureau every year during the 1910s and 1920s. Some wrote in desperation, others wrote with pride to explain how the Bureau’s courses and literature had helped them to raise healthy “Government Babies.”
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Despite, or perhaps because of, Sheppard-Towner’s popularity, the American Medical Association, anti-suffragists, and conservative politicians mounted a coordinated effort to dismantle the law. In 1929, they succeeded. When Sheppard-Towner funding expired, responsibility for funding maternal and infant health programs reverted to the states. Without the incentive of federal dollars, most state programs deteriorated. States that had invested heavily in maternal and infant health programs before federal funds were available continued to do so at lower levels. The states that hadn’t stopped funding the programs all together. Yet, the footprint of Sheppard-Towner programs and agencies remained, which proved crucial in the 1930s.
After the election of Franklin D. Roosevelt in 1932, the Children’s Bureau worked with his administration to revive Sheppard-Towner programs under Title V of the Social Security Act (SSA). Yet, the new law was a mixed blessing for the Bureau. It significantly increased its budget and staff. But unlike Sheppard-Towner, Title V programs were means-tested, which made them accessible to far fewer families and changed the way that the Children’s Bureau advertised them. It also placed Aid to Dependent Children (ADC) under the Social Security Administration, which began the process of breaking apart the Bureau’s singular administrative hold on child health and welfare policy.
In 1946, the Children’s Bureau moved from the Department of Labor to the Social Security Administration and lost its ability to administer matching grant programs. Under the SSA, the Bureau leadership no longer reported directly to a cabinet level official, which further diluted its status.
As the federal government expanded during the latter half of the 20th century, child health and welfare programs became further divided across agencies and departments. Since the Children’s Bureau’s “dismemberment” in 1946, no single federal agency “has lobbied exclusively in the interests of children.” Without a single agency actively promoting children’s health and welfare, most Americans soon lost sight of the federal government’s role in the matter altogether.
That reflects a broader problem today: citizens are unaware of scores of programs that provide real benefits to millions of Americans. The government appears opaque, complex, and remote.
The model employed by the Children’s Bureau in the 1910s and 1920s offers a potential path forward. For two decades, it very intentionally made visible the work of state and federal agencies to American families. This empowered the Bureau to build out state and federal administrative capacity, which, in turn, enabled it to lower infant and maternal mortality rates. The Bureau’s staff grasped that administering their programs wasn’t enough. Sustaining and expanding their offerings required ensuring that Americans understood the Bureau and the services it provided. Moving forward, this history can provide a template for rebuilding federal agencies and programs in ways that Americans can see.
Michelle Bezark is a senior researcher at the Center for Early Learning Funding Equity at Northern Illinois University. Her forthcoming book reconstructs the administrative history of the Sheppard-Towner Act.
Made by History takes readers beyond the headlines with articles written and edited by professional historians. Learn more about Made by History at TIME here. Opinions expressed do not necessarily reflect the views of TIME editors.
