GENERAL MINIMUM STANDARDS.

ECONOMIC AND SOCIAL.

At a general session of the Washington conference the economic and social aspects of child-welfare standards were discussed. While detailed standards were not formulated in this wide field, it was recognized that an adequate wage for the father, wholesome and pleasant housing and living conditions, and the abolition of racial discrimination are fundamental to the realization of any child-welfare program.

Recreation. The desire for recreation and amusement is a normal expression of every child which must be considered in any program for the physical and moral education of children. Parents and others charged with their care should be educated as to the importance of recreation. Public provision should be made for wholesome play and recreation, both indoor and outdoor, under trained leadership, and especially adapted to the different age periods of the child.

Commercialized amusements should be safeguarded by official supervisors having a scientific knowledge of recreation.

Child-welfare legislation.-The child-welfare legislation of every State requires careful reconsideration as a whole at reasonable intervals in order that necessary revision and coordination may be made, and that new provisions may be incorporated in harmony with the best experience of the day. In States where children's laws have not had careful revision as a whole within recent years, a child-welfare committee or commission should be created for this purpose. Laws enacted by the several States should be in line with national ideals and uniform as far as desirable in view of diverse conditions in the several States.

Child-welfare legislation should be framed by those who are thoroughly familiar with the conditions and needs of children, and with administrative difficulties.

It should be drafted by a competent lawyer in such form as to accomplish the end desired by child-welfare experts and at the same time be consistent with existing laws. Much interest has been shown in these standards and it is hoped that they may prove a strong influence in securing attention for further needed legal protection for children by the Federal and State Governments. Among measures urgently important for strengthening the young of the Nation are two which are really implicit in the standards:

1. Federal aid to States for universal elementary education, for the prompt and immediate abolition of illiteracy and of child labor.

2. Federal aid to States for the universal public protection of

maternity and infancy.

In this summary, attention will be asked for the second measure only.

Public protection of maternity and infancy.—The Children's Bureau series of reports on infant and maternal mortality in urban and rural areas has for the last seven years steadily accumulated evidence of a high degree of annual wastage of life and vigor. The studies show that poverty and ignorance are yokefellows and that civic responsibility for decent conditions of living is only beginning to reach an expression which can help to ease the burden.

same cause.

More than 16,000 mothers die yearly from causes incident to childbearing, and ill health is suffered by a vast number of others from the These deaths and disabilities are now known to be needless; among women who can command adequate care their proportions are greatly reduced. Over 200,000 babies less than a year old die annually. These infant deaths are controllable almost without exception. Poverty is a constant condition of the highest infant mortality rates, and the rates steadily improve as income increases to a good living standard. In the interest of humanity and of sound national economy adequate care for maternity and infancy should be universally available. The lessening rates of infant mortality in the United States for the last few years are encouraging. They indicate the effect of many scattered public and volunteer activities for infant welfare, but the reduction is far too slow. New Zealand still shows a much lower rate than our best States, and the United States is eighth from the head of the list of countries judged by the favorable character of their infant mortality rates. The best available world figures for maternal mortality show that the United States is fourteenth down the list; that is, the life of the mother is safer in thirteen other countries than in the United States. The neglect of maternity is shown by the fact that in a thirteen-year period during which deaths from communicable diseases have been reduced-typhoidfever deaths cut in half, croup and diphtheria reduced two-thirds— the deaths of mothers from causes incident to childbirth show no diminution, although these causes are also known to be in great measure controllable.

Based upon American studies and upon the experience of various other countries, a measure believed to offer a practicable plan for reducing the present losses of life and vigor was proposed in the last annual report of the Children's Bureau. The essential feature of the proposed plan is that the United States Government shall cooperate with the States in providing a joint fund in each State to be used so as to afford effective means for the protection of maternity and infancy. Mothers and babies are the same in the rural community and the city areas. They need the same care. The rates of death are approximately the same. The proposal therefore is of general application.

The principal features of such care are

(1) Public-health nurses.

(2) Accessible hospital care and medical attention.

(3) Teaching and practical demonstrations for mothers of the hygiene of maternity and infancy and of the household arts essential to the well-being of mother and child. (4) Accessible consultation centers, or well children's clinics for the periodical examination of young children in order to secure their most vigorous development.

It will be seen that such a program involves more than medical and nursing care. For example, the State university extension divisions and departments of home economics are already doing excellent pioneer work and can greatly assist the plan. The public libraries, especially those in smaller towns, and the traveling libraries are already undertaking an educational function in the careful distribution of pamphlets and literature for mothers.

Such a partnership between the Government and the States already serves agriculture through the Smith-Lever law and vocational training through the Smith-Hughes law, and is creating through the joint work of the Government and the States a new and cleansing knowledge of social hygiene, and is slowly removing the isolation of the remote ranch and farm family by the good-roads act. On exactly the same plan of Federal aid stimulating and standardizing State and local activities, the well-being of mother and child, a basic national economy, may be secured.

It may be suggested that health insurance schemes with maternity benefits are in operation in European countries, and the question is raised as to whether they offer a satisfactory method of meeting the need. The experience of England seems to show that a general measure of such character as that outlined above is absolutely essential in a country of modern standards of health and comfort even when health insurance exists.

The health-insurance law of the United Kingdom went into operation in 1911. It provides a benefit of $7.50 upon the birth of a child for the wife of an insured man and double that sum if the wife herself is insured and the wife of an insured man. Yet since the insurance law went into effect two measures have been passed by Parliament permitting grants in aid to sanitary districts for the protection of maternity and infancy. They are clearly an expression of a belief that no provision already in existence is adequate.

As applied to the United States, it may be said with certainty that · any public provision for safeguarding maternity and infancy must be universal. It must afford a dignified service which can be utilized with the same self-respect with which the mother sends an older child to the public school. It must not be compulsory. In this connection Australian parliamentary reports of 1917 are of interest. For the last seven years the Australian Commonwealth has allowed for each living birth the sum of $25 and the acceptance of this allowance is general. Yet the report on infant mortality submitted to the Australian Parliament in June, 1917, by the committee concerning causes of death and invalidity in the commonwealth strongly urges

1 Maternity Benefit Systems in Certain European Countries, by H. J. Harris. Children's Bureau publication. Since Oct. 10, 1912.

the adoption of a general scheme of practical measures, such as are in force in New Zealand and elsewhere, as a means of lessening the infant mortality rate.

When the matter is carefully examined it becomes clear that only a plan of public cooperation making generally accessible instruction in public-health nursing and medical and hospital care offers the safeguards of life and vigor which are needed.

Necessity for food studies.-The mounting cost of living and the effect on infant feeding and the dietary of young children is illustrated by the Children's Bureau studies of the amount of milk consumed by children in three cities-New Orleans, Baltimore, and Washington. Attention is called to the importance of milk in the dietary of the growing child in Bureau Publication No. 35, Milk the Indispensable Food for Children. These studies indicate that milk has a value as a food which can not be measured by its cost and show the danger many parents are incurring by taking milk away from young children because they consider the price prohibitive.

National attention has been drawn to the subject of food, and especially to its relation to the nutrition of children, by the increase in the price of the essential foodstuffs such as milk. The fundamental factors in child health other than food are less well understood, but it is most important to secure and to popularize this essential knowledge.

In fact little headway has been made in ascertaining what are the irreducible minimum developmental requirements of a growing child. There have been, as far as we know, no intensive studies or surveys to ascertain what a child ought to have in order to be reared properly, a need that is strikingly brought out in Mr. Ogburn's development of "The financial cost of rearing a child." As Mr. Ogburn adds, "this is a most important question-and no doubt others will develop it."

Considering the general marked advance in the price of food, clothing, and other items in the family expenditure and the possibility that the high cost of living may endanger the health of the growing child if economies are made in the food, clothing, and other commodities used by him, it would seem vital to the welfare of our children that intensive and general surveys be made at this time to ascertain what are the irreducible minimum requirements of a growing child and how their attainment is being affected by high prices.

Such studies of actual living conditions require a considerable period of time. They must be made by trained investigators with the aid of nutrition experts and should be interpreted into practical terms for the use of the average mother. They must be related to actual living conditions within the household and to outside condi

tions such as climate, situation, size of community, available home products, and accessible markets.

The timeliness of such investigations is apparent to any one interested in child welfare.

Children of Territories and islands.-The lesson of the present time is that no class can be protected alone; that only universal provisions are equitable or socially prudent. Illiteracy and child labor flourish together in rural areas in the United States and efforts are being made to eliminate them together. They are found together in the islands which are within the protection of the United States. Porto Rico according to recent reports has special problems of child welfare, as have the Virgin Islands, Hawaii, and the Canal Zone.

For the past seven years the bureau has been occupied with investigations of "matters pertaining to the welfare of children and child life" in continental United States. In the first year of its existence it was asked by the then Secretary of War to make reports upon the children of the islands under the protection of the United States, but the resources of the bureau have never permitted this expansion. Various considerations, however, urge study at this time of the needs of those children who are indeed legally under the protection of the United States yet who are so far removed from American observation that comparatively little is known of them. Especial attention is called to the children of Porto Rico and of the Virgin Islands.

The Virgin Islands: The Virgin Islands were purchased from Denmark in 1917, and an act passed by Congress provided a temporary government for them. Little can be presented as to living conditions in the Virgin Islands, but thanks to the census taken by the United States Census Bureau in 1917 certain facts are available which are recognized as indicative of the degree of well-being enjoyed by a people.

The population of the Virgin Islands in 1917 was 26,051, of whom 7,321 were under 14 years of age. At the date of the last Danish census, in 1911, the population was 27,086. This shows a decrease of 4 per cent in the six intervening years. The excess of deaths over births and the excess of emigration over immigration are submitted by the census as explaining a decline in population which has been general since 1835, when the population was 43,178.

In 1917 it was found that 24.9 per cent of the population 10 years of age and over was illiterate. The proportion of illiteracy in continental United States, the purchasing country, was 7.7 per cent in 1910, a rate known to be alarming; and of Denmark, the selling country, 0.2 per cent according to latest available figures for that country, which give the rate for 1907.

The rate of infant mortality is not given in the printed census report but the text contains this statement: "The present high infant mortality rate probably is accounted for mainly by the fact that most