1917, the same committee submitted a report on maternal mortality in childbirth. Figures are given to show that, although there was a decrease in the death rate after the introduction of the maternity bonuses, this decrease was not so great as it had been during the preceding years.

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 with maternity benefits is in operation. In many other European countries such measures exist. In these countries, as in England, experience indicates the need of basic governmental responsibility for maternity and infancy.

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. The second was passed in August, 1918, and sanctions increased expenditures. It specifies the objects for which funds may be spent and is 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.

PROTECTION OF WORKING CHILDREN.

The imperative need of physical tests for children about to enter employment and of continuous supervision over the health of children at work has received national recognition in the organization by the Children's Bureau of a permanent committee to determine physical standards for working children.

Little has been done up to the present time in the United States to prevent children from going into work for which they are physically unfit, and practically no study has been made of the effects of early labor on the growth of the body. Yet the children who begin work between the ages of 14 and 18, and in many instances as early as 12 or even younger, are the children of least resistance in the community. They are in general the children of the poor, and, in consequence, are likely to be the ill nourished, the undersized, and the anemic. Already handicapped, their growing bodies can put up no resistance

these maturing years they are peculiarly liable to injury from overstrain and peculiarly sensitive to all sorts of industrial hazards.

A great deal of the work done by children is, moreover, totally unfit for them. It often involves too much sitting or too much standing, the carrying of weights beyond the child's strength, the overexercising of one set of muscles at the expense of another, and, in certain occupations, the loss of sleep. Foreign investigations have shown that the sickness rate among juvenile laborers is alarming, especially during the second year of working life when the injurious effects of early labor upon already undeveloped bodies have had time to make themselves felt.

The "physical minimum" for children entering employment adopted by the Child Welfare Conferences declared that "A child shall not be allowed to go to work until he has had a physical examination by a public-school physician or other medical officer especially appointed for that purpose by the agency charged with the enforcement of the law, and has been found to be of normal development for a child of his age and physically fit for the work at which he is to be employed." It provided also for annual physical examinations of all working children under 18 years of age.

What constitutes normal development for boys and girls of different ages, and what indicates that a child is "physically fit" for the employment which he is about to enter can be determined only through exact observation and measurements.

PROTECTION OF CHILDREN BORN OUT OF WEDLOCK.

At least 32,000 white children are born out of wedlock in the United States each year, and probably not more than 70 per cent of these children survive the first year of life.

The children who do survive infancy are likely to be deprived of normal home life and a mother's care. Rarely do they receive from their father the support to which they should be entitled. In a large proportion of cases the public must assume the burden of the support of these children.

The English common law, which regards the child born out of wedlock as the "child of no one," still prevails in some parts of the United States and deprives the child not only of a name but also of the substantial rights of inheritance and support. Advanced legislation in some States has in recent years altered the common law by provisions more favorable to the child, but the need for uniform legislation designed to protect rather than punish is evident.

Legislation bearing on the father's obligations has been particularly backward. In one State laws enacted as far back as 1793 have remained practically unaltered, and these in turn are modeled on the

"provision whatever for compelling the support of a child by its natural father. Where provision is made it is in many cases entirely inadequate, for when the payments are not too low, the period of support is too brief, extending sometimes only to the tenth or eleventh

year.

Minnesota, through legislation passed in 1917, affords a greater amount of protection to children born out of wedlock than does any other American State.

In February, 1920, two regional conferences were held under the auspices of the Children's Bureau to consider standards which should govern legislation for the protection of children born out of wedlock. In these conferences representatives from almost half the States participated. While the conferences were not a direct outcome of Children's Year, they were suggested by the work of the Child-Welfare Conferences. Resolutions were adopted by the regional conferences, and a committee has been appointed to prepare a single statement of principles, based on the resolutions.

PROGRAM OF CHILDREN'S YEAR FOLLOW-UP.

Throughout almost the entire country there is an obvious need of the continuance of certain activities which may be said to constitute a Children's Year follow-up program. The following measures are important:

1. Better birth registration. The year has shown afresh the value to the child of prompt public record of birth. Twenty-three States and the District of Columbia now keep records good enough to receive the sanction of the Bureau of the Census, and, hence, to be included in the birth-registration area. The States are California, Connecticut, Indiana, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, and Wisconsin. Twenty-five States are not so recognized. They are Alabama, Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Iowa, Louisiana, Mississippi, Missouri, Montana, Nebraska, Nevada, New Jersey, New Mexico, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, West Virginia, and Wyoming. Vigorous effort for one year would place all the States in the recognized list of the Bureau of the Census.

The Children's Bureau has prepared a simple test plan which can be used in any community in which there is a good law but where, because of nonenforcement, the State is not in the birth-registration area. In other States campaigns for adequate legislation should be waged.3

2. Establishment of health stations.

(a) Prenatal and infant-welfare stations for keeping mothers and babies well and for securing proper care.1

(b) Well-children stations for children of preschool age. These are natural developments from infant-welfare stations. and may be conducted with them or independently. 3. Protection of health and development of school children by weighing and measuring tests, open-air classes, nutritional clinics, and other measures.5

4. Protection of children from illiteracy and premature work by Back-to-School and Stay-in-School campaigns.o

3 See Bureau Publication No. 54. An Outline for a Birth Registration Test.

4 For desription of methods of conducting, see Bureau Publication No. 45, Children's Health Centers.

See Bureau Publication No. 60, Standards of Child Welfare, p. 228, "Nutrition Clinics," by Dr. William R. P. Emerson.

* See Bureau Publications Nos. 49, 50, 51, 53, 55, 56 on the Back-to-School and Stay-in-School campaigns.