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U. S. DEPARTM ENT OF LABOR
JAMES J. DAVIS, Secretary

CHILDREN’S BUREAU
GRACE ABBOTT. Chief

THE WELFARE OF INFANTS OF
ILLEGITIMATE BIRTH
IN BALTIMORE
AS AFFECTED BY A MARYLAND LAW OF 1916
GOVERNING THE SEPARATION FROM THEIR
MOTHERS OF CHILDREN UNDER 6 MONTHS OLD

Part I. M ORTALITY AMONG INFANTS BORN OUT OF
WEDLOCK IN 1915 AND 1921
By RENA ROSENBERG

Part II. EFFECT OF THE LAW ON THE POLICIES AND
WORK OF SOCIAL AGENCIES
By A. MADORAH DONAHUE

WASHINGTON
GOVERNMENT PRINTING OFFICE
1925

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SINGLE COPIES OF THIS PUBLICATION MAT BE
OBTAINED FREE UPON APPLICATION TO THE
CHILDREN’ S BUREAU.

ADDITIONAL COPIES MAT

BE PROCURED FROM THE SUPERINTENDENT OF
DOCUMENTS, GOVERNMENT PRINTING OFFICE,
WASHINGTON, D. C.
AT

5 CEN TS PE R COPY

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3 k a. T
Ll

CONTENTS
Page

Letter of transmittal___________________________________________________
Introduction___________________ ________________________ _ I
P art I.— Mortality among infants born out of wedlock, 1915 and 1921 _ I
Method and scope of study_____________________________
Illegitimate live births, 1915 and 1921_______________ 4
Infant mortality rates, 1915 and 1921___________________
Infant mortality rates, by color of mother______ ________
Age at death__________ _______________ _______________ _
Causes of death__________ ________________ _____ ______ g
P art II.— Effect of the law on the policies and work of social agencies__
Origin of the law____________________
Provisions of the law, and babies affected by it__________
Method of the study____________________________________
Agencies that care for unmarried mothers_______________
Changes in policies presumably due to the law___________
Residence of unmarried mothers cared for by five agencies
before and after the law became effective_________ _:___
Disposition of cases of illegitimate birth dealt with in 1921
by certain agencies___________________________________
Separations approved under the law_____________________
Attitude of certain groups toward the law______________
Appendix A.— Text of the Maryland law of 1916 governing the separation
of children under 6 months from their m others..____ ________________
Appendix B.— Form of physician’s certificate_______________________ ___
hi

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LETTER OF TRANSMITTAL

U nited States D epartment of L abor,
Children’s B ureau,
Washington, February 18, 1925.

Sir : There is transmitted herewith a report on The Welfare of

Infants of Illegitimate Birth in Baltimore as affected by a Maryland
law of 1916 governing the separation from their mothers of children
under 6 months old. The report has been prepared by Rena Rosen
berg, of the statistical division, and A. Madorah Donahue, of the
maternity and infant-hygiene division. The bureau is indebted tox
the Baltimore Health Department and to many of the social agencies
for helpful cooperation.
Respectfully submitted.
Grace A bbott, Chief.
Hon. James J. D avis ,
Secretary o f Labor,

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THE WELFARE OF INFANTS OF ILLEGITIMATE
BIRTH IN BALTIMORE
INTRODUCTION

1916 the General Assembly of Maryland passed a law 1 which
prohibits the separation of a child younger than 6 months from his
mother except under specified conditions. This law, known popu
larly as the “ six months law,” became effective June 1, 1916.
Although the text of the law makes no distinction between chil
dren of legitimate and of illegitimate birth, the great majority of the
children affected by its application are of illegitimate birth. For
this reason the Children’s Bureau study of the results of the law deals
chiefly with children of illegitimate birth.
Part I is a statistical study of births in 1921 which was made to
determine whether the mortality among infants of illegitimate birth
m Baltimore has been reduced since the law went into effect.
Infants bom to unmarried mothers in 1921 must have had better
care than such infants born in 1915, for 1 in every 3 such infants
born in 1915 died before he was 1 year old and 1 in every 4 before he
was 6 months old, whereas 1 in every 8 born in 1921 died before he
was 1 year old and 1 in every 12 before he was 6 months old. The
mortality rate for infants born out of wedlock in 1921 showed a
reduction of more than 50 per cent from the corresponding rate for
That this reduction was influenced by conditions which did not
affect infants of legitimate birth so much is shown by the fact that
the rate for these infants was reduced less than 20 per cent. The
ratio of the death rate among infants of illegitimate birth to the
death rate among infants of legitimate birth decreased greatly. For
infants.born in 1915 this ratio was approximately 3 to 1; for infants
born in 1921 it Was approximately 1.5 to 1.
Among infants of illegitimate birth the percentage of decrease in
mortality from gastric and intestinal diseases was great, and this
decrease was more marked in the earlier months of the first year of
fife than in the later months. The decrease in the mortality rate
from these causes is significant in connection with the reduction in
the rate from all causes because it probably would be influenced to a
greater extent than the rate from other causes by the wider preva
lence of breast feeding since the law went into effect. The high per
centage of decrease from 1915 to 1921 in the rate from gastric and
intestinal diseases in the first six months of life may be the result of
the increase in breast feeding.
According to the information available for the two years illegiti
macy seemed to be much less prevalent in 1921 than in 1915. In
1915, 7.2 per cent of all live births were illegitimate; in 1921 only 4.4
per cent were illegitimate. The decrease m the percentage of ille' Maryland, Laws of 1916, eh. 210, pp. 416-418. Also found in Bagby’s Annotated Code, vol. 4 (1918)
art. 27, secs. 483A-483E.

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IN F A N T S

IL L E G IT IM A T E

B IR T H

B A L T IM O R E

gitimacy was greater among white births than among colored.2 Of
the white births in 1915, 3.4 per cent were illegitimate, and in 1921,
1.3 per cent. Of the colored births in 1915, 27.1 per cent were ille
gitimate, and in 1921, 20.9 per cent. Part of this large apparent de
crease, however, was undoubtedly due Jto the fact that the 1921
figure for illegitimate births was not so nearly complete as that for
1915, owing to a difference in the methods of the two investigations
which will be explained later.
.
Part II is a general study of some agencies m Baltimore whose
activities might be affected by the law and of separations which have
taken place between mothers and babies. Between the time the law
went into effect and the end of 1923, 52 babies younger than fimonths
were separated from their mothers with official approval. The rec
ords of these separations were examined in the course of the study..
The majority of the infants wlio were separated from their mothers
with the approval of the board of State aid and charities during the
period for which the records were examined have had some super
vision in the foster homes where they were placed, through the co
operation of social agencies. It is desirable that all. inf ants so placed
should have the benefit of supervision. Experience has shown that
whenever a child is to be placed in a foster home, whether for temjmrary care or for legal adoption, the prospective home should be
investigated carefully, and also that after, a chiM is placed the agency
responsible for his placement should send a visiting agent regularly
to see that he is receiving proper care. This visitation and super
vision should continue until the child becomes of age or is legally
adopted.
. .
.
,
Twenty-four hospitals, social agencies, and maternity homes,
which deal especially with unmarried mothers, were visited. Of
these, about one-third have made changes in policy since the six
months law went into effect, and some commercial agencies of poor
character have gone out of business on account of the restriction
which the law has placed on their activities.
# .
, .
According to reports from hospitals and other institutions giving
maternity care, fewer unmarried women have been coming from States
other than Maryland into Baltimore for delivery. A study of some
of the institutions which accept such cases indicated that the reason
for this decline in out-of-State cases was the fact that babies can no
longer be placed soon after birth, as they could before the law went
into effect.
.
, r,
The six months law was designed primarily to protect the health,
of babies during the first six months of their lives. It has done more
than this; it has caused a record to be made whenever a baby under
6 months of age is transferred from his mother’s custody. Hence
legal sanction, which is familiar in all States in regard to property
transfers, is now required in Maryland in cases of transfers of babies
under 6 months of age, although it is not yet required in the case
of children older than this.
/
f r :„
,
In the course of the study it was found that the good effect the
law apparently has had on the welfare of infants of illegitimate
birth has caused it to be favorably regarded by various groups of
individuals in contact with the unmarried-mother problem.
! The term “ colored” is used throughout this report to include all other than white and may include
Indians, Chinese, and Japanese.

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PART

1.— MORTALITY AM ONG INFANTS BORN
W EDLOCK, 1915 AND 1921

OUT

M ETHOD AND SCOPE OF STUDY

As a result of a field study in Baltimore made by the Children’s
Bureau the mortality rate for infants under 1 year of age born out of
wedlock in 1915 was found to be 294.2 per 1,000 live births, a rate
almost three times as high as that for infants of legitimate birth,
which was 103.5.1 To determine whether the mortality among infants
o± illegitimate birth in Baltimore has been reduced since the 1915
study it was decided to ascertain the rate for such infants born in
1921. ^Birth certificates for all children born out of wedlock in Balti
more m 1921 were copied. First they were sorted by name of the
mother and were matched to the index of death certificates for 1921
and 1922 or to the date in 1922 when the baby would have reached
its first birthday. If a name similar to the one on the birth certificate
was found the death certificate itself was looked up, and if found to
be that of the same baby, was copied. After a thorough search of the
indexes for 1921 and 1922 had been made according to name of the
mother a second sorting was made by name of the father, and the
same procedure was followed in making a second search. If the birth
certificate showed that the baby had been registered under a name
ditterent from that of either f ather or mother, a third search was made,
mrf j re1cords showed 866 live-bom infants of illegitimate birth and
109 deaths among these infants before the end of their first year of
life. Since many of the infants were born in hospitals or maternity
homes to nonresident mothers who may have moved away fr o m the
« f t before i the child was 1 year old, there may have been a few
additional deaths which occurred outside the city and which therefore
were not recorded in Baltimore. For this reason it was decided to
exclude from the study all cases in which the mother’s residence was
giYGQ on tn.0 birth ccrtificatG as outsid.6 tho city. Fifty-six births
and five deaths were excluded on this basis. The total number of
infants born to resident mothers was 810; of these, 104 died under
1 year of age.2
The proportion of illegitimate births seemed to be much smaller in
. 2 1 than in 1915. Undoubtedly there has been some reduction
i° this proportion, but the methods by which the two figures were
obtained were somewhat different, and the actual reduction in ille
gitimacy is probably not so marked as the figures seem to show. In
the 1915 study the number of illegitimate births included not only
those registered as such on the birth certificates but also some births
which had been registered as legitimate. As a result of information
obtained from visits to the homes of the mothers of all children bom
in 1915, as far as they could be found, the number of illegitimate
tt*
Mortality Results of a Field Study in Baltimore, M d., based on births in one vear n 170
U. S. Children’s Bureau Publication No. 119. Washington, 1923
y ’ P' 170‘

givrah^ <inathe(5fty1.Uded tW° infantS who died just outside of the city but whose mothers’ residence was

36080°—25---- 2

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IN F A N T S

IL L E G IT IM A T E

B IR T H

B A L T IM O R E

births in that year was found to be larger than the information on
the birth certificates indicated. No follow-up work of this kind was
done in 1921, and the number of illegitimate births recorded in that
year is probably smaller than the actual number.
IL L E G IT IM A T E

LIVE B IR TH S,

1915 A N D

1921

Although the live births in Baltimore increased from 13,188 in
1915 to 18,444 in 1921, the number of illegitimate live births de
creased from 955 in 1915 to 810 in 1921; in other words, the ille
gitimate births were 7.2 per cent of all live births in 1915 and 4.4
per cent in 1921.3 If the 1915 ratio were applied in 1921, there would
have been 1,328 illegitimate live births instead of 810.
IN FA N T

M O R T A L IT Y

RATES,

1915 AN D

1921

The mortality rate of 294.2 for infants born out of wedlock in 1915
was in all probability an understatement of the true rate, since, though
it was based on all registered live births and all known deaths among
them of infants under 1 year,4 some additional deaths in this group
may have occurred. Of the 955 live-born infants, 256 could not be
traced; if each of these cases had been followed until the first birthday
was reached, or to death if the infant died when less than 1 year old,
some deaths undoubtedly would have been added to the number
recorded. The study of 1921 was based on the live-born infants
whose births (in 1921) were registered in Baltimore and on the known
deaths of infants under 1 year of age among them. The rate calcu
lated from these registered births and deaths is likewise an under
statement of the true rate, since some deaths may have occurred
outside Baltimore which would not have been included. The death
rate for infants born out of wedlock in 1921 (128.4), based on 810
registered births to resident mothers and 104 registered infant deaths,
is calculated upon a basis similar to that upon which the 1915 rate was
ascertained and seems to be a fair figure for comparison.
The mortality rates for infants born in 1915, 102 for infants of
legitimate birth and 294.2 for infants of illegitimate birth, were based
on registered live births and infant deaths exclusive of nonresident
hospital cases. These rates are based on figures given in the Children’s
B u r e a u study of infant mortality in Baltimore in 1915.5
The number of legitimate births in 1921 was found by subtracting
the number of illegitimate births reported on birth certificates from
the number of births reported by the census.® Births to both resident
and nonresident mothers were counted by the census. Therefore the
mortality rate for infants of legitimate birth born in 1921, which was
based on births to both resident and nonresident mothers, is not
strictly comparable with the rate for such infants born in 1915, which
was based on births to resident mothers. Two hundred and eightynine births and 22 deaths were excluded as nonresident cases from the
12,522 legitimate live births reported in 1915, and the 1,270 deaths
within a year of birth, among them. No information is available as
to how many nonresident cases are included in the number of legiti* Based on all registered live births exclusive of 289 nonresident hospital cases in 1915 and 56 in 1921.
tinfant Mortality—Results of a field study in Baltimore, M d., based on births in one year, p. 169.
‘ Ibid. T able2, p. 223.
•U. S. Bureau of the Census, Birth Statistics, 1921, Table 1.

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PART

I . ------M O R T A L I T Y

1915

AND

1921

mate live births in 1921 or in the number of deaths within one year of
birth among this group.
The infant mortality rates among the legitimate and the illegitimate
births for the two years compare as follows:
Year

Legitimate

1915.
1921.

. 102. 0
.

84. 7

Illegitimate

294. 2
128. 4

The decrease in the mortality rate for legitimate births in 1915 to
that in 1921 was 17.3 points, or 17 per cent, while the decrease in
the mortality rate for illegitimate births was 165.8 points, or 56.4
per cent.
Improvement in birth registration as a factor in this decrease in
the mortality rate would doubtless affect the .rates for infants of
legitimate and^ of illegitimate birth and to almost the same extent.
The degree of improvement in registration is impossible to determine
without some form of special test; in 1915 in connection with the
Children’s Bureau study special efforts were made to learn of un
registered births, which when discovered were reported to the health
department and registered. In 1916 Maryland was admitted to the
birth-registration area, the tests of birth registration made by the
United States Bureau of the Census having indicated that registration
was at least 90 per cent complete. In any case since an improvement
of 1 per cent in birth registration would result in an apparent improve
ment of only .1 per cent in the infant mortality rate, it is clear that the
decrease of 56.4 per cent in the mortality rate among infants of
illegitimate birth could have been due in but a small part, if at all,
to improved birth registration.
INFANT MORTALITY RATES, BY COLOR OF M OTHER

The percentage of illegitimate births was higher for colored mothers
than for white mothers both in 1915 and in 1921— 27.1 and 3 4 per
cent in 1915, and 20.9 and 1.3 in 1921. Among infants born in 1915 the mortality rate for illegitimate white
births was more than three times as high as that for legitimate white
births; the rate for illegitimate colored biofchs was not quite twice as
high as for legitimate colored births. Among infants Dorn in 1921
not only were the mortality rates for both the illegitimate and the
legitimate births materially reduced, but also the relative differences
were diminished; the mortality rate for illegitimate white births was
less than twice as high as that tor legitimate white births, whereas the
mÎ6? / 01"
two gf0UPs of colored infants were practically the same.
(Table 1.) Intensive study might show that the conditions under
which unmarried colored mothers lived in 1921— in those respects
which are of most importance in relation to infant mortality-—were
not far different from those found in the average colored family.
Such a finding would account for the approximately equal rates in
the colored groups in contrast with the marked difference in the rates
in the white groups.
The mortality rate for illegitimate white births decreased from
315.5 among infants bom in 1915 to 145 among those born in 1921— a
reduction of 54 per cent as compared with a reduction of 15.7 per
cent in the mortality rate for legitimate white births. For illegitimate
colored births the mortality rate dropped from 280.6 among infants
born in 1915 to 123 among those born in 1921— a reduction of 56.2

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IN F A N T S

IL L E G IT IM A T E

B IR T H

B A L T IM O R E

per cent as compared with, a reduction of 22.7 per cent in the mortality
rate for legitimate colored births.
T able 1.— Legitimacy o f birth and infant mortality rates, by color of mother; 1915
and 1921
1921

1915
Legitimacy and color

Legitimate K

Live
births

12,233

Infant
mortality
rates

Infant
deaths

Infant
Infant
deaths . mortality
. rates

Live
births

1,248

102.0

« 17,634

1,494

84,7

15,321
2,313

1,210
284

79.0
122.8

White........... J —
Colored____
Not reported.........

10,669
1,561
3

1,000
248

93.7
158.9

Illegitimate.

955

281

294,2

810

104

128.4

118
163

315.5
280.6

200
610

29
75

145.0
123.0

W h ite ........
Colored--------------

374
581

i Including all registered live births and all infant deaths exclusive of 289 nonresident hospital casas.
1 This number was found by subtracting the number of legitim ate births, as found through study of the
birth certificates, from the total number of births as given in Birth Statistics, 1921, Table I (U. S. Bureau
of the Census, Washington, 1923).

In a group of 572 illegitimate live births in 1915 for which detailed
schedules were taken the infant mortality rate was 300.7— 319 for
white and 293.4 for colored. Of the infants who survived at 3 months
of age 80.6 per cent remained with their mothers. This group had a
mortality rate in the last nine months of the first year of life of 120.1
(per 1,000 surviving at 3 months) contrasted with 315.2 for the 19.4
per cent who were separated from their mothers. For the group
surviving at 6 months of age the mortality rate in the last six months
of the first year of life was 76.7 (per 1,000 surviving at 6 months) for
those remaining with their mothers and 241 for those separated from
their mothers. (Table 2.)
T able 2.— Deaths per 1,000 infants surviving at specified ages, by separation of
infant from mother and color of mother; scheduled infants born out of wedlock in
1915 and surviving at 8 and 6 months o f age
Infants born out of wedlock in 1915 and surviving at—
Three months of age
Separation of infant from mother, and
- color of mother

White.......................... .......................

Colored..........................—-------

i Not shown where base is less than 50.

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Subsequent deaths

Subsequent deaths
Total

Total..................... .................— — -

Six months of age

Total
Per 1,000
Number survivors

P erl,000
Number survivors

475

157.9

448

107.1

383
92

46*
29

120 1
315.2

365 «
83

28~
20

76.7
241.0

138

195.7

129

139.5
106.8
- M S’

110
28

18
9

163.6
(l)

103
26

11
7

337

142.4

319

273
64

28
20

102.6
312.5

262
67

17
13

94T(T
64.9
228.1

PART

I .—

M O R T A L IT Y

1915

AND

1921

In the same group of infants for whom schedules were taken the
mortality rate for infants who were in institutions or boarded out at
some time during the first year was 362.9, compared with 284.1 for
those not boarded out or placed in institutions.
AGE AT DEATH

The greatest number of deaths among babies of illegitimate birth
in any one month of the first year of life occurred in the first month.
It is a fairly well-established fact that most of the deaths under 2
weeks and many of those between 2 weeks and 1 month are due to
natal and prenatal causes, though early separation of the infant
from his mother would doubtless markedly lessen his chance of
survival.
According to Table 3, a marked decrease from 1915 to 1921 occurred
in the mortality rate at each age period. The percentage of decrease
was greater (80.4) between 1 and 3 months than at any other age
period, and lowest (32) between 6 and 12 months. For babies
under 1 month the percentage decrease in the rate was 56.1. Between
3 and 6 months the decrease was 50.9 per cent.
T able 3.— Infant mortality rates, by age; illegitimate live births, 1915 and 1921
Death rate per 1,000
live births
Age at death
1915

1921

Decrease Per cent
of dein rate
crease

294.2

128.4

165.8

56.4

106.8
81.7
25.1
75.4
50.3
61.8

46.9
40.7
6.2
14.8
24.7
42.0

59.9
41.0
18.9
60.6
25.6
19.8

56.1
50.2
75.3
80.4
50.9
32.0

Although at each age period of the first six months there was a
greater decrease from 1915 to 1921 in the mortality rates for the
illegitimate group than for the entire group of babies born in these
two years, the percentage decrease in mortality in the illegitimate
group was greatest (80.4 per cent) between 1 and 3 months of age
and was markedly higher during the first six months than during the
last six months of the first year of life. For all babies, on the other
hand, the percentage decrease was fairly uniform for the several age
groups between 2 weeks and 1 year, varying only from 27.8 per cent
to 32.9 per cent, but was markedly higher for these ages than during
the first two weeks.

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IN F A N T S

IL L E G IT IM A T E

B IR T H

B A L T IM O R E

T able 4.— Infant mortality rates, by age; live births, 1915 and 1921
Total Infant deaths

Infant mortality rates

Age at death
1915

19211

1915

1921

Per cent
of de
crease

Total.............................. - ........- ..........................

31,529

1,598

115.9

86.6

25.3

Under 1 month_________ _____ ________________
Under 2 weeks............................... .......... - ...........
2 weeks, under 1 month..................... ........- .........
1 month, under 3. «.............................. .................... .
3 months, under 6________________ ______ _________
6 months, under 1 year 3_______________ ______ ____

645
535
110
219
285
380

727
622
105
220
268
383

48.9
40.6
8.3
16.6
21.6
28.8

39.4
33.7
5,7
11.9
14.5
20.8

19.4
17.0
31.3
28.3
32.9
27.8

* U. S. Bureau of the Census: Birth Statistics, 1921, Table 14, p. 261.
* Excluding 22 nonresident hospital cases. See U. S. Children’s Bureau Publication No. 119, Table 2,
p. 223.
8Including 1 infant whose age was not reported.

CAUSES OF DEATH

Among all illegitimate births and among illegitimate births to
white mothers in 1921 the mortality from causes peculiar to early
infancy was higher than that from any other cause. Among ille
gitimate births to colored mothers the death rate from these causes
was the same as that from respiratory diseases. (Table 5.) Among
illegitimate births in 1915 causes peculiar to early infancy were
responsible for the highest death rate, and gastric and intestinal dis
eases for the next highest. Among illegitimate births in 1921 the
rate from gastric and intestinal diseases was less than that from
respiratory diseases.
Comparison of the mortality rates from various groups of causes
among infants born out of wedlock in 1915 and in 1921 shows that
the rate for all causes and for each of the main groups of causes de
creased. The rate for all causes decreased by 56.4 per cent; for
causes peculiar to early infancy, by 61.4 per cent; for gastric and
intestinal diseases, by 61.3; for respiratory diseases, by 45.7 per cent.
The greatest decrease in mortality from causes peculiar to early in
fancy, 84.7 per cent, was found in the deaths attributed to “ con
genital debility,” which doubtless include many caused by faulty
feeding. Mortality from the other causes peculiar to early infancy
was not affected so much; the reduction in mortality from premature
birth was 36.5 per cent, and a slight increase appeared in the mor
tality from injuries at birth. , In view of the fact that the mortality
rates for breast-fed babies are always considerably lower than those
for the artificially-fed, it seems probable that the decreases in mor
tality from gastric and intestinal diseases and from “ congenital
debility” are due to keeping babies with their mothers and thus
giving the babies the benefit of breast feeding during the critical
months of infancy.

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PART

I .—

M O R T A L IT Y

1915

AND

1921

T able 5.— Number of deaths and infant mortality rates, by cause o f death; illegiti
mate live births, 1915 and 1921
Number of deaths

1921

1915

1921

1915

Colored

White

Total

Cause of death

1915

1921

All causes......................................... -

281

104

118

163

Gastric and intestinal diseases___________

67
10
104
39
62
3
52
48

22
4
34
21
8
5
24
20

37
1
50
14
34
2
17
13

30
9
54
25
28
1
35
35

14
4
21
14
4
3
21
15

Early infancy....... .......................................
Premature birth_______ ____ ________
Congenital debility____ ____________
Injuries at birth.......... ..........................
Respiratory diseases................................ .
All other causes___________ _____ _______

13
7
4
2
3
5

Infant mortality rates
All causes...........................................

294.2

128.4

315.5

145.0

280.5

123.0

Gastric and intestinal diseases............. .....

70.2
10.5
108.9
40.8
64.9
3.1
54.5
50.3

27.2
4.9
42.0
25.9
9.9
6.2
29.6
24.7

98.9
2.7
133.7
37.4
90.9
5.3
45.5
34.8

40.0

51.6
15.5
92.9
43.0
48.2
1.7
60.2
60.3

23.0
6.6
34.4
23.0
6.6
4.9
34.4
24.6

Early infancy__________ _______________
Premature birth...................................
Congenital debility...............................
Injuries at birth....... ..................... ........
Respiratory diseases..................................
All other causes____ ____________________

65.0
35.0
20.0
10.0
15.0
25.0

The number of deaths in each month of life and the mortality rates
from causes affecting children under 1 year of age are given in Table 6.
T able 6.— Number of deaths and infant mortality rates, by cause of death and
specified month of life; illegitimate live births, 1915 and 1921
Cause of death

All causes
Month of life

Gastric and Malforma
intestinal
tions
diseases

Early
infancy

Respiratory
diseases

All other
causes

NUMBER OF DEATHS

1915

1921

1915

1921

1915

1921

1915

1921

1915

1921

1915

Total..........................

281

104

First.....................................

102
43
29
17
12
19
59

38
5
7
10
3
7
34

6
9
10
4
5
8
25

1
2
3
4
1
2
9

6
1
2
1

70
16
4
7
2
2
3

31
2
1

9
6
8
4
3
6
16

2
1
3
3

4
11

11
11
5
1
2
3
15

3
2
1
13

54.5

29.6

50.3

24.7

9.4
73.3 38.3
6.3
16.8
2.5
8.4
4.2
1.2
7.3
4.2
3.1
2.1
6.3
2.1
3.1 ......... 16.8

2.5
1.2
3.7
3.7

11.5
11.5
5.2
1.0
2.1
3.1
15.7

1.2

Fifth
Seventh and later________

1921

INFANT MORTALITY RATES

Total____ ____

294.2 128.4

70.2

27.2

10.5

46.9
6.2
8.6
12.3
3.7
8.6
42.0

6.3
9.4
10.5
4.2
5.2
8.4
26.2

1.2
2.5
3.7
4.9
1.2
2.5
11.1

6.3
1.0
2.1
1.0

106.8
45.0
30.4
17.8
12.fi
19.9
61.8

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4.9 108.9
3.7

1.2

42.0

4.9
13.6

3.7
2.5
1.2
16.0

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PART

n.—EFFECT

OF THE LAW ON THE POLICIES AND
W OR K OF SOCIAL AGENCIES
ORIGIN OF THE LAW

As a result of the findings of the Maryland State Vice Commission,
which made a report to the governor of the State in December, 1915,
an effort was made by the commission to ascertain the relation be
tween illegitimate births and commercialized vice. The report
stated that a large proportion of the women in Baltimore’s segre
gated vice district, which then existed, had given birth to children out
of wedlock. Almost all these women had lost trace of their children
during very early infancy.1
Thereupon the commission made an inquiry to find out how babies
of illegitimate birth were being disposed of, and this inquiry revealed
activities by various persons and agencies whose aim was to assure
privacy to unmarried mothers. Among these persons and agencies
were some who sought conscientiously and earnestly to assist both the
mothers and the babies, and others who were engaged in the work
solely for profit. The commission found that the death rate was
exceedingly high among babies who had been separated from their
mothers and placed in institutions.
Such protection as the six months law affords has been needed
especially in Maryland because Maryland has no provision for State
supervision of all child-caring organizations. Those receiving State
aid or (in Baltimore) city aid are subject to inspection and regulation
by the board of State aid and charities or by the supervisors of city
charities, but it is not the function of the city or the State agency to
supervise organizations which do not receive public funds. No
credentials are required of any person who wishes to operate a
maternity home, a maternity hospital, a child-caring institution, or
a children’s agency, except that in Baltimore every boarding home
which admits children under three years of age must be licensed by
the city health department.
Some of the persons engaged in
child-caring activities operate charitable organizations; others, profit
able commercial enterprises.
The code provides2 that action may be taken by any person to
bring into court cases of children without proper care or guardian
ship. Such action may be taken against any institution except an
incorporated or a State institution. But as there is no central depart
ment charged with responsibility for safeguarding children, it is
obvious that few children would receive the benefit of this provision.
i Stanäürds of Legal Protection for Children Born out of Wedlock; a report of regional conferences held
underthe auspices of the U. S. Children’s Bureau and the Intercity Conference onlllegitimacy, pp. 106108. ü . S. Children’s Bureau Publication No, 77. Washington, 1921.
l - l i r o yl1363-1367gby’S Annotated Code* vo1- 4 (1918), art. 26, secs. 63-73. Laws of 1916, ch. 674, secs.

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PROVISIONS OP THE LAW, AND BABIES AFFECTED BY IT

To control the conditions which militated against the welfare of
babies born out of wedlock in Maryland the six months law was
enacted in 1916. It provides that no baby under 6 months of age
may be separated from his mother for placement in a foster home or
institution except by a regular proceeding which includes a record of
such placement. According to this law a baby under 6 months may
be separated from his mother in three ways: On the signing of cer
tificates by two qualified physicians, stating that the separation is
necessary tor the physical good of the mother or of the child and set
ting forth the reasons for this necessity; by direction of the board
of State aid and charities, acting upon' its own discretion; or by order
of a court having competent jurisdiction.
Except in cases in which a court orders that a baby be separated
from his mother, the law is administered by the board of State aid
and charities, and this board has delegated to its secretary full power
to act for it in approving or disapproving applications for separation.
That the operation of the law has affected mostly babies of ille
gitimate birth is shown by the fact that of the 52 separations approved
by the board from June 1, 1916, when the law became effective, to
the end of 1923, 43 were of illegitimate birth and 9 of legitimate.
METHOD OF THE STUDY

In an effort to ascertain how and to what extent the policies of
hospitals, social agencies, and institutions dealing especially with
unmarried mothers have been affected by the operation of the law,
30 hospitals, social agencies, and institutions were visited. Informa
tion was procured on their standards and policies before June 1, 1916,
and since that date. At the hospitals and other institutiohs receiving
any appreciable number of unmarried women—mothers or prospective
mothers— an effort was made to find from the records the number
of such patients who had been received during the five years before
the law became effective and during the first five years afterwards.
Only those agencies in the city which gave special attention to the
care of unmarried mothers and their children were included in this
study, as its scope was limited, and the inclusion of all the social
agencies in the city would have entailed a very much more extensive
piece of work. However, a large proportion of the cases known to
the social agencies were cared for in maternity homes or hospitals, and
these were included. Many of the agencies had lost all their records
by fire in 1919; and for these there was no basis for comparison with
later years.
Because of the selection of the vear 1921 for the infant mortality
study (see Part I), certain special data were also procured for the
cases received during that year by the maternity homes and the
agencies specializing in case work with unmarried mothers. In the
study of organizations only cases of white mothers were considered,
because the reduction in illegitimacy was mostly among white births.
Records of the agencies studied were checked so that no case would
be counted more than once. The “ six months law file” in the office
of the board of State aid and charities was studied, and an analysis
was made of all separations approved since the law became effective.
In the course of the study a number of physicians, nurses, social

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workers, and other persons connected with the institutions, socialservice agencies, and hospitals were interviewed to ascertain their
attitude toward the law.
•
The figures obtained were tabulated so as to show whether the
mothers lived in Maryland or in other States. Because Baltimore is
a great medical center its hospitals have always had a large number of
patients from States other than Maryland, and a certain proportion
of these patients have been maternity patients. Although the
majority of unmarried mothers delivered m Baltimore have been
legal residents of Maryland, Baltimore, like other large cities, has
attracted unmarried women residing elsewhere who, approaching
delivery, hope to conceal their condition from their friends or relatives
by coming to the city. This desire has led frequently to the accept
ance for permanent care of the babies of these mothers by organiza
tions in Baltimore. The extent to which any city is called on to
render maternity service to women from other States depends partly
on the resources available in that city for providing unmarried
mothers with the means of disposing of their babies quickly and
easily.
One of the points on which information was sought in this study
was whether there had been a decrease in the number of unmarried
women, residents of States other than Maryland, who came into
Baltimore for maternity care, especially those who came with the
intention of disposing of their babies. It would alsp be of interest
to know whether the decline in the number of illegitimate white
births registered in Baltimore was influenced by a possible increase
in the number of unmarried women, residents of Baltimore or its
vicinity, who sought to conceal their prospective motherhood by going
to places outside of Maryland for confinement, but information with
respect to this is not available.
AGENCIES THAT CARE FOR UNMARRIED MOTHERS

In Baltimore in 1924 work for unmarried mothers was included
m the programs of at least 24 agencies. These included 9 general
hospitals, 5 case-working agencies, 2 private health agencies, 3
maternity homes, and 5 public agencies ( l a health agency).
Of the 9 hospitals admitting unmarried mothers as maternity
patients, only 2 (the University of Maryland Hospital and the Johns
Hopkins Hospital) have now any considerable number of these
patients. At the other 7 (the Maryland General Hospital, the Frank
lin Square Hospital, the Hebrew Hospital and Asylum, St. Joseph’s
Hospital, South Baltimore General Hospital, Mercy Hospital, and
the Bay View City Hospital) the number of unmarried white mothers
cared for annually during recent years 3 ranges from two to eight.
The five case-working agencies which assist unmarried mothers
and their children are the Family Welfare Association, the Henry
Watson Children’s Aid Society of Baltimore, the Young Ladies’
Benevolent Society (Jewish), the Bureau of Catholic Charities, and
the Society to Protect Children from Cruelty and Immorality. All
these except the last do case work with unmarried mothers. Un
married mothers who form part of a family group are dealt with by
the Family Welfare Association unless they are in care of the Jewish
8 One of these seven hospitals gave figures for 10 years and the others for shorter periods.

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or the Catholic agency. Mothers who do not belong to a family
group are cared for by the Henry Watson Children’s Aid Society of
Baltimore. Jewish girls are referred to the Young Ladies’ Benev
olent Society and many of the Catholic girls are referred to the
Bureau of Catholic Charities. The Society to Protect Children
from Cruelty and Immorality limits its activities in illegitimacy
cases to those reported because of violations of the six months law.4
For the purpose of formulating plans for keeping babies with their
mothers, as well as for general case work with unmarried mothers,
this agency refers cases to one of the other four case-working agencies
in this group. The two health agencies— the Babies’ Milk Fund
Association and the Instructive Visiting Nurse Association— pro
vide prenatal and postnatal care, and assistance and advice in caring
for infants. Provision is made for follow-up of children during the
first three years. Obstetrical nursing is provided for patients in
their own homes. All the hospitals depend, wholly or m part, on
the service of these two health agencies for obstetrical nursing for
out-patients, for prenatal and postnatal care of house patients and
out-patients, and for follow-up of babies.
•b
The five public agencies whose work includes giving aid to the
unmarried mother are the police department (through the police
women), the juvenile court, the department of city charities, the
child-welfare bureau of the Baltimore Health Department, and the
board of State, aid and charities. The policewomen do case work
with unmarried mothers who come into the care of the police depart
ment. The department of city charities pays the hospital expenses
of Baltimore patients accepted for free care; it does no ca,se work
with unmarried mothers but refers them to private agencies; it makes
investigations to find the relatives of abandoned babies, and makes
arrangements for their care. Girls do not come into the juvenile
court merely because of illegitimate pregnancy or maternity. The
court assumes jurisdiction only in cases in which these conditions
are incidental to other causes for which girls become known to the
court. Illegitimacy cases which come to the juvenile court are
practically limited to those of girls under 16— the maximum age of
juvenile-court jurisdiction— though occasionally girls up to 18 years
of age are brought to the attention of the court. The policy is to
continue probation as long as it is necessary for complete adjust
ment for the mother and the baby. The child-welfare bureau sup
plies maternity and infancy care both at health centers and in homes
by means of visiting nurses. The board of State aid and charities
disburses the State appropriations to hospitals and other institutions.
The money so disbursed includes payment for care given to patients
who are temporary charges of the State.
The -three maternity homes included are the St. Vincent’s Infant
Asylum, the Florence Crittenton Mission, and the Exeter Street
Rescue Home for Women. The first of these homes has its own
intramural maternity hospital, and it sends certain patients to the
University of Maryland Hospital. The other two maternity homes
send all their patients to the Johns Hopkins Hospital.
4 These have usually been found to be cases of persons, almost all colored, who had placed babies in
ignorance of the law. They have always been amenable, on admonition, and plans have been made to
enable the mothers to keep their babies w ith them.

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Besides these 24 agencies there are presumably in Baltimore, as in
other cities, small institutions, chiefly maternity hospitals, where
unmarried mothers are received for care. These were not included
in the study because their actual number and location are not known.
In Maryland the absence of requirements for uniform minimum
standards or for records renders futile any effort to procure reliable
information for places of this type.
A marked degree of interdependence was observed among the 24
agencies which assist the unmarried mother and her baby. All the
hospitals, social agencies, maternity homes, and city departments
use the three health agencies. The maternity homes cooperate with
all the social agencies in accepting patients for care. These homes
in some cases call on the agencies for assistance in making social
investigations, formulating plans, procuring employment, and super
vising mothers and babies after discharge from the homes.
CHANGES IN POLICIES PRESUMABLY DUE TO THE LAW

Of the 24 agencies which deal with babies born out of wedlock,
20 are social agencies, and therefore their policies have been noted
particularly. (Hospitals are included in these 20 social agencies
because, although they are primarily health agencies, many of them
have always taken part in placing babies o? illegitimate birth in
foster homes and institutions.) Three of the 24 are health agencies
which refer to social agencies all cases requiring social service; there
fore their policies would not be affected by the law, and they are
excluded from this part of the study. The board of State aid and
charities is excluded because it had no direct connection with the
unmarried-mother problem until the law became effective.
In 13 of the 20 social agencies whose policies affected the treat
ment of the unmarried mother and her baby, no changes were evident.
The other 7 have adopted policies and methods of care which are
the direct result of the operation of the law. Before the law became
effective 2 of these agencies followed the general policy of keeping
together the mothers and babies but occasionally arranged to relieve
mothers of their children. Separation was not limited to cases in
which it was necessary because of the mother’s health, her mental
incapacity, or other reasons which many workers recognize as legiti
mate causes for early removal of a baby from his mother. The
remaining 5 agencies arranged for transfer of the custody of babies
to institutions, to individuals, and to agencies for placement.
Before the passage of the law the plans of work were varied, de
pending on the personal attitude of superintendents and directors,
on the wishes of the mothers, and on what were considered the
exigencies of individual cases. Babies of any age were accepted on
surrenders signed by the mothers. Some hospitals arranged that
mothers would not see their babies. Some hospital superintendents
placed advertisements in the newspapers, offering the babies for
adoption. Some conducted to mothers in the hospital persons
seeking babies to adopt. Sometimes surrenders of then children were
signed by the mothers during pregnancy. In the main, acceptance,
placement, and transfer of babies by these 7 agencies were accom
plished without cost to the mother, though in some cases she paid
surrender fees and other charges.

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It is clear that the enactment of such a statute as the six months
law must have necessitated radical changes in the policies of these
institutions and agencies. To practically all of them the law has
been a distinct advantage in deciding many problems which, without
it, would have been extremely difficult. Mothers, knowing that
they can not be relieved of their babies before the first six months
have passed, nurse them while in the hospital. Many of these
mothers have benefited by the social service available from various
sources because since the law went into effect agencies have not been
permitted to accept babies without their mothers as soon as the
mothers were discharged from the hospital.
These 7 agencies had standards which have made it possible for
them to remain in the field, with programs modified in conformity
with the new order. But there were in Baltimore, before the enact
ment of the law, other agencies, which now have gone out of existence
because they no longer found a profitable field for their business.
Chief among these were the small commercial maternity hospitals
conducted by persons of differing qualifications— midwives, nurses,
or others. These hospitals were of the same type as such enterprises
everywhere— marked by promises of seclusion and secrecy, giving
poor care to patients, engaging in “ baby traffic” — performing each
service for a price. Comparison of the number of such agencies
in existence before the law Jbecame effective and since then would be
informing, but as there never has been any central registration of
these places, such comparison is impossible.
The bureau of child welfare of the Baltimore Health Department
knew of only two small commercial maternity hospitals existing in
1924. Besides these maternity hospitals certain child-caring insti
tutions have been closed. It is not possible to obtain definite in
formation as to the number of these and their activities. One child
caring institution which for years had a maternity-home department
accommodating 15 mothers and which accepted babies of illegitimate
birth on surrender, usually for money, has closed the maternity
home and now accepts no children for care until they are 6 months
of age and accepts none on surrender. An institution accommodat
ing 20 babies, the population of which was practically limited to
babies of illegitimate birth accepted from their mothers either for
boarding care or on surrender for a sum of money, closed very soon
after the law became effective. Unfortunately, definite informa
tion could not be obtained for any other institutions of this char
acter.
RESIDENCE OF UNMARRIED MOTHERS CARED FOR BY FIVE
AGENCIES BEFORE AND AFTER THE LAW BECAME EFFECTIVE

The following table shows the number of unmarried white mothers
cared for in five Baltimore institutions, including three maternity
homes and two hospitals, during the five-year period before the six
months law was enacted and the five-year period after.

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T able 7.— Number of unmarried white mothers receiving maternity care in five
Baltimore institutions, fo r the five-year periods ended June 1, 1916, and June 1,
1921, by residence o f mother
Number of unmarried
white rnothers
Residence of mothers and place of care

Five years Five years
ended
ended
June 1,
June 1,
1921
1916
1,813

1,380

1,357
‘ 372
84

1,146
205
29

943

821

603
281
59

648
157
16

870

559

754
91
25

498
48
13

The proportion of out-of-State patients to the total in these five
institutions whose residence was reported has been reduced by about
one-third. Reports from 15 other institutions indicate that through
out the city the proportion of unmarried women residing outside of
Maryland who come to Baltimore for confinement care is decreas
ing. Undoubtedly the law has been responsible for some of this
reduction.
The total number of white unmarried maternity patients residing
in Maryland who were cared for in the three maternity homes and
the two hospitals was greatly reduced, but as the entire reduction
took place in only one of these institutions it can not be taken as an
indication of a general decrease in the prevalence of illegitimate
births to Maryland women.
The reduction in the number of such patients cared for was prob
ably not the result of fewer applications for care but of decreased
facilities. In 1918 two hospitals for administrative reasons reduced
by 16 beds their free-ward accommodations for white maternity
patients. This reduction affected especially the opportunity for
hospital care open to unmarried maternity patients, for the majority
of such patients must have free service if they are to have hospital
care, as they are unable to pay for it.
There was no indication of a decrease in the demand for ward
service for white maternity patients during the five years after the
law went into effect. The ward beds in the hospitals offering such
service were occupied all the time, and many of them were engaged
for several months in advance. Besides, a constantly increasing
. demand for out-patient service was reported by the hospitals. In
crease in the need for free maternity service is indicated by state
ments by staff members of certain hospitals that they are planning
to provide additional free beds for white patients. Since the study
was made some of the need for this service has been met by the Johns

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Hopkins Hospital, which in 1923 established 32 additional ward
beds for white maternity patients.
As a result of the reduction in ward accommodations many white
women, who would have been delivered in hospitals if there had been
accommodations for them, were delivered in other places. As births
in hospitals are as a rule more correctly reported than births in other
places, it is probable that a number of illegitimate births which
occurred in places other than hospitals were reported as legitimate.
The reduction in the number of white illegitimate births reported in
Baltimore for 1921 may have been caused partly by incorrect report
ing of legitimacy, and thus may have been the indirect result oi the
reduction in the number of beds for maternity care.
Detailed statistical information for 10 years was procured only for
the 5 organizations discussed in the foregoing pages, but some in
formation was procured regarding all the 20 agencies which either
do social work for unmarried mothers or provide hospital care for
them. It was significant that the amount of out-of-State patronage
of an agency depended upon its policy with regard to accepting
young babies from their mothers. The greatest decline in the num
ber oi out-of-State cases was shown in the institutions and agencies
which formerly relieved mothers of the responsibility of caring for
their babies, either by accepting the custody of the babies or by
arranging for their transfer to the custody of other institutions or of
individuals. An agency which previously received babies of any
age on surrender, usually for money, had 42 per cent fewer out-oiState cases during the five-year period following the date on which
the law became effective. Another agency whose policy was to
require mothers to remain with their babies through the nursing
period received 23 per cent fewer out-of-State cases.
In one maternity home where 15 unmarried women residing in
States other than Maryland were admitted during 1920, 6 left before
delivery. All these women went out of Maryland; but not all of
them returned to their own States. The departure from Maryland
of these women may have been caused by the realization that on
account of the six months law they could not dispose of their babies
easily, as they had expected to do. One maternity home has done
very effective work in arranging for unmarried mothers from outside
of Maryland to return to their own States by previously making
plans with institutions or agencies in these States.
DISPOSITION OF CASES OF ILLEGITIMATE BIRTH DEALT WITH IN
1921 BY CERTAIN AGENCIES

Although it was not possible to make a case-work study of all the
unmarried white mothers delivered in Baltimore in 1921, it is of interest
to analyze the work of certain social agencies and institutions equipped
to render them service. This analysis was limited to the five organiza
tions— three maternity homes and two case-working agencies—which
devote specific effort to this work. The total number of un
married women— expectant mothers and mothers— received for care
by these five organizations during 1921 was 214. Deducting 91 cases
in which there was duplication or incomplete records (including all
the cases cared for by one organization), there remained 123 new
cases received in 1921 by four organizations. Data for three of the

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organizations were obtained directly from the records; for the fourth
one the figures were supplied by its superintendent.
Of the 123 cases there were 6 in which separations had occurred
before the babies were 6 months of age; 29 in which the children
were between 6 months and 1 year of age; and 75 in which the
children had remained with their mothers at least through the first
year. Most of the separations which occurred before the baby was
6 months of age were for medical reasons, and one baby was com
mitted to a placing agency because he was neglected. The reason
given for separation from their mothers of most of the 29 children
who were between 6 months and 1 year of age was that the mother
could not take the baby home to relatives or that she wished to con
ceal from her community the fact of having the child. In a majority
of these cases the babies were boarded in family homes or institutions,
board being paid by their mothers or other relatives.
•

SEPARATIONS APPROVED UNDER THE LAW

Between the time the six months law became effective, June 1,
1916, and January 1, 1924, the board of State aid and charities
approved 52 separations from their mothers of children under 6
months of age. Records of these cases are filed with the board.
Of the 52 cases in which separation was approved, 46 were cases of
white mothers, 5 were of colored mothers; the color was omitted
from the record of one case. These cases fall into two groups, those
in which the separations were approved on the filing of medical
certificates and those in which the secretary of the board gave the
board’s approval without the filing of certificates. The first group
included 39 cases, and the second, 13.
In 12 of the 39 cases in which separation was necessary for medical
reasons certificates were filed by physicians stating that the mother
had pulmonary tuberculosis; in 16, certificates were filed stating that
the mother was mentally incompetent to care for her child. The
reasons given on the certificates for the remaining 11 cases were
varied. In one of these cases the mother had only one arm. In 6,
the reasons given do not indicate need for permanent separation:
1 mother had typhoid fever, and 5 required hospital care (in 2 cases
the reason for this was not specified). In 4 cases the certificates
gave nonmedical reasons, or medical reasons not clearly defined,
such as: Baby artificially fed and mother financially unable to
provide for it; poverty and ignorance of mother; poor health of
mother and no breast milk; mother unable to give proper attention.
As the law applies only to permanent separations, it seemed that in
some of these cases applications for separation were unnecessary.
In the 13 cases in which separations were’ approved by the secre
tary of the board without the filing of medical certificates varied
reasons were given for the applications for approval of separation.
Six of the .white mothers had given birth to colored babies; one
mother was reported as irresponsible; one, as mentally incapable;
one was a widow who placed her baby with relatives in order that
she might hold her employment; one was reported to be ill; one was
a married woman, and the child was of illegitimate birth. One
baby had been deserted by its mother, who, when found, was deemed
unfit to care for him; one baby was neglected.

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t The board of State aid and charities has no way of investigating
applications for separation or of following up placements of babies.
The secretary of the board considers investigation unnecessary in
cases in which physicians file certificates. In other cases he utilizes
the services of the Henry Watson Children’s Aid Society of Baltimore.
He stated that the results of this method have been entirely satis
factory. Some applications come from social agencies. From these
agencies he has the assurance that the interests of the child are safe
guarded. In 34 cases it was planned that the babies were to be
placed under the care or supervision of a child-caring institution or
a social agency after separation from their mothers.
Seventeen of the babies were transferred to the custody of private
individuals. Of these individuals, 4 were relatives of the baby
transferred and 1 was a person who intended to adopt him. In one
case the record did not state who accepted the custody of the child.
The ages of the babies at separation varied from 1 week to 5 months.
Thirteen babies were separated from their mothers before they were
1 month old, 21 when they were from 1 to 3 months old, and 9 when
they were from 3 to 5 months old. In 9 cases the age of the baby was
not reported.
The records of two cases showed that the mothers had come from
outside the State.
The secretary of the board of State aid and charities has kept no
record of the applications which he has disapproved. ' Consequently
there is no way of ascertaining their number, or the reasons which
were deemed to be insufficient cause for separation.
ATTITUDE OF CERTAIN GROUPS TOW ARD THE LAW

When the six months law was introduced into the legislature in
1916 it met with disfavor, and definite opposition developed. Only
by enlightening members of the legislature as to the conditions
existing, especially in regard to the activities of certain groups and
individuals engaged in actual baby traffic, was the necessary support
acquired. It is significant that no opposition was offered by the
management of several institutions where babies under 6 months had
been received for care. Superintendents of three of these homes had
expressed themselves in favor of the law. They regarded it as a
measure which would be a great advantage to them in their work.
In many other quarters, however, the attitude was distinctly unfa
vorable.
The practical application of the law and its results have apparently
been responsible for a greatly changed point of view. In this study
60 persons associated with the 24 organizations studied were asked to
state their attitude toward the law. The group included public
officials, superintendents of hospitals, child-caring institutions, and
social agencies, doctors, nurses, social workers, a judge, and members
of governing boards of institutions. Unqualified approval was given
by the great majority. All remarked on the advantage of the law
from the point of view of saving babies’ lives. One person approved
the plan for the sake of the babies’ health but feared that m some
cases too great a burden might be imposed on the mothers. A large
proportion spoke of the social benefit which the child derives from
being retained by the mother through the first six months. In most

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instances the contact extends to the mother’s family or other relatives;
their affection and interest are fostered, insuring to the baby a per
manent home with his own people—-the people who are morally
obligated for his protection and care. The influence of the law in the
establishment o f paternity was mentioned by several persons. A
mother who keeps lier baby is likely to feel the need for support from
the child’s father, and for this reason will take steps to procure such
support. Establishing paternity— the definite fixing of the father
hood of the baby— is in itself important.
One argument which was urged against the law was that its opera
tion would cause an increase in the number of babies abandoned.
On the contrary, results show a decrease in the number of foundlings.
Records of the department of city charities show 16 children abandoned
in the year June 1, 1916, to June 1, 1917, in contrast to 23 during the
year ending June 1, 1916. In the year 1923 the number of children
abandoned was 6.

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Appendix A.— TEXT OF THE MARYLAND LAW OF 1916 GOVERN
ING THE SEPARATION OF CHILDREN UNDER SIX M ONTHS
FROM THEIR M OTHERS
[Maryland, Laws of 1916, ch. 210, pp. 416-418 ij

An act to add five new sections to article 27 of the Code of Public General Laws,
subtitle “ Crimes and Punishments,” to be known as sections 484, 485, 486, 487,
and 488, and to follow immediately after section 483 thereof, making it unlawful
to separate or cause to be separated any child under six months of age from its
mother for the purpose of placing such child in a foster home or institution, or
to place, receive or retain such child in a foster home or institution, and to regu
late the manner and circumatances under which it may be done, and to provide
a penalty for violation of said act; the same to read as follows:
Section 1. Be it enacted by the General Assembly of Maryland, That five
new sections be, and the same are, hereby added to article 27 of the Code of
Public General Laws subtitle “ Crimes and Punishments,” to be known as sec
tions 484, 485, 486, 487, and 488, and to follow immediately after section 483
thereof, and to read as follows:
“ S e c . 484. Be it enacted by the General Assembly of Maryland, That it
shall be unlawful to separate a child under the age of six months from its mother
for the purpose of placing such child in a foster home or institution for the
maintenance of such child, or to assist or participate in such separation, or to
place, receive, or retain any child in a foster home or institution for the main
tenance of such child, or to assist or participate in so placing, receiving, or retain
ing such child; unless it be necessary for the physical good of the mother or of
such child that they be separated or that such child be placed, received, or
retained in a foster home or institution for the maintenance of such child, and
two physicians, qualified to practice medicine in the State of Maryland, and who
shall have been engaged in active practice for at least five years, shall have
signed a certificate setting out the reasons for such necessity, or unless a court
of competent jurisdiction shall have so ordered, or unless within the discretion of
the Board of State Aid and Charities such separation is necessary, and said
Board gives its written consent thereto.
“ S e c . 485. It shall be the duty of every person separating, or assisting or
participating in separating, any such child from its mother, and of every person
•placing, receiving, or retaining or assisting in placing, receiving or retaining any
such child in a foster home or institution for the maintenance of such child, before
so doing, to investigate whether the mother of such child be living and whether
two physicians have signed the certificate above providéd for or whether a court
of competent jurisdiction, or the Board of State Aid and Charities, has ordered
such separation and the placing of the child in such foster home or institution.
“ Sec . 486. It shall be the duty of the person who shall receive any such child
in a foster home or institution for the maintenance of such child to file forthwith
the certificate above provided for with the Board of State Aid and Charities and
the duty of every person who shall retain, or assist or participate in retaining,
any such child in a foster home or institution for the maintenance of such child,
to ascertain whether said certificate has been so filed, and, if there be no such
certificate, then to notify said board forthwith of the facts concerning the separa
tion of said child from its mother and the reception and retention of such child
in said foster home or institution.
“ S e c . 487. Whenever it shall come to the notice of said board that any such ^
child has been separated from its mother or has been placed in an institution for
the maintenance of such child, said board shall cause an investigation to be made,
and if it appear to the board that this act has been violated it shall make known
the facts to the authorities charged with the enforcement of the criminal laws
1 Also found in Bagby’s Annotated Code, vol. 4 (1918), art. 27, secs. 483A-483E.

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to the end that proceedings may be started for the punishment of the person
or persons who may have violated the act.
‘ ‘ Sec. 488. Every person who violates or fails to comply with any of the pro
visions of this act, and every physician who knowingly makes a false certificate as above provided for, shall be guilty of a misdemeanor and upon conviction
thereof may be fined not more than one hundred dollars ($100.00), or imprisoned
in jail for not more than 100 days, or both, in the discretion of the court.”
Sec . 2. And be it further enacted, that this act shall take effect from the 1st
day of June, 1916.
Approved April 11, 1916.

Appendix B.— FORM OF PHYSICIAN'S CERTIFICATE

State of ___________, county or city of _______ — :
I,
'_________ _, a resident of county or city of __________ being a grad
uate o f __________ Medical College, and having practiced as a physician for
five years, do hereby certify that on this __ dayof ____, 1921__, I have personally
examined
_______ , residing at - - - - - _____ , who was delivered of a
child on the __ day o f ____, 191 _, and I do further certify that in my opinion
it is necessary for the physical good of the said
that the child be sepa
rated from its mother and that it be placed in a foster home or institution, the
reason for the said necessity being — ------------------------ -—
: _______________ ____ , M. D. , .
_________________ Residence.
D a t e _______________.
I,
____________ , the ___________u______
of ___ —
------—
do
(Position of person)

(Name of institution)

hereby acknowledge the receipt of *said child as the ward of the said _______ _i ___.
I do further agree that the said child will be given proper care and will be raised
in the religious faith of its parents.
Date _____ — _ — ----------- i ----------- _i___
For the guidance of the Board of State Aid and Charities, the physician or
institution head is respectfully requested to answer the following questions:
1. Name of child ¿ _ ----- ------------ Sex ____-:--------- Color -----------___
2. Father’s name ___ !___________ Address ___ — --------- - — _
3. Will the parents or relatives of the child contribute toward its support?

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Full text of The Welfare of Infants of Illegitimate Birth in Baltimore : As Affected by a Maryland Law of 1916 Governing the Separation from Their Mothers of Children Under 6 Months Old, Bureau Publication No. 144

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