Date of Award

Spring 5-6-2024

Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Dr. Glenn T. Eskew

Second Advisor

Dr. Kathryn Wilson

Third Advisor

Dr. Tiffany Player

Fourth Advisor

Dr. Manrice Hobson



Spawned by America’s Progressive Era, the implementation of the first national healthcare law, The Sheppard-Towner Act of 1921, required midwifery training and licensures. Local Public Health Departments created by the Act encouraged strict regulations as a temporary resolution to the escalating high Infant and Maternal Mortality Rate. Medical professionals saw the Act as furthering the midwives as unauthorized and untrained medical practitioners. Due to the uniqueness of America’s agrarian South, with nearly ninety percent of the South’s population of African Americans dependent on midwives for medical care, federal and local state governments saw the midwives as a “necessary evil.” They were “necessary” because practices and laws of racial segregation excluded African American women from access to adequate healthcare, but “evil” because of the traditional folk medicine they practiced. Despite the negative propaganda, and derogatory attacks on the midwives, African American women relied on the services of the midwives.

This research explores how complexities in rural Georgia and Alabama such as racism, state and local politics, spiritual and cultural practices, and the influence of a racist American Medical Association’s control of the medicalization of childbirth through regulations contained in the Sheppard-Towner Maternity and Infancy Protection Act, rendered the midwives and traditional folk medicine obsolete. Heightened concerns about Mortality Rates and the implementation of the Sheppard-Towner Act led to major future federal interventions, among them the creation of hospitals under the Hill-Burton Act of 1946, the Civil Rights Act of 1964, and the emergence of public medical insurance (Medicaid) that severely impacted the presence, and practice of midwives across the South’s landscape of maternal healthcare.

Short-lived, criticized, and viewed as politically flawed, the Sheppard-Towner Act forced a reluctant nation, particularly the South, to address a healthcare system that marginalized its early practitioners and the populations in need of their services. The Act exposed the periodicity of a system that has failed and continues to fail its most vulnerable population.


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