Women's Suffrage, Political Responsiveness, and Child Survival in American History

Introduction

Women's choices often prioritize child welfare more than men's.
This paper explores how women's suffrage in America helped children benefit from bacteriological revolution breakthroughs.
Granting women the right to vote led to legislative changes and increased public health spending, which supported hygiene campaigns.
Child mortality decreased by 8-15% due to reductions in infectious diseases.
Sex differences suggest gender equality can significantly impact human development, especially in poorer countries.
"Empowering" women is believed to increase investments in children (World Bank 2001).
The discoveries of Ignaz Semmelweis, Louis Pasteur, Joseph Lister, and Robert Koch revolutionized disease knowledge in the 19th century.
These discoveries led to the promotion of household hygiene practices: hand and food washing, water and milk boiling, meat refrigeration, and breastfeeding.
Women were leading advocates for hygiene (Meckel 1990; Skocpol 1992; Tomes 1998).

Research Focus

This study investigates how women's suffrage impacted child survival by analyzing state-level data from 1869 to 1920.
America's federalism allows examination of varied suffrage laws across states and time.
Women's suffrage rights serve as a key example of nuanced incentives.
Data from the early 20th century United States provides detailed statistics, public finance records, and legislative data.
Findings suggest that women's suffrage helped children benefit from bacteriological revolution breakthroughs.
Politicians responded to electoral preference shifts when voting rights were extended to women.
Legislative voting patterns shifted, and local public health spending increased by about 35% within a year of suffrage law enactment.
Richard Meckel (1990) noted that fear of being punished at the polls motivated Congress to vote for the Sheppard–Towner Act of 1921.
Increased public health spending enabled door-to-door hygiene campaigns.
Child mortality declined by 8–15% with suffrage laws, specifically in infectious diseases (diarrheal diseases, diphtheria, and meningitis).
This resulted in approximately 20,000 averted child deaths annually, accounting for about 10% of the child mortality reduction between 1900 and 1930.
Validity tests indicated no increases in progressive legislative behavior or public spending before suffrage laws.
Suffrage estimates did not differ significantly between states that chose to grant suffrage and those where it was imposed by the Nineteenth Amendment.
There were no changes in “progressive” behavior or spending related to women’s rights initiatives that didn't lead to voting rights.
There were no systematic relationships between suffrage laws and internal migration.

Background

The Historical Advancement of American Women and the Women’s Suffrage Movement

Industrialization in the nineteenth century led to distinct social and economic roles for men and women.
Women formed voluntary organizations to promote "feminine virtues" for their benefit and society's.
Organizations consisted of elite urban women and middle-class women across localities.
Women’s organizations used their perceived moral superiority as caregivers to promote public welfare agendas.
The concept of “municipal housekeeping” became popular: “Woman’s place is in the home … But Home is not contained within the four walls of an individual home. Home is the community. The city full of people is the Family” (Dorr 1910).
This ideology supported the women’s suffrage movement, providing organizational infrastructure.
Voluntary organizations advanced a new child health and hygiene agenda during the Progressive Era.

The Women’s Suffrage Movement

The women’s suffrage movement emerged alongside women’s voluntary organizations.
Lucretia Mott and Elizabeth Cady Stanton articulated new ideals about women’s public and private roles at the Seneca Falls convention in 1848.
The end of the Civil War invigorated the movement, with the emancipation of slaves and the extension of voting rights to black men in 1870.
Early successes occurred in western territories (Wyoming in 1869 and Utah in 1870, later Colorado and Idaho).
Stagnation led to better coordinated efforts and appealing to municipal housekeeping as a rationale.
Prior to the Nineteenth Amendment in 1920, 29 of 48 states had extended suffrage rights to women.

Spatial and Temporal Patterns of State-Level Women’s Suffrage Laws

Western states allowed women to vote before other states.
Some suggest frontier conditions were favorable due to women supporting restrictions on vices or the harsh realities of frontier life.
Idiosyncratic circumstances in each state resulted in the vote for women.
Quantitative studies show the share of women in nonagricultural jobs correlates with suffrage law enactment.

Women, Hygiene Campaigns, and the “New Public Health”

Early public health efforts provided pure milk to mothers through local milk stations (Lee 2007; Ferrie and Troesken forthcoming).
However, in 1906, it was concluded that educating mothers about household hygiene was more promising (Phillips 1909).
This conclusion marked the beginning of a “new public health,” emphasizing widespread information about personal and household hygiene.
The New York Milk Committee’s household hygiene modification program’s effectiveness led to similar programs.
Hygienic home modification required regular home visits and individualized health education.
The American Association for Study and Prevention of Infant Mortality (1910) argued that only government had the resources for large-scale hygiene campaigns.
Public–private partnerships emerged, where local public funds supported door-to-door hygiene campaigns that built upon the infrastructure of philanthropic organizations (Neff 1910; Meckel 1990).
Community-based nurses played a key role, visiting families with babies, encouraging breastfeeding, and educating about hygienic practices.
The “ideology of instructed motherhood” helped hygiene campaigns succeed (Meckel 1990).
The 1921 Sheppard–Towner Act, lobbied for by women’s organizations, was a landmark public health appropriation and dramatic expansion of the federal Children’s Bureau.
Historians suggest congress passed the act out of fear of being punished at the polls (Lemons 1973).

Data and Empirical Strategy

Data

Dates women gained the right to vote obtained from Lott and Kenny (1999) and Cornwall (2003).
Partial and full suffrage rights not distinguished, recognizing the flux of electoral rules and uncertainty among politicians.
State-level mortality data by age/sex and cause needed to investigate how women’s suffrage related to child survival.
The Bureau of the Census established a “Death Registration Area” in 1880, publishing annual Mortality Statistics in 1900 (U.S. Bureau of the Census 1906 through 1938).
The registration area expanded from 10 states in 1900 to all 48 states in 1933.
An unbalanced panel of annual state-level deaths by age/sex and by cause was constructed for 1900–1936.
Local and state public finance data were matched with legislative records to explore spending changes.
Annual nominal health-related spending data was digitized for cities with populations exceeding 30,000 from the Statistics of Cities (1905–1908) and the Financial Statistics of Cities (1909–1913, 1915–1919, and 1921–1930).
Specific spending categories included health conservation and sanitation spending and infrastructure investment, charities, corrections, and hospital spending and investment.
Real state spending and revenue data between 1900 and 1930 in broad sectoral categories were provided by Larry Kenny and John Lott.
Information about establishing city public health departments extracted from state health board social service spending data.
Senate and House roll call data from 1900 to 1930 (56th through 71st Congressional sessions) were obtained from the Voteview database.

Empirical Strategy

A difference-in-difference approach used to estimate changes in public spending, legislative voting, and mortality associated with suffrage rights.
The equation is:
$ln(d{sy}) = α + βv{sy} + δy + δs + δs × t + ε{sy}$
Where:
* $d$ is outcome of interest
* $v$ is a dummy variable indicating whether or not women could legally vote
* $δs$ and $δy$ are state and year fixed effects
* $δ_s × t$ represents state-specific linear time trends
* $β$ is the parameter of interest
Only the timing of state suffrage laws assumed exogenous.

Results

Political Responsiveness to Women’s Suffrage

Women's enfranchisement improved child survival through its impact on public spending, particularly large-scale door-to-door hygiene campaigns.

Public Spending

Models predict that extending voting rights to women should cause politicians to shift policy positions immediately to reflect women’s preferences.
Spending for charities, corrections, and hospitals is a primary category for hygiene spending.
Women’s suffrage is associated with an 8% increase in total municipal spending, a 6% increase in spending on health conservation and sanitation, and a 36% increase in spending for charities, hospitals, and corrections.
The enfranchisement of women associated with a 24% increase in state social service spending.

Voter Turn-Out and Legislative Roll Call Behavior

State-level voter participation among adults increased by 44% the year after women enfranchised.
Patterns aligned with expectations among legislators, suggesting that female voting was a strategic consideration.
Progressive voting among senators immediately more progressive; no such response in the House.
Women’s suffrage was associated with a 23% increase in progressive voting in the Senate.

Mortality by Age/Sex and Cause

Rapid mortality declines for both boys and girls when suffrage legislation enacted.
Consistent with the theory that suffrage led to abrupt increases in local public health spending.
Women’s suffrage associated with mortality reductions for children at all ages between one and nineteen, but not for infants or adults.
In absolute terms, these reductions imply about 20,000 averted child deaths nationwide each year relative to mortality before suffrage laws.
Causes of death that responded to suffrage laws were diarrheal diseases (under age two), meningitis, and diphtheria, with reductions of 11%, 23%, and 24%, respectively.
Women’s suffrage is associated with an 18% decline in childhood infectious diseases but not with changes in other deaths.

Informal Validity Tests and Robustness

Assess whether there were relative decreases in child mortality before women's suffrage laws were adopted.
Investigate how suffrage law dates related to social, economic, and demographic conditions in 1900.
Evaluated estimates and determined if those varied between states that chose to extend suffrage and those forced to by the Nineteenth Amendment.
Determined whether women's right efforts that did not produce suffrage had detectable changes.
The enactment of suffrage laws could have caused internal migration, changing the demographics of those with suffrage rights. Analysis shows no patterns of that sort.
Considers confounding fertility responses to suffrage laws.
Also evaluated how the change in births varied for women based on age versus state.

Conclusions

Extending suffrage rights to American women allowed children to benefit more fully from discoveries of the bacteriological revolution.
Simple hygienic practices were among the most important innovations.
Greater local public health spending that fueled hygiene campaigns.
Today's failures in health education campaigns in developing countries need to be reconciled with this historic success.
Candidate explanations include: hygienic behaviors may not entail large behavioral costs; reforms raised the return to simple hygienic health behaviors; and the absence of curative measures a century ago strengthened incentives for prevention.
This paper’s findings suggest that strengthening the expression of women’s preferences can improve child health and welfare.
Policies and programs seeking to “empower” women introduce incentives with ambiguous consequences for children (Becker 1981).
Demand-oriented health improvement strategies may deserve more careful attention.