Twenty years of WIC: a review of some effects of the program. (Women, Infants, and Children nutrition program)

The purpose of this article is to provide an overview of some of the effects the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has had on participants. The first two sections outline briefly the history of WIC, the program design, and services provided. The third section summarizes a number of studies of WIC carried out during the first 15 years (1975 to 1990) of its full operation. The last section discusses some of the effects of the program and comments on future considerations.

HISTORY OF WIC

Enabling Legislation

The US Congress legislated WIC in 1972. Under the auspices of the US Department of Agriculture (USDA), WIC began as a 2-year pilot program linking health care to food assistance for pregnant women, nursing mothers, infants, and preschool children who were considered to be at health risk because of inadequate nutrition and low income. Legislative and regulatory highlights are summarized in Table 1.

Growth of the Program

In fiscal year (FY) 1975, funding for WIC was approximately $83 million. Funding totaled $1.4 billion by FY 1984, and $3.2 billion by 1995. Between FY 1975 and FY 1995, the number of participants increased from 344,000 to approximately 6 million, but has remained fairly stable since the early 1990s. It was estimated that the proportion of income-eligible women participating in WIC increased from 3% in 1972 to nearly 40% in 1980 (1). This proportion increased to approximately 50% in 1991 (2). The number of pregnant women participating in WIC has essentially tripled during the past 15 years.

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WIC DESIGN

Low income (poverty) predisposes at-risk women, infants, and children to inadequate diets and inadequate health care, and therefore, to poor nutrition and poor health status. In 1993, 15% of the US population and nearly 23% of children ([less than]18 years old) were in families with income below the federal poverty line (3).

The evidence linking poverty with nutritional risk for women is based on the relationship between poverty and poor perinatal outcomes. Rates of low birth weight among black and white infants are inversely associated with median family income (4). Data from the National Longitudinal Survey of Youth confirm that there is a higher risk of low birth weight among infants born to poor women (5). Evidence also suggests that infants born to poor women who were low birth weight themselves have a lower mean birth weight (6). Wang et al (7) showed that women who were low birth weight themselves and have previously delivered a low-birth-weight infant are at particularly high risk for having another low-birth-weight infant and experiencing shortened gestation ([less than]37 weeks). Intrauterine growth retardation is also more likely to occur among this group (7). In general, these women are likely to be low income (eg, teenagers, less well-educated), have lower prepregnancy weight, and smoke during pregnancy. It is also likely that prenatal weight gain may be less than recommended (8).

A number of surveys carried out in the 1960s and 1970s showed that young children from low-income families were smaller (height and weight) than children from higher-income families (9,10). During the same period, the prevalence of anemia (mostly iron deficiency) was estimated at 20% to 30% among poor 1- to 3-year-old toddlers (11,12).

Nutrition Risk Criteria

In order to most effectively target the available resources, those persons eligible for participation in WIC on the basis of income are screened using nutritional risk criteria (see Table 2). The nutritional risk criteria used in WIC serve as indicators of nutrition and health risk and as indicators of nutrition and health benefit.

Eligibility Priority System

A WIC priority system was established in 1980 to identify those considered to be at greatest risk and those most likely to benefit from WIC services. The current priority system is shown in Table 3.

Services Provided

WIC serves as an adjunct to health care to prevent occurrence of nutrition and health problems and to improve the nutritional and health status of participants by providing supplemental foods, nutrition education, and referrals to health care and social service providers and systems. …