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Profile
of WIC Children
EXECUTIVE
SUMMARY
The
Special Supplemental Nutrition Program
for Women, Infants and Children (WIC)
provides supplemental foods, nutrition
education and access to health care to
pregnant, breastfeeding and postpartum
women, infants, and children up to age
five. Since its inception in the early
1970’s, the program has received
fairly widespread support and it has
grown in size to serve 7.4 million
participants in FY98 at an annual cost
of around $4 billion.
Just
over half of the participants (51.4
percent) are children between the ages
of 1 and 5. While considerable research
has been done on the WIC program, most
of it focuses on pregnant women and
infants rather than on children. This
report uses existing data on children
and their families to describe the
children who participate in WIC. In
order to address a wide range of issues,
three main data sources were analyzed:
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the
Third National Health and Nutrition
Examination Survey (NHANES-III),
which provides information on a
nationally representative sample of
children between 1988 and 1994;
-
the
1993 Panel of the Survey of Income
and Program Participation (SIPP),
which provides information on a
nationally representative sample of
children between 1993 and 1995; and
-
the
second wave of the Comprehensive
Child Development Programs (CCDP2),
which provides information on a
nonrepresentative sample of children
between 1994 and 1997. The children
in the CCDP2 sample are
two-year-olds from ten sites across
the country, and do not span the
full range of WIC income
eligibility. Although WIC in general
serves children up to 185 percent of
the federal poverty level, this
sample was limited to children whose
households were under 100 percent of
the federal poverty level during
their prenatal period or infancy.
While the results from this sample
are not generalizable to the child
WIC population as a whole, they help
us to understand the poorest of WIC
participants more fully.
Much of the
analysis reported here consists of
comparisons between child WIC recipients
and other low-income children (under 185
percent of poverty). In interpreting
these comparisons, it is important to
recall that WIC children differ from
other low-income children in two
regards:
-
They
are economically needier. About a
quarter of WIC children are
extremely poor (under 50 percent of
poverty), compared with a sixth of
nonparticipating low-income
children.
-
They
were more likely to have received
WIC as infants. It is estimated that
72 percent of WIC children, compared
with 35 percent of other low-income
children, were also WIC infants.
Higher income
children are used as an additional
comparison group for measures using
NHANES-III or SIPP data. The analyses
reported here also include a description
of dynamic (age-related) patterns of
child WIC participation.
The purpose of
this project is descriptive. Although
the data may suggest some hypotheses
about possible impacts of WIC, testing
these hypotheses is a task for future
research. This is particularly important
to bear in mind when considering
comparisons between WIC children and
other low-income children. When we see a
difference, we cannot conclude that WIC
caused the difference; and conversely,
when we see no difference, we cannot
conclude that WIC had no effect.
This summary
briefly describes the WIC program for
children, and then reviews what has been
learned with regard to the following
issues:
characteristics
of the pregnancy and infancy
their
households, families, and
communities
nutrition
and health status; and
The profile of
WIC children that emerges from these
data sources includes the following
features:
-
The
average age of their mothers at the
time of the children’s birth was
25, but 7.5 percent had mothers who
were young teenagers (under 18) at
the time.
-
Nearly
a third of their mothers smoked
cigarettes during the pregnancy.
-
Around
12 percent of the children were low
birthweight.
-
Two-fifths
were breastfed, in most cases for
less than six months.
-
Most
(54 percent) live in poverty, and 25
percent are extremely poor (income
under 50 percent of the federal
poverty level).
-
Many
receive AFDC/TANF (43 percent) or
food stamps (60 percent), and nearly
a tenth live in subsidized housing.
-
Half
live in a household headed by a
married couple.
-
Nearly
all have medical insurance,
primarily Medicaid.
WIC
Eligibility and Benefits for Children
To be eligible
for WIC, a child must be under the age
of five, in a household with income
under 185 percent of the federal poverty
level, and at nutritional risk. WIC is
not an entitlement program. A system of
priorities has therefore been developed
by the Food and Nutrition Service (FNS)
to assist State and local WIC providers
in allocating limited benefits. Children
have lower priority for WIC services
than pregnant women and infants.
The program
benefits for children participating in
WIC are threefold. First, participants
receive vouchers for supplementary food.
The package includes milk, cheese, eggs,
cereal, 100 percent fruit juice, and
dried beans or peanut butter. Second,
nutritional education is provided to the
child’s caregiver, and in some cases
directly to the child. Finally, access
to health care is facilitated.
Prenatal
Period and Infancy
WIC children
differ from other low-income children in
several dimensions of their earliest
experiences. Their mothers tend to be
less healthy overall. The pregnancy was
more likely to have been attended with
certain obstetrical risks (older mother,
first pregnancy), to have had medical
complications, and to have been
compromised by the mother’s use of
alcohol and illegal drugs. Available
data do not indicate whether the mother
participated in WIC during pregnancy.
WIC children at birth were less healthy
than other low-income children.
A few
illustrative measures of pregnancy
status and birth outcomes are displayed
for WIC participants, other low-income
children, and higher income children in
Exhibit ES.1. (Items that are based on
the CCDP2 data are available for
low-income children only.) For some of
these measures, WIC children and other
low-income children look quite
similar–e.g., likelihood that the
mother was a young teenager, and use of
cigarettes during pregnancy.
For both of
these risk factors, higher income
children have substantially lower
values. Alcohol use during pregnancy, in
contrast, was substantially more
prevalent among mothers of WIC children
in the nonrepresentative CCDP2 sample
than among mothers of other low-income
children during pregnancy (15.5 versus
10.3 percent); and low birthweight was
significantly more common among WIC
children than among other low-income
children (11.6 percent versus 8.3
percent). Low birthweight was even less
common among higher-income children (5.3
percent).
Nonetheless,
WIC children’s feeding patterns during
infancy were generally better than that
of other low-income children: for
example, they were significantly less
likely to be given cow’s milk before
12 months of age, or put down with a
bottle containing anything other than
water. It is possible that this pattern
reflects effects of WIC participation
during infancy, because WIC children
were more likely to have been WIC
infants than other low-income children.
WIC children
were, however, no more likely than other
low-income children to have been
breastfed; and substantially less likely
than higher-income children (40.0
percent versus 66.7 percent).
Households
and Environments
WIC children
are worse off than other low-income
children in many aspects of household
wellbeing and environment. A striking
exception is that they are more likely
to have health insurance, because of
Medicaid. Also, despite greater poverty,
they are no more likely to experience
food insecurity. It is plausible that
WIC contributes to this situation (as
well as the Food Stamp Program, in which
60 percent of WIC children’s
households participate).
As mentioned
previously, WIC children are drawn
primarily from the low end of the income
distribution, even among households with
income under 185 percent of the federal
poverty level. Among WIC children, 54
percent are living in poverty and 25
percent in extreme poverty (under 50
percent of the federal poverty level).
The corresponding percentages for other
low-income children are 47 percent and
18 percent. WIC children are more likely
to be receiving other means-tested
benefits such as AFDC/TANF or food
stamps, to live in subsidized housing,
and to be in a female-headed household.
The CCDP2
sample showed a striking pattern of
differences in maternal effectiveness:
mothers of WIC children scored
significantly lower in locus of control
and financial skills, and significantly
higher in use of maladaptive coping
mechanisms (mental or behavioral
disengagement), than mothers of other
low-income children.
The home and
neighborhood environments of WIC
children are less conducive to their
development than those of other
low-income children. Mothers of WIC
children in CCDP2 sample were found to
be significantly more likely to harbor
inappropriate expectations for their
children, to lack empathy, and to engage
in role reversal than mothers of other
low-income children. In teaching their
children a new task, they were less
encouraging of children’s cognitive
growth. The neighborhoods in which WIC
children live are less safe and are
lower ranked as "a place to
live" or "a good place to
raise your children" than the
neighborhoods of other low-income
children.
On some other
measures, WIC children are not
significantly worse off than other
low-income children. As mentioned
previously, they are more likely to have
health insurance coverage (primarily
Medicaid), and no more likely to
experience economic or food insecurity,
as measured by standard batteries of
items on these topics. Home
environmental factors that are similar
for WIC children and other low-income
children include parenting practices
such as reading to the child, home
safety, and smoking in the home. These
measures, when available, were all
substantially more favorable for higher
income children: e.g. parents of higher
income children read to them more, their
homes are much less likely to be heated
by gas stoves or ovens, their homes are
safer from crime, and adults are much
less likely to smoke cigarettes in the
home.
Nutrition
and Health
Despite their
greater poverty, WIC children are as
well off as other low-income children
with regard to several (but not all)
aspects of nutrition and health that the
program attempts to improve. Their
dietary intake is similar to that of
other low-income children with regard to
most nutrients, and significantly higher
with respect to calcium and folate. As
expected, they consume more WIC foods,
such as milk (CCDP2 sample). Negative
aspects of WIC children’s nutrition
relative to that of other low-income
children include higher consumption of
high-fat foods (CCDP2 sample), and
greater prevalence of underweight.
Higher income children are significantly
less likely to be overweight.
Although WIC
children have better access to health
care than other low-income children, the
CCDP2 data suggest that they are more
likely to suffer developmental delays.
In addition, WIC children in the CCDP2
sample score significantly lower than
their counterparts on five scales of
cognitive development, language
development, and socioemotional
development.
Dynamic
Patterns of Receipt
For analyzing
age-related patterns of WIC receipt, we
considered WIC infants and children
jointly. The primary dynamic feature of
WIC participation in this group is that
participation declines sharply with age:
infants comprise 32 percent of infant
and child recipients, while
four-year-olds comprise only 12 percent.
Most infant recipients go on to
participate as children (81 percent).
Children may
participate at a lower rate than infants
for several reasons. The prioritization
system has historically restricted
children’s access to WIC; children
must be recertified every six months,
while infants may be certified for up to
a year; and the food package for
children has a lesser monetary value
than the package for infants that
receive formula. In addition, older
children may participate at a lower rate
than younger children because food is
more often available outside the home,
in Head Start and day care programs; and
because the child may develop food
preferences that do not coincide with
the WIC food package.
Of all infants
and children who ever enter the WIC
program, the great majority (70 percent)
do so in infancy. Final exits from the
WIC program are much more diffusely
distributed: about two-fifths of
recipients exit in infancy or at age
one, and nearly a quarter receive
benefits through their fifth birthday.
Few children exit WIC and then
subsequently reenter.
For children
not turning five, WIC exits can often be
related to trigger events, i.e. changes
in household circumstances. Those that
are most closely associated with WIC
exits are:
More than a
quarter of WIC exits occur without any
measured change in household
circumstances, however. Possible reasons
include loss of eligibility due to
removal of nutritional risk,
administrative closure due to
insufficient funding to serve all
eligible children, or decisions by
parents that WIC benefits are not worth
meeting the participation requirements.
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