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2002 PRAMS Surveillance Report: Multistate Exhibits
WIC Participation During Pregnancy |
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Data Highlights | References | Tables
Background
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a national program, established in 1972 by an amendment to the Child Nutrition Act of 1966, to enhance maternal and infant health through better nutrition and education. WIC enhances the health of women, infants, and children by promoting improved preconceptual nutrition status, breastfeeding, infant feeding practices, childhood immunizations, proper nutrition, and the use of appropriate medical services by women and children.1–4 WIC is administered by the Food and Nutrition Services, U.S. Department of Agriculture (USDA), and is managed at the state level by health departments. WIC services are available to eligible low-income pregnant, postpartum, and lactating women, infants (children less than 1 year old), and children up to 5 years of age. Eligibility for the WIC program is based on income, state residency, and nutritional risk. Income eligibility levels for most states are set at or below 185% of the federal poverty level. Two major types of nutritional risk recognized by WIC are medically based risks (e.g., anemia, underweight, maternal age, pregnancy complications, poor pregnancy outcomes) and diet-based risks (e.g., inadequate dietary pattern).5
A review of the literature on WIC evaluations has shown the program to be effective in reducing the incidence of low birthweight, very low birthweight, preterm delivery, and small-for-gestational-age births, especially among women at high risk because of sociodemographic characteristics or nutritional or medical conditions.1,6–11 In addition, a recent study of New York State Vital Statistics records linked to WIC records found a significant, positive effect of longer prenatal WIC participation on birthweight. In this study, black and Hispanic full-term infants experienced greater WIC benefits than whites.12 Nevertheless, considerable barriers in access to WIC services persist. The most often cited barriers in recent studies are long waiting time, job conflicts, and transportation problems.13,14
In 2004, an average of 7.9 million women, infants, and children participated in WIC each month, compared with 5.4 million in 1992.15 About 50% of WIC program participants are children, 26% are infants, 13% are breastfeeding and postpartum women, and 11% are pregnant women.16 In 2002, most (85%) of the pregnant women participating in WIC were between the ages of 18 and 34; only 8% of WIC participating pregnant women were age 17 or younger, down from 11% reported in 1998.16 The ethnic composition of the WIC population has also been changing over time, with a rising proportion of Hispanic participants and a declining proportion of non-Hispanic white participants. In 2002, 39% of participating pregnant women were non-Hispanic white, 36% were Hispanic, 19% were non-Hispanic black, 3% were Asian or Pacific Islander, and 1% were American Indian or Alaska Native.16
The 2002 WIC program data also show a sustained increase in WIC enrollment early in pregnancy. Between 1992 and 2002, enrollment in the first trimester increased by 11 percentage points.16 In 2002, 48% of participating pregnant women had enrolled in their first trimester, and 40% had enrolled in their second trimester. Only 11% had enrolled in their third trimester.
PRAMS collects data on WIC participation during pregnancy. This information can be used by states to assess the proportion of women participating in WIC services and to examine WIC enrollment over time. In addition, PRAMS data may be used to examine the impact of WIC on birth outcomes and healthy behaviors targeted by the program (e.g., breastfeeding).17,18
Data Highlights
- In 2002, the prevalence of WIC participation during pregnancy ranged from 30.6% (New Jersey) to 56.7% (West Virginia).
- During 1993–2002, WIC participation increased in 3 states (Alaska, New York, and Oklahoma) and decreased in 1 state (Maine).
- During 2000–2002, WIC participation increased in 1 state (Nebraska).
References
- Ahluwalia IB, Hogan VK, Grummer-Strawn LM, Colville WR, Peterson A. The effect of WIC participation on small-for-gestational-age births: Michigan, 1992. American Journal of Public Health 1998;88(9):1374–1377.
- Wright AL. The rise of breastfeeding in the United States. Pediatric Clinics of North America 2001;48(1):1–12.
- Finch C, Daniel EL. Breastfeeding education program with incentives increases exclusive breastfeeding among urban WIC participants. Journal of the American Dietetic Association 2002;102(7):981–984.
- American Academy of Pediatrics Provisional Section on Breastfeeding. WIC program. Pediatrics 2001;108(5):1216–1217.
- U.S. Department of Agriculture Food and Nutrition Service (Web site). Nutrition Program Facts: WIC—The Special Supplemental Nutrition Program for Women, Infants, and Children. December, 2004. Available at http://www.fns.usda.gov/wic/WIC-Fact-Sheet.pdf.
- Devaney B, Bilheimer L, Schore J. Medicaid costs and birth outcomes: the effects of prenatal WIC participation and the use of prenatal care. Journal of Policy Analysis and Management 1992;(11):573–592.
- U.S. General Accounting Office (GAO). Early Interventions: Federal Investments Like WIC Can Produce Savings. Washington, DC: GAO; 1992. GAO/HRD-92–18.
- Buescher PA, Larson LC, Nelson MD, Lenihan AJ. Prenatal WIC participation can reduce low birth weight and newborn medical costs: a cost-benefit analysis of WIC participation in North Carolina. Journal of the American Dietetic Association 1993;(93):163–166.
- Abrams B. Preventing low birth weight: does WIC work? A review of evaluations of the special supplemental food program for women, infants, and children. Annals of the New York Academy of Sciences 1993;678:306–316.
- Kowaleski-Jones L, Duncan GJ. Effects of participation in the WIC program on birthweight: evidence from the National Longitudinal Survey of Youth. Special Supplemental Nutrition Program for Women, Infants, and Children. American Journal of Public Health 2002;92(5):799–804.
- Reichman NE, Teitler JO. Effects of psychosocial risk factors and prenatal interventions on birth weight: evidence from New Jersey's HealthStart program. Perspectives on Sexual and Reproductive Health 2003;35(3):130–137.
- Lazariu-Bauer V, Stratton H, Pruzek R, Woelfel ML. A comparative analysis of effects of early versus late prenatal WIC participation on birth weight: NYS, 1995. Maternal and Child Health Journal 2004;8(2):77–86.
- Rosenberg TJ, Alperen JK, Chiasson MA. Why do WIC participants fail to pick up their checks? An urban study in the wake of welfare reform. American Journal of Public Health 2003;93(3):477–481.
- Woelfel ML, Abusabha R, Pruzek R, Stratton H, Chen SG, Edmunds LS. Barriers to the use of WIC services. Journal of the American Dietetic Association 2004;104(5):736–743.
- U.S. Department of Agriculture Food and Nutrition Service (Web site). WIC Program Participation and Costs: Data as of January 26, 2005. January 26, 2005. Available at http://www.fns.usda.gov/pd/wisummary.htm.
- U.S. Department of Agriculture (USDA) Food and Nutrition Service, Office of Analysis, Nutrition and Evaluation. WIC Participant and Program Characteristics 2002. Washington, DC: USDA; 2003. Publication number WIC-03-PC.
- Hickey CA, Kreauter M, Bronstein J, Johnson V, McNeal SF, Harshbarger DS, et al. Low prenatal weight gain among adult WIC participants delivering term singleton infants: variation by maternal and program participation characteristics. Maternal and Child Health Journal 1999;3(3):129–140.
- Ahluwalia IB, Tessaro I, Grummer-Strawn LM, MacGowan C, Benton-Davis S. Georgia's breastfeeding promotion program for low-income women. Pediatrics 2000;105(6):E85.
Prevalence of WIC Participation During Pregnancy, 2002
| State |
Respondents |
Percent† |
Standard Error |
95% CI‡ |
| Alabama |
1,559 |
55.3 |
1.2 |
53.0–57.7 |
| Alaska |
1,613 |
50.5 |
1.4 |
47.7–53.3 |
| Arkansas |
1,965 |
56.6 |
1.5 |
53.6–59.6 |
| Colorado |
2,276 |
31.9 |
1.3 |
29.4–34.4 |
| Florida |
2,005 |
44.9 |
1.6 |
41.7–48.0 |
| Hawaii |
1,810 |
42.1 |
1.4 |
39.4–44.8 |
| Illinois |
1,927 |
42.9 |
1.2 |
40.5–45.3 |
| Louisiana |
1,691 |
55.6 |
1.3 |
52.9–58.2 |
| Maine |
1,136 |
32.6 |
1.6 |
29.5–35.9 |
| Maryland |
1,451 |
37.3 |
2.0 |
33.5–41.2 |
| Michigan |
1,542 |
37.6 |
1.4 |
34.9–40.4 |
| Minnesotaa |
1,141 |
33.8 |
1.7 |
30.4–37.3 |
| Montana |
1,042 |
41.9 |
1.5 |
38.9–45.0 |
| Nebraska |
1,886 |
37.0 |
1.3 |
34.6–39.5 |
| New Jerseyb |
942 |
30.6 |
1.5 |
27.8–33.5 |
| New Mexico |
1,543 |
55.3 |
1.3 |
52.7–57.8 |
| New Yorkc |
1,221 |
32.3 |
1.8 |
29.0–35.9 |
| North Carolina |
1,536 |
44.3 |
1.6 |
41.3–47.4 |
| North Dakota |
903 |
36.3 |
1.4 |
33.6–39.1 |
| Ohio |
1,373 |
37.9 |
1.6 |
34.8–41.2 |
| Oklahoma |
1,861 |
53.3 |
1.8 |
49.7–56.8 |
| Rhode Island |
1,406 |
43.2 |
1.4 |
40.5–46.0 |
| South Carolina |
1,378 |
54.0 |
2.1 |
49.8–58.2 |
| Utah |
1,565 |
30.8 |
1.5 |
27.9–33.8 |
| Vermont |
1,103 |
40.9 |
1.5 |
38.0–43.8 |
| Washington |
1,508 |
40.9 |
1.7 |
37.7–44.2 |
| West Virginia |
1,684 |
56.7 |
1.7 |
53.4–60.0 |
| All PRAMS states§ |
41,067 |
41.8 |
0.4 |
41.1–42.6 |
† 2002 state range is 30.6–56.7%.
‡ Confidence interval.
§ Aggregate of the 27 PRAMS states.
a Data represent Minnesota births from May–December 2002.
b Data represent New Jersey births from July–December 2002.
c Data exclude New York City. |
Prevalence of WIC Participation During Pregnancy, 2002
Prevalence of WIC Participation During Pregnancy, 1993–2002
| State |
1993
(%) |
1994
(%) |
1995
(%) |
1996
(%) |
1997
(%) |
1998
(%) |
1999
(%) |
2000
(%) |
2001
(%) |
2002
(%) |
P value
for trend# |
| Alabama |
56.5 |
55.8 |
56.2 |
57.2 |
56.1 |
55.4 |
52.5 |
54.1 |
55.5 |
55.3 |
0.062 |
| Alaska |
32.6 |
33.2 |
42.3 |
44.4 |
41.4 |
47.9 |
47.0 |
48.5 |
45.4 |
50.5 |
0.000** |
| Arkansas |
— |
— |
— |
— |
56.4 |
56.6 |
54.5 |
54.5 |
53.9 |
56.6 |
0.603 |
| Colorado |
— |
— |
— |
— |
— |
32.4 |
33.6 |
31.3 |
32.4 |
31.9 |
0.591 |
| Florida |
44.3 |
43.7 |
43.4 |
44.4 |
46.8 |
45.7 |
42.0 |
40.9 |
41.8 |
44.9 |
0.293 |
| Hawaii |
— |
— |
— |
— |
— |
— |
— |
44.1 |
42.4 |
42.1 |
0.262 |
| Illinois |
— |
— |
— |
— |
37.4g |
34.5 |
36.7 |
35.6 |
41.3 |
42.9 |
0.000** |
| Louisiana |
— |
— |
— |
— |
— |
54.5 |
56.5 |
53.7 |
52.0 |
55.6 |
0.556 |
| Maine |
36.0 |
35.1 |
34.4 |
37.1 |
37.1 |
36.1 |
32.0 |
33.1 |
32.3 |
32.6 |
0.021* |
| Maryland |
— |
— |
— |
— |
— |
— |
— |
— |
33.4d |
37.3 |
# # |
| Michigan |
— |
— |
— |
— |
— |
— |
— |
— |
37.7e |
37.6 |
# # |
| Minnesota |
— |
— |
— |
— |
— |
— |
— |
— |
— |
33.8a |
# # |
| Montana |
— |
— |
— |
— |
— |
— |
— |
— |
— |
41.9 |
# # |
| Nebraska |
— |
— |
— |
— |
— |
— |
— |
31.6 |
34.9 |
37.0 |
0.001* |
| New Jersey |
— |
— |
— |
— |
— |
— |
— |
— |
— |
30.6b |
# # |
| New Mexico |
— |
— |
— |
— |
—h |
56.3h |
56.1 |
54.7 |
53.0 |
55.3 |
0.261 |
| New Yorkc |
27.9 |
31.1 |
29.4 |
29.6 |
31.4 |
33.6 |
32.8 |
35.1 |
31.2 |
32.3 |
0.024* |
| North Carolina |
— |
— |
— |
— |
47.0i |
46.1 |
47.4 |
48.2 |
48.4 |
44.3 |
0.653 |
| North Dakota |
— |
— |
— |
— |
— |
— |
— |
— |
— |
36.3 |
# # |
| Ohio |
— |
— |
— |
— |
— |
— |
36.6 |
35.9 |
37.2 |
37.9 |
0.461 |
| Oklahoma |
47.4 |
46.9 |
51.3 |
55.0 |
55.3 |
55.4 |
54.5 |
51.7 |
53.5 |
53.3 |
0.007* |
| Rhode Island |
— |
— |
— |
— |
— |
— |
— |
— |
— |
43.2 |
# # |
| South Carolina |
56.5 |
56.6 |
55.6 |
56.3 |
54.1 |
56.8 |
55.4 |
54.9 |
60.8 |
54.0 |
0.927 |
| Utah |
— |
— |
— |
— |
— |
— |
29.8 |
29.9 |
28.7 |
30.8 |
0.790 |
| Vermont |
— |
— |
— |
— |
— |
— |
— |
—f |
40.1f |
40.9 |
# # |
| Washington |
— |
38.3 |
41.3 |
41.7 |
41.2 |
42.3 |
42.1 |
40.5 |
42.0 |
40.9 |
0.406 |
| West Virginia |
56.1 |
54.4 |
57.1 |
57.4 |
59.8 |
58.2 |
58.3 |
59.2 |
59.7 |
56.7 |
0.071 |
# Based on a test for linear trend using logistic regression.
* p value is less than 0.05.
** p value is less than 0.001.
# # < 3 years of data available; test for linear trend not applicable.
a Data represent Minnesota births from May–December 2002.
b Data represent New Jersey births from July–December 2002.
c Data exclude New York City.
d Data represent Maryland births from February–December 2001.
e Data represent Michigan births from July–December 2001.
f Data represent Vermont births from October 2000–December 2001.
g Data represent Illinois births from June–December 1997.
h Data represent New Mexico births from July 1997–December 1998.
i Data represent North Carolina births from July–December 1997. |
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Page last reviewed: 8/23/06
Page last modified: 8/23/06
Content source: Division
of Reproductive Health,
National Center for Chronic Disease
Prevention and Health Promotion |
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