CDC Home

Eligibility and Enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) — 27 States and New York City, 2007–2008

The national Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrition education, growth monitoring, breastfeeding promotion and support, and food to low-income pregnant or postpartum women, infants, and children aged <5 years. Several studies have linked WIC services with improved maternal and infant health outcomes (1–3). Most population-based studies have lacked information needed to identify eligible women who are not receiving WIC services and might be at risk for poor health outcomes. This report uses multistate, population-based 2007–2008 survey data from CDC's Pregnancy Risk Assessment Monitoring System (PRAMS) and California's Maternal and Infant Health Assessment (MIHA) to estimate how many women were eligible but not enrolled in WIC during pregnancy and to describe their characteristics and their prevalence of markers of risk for poor maternal or infant health outcomes (4–6). Approximately 17% of all women surveyed were eligible but not enrolled in WIC during pregnancy. The proportion of women eligible for WIC and WIC participation rates varied by state. WIC participants had higher prevalences of markers of risk for poor maternal or infant health outcomes than eligible nonparticipants, but both groups had higher prevalences of risk markers than ineligible women, suggesting that many eligible women and their children might benefit from WIC services. The results of this analysis can help identify the scope of WIC outreach needed to include more eligible nonparticipants in WIC and whom to target.

This study's sample included 71,267 women who participated in CDC's PRAMS survey in 26 states and New York City, and 6,435 women who participated in California's MIHA during 2007 or 2008 (Table 1). The two separate surveillance systems, PRAMS and MIHA, conduct annual, population-based mail surveys of women with recent live births sampled from birth certificates, with telephone follow-up of nonrespondents. The surveys used in this study include many similar questions, use similar methods (7), and have response rates of at least 65%.

Women reporting WIC participation at any time during their most recent pregnancies were classified as WIC participants. WIC eligibility requires a household income ≤185% of the federal poverty level (FPL)* or participation in another program (e.g., Medicaid) with similar income criteria. WIC nonparticipants were considered eligible if they reported incomes ≤185% FPL in the survey or if the birth certificate indicated Medicaid payment for prenatal care or delivery. Nonparticipants in WIC or Medicaid with incomes >185% FPL were considered ineligible. Women with missing information on WIC enrollment, insurance, or income (n = 1,653) were excluded, yielding a final sample of 76,049 women, which is representative of a total of 4,023,136 live births to resident women in these states, approximately half of all births in the United States during 2007–2008.

WIC participants and eligible nonparticipants as a proportion of all women delivering a live infant and as a percentage of all eligible women delivering a live birth were examined overall, then in each state. In the overall sample, WIC participants, eligible nonparticipants, and ineligible women were then compared on social characteristics important for targeting programs (e.g., race/ethnicity and language) or for assessing potential need for WIC services, as indicated by well-documented markers of risk for adverse maternal or infant health outcomes (4–6) (Table 2). Markers of risk included 1) having less than a high school education or being aged <18 years, 2) having delivered four or more live infants, 3) being unmarried at time of delivery, 4) being poor (income ≤100% FPL), 5) having Medicaid or no health-care coverage before pregnancy, 6) having no prenatal care in the first or second trimester, 7) having an unintended pregnancy, 8) being either underweight or obese before pregnancy, 9) smoking before pregnancy, and 10) having a history of delivering an infant preterm (before 37 weeks completed gestation) or of low birth weight (<2,500 g) (4,5). Finally, the percentage of women in each group with one, two, three, or four or more of the risk markers was examined. Prenatal health-care coverage was not included in the sum of the risk markers because it was used to define the WIC groups (Table 2). All estimated counts, percentages, and 95% confidence intervals were weighted to represent all live births in the participating states using statistical survey procedures that account for complex sample design.

Among all women surveyed, 46% were WIC participants, approximately 17% were classified as eligible nonparticipants (Table 1), and 37% were classified as ineligible (Table 2). Variation by state was evident in the percentage of all women delivering a live infant who were enrolled in WIC during pregnancy, from a low of 28% in Utah to a high of 57% in Oklahoma, and in the percentage of all women classified as WIC-eligible but who were not enrolled, from a low of 11% in Rhode Island to a high of 31% in Utah (Table 1). The proportion of all eligible women enrolled in WIC was approximately 74% overall, varying from a low of 48% in Utah to a high of 83% in California (Table 1).

Nearly one fifth (19%) of WIC participants were non-Hispanic blacks and 39% were Hispanics, compared with 14% and 21% of eligible nonparticipants and 5% and 7% of ineligible women, respectively (Table 2). Conversely, WIC participants included a lower proportion of non-Hispanic white women (35%) than was found among eligible nonparticipants (57%), or among ineligible women (76%). Approximately 25% of WIC participants completed the survey in Spanish, compared with 12% of eligible nonparticipants and <2% of ineligible women.

Overall, the risk characteristics of WIC participants and eligible nonparticipants differed from those of ineligible women (Table 2). WIC participants generally appeared to be at greater social and economic disadvantage, as measured by indicators of risk for delivering a preterm or low birth weight infant, than were eligible nonparticipants. WIC participants and eligible nonparticipants were more disadvantaged than ineligible women, as reflected by their low incomes and the proportion of women who had <12 years of education, were aged <18 years, had four or more live births, were unmarried, had Medicaid or no health-care coverage before pregnancy, or initiated prenatal care in the third trimester or not at all (Table 2). WIC participants and eligible nonparticipants also had higher prevalences of other health risks than ineligible women, as reflected, for example, by prepregnancy obesity, smoking before pregnancy, and a previous low birth weight or preterm birth.

WIC participants and eligible nonparticipants appeared to be at risk for poor maternal or infant outcomes, based on markers of risk (Table 2). Approximately 91% of eligible nonparticipants had at least one risk marker, and 75% reported at least two markers, compared with 97% and 90% of WIC participants, respectively. Among eligible nonparticipants, 36% reported four or more risk markers, compared with 54% of WIC participants. WIC-ineligible women reported markedly fewer risk characteristics than women in the other two groups.

Reported by

Kristen S. Marchi, MPH, Paula A. Braveman, MD, Dept of Family and Community Medicine, Univ of California, San Francisco; Katie Martin, PhD, Michael Curtis, PhD, Maternal, Child and Adolescent Health Program, California Dept of Public Health. Tonya Stancil, PhD, Leslie Harrison, MPH, Div of Reproductive Health, CDC. Corresponding contributor: Kristen S. Marchi, marchik@fcm.ucsf.edu, 415-476-8188.

Editorial Note

The results of this analysis indicate that, although WIC covered most eligible women overall and in many states during 2007–2008, an estimated 662,800 eligible women were not enrolled in WIC in the 27 states examined. The proportion of eligible women who were enrolled in WIC varied widely by state. Overall, the findings indicate that WIC is enrolling high-risk women and reveal that most eligible nonparticipants also have social and economic characteristics that repeatedly have been linked to adverse maternal or infant health outcomes. In addition, WIC participants and eligible nonparticipants have higher rates of other health risks, such as prepregnancy obesity and previous poor birth outcomes, than ineligible women. Three quarters of eligible nonparticipants had two or more markers of risk; more than one third had four or more. Although WIC's services cannot address all relevant risks, promoting and supporting more adequate nutrition might improve some health outcomes among vulnerable women and their children during the critical periods of pregnancy and infancy, with potentially lifelong benefits (8–10). Referrals by WIC to outside services, such as prenatal care and smoking cessation programs, also could benefit women, infants and children in the long run.

The findings in this report are subject to at least four limitations. First, the study relied on unverified self-reports of income and WIC participation. Second, PRAMS and MIHA measure average income over 1 year, which might underestimate WIC eligibility. Third, health-care coverage can change during pregnancy, affecting the ability to determine eligibility for WIC. Finally, although survey response rates were at least 65%, differences might exist between the respondents and nonrespondents. This concern was mitigated through nonresponse weighting of the survey data, by which differing weights were assigned to demographic groups with significantly different response rates.

The large size of the WIC-eligible population reflects levels of poverty (<100% FPL) and near-poverty (101%–185% FPL) around the time of pregnancy, confirming previous findings that many women giving birth in the United States are poor or near-poor (7). Given current economic conditions, it is possible that many women and infants continue to be socioeconomically vulnerable and hence in need of WIC services. These multistate findings suggest that expanded outreach to eligible nonparticipants should be considered. The information in this study can help identify the scope of WIC outreach needed and whom to target.

Acknowledgments

Susan Egerter, PhD, Univ of California, San Francisco; Carina Saraiva, MPH, Maternal, Child and Adolescent Health Program, California Dept of Public Health. Brian Morrow, MA, Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

References

  1. Foster EM, Jiang M, Gibson-Davis CM. The effect of the WIC program on the health of newborns. Health Serv Res 2010;45:1083–104.
  2. Bitler MP, Currie J. The changing association between prenatal participation in WIC and birth outcomes in New York City: what does it mean? J Policy Anal Manage 2005;24:687–90.
  3. 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. Am J Public Health 2002;92:799–804.
  4. Blumenshine P, Egerter S, Barclay CJ, Cubbin C, Braveman PA. Socioeconomic disparities in adverse birth outcomes: a systematic review. Am J Prev Med 2010;39:263–72.
  5. Behrman RE, Butler AS, eds. Preterm birth: causes, consequences, and prevention. Washington, DC: National Academies Press; 2007.
  6. Kramer MS. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ 1987;65:663–737.
  7. Braveman P, Marchi K, Egerter S, et al. Poverty, near-poverty, and hardship around the time of pregnancy. Matern Child Health J 2010;14:20–35.
  8. Laraia BA, Siega-Riz, AM, Gunderson C. Household food insecurity is associated with self-reported pregravid weight status, gestational weight gain, and pregnancy complications. J Am Diet Assoc 2010;110:692–701.
  9. Shapira N. Prenatal nutrition: a critical window of opportunity for mother and child. Womens Health 2008;4:639–56.
  10. Lu MC, Kotelchuck M, Hogan V, Jones L, Wright K, Halfon N. Closing the black-white gap in birth outcomes: a life-course approach. Ethn Dis 2010;20(1 Suppl 2):S2-62–76.

* FPL for a family of four was $20,650 in 2007 and $21,200 in 2008, and 185% of FPL was $38,203 in 2007 and $39,220 in 2008. Additional information on WIC eligibility requirements is available at http://www.fns.usda.gov/wic. Additional information on the FPL is available at http://aspe.hhs.gov/poverty/figures-fed-reg.cfm.


What is already known on this topic?

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrition education, growth monitoring, breastfeeding promotion and support, and food to low-income pregnant or postpartum women, infants, and children aged <5 years. Several studies have linked WIC services with improved maternal and infant health.

What is added by this report?

Among women from 27 states and New York City who participated in a survey of mothers who had recently delivered a live infant during 2007–2008, 46% were WIC participants and approximately 17% were classified as eligible nonparticipants. WIC participants generally were at greater social and economic disadvantage than were eligible nonparticipants, as measured by indicators of risk for delivering a preterm or low birth weight infant, but both groups were more disadvantaged than ineligible women.

What are the implications for public health practice?

Efforts to expand outreach to eligible non-WIC participants could improve maternal and infant health outcomes among low-income pregnant or postpartum women, infants, and children aged <5 years. The results of this analysis can help identify the scope of WIC outreach needed and whom to target.


TABLE 1. Eligibility and enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in 27 states and New York City — Pregnancy Risk Assessment Monitoring System (PRAMS) and California Maternal and Infant Health Assessment (MIHA), 2007–2008

State

Sample size*

Live births population

WIC-eligible population

WIC participants§

Eligible nonparticipants§

No.

All women

Eligible women

No.

All women

Eligible women

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Overall

76,049

4,023,136

2,526,026

1,863,195

46.3

(45.8–46.9)

73.8

(73.1–74.4)

662,831

16.5

(16.1–16.9)

26.2

(25.6–26.9)

Alaska

2,764

21,528

14,998

10,386

48.2

(45.9–50.6)

69.3

(66.6–71.9)

4,612

21.4

(19.4–23.4)

30.7

(28.1–33.4)

Arkansas

3,491

75,415

56,914

42,762

56.7

(54.5–58.9)

75.1

(72.8–77.4)

14,152

18.8

(16.9–20.6)

24.9

(22.6–27.2)

California**

6,272

934,463

604,330

503,376

53.9

(52.7–55.0)

83.3

(82.1–84.5)

100,954

10.8

(10.0 –11.6)

16.7

(15.5–17.9)

Colorado

4,036

135,344

76,100

48,300

35.7

(33.5–37.8)

63.5

(60.6–66.4)

27,800

20.5

(18.8–22.3)

36.5

(33.6–39.4)

Delaware

1,893

18,611

12,074

8,607

46.2

(43.9–48.5)

71.3

(68.6–73.9)

3,467

18.6

(16.8–20.5)

28.7

(26.1–31.4)

Georgia

1,750

278,292

205,092

147,067

52.8

(49.2–56.5)

71.7

(67.8–75.6)

58,024

20.9

(17.8–23.9)

28.3

(24.4–32.2)

Hawaii

3,386

36,763

24,746

15,926

43.3

(41.7–45.0)

64.4

(62.4–66.3)

8,820

24.0

(22.5–25.4)

35.6

(33.7–37.6)

Illinois

1,706

169,046

108,018

76,584

45.3

(42.7–47.9)

70.9

(68.0–73.8)

31,435

18.6

(16.6–20.6)

29.1

(26.2–32.0)

Maryland

3,271

135,195

74,503

55,041

40.7

(38.1–43.4)

73.9

(70.6–77.1)

19,462

14.4

(12.5–16.3)

26.1

(22.9–29.4)

Maine

2,238

26,127

16,290

10,578

40.5

(38.1–42.9)

64.9

(62.0–67.9)

5,712

21.9

(19.9–23.8)

35.1

(32.1–38.0)

Michigan

1,497

119,636

69,976

52,060

43.5

(40.7–46.3)

74.4

(71.0–77.8)

17,916

15.0

(12.9–17.1)

25.6

(22.2–29.0)

Minnesota

3,068

137,628

72,107

55,689

40.5

(38.5–42.4)

77.2

(74.9–79.5)

16,418

11.9

(10.6–13.2)

22.8

(20.5–25.1)

Missouri

1,371

76,871

51,144

36,080

46.9

(43.7–50.1)

70.5

(66.8–74.3)

15,063

19.6

(16.9–22.3)

29.5

(25.7–33.2)

North Carolina

3,005

249,912

163,375

117,399

47.0

(44.8–49.1)

71.9

(69.4–74.3)

45,976

18.4

(16.7–20.1)

28.1

(25.7–30.6)

Nebraska

3,140

49,990

29,220

19,007

38.0

(36.1–40.0)

65.0

(62.4–67.7)

10,214

20.4

(18.7–22.2)

35.0

(32.3–37.6)

New Jersey

3,003

204,664

103,236

72,368

35.4

(33.8–37.0)

70.1

(67.7–72.5)

30,868

15.1

(13.7–16.5)

29.9

(27.5–32.3)

New York

2,196

229,011

125,921

92,420

40.4

(37.7–43.0)

73.4

(70.1–76.6)

33,501

14.6

(12.7–16.5)

26.6

(23.4–29.9)

Ohio

2,938

281,565

176,193

119,690

42.5

(40.1–44.9)

67.9

(65.0–70.9)

56,502

20.1

(18.1–22.1)

32.1

(29.1–35.0)

Oklahoma

4,012

103,957

77,481

59,617

57.3

(54.8–59.9)

76.9

(74.4–79.5)

17,864

17.2

(15.2–19.2)

23.1

(20.5–25.6)

Oregon

3,434

93,597

60,053

43,829

46.8

(44.2–49.4)

73.0

(70.0–76.0)

16,224

17.3

(15.3–19.4)

27.0

(24.0–30.0)

Rhode Island

2,583

22,579

13,230

10,812

47.9

(45.8–50.0)

81.7

(79.4–84.0)

2,418

10.7

(9.3–12.1)

18.3

(16.0–20.6)

South Carolina

1,450

57,711

39,916

28,770

49.9

(45.7–54.0)

72.1

(67.4–76.7)

11,146

19.3

(15.9–22.7)

27.9

(23.3–32.6)

Utah

3,520

106,320

62,764

29,842

28.1

(26.6–29.6)

47.5

(45.3–49.8)

32,922

31.0

(29.3–32.7)

52.5

(50.2–54.7)

Washington

2,958

170,591

101,467

73,829

43.3

(41.1–45.4)

72.8

(70.1–75.4)

27,638

16.2

(14.4–18.0)

27.2

(24.6–29.9)

Wisconsin

2,028

135,494

77,409

52,349

38.6

(36.4–40.9)

67.6

(64.6–70.7)

25,060

18.5

(16.5–20.5)

32.4

(29.3–35.4)

West Virginia

1,744

18,926

14,025

10,832

57.2

(53.9–60.6)

77.2

(73.9–80.6)

3,193

16.9

(14.3–19.4)

22.8

(19.4–26.1)

Wyoming

1,849

15,436

9,426

5,549

35.9

(33.5–38.4)

58.9

(55.7–62.1)

3,878

25.1

(22.9–27.3)

41.1

(37.9–44.3)

New York City

1,446

118,462

86,020

64,429

54.4

(51.1–57.7)

74.9

(71.5–78.3)

21,592

18.2

(15.6–20.8)

25.1

(21.7–28.5)

* Unweighted number of women who participated in the PRAMS and MIHA surveys.

Population counts weighted to population of live births represented by the survey, adjusting for the sample design and nonresponse.

§ WIC participants reported that they were on WIC during pregnancy in the survey; eligible nonparticipants did not report that they were on WIC during pregnancy, but reported household incomes ≤185% of the federal poverty level in the survey or the birth certificate indicated Medicaid paid for prenatal care or delivery.

Percentages and 95% confidence intervals (CIs) weighted to adjust for the sample design and nonresponse.

** California data are from MIHA; data for the other states are from PRAMS.


TABLE 2. Characteristics of women in 27 states and New York City delivering live-born infants — Pregnancy Risk Assessment Monitoring System (PRAMS) and California Maternal and Infant Health Assessment (MIHA), 2007–2008

Characteristic

Total

WIC participant§

Eligible nonparticipant§

Ineligible for WIC§

No.*

%

(95% CI)

No.*

%

(95% CI)

No.*

%

(95% CI)

No.*

%

(95% CI)

Total

76,049

100

(100–100)

35,953

46.3

(45.8–46.9)

13,680

16.5

(16.1–16.9)

26,416

37.2

(36.7–37.7)

Race/Ethnicity

All non-Hispanic

61,244

75.6

(75.2–76.0)

25,566

60.8

(60.0–61.5)

11,208

79.1

(77.9–80.2)

24,470

92.6

(92.1–93.1)

White

38,464

54.2

(53.7–54.7)

12,812

35.4

(34.6–36.1)

6,962

56.9

(55.5–58.2)

18,690

76.4

(75.6–77.1)

Black

11,596

12.7

(12.3–13.0)

7,844

18.8

(18.2–19.5)

2,136

13.8

(12.8–14.8)

1,616

4.6

(4.2–4.9)

Asian/Pacific Islander

6,420

6.4

(6.1–6.6)

1,982

3.7

(3.4–4.0)

1,211

5.8

(5.2–6.4)

3,227

9.9

(9.4–10.5)

American Indian/Alaska Native

3,041

1.0

(0.9–1.0)

2,070

1.4

(1.3–1.6)

562

1.0

(0.8–1.2)

409

0.4

(0.3–0.5)

Other/Mixed

1,723

1.7

(1.5–1.9)

858

1.8

(1.5–2.0)

337

2.0

(1.5–2.4)

528

1.5

(1.2–1.7)

Hispanic

13,819

24.4

(24.0–24.8)

9,958

39.2

(38.5–40.0)

2,314

20.9

(19.8–22.1)

1,547

7.4

(6.9–7.9)

White

10,425

20.3

(19.9–20.7)

7,537

32.7

(32.0–33.4)

1,677

16.9

(15.8–18.0)

1,211

6.4

(5.9–6.8)

Black

329

0.5

(0.4–0.6)

246

0.9

(0.7–1.0)

43

0.4

(0.2–0.5)

40

0.2

(0.1–0.2)

Other

3,065

3.6

(3.4–3.8)

2,175

5.8

(5.4–6.2)

594

3.7

(3.2–4.3)

296

0.9

(0.7–1.0)

Survey language

English

68,387

85.9

(85.5–86.3)

29,802

75.1

(74.4–75.8)

12,436

88.0

(87.1–88.9)

24,149

98.4

(98.2–98.6)

Spanish

7,659

14.1

(13.7–14.5)

6,151

24.9

(24.2–25.6)

1,241

12.0

(11.1–12.9)

267

1.6

(1.4–1.8)

Education (yrs)

0–11

14,541

20.4

(20.0–20.8)

11,458

35.3

(34.6–36.0)

2,664

20.8

(19.6–22.0)

419

1.7

(1.5–2.0)

12

21,628

28.0

(27.5–28.5)

13,732

38.3

(37.5–39.1)

4,626

34.8

(33.5–36.2)

3,270

12.2

(11.6–12.8)

≥13

38,718

51.7

(51.1–52.2)

10,133

26.4

(25.7–27.1)

6,164

44.3

(42.9–45.7)

22,421

86.1

(85.5–86.7)

Age group (yrs)

<18

2,537

3.1

(2.8–3.3)

2,077

5.5

(5.1–5.9)

415

2.7

(2.3–3.2)

45

0.1

(0.1–0.1)

18–24

23,697

29.8

(29.2–30.3)

16,655

45.5

(44.6–46.3)

4,900

35.6

(34.3–37.0)

2,142

7.6

(7.1–8.1)

25–39

47,510

64.4

(63.9–65.0)

16,578

47.5

(46.6–48.3)

7,965

58.9

(57.5–60.3)

22,967

87.9

(87.3–88.5)

≥40

2,302

2.8

(2.6–2.9)

642

1.5

(1.3–1.7)

398

2.7

(2.3–3.1)

1,262

4.3

(4.0–4.7)

Total live births 

1st live birth

31,888

41.2

(40.6–41.7)

14,852

40.2

(39.4–41.1)

5,132

37.2

(35.8–38.6)

11,904

44.1

(43.2–45.0)

2nd–3rd birth

35,209

48.3

(47.7–48.8)

15,912

46.3

(45.4–47.1)

6,346

47.7

(46.3–49.1)

12,951

50.9

(50.0–51.8)

4th birth or greater

8,615

10.6

(10.2–10.9)

5,025

13.5

(12.9–14.1)

2,121

15.1

(14.1–16.1)

1,469

5.0

(4.6–5.3)

Not married at delivery

29,988

38.7

(38.1–39.2)

22,225

62.3

(61.5–63.1)

5,911

43.8

(42.4–45.2)

1,852

7.1

(6.6–7.6)

Income as % of FPL

0–100% FPL

26,473

32.2

(31.6–32.7)

20,852

55.5

(54.7–56.4)

5,621

39.1

(37.7–40.5)

0

0.0

101%–185% FPL

14,584

18.6

(18.1–19.0)

8,313

23.6

(22.9–24.4)

6,271

46.2

(44.8–47.6)

0

0.0

≥185% FPL

29,780

41.8

(41.3–42.4)

2,563

7.6

(7.2–8.1)

801

6.7

(6.0–7.4)

26,416

100.0

Missing

5,212

7.4

(7.1–7.8)

4,225

13.2

(12.6–13.8)

987

8.0

(7.1–8.9)

0

0.0

Preconception health coverage

Medicaid

12,957

17.7

(17.3–18.1)

10,423

31.0

(30.2–31.8)

2,302

17.4

(16.4–18.5)

232

1.4

(1.1–1.6)

Private/Other

40,098

53.0

(52.5–53.6)

8,930

23.2

(22.5–23.9)

6,051

42.5

(41.1–43.9)

25,117

94.6

(94.2–95.0)

Uninsured

22,630

29.3

(28.7–29.8)

16,340

45.8

(44.9–46.6)

5,267

40.1

(38.7–41.5)

1,023

4.0

(3.6–4.4)


TABLE 2. (Continued) Characteristics of women in 27 states and New York City delivering live-born infants — Pregnancy Risk Assessment Monitoring System (PRAMS) and California Maternal and Infant Health Assessment (MIHA), 2007–2008

Characteristic

Total

WIC participant§

Eligible nonparticipant§

Ineligible for WIC§

No.*

%

(95% CI)

No.*

%

(95% CI)

No.*

%

(95% CI)

No.*

%

(95% CI)

Prenatal health-care coverage

Medicaid/Medi-Cal

32,244

43.3

(42.7–43.8)

25,804

75.9

(75.1–76.6)

6,440

51.6

(50.2–53.1)

0

0.0

Private/Other

36,545

53.0

(52.5–53.6)

6,357

20.1

(19.5–20.8)

5,161

40.8

(39.4–42.2)

25,027

98.2

(98.0–98.4)

Uninsured

2,906

3.7

(3.5–4.0)

1,429

4.0

(3.6–4.4)

907

7.6

(6.7–8.4)

570

1.8

(1.6–2.0)

Prenatal care initiation

No prenatal care

1,016

1.8

(1.7–2.0)

524

2.3

(2.0–2.6)

358

2.7

(2.2–3.1)

134

0.9

(0.7–1.0)

1st trimester

58,684

82.3

(81.9–82.8)

25,519

76.0

(75.3–76.7)

9,639

75.2

(73.9–76.4)

23,526

93.1

(92.6–93.6)

2nd trimester

10,658

13.6

(13.3–14.0)

6,764

18.7

(18.0–19.4)

2,346

18.4

(17.3–19.5)

1,548

5.4

(5.0–5.8)

3rd trimester

1,812

2.2

(2.1–2.4)

1,111

3.0

(2.7–3.3)

524

3.8

(3.3–4.3)

177

0.6

(0.5–0.8)

Unintended pregnancy

31,752

42.4

(41.9–43.0)

19,300

55.8

(55.0–56.7)

6,738

51.1

(49.6–52.5)

5,714

22.1

(21.3 -22.9)

Prepregnancy BMI**

Underweight (<18.5)

3,568

4.1

(3.8–4.3)

1,872

4.4

(4.0–4.7)

792

5.1

(4.5–5.7)

904

3.2

(2.9 -3.6)

Normal (18.5–24.9)

36,141

48.1

(47.6–48.7)

14,695

40.6

(39.7–41.4)

6,507

47.4

(45.9–48.8)

14,939

57.9

(57.0–58.8)

Overweight (25.0–29.9)

17,094

23.2

(22.7–23.7)

8,027

23.5

(22.8–24.2)

3,075

23.0

(21.8–24.2)

5,992

23.0

(22.2–23.7)

Obese (≥30)

14,662

18.0

(17.6–18.5)

8,009

21.0

(20.3–21.7)

2,499

17.8

(16.8–18.9)

4,154

14.4

(13.7–15.0)

Missing

4,584

6.6

(6.3–6.8)

3,350

10.6

(10.0–11.1)

807

6.7

(5.9–7.4)

427

1.5

(1.3–1.7)

Preconception smoker

17,207

21.2

(20.7–21.7)

10,612

27.5

(26.7–28.3)

3,614

25.1

(23.9–26.4)

2,981

11.8

(11.2–12.4)

Prior LBW or preterm birth††

No previous live birth

31,888

42.7

(42.1–43.3)

14,852

41.7

(40.8–42.6)

5,132

38.7

(37.3–40.1)

11,904

45.7

(44.8–46.6)

No LBW or preterm birth

31,534

48.1

(47.5–48.6)

14,409

47.3

(46.4–48.1)

6,035

50.7

(49.3–52.1)

11,090

47.9

(47.0–48.8)

LBW and/or preterm birth

8,651

9.2

(8.9–9.5)

4,844

11.1

(10.5–11.6)

1,814

10.6

(9.7–11.4)

1,993

6.4

(5.9–6.8)

Markers of risk§§

One or more

61,344

79.1

(78.7–79.5)

34,970

97.1

(96.8–97.4)

12,420

90.7

(90.0–91.5)

13,954

51.5

(50.6–52.4)

Two or more

48,016

61.2

(60.7–61.7)

32,470

90.3

(89.8–90.8)

10,277

75.1

(73.9–76.3)

5,269

18.9

(18.2–19.6)

Three or more

36,917

46.7

(46.1–47.2)

27,653

76.2

(75.5–76.9)

7,779

56.9

(55.5–58.3)

1,485

5.4

(5.0–5.8)

Four or more

25,404

31.2

(30.7–31.8)

20,044

54.0

(53.2–54.9)

5,073

36.0

(34.6–37.4)

287

0.8

(0.6–1.0)

Abbreviations: CI = confidence interval; WIC = Special Supplemental Nutrition Program for Women, Infants, and Children; BMI = body mass index; LBW = low birth weight; FPL = federal poverty level.

* Unweighted number of women who participated in the PRAMS and MIHA surveys.

Percentages and 95% CIs weighted to adjust for sample design and nonresponse.

§ WIC participants reported that they were on WIC during pregnancy in the survey; eligible nonparticipants did not report that they were on WIC during pregnancy, but reported household incomes ≤185% of the FPL in the survey or the birth certificate indicated Medicaid paid for prenatal care or delivery; nonparticipants in WIC or Medicaid with incomes >185% FPL were considered ineligible for WIC.

Incomes ≤185% FPL are WIC-eligible.

** BMI calculated as (weight [kg] / height [m]2) where values 0–18.49 = underweight, 18.5–24.9 = healthy weight, 25–29.9 = overweight, and ≥30 = obese.

†† Low birth weight = less than 5 pounds, 8 ounces (<2,500 g); preterm birth is before 37 weeks gestation.

§§ Markers of risk include either age <18 years or <12 years of education (composite variable); 4th live birth or greater; not married; poor; Medicaid or uninsured before pregnancy; unintended pregnancy; underweight or obese before pregnancy; prenatal smoking; and any history of prior poor birth outcome.


Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.


All MMWR HTML versions of articles are electronic conversions from typeset documents. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version (http://www.cdc.gov/mmwr) and/or the original MMWR paper copy for printable versions of official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.

 
USA.gov: The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Rd. Atlanta, GA 30333, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO
A-Z Index
  1. A
  2. B
  3. C
  4. D
  5. E
  6. F
  7. G
  8. H
  9. I
  10. J
  11. K
  12. L
  13. M
  14. N
  15. O
  16. P
  17. Q
  18. R
  19. S
  20. T
  21. U
  22. V
  23. W
  24. X
  25. Y
  26. Z
  27. #