Why Wait?: Examining Delayed WIC Participation among Pregnant Women

By Tiehen, Laura; Jacknowitz, Alison | Contemporary Economic Policy, October 2008 | Go to article overview

Why Wait?: Examining Delayed WIC Participation among Pregnant Women


Tiehen, Laura, Jacknowitz, Alison, Contemporary Economic Policy


1. INTRODUCTION

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritious foods, nutrition counseling, and referrals to health and other social services to low-income women and their infants and children up to age 5. The program was established as a pilot program in 1972 and has grown from serving 88,000 participants in fiscal year 1974 to approximately 8.1 million in fiscal year 2006 (U.S. Department of Agriculture [USDA], 2007). Approximately 941,000 pregnant women participated in WIC during April 2004, comprising 11% of WIC participants (USDA, 2006a).

A substantial body of research finds that women who participated in WIC during their pregnancy have better birth outcomes than low-income women who did not. Fox, Hamilton, and Lin (2004) review 38 studies conducted since the late 1970s and conclude that the research provides evidence that WIC has a positive impact on several key birth outcomes such as low birthweight, mean birth-weight, and mean gestational age. More recent studies provide further evidence of the positive impact of WIC on birth outcomes (e.g., Bitler and Currie, 2005).

There is also evidence that earlier participation in WIC by pregnant women results in greater improvements in birth outcomes than later participation (Ahluwalia et al., 1998; Brien and Swann, 2001; Buescher et al., 1993; Devaney, Bilheimer, and Schore, 1992; Edozien, Switzer, and Bryan, 1979; Finch, 2003; Kennedy et al., 1982; Lazariu-Bauer et al., 2004; Schramm, 1986). Most recently, Lazariu-Bauer et al. (2004) find an increase in birthweight among infants born to early prenatal WIC entrants compared to late entrants, with the greatest increases among more disadvantaged populations. In addition, studies suggest that early receipt of prenatal care has a positive impact on birth outcomes (Evans and Lien, 2005; Kotelchuck, 1994).

Despite the health benefits of prenatal WIC participation and especially participation that begins early in the pregnancy, not all eligible women take up during pregnancy and some prenatal participants do not take up until later in their pregnancies. In 2003, 69.6% of eligible pregnant women participated (USDA, 2006b). Among prenatal participants in April 2004, 48.1% did not enroll until after their first trimester (USDA, 2006a). Many eligible nonparticipants and late entrants exhibit need for program benefits, despite their lack of participation. Swann (2007) finds that almost 19% of eligible prenatal nonparticipants experiencing their first pregnancy had annual income below $5,000 in 1988, when the poverty threshold for a single-person household was $5,770. Finch (2003) finds that 55% of late prenatal WIC entrants in 1988 had income below the poverty line. Understanding the characteristics associated with WIC participation and, in particular, early participation can help target program resources and outreach efforts more effectively. In addition, although WIC is a Federal program, states have some discretion over program design and operation. Understanding the interaction between state-level WIC policies and the timing of participation may inform decisions regarding state-level policy design.

Further, there has been some debate over the role WIC participation itself plays in the improvement in birth outcomes (Besharov and Germanis, 2001; Joyce, Gibson, and Colman, 2005). One of the underlying issues in this debate is whether WIC participants would be more likely to have better birth outcomes than eligible nonparticipants, regardless of whether they participated in WIC. (1) A more thorough understanding of the factors associated with WIC participation, as well as the timing of participation, can contribute to the debate over the effectiveness of WIC.

This research uses a recently released data set, the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), with extensive information on household characteristics to examine prenatal participation in WIC among eligible women. …

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