Policy Analysis Paper 1

Capri L. Jackson Policy Analysis Paper October 14, 2013 SW 4710 Fall 2013 Wayne State University Professor Lori Klein-Shapiro

Policy Analysis Paper 2 Social Problem Hunger exists in the United States, but unlike the stereotype of emancipated Third World children, it typically occurs in subtle ways (Karger, & Stoesz, 2010). For example, poor Americans may eat only once a day or skips meals for several days; they may be subject to chronic malnutrition; women may deliver low-birth-weight babies; and babies may be at risk from high infant mortality rates (Karger, & Stoesz, 2010). The social problem that I am most concerned with is that which involves women and children as it relates to economic conditions and malnutrition. As we know in social work, women and children have been considered to be a part of the vulnerable population here in the United States since then beginning of social work practice existence. The extent of hunger and food insecurity is reflected in the number of people seeking food from emergency food providers (Karger, & Stoesz, 2010). Vulnerable populations are at risk of poor physical, psychological, and/or social health (Aday, 1994). The nutritional risks of women and children have been at all time high. The combination of poor nutritional health, exposure to morbidity and a difficult living environment results in high mortality rates for infants and young children (Goudet, & Faiz, 2011). Poor nutritional health can be caused by a number of environmental factors, one being the mother not having adequate resources to obtain the necessary services and proper nutritional daily intake. This is usually the case both during her pregnancy and after giving birth resulting in the malnutrition of both her and the child. Malnutrition has long-term negative effects on the physical growth and cognitive development of children (Goudet, & Faiz, 2011). Children who are denied an adequate diet are at a greater risk of not reaching their full potential as individuals (Karger, & Stoesz, 2010). Undernourished children have trouble concentrating and bonding with

Policy Analysis Paper 3 other children and are more likely to suffer illnesses resulting in school absences (Karger, & Stoesz, 2010). Policies in place to address Social Problem In order to approach this concern, a number of policies have been put in place to try and reduce the health risks of malnutrition of women and children here in the United States. These policies include the Supplemental Nutrition Assistance Program (SNAP), the School Breakfast Program (SBP), the Summer Food Service Program, and the Supplemental Nutrition Program for Women, Infants and Children (WIC) just to name a few. The Supplemental Nutrition Assistance Program, formerly known as Food Stamps, was enacted by U.S. Congress in 1964. The federal government funds 100 percent of SNAP benefits, with federal and state governments sharing 50 percent of administrative costs (Karger, & Stoesz, 2010). The Purpose of SNAP is to increase the nutritional value of low-income households (Karger, & Stoesz, 2010). The School Breakfast Program provides breakfasts to promote learning readiness and healthy eating behaviors (Karger, & Stoesz, 2010). The School Breakfast Program is administered at the federal level by the U.S. Department of Agriculture (USDA) through the Food and Nutrition Service (FNS) (Karger, & Stoesz, 2010). State education, agencies and local school food authorities administer the program at the local level (Karger, & Stoesz, 2010). Almost 60 percent of food-insecure households in 2010 participated in one or more of Federal food and nutrition assistance programs such as SNAP and WIC (Karger, & Stoesz, 2010). The policy that I will be focusing on in great depth for the remainder of this paper is the Supplemental Nutrition Program for Women, Infants and Children (WIC).

Policy Analysis Paper 4 What is WIC? The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) was established in 1972 in order to enhance the nutritional status of these vulnerable groups (Bitler, & Currie, 2005). WIC has been one of the most important and adventuresome expressions of our societys attempts to ameliorate or reverse the effects of poverty among young children and pregnant women, groups predicated to be particularly vulnerable to the effects of less than optimal nutrition and health care (Rush & Leighton, 1988). The WIC program was originally designed as a two-year pilot program (Karger, & Stoesz, 2010). Today, WIC provides participants with healthy foods (generally in the form of vouchers) and nutritional counseling (Bitler, & Currie, 2005). The goal of WIC is to address areas of child development that are most affected by poor health and inadequate nutrition, including impaired learning (Karger, & Stoesz, 2010). These goals include (1) enriching the food intake of participants and (2) educating mothers (individually and in groups) on how to prevent nutritional difficulties (Karger, & Stoesz, 2010). Over the history of the program, the Federal government has exercised increasing control over program administration (Swann, 2010). WIC Eligibility To receive WIC benefits, an individual must be categorically eligible and must meet two other criteria (Jacknowitz, 2009). First, the individual must reside in a household with income at or below 185 percent of the federal poverty threshold or be enrolled in another assistance program, such as the Food Stamp Program, Temporary Assistance for Needy Families (TANF), or Medicaid (Jacknowitz, 2009). Participants are certified as eligible for a specified period of time, and the length of eligibility period varies by participant category (Jacknowitz, 2009). A pregnant participant is certified for the duration of her pregnancy and does not have to recertify

Policy Analysis Paper 5 her eligibility until 6 weeks after the birth of her infant (Jacknowitz, 2009). Infants are generally certified for eligibility until age 1; children ages 1-5 are certified for a 6-month period (Oliveira and Frazao, 2009). Eligible applicants are not guaranteed services because WIC is not an entitlement program (Jacknowitz, 2009). Since WIC is not an entitlement program, Congress does not set aside funds to allow each and every eligible individual to participate (Karger, & Stoesz, 2010). Instead, WIC is a federal grant program for which Congress authorizes a specific amount of funds each year (Karger, & Stoesz, 2010). WIC operates in all states and is administered at the federal level by USDAs Food and Nutritional Service (FNS) and by state WIC agencies (Karger, & Stoesz, 2010). What does WIC Provide? By law, the foods provided by WIC must contain protein, calcium, iron, and vitamins A and C (Bitler, & Currie, 2005). WIC provides a variety of Supplemental Foods. Nutritious foods are provided to supplement and help improve the diet ("What is WIC?", 2001-2013). According to the Michigan Department of Community Health, WIC Provides the following foods to its participants: Women and children may receive milk, cheese, eggs, juices rich in Vitamin C, cereals rich in iron, and dry peas/beans or peanut butter, fresh fruits and vegetables, whole grain breads or tortillas. Breastfeeding women, who do not receive formula from WIC, may also receive tuna fish, as well as extra cheese, juice & beans. Starting at 6 months of age, infants are eligible to receive infant cereal and infant juice, baby foods in jars. For infants who are partially breastfed or not breastfed, WIC provides iron-fortified formula. Fresh produce is provided to many WIC participants through Project FRESH, a Farmer's Market Nutrition Program.

Policy Analysis Paper 6 WIC also provides Nutrition Education. Nutrition education is offered to all WIC participants or their care givers ("What is WIC?", 2001-2013). The education must relate to the nutrition need of the individual and be of interest to them ("What is WIC?", 2001-2013). Participants with high risk nutrition conditions are referred to a registered dietitian for a nutrition care plan & counseling ("What is WIC?", 2001-2013). Common nutrition education topics include nutrition during pregnancy, infant feeding, during childhood, and wise food shopping. WIC encourages women to breastfeed because of many health benefits for both baby and mother ("What is WIC?", 2001-2013) What is working? I believe that WIC is working to some degree. According to Bitler and Currie, their study suggest that WIC reduces the probability that an infant is low birth weight by 29 percent, and reduces the probability that an infant is very low birth weight by more than half . There is a large volume of research showing that low birth weight increases death, and is also associated with a range of negative outcomes for surviving infants (Bitler, & Currie, 2005). I feel that the birth weight is important to look at for the simple fact that if women are not getting the proper nutrition during their pregnancy, then it will most definitely affect their unborn child both inside the womb and after the baby is born. Since WIC is set up to provide services for pregnant women, I feel that this has been causing a great decrease in low birth weights and malnutrition over the last few years. There is always room for improvement and this may come in many forms. According to USDA studies, WIC saves lives and improves health of nutritionally at risk women, infants, and children (Karger, & Stoesz, 2010). The results conducted by Food and Nutrition Services (FNS) and other nongovernment entities demonstrate that WIC is one of the

Policy Analysis Paper 7 nations most successful and cost-effective nutrition intervention programs (Karger, & Stoesz, 2010). What is not working? In doing my research, I found that there are two main issues with the WIC policy here in the United States. There is evidence that geographic location may be a factor in WIC participation (Jacknowitz, 2009). It seems as though there is a lack of participants within the program, or that there just arent enough resources to go around. Although not as large as food stamps or Medicaid in dollar value, over 50 percent of infants and pregnant women are estimated to be eligible for WIC (Swann, 2010). During a study that was conducted in the Chicago Journals, results suggest that delaying participation is negatively related to residing in states where SSI participation confers WIC eligibility (Jacknowitz, 2009). Nationally, the WIC Program reaches more than 50% of all infants and has been criticized for undermining breastfeeding through the provision of infant formula (Jacknowitz, 2009). While conducting an interview with a social worker at my field placement, I was able to obtain their views on the WIC policy. Mrs. Henderson, whom I had the pleasure of interviewing, stated that although she is for WIC, she still finds it difficult at times to see the effects of the WIC program and the positive impact it has on the community in Urban Detroit. I find it to be a little contradicting for the WIC Program to promote breastfeeding, but also provide infant formula to non-breastfeeding mothers. I think that oftentimes this may cause mothers to steer clear of signing up for WIC because they may feel pressured into breastfeeding if they are not considering doing so already. Although it is difficult to further expand the program under current economic conditions, directing more resources within the WIC program itself towards women and infants who are at

Policy Analysis Paper 8 higher risk could be one of the ways to improve the effectiveness of the WIC program (Gai, & Feng, 2012). Who supports and/or opposes the WIC policy? As we know, many people have been against providing funding for helping programs such as SNAP and WIC that continuously assist vulnerable populations. The National WIC Association, the advocacy arm of a nutritional food program for poor women, infants and children, strongly denounced a Republican-sponsored measure on Friday that would fund WIC while the rest of the government remains shut down (Bassett, 2013). The WIC Association called H J Res 75, the Nutrition Assistance for Low-Income Women and Children Act, "a cynical ploy to use low-income nutritionally at-risk mothers and young children as political pawns for political ends. (Bassett, 2013). When Congress failed to pass a Continuing Resolution (CR) at the end of September, keeping the federal government running into fiscal year 2014, funding for Americas highly regarded public health nutrition program the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) ceased (National WIC Association, 2013). Since then, WIC Programs have found their footing with the help of temporary operating funds to keep WIC open through October 31st. For now, State WIC Programs are operating in an environment of tremendous uncertainty relying on unspent funds from the last fiscal year, limited costcontainment revenue, and the finite amount of contingency funds provided by USDA (National WIC Association, 2013). If congress is unable to come to a resolution by October 31, 2013, this may cause major health consequences for the mothers and young children participating in WIC and huge financial consequences for the United States.

Policy Analysis Paper 9 Rev. Douglas A. Greenaway, President and CEO of the National WIC Association stated during an interview, If Congress fails to pass a clean continuing resolution before months end, many WIC Programs across the nation will run out of operating funds. Clinics will be forced to close their doors, turn participants away, and end benefits. This would be unconscionable. Overall, it is pretty clear that the Republican party in Congress are opposed to the WIC program, with hopes to do away with continuing to fund this program which they deem to be unnecessary. Interview of WIC Advocate After retrieving a great deal of research on the WIC policy, it was interesting to hear the viewpoint of an advocate who is very familiar with WIC. Mrs. Henderson, LMSW , with whom I had the pleasure of meeting at my field placement, was very knowledgeable with the WIC policy and was very comfortable in sharing her views on the policy. Mrs. Henderson is a social worker at Gilead Wellness Network who provides services to pregnant women and infants up to 1 year of age through a program known as the Maternal Infant Health Program (MIHP). MIHP is a program for all Michigan women with Medicaid health insurance who are pregnant and all infants with Medicaid ("Maternal infant health program," 2001-2013). The program provides support to promote healthy pregnancies, good birth outcomes, and healthy infants. I asked Mrs. Henderson a series of questions during our interview. The main question that I was most concerned with was if she felt that the WIC program has had any impact on the Maternal Infant Health Program in regards to lowering malnutrition in the homes of her clients here urban Detroit. Mrs. Henderson, LMSW stated that she does see a difference between her clients that receive WIC and those that do not. She noticed that the mothers who receive WIC while they are pregnant are more likely to have a healthy baby at birth. Even though she does

Policy Analysis Paper 10 have some clients that do not receive WIC, Mrs. Henderson, LMSW stated that these women do not think that WIC will make a difference in their health nor their infants health. Mrs. Henderson made mention during our interview that the women who do receive WIC expresses that these service are a great help and very beneficial to them. Conclusion In conclusion, I feel as though WIC is a very beneficial program when it comes to the concern of reducing malnutrition and low-birth weight here in the United States. I believe that the biggest factor for reducing these numbers is to continue to educate, promote and assist these women in receiving these services. Even though this social problem has been around for quite some time, each day is one step closer to striving for a healthier country; not just for the sake of doing it, but for our future, the children.

Policy Analysis Paper 11 Bibliography Aday, L. (1994). Health status of vulnerable population. Annual Reviews Mobile, 15, 487-509. Retrieved from 10.1146/annurev.pu.15.050194.002415 Bassett, L. (2013, October 04). National WIC association opposes gop effort to restore wic funding . Huffinton Post. Retrieved from http://www.huffingtonpost.com/2013/10/04/wic-funding_n_4044736.html Bitler, M. P., & Currie, J. (2005). Does WIC Work? The Effects of WIC on Pregnancy and Birth Outcomes. Journal Of Policy Analysis & Management, 24(1), 73-91. doi:10.1 002/parn.20070 Gai, Y., & Feng, L. (2012). Effects of Federal Nutrition Program on Birth Outcomes. Atlantic Economic Journal, 40(1), 61-83. doi:10.1007/s11293-011-9294-y Goudet, S., & Faiz, S. (2011). Pregnant women's and community health workers' perceptions of root causes of malnutrition amonng infants and young children in the slums of dhaka, bangladesh. American Journal of Public Health, 101(7), 1225-1233. Henderson, LMSW , S. (2013, October 04). Interview by C Jackson []. Personal views on wic policy. Jacknowitz, Alison, (2009-06-01). Transitions into and out of the WIC program: a cause for concern?(Women, Infants, and Childern). The Social service review (Chicago), 83(2), 151-183. Karger, H., & Stoesz, D. (2010). American social welfare: A pluralist approach. (7 ed., pp. 371379). Boston: Allyn & Bacon. Michigan Department of Community Health, (2001-2013). Maternal infant health program.

Policy Analysis Paper 12 Retrieved from website: http://www.michigan.gov/mdch/0,4612,7-132-2943_4672_4830106183--,00.html Michigan Department of Community Health, (2001-2013). What is WIC?. Retrieved from website: http://www.michigan.gov/mdch/0,4612,7-132-2942_4910_6329-12607-,00.html National WIC Association (2013, October 03). [Web log message]. Retrieved from https://www.nwica.org/blog/wic-programs-remain-open-despite-government-shutdown Oliveira, V., E. Racine, J. Olmsted, and L. Ghelfi, 2002, The WIC Program: background, Trends, and Issues, Food Assistance and Nutrition Research Report Number 27, U.S. Department of Agriculture: Washington, DC. Rush, D., & Leighton, J. (1988). The American Journal of Clinical Nutrition , 48(2), 394-411. Retrieved from http://ajcn.nutrition.org/content/48/2/394.full.pdf html Swann, C. A. (2010). WIC Eligibility and Participation: The Roles of Changing Policies, Economic Conditions, and Demographics. B.E. Journal Of Economic Analysis & Policy: Contributions To Economic Analysis & Policy, 10(1), 1-35. Whaley, S. E., Koleilat, M., Whaley, M., Gomez, J., Meehan, K., & Saluja, K. (2012). Impact of Policy Changes on Infant Feeding Decisions Among Low-Income Women Participating in the Special Supplemental Nutrition Program for Women, Infants, and Children. American Journal Of Public Health, 102(12), 2269-2273. doi:10.2105/AJPH.2012.300770