In 1972, we welcomed the passage of legislation establishing a new pilot nutrition program, the special supplemental food program for women, infants and children, referred to as WIC. For nearly 3 years the Children's Foundation has conducted a WIC advocacy project. We have monitored the program and provided technical assistance to local sponsors, interested applicants, and supportive organizations.

The first 3 years of the WIC program have been stormy, but highly successful. As stated in our comprehensive report on WIC "Women and Children, First... or Last?" excerpts of which I would like to submit for the record,* the overwhelming feeling about WIC is that it is an extremely effective way to provide needed nutritional supplements to a highly vulnerable group.

Medical professionals, State and local administrators, and many elected officials feel that the program has been successful and ought to be continued and expanded.

Today and Thursday this subcommittee will hear testimony on WIC from individuals from California, Washington, Vermont, North Carolina, Alabama, Georgia, and Florida, and from individuals representing professional organizations concerned with maternal and infant health. These witnesses will speak specifically about State experiences and the medical benefits of this nutrition program. My purpose is simply to give an overview of the program, and to convey to members of this subcommittee some of what has been learned during the initial years of the program.

The responsibility for WIC rests with USDA at the Federal level, with State health departments at the State level, and with public and private nonprofit health facilities and community groups locally. WIC provides protein and iron-rich supplements, milk, eggs, cereal, and juice to low-income pregnant women, new mothers, and children under 4 years old who are at nutritional risk.

Most participants purchase the WIC supplemental foods with vouchers which they redeem at local grocery stores. Some participants pick up the foods at distribution centers, and others receive their foods at home through home delivery systems.

Today there are 335 WIC programs with an authorized caseload of 635,415 individuals. There are programs operating in every State but Virginia and Utah. On April 1, 1975, USDA announced 45 additional grantees which were funded for 3 months of operation. The additional grantees included 85,400 participants, bringing the total authorized caseload to 720,815.

Last June Congress authorized $100 million for the WIC program in fiscal year 1975. In addition, the unspent fiscal year 1974 funds, amounting to approximately $29 million, were to be carried over and allocated during this fiscal year. During fiscal year 1975, USDA has allocated approximately $129 million through the funding of 12 month, 9 month, 7 month, 6 month, as well as 3 month grants. The annualized budget for all grantees totals over $200 million.

WIC has expanded considerably over the past 12 years and today is an admirable beginning of the campaign needed to curb the effects of malnutrition among mothers and young children. However, it is only a beginning; the need for expadsion is urgent.

...

*The report, "Women and Children, First . . or Last?" is retained in the Committee files. See p. 151.

The 720,000 mothers, infants, and children currently authorized to participate includes less than 20 percent of the 4.6 million women, infants, and children in this country who are potentially eligible and in need of the benefits of the WIC program.

The WIC program is widespre: d in some States. For instance, in Arizona and Washington there is a WIC program in every county. In other States, WIC must be expanded. For example, in Mississippi, Georgia, and Alabama there are 28 counties in which more than 50 percent of the population is below the poverty level; WIC presently operates in only 3 of these counties.

It is these counties, and others like them-the poorest in the Nation—that have an urgent need for a supplemental nutrition program. There are 35 programs in California, 29 programs in New York, and 22 programs in Texas. However, there are only nine programs in the four States of Iowa, North Dakota, Oklahoma, and Kansas. Next year is the time not only to continue strengthening the existing programs, but also to creatively and aggressively expand WIC to the areas most in need.

I would like to comment very briefly on changes that are necessary according to people who have been involved with WIC during its pilot phase. My comments are based upon letters and conversations with State and local administrators and responses from them and others to a national survey we conducted in February 1975.

Everyone with whom we have been in contact agrees that WIC ought to be made a national permanent program as proposed by S. 850. The current 10 percent for administrative costs has, in most instances, been insufficient. This ought to be increased, and funding for nutrition education and outreach ought to be provided.

Enabling all participating clinics to include nutrition education will greatly strengthen the program and increase its long-range effectiveness. Money for outreach will insure that all eligible participants in a project area will learn about the availability of WIC.

S. 850 proposes strengthening WIC by increasing the administrative money from 10 percent to 25 percent, and having that money earmarked for nutrition education and outreach as well as the administration of the program. Additional recommendations concerning all facets of WIC are listed on pages 59 through 64 of our report, "Women and Children, First or Last?" Many of them, like expanded eligibility, provisions for startup costs, and flexibility of the food packages would be authorized by the passage of S. 850.

We are hopeful that the Senate Agriculture Committee will favorably review S. 850 and send to the Senate a bill which will continue and strengthen this vital supplemental nutrition program.

Senator LEAHY. Thank you very much. Did you have any testimony that you would like to add?

Ms. HARVEY. NO.

[The following excerpt from the report, "Women and Children, First... or Last?" was referred to on p. 150.]

CHAPTER VIII. THE CHILDREN'S FOUNDATION RECOMMENDATIONS

The Children's Foundation has worked closely with the WIC program for nearly three years. From hundreds of visits and consultations with local programs, we have developed a series of recommendations for improving WIC's operations.

When we were requested by the Senate Select Committee on Nutrition and Human Needs to submit legislative recommendations, we prepared the following suggestions. They have been circulated to all local programs, and represent the best advice we have been given by state officials, local sponsors, and participants.

There is a clear public consensus that WIC should be continued on a permanent nationwide basis. Health facilities have proven that a supplemental nutrition program can be administered, and participants have found that the program does make a difference in their health and the health of their children. Renewed legislation and administration of WIC should, however, include these changes:

AUTHORIZATION

Extend the program for four years at a time

This will provide for smoother program operation and continuity, better state planning, and less costly administrative uncertainty.

Increase the funding level rapidly until it is sufficient to serve all those eligible As of January, 1975, the current annual cost of WIC was just under $200 million. A new authorization for fiscal year 1976 should be at least $300 million. Apportion the money among States according ot the number of eligibles and the rate of infant mortality

The formula should allow proportionately more funds to go to states where infant mortality is particularly severe either generally or in one segment of the population, for example, where nonwhite infant mortality rates are makedly higher than white rates.

ELIGIBILITY

Clearly label the program preventive as well as remedial

Although this provision is now in the regulations, it should also be explicit in the law. The logic of WIC is to prevent the consequences of malnutrition before they begin.

Adopt the same income eligibility criteria as other child nutrition programs The present variation among states in determining whether particpants qualify for medical aid, and therefore WIC, should be replaced by a minimum income eligibility standard, with higher standards at state option.

Make the eligibility criteria sufficiently flexible to allow for the special needs of Indians and migrants

The particular problems of Indians who live off reservations and of migrants who move to different areas at different times of year, frequently cause people who are otherwise eligible to be left out of WIC benefits. The program design should explicitly include these populations.

Include women up to one year post partum or after loss of a child

According to the American Public Health Association, "post partum mothers should be covered up to one year after birth or abortion. Low-income mothers are known to show the greatest nutritional depletion after pregnancy. This is true whether they breast feed their infants, abort, or deliver and do not breast feed. Low-income women also show a higher incidence of maternal morbidity and mortality and produce more infants who die or have handicapping conditions". Participation in WIC for a year instead of six weeks would help these women regain adequate nutritional status.

Include children up to the age of six

The great majority of children up to six are without supplemental food assistance. They are too young to be included in any program of child nutrition other than the Special Food Services Program, which reaches only 8.2 percent of lowincome children. The Commodity Supplemental Food Program includes children up to age six, and WIC ought to do so as well.

ADMINISTRATIVE COSTS

Double or triple administrative cost allowances

The present 10 percent allowance is not adequate to cover costs. This discourages clinics from applying for WIC and makes it impossible to have a

program in many needy areas where there are no health facilities able to absorb the extra overhead.

Add special additional funds for nutrition education and outreach

Nutrition education is vital to the effectiveness of WIC; women must learn why certain foods are important, and become involved in better planning while they are pregnant. Also, a program's capacity for outreach and publicity will determine whether it can reach all eligible participants in its area.

Base administrative reimbursement on the number of participants instead of a percentage of total food costs

As long as the administrative allowance is based on food costs, there will be an incentive to maximize those costs in order to get enough overhead to run the program. The reimbursement should be based on caseloads in the form of a sliding scale which allows more money per person for smaller projects.

Provide start-up costs

Extra funds up to two months' program budget costs should be allowed in addition to the annual budget.

EVALUATION

Redesign the evaluation of WIC to study program effectiveness rather than basic medical research information

The beneficial effects of improved fetal and infant nutrition in preventing death and disability among children is already scientifically established. The greater incidence of malnutrition among poor families is also well known. The WIC program should not be burdened with a primary research component to reconfirm accepted facts. If more detailed and long-range scientific information is desirable, it should not be sponsored by the Department of Agriculture in the guise of a food and nutrition program.

The focus of WIC evaluation should instead be on ways to make nutritious food supplements as effective as possible in achieving the goal of eradicating malnutrition among American children. Evaluation should concentrate on questions such as (a) what combination of foods is both nutritionally effective and acceptable to local participants? (b) how can local sponsors best combine nutrition education with food distribution? (c) how long a period of participation and follow-up is necessary to guarantee significant nutritional results? (d) how can the mutual support of food distribution programs and other health care services be enhanced? (e) what are the relative costs of different kinds of distribution schemes?

The responsibility for such evaluation should rest with state health departments, which can adapt a study to their own priorities and range of programs. Not every clinic should be required to participate in gathering evaluation data. Evaluation funds should be separately designated and sufficient to insure competent professional implementation.

Many health departments will, of course, wish local clinics to keep significant medical records on participants in the WIC program in connection with their general health care service. Heights, weights and measurements are frequently a standard part of prenatal and child care, and should be an important part of patient education. But few clinics have the trained personnel and precise record keeping capacity to participate in a basic scientific research program; to try to extract new and reliable medical knowledge from a broad scale food distribution program is both inefficient and inconclusive.

LOCAL GRANTEE QUALIFICATIONS

Give equal priority to private non-profit groups serving community welfare needs Applications should not be restricted to clinics. Any group that can find a subcontractor for the health component of WIC should be given full consideration. This would attract programs to areas that are not served by public health clinics and help communities participate more actively in the overall goals of the program.

Make clear that IRS tax-exemption is not a requirement for participation

Although the present legislation does not require tax-exemption, the new legislation should specifically prevent USDA from imposing this unnecessary burden. Any reasonable evidence of non-profit status should be acceptable.

Establish a fair hearing procedure for rejected applicants

Just as participants declared ineligible have a right to a fair hearing process, so should applicant organizations which are turned down.

Require local programs to establish participant advisory councils

Requiring the involvement of those who are eligible, or whose children are eligible, for WIC would increase the program's responsiveness to the people it serves. It would also help participants become more knowledgeable and sophisticated about the conditions of their lives, rather than passive recipients of aid. Allow WIC to operate in areas where a commodity supplemental food program exists

Although USDA has changed its policy to allow areas to apply for WIC where commodity programs have closed, it generally does not fund WIC applicants from supplemental program areas. Communities should not have to trade one for the other. Areas that want both, and are capable of administering them, ought to have both until all eligible people in the area are served.

STATE AND NATIONAL ADMINISTRATION

Require State agencies to reimburse the expenses of local programs within a maximum of four weeks after receiving a valid request

State delays in reimbursement have made it very difficult to keep local programs operating and have sometimes caused grocers to drop out of the program. States must ensure that local programs receive timely reimbursements.

Require States to inform program administrators and participant advisory committees in writing at least ten working days before policy changes or new policies are to become effective

Adequate consultation beforehand would be ideal, but in any case administrators and participants must be given a chance to consider and react.

Require USDA to inform States in writing at least fifteen working days before proposed policy changes or new policies are to become effective

State directors deserve the same opportunity to share their views with USDA before changes in policy, to be sure that all potential effects are considered.

THE FOOD PACKAGE

Allow changes in the food package to allow for cultural differences

Local nutritionists should have the right to substitute nutritious foods which are more likely to be acceptable, subject to general guidelines.

Allow substitutions in the food package when it is medically necessary

Occasional problems arise with allergies or other medical conditions. For example, it should be possible to substitute soybased formula for children who are allergic to milk.

In summary, The Children's Foundation sees the need for a number of changes in the WIC program, to make it more flexible in its food package, more comprehensive in its coverage of low-income women and children, more imaginative in its encouragement of sponsoring organizations and innovative delivery systems, more realistic in its administrative costs, and more useful in its evaluation. We hope as well that the Department of Agriculture will become a more convinced and effective administrator of WIC.

But our support for the program remains steadfast. We have seen countless children whose lives are being changed by this opportunity for adequate nutrition, we have talked to countless health professionals who have at last an effective means of combatting malnutrition.

We know that WIC already makes a difference; we are convinced that a revised and expanded program will at last begin to defeat the sorrowful and expensive consequences of malnutrition in America.

The real horror of malnutrition is that it is not a rare disease. Malnutrition is a much bigger problem than is leukemia. If we could find ways to stop leukemia altogether in this age group, there would only be a small, or virtually no effect on the world's population. But if we found ways to stop malnutrition, it would have an almost immeasurable effect on the world.

Dr. DONALD PINKEL,

Memphis Commercial Appeal, December 27, 1970.