brain damage, respiratory distress syndrome, and hyaline membrane disease, occur more frequently in the underweight baby. Nearly half of all infant deaths in the United States are associated with low birth weight, a significantly larger proportion than in several other countries, which may explain in part why 17 other nations have a lower infant mortality rate than the United States.

Low birth weight also is associated with retarded mental development for which the affected families and society at large pay a heavy price. Roberts and Engel, reporting on the examination of a national sample of children aged 6 to 11, found a striking relationship between the children's intelligence scores and their weight at birth. Children who weighed less than 5 pounds at birth had an average I.Q. of 94.6 as compared with 99.6 for children whose birth weight ranged from 5 to 10 pounds. The highest average-101.1-was recorded for children who weighed 7 pounds, 12 ounces to 8 pounds, 13 ounces at birth.

Low birth weight may be due to premature labor, the causes of which are as yet largely unkown, or to retarded fetal growth which usually results either from maternal, placental or fetal abnormalities or from maternal undernutrition. Naeye and his associates at Babies Hospital in New York obtained data from autopsies of stillborn and newborn infants who had died from causes other than those associated with structural defects or maternal complications. The families of these babies were categorized according to weekly income. The dead babies whose families fell below the poverty line, as defined by the Social Security Administration, averaged 94 percent of normal body weight as compared with 109 percent of normal for those whose family earnings exceeded the poverty level. Body length and all organ weights were smaller in infants of poor families. Their thymuses, spleens, livers and adrenal glands were more undergrown than their kidneys, hearts or skeletons. This growth pattern has been repeatedly observed in children and young animals with chronic malnutrition. From these observations, they concluded that "maternal malnutrition during gestation provides the simplest explanation for the undernutrition found in the newborn infants of the poor."

Winick has stated that "an association exists between the amount of weight gained during pregnancy and birth weight" and that "malnutrition retards infant growth producing smaller *** brains." He states further that "the difference in birth weight between rich and poor accounts for the difference in mortality between rich and poor" and that "feeding a better diet during pregnancy increases maternal weight gain, birth weight and, therefore, should decrease mortality and the incidence of retardation."

There is growing experimental evidence that improving nutrition during pregnancy-even as late as the last trimester-can have a marked effect on birth weight and that maternal weight gain during pregnancy probably is the most important determinant of birth weight. With these findings in mind, the Foundation enthusiastically welcomed the creation of the WIC program, recognizing it as an opportunity to improve the outcome of pregnancy for many thousands of needy pregnant women and to maintain the health of their children. Malnutrition of the mother during pregnancy has greater potential for dealing lasting damage to the child than at any other stage in the child's development. An important byproduct of the WIC program,

moreover, is that it has encouraged low-income families to come to health centers so that total maternal and infant care can be provided. I might add that less than $2 per day can feed an undernourished fetus and thereby avert subnormal brain development. You can spend all you want to feed an undernourished school child, but it cannot undo the mental deficits resulting from poor nutrition during pregnancy. Only a good prenatal diet can do that.

One serious difficulty in food supplementation programs under conditions of poverty, however, is that the food supplement tends to serve as an income supplement; that is, outlays for food tend to be reduced by the dollar value of the supplement, with the savings used for other essential purposes. This means that for the WIC program to succeed in increasing the food intake of pregnant women, there needs to be built into that program an effective educational and motivational component so that program participants realize that the only source of fetal nourishment is their own food intake.

We believe that the voluntary sector, working together with government, can contribute to the achievement of this educational objective. Indeed. The National Foundation-March of Dimes has been cooperating with State and local health departments and with local WIC projects in many parts of the country to this end. We have cosponsored statewide training institutes for the health professionals working in WIC programs in Ohio, Georgia, Texas, and North Carolina. Other such institutes are scheduled in Illinois, Maryland, New York City, South Carolina, and in the New England States. The purposes of these institutes include indoctrination in the scientific basis for nutritional intervention during pregnancy, discussion of techniques for counseling the women being served in the programs, consideration of public education techniques, and discussion of administrative problems and their possible solution.

Local chapters of The National Foundation-March of Dimes have made grants to WIC projects in New York, Michigan, New Hampshire, and Georgia for the salaries of nutritionists and health aides who work with the women being served in the program. More than 100 of our local chapters report that they are furnishing WIC projects with educational materials on maternal nutrition or rendering volunteer service in the clinics which are the site of these projects.

A recent progress report to the Foundation's regional office in Atlanta illustrates the importance of the educational efforts of the nutrition aides who are serving several of the WIC projects in Georgia under a March of Dimes grant. The report states:

The month of February proved to be a very busy one for the nutrition aides. One hundred and thirty families were contacted. A large portion of the

clients started on the WIC program recently in Clarke, as well as the other counties, have been pregnant women. We are trying to reach as many of these as possible in the homes so that we can have a greater opportunity to stress the importance of nutrition throughout the entire pregnancy. Nine group presentations were given in seven health departments during the month. The discussions included normal nutrition and diet in pregnancy . . . Surprisingly, the men attending the talks generally got more involved in asking questions than many of the women did. The men appeared very concerned over the nutritional welfare of their children. The aides believe the clinics offer an excellent setting for teaching nutrition. . . . They feel they are reaching people who need it the most. Many of the clients . . . have little or no exposure to nutrition (education). The aides always stress the importance of diet as a preventive measure.

The administration's budget proposal to consolidate the WIC program next year with other child nutrition programs under a block grant to the States would strike a staggering blow to those served by the WIC program by reducing direct funds, eliminating administrative guidance now coming from the Federal level and leaving implementation entirely in the hands of financially overburdened State governments. The budget proposal would drop pregnant and nursing women over 17 years of age from the program entirely, thereby eliminating the population group in which undernutrition has the gravest consequences.

The National Foundation, therefore, regards with favor the intent of S. 850 to continue, expand and improve the WIC program as a permanent adjunct of maternal and child health. We commend especially the proposed allowance of 25 percent of total project funds for administrative, educational, and outreach activities and the liberalization of administrative allowances for project startup purposes. We also strongly favor the financing of the WIC program out of funds appropriated by section 32 of the act of August 24, 1935. Failure to allow this source of funding would cast doubt on the survival of this component of child nutrition legislation, which in our view is the most critical as far as long term social benefits are concerned.

With regard to the proposed level of funding, we recognize that S. 850 constitutes a significant improvement over the current level of support and over the level proposed in H.R. 4222. Nevertheless, we believe that the total authorization for the WIC program should be increased to $400 million per annum to offset the effects of anticipated increases in the cost of food, to reflect the necessary and realistic administrative, educational, and outreach objectives of the bill and to permit an expansion of the maximum authorized caseload to 800,000. The present program serves a relatively small number of the women, infants and children who are at high nutritional risk. Under the pressure of rising prices for food, health care and other essentials, as well as growing unemployment, the number of individuals who are at such risk can be expected to grow substantially.

Under S. 850, two new advisory boards would be convened by the Secretary. One of these would consider methods of evaluation of the medical benefits of the WIC program. We endorse this provision but call to the committee's attention the omission from the advisory committee of the American College of Obstetricians and Gynecologists which has provided definitive professional leadership in the field of maternal nutrition.

With regard to the proposed National Advisory Council on Maternal, Infant and Fetal Nutrition, we urge that the proposed composition of the Council be amended to include representatives of consumer organizations, as well as representatives of national voluntary health agencies with significant programs of maternal and child nutrition.

It is our view that the special supplemental food program for women, infants and children represents the first significant effort by the Federal Government to improve the quality of life at birth and during early childhood by reinforcing sound advice about maternal and infant nutrition with the food required to make that advice really effective.

This morning, Senator Dole pointed out that all of the witnesses were asking for increased appropriations. Well, The National Foundation does not regard the nutrition of pregnant women, infants and children to be solely the responsibility of Government. On the contrary, we are determined to continue doing our part to make this program more effective through volunteer service and education and through the support of nutritionists, dietitians, and health aides working to inform and motivate those being served.

Senator LEAHY. If the increase in the appropriation is made along the lines you suggested, would your foundation make a proportional increase or do you feel it would be possible for your foundation to decrease its aid because of that additional appropriation?

Mr. STICKLE. Not at all.

We feel that as the program grows in coverage and size, there is an increased need for the private and voluntary sector to support the program to make it more effective from the cost point of view.

We think that the voluntary agencies are uniquely qualified to carry out programs of health education, perhaps more so than the Federal Government.

Senator LEAHY. I tend to agree.

Do you have any other points that you would like to add to your statement?

Mr. STICKLE. No: simply to urge the committee to report promptly and favorably on the provisions of S. 850 relating to the WIC program. We feel that the cost of providing this assistance is modest in comparison with the benefits which accrue, not only to those served directly but to all citizens who bear the infinitely heavier burden of caring for those who suffer the consequences of maternal, fetal, and infant malnutrition.

Senator LEAHY. Fine.

The committee certainly appreciates your taking the time to make your statement.

As I stated before, I apologize that the vote interfered, but I am sure you can understand that when such a vote comes all Senators are required to be on the floor.

We will reconvene Thursday morning at 10 o'clock, and we are in recess until then.

[Whereupon, at 3:45 p.m., the subcommittee recessed, to reconvene at 10 a.m., Thursday, April 24, 1975.]