clinics, migrant and family health clinics, and the maternity and infant care projects. The clinics particularly that we have been very anxious to get into are those that serve high-risk pregnant women and infants, clinics that are associated with schools that serve teenage pregnant school girls, and the early periodic screening, diagnosis and treatment programs for children, which are related to screening under medicaid.

These clinics provide the health care services, conduct the medical examinations, the body measurements, blood tests, the dietary assessment needed both for good health supervision as well as for certification for the WIC program. Nutritionists serving the maternal and child health clinics are able to integrate the WIC program into the clinic routine, document the need for certification, assess nutritional problems, and provide some diet counseling.

Nutrition education has been expanded with the WIC program, not only to cover basic nutritional needs in the stressful periods of growth, but also to emphasize the nutrient values of the foods specified for the WIC programs and procedures for using our WIC coupons.

We have done some surveys of our participants ourselves, in addition to the survey that is now being conducted by the National Bureau of Standards, and we have found that the response of our participants has been overwhelmingly in favor of the program. Even in the days when we were having problems with our public health nurses about getting in their way in clinics and new procedures and not having enough staff for WIC, the participants were enthusiastic.

Now, 14 months after the beginning of our program, we are getting unsolicited observations of physicians and nurses, as well as our public health nutritionists that clearly affirm the positive values of this

program.

We are not one of the States that has the University of North Carolina medical evaluation, so that we do not now have any tabulated data. We have a tremendous number of impressions and observations of improvements in health status, and better quality of food intakes because of the WIC program. We have plans to collect and tabulate the data which does exist in our medical records.

In addition to the benefits that are observed specifically in terms of health improvement of individual patients, we also have observed tremendously increased utilization of health care. Much of it is very much needed. In Jacksonville, the nurses are citing 75 percent improvement in the return of infants and children for their immunizations because they come back to get their coupons for WIC. Women are noted to be presenting themselves for prenatal care earlier in pregnancy, which we also feel is very important.

Children are being brought into clinics to be put on the WIC program with such low hemoglobins that there is urgent need for medical care, health supervision, as well as the supplemental food. The Brevard County Health Department, which is in an area which is particularly deprived because of the economic situation, they have seen a measurable increase in the use of their child health clinics since we began, and I feel that they are now reaching families who have needed health services all along, but never presented themselves to the health department.

Now, they also are noting that there are improvements in the hemoglobins and hematocrits and these are maintained over time with the WIC program.

We feel that the WIC program has filled a definite nutritional gap in maternal and child health services and that one of the things that needs to be pointed out again and again is that this is a truly preventive nutrition program, and in the long run can probably prevent costly needs for medical care and medical services and institutionalization which certainly are very consuming of taxpayers' money.

We have tried to implement a nutrition education component so that when the mothers "graduate" from WIC they will have permanent food buying habits and will select some of the foods that we are able to provide with the WIC program. We have already had indications that this was happening. A nutritionist in the Brevard County Health Department has pointed out that some of their patients who are no longer on the WIC program but are still being followed in their health clinics do report that they are continuing to purchase some of the foods that they learned to use while they were on the WIC program. As an administrator and coordinator of the State WIC program, the pilot period has been very traumatic because of the constraints on administrative funding and the lack of startup costs in the initial legislation, as well as the restrictive and changing administrative regulations and guidelines that interpret the legislation.

We are delighted with Senate bill 850 because we feel that it would essentially solve many of the administrative and operational problems that we have been confronted with in the last 14 months.

The significant features that would aid State administration by health agencies are: making available 25 percent of projected program funds for administrative costs and operations. I think that the problem that we have all faced was the lack of a defined budgeted figure where the 10 percent was limited to the amount that was spent at the grocery store, so that this was an undependable figure, but 25 percent of the projected program funds would be a firm figure.

Startup costs until programs achieve their projected caseloads is another important feature.

The defining of administrative costs to include not only operation and general administration at State and local levels. but also outreach, referral, clinic costs, and nutrition education-another area. Senator CLARK. Ms. Kaufman, I am afraid your time has run out. Please finish up your statement.

Ms. KAUFMAN. The stipulating of the contents of the food package to be flexible on medical and cultural eating patterns I think is very important. We have battled for buttermilk since the beginning of the WIC program. We are also aware that there are many children over a year old who need special formulas because of allergies, so I think that this should be made possible.

We are pleased that the Senate bill 850 does make WIC a component of a health program because we feel that this is a program that should be tied to a public health program or a health service for mothers, infants, and children. I think most of what I have said is in the statement that I have submitted.

Senator CLARK. That was an excellent statement, and we appreciate having your point of view.

[The prepared statement of Ms. Kaufman follows:]

STATEMENT OF MS. MILDRED KAUFMAN, ADMINISTRATOR, NUTRITION SECTION, FLORIDA DIVISION OF HEALTH, JACKSONVILLE, FLA.

For the expectant mothers, babies and young children realizing the nutritional health benefits of the WIC Program, I would like to thank you who introduced and supported the current WIC legislation. We who work with WIC participants know their urgent health and food needs, their gratitude for the food and health care supervision, and their concern that this excellent program may not be continued.

In Florida we have had over a year's experience with seven Supplemental Food Programs for Women, Infants and Children now serving patients in six counties. Six of these programs are operated by county health departments in Brevard, Broward, Collier, Dade, Duval and Okaloosa Counties. The seventh is part of the University of Miami Comprehensive Health Care Program for Children. At the end of March a total of 1,668 women, 3,663 infants and 6,934 children for a total caseload of 12,265 individuals were receiving benefits of food and associated health care made possible through this program. In Florida we have used WIC as an added dimension to ongoing maternity, infant and child health programs. Fortunately our county health directors and directors of maternity and infaut care and children and youth health projects have kept abreast with the findings of nutrition and medical science relating nutritional quality of diets to outcome of pregnancy and growth and development of children including brain and intellectual development. In efforts to reduce our higher than national average infant death rate, reduce prematurity and low birth weight infants, occurrence of mental retardation and costs of medical care for high risk infants and children, nutritionists have increasingly been added to the health team and we now have 60 public health nutritionists working in Florida's public health programs. However, nutritionists, nurses and physicians counseling low income pregnant women and mothers about nutritional needs prior to the WIC Program were frustrated when mothers said they could not afford to buy foods recommended. Department of Health, Education and Welfare maternal and child health funds could be used for nutritionist positions, for iron and vitamin supplements, but could not be spent to help patients purchase nutritious foods that support the nutrient supplementation. The Food Stamp Program was a referral resource but was limited in amounts of foods provided with no provision to meet above normal food and nutrient needs. To health programs for prenatal care, infant care and child health services the WIC Program has proven to be the answer to a long identified unmet need.

Health service programs to which our WIC Programs are attached are maternity clinics, well baby and well child clinics, migrant or family health clinics and maternity and infant care projects. Clinics particularly serving high risk pregnant women and infants, clinics associated with schools serving teenage pregnant school girls and the early and periodic screening, diagnosis and treatment programs are included. These clinics provide the health care services, conduct the medical examinations, body measurements, blood tests and dietary evaluations needed for both health supervision and certification and referral to the WIC Programs. Nutritionists serving the maternal and child health clinics and integrating the WIC Program documents needs for certification, assess nutritional problems and provide diet counseling. Nutrition education has been expanded with the WIC Program not only to cover basic nutritional needs in stressful periods of growth but to emphasize nutrient values of WIC foods and procedures for the program.

A survey of participants conducted early in the program compiled responses of participants and observations of physicians and nurses clearly affirm the positive values. We do not have any of the University of North Carolina medical evaluation projects but are impressed with observations of improvements in health status and better quality food intakes of WIC participants. We have plans to collect and tabulate data to more adequately document these observations. Meanwhile, physicians and nurses have commented on improvements in health and are gratified with increased utilization of related health services. In Jacksonville nurses cite a 75% improvement in return of infants and children for immunizations because of WIC. Women are noted to be presenting them

selves for prenatal care earlier in pregnancy. Cases are reported of children brought in to be put on the WIC Program with such low hemoglobins that there is urgent need for medical care and health supervision as well as supplemental food. Brevard County Health Department documents a measurable increase in use of well child clinics since WIC began.

As a health professional I feel that WIC has filled a nutritional gap in maternal and child health services. Participation in a WIC Program with a nutrition education and consumer education component, as we have tried to implement it, can enable WIC "graduates" to continue improved eating and buying habits which they "learned by doing."

Our food delivery system uses coupons color coded for each nutritionally equivalent food group. It provides the opportunity to make some choices at the grocery store within permitted WIC foods.

As an administrator and coordinator of a state WIC Program the pilot period has been inordinately traumatic because of constraints on administrative funding and startup costs of the initial legislation, and the restrictive and changing administrative regulations and guidelines interpreting that legislation. Senate Bill 850 which you are considering would essentially solve many of the administrative and operational problems and I believe I speak for my counterparts in all of the states urging your favorable consideration. Significant features that would aid state administration by health agencies are:

1. Making available 25% of projected program funds for administrative costs and operations;

2. Providing for program startup costs until programs achieve projected caseloads:

3. Defining administrative costs to include not only operation and general administration at state and local levels, monitoring and startup costs but also outreach, referral, clinic costs and nutrition education; and

4. Stipulating that the contents of the food package be flexible based on medical need and cultural eating patterns.

Specific factors which would safeguard and assure program quality and evaluation as a health service are:

1. Defining the program as an adjunct to good health care;

2. Requiring the administering agency to submit a plan for nutrition education and outreach;

3. Stipulating eligibility for participation to be certified by a health professional based on evidence of nutritional risk and providing for maintenance of adequate medical records;

4. Providing for stipulated advisory committees with members expert in medicine and nutrition as well as consumers; and

5. Extending to six months post partum period of participation for women and up to five years for children.

Again, I thank you for providing the pilot WIC Programs. On the basis of a very difficult but rewarding 14 months of experience, it is hoped that WIC has emerged as a valuable program which can be continued, expanded and made more responsive to the needs of participants and administering health agencies as these have emerged during this trial period.

NEWS FROM STATE OF FLORIDA, DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES, DIVISION OF HEALTH

Florida's public health officials are supporting extension and expansion of the U.S. Department of Agriculture's Supplemental Food Program for Women, Infants and Children (WIC) which is slated to end on June 30, 1975.

Physicians, nurses, nutritionists and other public health workers have issued a statement which says "the WIC Program should not only be continued but expanded to meet the needs of an estimated 120,000 women, infants and children in Florida."

The benefits to society, health officials say, that will result from the prevention of nutritional health problems in the early developmental stages of life in the target groups will outweigh the costs of the program. They predict the program will help head off a costly crisis in health care, and will greatly reduce otherwise needed care in state and federal institutions and for the dependency of these groups on society.

"Unless Congress takes prompt action," E. Charlton Prather, M.D., director of the Division of Health of the Florida Department of Health and Rehabilitative Services (HRS), said, "federal legislation which funds Florida's seven

special Supplemental Food Programs for Women, Infants and Children will terminate at the end of this fiscal year."

"These programs provide highly nutritious foods especially selected to overcome or prevent iron deficiency anemias, impaired growth and mental retardation which afflict many low income families. Large numbers of these families are forced by high food prices to live on diets deficient in those foods which provide essential nutrients such as protein, iron, calcium and important vitamins.

"The Division of Health has been receiving funds from the U.S. Department of Agriculture since February 1974 to operate seven pilot projects. Funds for the period from July 1 to June 30, 1975 for Florida amount to $3,700,000. The projects are being operated by the Brevard, Broward, Collier, Dade, Okaloosa, City of Jacksonville-Duval county health departments and the University of Miami School of Medicine's Comprehensive Health Care Project for Children. The total number of pregnant and lactating women, infants and children authorized to be served by the Florida projects is 13,561.

The purpose of the program is to supplement the diets of pregnant women, nursing mothers, newborn infants and young children who have been identified by a physician, nurse or nutritionists as a "nutritional or health risk". Participating local health clinics provide the participants in the program with coupons which buy iron fortified infant formula, milk, cereals highly fortified with iron and vitamins, vitamin c-rich fruit juices and eggs.

"The program," Dr. Prather said, "is an important step toward decreasing or preventing the number of infants and children with iron deficiency anemia in the disadvantaged population. About 10 percent of the infants and children screened in the Medicaid program have iron deficiency anemia. This constitutes a serious public health problem."

"Overcoming the symptoms of iron deficiency anemia such as fatigue, apathy and possible lowered resistance to infection, can improve the productivity and performance of infants and children and can give them a better start in life," he said.

"The rationale of the WIC program is based on new research relating brain as well as physical growth and development to the nutritional quality of the mother's diet during pregnancy and the child's food intake during the first months of life. About 90 percent of brain growth occurs by the fourth year of life. Thus the WIC program is an investment in the future quality of life in our technological society," said Emily H. Gates, M.D., administrator of the Child Health Section of the Division of Health.

"The WIC program," she said, "is directed toward decreasing the number of low birth weight infants and reduction of birth defects, both costly in terms of needed medical care to say nothing of human misery."

"The WIC program," said Miss Mildred Kaufman, adimnistrator of the Division of Health's Nutrition Section, "is an important contribution to health and productivity. The coupon system used in Florida, enables mothers to purchase the selected nutritious foods at the grocery stores, teaches them about nutritional values and economics of food buying and can bring about lifelong improvements in quality of diets and changes in types of food selected.'

"The participants," she said, “have used it to advantage and have appreciated its health benefits. They are all distressed to hear that this valuable program may soon be terminated.

"Public health nutritionists working in Florida's maternity and child health clinics have long been frustrated when they advised mothers about what foods they or their children need because they were aware that the mothers could not afford to purchase the necessary foods."

"One of the overall goals of our bureau." said Jorge Deju, M.D., chief of the Bureau of Maternal Health and Family Planning, "is to improve the health of mothers and their babies. The Family Planning program helps meet this particular goal by allowing the mother to space her pregnancies. This gives the mother time between and during pregnancies to replace vital nutrients drained from her body while she is carrying a child. To do this, the mother should eat the proper foods, those which supply adequate nutrition.

"In the case of many indigent mothers, good nutrition has not been possible before pregnancy, therefore good nutrition during the time she is carrying her baby is even more important. Fortunately, because of the food supplied through the WIC program, many of these women, often teenagers, are able to improve