tion. The poor and the large numbers of recently unemployed are literally fighting for survival. The prices of low cost food staples have increased 200%, a much larger percentage increase than that for beef and butter. There is ample evidence that hunger and malnutrition in children costs this nation far more in dollars spent for medical care and corrective institutions than dollars spent for nutrition programs. The cost, in human terms, of under-educated, underemployed, sick and alienated persons is a national disgrace. We are, therefore, happy to have this opportunity to speak to this committee on legislation that will permit continuation and expansion of all child nutrition programs.

SCHOOL LUNCH

By far, the largest and oldest of the programs under consideration today is the School Lunch Program which was originally established, not only to use up surplus foods, but also to improve the nutrition and health of the nation's children. The latter, hopefully, is still our goal. Perhaps Maryland's experience will be instructive. Exhibit I and IA compares participation: paid, free, and reduced for the past two years.

1. Paid lunches are declining; this is part of a steady trend over the last 5 years, which has seen a decline from the 1969 total of approximately 46 million to the present 36 million. This is a serious consideration if we are talking about child nutrition, particularly in the face of the findings of the Ten State Nutrition Survey of the prevalence of malnutrition among all school children, especially those in high school.

2. Free lunches have increased steadily, although the gains this year are less dramatic than in the past. In 1969, we had a total of 3,560,000 free lunches; this year 23,700,000.

3. Reduced price lunches-The increase has been pitiful, particularly in view of the fact that 1975 is the first year the state used the maximum allowable federal income guidelines. The Maryland Food Committee estimates conservatively that a minimum of 60,000 children, at present levels, are eligible to receive reduced price lunches. Only 8,300 are receiving them. There are still five counties in Maryland, including our "Hunger County", Somerset, which offer no reduced price lunch.

In looking at these statistics, two facts must be remembered. First, since 1970, Maryland has by law mandated a school meals program in every public school where needy children are fed free but reduced price meals are the option of the principal. Second, because of the tremendous gains made in the total number of meals served since 1969 (49.5 million to 63.7 million) much of the equipment bought early in that period is now in need of replacement or extensive repair. Therefore, the Maryland Food Committee is recommending that this year's National School Lunch legislation incorporate the following:

1. Income eligibility levels to 200% of poverty to assist the low income working, tax-paying poor, and mandatory reduced price lunches;

2. Increased funds for non-food assistance equipment;

3. If a 10 additional subsidy to the paying child's lunch can be included without jeopardizing the legislation as a whole, we are in favor of it. Many states do not have a mandatory school meals law. In such states, schools where most of the children are not eligible for a free or reduced price lunch may not be able to afford a lunch program if middle income children cannot afford lunch. Several inner-city parochial schools in Baltimore with 40-50% free lunches have regretfully done just this. 55¢ a day is too much for a middle income family with several children to have to pay for lunch. 35-40¢ would be more reasonable.

4. In the matter of commodities, we suggest some thought be given to providing cash-in-lieu of commodities to schools which have no kitchens, have high percentages of low income children, and must rely on catered meals to serve those children.

SCHOOL BREAKFAST

Exhibit I also gives some Maryland statistics on the Breakfast Program. There are 10 counties out of 24 in Maryland without the Breakfast Program. Participation in the free breakfast programs at 9,583 per day in 1975 should be compared with the 131,667 free lunches served per day. The same number of children are eligible for each, but the school administrators can decide whether or not to implement the breakfast program. Proposed legislation extends the life of this valuable program indefinitely and requires USDA to formulate plans for its expansion. The Maryland Food Committee's experience with working to expand the breakfast program in Baltimore City is very helpful. We found most parents did not know of the possibility of such a program and when working mothers or low-income mothers found out about it they were eager to work with

school principals to get the program going. In six months of parent participation, 20 schools were added to the program. However, a school breakfast program frequently requires additional equipment for refrigeration and storage of food; the energy crisis has reduced the frequency of milk and grocery deliveries. Moreover, because a breakfast program requires schools to open earlier, additional monies are needed for aides to serve and supervise the program. Providing funds for salaries for aides would be in line with the Congressional effort to provide jobs in a period of national economic slump.

We, therefore, recommend continuing the Breakfast Program indefinitely; insisting that it be publicized to all parents each year; providing additional funds for equipment; and, allowing the cost of "supervising" aides to be counted as a cost of serving the meal.

SPECIAL SUPPLEMENTAL FOOD PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC) The Maryland Food Committee since 1970 has been very much involved in the effort to provide adequate nutrition for infants at risk. It was the Cherry Hill Iron Fortified Infant Feeding Program funded by the Maryland Food Committee, as studied and reported by Dr. David Paige of our Board of Directors, which provided some of the base data which influenced the Congress in establishing the WIC program.

Besides several small pilot efforts at infant feeding funded by our Committee, Maryland has had two major infant feeding projects prior to the first WIC grant to the state in February, 1974. The first funded by HUD in 1969, included about 2,500 infants in Baltimore's Model Cities area. The second, funded by OEO in 1972, included about 2,000 babies on Maryland's Eastern Shore and in South Baltimore. In 1974, the state received its first WIC grants in Garrett county, Prince George's county, part of Anne Arundel county, Carroll county, and parts of Baltimore City-to feed a total of 2,500 infants, 1,000 toddlers and 80 women. In January, 1975, two more large WIC grants (for Baltimore City, Montgomery county and Calvert county) opened the way to supplement the nutrition of 12,000 more infants. As of March, 1975, Maryland had 7,000 infants on supplemental food programs (5,000 of these are WIC infants) plus 1,000 toddlers and 50 mothers on WIC. It is anticipated that very rapidly enrollment will reach the now 16,000 infants authorized under the state's WIC grants. In short, Maryland has had considerable experience over six years with supplemental food programs for infants and, for a shorter time, with programs for toddiers and pregnant women. Certain tentative conclusions can be drawn from this experience:

1. Where iron fortified feeding programs are established, iron deficiency anemia among low income infants is markedly reduced. Before the Model Cities program was established the incidence was nearly 54%, while afterwards it had decreased to 3%.

2. Supplemental infant feeding programs are most important to the older infant and young toddler, 6 months to 2 years of age. These children once they are on table food and have to compete with older siblings for the frequently inadequate family food, show signs of malnutrition unless this diet is supplemented. 3. Nutrition education would seem to be an invaluable aspect of these programs and should be provided. Young mothers need help in choosing foods wisely for these children, particularly when the family food budget is very tight.

4. Although pregnant and lactating women in low income families, particularly teenage mothers, obviously need supplemental nutrition, it is of concern to the Maryland Food Committee that Maryland has not submitted more requests for programs that include mothers.

5. Finally, one of the factors which delays implementing the WIC Program is the present inadequate funding of administrative costs. Maryland has implemented its WIC grants faster than most states because of our long experience: nevertheless, the low level of administrative funding is a handicap. We were happy to note in S. 850 the percentage of funds for administration is sharply increased and that administrative costs could include nutrition education.

The Maryland Food Committee has always thought of the WIC program as an experimental program. We believe it should be continued until a final report is given on its effectiveness-at least until 1978. But we believe there is another more urgent consideration at the moment. By the end of this year, the only funding available in Maryland for this sort of a supplemental food program will be WIC (HUD funding terminated in 1974; OEO funds terminate in September, 1975). If Maryland is to continue to serve the 8,000 infants presently receiving supplemental foods and to enroll the additional 8,000 authorized and serve them for one year, it must receive $4.9 million in FY '76. We understand that to con52-880-75-17

tinue all the presently authorized WIC programs in the country will take a minimum of $180 million. Therefore, we strongly urge that the program be funded for at least $200 million in FY '76, preferably more, and since such funding must be available without delay, that funding continue to come from funds appropriated by Section 32 of the Act of August 24, 1935, 7 USC 612(e).

However, we are not at this time recommending that WIC be made a permanent program. We believe that inadequate food income is basic to the ma!nutrition among pregnant women, infants, and toddlers, and that before WIC is made a permanent food supplement program some thought should be given to whether drastic improvements in the Food Stamp Program might not obviate the present urgent need for WIC and save the taxpayer the cost of maintaining the WIC bureaucracy. The basic question to be determined is whether, in the interests of improving both the nutrition and health care of these very vulnerable population groups, it is important to maintain WIC in its present design, or whether once the presence of a nutritional need is established, it is sufficient to meet that need with improvement in the already existing programs.

DAY CARE

The Special Food Service Program for Children presents some special problems. Centers for the care of young children are generally not part of a school system and are frequently run by organizations or individuals with minimal financial backing. For this reason, a program to assist such centers must involve a minimum of paper work and administrative red tape. On the other hand, nutritious meals for young children, the group comprising most of the day care population, are an urgent necessity as my previous remarks on the WIC program ind!cate.

One of the groups of day care centers which has been neglected in previous SFSP legislation is the family day care center. In Maryland, a majority of the youngest and most disadvantaged children in day care are in a family day care center. We, therefore, feel it urgent that these very vulnerable youngsters receive the benefit of this program. We would view with alarm, however, any effort to put day care meals under the School Food Service.

Therefore, we are strongly supporting legislation that expands and continues the day care program; provides flat per meal reimbursement rates similar to those of the School Lunch Program and more nearly approximates the cost of these meals; and provides a separate allocation for non-food assistance. (Otherwise, equipment needs may be used to justify the non-use of the "especially needy" category of day care funding to centers able to cope with the additional paper work necessary to 80:20 funding.) We are also urging SFSP eligibility to include family day care centers.

SUMMER LUNCH

We are delighted that summer lunch funds have finally been provided for this summer. This is one program which has proved its usefulness and deserves to be made part of our permanent child nutrition legislation. We, therefore, are in favor of legislation to establish this program on a permanent basis, raise reimbursements in line with cost-of-living increases, and set deadlines for advance publication of regulations and guidelines by USDA so that participating agencies have time for adequate planning.

It has been a great honor to testify before this committee and we recognize the careful consideration you give to the use of our country's tax dollars and national resources. In closing, I would point out that our most invaluable and irreplaceable resource is our children and the provision of adequate food for them today is the only hope of a better tomorrow.

EXHIBIT I-MEALS SERVED IN MARYLAND PUBLIC SCHOOLS

Total, State.

49,552,987 55, 024, 709 54, 879, 931

57, 998, 188

3,562, 683

9,035, 014 14, 533, 800 20,788, 559 45,990, 304 45,989, 695 39,654, 131

37, 211, 601

STATE OF MARYLAND,

Mrs. SUSAN TIPPETT,

DEPARTMENT OF HEALTH AND MENTAL HYGIENE,
Baltimore, Md., April 23, 1975.

Executive Director, Maryland Food Committee,
Baltimore, Md.

DEAR MRS. TIPPETT: I am pleased to learn that the Maryland Food Committee will testify at hearings on the proposed WIC legislation this week. No group should have a better perspective concerning nutrition intervention programs for at-risk members of our society, since the Committee has been involved in intervention programs encompassing food assistance, research and education for longer than WIC has existed, and undoubtedly has excellent ideas for future -direction of effort.

It is unnecessary for me to tell you how much the WIC program means to the 6000 participants in the seven project areas of the state, and how calamitous the extinction of the program at this time would be. Although Maryland filed twelve -applications in August 1973, program approvals occurred slowly so that WIC enrollments did not begin in Maryland until April 1974 (except for one program in southern Anne Arundel County). Despite the fact that we could bring considerable experience in operating supplemental food assistance programs in conjunction with health services to the task of implementing the new WIC programs, it was a year of confusion, frustration and hard work for all the health staff involved. On this first anniversary so much is finally "ready to be" that it is difficult to even contemplate the waste of manpower, resources, enthusiasm and public interest that will result if the program cannot continue. Let me cite a few examples:

1. Maryland has been approved for about 12,500 new WIC participants since January 1, 1975, which represents a four-fold increase. The new programs are just getting underway, and since enrollment requires several months to build up, we will not approach the potential capacity of the program in Maryland before June. Since we were operating in excess of 85% capacity prior to the new program approvals, we know Maryland can continue to do this, but we need more time!

2. Our first infant participants, enrolled shortly after birth, are only now beginning to "graduate" from the program, giving us a chance to review the results of a full period of program benefits. If the program terminates, many enrollees will have received benefits for less than six months.

3. At least three counties which have never participated in this kind of supplemental feeding program have expressed interest in applying for WIC. This degree of concern and interest in nutrition intervention has taken considerable time to emerge, and curtailment of the program may discourage these areas from future participation in any nutrition intervention programs.

4. WIC has provided the impetus for community groups and official and nonofficial health agencies to explore ways to plan and implement a program together, but continued collaborative efforts will depend a great deal on this successful initial effort.

5. Finally, it is only now beginning to seem possible to embark on aspects of the program that may make it truly an integrated component of comprehensive health care and a positive educational experience, and not simply a food assistance program operated out of a health care facility.

The WIC program has helped to meet an important need in Maryland this year, and we are very anxious that it continue so that we can fully realize its potential. At the same time there are so many others at high nutritional risk who are not covered by the program that we hope efforts will continue to seek more comprehensive solutions to the problems of inadequate incomes and inadequate understanding of nutrition that underlie our nutrition problems in Maryland and in the nation.

Sincerely,

Mr. THORNTON. Dr. William Allen.

CAROL L. LOOMIS,

WIC Coordinator.

Would you kindly introduce your companions. Dr. ALLEN. This is Mr. Bernard Conway, Chief Legal Officer of the ADA, and Mr. Weaver, Legislative Assistant in the Washington office. I think, with your permission, I will just summarize my statement. Mr. THORNTON. Your entire statement will appear in the record.