Nutrition Assistance Program Report Series

The Office of Analysis, Nutrition and Evaluation

Special Nutrition Programs Report No. WIC-00-PC

WIC Participant and Program

Characteristics 1998

United State Food and

Department of Nutrition

Agriculture Service

May 2000
WIC Participant and Program

Characteristics 1998

Authors:

Susan Bartlett

Melanie Brown-Lyons

Douglas Moore

Angela Estacion

Assisted by:

Don Laliberty

Sheela Kennedy

Eileen McEnaney

Eileen Fahey

Submitted by: Submitted to:

Abt Associates, Inc. Office of Analysis, Nutrition and Evaluation

55 Wheeler Street USDA, Food and Nutrition Service

Cambridge, MA 02138 3101 Park Center Drive

Alexandria, VA 22302-1500

Project Director: Susan Bartlett Project Officer: Julie Kresge

This study was conducted under Contract number 53-3198-7-005 with the Food and Nutrition Service.

This report is available on the Food and Nutrition Service web site: http://www.fns.usda.gov/oane.

Suggested Citation:

U.S. Department of Agriculture, Food and Nutrition Service, Office of Analysis, Nutrition and Evaluation,

WIC Participant and Program Characteristics 1998, WIC-00-PC, by Susan Bartlett, Melanie Brown-Lyons,

Douglas Moore, and Angela Estacion. Project Officer, Julie Kresge. Alexandria, VA: 2000.

United State Food and

Department of Nutrition

Agriculture Service

May 2000

Special Nutrition Programs

Report No. WIC-00-PC
Acknowledgments i

ACKNOWLEDGMENTS

The 1998 study of WIC participant and program characteristics must be dedicated to

our friends and colleagues in State and local WIC agencies. They provide all of the

data presented in this report and its appendices. We gratefully and humbly

acknowledge their cooperation and commend the diligence of the WIC Program in

creating and maintaining viable, practical client information systems.

James Tymon, Julie Kresge, Dr. Janet Schiller and Donna Hines at the Food and

Nutrition Service have provided support, good advice, and have given special

encouragement to both Abt and WIC State Agencies in developing this report.

Thanks also to Dr. Lawrence Grummer-Strawn of the Maternal and Child Nutrition

Branch, Division of Nutrition and Physical Activity, CDC for assistance in framing

questions to WIC local agencies regarding blood iron measurement.

At Abt Associates, Bonnie Randall and Nancy Burstein provided technical guidance

and insightful commentary.
PC98 Executive Summary iii

EXECUTIVE SUMMARY

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

is administered by the Food and Nutrition Service (FNS) of the US Department of

Agriculture (USDA). The WIC Program provides a combination of direct nutritional

supplementation, nutrition education and counseling, and increased access to health

care and social service providers for pregnant, breastfeeding, and postpartum women;

infants; and children up to the age of five years. WIC seeks to improve fetal

development and reduce the incidence of low birthweight, short gestation, and anemia

through intervention during the prenatal period. Infants and children who are at

nutritional or health risk receive food supplements, nutrition education, and access to

health care services to maintain and improve their health and development.

To receive WIC benefits, an individual must be categorically eligible; that is, the person

must be a pregnant, breastfeeding, or postpartum woman; an infant up to the age of one

year; or a child aged one through four years. In addition, each applicant must be found

to be income eligible and at nutritional risk. Eligible applicants receive supplemental

food usually in the form of vouchers or checks which allow them to obtain specific

types of food (milk, juice, cereal, for example) from participating retail grocers.

The WIC Program was established in 1972 by an amendment to the Child Nutrition

Act of 1966. WIC has greatly expanded since its inception, and, in April 1998, WIC

enrolled approximately eight million participants at an annual cost of about four billion

dollars.

Since 1988, FNS has produced biennial reports on current participant and program

characteristics in the WIC Program for general program monitoring as well as for

managing the information needs of the program. FNS uses this regularly updated WIC

program information to estimate budgets, identify needs for research, and review

current and proposed WIC policies and procedures. The biennial reports include:

C Information on the income and nutritional risk characteristics of WIC

participants.

C Data on WIC program participation for migrant farm worker

families.

C Other information on WIC participation that is deemed

appropriate by the Secretary of Agriculture. 

This publication is the seventh report in the series of studies on WIC participants and

program characteristics.

The 1998 Study The 1998 study of WIC program and participant characteristics (PC98), like PC92,

PC94, and PC96, is substantially different from earlier efforts to collect data on WIC

participants. PC98 employs the prototype reporting system which was developed by

FNS for the 1992 study and which routinizes compilation of participant information

from State WIC agencies. Earlier FNS studies of the WIC Program—in 1984 (PC84),

1988 (PC88), and 1990 (PC90)—were based on nationally representative samples of
PC98 Executive Summary iv

WIC participants and programs. PC98, like PC92, PC94, and PC96, contains

information on a near-census of WIC participants in April 1998.

 

Participant Records. The current system for reporting participant data is based on

the automated transfer of an agreed-upon set of data elements. State WIC agencies

download routinely collected information which is on their existing automated client

and management information systems. State and local WIC staff use these data to

certify applicant eligibility for WIC benefits and to issue food vouchers and checks.

This Minimum Data Set (MDS), which consists of twenty items, was developed by

FNS working with the Information Committee of the National Association of WIC

Directors (NAWD).

For the month of April 1998, each State WIC agency submitted MDS data on a census

of its WIC participants. In April of 1998, there were eighty-eight State WIC agencies:

the fifty States, the District of Columbia, Guam, Puerto Rico, American Samoa, and

the American Virgin Islands, along with thirty-three Indian Tribal Organizations

(ITOs). All eighty-eight WIC agencies provided data for PC98.

The State-maintained automated information systems from which PC98 data are drawn

do not always contain complete information on every individual enrolled in the WIC

Program. Unreported PC98 data may be unavailable for a variety of reasons which

may indicate that participants in any of the not-reported categories may be different

from those individuals with data reported. Assumptions regarding missing data vary

by the nature of the variable and by the category of WIC participant. To account for

these anomalies, a uniform strategy has been adopted for preparing all tables in this

report. Data not reported are included in the calculation of percentage distributions for

each characteristic. While including missing data in the denominators for all

calculations tends to place estimates for each characteristic at a lower bound, this

approach has allowed consistent presentation of tabulations throughout the report.

Further, it assures that all information needed to calculate upper-bound estimates is

readily available in every table. Caution should be used in comparing results across

groups; missing data must always be considered in gauging differences between,

among, or across groups or categories of WIC participants.

Summary of State Programs. The 1998 study, like earlier studies, included a survey

of State WIC agencies which obtained information on WIC program characteristics.

This survey was conducted by mail, with telephone followup. Data were collected on

State WIC operating policies and procedures for income determination, food package

tailoring, food instrument issuance, and average monthly food package costs by

participant category.

All of the eighty-eight State WIC agencies operating in April 1998 completed

questionnaires. Since 1992, little change has occurred in WIC program operations and

procedures.

Summary of Local Programs. PC98, like PC96, included a mail survey of local WIC

agencies. The PC 98 sample is longitudinal, that is, PC98 surveyed the same agencies

as did PC96. For the 1998 survey, the longitudinal sample was supplemented with a
PC98 Executive Summary v

sample of agencies that came into existence after the 1996 sample was selected. Data

for April 1, 1998, were obtained on such topics as sponsoring agencies, nutrition

education practices, breastfeeding promotion and education, and referral practices.

Most (96 percent) sampled agencies completed their SLPs; PC98 reports information

from 460 local WIC agencies.

The 1998 WIC Program In 1998, WIC services were delivered in the fifty States, the District of Columbia,

Puerto Rico, Guam, American Samoa, and the American Virgin Islands as well as by

thirty-three Indian Tribal Organizations. These eighty-eight State WIC agencies

operated 2,203 local WIC agencies where staff delivered WIC services at about nine

thousand service sites. The ten largest States—California, Florida, Georgia, Illinois,

Michigan, New York, North Carolina, Ohio, Pennsylvania, and Texas—served more

than half (57 percent) of all WIC participants. In fact, one-third of WIC participants

can be found in three states—California, New York, and Texas. This proportion has

grown steadily since 1992 when one-quarter of all participants were in these states.

Participant Characteristics In April 1998, 8,042,758 women, infants, and children were enrolled in the WIC

in 1998 Program—a 4 percent increase over WIC enrollment reported in 1996. The rate of

growth between 1996 and 1998 was substantially smaller than the 20 percent growth

in enrollment that occurred between 1992 and 1994 and the 12 percent growth that

occurred between 1994 and 1996.

While approximately 8 million participants were enrolled in WIC during April 1998,

fewer participants—approximately 7.4 million—actually picked up or cashed their

vouchers. Thus, monthly participation figures are about eight percent less than

monthly enrollment figures. A similar pattern was observed in PC92, PC94 and PC96.

Half (51.2 percent) of WIC participants are children. Infants account for 25.5 percent

and women 23.3 percent. The PC98 and PC96 distributions are similar. However,

betweeen 1992 and 1996, the proportion of children served by WIC increased (from

47.5 percent to 51.4 percent) and the proportion of infants decreased (from 30.1

percent to 25.7 percent). This shift may reflect increased funding which has allowed

WIC agencies to expand their caseloads and serve lower priority children.

Women were further divided into pregnant (11.1 percent of all participants),

breastfeeding (4.8 percent of all participants), and postpartum (7.3 percent of all

participants). The percentage of breastfeeding women has risen from 4.0 percent in

1994 to 4.3 percent in 1996 to 4.8 percent in 1998. See Exhibit E.1.

Most (83 percent) of the pregnant women participating in WIC are between the ages

of 18 and 34 as are 85 percent of breastfeeding and 84 percent of postpartum women.

Only 9 percent of women WIC clients are aged seventeen or younger. Most (88

percent) infant WIC participants are certified for WIC benefits during their first three

months of life. Child participation decreases as age increases—36 percent of child

participants are one year of age and only 16 percent are four years of age. 

In 1998, more pregnant WIC participants enrolled in the program during their first than

second trimesters, with 46.6 percent in the first trimester and 37.8 in the second. Only
Children

51%

Breastfeeding women

5%

Postpartum women

7%

Pregnant women

11%

Infants

26%

1 year old

18%

2 years old

13%

3 years old

12%

4 years old

8%

PC98 Executive Summary vi

11.8 enrolled in the third trimester. These percentages are similar to those reported in

1996. Between 1992 and 1996, enrollment in the first trimester increased by

approximately 10 percentage points.

Exhibit E.1

Distribution of Individuals Enrolled in the WIC Program

April 1998

Race and Ethnicity. In the 1998 study, as in previous studies, whites made up the

largest percentage of WIC participants (39.2 percent), followed by Hispanics (32.3

percent), blacks (22.9 percent), Asian or Pacific Islanders (3.2 percent), and American

Indian or Alaskan Natives (1.5 percent). Race/ethnicity data were reported for 99

percent of WIC participants. The ethnic composition of the WIC program has been

changing steadily since 1992; the percentage of Hispanic WIC enrollees has risen,

while percentages of black and white (non-Hispanic) enrollees has decreased.

Household Size. The mean household size of WIC participants in April 1998 was 3.9.

Average size has remained stable since 1992, through some fluctuations have occurred

within participant categories over time. Overall, as in 1996, information on household

size was reported for about 99 percent of WIC participants.

Income. Among WIC participants reporting some income, the average annualized

income of families/economic units of persons enrolled in the WIC Program in April
PC98 Executive Summary vii

1998 was $12,479 an increase of $1,671 (16 percent) since 1996. Across participant

categories, breastfeeding women reported the highest average income at $13,607;

postpartum women exhibited the lowest average income at $11,532. These findings

replicate PC92, PC94, and PC96 results. As in 1988, 1990, 1992, 1994, and 1996,

black WIC enrollees displayed the lowest average income—$9,593 for families or

economic units. As they did in previous PC studies, Asian or Pacific Islander

participants had the highest average annualized income at $14,272. Findings about

income must be interpreted with caution given the proportion of unreported

information. For PC98, income cannot be calculated for 15 percent of WIC enrollees.

Participation in Other Programs. WIC legislation allows income eligibility

requirements to be met by participation in means-tested programs such as the

Medicaid, Food Stamp, and Transitional Assistance to Needy Families (TANF)

Programs. In 1998, 57 percent of WIC participants received benefits from at least one

other public assistance program. With regard to participation in each program, 48

percent of WIC clients received Medicaid benefits; 27 percent participated in the Food

Stamp Program; and 17 percent of WIC participants reported receiving TANF benefits.

Only 15 percent participated in all three programs, receiving Medicaid, food stamp, and

AFDC benefits. Such data were not reported for 10.5 percent of 1998 WIC enrollees.

Reported participation in TANF, food stamps, and Medicaid decreased substantially

between 1996 and 1998. This observed decline among WIC enrollees mirrors overall

trends in the programs since passage of the Personal Responsibility and Work

Opportunity Reconciliation Act of 1996.

These estimates of reported participation in other programs may well represent a lower

bound. At certification, staff in local WIC agencies provide information on other

programs so that some WIC clients apply for these benefits after they are certified to

receive WIC benefits and after this information on program participation is recorded.

Poverty Status. Compared with the general US population, the WIC population is

distinctly poor, with two-thirds of WIC participants at or below the poverty line,

compared to 13 percent of the general population. The sharp contrast between WIC

clients and the general population can be seen in Exhibit E.2 which compares the

poverty status of WIC participants reporting income to the general US population.

More detailed figures appear in Chapter Four of this report.

Nutritional Risk. For PC98, States could report up to three nutritional risks for each

participant. For women, general obstetrical risks and inadequate or inappropriate

nutrient intake were the predominant risks reported. Children showed inappropriate or

inadequate nutrient intake and anthropometric risks (low weight for height, for

example) as their most frequently recorded risks. Three-quarters of WIC infants were

recorded at risk due, at least in part, to the WIC-eligibility of their mothers or because
PC98 Executive Summary viii

Exhibit E.2

Comparison of Poverty Levels of WIC Participants Reporting Income to Persons in the US Population
PC98 Executive Summary ix

their mothers were at risk during pregnancy. At least one nutritional risk was reported

for 99.5 percent of WIC enrollees in April 1998.

Breastfeeding Rates. Beginning with PC98, States were required to submit data on

breastfeeding initiation and duration for infants aged seven to eleven months old in

April 1998. The PC98 benchmark estimate is based on data from 63 State WIC

agencies, which represent 85 percent of all seven-to-eleven-month old infants. In these

States reporting breastfeeding data, 42 percent of infants aged seven to eleven months

are currently breastfed or were breastfed at some time.

Food Package Data. For the first time in April 1998, States were required to provide

food prescription data as part of the WIC Minimum Data Set (MDS). Due to the

complexity of analyzing widely varying coding systems among the eighty-eight State

WIC agencies, this report does not contain analyses of these food package data. An

addendum to this report is planned to address food prescriptions.

Migrant Status. Of particular interest is the participation of migrant farmworkers in

the WIC Program. Exhibit E.3 shows migrant participation across the States. In April

1998, there were 53,158 migrant WIC participants identified on State WIC enrollment

files. Migrant WIC participants make up less than 1 percent of the population

receiving WIC services. More than half of these participants were enrolled in the WIC

Program in California, Florida, and Texas. Migrant women enrollees in WIC tend to

be older than the general WIC population; this population also reports lower incomes.

Average income in the non-migrant WIC population is higher than incomes reported

by migrant farmworker WIC enrollees. However, the gap decreased between 1996 and

1998—non-migrant income was 12 percent higher than migrant income in 1996 and

only 6 percent higher in 1998. For PC98, State WIC agencies reported information on

migrant status for 99 percent of US WIC participants.
PC98 Executive Summary x

Exhibit E.3

Distribution of Migrant Farmworker WIC Participants by State

April 1998
 Contents xi

CONTENTS

Acknowledgments ................................................... i

Executive Summary .................................................. iii

Contents ........................................................... xi

List of Exhibits ...................................................... xiii

Chapter One Introduction ....................................... 1

Program Operations .................................. 1

Participant Benefits .................................. 4

Eligibility of WIC Benefits ............................ 8

Program Participation ................................ 8

Previous Studies of WIC Participant and Program

 Characteristics .................................... 9

The 1998 Study of WIC Participant and Program

 Characteristics .................................... 10

PC98 Summary of State Programs ...................... 18

PC98 Summary of Local Programs ...................... 18

Organization of This Report ........................... 19

Chapter Two Overview of WIC Participation and Food Package Costs . 21

Food Packages ...................................... 21

Chapter Three Demographics of WIC Participants ................... 37

Chapter Four Income of WIC Participants ......................... 47

Income and Poverty .................................. 52

Poverty Status ...................................... 54

Chapter Five Nutritional Risk Characteristics ...................... 67

Nutritional Risk Criteria .............................. 67

Nutritional Risks in PC98 ............................. 71

Nutrition and Poverty Status ........................... 98

Anthropometric Values ............................... 98

Blood Measures ..................................... 113

Chapter Six Nutrition Education and Breastfeeding ................ 127

Breastfeeding ....................................... 131

Chapter Seven Priority Levels ..................................... 149

Chapter Eight Characteristics of Migrant WIC Participants ........... 155

Chapter Nine Local WIC Agency Operations ....................... 169

Access to Health Care and Social Services ................ 175

Staffing Local WIC Agencies .......................... 175
 Contents xii

CONTENTS

(continued)

Appendix A Data Collection Instruments

Summary of State Programs

Summary of Local Programs

Appendix B Chapter Two Supplemental Tables

WIC Participants by Participant Category

Food Packages and Instrument Issuance

State-by-State Tables

Appendix C Chapter Four Supplemental Tables

Means-Tested Programs for Determining WIC Income Eligibility

Income Documentation and Verification

Distribution of Poverty, 1992, 1994, 1996, 1998

State-by-State Tables

Appendix D Chapter Five Supplemental Tables

Dietary Intake Policies and Methods

Documentation of Nutritional Risk Criteria

Nutritional Risk Eligibility Criteria

State-by-State Tables

Appendix E Chapter Eight Supplemental Table

Distribution of Migrant WIC Participants by State

Appendix F Supplemental Data Set

State-by-State Tables
List of Exhibits xiii

LIST OF EXHIBITS

Exhibit E.1 Distribution of Individuals Enrolled in the WIC

Program, April 1998 ................................. vi

Exhibit E.2 Comparison of Poverty Levels of WIC Participants Reportng

Income to Persons in the US Population .................. viii

Exhibit E.3 Distribution of Migrant Farmworker WIC Participants

by State, April 1998 ................................. x

Exhibit 1.1 Distribution of Local WIC Agencies and WIC

Participants by State ................................. 2

Exhibit 1.2 Sponsors of Local WIC Agencies ....................... 5

Exhibit 1.3 Geographic Areas Served by Local WIC Agencies ......... 6

Exhibit 1.4 Minimum Data Set Definitions ......................... 11

Exhibit 1.5 WIC Enrollment, April 1998 ........................... 15

Exhibit 1.6 Supplemental Data Set Definitions ...................... 16

Exhibit 2.1 Distribution of WIC Participants by Participant

Category in 1996 and 1998 ............................ 22

Exhibit 2.2 Food Package Adjustment and Tailoring Practices

Used by States ...................................... 23

Exhibit 2.3 Food Package Tailoring Practices and Use of Standard

Food Instruments .................................... 24

Exhibit 2.4 Frequency of WIC Food Instrument Issuance Among

State WIC Agencies .................................. 26

Exhibit 2.5 Frequency of Food Instrument Issuance in Local WIC 

Agencies ........................................... 27

Exhibit 2.6 Frequency of Mailing Food Instruments in Local WIC

Agencies ........................................... 28

Exhibit 2.7 Verification of Food Instrument Receipt by Local

Agencies ........................................... 29

Exhibit 2.8 Estimated Average Cost of Food Packages by Participant

Category, Region, and State ........................... 30

Exhibit 2.9 Estimated Average Food Package Costs After Rebate

by Region .......................................... 35

Exhibit 3.1 Distribution of Age of WIC Participants at Certification by

WIC Participant Category 1994, 1996, 1998 .............. 38

Exhibit 3.2 Distribution of Pregnant Women WIC Participants by

Trimester of Enrollment, 1994, 1996, 1998 ............... 39

Exhibit 3.3 Distribution of WIC Participants by Region, 1994 1996, 1998 40

Exhibit 3.4 Distribution of Racial and Ethnic Characteristics of WIC

Participants by Participant Category ..................... 41

Exhibit 3.5 WIC Participation by Race/Ethnicity .................... 41

Exhibit 3.6 Distribution of Racial and Ethnic Characteristics of WIC

Women, Infants, and Children, 1994, 1996, 1998 .......... 42

Exhibit 3.7 Distribution of Racial and Ethnic Characteristics of WIC

Participants by Region ................................ 43
LIST OF EXHIBITS

(continued)

List of Exhibits xiv

Exhibit 4.1 Means-Tested Programs Used to Determine WIC Income

Eligibility .......................................... 48

Exhibit 4.2 Income Documentation and Verification Policy ............ 49

Exhibit 4.3 Determining Eligibility in Local WIC Agencies ............ 50

Exhibit 4.4 Number and Percent of WIC Participants with Reported

Participation in Other Programs at Certification ........... 53

Exhibit 4.5 Distribution of the Size of Families or Economic Units of

WIC Participants by Participant Category ................ 55

Exhibit 4.6 Mean and Median Annualized Family or Economic Unit

Income of WIC Participants by Participant Category ........ 56

Exhibit 4.7 Average Annualized Family or Economic Unit Income of

WIC Participants by Participant Category and Racial

or Ethnic Characteristics .............................. 57

Exhibit 4.8 Distribution of Percent of Poverty Level of WIC Participants

by Participant Category ............................... 59

Exhibit 4.9 Distribution of Percent of Poverty Level of WIC Participants

by Participant Category and Racial or Ethnic

Characteristics ...................................... 60

Exhibit 4.10 Distribution of Percent of Poverty Level at Certification for

WIC Participants Reporting No Other Benefit Receipt ...... 63

Exhibit 4.11 Comparison of Poverty Levels of WIC Participants to

Persons in the US Population in 1998 .................... 64

Exhibit 5.1 Broad Categories of Nutritional Risk Criteria Developed by

the National Association of WIC Directors ............... 68

Exhibit 5.2 State Policies for Obtaining Dietary Intake Information ..... 69

Exhibit 5.3 Dietary Intake Methods Routinely Used by States .......... 70

Exhibit 5.4 State and Local Agency Documentation of Nutritional 

Risk Criteria ........................................ 72

Exhibit 5.5 Distribution of Number of Nutritional Risk Factors for WIC

Participants Reported at Certification, 1994, 1996, 1998 .... 73

Exhibit 5.6 Number and Percent of Women WIC Participants by

Participant Category, Age at Certification, and Type of

Nutritional Risk Reported ............................. 74

Exhibit 5.7 Number and Percent of Infant and Child WIC Participants

by Age at Certification and Type of Nutritional Risk

Reported ........................................... 75

Exhibit 5.8 Number and Percent of WIC Participants with Specific 

Nutritional Risks Reported at Certification ............... 76

Exhibit 5.9 Number and Percent of Women WIC Participants by

Participant Category with Specific Nutritional Risks

Reported ........................................... 77

Exhibit 5.10 Number and Percent of Infant WIC Participants with Specific

Nutritional Risks Reported by Age at Certification ......... 78

Exhibit 5.11 Number and Percent of Child WIC Participants with Specific

Nutritional Risks Reported by Age at Certification ......... 79
LIST OF EXHIBITS

(continued)

List of Exhibits xv

Exhibit 5.12 Number and Percent of American Indian and Alaskan Native

WIC Participants with Specific Nutritional Risks Reported

by Participant Category ............................... 80

Exhibit 5.13 Number and Percent of Asian or Pacific Islander WIC

Participants with Specific Nutritional Risks Reported

by Participant Category ............................... 82

Exhibit 5.14 Number and Percent of Black (non-Hispanic) WIC

Participants with Specific Nutritional Risks Reported

by Participant Category ............................... 84

Exhibit 5.15 Number and Percent of Hispanic WIC Participants with

Specific Nutritional Risks Reported by Participant

Category ........................................... 86

Exhibit 5.16 Number and Percent of White (non-Hispanic) WIC

Participants with Specific Nutritional Risks Reported

by Participant Category ............................... 88

Exhibit 5.17 Nutritional Risks Reported in at Least 15 Percent of WIC

Participants, 1994, 1996, 1998 ......................... 90

Exhibit 5.18 Nutritional Risks Reported in at Least 15 Percent of American

Indian and Alaskan Native WIC Participants by

Participant Category ................................. 91

Exhibit 5.19 Nutritional Risks Reported in at Least 15 Percent of Asian and

Pacific Islander WIC Participants by Participant Category ... 92

Exhibit 5.20 Nutritional Risks Reported in at Least 15 Percent of Black

(non-Hispanic) WIC Participants by Participant Category .... 93

Exhibit 5.21 Nutritional Risks Reported in at Least 15 Percent of Hispanic

WIC Participants by Participant Category ................ 94

Exhibit 5.22 Nutritional Risks Reported in at Least 15 Percent of White

(non-Hispanic) WIC Participants by Participant Category .... 95

Exhibit 5.23 Nutritional Risks Reported in at Least 15 Percent of Pregnant

WIC Participants by Age at Certification ................. 96

Exhibit 5.24 Number and Percent of Women WIC Participants with

Specific Nutritional Risks Reported At Certification by

Percent of Poverty ................................... 99

Exhibit 5.25 Number and Percent of Infant WIC Participants with

Specific Nutritional Risks Reported At Certification by

Percent of Poverty ................................... 100

Exhibit 5.26 Number and Percent of Child WIC Participants with

Specific Nutritional Risks Reported At Certification by

Percent of Poverty ................................... 101

Exhibit 5.27 Number and Percent of One-Year-Old Child WIC

Participants with Specific Nutritional Risks Reported

At Certification by Percent of Poverty ................... 102

Exhibit 5.28 Number and Percent of Two-Year-Old Child WIC

Participants with Specific Nutritional Risks Reported

At Certification by Percent of Poverty ................... 103
LIST OF EXHIBITS

(continued)

List of Exhibits xvi

Exhibit 5.29 Number and Percent of Three-Year-Old Child WIC

Participants with Specific Nutritional Risks Reported

At Certification by Percent of Poverty ................... 104

Exhibit 5.30 Number and Percent of Four-Year-Old Child WIC

Participants with Specific Nutritional Risks Reported

At Certification by Percent of Poverty ................... 105

Exhibit 5.31 Distribution of Infant WIC Participants According to Selected

Anthropometric Measures: 1994, 1996, 1998 ............. 106

Exhibit 5.32 Distribution of Infant WIC Participants by Racial or Ethnic

Characteristics According to Selected Anthropometric

Measures .......................................... 107

Exhibit 5.33 Distribution of Child WIC Participants by Age According

to Selected Anthropometric Measures: 1994, 1996, 1998 .... 108

Exhibit 5.34 Distribution of Child WIC Participants by Age and Race 

or Ethnicity According to Selected Anthropometric

Measures .......................................... 109

Exhibit 5.35 Number and Percent of Infant WIC Participants at Risk

According to Several Anthropometric Criteria ............. 110

Exhibit 5.36 Number and Percent of Child WIC Participants at Risk

According to Several Anthropometric Criteria ............. 111

Exhibit 5.37 Number and Percent of Breastfeeding and Postpartum Women

WIC Participants at Risk According to Several

Anthropometric Criteria .............................. 112

Exhibit 5.38 State 1998 Nutritional Risk Eligibility Criteria for Hemoglobin

and Hematocrit Levels Compare with 1989 CDC Standards

for Anemia ......................................... 114

Exhibit 5.39 Hematologic Criteria Commonly Used for Determining WIC

Eligibility .......................................... 115

Exhibit 5.40 Percent of Clients Screened for Anemia at Doctor’s

Office or Non-WIC Clinic ............................. 116

Exhibit 5.41 Blood Screening Procedures at WIC Clinics ............... 117

Exhibit 5.42 Instruments Used to Test Hemoglobin or Hematocrit

at WIC Clinics ...................................... 119

Exhibit 5.43 Availability of Hematological Data for WIC Participants;

Percent of WIC Participants by Participant Category with

Specific Types of Hematological Measures ............... 120

Exhibit 5.44 Number and Percent of Women WIC Participants Falling

Below Several Hematologic Standards ................... 122

Exhibit 5.45 Number and Percent of Child WIC Participants Falling

Below Several Hematologic Standards ................... 123

Exhibit 5.46 Number and Percent of Anemic Women WIC Participants

by Participant Category and Racial or Ethnic Characteristics . 124

Exhibit 5.47 Number and Percent of Anemic Child WIC Participants

by Age at Time of Blood Measurement and Racial or

Ethnic Characteristics ................................ 125
LIST OF EXHIBITS

(continued)

List of Exhibits xvii

Exhibit 6.1 Scheduled Nutrition Education Contacts in Local WIC

Agencies by Participant Category ....................... 128

Exhibit 6.2 Topics Emphasized in Nutrition Education Sessions ........ 129

Exhibit 6.3 Methods and Materials Used to Provide Nutrition

Education .......................................... 130

Exhibit 6.4 Nutrition Education in Local WIC Agencies by

Participant Category ................................. 132

Exhibit 6.5 Average Length of Nutrition Education Sessions ........... 133

Exhibit 6.6 Special Nutrition Education Services Provided by Local WIC

Agencies to High-Risk Participants by Participant Category . . 134

Exhibit 6.7 Availability of Nutrition Education in Foreign Languages

at WIC Local Agencies and Service Delivery Sites ......... 135

Exhibit 6.8 Breastfeeding Support and Promotion Services Provided

at WIC Service Delivery Sites .......................... 136

Exhibit 6.9 Breastfeeding Rates for WIC Infants Aged Seven-to-Eleven

Months in April 1996 by State ......................... 137

Exhibit 6.10 Median Breastfeeding Duration in Weeks for WIC Infants

Aged Seven-to-Eleven Months in April 1996 by State ....... 141

Exhibit 6.11 Estimated Breastfeeding Duration by State; Number and

Percent of WIC Infants Ages Seven-to-Eleven Months in

April 1998 Breastfeeding for Six Months or More ......... 144

Exhibit 7.1 WIC Priorities ...................................... 150

Exhibit 7.2 Priority of All WIC Participants by Participant Category .... 151

Exhibit 7.3 Priority of Infant WIC Participants by Age at Certification ... 152

Exhibit 7.4 Priority of Child WIC Participants by Age at Certification ... 153

Exhibit 8.1 Distribution of Migrant Farmworker WIC Participants by

State, April 1998 .................................... 156

Exhibit 8.2 Distribution of Migrant Farmworker WIC Participants by

WIC Participant Category and Age at Certification ......... 157

Exhibit 8.3 Distribution of Migrant Pregnant Women WIC Participants

by Trimester of Enrollment ............................ 159

Exhibit 8.4 Number and Percent of Migrant WIC Participants with

Reported Participation in Other Programs at Certification .... 160

Exhibit 8.5 Mean and Median Annualized Family or Economic Unit

Income of WIC Participants by Participant Category and

Migrant Status ...................................... 161

Exhibit 8.6 Distribution of Percent of Poverty Level of WIC Participants

by Participant Category and Migrant Status ............... 162

Exhibit 8.7 Nutritional Risks Reported in at Least 15 Percent of Migrant

Farmworker WIC Participants by Participant Category ...... 164

Exhibit 8.8 Number and Percent of Migrant Farmworker WIC Participants

with Specific Nutritional Risks Reported by Participant

Category ........................................... 165
LIST OF EXHIBITS

(continued)

List of Exhibits xviii

Exhibit 8.9 Number and Percent of Anemic Migrant Farmworker WIC

Participants by Participant Category ..................... 166

Exhibit 8.10 Distribution of Infant and Child Migrant Farmworker WIC

Participants According to Selected Anthropometric

Measures .......................................... 167

Exhibit 8.11 Priority of Migrant Farmworker WIC Participants by

Participant Category ................................. 168

Exhibit 9.1 Features of WIC Service Delivery Sites .................. 170

Exhibit 9.2 Local WIC Agency Contacts with Participants Who Miss

Scheduled Appointments .............................. 171

Exhibit 9.3 Allocation of Nutrition Services and Administration (NSA)

Funds by Local WIC Agencies ......................... 173

Exhibit 9.4 Provision of Health Services at WIC Service Delivery Sites

by Type of Service ................................... 176

Exhibit 9.5 Provision of Health Services for WIC Participants by

Type of Service ..................................... 177

Exhibit 9.6 Availability of Social Services at WIC Service Delivery Sites

by Type of Service ................................... 178

Exhibit 9.7 Availability of Social Services for WIC Participants by 

Type of Service ..................................... 179

Exhibit 9.8 Referral Procedures for Social Services at WIC Service 

Delivery Sites by Type of Service ....................... 180

Exhibit 9.9 Referral Procedures for Social Services to WIC Participants 

by Type of Service ................................... 181

Exhibit 9.10 Staffing in Local WIC Agencies by Type of Staff .......... 182

Exhibit 9.11 Staff Skills and Experience in Local WIC Agencies by

Type of Staff ....................................... 184

Exhibit 9.12 Staff Hiring in Local WIC Agencies by Type of Staff ....... 186

Exhibit 9.13 Level of Difficulty Reported by Local WIC Agencies in

Recruiting and Hiring Staff ............................ 187

Exhibit 9.14 Difficulties Reported by Local WIC Agencies in Recruiting

and Hiring Staff ..................................... 188

Exhibit 9.15 Level of Difficulty Reported by Local WIC Agencies in

Retaining Staff ...................................... 190

Exhibit 9.16 Difficulties Encountered by Local WIC Agencies Retaining

Staff .............................................. 191

Exhibit 9.17 Use of Volunteers to Deliver WIC Services ............... 194

Exhibit 9.18 Physical Space at WIC Service Delivery Sites ............. 195

A list of exhibits for each appendix appears at the beginning of the appendix.
Chapter One: Introduction to PC98 1

1. INTRODUCTION

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

was created in 1972 and is administered by the Food and Nutrition Service (FNS) of

the US Department of Agriculture (USDA). WIC was established to counteract the

negative effects of poverty on prenatal and pediatric health and provides a combination

of direct nutritional supplementation, nutrition education and counseling, and increased

access to health care and social service providers for pregnant, breastfeeding, and

postpartum women; infants; and children up to the age of five years. By intervening

during the prenatal period, WIC seeks to improve fetal development and reduce the

incidence of low birthweight, short gestation, and anemia. Infants and children who are

at nutritional or health risk can receive food supplements, nutrition education, and

access to health care to maintain and improve their health and development.

The WIC Program was established in 1972 by an amendment to the Child Nutrition

Act of 1966. WIC has vastly expanded since its inception, and, in April 1998, WIC

served approximately eight million participants at an annual cost of about four billion

dollars. 

Since 1988, FNS has produced biennial reports on current participant and program

characteristics in the WIC Program for general program monitoring as well as for

managing the information needs of the program. FNS uses this regularly updated WIC

program information to estimate budgets, identify needs for research, and review

current and proposed WIC policies and procedures. The biennial reports include:

• Information on the income and nutritional risk characteristics

of WIC participants. 

• Data on WIC program participation for migrant farm worker

families.

• Other information on WIC participation that is deemed

appropriate by the Secretary of Agriculture.

For purposes of the biennial reports, a WIC participant is defined as a person who is

certified to receive WIC benefits in April, including individuals who do not claim or use

the food instruments issued during the time period.

Program Operations WIC services are delivered in each of the fifty States, American Samoa, the District of

Columbia, Guam, Puerto Rico, and the American Virgin Islands. Additionally, in

1998, thirty-three Indian tribal organizations (ITOs) served as State WIC agencies.

Approximately 2,200 local agencies (defined as the organizations one level below State

WIC agencies) provide services to participants at approximately 9,000 service sites.

Exhibit 1.1 presents information on the number of local service delivery agencies

operated by the eighty-eight State WIC agencies. Ten States serve more than half (57

percent) of all WIC participants. Two of these States—California and Texas—provide

services to 25 percent of WIC participants.
Chapter One: Introduction to PC98 2

Exhibit 1.1

Distribution of Local WIC Agencies and WIC Participants by State

State Number of Local Percent of All Local Percent of US

Agencies Agencies WIC Participants

Northeast

Connecticut 21 0.95% 0.74%

Maine 11 0.50 0.33

Massachusetts 35 1.59 1.63

New Hampshire 9 0.41 0.23

New York 100 4.54 6.61

Rhode Island 14 0.64 0.29

Vermont 12 0.54 0.20

Indian Township (ME) 1 0.05 0.00*

Pleasant Point (ME) 1 0.05 0.00*

Seneca Nation (NY) 1 0.05 0.00*

Mid-Atlantic

Delaware 15 0.68 0.20

District of Columbia 5 0.23 0.22

Maryland 18 0.82 1.20

New Jersey 19 0.86 1.85

Pennsylvania 25 1.13 3.20

Puerto Rico 7 0.32 2.71

Virginia 35 1.59 2.02

Virgin Islands 1 0.05 0.10

West Virginia 8 0.36 0.68

Southeast

Alabama 67 3.04 1.46

Florida 48 2.18 5.00

Georgia 21 0.95 3.32

Kentucky 55 2.50 1.58

Mississippi 23 1.04 1.34

North Carolina 85 3.86 2.78

South Carolina 16 0.73 1.50

Tennessee 14 0.64 2.03

Eastern Band—Cherokee (NC) 1 0.05 0.01

Mississippi Choctaw 1 0.05 0.01

Midwest

Illinois 94 4.27 3.45

Indiana 55 2.50 1.88

Michigan 52 2.36 3.04

Minnesota 70 3.18 1.23

Ohio 76 3.45 3.20

Wisconsin 69 3.13 1.43

Southwest

Arkansas 75 3.40 1.13

Louisiana 131 5.95 1.73

New Mexico 93 4.22 0.84

Oklahoma 23 1.04 1.11

Texas 90 4.09 9.19

ACL (NM) 1 0.05 0.01

Cherokee Nation (OK) 1 0.05 0.09

Chickasaw Nation (OK) 1 0.05 0.04

Notes

The estimate of local WIC agencies is derived from State enrollment files containing identifiers for local agencies charged with

administering WIC services.

*Indicates agencies serving less than 0.01 percent of US WIC.
Exhibit 1.1 (continued)

Distribution of Local WIC Agencies and WIC Participants by State

State Number of Local Percent of All Local Percent of US

Agencies Agencies WIC Participants

Chapter One: Introduction to PC98 3

Southwest (continued)

Choctaw Nation (OK) 1 0.05% 0.03%

Citizen—Potawatomi (OK) 1 0.05 0.02

Eight Northern Pueblos (NM) 1 0.05 0.00*

Five Sandoval Pueblos (NM) 1 0.05 0.00*

ITC—Oklahoma 1 0.05 0.00*

Muscogee Creek Nation (OK) 1 0.05 0.01

Osage Nation (OK) 1 0.05 0.01

Otoe-Missouria (OK) 1 0.05 0.01

Pueblo of Isleta (NM) 1 0.05 0.01

Pueblo of San Felipe (NM) 1 0.05 0.00*

Pueblo of Zuñi (NM) 1 0.05 0.01

Sac and Fox Nation (OK) 1 0.05 0.00*

Santo Domingo (NM) 1 0.05 0.00*

WCD (OK) 1 0.05 0.03

Mountain Plains

Colorado 40 1.82 1.07

Iowa 20 0.91 0.81

Kansas 36 1.63 0.66

Missouri 120 5.45 1.89

Montana 40 1.82 0.27

Nebraska 14 0.64 0.39

North Dakota 27 1.23 0.18

South Dakota 64 2.91 0.24

Utah 15 0.68 0.73

Wyoming 17 0.77 0.14

Cheyenne River Sioux (SD) 1 0.05 0.01

Omaha-Santee Sioux (NE) 1 0.05 0.01

Rosebud Sioux (SD) 1 0.05 0.02

Shoshone-Arapahoe (WY) 1 0.05 0.01

Standing Rock Sioux (ND) 1 0.05 0.01

Three Affiliated (ND) 1 0.05 0.01

Ute Mountain Ute (CO) 1 0.05 0.00*

Winnebego (NE) 1 0.05 0.00*

Western

Alaska 17 0.77 0.30

American Samoa 1 0.05 0.08

Arizona 18 0.82 1.56

California 84 3.81 16.75

Guam 1 0.05 0.07

Hawaii 18 0.82 0.49

Idaho 9 0.41 0.43

Nevada 5 0.23 0.59

Oregon 34 1.54 1.15

Washington 72 3.27 2.04

ITC—Arizona 11 0.50 0.12

ITC—Nevada 1 0.05 0.01

Navajo Nation (AZ) 17 0.77 0.20

Total 2203 100.00% 100.00%

Notes

The estimate of local WIC agencies is derived from State enrollment files containing identifiers for local agencies charged with

administering WIC services.

*Indicates agencies serving less than 0.01 percent of US WIC.
Information on local agencies is drawn from the PC98 survey of local WIC agencies which 1

is described later in this chapter. Respondents were permitted multiple responses so percentages do not

add to 100 percent.

Chapter One: Introduction to PC98 4

At the federal level, FNS and its seven regional offices provide cash grants to State

WIC agencies for program administration and operations; issue regulations and

monitor compliance with these regulations; provide technical assistance to States, and

conduct studies of program operation and performance. State WIC agencies set

nutritional risk eligibility standards, allocate funds to local WIC sponsoring agencies,

monitor compliance with federal and State regulations, and provide technical assistance

to local WIC agency staff. Virtually all local WIC service providers are health

agencies. (See Exhibit 1.2.) State (36 percent) and county (36 percent) health

1

departments account for almost three-quarters of all WIC sponsors. WIC sponsors also

include private or non-profit agencies (10 percent), and community action agencies (5

percent). The funds received by local WIC agencies are used to provide federally

specified supplemental foods to WIC participants and to pay administrative costs,

including the costs of certifying applicants as eligible and counseling WIC participants

on nutritional issues. About half of local WIC agencies in the PC98 survey report they

provide WIC services within a county. (See Exhibit 1.3.)

Since 1987, State agencies have negotiated rebates provided by manufacturers of infant

formula and juice. These rebates are used by State and local WIC agencies to provide

WIC services to larger numbers of eligible individuals.

Participant Benefits WIC seeks to improve the health of program participants by providing nutritious food

and nutrition education as adjuncts to good health care. The benefits provided by WIC

are briefly described below.

• Food Packages. Food, food vouchers, or food checks are

distributed to participants to provide specific nutrients

known to be lacking in the diets of target populations. FNS

regulations specify WIC food packages that are designed for

different categories of participants. These packages contain

foods that are good sources of specific nutrients—protein,

iron, calcium, and vitamins A and C. Content of infant food

packages is grounded in the developmental needs of infants

as well as in pediatric recommendations on infant feeding.

Other food packages incorporate into their contents the

recommended eating patterns for preschool children and the

special additional nutritional requirements of pregnant and

breastfeeding women.

Most States operate retail food delivery systems where WIC

clients receive food instruments to purchase their

supplemental foods at participating local grocery stores.

These checks or vouchers are “food-specific,” in that they

can be used only for food prescribed by health or nutrition

professionals at local WIC agencies. These food items are

specified on each WIC food instrument. In a few geographic

areas, food is delivered to participant homes, or participants

pick up food at specified distribution points. A small
Chapter One: Introduction to PC98 5

Exhibit 1.2

Sponsors of Local WIC Agencies

Organizational Sponsor Percent of Percent of

Local Agencies Participants a a

State health agency 36.1% 23.5% 

(2.21) (3.09) 

District health agency 5.0 7.9 

(1.19) (2.43) 

Multi-county agency 2.9 1.6 

(0.94) (0.94) 

County health agency 35.6 30.9 

(2.51) (4.73) 

Municipal health agency 3.0 9.5 

(0.99) (3.10) 

Community health agency 8.7 5.5 

(1.58) (1.98) 

Community action agency 4.6 3.8 

(1.19) (1.65) 

Indian health agency 1.5 0.3 

(0.71) (0.20) 

Indian agency 3.6 1.2 

(2.73) (0.89) 

Public hospital 1.8 2.9 

(1.73) (3.89) 

Private voluntary hospital 0.9 0.9 

(0.52) (0.83) 

Private proprietary hospital 0.3 0.1 

(0.29) (0.12) 

Private/non-profit agency 9.9 18.8 

(1.72) (3.91) 

Other 0.6 2.4 

(1.69) (7.43) 

Not reported 12.8 8.8

(1.85) (2.33)

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe of

2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

Columns do not sum to 100 percent because respondents were permitted multiple responses. a
Chapter One: Introduction to PC98 6

Exhibit 1.3

Geographic Areas Served by Local WIC Agencies

Service Area Percent of Local Percent of

Agencies Participants

A single neighborhood 0.0% 0.0% 

(0.00) (0.00) 

A group of neighborhoods 3.2 3.5 

(1.02) (2.70)

A city 5.0 10.5 

(1.24) (3.77)

A portion of one county (or parish) 5.3 6.0 

(1.15) (2.05)

One county (or parish) 48.5 44.1 

(2.68) (4.97)

Portions of several counties 5.2 6.3 

(1.34) (1.14)

Multiple counties or parishes 8.6 10.4 

(1.47) (2.98)

A State-designated health district . . .

covering 1-3 counties 7.6 5.5 

(1.48) (1.68)

covering 4-6 counties 2.2 1.8 

(0.78) (1.16)

covering 7-9 counties 0.3 0.1 

(0.37) (0.16)

covering 10 or more counties 1.3 3.4 

(0.69) (2.07)

Special populations throughout the State 0.9 0.5 

(0.59) (0.46)

The entire State 0.7 0.2 a

(0.51) (0.15)

Other 1.4 1.3 

(2.81) (1.06)

Not reported 9.9 6.4 

(1.90) (2.08)

Total 100.0% 100.0%

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe of

2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.
Chapter One: Introduction to PC98 7

number of States operate both retail and direct delivery

systems. 

During the past decade, States began considering electronic

benefit transfer (EBT) of WIC benefits. Wyoming tested the

feasibility of EBT in the WIC Program and is in the process

of rolling out an electronic system for WIC and food stamps.

Ohio is also in the process of adding WIC to its food stamp

EBT system. The application of electronic benefits to WIC

is hampered by the need to match purchased food items with

WIC food package prescriptions. Automating this task is

complicated and expensive and requires electronic

connections which do not normally exist in retailer scanning

and payment systems. Integrated circuit chips embedded in

plastic cards (smart cards) are offering WIC a new solution

to traditional paper-based food prescriptions.

• Nutrition Education and Counseling. Nutrition education

plays a crucial role in the WIC Program and is viewed as an

essential benefit directed toward achieving positive changes

in participant knowledge, attitude, and behavior about food

consumption. FNS regulations require WIC service agencies

to offer to participants at least two nutrition education

sessions during each—usually six-month—certification

period. Participants may be counseled in one-on-one

settings; attend group classes; or view films, slide-tape

presentations, or videos on a variety of health and nutritionrelated topics. In recent years, WIC has emphasized the

value of breastfeeding and spent substantial funds to

promote breastfeeding.

• Access to Health Care and Social Services. Each WIC

agency is charged with assisting WIC participants to obtain

and use preventive health care services. Through either the

provision of on-site health services or referral to other

agencies, the WIC Program serves as a link between the

participant and an appropriate health-care provider or

system.

Since 1978, most local WIC agencies have referred clients to

a variety of social services, including welfare, child support

and child care services, and substance abuse counseling.

Coordination between WIC and social service programs has

increased since 1989 when Federal law created adjunctive

eligibility for WIC benefits based on eligibility for other

programs. During 1998, most local WIC agencies provided

information on other social services such as the Food Stamp

Program, Medicaid, Transitional Aid to Needy Families

(TANF), substance abuse counseling and treatment, and

other programs providing services needed by WIC clients.

The degree to which local WIC agencies actively facilitate

such access varies with the type of local sponsoring agency
The 1997 guidelines, in effect until June 1998, were used to determine income eligibility for 2

most WIC participants enrolled in April 1998.

Chapter One: Introduction to PC98 8

and the nature of the service site at which WIC benefits are

delivered.

Eligibility for WIC Eligibility for receipt of WIC benefits is based on three factors: categorical eligiBenefits bility; income eligibility; and nutritional risk. First, a participant must be a member of

certain categorically eligible groups: women during pregnancy and up to the first six

weeks after delivery; women up to one year postpartum if breastfeeding or up to six

months postpartum if not breastfeeding; infants up to one year old; and children aged

one through four years. 

Second, a participant must be income-eligible. The income limit for eligibility is set

by each State agency. However, this income limit may not exceed 185 percent or be

less than 100 percent of the Department of Health and Human Services (HHS) poverty

income guidelines, which are based on household size. As of July, 1997 at the 185-

percent threshold, a person from a family of four, living within the forty-eight

contiguous States, with an annual household income of $29,693 or less would be

income-eligible for WIC benefits . All States WIC agencies, except Guam, set WIC 2

income eligibility at 185 percent of poverty, as of April 1998.

States are also permitted to establish standards and procedures for verifying and

documenting income. Some States require paystubs; others allow applicants to selfdeclare income. FNS regulations allow a WIC service provider to conclude that a

participant is adjunctively income-eligible for WIC benefits through documentation of

his/her participation in another means-tested program such as Medicaid, TANF, or

food stamps. 

Finally, each WIC participant must be determined to be at nutritional risk based on a

medical and/or nutritional assessment by a competent professional authority such as

a physician, nutritionist, nurse, or other health professional or paraprofessional. At a

minimum, height (or length) and weight are measured and, with the exception of infants

under six months, a hematological test (generally a hemoglobin) is administered to

assess nutritional status. Federal program regulations allow State and local agencies

to develop appropriate screening systems to assess nutritional risk. According to

program regulations, risk can be indicated by such factors as abnormal weight gain

during pregnancy, a history of high-risk pregnancies, low birthweight, stunted growth,

low weight, obesity, anemia, or an inadequate dietary pattern. Beginning in 1999, a

national set of nutritional criteria was established. However, in 1998, no single

national set of nutritional criteria existed. Therefore, WIC eligibility could vary with

location. Individuals who are adjunctively income-eligible for WIC because of

participation in other qualifying means-tested programs must also be determined to be

at nutritional risk to receive benefits.

Program Participation The WIC Program must operate within annual funding levels established by

appropriation law. The number of participants served each year depends on total funds

available as well as on FNS allocation of these funds to individual States. For each

local agency, a maximum caseload is determined based on the agency's funding level

and predicted caseload turnover. When a local WIC agency reaches this maximum

participation level within available funding, a system of priorities is followed in
Chapter One: Introduction to PC98 9

allocating caseload “slots” to eligible applicants. Some agencies maintain waiting lists

of eligible applicants and, as WIC openings become available, fill them from their

waiting lists. 

To assist State and local WIC providers with service provision, FNS has defined seven

priority levels, based on applicant categorical status and type of nutritional risk

condition. In general, the purpose of the existing priority system is to give precedence

to medically based nutritional risks over risks based only on inadequate diet. Detailed

information on priorities is presented in Chapter Seven.

Previous Studies of FNS has completed six previous studies of WIC participant and program characterWIC Participant and istics. In 1984 (PC84), 1988 (PC88), and 1990 (PC90), FNS and its contractors conProgram Characteristics ducted studies using nationally representative samples of WIC participants. Data were

obtained through mail surveys of State and local WIC agencies; record abstractions at

local WIC service sites; and, in PC88, interviews with participants and followup data

collection on food instrument pickup.

PC84, conducted for FNS by Ebon Research Systems, collected data from twenty-eight

State agencies, 204 local agencies, 356 service sites, and 6,444 participant records.

Major findings addressed:

• The distribution of participants by participant category, by

priority, and by income.

• The nutritional risks of WIC participants.

• State and local WIC agency coordination with health and

social service programs.

• The methods, frequency, and types of nutrition education

provided to WIC participants.

PC88, the second study of WIC participant and program characteristics, was conducted

by Research Triangle Institute. For this study, staff in State and local WIC agencies

collected data and interviewed a nationally representative sample of approximately

7,000 WIC clients. A six-month followup data collection effort determined the rate of

actual pickup of WIC food instruments. State and local WIC agencies were surveyed

to gather information on WIC Program operations. PC88 reported on:

• The distribution of participants by participant category, by

priority, by participation in other programs, and by family

income.

• The nutritional risks of WIC participants.

• State and local policies and agency coordination with health

and social service programs.

• Food package prescriptions.

PC90 served as a transitional study which built on the PC84 and PC88 research designs

while minimizing sample size to conserve research expenditures. A goal for PC90, and
Chapter One: Introduction to PC98 10

all future studies of WIC participant characteristics, was limiting burden on State WIC

agencies to encourage continuing biennial participation in the WIC reporting system.

For PC90, field researchers from Abt Associates abstracted data from a nationally

representative sample of 2,343 participant records. All State WIC agencies were

surveyed to obtain information on WIC Program operations.

The methodology used for PC98 was first developed for the 1992 study. The 1992

study of WIC participant and program characteristics (PC92) was substantially

different from earlier studies with regard to collecting data on WIC participation. FNS

developed a prototype reporting system which allows acquisition of all participation

data through the automated transfer of an agreed-upon set of data elements. State WIC

agencies download, to diskettes, magnetic tapes, or CD-ROMs, routinely collected

information from their existing automated client and management information systems.

State and local WIC staff obtain these data to certify applicant eligibility for WIC

benefits, to guide nutrition education, and to issue food instruments. This Minimum

Data Set (MDS) was developed by FNS working with the Information Committee of

the National Association of WIC Directors (NAWD) and the Centers for Disease

Control and Prevention (CDC). The MDS, which consists of twenty items, appears in

Exhibit 1.4.

The methodology developed for PC92 was successfully applied in 1994, 1996, and

again in 1998. Two PC98 changes are the mandatory reporting of breastfeeding data

and the inclusion of food package codes in the MDS. 

For PC96, States were asked to report information on breastfeeding (if their

management information systems contained the data) and forty-two States provided

sufficient data to compute individual State estimates. National estimates could not be

calculated because of the large amount of unreported data. Reporting of breastfeeding

data improved significantly in PC98, though States continued to have some difficulty.

Sixty-three States, representing approximately 85 percent of all infants, reported

sufficient data to calculate a national estimate of breastfeeding initiation. Only

individual State estimates of breastfeeding duration could be calculated due to the large

amount of unreported data on this variable.

Food package codes describe the contents of food packages or food prescriptions issued

to WIC participants during the month of April 1998. All States were able to provide

this information and national estimates are calculated.

The 1998 Study of WIC For the reference month of April 1998, each State WIC agency submitted MDS data

Participant and Program on a census of its WIC participants. The final PC98 dataset encompasses informaCharacteristics tion on all individuals enrolled in the WIC Program as of the reference month.

Enrollment is defined as individuals certified to receive WIC benefits for specific time

periods, including individuals who did not claim or use the food instruments issued

during those time periods. Many studies of the WIC Program have reported

participation measured by the numbers of individuals who received and cashed food

instruments during designated time periods. Similarly, FNS administrative data on

WIC participation are based on voucher redemption. Comparing April 1998

redemption data (7,418,120 participants) with April 1998 enrollment data (8,042,758

enrollees) suggests that approximately 92 percent of WIC enrollees pick up and spend

their monthly benefits. PC96 findings were similar.
Chapter One: Introduction to PC98 11

Exhibit 1.4

Minimum Data Set Variables and Definitions

For biennial reports on WIC participant and program characteristics, the term “participant” means a person

on WIC master lists or a person listed in WIC operating files who is certified to receive WIC benefits in April

1998.

The data items should reflect the participant's status on each item at the time of the most recent WIC

Program certification as of April 1998. However, as a convenience to State agencies that do not maintain

historical files and that update the information in their automated systems during certification periods, current

information that is on the file for each participant in April 1998 will be accepted.

1. State Agency ID A unique number that permits linkage to the WIC State agency where the

participant was certified.

2. Local Agency ID A unique number that permits linkage to the local agency where the participant

was certified as eligible for WIC benefits.

or

Service Site ID A unique number that permits linkage to the service site where certified.

Either local agency ID or service site ID may be reported according to the

level the State Agency feels appropriate. At a minimum, State agencies must

provide agency names and addresses for each ID provided on their files.

3. Case ID A unique record number for each participant which maintains individual

privacy at the national level.

General

Instructions

Participant or Case IDs for each participant should continue to maintain

individual privacy at the national level. States are requested to generate these

IDs in the same manner that was applied for PC92 to allow longitudinal

tracking of participant characteristics. This task can be accomplished by

applying the PC92 algorithm to construction of PC98 participant IDs.

4. Date of Birth Month, day, and year of participant's birth reported in MMDDYYYY format.

5. Race/Ethnicity The classification of the participant into one of the five (5) racial/ethnic

categories: white; black; Hispanic; American Indian or Alaskan Native; or

Asian or Pacific Islander. The ethnic categories, white and black, include only

those persons who are not of Hispanic origin.

6a. Certification

Category

The category—one of five (5) possible categories—under which a person is

certified as eligible for WIC benefits: pregnant woman; breastfeeding woman;

postpartum woman (not breastfeeding); infant (under 12 months); or child (12-

59 months).

6b-c. Expected Date

of Delivery or

Weeks

Gestation

For pregnant women, the projected date of delivery (MMDDYYYY format)

or the number of weeks since the last menstrual period as determined at WIC

Program certification.
Chapter One: Introduction to PC98 12

Exhibit 1.4 (continued)

7. Date of

Certification

The date the person was declared eligible for the most current WIC Program

certification as of April 1998. Month, day, and year should be reported in

MMDDYYYY format.

8. Sex For infants and children, male or female.

9. Priority Level Participant priority level for WIC Program certification at the time of the

most recent WIC Program certification as of April 1998.

10a-c. Participation in

TANF/AFDC,

Food Stamps,

Medicaid

The participant's reported participation in each of these programs at the time

of the most recent WIC Program certification as of April 1998.

11. Migrant Status Participant migrant status according to the federal WIC Program definition

of a migrant farmworker (currently counted in the FNS 498 report).

12. Number in

Family or

Economic Unit

The number of persons in the family or economic unit upon which WIC

income eligibility was based. A self-declared number in the family or

economic unit may be reported for participants whose income was not

required to be determined as part of the WIC certification process. 

13a-c. Family or

Economic Unit

Income

1. For persons for whom income is determined during the certification

process, the income amount that was determined to qualify them for the

WIC Program during the most recent certification as of April 1998.

FNS will convert income expressed in different measures (weekly,

monthly, yearly, etc.) to annual amounts.

2. For descriptive purposes only, for participants whose income was not

required to be determined as part of the WIC Program certification

process, the self-reported income at time of certification. These

participants include adjunctively income-eligible participants (due to

TANF, Food Stamp Program, or Medicaid participation) and those

participants deemed income eligible under optional procedures available

to the State Agency in Federal WIC Regulations, Section

246.7(d)(2)(vi-viii) (means tested programs identified by the State for

automatic WIC Program income eligibility, income eligibility of Indian

and instream migrant farmworker applicants).

Zero should not be used to indicate income values that are missing or

not available. Zero should indicate only an actual value of zero.
Chapter One: Introduction to PC98 13

Exhibit 1.4 (continued)

14a-c. Nutritional

Risks Present at

Certification

The three highest priority nutritional risks present at the WIC Program

certification current in April 1998.

15a-b. Hemoglobin or

Hematocrit

That value for the measure of iron status that applies to the WIC Program

certification current in April 1998. It is assumed that the measure was

collected within sixty (60) days of the certification date.

16a-b. Weight The participant's weight measured according to the CDC nutrition

surveillance program standards [nearest one-quarter (1⁄4) pound]. If weight

is not collected in pounds and quarter pounds, weight may be reported in

grams.

17a-b. Height The participant's height (or length) measured according to the CDC nutrition

surveillance program standards [nearest one-eighth (c) inch]. If height is not

collected in inches and eighth inches, height may be reported in centimeters.

18. Date of Height

and Weight

Measure

The date of the height and weight measures that were used during the most

recent WIC Program certification period as of April 1998 in MMDDYYYY

format.

19a. Currently

Breastfed

For infant participants between the ages of seven and eleven months in April

1998, whether or not the participant is currently receiving breastmilk. 

19b. Ever Breastfed For infants between the ages of seven and eleven months in April 1998,

whether or not the infant was ever breastfed.

19c. Length of Time

Breastfed 

For infants between the ages of seven and eleven months in April 1998, the

number of weeks the infant received breastmilk. 

19d. Date

Breastfeeding

Data Collected 

For infants between the ages of seven and eleven months in April 1998, the

date on which breastfeeding status was reported in MMDDYYYY format.

20a-j. Food Packages The food package code(s) for the WIC food package or for all food

instruments prescribed for the participant during the month of April 1998.
Chapter One: Introduction to PC98 14

In April 1998, there were eighty-eight State WIC agencies: the fifty States, American

Samoa, the District of Columbia, Guam, Puerto Rico, and the American Virgin Islands,

along with thirty-three Indian Tribal Organizations (ITOs). PC98 data were submitted

by 100 percent of State WIC agencies, and all agencies reported on censuses of their

WIC participants. PC98 describes more than 8 million individuals certified as eligible

for WIC benefits in April 1998. Actual WIC enrollment by State is mapped in Exhibit

1.5.

The State-maintained automated information systems that are the sources of data for

PC98 do not always contain complete information on every individual enrolled in the

WIC Program. To account for this anomaly, all of the tables in this publication include

columns or rows labeled not reported. These figures indicate the numbers and

percentages of WIC participants for whom States could not provide information on

specific items. 

Most State agencies provided information on each MDS item— with the exception of

breastfeeding data—for each participant. However, unreported data should be

addressed for several other items. PC98 contains data on participation in other

programs for about 90 percent of the participants in the database, a decrease of 5

percentage points from 1996. Data on income were submitted for 85 percent of the 8

million WIC participants. The decline in income reported between PC96 and

PC98—from 90 to 85 percent—can be primarily attributed to a large decrease in

income reporting for the State of Texas. In PC96, Texas reported income for 86

percent of its WIC participants; in PC98 Texas reported income for only 40 percent of

WIC. Income reporting for migrant households showed a larger decrease (84 percent

to 22 percent) than did nonmigrant household reporting (87 percent to 41 percent).

Five other State WIC agencies—Florida, Indiana, Michigan, Virginia, and Mississippi

Band of Choctaw Indians—also affected the income reporting rate by providing

income data for under 70 percent of their WIC participants. All these States, except

Florida, had similar difficulties reporting income data in 1996. In addition, in some

instances, information on blood measurements may be absent from a State database.

WIC regulations permit clinics to dispense with blood tests for infants under six

months of age, as well as for children within normal ranges at their most recent prior

certifications.

PC98 data may be unreported for a variety of reasons, some of which may indicate that

participants in the not-reported category may be different from those individuals with

data reported. As noted above, assumptions regarding missing data vary by the nature

of the variable and by WIC participant category. To account for these anomalies, a

uniform strategy has been adopted for preparing all tables in this report. Data not

reported are included in the calculation of percentage distributions for each

characteristic. While including missing data in the denominators for all calculations

tends to place estimates for each characteristic at a lower bound, this approach has

allowed consistent presentation of tabulations throughout the report. Further, it assures

that all information needed to calculate upper-bound estimates is readily available in

every table. Caution should be used in comparing results across groups; missing data

must always be considered in gauging differences among groups or categories of WIC

participants.

The specifications for the 1998 study of WIC participant and program characteristics

included a sixteen-item Supplemental Data Set (SDS). Included in this dataset are such

items as birthweight, birth length, and source of prenatal care (Exhibit 1.6). Sixty-three
Exhibit 1.5

WIC Enrollment, April 1998

United States

WIC Enrollment by State

220,000 to 1,350,000 (10)

120,000 to 220,000

70,000 to 120,000 (10)

30,000 to 70,000 (9)

10,000 to 30,000 (10)

ITOs included in State totals.

Fewer than 10,000 not shown on map.

 (11)
Chapter One: Introduction to PC98 16

Exhibit 1.6

Supplemental Data Set Variables and Definitions

For biennial reports on WIC participant and program characteristics, the term participant means a person on

WIC master lists or a person listed in WIC operating files who is certified to receive WIC benefits in April

1998.

The data items should reflect the participant's status on each item at the time of the most recent WIC

Program certification as of April 1998. However, as a convenience to State agencies that do not maintain

historical files and that update the information in their automated systems during certification periods, current

information that is on the file for each participant in April 1998 will be accepted.

21. Date of First WIC

Certification 

Date the participant was first certified for the WIC Program in

MMDDYYYY format. For pregnant, breastfeeding and postpartum women

this applies to the current/most recent pregnancy and not to prior

pregnancies.

22. Education Level For pregnant, breastfeeding and postpartum women, the highest grade or

year of school completed. For infants and children, the highest grade or year

of school completed by mother or primary caretaker.

23. Number in

Household in WIC 

The number of people in the participant's household receiving WIC benefits.

24. Source of Prenatal

Care 

For pregnant, breastfeeding and postpartum women, source of care for

current/most recent pregnancy.

25. Date When Prenatal

Care Began 

For pregnant, breastfeeding and postpartum women, the date when prenatal

care began for the most recent pregnancy in MMDDYYYY format.

26. Date Previous

Pregnancy Ended 

For pregnant women, the date that the previous pregnancy ended in

MMDDYYYY format.

27. Total Number of

Pregnancies 

For pregnant women, the total number of times the woman has been

pregnant, including this pregnancy, all live births and any pregnancies

resulting in miscarriage, abortion or stillbirth.

28. Total Number of

Live Births 

For pregnant women, the total number of babies born alive to this woman,

including babies who may have died shortly after birth.
Chapter One: Introduction to PC98 17

Exhibit 1.6 (continued)

29a-b. Prepregnancy

Weight 

For pregnant women only, the participant's weight immediately prior to

pregnancy. Prepregnancy weight may be reported either in pounds and

ounces, or in grams.

30a-b. Weight Gain During

Pregnancy 

For breastfeeding and postpartum women, the participant's weight gain

during pregnancy as taken immediately at or prior to delivery. Weight

gain during pregnancy may be reported in either pounds and ounces, or

in grams.

31a-b. Birth Weight For infants and children, the participant's weight at birth measured

according to CDC nutrition surveillance program standards (lbs/ounces).

Birth weight may be reported in either pounds and ounces, or in grams.

32a-b. Birth Length For infants and children, the participant's length measured according to

CDC nutrition surveillance program standards (nearest c inches). Birth

length may be reported in either inches and eighth inches, or in

centimeters.

33. Date of Last

Routine Checkup or

Immunization 

Month, day, and year of the last routine check-up or immunization for

infants and children reported in MMDDYYYY format.

34. Length of Time

Mother on WIC

During Pregnancy 

For infant participants, the length of time mother was on WIC during this

infant's prenatal period.

The following items may be reported at the discretion of individual States.

35. Erythrocyte

Protoporphyrin 

That value for the measure of iron status that applies to the WIC Program

certification current in April 1998.

36. Participation in the

Food Distribution on

Indian Reservations

Program

The participant's reported participation in this program at the time of the

most recent WIC Program certification as of April 1998.
The two largest States—California and Texas—did not report any SDA data, which limits 3

the completeness of SDS reporting.

Chapter One: Introduction to PC98 18

(75 percent) provided some SDS data for PC98—an increase from PC96 when fiftyfive States provided some data. For PC98, eleven SDS items were reported by at least 3

half of the 63 States reporting SDS data. No States reported every SDS item for every

participant. The most frequently reported SDS item was birthweight, submitted by

sixty State agencies. The limited amount and incompleteness of SDS data preclude

computation of national estimates. Appendix F of this report presents a series of tables

reporting State-level data for those States submitting SDS information. A list of State

agencies supplying SDS data is also included in the appendix.

PC98 Summary of State The 1998 study, like earlier studies, included a survey of State WIC agencies to obtain

Programs information on WIC program characteristics. For PC98, each State WIC agency was

mailed a computer-generated paper copy of its responses to the PC96 Summary of

State Programs (SSP). State respondents were asked to confirm or revise their 1996

responses. A copy of the Summary of State Programs (SSP) appears in Appendix A.

Data were collected on: 

• Operating policies and procedures of State WIC agencies

with regard to income determination, food package tailoring,

and food instrument issuance.

• Average monthly food package costs by participant category.

• Nutritional risk criteria established by State WIC agencies

including standards for hemoglobin and hematocrit values as

well as methods for obtaining dietary intake information.

All of the eighty-eight State WIC agencies operating in April 1998 completed

questionnaires. Each of the eighty-eight reporting agencies provided information on

every item in the questionnaire. 

PC98 Summary of Local PC98, like PC96, included a mail survey of local WIC agencies. The purpose was to

Programs obtain information on local-level WIC programs and services. In PC98, the Summary

of Local Programs (SLP), was mailed to a representative sample of 422 WIC agencies.

A copy of the SLP appears in Appendix A. Data were collected on:

• Sponsoring agencies and service areas

• WIC services

• Allocation of WIC funds

• Income verification and documentation policies

• Outreach activities

• Recording nutritional risks

• Nutrition education practices

• Breastfeeding promotion and education

• Languages available

• Referral procedures to health and social services

• Clinic accessibility

• Adequacy of staff and physical space.
The PC98 and NSWP samples were drawn independently and can be combined, with

4

appropriate adjustments to statistical weights, to yield a larger analytic sample. PC98 included several

questions on anemia screening and maintenance of ineligible applicant records not included in the

NSWP.

Chapter One: Introduction to PC98 19

The PC98 local agency sample is longitudinal, that is, PC98 surveyed the same

agencies as did PC96. For the 1998 survey, this longitudinal sample was supplemented

with a sample of agencies that came into existence after the PC96 sample was selected.

The local agency survey uses a proportionate-stratified random design. Stratifying

variables included FNS region, size of local agency, percent of participants receiving

TANF, percent of participants below the poverty level, percent Hispanic participants,

and nutritional risk priorities. Stratification helps to ensure the “representativeness”

of the sample. In addition, the twenty-six largest local agencies in the US were

included in the sample with certainty. These agencies represent only 1 percent of all

local WIC agencies, but they account for about 20 percent of total WIC participants.

Given this latter statistic, we wanted to ensure that these agencies were included in the

sample. The remaining local agencies were randomly selected within each stratum.

This design is appropriate because the objectives of the analysis are computing both

local agency and participant-weighted local agency estimates.

A large number (407 or 96 percent) of local agencies completed their SLPs. In this

report, PC98 survey responses are supplemented by fifty-three additional surveys from

the National Survey of WIC Participants and Their Local Agencies (NSWP). The

NSWP, conducted by Abt, used a questionnaire identical to PC98 and also referenced

local agency operations in April 1998. Including these surveys increases the precision

of PC98 local agency analyses. Because information on local WIC is based on

4

responses from a sample of local WIC agencies, these findings are estimates. Unlike

the PC98 participant findings, these results do not represent a census of local WIC

agencies. Responses are weighted to reflect the universe of local WIC agencies.

Standard errors are calculated for all estimates and are presented in the tables.

Organization of This Chapters Two through Nine contain tabular presentations which display PC98 data

Report on WIC participants and programs. Tables are accompanied by limited text which is

provided only to explain WIC procedures or to distinguish changes in the

characteristics of WIC programs and participants that have occurred over time.

Chapter Two presents information on overall participation in the WIC Program as well

as information on WIC food packages and their costs. In Chapter Three, demographic

data on WIC participants are reported. Chapter Four offers information on State

procedures for determining income eligibility along with participation data on receipt

of benefits from programs other than WIC, household size, average annual income, and

percent of poverty of WIC households. Chapters Five and Six provide information on

nutritional risk, nutrition education at the local level, and breastfeeding. Chapter Seven

describes WIC priority groups while Chapter Eight contains information on migrant

WIC participants. Finally, Chapter Nine describes services in local WIC agencies.
%JCRVGT 6YQ 1XGTXKGY QH 2% 9+% 2CTVKEKRCVKQP CPF (QQF 2CEMCIG %QUVU 

2. OVERVIEW OF WIC PARTICIPATION AND FOOD PACKAGE

COSTS

During April 1998, there were 8,042,758 individuals enrolled in the WIC Program.

(See Exhibit 2.1.) Enrollment is defined as individuals certified to receive WIC

benefits in April 1998, including individuals who did not claim or use the food

instruments issued. This differs from the participation measure used in FNS

administrative data which is based on voucher redemption. Between 1992 and 1994,

the number of participants increased by 20 percent; participation then increased

another 12 percent between 1994 and 1996. While the number of WIC participants

grew between 1996 and 1998, the rate of increase (3.8 percent) was much lower than

in previous years. In most regions of the country, total WIC enrollment remained

essentially the same. The 3.8 percent increase in the number of WIC participants

nationwide can be primarily attributed to increases in the Western states, where the

net increase between 1996 and 1998 amounted to 13.1 percent. California alone

accounted for 58 percent of the national enrollment increase.

Following trends observed in previous years, there were some minor changes in the

distributions of WIC enrollment across participant categories between 1996 and

1998. The proportion of pregnant women declined from 13.6 percent in 1992 to 12.0

percent in 1994 and 11.3 percent in 1996. By 1998, this percentage had dropped to

11.1 percent. The proportion of infant enrollees has fallen from 30.1 percent in 1992

to 25.5 percent in 1998, while children now account for 51.2 percent of all WIC

participants—up from 47.5 percent in 1992. These changes are due in part to the

increased funding that has enabled States to serve more lower-priority individuals.

They may also be the result of income shifts (financial eligibility), changes in the

numbers of eligibles who apply, or the declining national birthrate. The proportion

of breastfeeding women rose steadily between 1992 and 1998. Between 1992 and

1994, this percentage increased from 3.6 percent to 4.0 percent; it then rose to 4.3

percent in 1996 and to 4.8 percent in 1998. 

Food Packages Issuance Seven food packages are defined by federal WIC regulations: two for infants which

are age-dependent; one for children or women with special dietary needs; one for

children aged one through four years; one for pregnant and breastfeeding women;

one for non-breastfeeding postpartum women; and an enhanced package for

breastfeeding women. FNS specifies the maximum amount of food allowed in each

package; State and local agencies may tailor food packages to achieve administrative

efficiencies or to meet the nutritional needs of individual WIC clients.

Administrative adjustments to WIC food packages include specifying package size,

brand, or form. Nutritional tailoring often focuses on specifying a form of infant

formula or changing food types to address the specific nutritional risks of individual

participants. Exhibits 2.2 and 2.3 provide information on food package tailoring

practices reported by States. No substantial changes in these practices were reported

between 1996 and 1998.

Most WIC participants receive food instruments (either vouchers or checks for use

in retail grocery stores) that contain information on type and amount of food and may

include information on maximum allowable cost. A food instrument is designated

a voucher or check to indicate the State's redemption process. States determine the
Chapter Two: Overview of PC98 WIC Participation and Food Package Costs 22

Exhibit 2.1

Distribution of WIC Participants by Participant Category in 1996 and 1998

Participant Category Number of Numbers of Percent

Participants Participants Change

1996 1998 1996-1998

Women

Pregnant women 877,747 892,674 +1.7%

Breastfeeding women 330,176 389,391 +17.9

Postpartum women 567,913 591,049 +4.1

Total women 1,775,837 1,873,115 +5.5

Infants 1,988,789 2,048,625 +3.0

Children 3,982,815 4,121,016 +3.5

US WIC 7,747,441 8,042,758 3.8

Distribution of WIC Participants by Participant Category

1992, 1994, 1996, 1998

Percent of Total WIC Participants

Participant Category 1992 1994 1996 1998

Women

Pregnant women 13.6% 12.0% 11.3% 11.1%

Breastfeeding women 3.6 4.0 4.3 4.8

Postpartum women 5.2 7.2 7.3 7.3

Total women 22.4 23.1 22.9 23.3

Infants 30.1 26.9 25.7 25.5

Children 47.5 50.2 51.4 51.2

US WIC 5,754,003 6,907,849 7,747,441 8,042,758

Note

For the biennial PC reports, participants are defined as persons on WIC master lists who are certified to receive WIC benefits in April

1998, including individuals who do not claim or use their food instruments. This differs from FNS administrative data in which participants

are defined as individuals who pick up or redeem their food vouchers.
Chapter Two: Overview of PC98 WIC Participation and Food Package Costs 23

Exhibit 2.2

Food Package Adjustment and Tailoring Practices Used by States

State Agencies

Adjustment/Tailoring Practices Number Percent

Only use maximum allowable federal food package 1 1.1

Adjustment for administrative efficiency 87 98.9

Brands of food are designated or disallowed 71 80.7

Size of food container is designated 76 86.4

Specific form of food (within a food group) is specified 69 78.4

Certain food types (from within a food category) are eliminated 29 33.0

Other methods (such as adding special foods) 11 12.5

Tailoring for participant nutritional needs 86 97.7

Type of milk is specified (to reduce fat, lactose, or calories) 68 77.3

Type of cheese is specified (to reduce fat) 25 28.4

Type of cereal is specified (to reduce sucrose) 10 11.4

Specific forms of formula are specified (ready-to-feed or powdered formula) 82 93.2

Amounts of certain food types are reduced (to reduce calories or nutrient intake for

weight control) 43 48.9

Amounts of certain food types are reduced (to meet age-related needs) 48 54.5

Amounts of milk and juice are reduced 13 14.8

Quantity of eggs is reduced (to reduce cholesterol) 17 19.3

A specific form of food is specified for the convenience of the participant

(powdered milk, juice concentrate) 72 81.8

Other methods (such as adjustments for food allergies) 22 25.0

Notes

Responses are not mutually exclusive, so percentages do not sum to 100 percent. Percentages are based on the number (88) of

reporting State WIC agencies.

WIC food instruments list specific foods up to maximum amounts for each month as defined in federal WIC regulations.
Chapter Two: Overview of PC98 WIC Participation and Food Package Costs 24

Exhibit 2.3

Food Package Tailoring Practices and Use of Standard Food Instruments

State Agencies

Standardized Instruments and Tailoring Number Percent

Standard food packages are available for specific 43 48.9%

categories of participants

Standard food instruments can be selected or 8 9.1

combined to create food packages for participants

Standard food instruments can be tailored by 28 31.8

marking choices or amounts of food types directly

on each food instrument

Standard food packages or food instruments are 8 9.1

not used. Each food package prescription is

individualized

Other methods of food tailoring 1 1.1 a

Total State WIC agencies 88 100.0%

Notes

WIC food instruments list specific foods up to maximum amounts for each month as defined in federal WIC regulations.

For more information on other methods of food tailoring, see Exhibit B2.3 in Appendix B. a
%JCRVGT 6YQ 1XGTXKGY QH 2% 9+% 2CTVKEKRCVKQP CPF (QQF 2CEMCIG %QUVU 

frequency of issuance for these food instruments, which are generally produced using

automated information systems at standard intervals. In most States, WIC

participants pick up food instruments at local WIC service sites. Information on State

and local agency issuance appears in Exhibit 2.4 and Exhibit 2.5, respectively.

A majority of State WIC agencies use the same food instrument issuance frequency

for all participant categories—89 percent of State WIC agencies report using the

same issuance frequency for all non-high-risk participants; 53 percent report using

the same issuance frequency for high-risk participants. Among the 36 percent of

State WIC agencies where variation exists only for high-risk participants, more

frequent food issuance is used.

Most State WIC agencies offer either monthly or bimonthly issuance, with a higher

proportion using monthly issuance for at least one participant category. States are

more likely to use monthly issuance for high-risk participants, pregnant women and

breastfeeding women. Non-breastfeeding postpartum women, infants and children

are more likely to receive food instruments on a bimonthly basis. The trend toward

bimonthly issuance, observed in previous years, has continued, as has the increase

in the number of states distributing food packages every three months. Less frequent

issuance is seen by many States as administratively efficient and less burdensome for

WIC participants. Local agencies report more frequent use of bimonthly and

trimonthly issuance than do State agencies, indicating that local agencies are

concentrated in States with less frequent issuance (see Exhibit 2.5).

State-by-State information for Exhibits 2.1 through 2.4 appears in Appendix B of this

report.

Almost all local WIC agencies require clients to pick up their food instruments in

person; 89 percent do not routinely mail instruments to any participants (see Exhibit

2.6). Among the small percentage of agencies that do routinely mail food

instruments, most do not verify receipt (see Exhibit 2.7).

Food Packages Costs Information on costs of prescribed food packages for April 1998 is presented in

Exhibit 2.8. Costs by participant category are reported by State WIC agencies. Data

on average costs for all WIC participants are FY 1998 close-out food package costs

from the FNS national data bank. Regional estimates of average costs were

calculated using the average cost for each State weighted by the number of

participants in the State. The highest average cost before rebates appears in the

Northeast region, and the lowest average food package cost before rebates occurs in

the Mountain Plains. Taking into account rebates received by State WIC agencies,

highest average costs appear in the Mid-Atlantic region and lowest average costs

occur in the Southwest. (See Exhibit 2.9.)
Chapter Two: 1XGTXKGY QH 2% 9+% 2CTVKEKRCVKQP C

Exhibit 2.4Frequency of WIC Food Instrument Issuance Among State WIC Agencies

Issuance Patterns

Issuance Frequency

One month Two months Three months Other 

Number Percent Number Percent Number Percent Number Perce

Participant Category

Pregnant women 37 42.1% 31 35.2% 19 21.6% 1 1.1% 

b

Breastfeeding women 34 38.6 33 37.5 20 22.7 1 1.1 

b

Postpartum women 28 31.8 39 44.3 20 22.7 1 1.1 

b

Infants 30 34.1 37 42.1 20 22.7 1 1.1 

b

Children 28 31.8 39 44.3 20 22.7 1 1.1 

b

High-risk 65 73.9 37 42.1 14 15.9 1 1.1 c

Note

Responses for high-risk participants are not mutually exclusive, so row percentages do not sum to 100 percent. Percentages are based on the number (88) of 

a

In Georgia, one-half of the local agencies issue benefits on a monthly basis and one-half issue benefits on a bimonthly basis. b

 In Texas, food package issuance for high-risk participants is “highly variable.” c
Chapter Two: Overview of PC98 WIC Participation and Food Package Costs 27

Exhibit 2.5

Frequency of Food Instrument Issuance in Local WIC Agencies

Issuance Frequency

Participant Category One Two Three Not

month months months Other Reported Total

Percent of Local Agencies

Pregnant women 32.9% 35.7% 27.7% 1.0% 2.8% 100.0%

(2.19) (2.44) (2.10) (0.55) (0.94)

Breastfeeding women 22.3 41.6 31.0 1.1 4.0 100.0%

(2.11) (2.46) (2.09) (0.56) (0.98)

Postpartum women 16.9 44.4 34.4 1.0 3.3 100.0%

(1.96) (2.53) (2.15) (0.56) (0.97)

Infants 20.2 44.9 30.0 1.1 3.8 100.0%

(2.10) (2.56) (2.18) (0.56) (1.05)

Children 15.0 44.4 37.2 0.5 2.9 100.0%

(1.83) (2.42) (2.12) (0.39) (0.94)

High-risk 66.7 34.9 18.6 1.8 4.6 

(2.55) (2.54) (1.92) (0.70) (1.20)

a

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe of

2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

Responses for high-risk participants are not mutually exclusive, so row percentages do not sum to 100 percent. a
Chapter Two: Overview of PC98 WIC Participation and Food Package Costs 28

Exhibit 2.6

Frequency of Mailing Food Instruments in Local WIC Agencies

Mail Instruments

Participant Category Do not routinely mail to Every Every two Every three Do not mail to Not

any participants month months months participant category Reported

Percent of Local Agenciesa

Pregnant women 89.1% 3.2% 2.3% 1.2% 0.3% 4.1% 

(1.57) (1.05) (0.90) (0.56) (0.30) (1.70)

Breastfeeding women 89.1 3.2 2.4 1.2 0.3 4.1 

(1.57) (1.05) (0.90) (0.56) (0.30) (1.70)

Postpartum women 89.1 3.1 2.3 1.2 0.4 4.1 

(1.57) (1.04) (0.90) (0.56) (0.32) (1.70)

Infants 89.1 3.3 2.4 1.0 0.3 4.1 

(1.57) (1.09) (0.90) (0.53) (0.20) (1.70)

Children 89.1 3.2 2.3 1.2 0.3 4.1 

(1.57) (1.05) (0.90) (0.56) (0.30) (1.70)

All high-risk participants 89.1 1.6 1.9 1.3 0.5 5.6 

(1.57) (0.72) (0.84) (0.64) (0.30) (1.55)

Certain high-risk participants 89.1 2.0 1.6 0.5 0.4 6.4 

(1.57) (0.81) (0.88) (0.37) (0.28) (1.16)

Other 89.1 1.8 0.6 0.0 0.0 8.7 

(1.57) (0.77) (0.37) (0.00) (0.00) (1.52)

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe of 2,203 local agencies, the estimated universe of 8,932

service delivery sites, and the universe of 8,042,758 participants.

Rows may not sum to 100 percent because respondents were permitted multiple responses to frequency of instrument mailing. a
Chapter Two: Overview of PC96 WIC Participation and Food Package Costs 29

Exhibit 2.7

Verification of Food Instrument Receipt by Local Agencies

Verification Procedures Percent of Local Agencies

Do not mail food instruments 89.1% 

(1.57)

Do not verify receipt of mailed instruments 6.6 

(1.34)

Instruments mailed via registered mail with return receipt 1.4 

(0.65)

Verify receipt with telephone call 0.6 

(0.42)

Other method of verification 1.6 

(0.90)

Not reported 0.6 

(0.39)

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe of

2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.
Chapter Two: Overview of PC98 WIC Participation a

Exhibit 2.8Estimated Average Cost of Food Packages by Participant Category, Region, and State for Geographic State WIC Agencie

Outlays in Dollars for April 1998

Region/State Women Women Women Women Before Rebates Rebates Children Participants Before 

All Pregnant Breastfeeding Postpartum All Infants All Infants After Average for All 

US WICMean $47.03 NortheastMean 48.81 Connecticut N/A N/A N/A N/A N/A N/A N/A 47.70 Maine N/A N/A N/A N/A N/A N/A N/A 39.29 Massachusetts $32.90 $36.53 $38.01 $23.34 $77.18 $13.76 $32.12 42.15 New Hampshire N/A N/A N/A N/A N/A N/A N/A 39.83 New York 44.85 N/A N/A N/A 89.63 24.24 39.73 52.14 Rhode Island 32.80 35.14 40.42 26.33 82.02 19.29 33.52 44.72 Vermont 49.82 49.88 51.06 37.82 15.05 15.05 52.38 33.38 

a a a a a a,b a 

Indian Township (ME) N/A N/A N/A N/A N/A N/A N/A 42.80 Pleasant Point (ME) N/A N/A N/A N/A N/A N/A N/A 45.34 Seneca Nation (NY) N/A N/A N/A N/A N/A N/A N/A 43.15 Mid-Atlantic

Mean 48.74 Delaware N/A N/A N/A N/A N/A N/A N/A 46.02 District of Columbia 39.46 90.76 33.71 18.73 91.23 21.52 38.64 53.84 Maryland N/A N/A N/A N/A N/A N/A N/A 49.91 New Jersey N/A N/A N/A N/A N/A N/A N/A 42.34 Pennsylvania 34.37 36.49 40.49 30.85 82.61 21.26 36.21 45.26 Puerto Rico N/A N/A N/A N/A N/A N/A N/A 58.94 Virginia N/A N/A N/A N/A N/A N/A N/A 46.89 Virgin Islands N/A N/A N/A N/A N/A N/A N/A 58.45 West Virginia N/A N/A N/A N/A N/A N/A N/A 42.65 

NotesFood package costs by participant category provided by State WIC agencies. Average costs for all participants are FY1998 close-out food package costs from FNS national data bank.N/A = Not available.

Estimated average monthly cost.

a

Agency does not receive rebates. 

b
Exhibit 2.8 (continued)

Estimated Average Cost of Food Packages by Participant Category, Region, and State for Geographic State WIC Agencie

Outlays in Dollars for April 1998

Region/State Women Women Women Women Before Rebates Rebates Children Participants Before 

All Pregnant Breastfeeding Postpartum All Infants All Infants After Average for All 

Chapter Two: Overview of PC98 WIC Participation a

Southeast

Mean $46.09 

Alabama $42.92 N/A N/A N/A $92.90 $32.84 $40.68 52.05 

a a aa

Florida 37.76 $39.31 $40.98 $32.51 90.35 27.26 35.60 50.12 Georgia 36.34 31.62 32.19 21.32 91.47 34.24 30.73 45.08 

aa a a a a a

Kentucky 31.70 34.57 34.57 25.96 132.70 53.67 32.53 44.74 Mississippi N/A N/A N/A N/A N/A N/A N/A 29.41 North Carolina 30.97 33.96 37.94 23.50 83.60 21.57 30.61 44.89 South Carolina N/A N/A N/A N/A N/A N/A N/A 45.91 Tennessee 36.29 39.29 46.74 29.31 100.37 27.24 36.70 47.68 Eastern Band-Cherokee (NC) N/A N/A N/A N/A N/A N/A N/A 35.91 Mississippi Choctaw 24.52 24.30 34.64 14.63 14.12 14.12 23.90 24.95 

a a a a a a,b a 

Midwest

Mean 46.80 Illinois N/A N/A N/A N/A N/A N/A N/A 52.67 Indiana 36.76 40.06 40.06 32.11 97.84 15.71 34.26 46.91 Michigan N/A N/A N/A N/A N/A N/A N/A 47.42 Minnesota N/A N/A N/A N/A N/A N/A N/A 44.57 Ohio 27.88 30.35 32.65 22.48 78.19 48.17 28.68 42.38 Wisconsin 36.37 40.24 40.24 30.72 103.55 26.60 33.62 44.68 

NotesFood package costs by participant category provided by State WIC agencies. Average costs for all participants are FY1998 close-out food package costs from FNS national data bank.N/A = Not available.

Estimated average monthly cost. a

Agency does not receive rebates. b
Exhibit 2.8 (continued)

Estimated Average Cost of Food Packages by Participant Category, Region, and State for Geographic State WIC Agencie

Outlays in Dollars for April 1998

Region/State Women Women Women Women Before Rebates Rebates Children Participants Before 

All Pregnant Breastfeeding Postpartum All Infants All Infants After Average for All 

Chapter Two: Overview of PC98 WIC Participation a

Southwest

Mean $45.48 

Arkansas $33.04 $35.07 $37.55 $28.15 $98.71 $29.49 $31.49 49.37 

aa a a a a a

LouisiaN/A 43.18 45.48 44.95 36.80 102.64 31.70 41.40 55.06 

a a

New Mexico N/A N/A N/A N/A N/A N/A N/A 42.45 Oklahoma N/A N/A N/A N/A N/A N/A N/A 42.80 Texas 28.80 30.77 32.70 24.11 84.18 14.18 30.04 43.72 

aa a a a a a

ACL WIC (NM) N/A N/A N/A N/A N/A N/A N/A 36.20 Cherokee Nation (OK) N/A N/A N/A N/A N/A N/A N/A 44.05 Chickasaw Nation (OK) 33.82 40.34 39.35 33.50 94.51 20.63 23.52 46.57 Choctaw Nation (OK) N/A N/A N/A N/A N/A N/A N/A 47.70 Citizen-Potawatomi (OK) N/A N/A N/A N/A N/A N/A N/A 50.27 Eight Northern Pueblos (NM) N/A N/A N/A N/A N/A N/A N/A 39.59 Five Sandoval Pueblos (NM) N/A N/A N/A N/A N/A N/A N/A 44.38 ITC-Oklahoma N/A N/A N/A N/A N/A N/A N/A 43.64 Muscogee Creek Nation (OK) 39.65 37.41 50.89 30.66 98.42 39.03 41.63 45.42 

aa a a a a a

Osage Nation (OK) N/A N/A N/A N/A N/A N/A N/A 36.91 Otoe-Missouria (OK) N/A N/A N/A N/A N/A N/A N/A 39.17 Pueblo of Isleta (NM) N/A N/A N/A N/A N/A N/A N/A 35.52 Pueblo of San Felipe (NM) 39.73 37.96 43.78 32.31 43.38 43.38 35.28 37.42 

b 

Pueblo of Zuñi (NM) N/A N/A N/A N/A N/A N/A N/A 44.11 Sac and Fox Nation (OK) 16.72 20.62 12.23 17.30 97.95 92.83 17.51 46.39 

aa a a a a a

Santo Domingo (NM) N/A N/A N/A N/A N/A N/A N/A 43.09 WCD (OK) 29.17 29.87 38.88 21.96 93.61 52.43 29.50 48.30 NotesFood package costs by participant category provided by State WIC agencies. Average costs for all participants are FY1998 close-out food package costs from FNS national data bank.N/A = Not available.

Estimated average monthly cost. a

Agency does not receive rebates. b
Exhibit 2.8 (continued)

Estimated Average Cost of Food Packages by Participant Category, Region, and State for Geographic State WIC Agencie

Outlays in Dollars for April 1998

Region/State Women Women Women Women Before Rebates Rebates Children Participants Before 

All Pregnant Breastfeeding Postpartum All Infants All Infants After Average for All 

Chapter Two: Overview of PC98 WIC Participation a

Mountain Plains

Mean $43.13 

Colorado $35.49 $35.17 $41.19 $28.66 $72.92 $46.37 $34.88 44.11 Iowa 29.82 32.38 34.25 24.20 83.44 35.56 31.20 42.46 

aa a a a a a

Kansas 31.00 33.05 35.58 25.37 88.88 N/A 31.88 44.47 Missouri 41.94 46.53 46.53 35.52 84.95 10.24 41.39 42.45 

aa a a a a a

Montana N/A N/A N/A N/A N/A N/A N/A 41.20 Nebraska 31.74 33.60 37.23 26.22 87.16 25.70 33.31 46.29 North Dakota 37.04 38.80 41.85 27.94 86.73 32.73 32.08 45.09 South Dakota N/A N/A N/A N/A N/A N/A N/A 39.73 Utah 44.64 43.34 51.15 36.82 104.80 17.16 40.67 42.70 

aa a a a a a

Wyoming 50.85 49.42 59.85 43.28 59.05 9.34 44.88 40.06 

aa a a a a a

Cheyenne River Sioux (SD) 30.94 29.93 32.92 29.97 86.37 86.37 31.66 51.03 

b 

Omaha-Santee Sioux (NE) N/A N/A N/A N/A N/A N/A N/A 47.05 Rosebud Sioux (SD) N/A N/A N/A N/A N/A N/A N/A 48.03 Shoshone-Arapahoe (WY) N/A N/A N/A N/A N/A N/A N/A 43.33 Standing Rock Sioux (ND) N/A N/A N/A N/A N/A N/A N/A 49.67 Three Affiliated (ND) 42.93 43.95 44.73 39.99 101.37 85.67 40.11 52.76 Ute Mountain Ute (CO) 30.57 26.45 28.47 36.81 69.87 69.87 30.91 40.70 

b 

Winnebego (NE) N/A N/A N/A N/A N/A N/A N/A 46.79 NotesFood package costs by participant category provided by State WIC agencies. Average costs for all participants are FY1998 close-out food package costs from FNS national data bank.N/A = Not available.

Estimated average monthly cost. a

Agency does not receive rebates. b
Exhibit 2.8 (continued)

Estimated Average Cost of Food Packages by Participant Category, Region, and State for Geographic State WIC Agencie

Outlays in Dollars for April 1998

Region/State Women Women Women Women Before Rebates Rebates Children Participants Before 

All Pregnant Breastfeeding Postpartum All Infants All Infants After Average for All 

Chapter Two: Overview of PC98 WIC Participation a

WesternMean $48.30 Alaska N/A N/A N/A N/A N/A N/A N/A 50.45 American Samoa $59.24 $59.52 $59.65 N/A $76.58 $64.98 $57.48 60.27 Arizona 40.55 43.74 43.74 $34.18 95.63 17.32 39.76 48.64 

aa a a a a a

California 43.65 45.35 47.59 42.37 82.76 20.43 38.56 48.82 Guam N/A N/A N/A N/A N/A N/A N/A 66.03 Hawaii 43.50 45.00 45.00 40.00 103.50 50.00 43.00 58.08 

aa a a a a a

Idaho N/A N/A N/A N/A N/A N/A N/A 39.09 Nevada N/A N/A N/A N/A N/A N/A N/A 45.71 Oregon 42.33 N/A N/A N/A 86.70 9.97 36.63 42.10 Washington N/A N/A N/A N/A N/A N/A N/A 45.63 ITC-Arizona 41.48 44.05 44.05 36.19 98.85 20.94 41.89 42.80 ITC-Nevada N/A N/A N/A N/A N/A N/A N/A 45.56 Navajo Nation (AZ) N/A N/A N/A N/A N/A N/A N/A 57.73 NotesFood package costs by participant category provided by State WIC agencies. Average costs for all participants are FY1998 close-out food package costs from FNS national data bank.N/A = Not available.

Estimated average monthly cost. a

Agency does not receive rebates. b
Exhibit 2.9

Estimated Average Food Package Costs After Rebate by Region

$33.22

$35.08

$30.66 $30.17

$27.73

$30.63

$34.01

$0.00

$10.00$20.00$30.00$40.00$50.00

Food Package Cost

Northeast Mid-Atlantic Southeast Midwest Southwest Mountain

Plains

West

WIC Region

Chapter Two: Overview of PC98 WIC Participation a
If we assume that the distribution was the same for participants with missing data, 1

enrollment in the first trimester was 37.0 percent in 1992, 43.4 percent in 1994, 47.0 percent in 1996,

and 48.4 percent in 1998.

%JCRVGT 6JTGG &GOQITCRJKEU QH 2% 9+% 2CTVKEKRCPVU 

3. DEMOGRAPHICS OF WIC PARTICIPANTS

Demographic items in the Minimum Data Set are age, trimester of enrollment during

pregnancy, and race/ethnicity of WIC enrollees in April 1998. These data are

displayed in Exhibits 3.1 through 3.7.

For PC98, States reported age data on 99 percent of women, infants, and children

enrolled in the WIC Program. Across 1992, 1994, 1996, and 1998, there were

virtually no changes in the age distribution of WIC women. Most WIC women (84

percent) are between the ages of eighteen and thirty-four. While the age distributions

for pregnant and postpartum women are similar, breastfeeding women appear to be

older, with 11 percent over thirty-four years of age. Almost 90 percent of all WIC

infants fall into the zero-to-three-month-old age group at time of certification in 1998.

The clustering of infants in the zero-to-three-month-old category has increased

steadily since 1992 when 76 percent of infants were less than three months old at

certification. Between 1992 and 1996, the age distribution of children showed slight

shifts to the older ages. During that period, enrollment of children three years or

older increased by eight percentage points from 30 percent to 38 percent. The age

distribution of children in 1998 was similar to the 1996 distribution.

In 1998, more pregnant WIC participants enrolled in the program during their first

than second trimesters, with 46.6 percent in the first trimester and 37.8 percent in the

second. Only 11.8 percent enrolled in the third trimester. These percentages are

similar to those reported in 1996. Data to calculate trimester of enrollment were

reported for 96.2 percent of pregnant WIC enrollees. A change between PC92/PC94

and PC96/PC98 is the increase in data reported. For earlier PCs, information on

trimester of enrollment was not reported for 10 percent of pregnant women. Because

such data were unavailable for a large proportion of pregnant WIC clients in 1992

and 1994, estimates for these years should be seen as lower bounds. The overall 1

increase in first-trimester enrollments may indicate that WIC's outreach to pregnant

women and promotion of early prenatal enrollment are successful efforts.

The Western region, driven by California, has experienced the largest increase in

WIC participants in every period since 1992. Enrollment grew from approximately

800,000 in 1992 to almost 2,000,000 in 1998. As a result of this rapid growth, the

Western region’s share of WIC participants increased steadily from 14.3 percent of

total participants in 1992 to 18.2 percent in 1994, 21.8 percent in 1996 and to 23.8

percent in 1998. Enrollment has grown in all other regions since 1992, though at a

lower rate than in the Western region.

Between 1996 and 1998, the Western region was the only region that experienced

substantial growth in enrollment. WIC enrollment in the Southwest and Mountain

Plains actually decreased slightly between 1996 and 1998. Enrollment was

essentially stable in the remaining regions over the last two years. Within all regions,
Chapter Three: Demographics of PC98 WIC Participants 38

Exhibit 3.1

Distribution of Age of WIC Participants at Certification by WIC Participant Category 1994, 1996,

1998

Participant Category and Age 1994 1996 1998

at Certification

Percent by participant category

Pregnant women 823,604 877,747 892,674

Under 15 years 1.0% 0.9% 0.8%

15 - 17 years 11.2 10.7 10.1

18 - 34 years 81.7 82.3 83.1

35 or more years 5.0 5.4 5.8

Age not reported 1.0 0.7 0.2

Breastfeeding women 275,158 330,176 389,391

Under 15 years 0.2% 0.2% 0.2%

15 - 17 years 4.0 4.2 4.1

18 - 34 years 83.7 84.9 84.6

35 or more years 9.6 10.5 10.7

Age not reported 2.5 0.2 0.5

Postpartum women 491,998 567,913 591,049

Under 15 years 0.7% 0.6% 0.5%

15 - 17 years 9.6 9.7 8.9

18 - 34 years 83.0 83.5 83.9

35 or more years 5.1 5.8 6.0

Age not reported 1.6 0.4 0.6

Total women 1,590,762 1,775,837 1,873,115

Under 15 years 0.8% 0.7% 0.6%

15 - 17 years 9.5 9.2 8.5

18 - 34 years 82.5 83.2 83.7

35 or more years 5.8 6.5 6.9

Age not reported 1.5 0.5 0.4

Infants 1,852,455 1,988,789 2,048,625 a

0 - 3 months 84.2% 86.1% 88.4%

4 - 5 months 3.1 3.3 2.7

6 - 8 months 7.2 7.3 6.3

9 - 11 months 2.6 3.1 2.4

Age not reported 3.0 0.2 0.2

Children 3,464,631 3,982,815 4,121,016 b

1 year 40.0% 35.7% 35.6%

2 years 24.6 25.9 25.1

3 years 19.9 22.5 22.3

4 years 12.7 15.6 16.2

Age not reported 2.9 0.2 0.8

US WIC 6,907,848 7,747,441 8,042,758

Notes

An infant is defined as a participant who, at certification, is under one year of age and who would be classified as a child at the age of 366 days. a

In 1998, about 3.2 percent of one-year-old children are eleven-month-old infants who have been recertified as children; about 0.1 percent of WIC b

participants who are classified as infants are participants who are older than 366 days. In 1996, these figures were 7.8 percent and 0.2 percent,

respectively. In 1994, they were 12.8 percent and 0.1 percent, respectively.
Chapter Three: Demographics of PC98 WIC Participants 39

Exhibit 3.2

Distribution of Pregnant Women WIC Participants by Trimester of Enrollment

1994, 1996, 1998

1994 1996 1998

Trimester of Enrollment Number Percent Number Percent Number Percent

First trimester 320,085 38.9% 400,023 45.6% 415,983 46.6%

Second trimester 330,020 40.1 357,785 40.8 337,089 37.8

Third trimester 88,370 10.7 94,583 10.8 105,452 11.8

Trimester not reported 85,128 10.3 25,355 2.9 34,148 3.8

Total pregnant women 823,604 100.0% 877,747 100.0% 892,674 100.0%
Chapter Three: Demographics of PC98 WIC Participants 40

Exhibit 3.3

Distribution of WIC Participants by Region

1994, 1996, 1998

1994 1996 1998

Region Number Percent Number Percent Number Percent

Northeast 780,779 11.3% 800,630 10.3% 808,228 10.0%

Mid-Atlantic 931,463 13.5 976,845 12.6 979,446 12.2

Southeast 1,348,329 19.5 1,474,359 19.0 1,531,268 19.0

Midwest 1,091,716 15.8 1,130,068 14.6 1,143,477 14.2

Southwest 987,720 14.3 1,153,862 14.9 1,149,662 14.3

Mountain Plains 511,977 7.4 520,548 6.7 517,839 6.4

Western 1,255,861 18.2 1,691,128 21.8 1,912,837 23.8

US WIC 6,907,848 100.0% 7,747,441 100.0% 8,042,758 100.0%
Chapter Three: Demographics of PC98 WIC Participants 41

Exhibit 3.4

Distribution of Racial and Ethnic Characteristics of WIC Participants by Participant

Category

Racial or Ethnic Pregnant Breastfeeding Postpartum Total Total WIC

Characteristics Women Women Women Women Infants Children Participants

Percent by participant category

American Indian or 1.4% 1.5% 1.2% 1.4% 1.3% 1.7% 1.5%

Alaskan Native

Asian or Pacific 2.8 3.4 3.1 3.0 3.1 3.4 3.2

Islander

Black 21.7 14.9 25.2 21.4 24.3 22.9 22.9

(non-Hispanic)

Hispanic 30.4 42.2 25.4 31.2 30.4 33.7 32.3

White 43.0 36.9 44.1 42.1 39.8 37.7 39.2

(non-Hispanic)

Race or ethnicity 0.8 1.0 1.0 0.9 1.0 0.7 0.8

not reported

Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

US WIC 892,674 389,391 591,049 1,873,115 2,048,625 4,121,016 8,042,758

Exhibit 3.5

WIC Participation by Race/Ethnicity
Chapter Three: Demographics of PC98 WIC Participants 42

Exhibit 3.6

Distribution of Racial and Ethnic Characteristics of WIC Women, Infants, and Children

1994, 1996, 1998

Women Infants Children Total WIC

Racial or Ethnic

Characteristic 1994 1996 1998 1994 1996 1998 1994 1996 1998 1994 1996 1998

American Indian or 1.5% 1.4% 1.4% 1.5% 1.4% 1.3% 1.9% 1.8% 1.7% 1.7% 1.6% 1.5%

Alaskan Native

Asian or Pacific 2.7 2.7 3.0 2.8 2.8 3.1 2.4 2.9 3.4 2.6 2.9 3.2

Islander

Black (non-Hispanic) 22.4 21.1 21.4 26.3 24.6 24.3 26.3 24.2 22.9 25.4 23.6 22.9

Hispanic 28.0 31.1 31.2 27.9 29.5 30.4 24.2 31.4 33.7 26.1 30.9 32.3

White (non-Hispanic) 44.5 43.0 42.1 40.8 40.7 39.8 42.8 39.1 37.7 42.7 40.4 39.2

Race or ethnicity not 0.9 0.6 0.9 0.8 0.9 1.0 2.3 0.6 0.7 1.6 0.7 0.8

reported

Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

US WIC 1,590,762 1,775,837 1,873,115 1,852,455 1,988,789 2,048,625 3,464,631 3,982,815 4,121,016 6,907,848 7,747,441 8,042,758
Chapter Three: Demographics of PC98 WIC Participants 43

Exhibit 3.7

Distribution of Racial and Ethnic Characteristics of WIC Participants by Region

Region Alaskan Native Islander (non-Hispanic) Hispanic (non-Hispanic) Not Reported Total WIC

American Asian or Race or

Indian or Pacific Black White Ethnicity

Percent by region Percent Number

Northeast 0.4% 4.7% 24.8% 28.9% 38.7% 2.4% 100.0% 808,228

Mid-Atlantic 0.2 1.7 27.3 33.2 37.4 0.2 100.0 979,446

Southeast 0.5 1.0 40.3 10.9 47.1 0.2 100.0 1,531,268

Midwest 0.8 2.3 27.7 12.2 56.0 1.1 100.0 1,143,477

Southwest 2.2 1.1 20.0 46.7 29.1 0.9 100.0 1,149,662

Mountain Plains 4.0 1.5 11.6 15.1 66.9 0.9 100.0 517,839

Western 2.8 7.5 7.9 58.4 22.7 0.8 100.0 1,912,837

US WIC 1.5% 3.2% 22.9% 32.3% 39.2% 0.8% 100.0%

Number of 121,139 260,036 1,842,107 2,596,165 3,155,604 67,704 8,042,758

Participants
%JCRVGT 6JTGG &GOQITCRJKEU QH 2% 9+% 2CTVKEKRCPVU 

many States experienced a levelling off or a small decline in enrollment between

1996 and 1998.

In 1998, 39.2 percent of all WIC participants were white, 32.3 percent were

Hispanic, and 22.9 percent were black (Exhibit 3.4). The remaining 5.6 percent of

WIC participants were comprised of American Indians, Alaskan Natives, and Asians.

In general, the ethnic composition in different certification categories is similar to the

overall distribution. The one notable exception is that breastfeeding women are

disproportionately Hispanic (42.2 percent). Similar findings were reported in 1992,

1994, and 1996. Blacks, in contrast, represent a disproportionately low percentage

(25.4 percent) of breastfeeding women, though their share has increased over time.

The ethnic composition of the WIC program has been changing steadily since 1992;

the percentage of Hispanic WIC enrollees has risen, while percentages of black and

white (non-Hispanic) enrollees have decreased. Hispanic enrollment increased by 9

percentage points across the nation between 1992 and 1996, from 23 percent to 32

percent of total WIC participants. Actual enrollment doubled, from 1.3 million to 2.6

million individuals. The largest increases occurred in the Western region. Hispanic

WIC enrollees in the Western region increased, from approximately 400,000 in 1992

to over 1 million in 1998—a 175 percent increase. Between 1996 and 1998,

Hispanic enrollment continued to grow, though at a smaller rate than reported in

previous PCs. While partially attributable to improved reporting of racial/ethnic data

in the Western region, this substantial increase may reflect WIC outreach to nonEnglish-speaking populations. It may also reflect national demographic trends. The

Bureau of the Census estimates that the Hispanic population resident in the US has

increased from 9.5 percent of the population in 1992 to 11.2 percent of the

population in 1998, so the number of Hispanic residents rose from 24.2 million in

1992 to 30.2 million in 1998.

Black enrollment, as a fraction of total enrollment, decreased by almost five

percentage points between 1992 and 1998. Between 1996 and 1998, black

enrollment decreased by nearly one percentage point. This decrease was seen in the

Southeast, Midwest, and Mountain Plains regions. Similar findings were reported

in PC96 and PC94, though the decrease was seen in more regions. In absolute terms,

numbers of black (non-Hispanic) WIC participants have increased by about 13,000

participants since 1996 and by 244,000 since 1992.

White enrollment, as a fraction of total enrollment, decreased by five percentage

points since 1992. Between 1996 and 1998, enrollment decreased by one percentage

point, with the largest declines occurring in the Mid-Atlantic, Mountain Plains,

Midwest, and Southwest regions. Actual numbers of white enrollees increased from

2.5 million in 1992 to 2.9 million in 1994, then to 3.2 million in 1996 and to 3.1

million in 1998.

Between 1994 and 1998, the proportion of Asians/Pacific Islanders enrolled in the

WIC program shows virtually no change. The proportion of Asians enrolled in the

program did, however, increase slightly between 1992 and 1994. The total number

of Asian/Pacific Islander WIC participants, however, increased by almost 20 percent

nationally, from about 220,000 in 1996 to over 260,000 in 1998. The largest

increase can be seen in the Western region, where the number of Asian enrollees has

increased by about 25 percent (or 30,000 participants) since 1996. 
%JCRVGT 6JTGG &GOQITCRJKEU QH 2% 9+% 2CTVKEKRCPVU 

While American Indian or Alaskan Native enrollment also appears proportionally

unchanged at the national level since 1992, there are regional variations. American

Indian or Alaskan Native WIC enrollees in the Midwest increased, from 7,910

participants in 1996 to 9,148 in 1998—a 16 percent increase. American Indian or

Alaskan Native WIC enrollees in the Southeast region decreased, from 8,846

participants in 1996 to 7,656 in 1998—a 13 percent decrease.
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4. INCOME OF WIC PARTICIPANTS

Federal regulations require categorically eligible WIC applicants to meet income

eligibility standards set by State WIC agencies. Income limits set by the States may

not exceed 185 percent or be less than 100 percent of the Department of Health and

Human Services (HHS) poverty income guidelines, which are based on household

size. As of July 1997, at the 185-percent threshold, a person from a family of four

with an annual household income of $29,693 or less is income-eligible for the WIC

Program.1

In 1990, State WIC agencies were required to establish procedures for determining

an applicant adjunctively or automatically income eligible for WIC benefits if the

individual could document participation in such means-tested programs as the

Temporary Assistance to Needy Families (TANF) , Food Stamp, or Medicaid 2

Programs. WIC regulations also allow States to extend automatic WIC income

eligibility to individuals who participate in other State-selected, means-tested

programs which apply income eligibility guidelines that are in congruence with State

regulations on WIC income. Exhibit 4.1 displays information reported by States on

their use of means-tested programs to determine WIC income eligibility. As of April

1998, all State agencies except American Samoa and Puerto Rico apply TANF, food

stamp, and Medicaid participation to determine WIC income eligibility. American

Samoa does not participate in these other means-tested programs. Puerto Rico does

not participate in the Food Stamp Program, but TANF and Medicaid recipients are

adjunctively eligible for WIC. The percentages of States using participation in

Supplemental Security Income, Free or Reduced-Price National School Lunch

Program, or other means-tested programs to establish adjunctive eligibility increased

between 1990 and 1994 but appear to have leveled off and remained steady between

1994 and 1998.

Legislation enacted in October 1998 requires WIC applicants (except in limited

circumstances) to present documentation of family income at certification for those

individuals who are not adjunctively income eligible. However, for the data

collection period reflected in this report, States were permitted to establish

requirements for documenting and verifying income. Such documentation could

range from a paystub to self-declaration. State-reported information on income

documentation appears in Exhibit 4.2. Income documentation procedures in local

WIC agencies are reported in Exhibit 4.3. One half of State WIC agencies require

WIC applicants to document income, as compared with approximately 40 percent in

1992, 1994, and 1996. In an additional 14 percent of States, documentation of

income may be required by local WIC agencies. A review of income documentation

policies in local WIC agencies indicates that 51 percent of all agencies require proof

of income, a decline of nine percentage points since 1996. About 55 percent of all

WIC participants are affected by these policies and must document income before

being certified for benefits, compared to 62 percent in 1996. Types of documentation
Chapter Four: +PEQOG QH 

Exhibit 4.1Means-Tested Programs Used to Determine WIC Income Eligibility

State Agencies 

1994 1996 1998 

Program Number Percent Number Percent Number Percent 

b b 

Adjunctive Income Eligibility

TANF (formerly AFDC) 73 86.9% 87 98.9% 87 98.9% 

c,d

Food Stamp Program 74 88.1 86 97.7 86 97.7 

c

Medicaid 77 91.7 87 98.9 87 98.9 

c

Automatic Income Eligibility

Supplemental Security Income 22 26.2% 20 22.7% 20 22.7% Free or Reduced-Price NSLP meals 21 25.0 17 19.3 17 19.3 Head Start e e 6 6.8 

General Assistance e e 4 4.5 Low Income Energy Assistance e e 1 1.1 Food Distribution Programs on Indian 25 28.4 

Reservations (FDPIR) 

e e

Other Programs 18 21.4 31 35.2 12 13.6 

f

No Programs Reported 2 2.4% 1 1.1% 1 1.1% 

Notes

Standard errors are in parentheses. a

Responses are not mutually exclusive, so percentages do not sum to 100 percent. For State agency data, percentages are based on the number of reporting State WIC agenci

brate for the Summary of State programs was 100 percent; 88 agencies reported in 1996 and 1998, and 84 agencies reported in 1994. A total of 460 local WIC agencies responPrograms; responses are weighted to reflect the universe of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participan

Because American Samoa does not participate in TANF, FSP, or Medicaid; and Puerto Rico does not participate in the FSP, these programs cannot be used to determine WIC 

c

Prior to the 1998 survey, this response option was labeled “AFDC or ADC.” d

Prior to the 1998 survey, Head Start, General Assistance, Low-Income Energy Assistance and Food Distribution Programs on Indian Reservations were not pre-printed on State 

eStates, these programs were included under “Other Programs” for 1994 and 1996.

For more information on other programs used to determine WIC income eligibility and for State-by-State information, see Exhibit C4.1 in Appendix C. f
Chapter Four: Income of PC 98 WIC Participants 49

Exhibit 4.2

Income Documentation and Verification Policy

State Agencies

Documentation Verification and Requirements Number Percent a

Income documentation required 44 50.0%

Applicant self-declares income for economic unit 25 28.4

In some cases local agencies have discretion with regard to income

documentation 12 13.6

Income documentation preferred in all cases but not required 7 8.0

Total State WIC agencies 88 100.0%

Note

Reflects requirements in April 1998, prior to the October 1998 legislation affecting income documentation. a
Chapter Four: +PEQOG QH 2% 9+% 2CTVKEKRCPVU 50

Exhibit 4.3

Determining Eligibility in Local WIC Agencies

Process Percent of Percent of

 Local Agencies Participants

Documentation Requirements

Income documentation required 51.4% 55.4% 

(2.30) (4.38)

Applicant self-declares income for economic unit 28.4 19.4 

(2.26) (3.53)

Documentation preferred, but not required 16.3 21.8 

(1.85) (2.86)

Other 3.8 3.3 

(1.14) (2.44)

Not reported 0.0 0.1 

(0.00) (0.00) 

Total 100.0% 100.0%

Types of documentation accepted at all service delivery sitesa,b

Paystub 87.7% 91.5% 

(0.00) (0.00) 

W-2 80.2 85.8 

(2.10) (3.37)

Proof of certification for program providing adjunct eligibility 81.9 88.6 

(1.87) (2.91)

Letter from employer 72.1 84.1 

(2.26) (3.19)

Tax forms 81.1 84.9 

(0.00) (0.00) 

Other 17.5 24.1 

(1.90) (4.68)

Not reported 7.4 6.4 

(1.38) (2.76)
Exhibit 4.3 (continued)

Determining Eligibility in Local WIC Agencies

Process Percent of Percent of

 Local Agencies Participants

Chapter Four: +PEQOG QH 2% 9+% 2CTVKEKRCPVU 51

Income Documentation Procedures

State WIC agency establishes procedures 82.2% 79.8% 

(2.00) (4.28)

State WIC agency provides general guidelines and local agency 15.6 18.2 

establishes procedures (1.89) (4.28)

Local agency establishes procedures 1.4 0.6 

(0.69) (0.41)

Other 0.2 0.1 

(0.19) (0.09)

Not reported 0.7 1.4 

(0.38) (0.12)

Total 100.0% 100.0%

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe

of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

Columns do not sum to 100 percent because respondents were permitted multiple responses. a

Some agencies that do not require documentation of income reported the types of documentation they accept. b
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accepted include paystubs, W-2 forms, letters from employers, and proof of

certification in programs providing adjunctive eligibility. Approximately one-quarter

of States and 28 percent of local agencies allow applicants to self-declare income.

In comparison, one-third of State agencies allowed self-declaration of income in

1992, 1994, and 1996. Forty percent of local agencies allowed self-declaration of

income in 1996.

State-level tables containing information on means-tested programs and income

documentation appear in Appendix C.

The reported 1998 participation of WIC clients in other programs appears in Exhibit

4.4. Reported participation in TANF, food stamps, and Medicaid decreased

substantially between 1996 and 1998 after having remained fairly constant between

1992 and 1996. In 1998, 57 percent of WIC recipients for whom other program

participation is reported, were receiving benefits from at least one other public

assistance program at time of WIC certification. This figure is down 5 percentage

points from the 62 percent of WIC recipients who were receiving any public

assistance benefits in 1996. Just under one half (48 percent) of WIC clients received

Medicaid benefits in 1998, a 7 percentage point decline from 1996. The percent of

WIC recipients reporting participation in the Food Stamp Program declined from 36

percent in 1996 to 27 percent in 1998, a 9 percentage point drop. Only 17 percent

of WIC participants reported receiving TANF benefits, a decline of 8 percentage

points from 1996. Fifteen percent of WIC recipients participated in all three

programs, receiving TANF, food stamps, and Medicaid benefits, as compared to 22

percent in 1996. The observed decline in TANF, food stamp, and Medicaid

participation among WIC enrollees mirrors overall trends in these programs since

passage of the Personal Responsibility and Work Opportunity Reconciliation Act

(PRWORA) of 1996. 

States reported program participation information for 89.5 percent of WIC enrollees,

down from 94.8 percent in 1996. Estimates of program participation represent a

lower bound because of missing information and because the data are recorded at

time of certification. Staff in local WIC service sites refer WIC enrollees to other

programs, and any subsequent enrollment is not captured in the estimates presented

here. 

Income and Poverty For the 1998 WIC participants and program characteristics study, State agencies were

asked to report for each person enrolled in WIC during April 1998, the size and

income of her/his family or economic unit. Household size is reported for nearly all

(99 percent) households. However, income is reported for only 85 percent of WIC

households in April 1998. Income reporting declined somewhat from 1996 when

income information was available for 90 percent of all households. States with

income missing for over 30 percent of their WIC participants include Florida,

Illinois, Indiana, Maine, Texas, and Virginia. The increase in percent not reporting

income in 1998 was primarily driven by changes in Texas, which had income data

missing for 59.4 percent of its population in 1998 as compared with 13.6 in 1996.3

For some applicants, States reported “actual” income—that is, the figures provided

by WIC applicants. For some applicants determined adjunctively income eligible,

States indicated income ranges. In these cases, midpoints of income ranges were
27.1%

24.9%

17.0%

36.8% 36.4%

26.6%

53.4% 54.5%

48.3%

0%

10%

20%

30%

40%

50%

60%

Percent of WIC Participants

TANF Food Stamp Program Medicaid

1994 1996 1998

Chapter Four: Income of PC 98 WIC Participants 53

Exhibit 4.4

Number and Percent of WIC Participants with Reported Participation in Other Programs at

Certification

Reported receiving benefits from... Number Percent of US WIC

Temporary Assistance to Needy Families (TANF), Food 1,208,763 15.0%

Stamp, and Medicaid Programs

TANF and Food Stamp Programs 35,924 0.4

TANF and Medicaid Programs 104,455 1.3

Food Stamp and Medicaid Programs 716,527 8.9

TANF only 21,113 0.3

Food Stamp Program only 179,287 2.2

Medicaid Program only 1,858,431 23.1

Do not participate in other programs 3,076,828 38.3

Not reported 841,430 10.5

US WIC 8,042,758 100.0%

Notes

Not reported indicates the number and percentage of participants for whom no data regarding participation in Medicaid, AFDC, and Food Stamps are reported.

Most Indian Tribal Organizations (ITOs) participate in the Food Distribution Program on Indian Reservations (FDPIR). Although PC98 data specifications

permitted Indian WIC programs to report FDPIR participation, only fourteen of 33 ITOs (representing half of all participants in ITO WIC programs) chose to

report these data. Of the 30,525 individuals for whom these data were reported, only 6.4 percent participate in the FDPIR program.
Chapter Four: +PEQOG QH 

Exhibit 4.5Distribution of the Size of Families or Economic Units of WIC Participants by Participant Category

Size of Family or Economic Unit Pregnant Women Breastfeeding Women Postpartum Women 

Percent by category

1994 1996 1998 1994 1996 1998 1994 1996 1998 1994 

1 person 17.8% 11.3% 9.2% 0.0% 0.0% 0.0% 4.2% 1.5% 1.2% 10.5% 

a

2 persons 26.5 23.8 23.9 15.6 13.1 11.9 19.5 18.2 16.9 22.5 3 persons 25.0 26.9 27.9 27.1 29.3 29.4 29.4 30.2 30.3 26.7 4 persons 15.1 18.7 19.8 22.1 25.3 26.1 22.6 24.1 25.2 18.6 5 persons 7.7 9.9 10.2 13.6 15.8 16.5 12.2 13.2 13.9 10.1 6 or more persons 6.9 8.0 8.1 16.5 14.3 14.4 10.9 10.9 11.0 9.8 Size not reported 0.7 1.1 0.7 4.9 1.9 1.3 0.8 1.5 1.2 1.5 Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% US WIC 823,604 877,747 892,674 275,158 330,176 389,391 491,998 567,913 591,049 1,590,762 Mean 3.0 3.2 3.3 4.6 4.0 4.0 3.7 3.7 3.8 3.5 

Size of Family or Economic Unit Infants Children T

Percent by category

1994 1996 1998 1994 1996 1998 1994 

1 person 1.7% 1.2% 1.4% 2.2% 1.3% 1.3% 4.0% 

a

2 persons 16.3 16.0 14.8 11.9 11.5 11.3 15.5 3 persons 29.7 30.1 30.1 24.3 24.0 24.0 26.3 4 persons 24.6 25.1 25.8 27.0 28.5 28.9 24.4 5 persons 14.1 14.3 14.8 16.8 17.8 18.2 14.5 6 or more persons 12.1 11.9 12.1 16.5 15.3 15.2 13.8 Size not reported 1.1 1.2 0.8 0.9 1.3 0.9 1.1 Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% US WIC 1,852,455 1,988,789 2,048,625 3,464,631 3,982,815 4,121,016 6,907,848 Mean 3.8 3.8 3.8 4.4 4.1 4.1 4.0 

NotesCalculations in this table are based on all families or economic units reporting size. Units reporting zero members are included in the size-not-reported category.

Mothers who miscarry, mothers of infants assigned to foster care, and infants and children assigned to foster care may be reported as one-person economic units. a
Chapter Four: +PEQOG QH 

Exhibit 4.6Mean and Median Annualized Family or Economic Unit Income of WIC Participants by Participant Catego

2TGIPCPV $TGCUVHGGFKPI 2QUVRCTVWO 6QVCN 

9QOGP 9QOGP 9QOGP 9QOGP +PHCPVU %

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C

2GTEGPV YKVJ KPEQOG PQV TGRQTVGF      

D

75 9+%      

0QVGU5VCVG CPF NQECN 9+% CIGPEKGU OC[ EQNNGEV FCVC QP YGGMN[ OQPVJN[ QT CPPWCN KPEQOGU (QT TGRQTVKPI CPF CPCN[UKU CPPWCNK\GF KPEQOGU JCX#NUQ PQVG VJCV KPEQOG ECNEWNCVKQPU KPENWFG QPN[ VJQUG RCTVKEKRCPVU HQT YJQO 5VCVG 9+% CIGPEKGU TGRQTVGF FCVC QP KPEQOG KPEQOG RGTKQF C+P  C 5VCVG 9+% CIGPE[ EQWNF TGRQTV CEVWCN KPEQOG HQT C RCTVKEKRCPV QT EQWNF TGRQTV CP KPEQOG TCPIG $QVJ V[RGU QH FCVC CTG KPENWFGF 

CPF OGFKCP KPEQOGU

Zero incomes are reported separately and excluded from mean and median calculations. In some reporting agencies, zero may be used to in

C

adjunctive eligibility. PC98 cannot, therefore, distinguish between households with missing income information and households reporting zero inNot reported indicates the percentage of participants by participant category for whom no data on income, income period, or size of economic un

b
Chapter Four: +PEQOG QH 

Exhibit 4.7Average Annualized Family or Economic Unit Income of WIC Participants by Participant Category and Racial o

Racial or Ethnic Characteristic Pregnant Breastfeeding Postpartum 

Women Women Women Total Women Infants 

American Indian or Alaskan NativeAverage (mean) income $12,172 $12,907 $11,678 $12,222 $12,131 Median income $11,040 $12,000 $10,400 $11,076 $10,836 Percent with income reported 80.5% 84.5% 78.8% 81.0% 80.0% Percent with income reported as zero 4.1 2.2 3.2 3.4 3.7 

a

Percent with income not reported 15.4 13.3 17.9 15.6 16.3 

b

Number of WIC Participants 12,506 5,996 6,940 25,442 27,656 Asian or Pacific IslanderAverage (mean) income $13,662 $14,354 $13,995 $13,939 $13,846 Median income $12,600 $13,200 $12,960 $12,960 $12,672 Percent with income reported 83.5% 87.2% 86.6% 85.4% 83.4% Percent with income reported as zero 4.1 3.3 2.4 3.4 4.1 

a

Percent with income not reported 12.4 9.5 10.9 11.2 12.5 

b

Number of WIC Participants 24,914 13,425 18,600 56,940 64,400 Black (non-Hispanic)Average (mean) income $9,467 $10,972 $8,623 $9,378 $9,053 Median income $7,823 $9,540 $6,444 $7,560 $6,780 Percent with income reported 79.2% 81.0% 79.1% 79.4% 76.5% Percent with income reported as zero 5.1 3.8 2.8 4.1 4.6 

a

Percent with income not reported 15.7 15.2 18.1 16.5 18.9 

b

Number of WIC Participants 194,038 58,120 149,043 401,202 498,190 HispanicAverage (mean) income $12,142 $12,884 $11,752 $12,264 $12,006 Median income $11,520 $12,220 $10,920 $11,752 $11,400 Percent with income reported 80.7% 83.2% 75.8% 80.1% 74.7% Percent with income reported as zero 4.2 3 3 3.6 4.9 

a

Percent with income not reported 15.1 13.8 21.1 16.3 20.4 

b

Number of WIC Participants 271,086 164,307 149,931 585,324 622,187 
Exhibit 4.7 (continued)

Average Annualized Family or Economic Unit Income of WIC Participants by Participant Category and RaciaCharacteristics

Racial or Ethnic Characteristic Pregnant Breastfeeding Postpartum 

Women Women Women Total Women Infants 

Chapter Four: +PEQOG QH 

White (non-Hispanic)Average (mean) income $13,029 $15,379 $12,803 $13,393 $13,552 Median income $12,132 $15,000 $12,048 $12,636 $13,056 Percent with income reported 84.5% 85.8% 82.4% 84.0% 81.8% Percent with income reported as zero 3.6 2.3 2.6 3 3.2 

a

Percent with income not reported 11.9 11.9 15.1 12.9 15 

b

Number of WIC Participants 383,421 143,711 260,523 787,656 814,779 Ethnicity not reportedAverage (mean) income $11,405 $13,349 $13,115 $12,405 $11,592 Median income $10,392 $12,480 $12,384 $11,424 $10,400 Percent with income reported 67.3% 66.5% 49.4% 60.6% 69.5% Percent with income reported as zero 12.2 5.7 4.8 8 9 

a

Percent with income not reported 20.4 27.7 45.9 31.4 21.5 

b

Number of WIC Participants 6,709 3,832 6,012 16,553 21,413 

0QVGU5VCVG CPF NQECN 9+% CIGPEKGU OC[ EQNNGEV FCVC QP YGGMN[ OQPVJN[ QT CPPWCN KPEQOGU (QT TGRQTVKPI CPF CPCN[UKU CPPWCNK\GF KPEQOGU JCXG DGGP EQORWVG F#NUQ PQVG VJCV KPEQOG ECNEWNCVKQPU KPENWFG QPN[ VJQUG RCTVKEKRCPVU HQT YJQO 5VCVG 9+% CIGPEKGU TGRQTVGF FCVC QP KPEQOG KPEQOG RGTKQF CPF UK\G QH GEQ PQOKE WP+P  C 5VCVG 9+% CIGPE[ EQWNF TGRQTV CEVWCN KPEQOG HQT C RCTVKEKRCPV QT EQWNF TGRQTV CP KPEQOG TCPIG $QVJ V[RGU QH FCVC CTG KPENWFGF KP VJG ECNEWNCVK QPU QH O

Zero incomes are reported separately and excluded from mean and median calculations. In some reporting agencies, zero may be used to indicate missing information or adjun

C

distinguish between households with missing income information and households reporting zero income.Not reported indicates the percentage of participants by participant category for whom no data on income, income period, or size of economic unit are reported. b
Chapter Four: +PEQOG QH 

Exhibit 4.8Distribution of Percent of Poverty Level of WIC Participants by Participant Category

Pregnant Breastfeeding Women Postpartum Total

Women Women Women Infants C

Percent of Cumulative Cumulative Cumulative Cumulative Cumulative Poverty Level Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent 

Percent by participant category

0 - 50 24.8% 24.8% 23.0% 23.0% 31.0% 31.0% 26.4% 26.4% 28.6% 28.6% 28.7% 51 - 100 27.4 52.1 32.2 55.2 25.4 56.3 27.7 54.1 26.1 54.7 30.4 101 - 130 12.9 65.0 13.9 69.1 11.2 67.6 12.6 66.7 11.6 66.3 12.8 131 - 150 7.0 72.0 6.9 76.1 5.5 73.1 6.5 73.2 5.5 71.8 6.2 151 - 185 8.8 80.8 7.1 83.2 5.9 79.0 7.6 80.7 5.8 77.7 6.6 186 - 200 0.5 81.3 0.3 83.5 0.3 79.3 0.4 81.1 0.2 77.9 0.3 201 - 225 0.3 81.6 0.1 83.6 0.2 79.4 0.2 81.3 0.1 78.0 0.1 226 - 250 0.2 81.8 0.1 83.7 0.1 79.5 0.1 81.5 0.1 78.1 0.1 Over 250 0.2 82.0 0.1 83.8 0.1 79.6 0.2 81.6 0.1 78.2 0.1 Income reported as 4.2 86.2 2.9 86.7 2.8 82.4 3.5 85.1 4.2 82.4 1.7  zeroa

Not reported 13.8 100.0 13.3 100.0 17.6 100.0 14.9 100.0 17.6 100.0 12.9 

b

US WIC 892,674 389,391 591,050 1,873,116 2,048,626 4,

NotesPoverty level calculations are based on income, income period, and household size as reported by State WIC agencies.

Zero incomes are reported separately and excluded from these income calculations. In some reporting agencies, zero may be used to indicate missing information or adjunctive el

a

between households with missing income information and households reporting zero income.Not reported indicates the percentage of participants by participant category for whom no data on income, income period, or size of economic unit are reported. b
Chapter Four: +PEQOG QH 

Exhibit 4.9Distribution of Percent of Poverty Level of WIC Participants by Participant Category and Racial or Ethnic Charact

Percent of Poverty Level Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percen

Pregnant Breastfeeding Postpartum Total 

Women Women Women Women Infants 

Cumulative Cumulative Cumulative Cumulative Cumulative 

American Indian or Alaskan

Native

0 - 50 27.7% 27.7% 30.4% 30.4% 33.3% 33.3% 29.9% 29.9% 31.9% 31.9% 30.3% 51 - 100 27.0 54.7 31.1 61.6 26.2 59.5 27.8 57.6 28.1 60.0 31.5 101 - 130 11.4 66.2 11.5 73.1 9.8 69.3 11.0 68.7 10.2 70.3 11.8 131 - 150 6.1 72.3 5.4 78.5 4.4 73.7 5.5 74.1 4.7 75.0 5.2 151 - 185 7.4 79.6 5.4 83.8 4.5 78.2 6.1 80.2 4.4 79.4 5.2 186 - 200 0.4 80.0 0.3 84.1 0.3 78.5 0.3 80.6 0.2 79.7 0.3 201 - 225 0.3 80.3 0.1 84.2 0.1 78.6 0.2 80.7 0.1 79.8 0.1 226 - 250 0.1 80.4 0.2 84.4 0.1 78.7 0.1 80.9 0.1 79.9 0.1 Over 250 0.2 80.5 0.1 84.5 0.2 78.8 0.1 81.0 0.1 80.0 0.1 Income reported as zero 4.1 84.6 2.2 86.7 3.2 82.1 3.4 84.4 3.7 83.7 1.9 

a

Not reported 15.4 100.0 13.3 100.0 17.9 100.0 15.6 100.0 16.3 100.0 13.7 

b

Total WIC 12,506 5,996 6,940 25,442 27,656 Asian or Pacific Islander0 - 50 20.2% 20.2% 21.9% 21.9% 24.7% 24.7% 22.1% 22.1% 24.6% 24.6% 28.1% 51 - 100 29.5 49.7 32.1 54.0 32.4 57.0 31.1 53.1 30.7 55.3 35.3 101 - 130 14.2 63.9 15.4 69.4 14.0 71.1 14.4 67.6 13.5 68.7 13.0 131 - 150 7.9 71.8 8.4 77.9 7.4 78.5 7.9 75.4 7.0 75.7 6.5 151 - 185 11.0 82.8 8.8 86.6 7.6 86.1 9.4 84.8 7.2 82.9 7.1 186 - 200 0.3 83.1 0.2 86.8 0.2 86.3 0.2 85.1 0.2 83.1 0.2 201 - 225 0.2 83.4 0.2 87.0 0.1 86.4 0.2 85.2 0.1 83.2 0.1 226 - 250 0.1 83.4 0.1 87.1 0.1 86.5 0.1 85.3 0.1 83.3 0.1 Over 250 0.1 83.5 0.1 87.2 0.1 86.6 0.1 85.4 0.1 83.4 0.1 Income reported as zero 4.1 87.6 3.3 90.5 2.4 89.1 3.4 88.8 4.1 87.5 1.7 

a

Not reported 12.4 100.0 9.5 100.0 10.9 100.0 11.2 100.0 12.5 100.0 7.9 

b

Total WIC 24,914 13,425 18,600 56,940 64,400 
Exhibit 4.9 (continued)

Distribution of Percent of Poverty Level of WIC Participants by Participant Category and Racial or Ethnic Charact

Percent of Poverty Level Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percen

Pregnant Breastfeeding Postpartum Total 

Women Women Women Women Infants 

Cumulative Cumulative Cumulative Cumulative Cumulative 

Chapter Four: +PEQOG QH 

Black (non-Hispanic)0 - 50 34.4% 34.4% 34.4% 34.4% 44.6% 44.6% 38.2% 38.2% 41.5% 41.5% 39.9% 51 - 100 23.5 57.9 24.8 59.2 19.9 64.5 22.3 60.5 19.7 61.2 25.6 101 - 130 10.0 67.8 10.5 69.7 7.5 72.0 9.1 69.6 8.2 69.4 9.8 131 - 150 4.9 72.7 5.6 75.3 3.5 75.5 4.5 74.1 3.5 72.9 4.2 151 - 185 5.7 78.4 5.3 80.6 3.3 78.7 4.7 78.8 3.3 76.1 3.8 186 - 200 0.3 78.8 0.2 80.8 0.2 78.9 0.3 79.1 0.1 76.3 0.2 201 - 225 0.2 79.0 0.1 80.9 0.1 79.0 0.1 79.2 0.1 76.3 0.1 226 - 250 0.1 79.1 0.0 80.9 0.0 79.0 0.1 79.3 0.0 76.4 0.1 Over 250 0.2 79.2 0.1 81.0 0.1 79.1 0.1 79.4 0.1 76.5 0.1 Income reported as zero 5.1 84.3 3.8 84.8 2.8 81.9 4.1 83.5 4.6 81.1 1.9 

a

Not reported 15.7 100.0 15.2 100.0 18.1 100.0 16.5 100.0 18.9 100.0 14.5 

b

Total WIC 194,038 58,120 149,043 401,202 498,190 Hispanic0 - 50 21.8% 21.8% 21.9% 21.9% 26.6% 26.6% 23.1% 23.1% 24.6% 24.6% 27.7% 51 - 100 32.0 53.8 39.7 61.6 30.5 57.1 33.8 56.8 32.1 56.8 34.9 101 - 130 12.9 66.6 12.4 73.9 10.3 67.4 12.1 68.9 10.0 66.8 11.2 131 - 150 6.1 72.8 4.7 78.6 4.1 71.5 5.2 74.1 3.9 70.7 4.5 151 - 185 7.5 80.3 4.4 83.0 4.1 75.6 5.7 79.8 3.8 74.5 4.4 186 - 200 0.2 80.5 0.1 83.1 0.1 75.7 0.1 80.0 0.1 74.6 0.1 201 - 225 0.1 80.5 0.1 83.2 0.1 75.7 0.1 80.0 0.0 74.6 0.0 226 - 250 0.0 80.6 0.0 83.2 0.0 75.8 0.0 80.1 0.0 74.7 0.0 Over 250 0.1 80.7 0.0 83.2 0.0 75.8 0.1 80.1 0.0 74.7 0.0 Income reported as zero 4.2 84.9 3.0 86.2 3.0 78.9 3.6 83.7 4.9 79.6 1.7 

a

Not reported 15.1 100.0 13.8 100.0 21.1 100.0 16.3 100.0 20.4 100.0 15.4 

b

Total WIC 271,086 164,307 149,931 585,324 622,187 
Exhibit 4.9 (continued)

Distribution of Percent of Poverty Level of WIC Participants by Participant Category and Racial or Ethnic Charact

Percent of Poverty Level Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percen

Pregnant Breastfeeding Postpartum Total 

Women Women Women Women Infants 

Cumulative Cumulative Cumulative Cumulative Cumulative 

Chapter Four: +PEQOG QH 

White (non-Hispanic)0 - 50 22.3% 22.3% 19.6% 19.6% 26.4% 26.4% 23.2% 23.2% 24.1% 24.1% 22.9% 51 - 100 26.0 48.3 27.0 46.6 25.2 51.6 25.9 49.1 25.0 49.2 28.8 101 - 130 14.4 62.7 17.1 63.7 13.9 65.4 14.7 63.8 14.8 64.0 16.2 131 - 150 8.6 71.3 10.0 73.7 7.4 72.9 8.5 72.2 7.9 71.8 9.0 151 - 185 11.3 82.6 11.0 84.7 8.4 81.3 10.3 82.5 8.9 80.7 10.4 186 - 200 0.8 83.4 0.5 85.2 0.5 81.7 0.6 83.2 0.4 81.2 0.5 201 - 225 0.5 83.9 0.3 85.5 0.3 82.0 0.4 83.6 0.3 81.4 0.3 226 - 250 0.3 84.2 0.1 85.6 0.2 82.2 0.2 83.8 0.2 81.6 0.1 Over 250 0.3 84.5 0.2 85.8 0.2 82.4 0.3 84.0 0.2 81.8 0.2 Income reported as zero 3.6 88.1 2.3 88.1 2.6 84.9 3.0 87.1 3.2 85.0 1.6 

a

Not reported 11.9 100.0 11.9 100.0 15.1 100.0 12.9 100.0 15.0 100.0 10.0 

b

Total WIC 383,421 143,711 260,523 787,656 814,779 Racial data not reported0 - 50 21.2% 21.2% 19.0% 19.0% 15.4% 15.4% 18.6% 18.6% 26.1% 26.1% 24.2% 51 - 100 24.5 45.6 24.1 43.1 17.0 32.3 21.7 40.2 23.9 50.0 24.9 101 - 130 10.5 56.1 11.9 55.1 7.9 40.2 9.9 50.1 9.9 59.9 11.5 131 - 150 5.8 61.9 6.0 61.1 4.0 44.2 5.2 55.3 4.8 64.7 5.6 151 - 185 5.1 67.0 5.0 66.0 5.0 49.3 5.1 60.3 4.3 69.0 5.6 186 - 200 0.1 67.1 0.2 66.3 0.0 49.3 0.1 60.5 0.1 69.2 0.2 201 - 225 0.1 67.2 0.0 66.3 0.0 49.3 0.0 60.5 0.1 69.3 0.1 226 - 250 0.1 67.3 0.1 66.3 0.0 49.3 0.1 60.5 0.1 69.3 0.0 Over 250 0.0 67.3 0.2 66.5 0.0 49.4 0.1 60.6 0.2 69.5 0.1 Income reported as zero 12.2 79.6 5.7 72.3 4.8 54.1 8.0 68.6 9.0 78.5 4.8 

a

Not reported 20.4 100.0 27.7 100.0 45.9 100.0 31.4 100.0 21.5 100.0 23.0 

b

Total WIC 6,709 3,832 6,012 16,553 21,413 

NotesPoverty level calculations are based on income, income period, and household size as reported by State WIC agencies. 

Zero incomes are reported separately and excluded from these income calculations. In some reporting agencies, zero may be used to indicate missing information or adjunctive eligibility. PC98 cannot, the

a

income information and households reporting zero income.Not reported indicates the percentage of participants by participant category for whom no data on income, income period, or size of economic unit are reported. b
Chapter Four: +PEQOG QH 

Exhibit 4.10Distribution of Percent of Poverty Level at Certification for WIC Participants Reporting No Other Benefit Receipt

2GTEGPV QH 2QXGTV[ .GXGN $TGCUVHGGFKPI 2QUVRCTVWO

2TGIPCPV 9QOGP 9QOGP 9QOGP 6QVCN 9QOGP +PHCPVU %

0WODGT 2GTEGPV 0WODGT 2GTEGPV 0WODGT 2GTEGPV 0WODGT 2GTEGPV 0WODGT 2GTEGPV 0WODG

2GTEGPV D[ RCTVKEKRCPV ECVGIQT[

                                                                                          1XGT            +PEQOG TGRQTVGF CU \GTQ           

D

0QV TGRQTVGF           

E

6QVCN 9+%           

0QVGU

6JKU VCDNG GZENWFGU KPFKXKFWCNU HQT YJQO PQ FCVC TGICTFKPI RCTVKEKRCVKQP KP 6#0( (QQF 5VCORU CPF /GFKECKF CTG TGRQTVGF C

Zero incomes are reported separately and excluded from these income calculations. In some reporting agencies, zero may be used to indicate missing information or adjunctive eligibility. PC98 cann

D

missing income information and households reporting zero income.Not reported indicates the percentage of participants by participant category for whom no data on income, income period, or size of economic unit are reported. c
Chapter Four: +PEQOG QH 

Exhibit 4.11Comparison of Poverty Levels of WIC Participants to Persons in the US Population in 1998

Percent of Poverty Level General US Population Families Six Years US WIC 

a

1998 1998 1998 1998 

Persons in US with Children Under

a

Persons in US Families

ab 

0 - 50 5.0% 4.9% 9.7% 28.1% 51 - 100 8.1 7.4 11.6 28.7 101 - 130 5.4 4.9 7.1 12.5 131 - 150 3.8 3.5 4.4 6.1 151 - 185 6.8 6.5 8.1 6.6 186 - 200 2.8 2.8 3.0 0.3 Over 200 66.7 69.1 54.6 0.4 Income reported as zero 1.4 1.0 1.7 2.8 

c

Not reported N/A N/A N/A 14.6 

d

Total 268,480,000 226,809,000 69,825,000 8,042,758 

NotesN/A indicates not applicable.

Source: March 1998 Current Population Survey. a

Current Population Survey poverty levels reflect respondents’ 1997 incomes.

WIC participant poverty level calculations are based on income, income period, and household size as reported by State WIC agencies. Figures in this ta

b

WIC participants. Zero incomes are reported separately and excluded from these income calculations. In some reporting agencies, zero may be used to indicate missing i

c

PC98 cannot, therefore, distinguish between households with missing income information and households reporting zero income.Not reported indicates the percentage of participants for whom no data on income, income period, or size of economic unit are reported. d
'ZJKDKV % KP #RRGPFKZ % RTGUGPVU FCVC QP RQXGTV[ NGXGN D[ RCTVKEKRCPV ECVGIQT[ HQT  

  CPF 

%JCRVGT (QWT +PEQOG QH 2% 9+% 2CTVKEKRCPVU 

assigned as household income. Both types of data have been combined to compute

average annualized income and to calculate percent of poverty. 

Footnotes on tables indicate that, in some States, individuals were reported to have

zero incomes. While available income data from all States have been included in this

analysis, these zeroes are always tabulated separately because some States use zero

to indicate missing data or adjunctive eligibility. 

Exhibits 4.6 through 4.11 present data on the income and poverty status of WIC

participants during 1998. The mean and median incomes of WIC enrollees remain

low.

Average family (economic unit) size has remained about 4.0 persons (Exhibit 4.5)

since 1992, though some fluctuations occurred within participant categories over

time. In general, the size distribution of households was similar in 1996 and 1998.

The one exception is that the number of pregnant women living in one-person

households declined from 11 percent in 1996 to 9 percent in 1998. This continued

a trend reported in PC96 when the percent of pregnant women in one-person

households declined by 7 percentage points from PC94. Some of this observed

decline is presumably attributable to revised WIC policy which allows States to count

pregnant women as two-person households.

Approximately 1.4 percent of infants and children and 1.2 percent of postpartum

women are classified as residing in one-person households. These categories include

children placed in foster care and mothers who miscarry or whose infants are placed

in foster care.

Exhibits 4.6 and 4.7 present mean and median incomes by participant and ethnic

categories. Data to calculate mean and median income were not reported for 14.6

percent of WIC enrollees and are reported as zero for an additional 2.8 percent of US

WIC. The incomes of WIC participants increased substantially between 1996 and

1998. For the 85.4 percent of WIC enrollees with income data, average

family/economic unit income across all categories was $12,479 in April 1998, a 15.5

percent (or $1,671) increase from 1996. Median income in 1998 shows a 19.2

percent increase over 1996. The incomes of WIC enrollees in all participant and all

ethnic categories have increased. There were, however, few changes in the relative

positions of different groups since 1992. The highest average income continues to

be reported for breastfeeding women. Across ethnic categories, Asian or Pacific

Islanders reported the highest incomes while Black participants reported the lowest

incomes. Hispanic participants experienced the largest percentage increase between

1996 and 1998. 

Poverty Status In Exhibits 4.8 and 4.9, information is presented on percent of poverty level by

participant category and by race/ethnicity. Despite the substantial increase in 4

average income, WIC participants remain relatively poor. Almost 70 percent of

participants reported incomes at or below 130 percent of poverty, while 57 percent

reported incomes at or below the poverty level. Although WIC participants remain

in the country’s lowest income categories, since 1994, the data show a decrease in

the percent of WIC participants with incomes below 50 percent of poverty. The
Chapter Four: +PEQOG QH 

Exhibit 4.5Distribution of the Size of Families or Economic Units of WIC Participants by Participant Category

Size of Family or Economic Unit Pregnant Women Breastfeeding Women Postpartum Women 

Percent by category

1994 1996 1998 1994 1996 1998 1994 1996 1998 1994 

1 person 17.8% 11.3% 9.2% 0.0% 0.0% 0.0% 4.2% 1.5% 1.2% 10.5% 

a

2 persons 26.5 23.8 23.9 15.6 13.1 11.9 19.5 18.2 16.9 22.5 3 persons 25.0 26.9 27.9 27.1 29.3 29.4 29.4 30.2 30.3 26.7 4 persons 15.1 18.7 19.8 22.1 25.3 26.1 22.6 24.1 25.2 18.6 5 persons 7.7 9.9 10.2 13.6 15.8 16.5 12.2 13.2 13.9 10.1 6 or more persons 6.9 8.0 8.1 16.5 14.3 14.4 10.9 10.9 11.0 9.8 Size not reported 0.7 1.1 0.7 4.9 1.9 1.3 0.8 1.5 1.2 1.5 Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% US WIC 823,604 877,747 892,674 275,158 330,176 389,391 491,998 567,913 591,049 1,590,762 Mean 3.0 3.2 3.3 4.6 4.0 4.0 3.7 3.7 3.8 3.5 

Size of Family or Economic Unit Infants Children T

Percent by category

1994 1996 1998 1994 1996 1998 1994 

1 person 1.7% 1.2% 1.4% 2.2% 1.3% 1.3% 4.0% 

a

2 persons 16.3 16.0 14.8 11.9 11.5 11.3 15.5 3 persons 29.7 30.1 30.1 24.3 24.0 24.0 26.3 4 persons 24.6 25.1 25.8 27.0 28.5 28.9 24.4 5 persons 14.1 14.3 14.8 16.8 17.8 18.2 14.5 6 or more persons 12.1 11.9 12.1 16.5 15.3 15.2 13.8 Size not reported 1.1 1.2 0.8 0.9 1.3 0.9 1.1 Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% US WIC 1,852,455 1,988,789 2,048,625 3,464,631 3,982,815 4,121,016 6,907,848 Mean 3.8 3.8 3.8 4.4 4.1 4.1 4.0 

NotesCalculations in this table are based on all families or economic units reporting size. Units reporting zero members are included in the size-not-reported category.

Mothers who miscarry, mothers of infants assigned to foster care, and infants and children assigned to foster care may be reported as one-person economic units. a
Chapter Four: +PEQOG QH 

Exhibit 4.6Mean and Median Annualized Family or Economic Unit Income of WIC Participants by Participant Catego

2TGIPCPV $TGCUVHGGFKPI 2QUVRCTVWO 6QVCN 

9QOGP 9QOGP 9QOGP 9QOGP +PHCPVU %

#XGTCIG 
OGCP KPEQOG      /GFKCP KPEQOG      2GTEGPV YKVJ KPEQOG TGRQTVGF      2GTEGPV YKVJ KPEQOG TGRQTVGF CU \GTQ      

C

2GTEGPV YKVJ KPEQOG PQV TGRQTVGF      

D

75 9+%      

0QVGU5VCVG CPF NQECN 9+% CIGPEKGU OC[ EQNNGEV FCVC QP YGGMN[ OQPVJN[ QT CPPWCN KPEQOGU (QT TGRQTVKPI CPF CPCN[UKU CPPWCNK\GF KPEQOGU JCX#NUQ PQVG VJCV KPEQOG ECNEWNCVKQPU KPENWFG QPN[ VJQUG RCTVKEKRCPVU HQT YJQO 5VCVG 9+% CIGPEKGU TGRQTVGF FCVC QP KPEQOG KPEQOG RGTKQF C+P  C 5VCVG 9+% CIGPE[ EQWNF TGRQTV CEVWCN KPEQOG HQT C RCTVKEKRCPV QT EQWNF TGRQTV CP KPEQOG TCPIG $QVJ V[RGU QH FCVC CTG KPENWFGF 

CPF OGFKCP KPEQOGU

Zero incomes are reported separately and excluded from mean and median calculations. In some reporting agencies, zero may be used to in

C

adjunctive eligibility. PC98 cannot, therefore, distinguish between households with missing income information and households reporting zero inNot reported indicates the percentage of participants by participant category for whom no data on income, income period, or size of economic un

b
Chapter Four: +PEQOG QH 

Exhibit 4.7Average Annualized Family or Economic Unit Income of WIC Participants by Participant Category and Racial o

Racial or Ethnic Characteristic Pregnant Breastfeeding Postpartum 

Women Women Women Total Women Infants 

American Indian or Alaskan NativeAverage (mean) income $12,172 $12,907 $11,678 $12,222 $12,131 Median income $11,040 $12,000 $10,400 $11,076 $10,836 Percent with income reported 80.5% 84.5% 78.8% 81.0% 80.0% Percent with income reported as zero 4.1 2.2 3.2 3.4 3.7 

a

Percent with income not reported 15.4 13.3 17.9 15.6 16.3 

b

Number of WIC Participants 12,506 5,996 6,940 25,442 27,656 Asian or Pacific IslanderAverage (mean) income $13,662 $14,354 $13,995 $13,939 $13,846 Median income $12,600 $13,200 $12,960 $12,960 $12,672 Percent with income reported 83.5% 87.2% 86.6% 85.4% 83.4% Percent with income reported as zero 4.1 3.3 2.4 3.4 4.1 

a

Percent with income not reported 12.4 9.5 10.9 11.2 12.5 

b

Number of WIC Participants 24,914 13,425 18,600 56,940 64,400 Black (non-Hispanic)Average (mean) income $9,467 $10,972 $8,623 $9,378 $9,053 Median income $7,823 $9,540 $6,444 $7,560 $6,780 Percent with income reported 79.2% 81.0% 79.1% 79.4% 76.5% Percent with income reported as zero 5.1 3.8 2.8 4.1 4.6 

a

Percent with income not reported 15.7 15.2 18.1 16.5 18.9 

b

Number of WIC Participants 194,038 58,120 149,043 401,202 498,190 HispanicAverage (mean) income $12,142 $12,884 $11,752 $12,264 $12,006 Median income $11,520 $12,220 $10,920 $11,752 $11,400 Percent with income reported 80.7% 83.2% 75.8% 80.1% 74.7% Percent with income reported as zero 4.2 3 3 3.6 4.9 

a

Percent with income not reported 15.1 13.8 21.1 16.3 20.4 

b

Number of WIC Participants 271,086 164,307 149,931 585,324 622,187 
Exhibit 4.7 (continued)

Average Annualized Family or Economic Unit Income of WIC Participants by Participant Category and RaciaCharacteristics

Racial or Ethnic Characteristic Pregnant Breastfeeding Postpartum 

Women Women Women Total Women Infants 

Chapter Four: +PEQOG QH 

White (non-Hispanic)Average (mean) income $13,029 $15,379 $12,803 $13,393 $13,552 Median income $12,132 $15,000 $12,048 $12,636 $13,056 Percent with income reported 84.5% 85.8% 82.4% 84.0% 81.8% Percent with income reported as zero 3.6 2.3 2.6 3 3.2 

a

Percent with income not reported 11.9 11.9 15.1 12.9 15 

b

Number of WIC Participants 383,421 143,711 260,523 787,656 814,779 Ethnicity not reportedAverage (mean) income $11,405 $13,349 $13,115 $12,405 $11,592 Median income $10,392 $12,480 $12,384 $11,424 $10,400 Percent with income reported 67.3% 66.5% 49.4% 60.6% 69.5% Percent with income reported as zero 12.2 5.7 4.8 8 9 

a

Percent with income not reported 20.4 27.7 45.9 31.4 21.5 

b

Number of WIC Participants 6,709 3,832 6,012 16,553 21,413 

0QVGU5VCVG CPF NQECN 9+% CIGPEKGU OC[ EQNNGEV FCVC QP YGGMN[ OQPVJN[ QT CPPWCN KPEQOGU (QT TGRQTVKPI CPF CPCN[UKU CPPWCNK\GF KPEQOGU JCXG DGGP EQORWVG F#NUQ PQVG VJCV KPEQOG ECNEWNCVKQPU KPENWFG QPN[ VJQUG RCTVKEKRCPVU HQT YJQO 5VCVG 9+% CIGPEKGU TGRQTVGF FCVC QP KPEQOG KPEQOG RGTKQF CPF UK\G QH GEQ PQOKE WP+P  C 5VCVG 9+% CIGPE[ EQWNF TGRQTV CEVWCN KPEQOG HQT C RCTVKEKRCPV QT EQWNF TGRQTV CP KPEQOG TCPIG $QVJ V[RGU QH FCVC CTG KPENWFGF KP VJG ECNEWNCVK QPU QH O

Zero incomes are reported separately and excluded from mean and median calculations. In some reporting agencies, zero may be used to indicate missing information or adjun

C

distinguish between households with missing income information and households reporting zero income.Not reported indicates the percentage of participants by participant category for whom no data on income, income period, or size of economic unit are reported. b
Chapter Four: +PEQOG QH 

Exhibit 4.8Distribution of Percent of Poverty Level of WIC Participants by Participant Category

Pregnant Breastfeeding Women Postpartum Total

Women Women Women Infants C

Percent of Cumulative Cumulative Cumulative Cumulative Cumulative Poverty Level Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent 

Percent by participant category

0 - 50 24.8% 24.8% 23.0% 23.0% 31.0% 31.0% 26.4% 26.4% 28.6% 28.6% 28.7% 51 - 100 27.4 52.1 32.2 55.2 25.4 56.3 27.7 54.1 26.1 54.7 30.4 101 - 130 12.9 65.0 13.9 69.1 11.2 67.6 12.6 66.7 11.6 66.3 12.8 131 - 150 7.0 72.0 6.9 76.1 5.5 73.1 6.5 73.2 5.5 71.8 6.2 151 - 185 8.8 80.8 7.1 83.2 5.9 79.0 7.6 80.7 5.8 77.7 6.6 186 - 200 0.5 81.3 0.3 83.5 0.3 79.3 0.4 81.1 0.2 77.9 0.3 201 - 225 0.3 81.6 0.1 83.6 0.2 79.4 0.2 81.3 0.1 78.0 0.1 226 - 250 0.2 81.8 0.1 83.7 0.1 79.5 0.1 81.5 0.1 78.1 0.1 Over 250 0.2 82.0 0.1 83.8 0.1 79.6 0.2 81.6 0.1 78.2 0.1 Income reported as 4.2 86.2 2.9 86.7 2.8 82.4 3.5 85.1 4.2 82.4 1.7  zeroa

Not reported 13.8 100.0 13.3 100.0 17.6 100.0 14.9 100.0 17.6 100.0 12.9 

b

US WIC 892,674 389,391 591,050 1,873,116 2,048,626 4,

NotesPoverty level calculations are based on income, income period, and household size as reported by State WIC agencies.

Zero incomes are reported separately and excluded from these income calculations. In some reporting agencies, zero may be used to indicate missing information or adjunctive el

a

between households with missing income information and households reporting zero income.Not reported indicates the percentage of participants by participant category for whom no data on income, income period, or size of economic unit are reported. b
Chapter Four: +PEQOG QH 

Exhibit 4.9Distribution of Percent of Poverty Level of WIC Participants by Participant Category and Racial or Ethnic Charact

Percent of Poverty Level Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percen

Pregnant Breastfeeding Postpartum Total 

Women Women Women Women Infants 

Cumulative Cumulative Cumulative Cumulative Cumulative 

American Indian or Alaskan

Native

0 - 50 27.7% 27.7% 30.4% 30.4% 33.3% 33.3% 29.9% 29.9% 31.9% 31.9% 30.3% 51 - 100 27.0 54.7 31.1 61.6 26.2 59.5 27.8 57.6 28.1 60.0 31.5 101 - 130 11.4 66.2 11.5 73.1 9.8 69.3 11.0 68.7 10.2 70.3 11.8 131 - 150 6.1 72.3 5.4 78.5 4.4 73.7 5.5 74.1 4.7 75.0 5.2 151 - 185 7.4 79.6 5.4 83.8 4.5 78.2 6.1 80.2 4.4 79.4 5.2 186 - 200 0.4 80.0 0.3 84.1 0.3 78.5 0.3 80.6 0.2 79.7 0.3 201 - 225 0.3 80.3 0.1 84.2 0.1 78.6 0.2 80.7 0.1 79.8 0.1 226 - 250 0.1 80.4 0.2 84.4 0.1 78.7 0.1 80.9 0.1 79.9 0.1 Over 250 0.2 80.5 0.1 84.5 0.2 78.8 0.1 81.0 0.1 80.0 0.1 Income reported as zero 4.1 84.6 2.2 86.7 3.2 82.1 3.4 84.4 3.7 83.7 1.9 

a

Not reported 15.4 100.0 13.3 100.0 17.9 100.0 15.6 100.0 16.3 100.0 13.7 

b

Total WIC 12,506 5,996 6,940 25,442 27,656 Asian or Pacific Islander0 - 50 20.2% 20.2% 21.9% 21.9% 24.7% 24.7% 22.1% 22.1% 24.6% 24.6% 28.1% 51 - 100 29.5 49.7 32.1 54.0 32.4 57.0 31.1 53.1 30.7 55.3 35.3 101 - 130 14.2 63.9 15.4 69.4 14.0 71.1 14.4 67.6 13.5 68.7 13.0 131 - 150 7.9 71.8 8.4 77.9 7.4 78.5 7.9 75.4 7.0 75.7 6.5 151 - 185 11.0 82.8 8.8 86.6 7.6 86.1 9.4 84.8 7.2 82.9 7.1 186 - 200 0.3 83.1 0.2 86.8 0.2 86.3 0.2 85.1 0.2 83.1 0.2 201 - 225 0.2 83.4 0.2 87.0 0.1 86.4 0.2 85.2 0.1 83.2 0.1 226 - 250 0.1 83.4 0.1 87.1 0.1 86.5 0.1 85.3 0.1 83.3 0.1 Over 250 0.1 83.5 0.1 87.2 0.1 86.6 0.1 85.4 0.1 83.4 0.1 Income reported as zero 4.1 87.6 3.3 90.5 2.4 89.1 3.4 88.8 4.1 87.5 1.7 

a

Not reported 12.4 100.0 9.5 100.0 10.9 100.0 11.2 100.0 12.5 100.0 7.9 

b

Total WIC 24,914 13,425 18,600 56,940 64,400 
Exhibit 4.9 (continued)

Distribution of Percent of Poverty Level of WIC Participants by Participant Category and Racial or Ethnic Charact

Percent of Poverty Level Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percen

Pregnant Breastfeeding Postpartum Total 

Women Women Women Women Infants 

Cumulative Cumulative Cumulative Cumulative Cumulative 

Chapter Four: +PEQOG QH 

Black (non-Hispanic)0 - 50 34.4% 34.4% 34.4% 34.4% 44.6% 44.6% 38.2% 38.2% 41.5% 41.5% 39.9% 51 - 100 23.5 57.9 24.8 59.2 19.9 64.5 22.3 60.5 19.7 61.2 25.6 101 - 130 10.0 67.8 10.5 69.7 7.5 72.0 9.1 69.6 8.2 69.4 9.8 131 - 150 4.9 72.7 5.6 75.3 3.5 75.5 4.5 74.1 3.5 72.9 4.2 151 - 185 5.7 78.4 5.3 80.6 3.3 78.7 4.7 78.8 3.3 76.1 3.8 186 - 200 0.3 78.8 0.2 80.8 0.2 78.9 0.3 79.1 0.1 76.3 0.2 201 - 225 0.2 79.0 0.1 80.9 0.1 79.0 0.1 79.2 0.1 76.3 0.1 226 - 250 0.1 79.1 0.0 80.9 0.0 79.0 0.1 79.3 0.0 76.4 0.1 Over 250 0.2 79.2 0.1 81.0 0.1 79.1 0.1 79.4 0.1 76.5 0.1 Income reported as zero 5.1 84.3 3.8 84.8 2.8 81.9 4.1 83.5 4.6 81.1 1.9 

a

Not reported 15.7 100.0 15.2 100.0 18.1 100.0 16.5 100.0 18.9 100.0 14.5 

b

Total WIC 194,038 58,120 149,043 401,202 498,190 Hispanic0 - 50 21.8% 21.8% 21.9% 21.9% 26.6% 26.6% 23.1% 23.1% 24.6% 24.6% 27.7% 51 - 100 32.0 53.8 39.7 61.6 30.5 57.1 33.8 56.8 32.1 56.8 34.9 101 - 130 12.9 66.6 12.4 73.9 10.3 67.4 12.1 68.9 10.0 66.8 11.2 131 - 150 6.1 72.8 4.7 78.6 4.1 71.5 5.2 74.1 3.9 70.7 4.5 151 - 185 7.5 80.3 4.4 83.0 4.1 75.6 5.7 79.8 3.8 74.5 4.4 186 - 200 0.2 80.5 0.1 83.1 0.1 75.7 0.1 80.0 0.1 74.6 0.1 201 - 225 0.1 80.5 0.1 83.2 0.1 75.7 0.1 80.0 0.0 74.6 0.0 226 - 250 0.0 80.6 0.0 83.2 0.0 75.8 0.0 80.1 0.0 74.7 0.0 Over 250 0.1 80.7 0.0 83.2 0.0 75.8 0.1 80.1 0.0 74.7 0.0 Income reported as zero 4.2 84.9 3.0 86.2 3.0 78.9 3.6 83.7 4.9 79.6 1.7 

a

Not reported 15.1 100.0 13.8 100.0 21.1 100.0 16.3 100.0 20.4 100.0 15.4 

b

Total WIC 271,086 164,307 149,931 585,324 622,187 
Exhibit 4.9 (continued)

Distribution of Percent of Poverty Level of WIC Participants by Participant Category and Racial or Ethnic Charact

Percent of Poverty Level Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percen

Pregnant Breastfeeding Postpartum Total 

Women Women Women Women Infants 

Cumulative Cumulative Cumulative Cumulative Cumulative 

Chapter Four: +PEQOG QH 

White (non-Hispanic)0 - 50 22.3% 22.3% 19.6% 19.6% 26.4% 26.4% 23.2% 23.2% 24.1% 24.1% 22.9% 51 - 100 26.0 48.3 27.0 46.6 25.2 51.6 25.9 49.1 25.0 49.2 28.8 101 - 130 14.4 62.7 17.1 63.7 13.9 65.4 14.7 63.8 14.8 64.0 16.2 131 - 150 8.6 71.3 10.0 73.7 7.4 72.9 8.5 72.2 7.9 71.8 9.0 151 - 185 11.3 82.6 11.0 84.7 8.4 81.3 10.3 82.5 8.9 80.7 10.4 186 - 200 0.8 83.4 0.5 85.2 0.5 81.7 0.6 83.2 0.4 81.2 0.5 201 - 225 0.5 83.9 0.3 85.5 0.3 82.0 0.4 83.6 0.3 81.4 0.3 226 - 250 0.3 84.2 0.1 85.6 0.2 82.2 0.2 83.8 0.2 81.6 0.1 Over 250 0.3 84.5 0.2 85.8 0.2 82.4 0.3 84.0 0.2 81.8 0.2 Income reported as zero 3.6 88.1 2.3 88.1 2.6 84.9 3.0 87.1 3.2 85.0 1.6 

a

Not reported 11.9 100.0 11.9 100.0 15.1 100.0 12.9 100.0 15.0 100.0 10.0 

b

Total WIC 383,421 143,711 260,523 787,656 814,779 Racial data not reported0 - 50 21.2% 21.2% 19.0% 19.0% 15.4% 15.4% 18.6% 18.6% 26.1% 26.1% 24.2% 51 - 100 24.5 45.6 24.1 43.1 17.0 32.3 21.7 40.2 23.9 50.0 24.9 101 - 130 10.5 56.1 11.9 55.1 7.9 40.2 9.9 50.1 9.9 59.9 11.5 131 - 150 5.8 61.9 6.0 61.1 4.0 44.2 5.2 55.3 4.8 64.7 5.6 151 - 185 5.1 67.0 5.0 66.0 5.0 49.3 5.1 60.3 4.3 69.0 5.6 186 - 200 0.1 67.1 0.2 66.3 0.0 49.3 0.1 60.5 0.1 69.2 0.2 201 - 225 0.1 67.2 0.0 66.3 0.0 49.3 0.0 60.5 0.1 69.3 0.1 226 - 250 0.1 67.3 0.1 66.3 0.0 49.3 0.1 60.5 0.1 69.3 0.0 Over 250 0.0 67.3 0.2 66.5 0.0 49.4 0.1 60.6 0.2 69.5 0.1 Income reported as zero 12.2 79.6 5.7 72.3 4.8 54.1 8.0 68.6 9.0 78.5 4.8 

a

Not reported 20.4 100.0 27.7 100.0 45.9 100.0 31.4 100.0 21.5 100.0 23.0 

b

Total WIC 6,709 3,832 6,012 16,553 21,413 

NotesPoverty level calculations are based on income, income period, and household size as reported by State WIC agencies. 

Zero incomes are reported separately and excluded from these income calculations. In some reporting agencies, zero may be used to indicate missing information or adjunctive eligibility. PC98 cannot, the

a

income information and households reporting zero income.Not reported indicates the percentage of participants by participant category for whom no data on income, income period, or size of economic unit are reported. b
Chapter Four: +PEQOG QH 

Exhibit 4.10Distribution of Percent of Poverty Level at Certification for WIC Participants Reporting No Other Benefit Receipt

2GTEGPV QH 2QXGTV[ .GXGN $TGCUVHGGFKPI 2QUVRCTVWO

2TGIPCPV 9QOGP 9QOGP 9QOGP 6QVCN 9QOGP +PHCPVU %

0WODGT 2GTEGPV 0WODGT 2GTEGPV 0WODGT 2GTEGPV 0WODGT 2GTEGPV 0WODGT 2GTEGPV 0WODG

2GTEGPV D[ RCTVKEKRCPV ECVGIQT[

                                                                                          1XGT            +PEQOG TGRQTVGF CU \GTQ           

D

0QV TGRQTVGF           

E

6QVCN 9+%           

0QVGU

6JKU VCDNG GZENWFGU KPFKXKFWCNU HQT YJQO PQ FCVC TGICTFKPI RCTVKEKRCVKQP KP 6#0( (QQF 5VCORU CPF /GFKECKF CTG TGRQTVGF C

Zero incomes are reported separately and excluded from these income calculations. In some reporting agencies, zero may be used to indicate missing information or adjunctive eligibility. PC98 cann

D

missing income information and households reporting zero income.Not reported indicates the percentage of participants by participant category for whom no data on income, income period, or size of economic unit are reported. c
Chapter Four: +PEQOG QH 

Exhibit 4.11Comparison of Poverty Levels of WIC Participants to Persons in the US Population in 1998

Percent of Poverty Level General US Population Families Six Years US WIC 

a

1998 1998 1998 1998 

Persons in US with Children Under

a

Persons in US Families

ab 

0 - 50 5.0% 4.9% 9.7% 28.1% 51 - 100 8.1 7.4 11.6 28.7 101 - 130 5.4 4.9 7.1 12.5 131 - 150 3.8 3.5 4.4 6.1 151 - 185 6.8 6.5 8.1 6.6 186 - 200 2.8 2.8 3.0 0.3 Over 200 66.7 69.1 54.6 0.4 Income reported as zero 1.4 1.0 1.7 2.8 

c

Not reported N/A N/A N/A 14.6 

d

Total 268,480,000 226,809,000 69,825,000 8,042,758 

NotesN/A indicates not applicable.

Source: March 1998 Current Population Survey. a

Current Population Survey poverty levels reflect respondents’ 1997 incomes.

WIC participant poverty level calculations are based on income, income period, and household size as reported by State WIC agencies. Figures in this ta

b

WIC participants. Zero incomes are reported separately and excluded from these income calculations. In some reporting agencies, zero may be used to indicate missing i

c

PC98 cannot, therefore, distinguish between households with missing income information and households reporting zero income.Not reported indicates the percentage of participants for whom no data on income, income period, or size of economic unit are reported. d
%JCRVGT (QWT +PEQOG QH 2% 9+% 2CTVKEKRCPVU 

percent of WIC participants in that category declined 8 percentage points from 36

percent in 1994 to 34 percent in 1996 and to 28 percent in 1998. The expansion of

WIC has allowed the program to serve more “near poor” individuals—households

with incomes above the poverty level but less than 185 percent of poverty. Because

of the large amount of unreported income data, caution must be exercised when

interpreting these figures.

Within racial/ethnic categories, the percentage of Hispanic WIC enrollees below the

poverty line has decreased from 71 percent in 1996 to 60 percent in 1998. This

decline represents the greatest decrease among any ethnic group, though 60 percent

of Hispanic WIC enrollees still live below the poverty line. The percentage of black

WIC enrollees below the poverty line has decreased 4.6 percentage points since

1996, after decreasing 3 percentage points between 1994 and 1996. The percent of

Asians reporting income at or below the poverty level declined by 7.4 percentage

points between 1996 and 1998. Whites displayed a five percentage point decrease

during this time. Again, it is important to note that these findings apply to only the

83 percent of April 1998 WIC participants for whom income data were reported.

Exhibit 4.10 presents the distribution of percent of poverty for those participants who

report no participation in the TANF, Food Stamp, and Medicaid Programs. This

group accounts for 38 percent of the WIC population. There are some differences

between this group and the WIC population receiving other benefits. About one-half

(46 percent) of these individuals are below the poverty line as compared with 62

percent of the WIC population reporting participation in public aid programs. While

the percentage of participants below the poverty line decreased by 11 percentage

points between 1996 and 1998 for the WIC population reporting participation in aid

programs, the decline was only one percentage point for participants receiving no

other benefits.

The poverty of WIC participants can be seen in the information displayed in Exhibit

4.11. This table contains data on percent of poverty level for the general US

population, for American families, and for families with children under six years of

age. National data are drawn from the US Census Bureau's Current Population

Survey. In general, in this country, 5 percent of the population falls into the 0-to-50

percent poverty level. The rate increases to 9.7 percent for families with children

under six years of age. In 1998, over one-quarter (28.1 percent) of all WIC

participants reported incomes falling into the 0-to-50 percent of poverty range. WIC

participants are clearly concentrated at the lower end of the poverty distribution.
 Children with normal blood test results at last certification are also not tested. 1

Chapter Five: Nutritional Risk Characteristics in PC98 67

5. NUTRITIONAL RISK CHARACTERISTICS

Applicants must be determined to be at nutritional risk to meet eligibility requirements

for the WIC program. To qualify for WIC benefits, applicants must be determined to

be at risk based on anthropometric, biochemical, medical, or dietary factors. During

the determination process, height and weight must be measured, and a blood test for

anemia (usually hemoglobin or hematocrit) administered to all participants except

infants under six months of age. Medical history or dietary patterns may also be

1

considered during this process. The nutritional risk determination is made by a

competent professional authority, such as a physician, nutritionist, nurse, or other

health professional or paraprofessional.

In order to allow for coordination with medical care, Federal policy has, since the

inception of the WIC Program, permitted State agencies to develop nutrition risk

criteria within broad Federal parameters spelled out in the Child Nutrition Act of 1966,

as amended. Accordingly, the nutrition risk criteria used to determine eligibility have

historically varied from State to State. WIC Participant and Program Characteristics

reports from 1988 through 1998 reflect these differences among States. Because of

concerns about equity, in 1992 FNS asked the National Academy of Sciences (NAS)

Institute of Medicine to review the scientific basis for risk criteria used in the program,

and recommend definitions and cutoffs. NAS issued a report with recommendations

in 1996, which became the basis for a policy change that took effect April 1, 1999.

States are now required to use only criteria that have been reviewed by the Risk

Identification and Selection Collaborative (a joint NAWD/FNS working group) and

approved by FNS. Data reflecting these uniform risk definitions will first become

available with the publication of PC2000.

Because nutritional risk criteria vary across State WIC agencies, criteria must be

grouped into categories (standardized) in order to report on national participant

characteristics. A committee of the National Association of WIC Directors (NAWD)

created a set of risk categories which FNS has chosen to use for reporting nutritional

risk data for biennial participant studies, including PC98. Each State WIC agency

converted its specific nutritional risk criteria into the NAWD categories that are used,

throughout this chapter, to display PC98 data on nutritional risks. Definitions of the

NAWD risks appear in Exhibit 5.1.

Nutritional Risk Criteria During the eligibility determination process, WIC staff collect dietary information from

applicants and participants. Exhibits 5.2 and 5.3 present information on State dietary

intake policies and methods. Most States obtain dietary intake information from all

participants. In PC98, as in PC96, approximately four-fifths of the States used twentyfour hour recalls and food frequency/food item checklists to obtain nutritional data.

State-by-State tables appear in Appendix D. 

During the certification process, nutritional risks are recorded in applicant files. An

applicant may be determined to possess more than one nutritional risk. Approximately

65 percent of the State WIC agencies and 85 percent of local WIC agencies
Chapter Five: Nutritional Risk Characteristics in PC98 68

Exhibit 5.1

Broad Categories of Nutritional Risk Criteria Developed by the National Association

of WIC Directors

Anthropometric

• Low weight for height

• High weight for height

• Short stature

• Inappropriate growth/weight gain pattern

• Low birth weight/premature birth

• Other anthropometric risk

Biochemical

• Hematocrit or hemoglobin below State criteria

• Other biochemical test results which indicate nutritional abnormality

(such as cholesterol, folic acid, B , B , other nutritional anemias) 6 12

Clinical/Health/Medical

• Pregnancy-induced conditions (such as toxemia, preeclampsia,

eclampsia, pregnancy-induced hypertension, gestational diabetes,

excessive vomiting, and nausea)

• Delivery of low-birthweight/premature infant

• Prior stillbirth, miscarriage, spontaneous abortion, or neonatal death

• General obstetrical risks (such as multiple fetus births, high parity,

closely spaced pregnancies, age)

• Nutrition-related risk conditions (such as any nutrition-related chronic

disease, genetic disorder, infectious disease, clinical malnutrition,

failure to thrive, drug nutrient interactions)

• Substance abuse (drugs, alcohol, tobacco)

• Other health risk (such as mental retardation)

Dietary

• Inadequate/inappropriate nutrient intake

• Other dietary risk

Other Risk

• Regression

• Transfer (nutrition risk unknown)

• Breastfeeding mother/infant dyad

• Infant of a WIC-eligible mother or mother at risk during pregnancy

• Homelessness/migrancy

• Other nutritional risks
%JCRVGT (KXG 0WVTKVKQPCN 4KUM %JCTCEVGTKUVKEU KP 2% 

Exhibit 5.2

State Policies for Obtaining Dietary Intake Information

State Agencies

State Dietary Policy Number Percent

Information is obtained from all participants 76 86.4%

Information is obtained only from participants 5 5.7

at risk due to dietary inadequacy

Other policies affect obtaining information 7 8.0 a

Total 88 100.0%

Note

For more information on other policies, see Exhibit D5.2 in Appendix D. a
%JCRVGT (KXG 0WVTKVKQPCN 4KUM %JCTCEVGTKUVKEU KP 2% 

Exhibit 5.3

Dietary Intake Methods Routinely Used by States

State Agencies

Dietary Intake Method Number Percenta

Twenty-four hour recall 72 81.8%

Food frequency/food item checklist 70 79.5

Dietary record or diary 6 6.8

Computer-assisted analysis 7 8.0

Some other method 2 2.3 b

Notes

Responses are not mutually exclusive, so percentages do not sum to 100 percent. Percentages are based on the a

number (88) of reporting State WIC agencies.

For more information on other methods, see Exhibit D5.3 in Appendix D. b
Chapter Five: Nutritional Risk Characteristics in PC98 71

(representing about three-quarters of all WIC participants) reported that every

identified nutritional risk is recorded for each participant. State and local

documentation policies are displayed in Exhibit 5.4; State-by-State tables appear in

Appendix D.

States may report the three highest priority nutritional risks present at the current

certification. The percentage of WIC participants for whom three nutritional risks were

reported was almost 22 percent in 1998, slightly more than the 18 percent reported in

1994 and the 19 percent in 1996, but less than the 26 percent reported in 1992. PC98

data are not conducive to more detailed analysis of these fluctuations. An infant or

child is more likely to have a single nutritional risk reported, while the categories of

pregnant and breastfeeding women have the highest percentages of participants with

three nutritional risks. At least one nutritional risk was reported for 99.2 percent of all

individuals enrolled in the WIC Program in April 1998. (See Exhibit 5.5.)

Nutritional Risks in PC98 One notable strength of PC98's census dataset is that it allows examination of

nutritional risks for specific participant subgroups, such as American Indian/Alaskan

Native WIC enrollees. PC98 also permits consideration of characteristics of pregnant

teenagers and migrants. Distributions of nutritional risks by participant category, age,

and race/ethnicity are presented in Exhibits 5.6 through 5.23. Exhibits 5.6, 5.7, 5.10,

5.11, and 5.23 provide detailed analysis by participant age, while Exhibits 5.12 through

5.16 and 5.18 through 5.22 display distributions of nutritional risk by racial/ethnic

categories. (Migrant WIC enrollment is described in Chapter Eight.)

Consistent with earlier PCs, the most commonly reported categories of nutritional risk

reported for the entire WIC population are anthropometric and dietary risks (Exhibit

5.8). Distributions vary, however, across participant categories.

The nutritional risks reported most frequently for WIC women in PC98, as in PC96,

PC94, and PC92, are general obstetrical risks and inadequate or inappropriate nutrient

intake. Blood measurements below State criteria were reported for a quarter of WIC

women. Clinical, medical, and health risks (and, in particular, general obstetrical risks)

were reported for almost 90 percent of women under eighteen years of age and 77

percent of women over thirty-four years of age, compared with about 50 percent of

women between the ages of eighteen and thirty-four. Dietary risk reports were highest

among women eighteen to thirty-four years of age. (See Exhibits 5.6, 5.9, and 5.23.)

While the distribution of nutritional risks in 1998 is generally similar to that in PC96,

a few substantial changes occurred. For pregnant, breastfeeding, and postpartum

women, the rate at which high weight for height was reported increased by 3 to 4

percentage points. The incidence of high weight for height has increased steadily from

1992—an overall increase of 8 percentage points. This incidence of inappropriate

weight gain reported for all women has also increased for all women from 22 percent

in 1992 to 25 percent in 1998. These trends among WIC participants mirror changes

observed in the general population. From PC96 to PC98, the rate at which inadequate

or inappropriate nutrition intake was reported increased among all women by 2.3

percentage points, with the largest increase occurring among breastfeeding women.

However, the rate has fluctuated since 1992, so no trend is evident. The incidence of

other categories of risks changed by smaller amounts, if at all, from PC96 to PC98.

Nutritional risks for infants vary by age at certification. (See Exhibits 5.7 and 5.10.)

In PC92, PC94, PC96 and PC98, about three-quarters of all infants from zero to three
Chapter Five: Nutritional Risk Characteristics in PC98 72

Exhibit 5.4

State and Local Agency Documentation of Nutritional Risk Criteria

Method Local Agencies Participants

State Agencies Percent of Percent of

Number Percent

a,b a,b

The single most important risk criterion 0 0.0% 1.0% 1.4% 

is recorded (0.53) (0.42) c

All risk criteria are recorded 56 63.6 86.7 78.8 

(0.00) (0.00) 

A set number of the more important risk 21 23.9 8.4 15.4 

criteria are recorded (1.44) (4.01) d

The most easily and quickly identifiable 3 3.4 0.4 0.5 

criteria are recorded (0.32) (0.34)

Local certifiers decide which criteria and 7 8.0 2.7 1.2 

how many criteria to record (0.85) (0.48)

Some other procedure is used 1 1.1 0.7 1.0 e

(0.36) (0.51)

Not reported 0 0.0 0.2 1.6 

(0.25) (2.22)

Total 88 100.0% 100.0% 100.0%

Notes

Standard errors are in parentheses. a

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe b

of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

It is likely that the local WIC agencies in this category are located in States allowing local discretion and that these local agencies have c

chosen to record the single most important risk.

Most State agencies report documenting three or five risks. d

For more information on other procedures reported by State WIC agencies, see Exhibit D5.4 in Appendix D. e
Chapter Five: Nutritional Risk 

Exhibit 5.5Distribution of Number of Nutritional Risk Factors for WIC Participants Reported at Certification1994, 1996, 1998

Pregnant Women Breastfeeding Women Postpartum Women Infants Children 

Number ofRisk Factors 1994 1996 1998 1994 1996 1998 1994 1996 1998 1994 1996 1998 1994 1996 

Percent by participant category

1 22.6% 19.6% 17.1% 24.2% 19.8% 17.1% 30.5% 31.7% 27.4% 58.9% 57.2% 53.0% 53.3% 54.5% 2 33.4 33.3 32.1 31.6 35.3 32.5 35.7 35.3 34.6 30.2 30.1 32.7 33.7 32.2 3 42.7 45.7 50.3 43.2 44.2 49.9 32.2 32.4 37.5 9.9 12.1 13.8 12.1 12.9 No risk 1.4 1.3 0.5 1.0 0.7 0.4 1.6 0.6 0.4 1.0 0.5 0.5 1.0 0.5  reportedTotal 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 1

Note In 1994, 1996, and 1998 each State WIC agency reported up to three risks, recorded for each participant, on its automated client information system. 
Chapter Five: Nutritional Risk 

Exhibit 5.6Number and Percent of Women WIC Participants by Participant Category, Age at Certification, and Type of Nutr

Anthropometric Biochemical Medical Dietary Other Risks 

Clinical, Health, and

a 

Participant Category and Age atCertification Number Percent Number Percent Number Percent Number Percent Number Percent N

Percent by participant category and age

Pregnant women 577,828 64.7% 214,438 24.0% 543,284 60.9% 409,442 45.9% 17,953 2.0% 

Under 15 years 3,661 53.6 2,020 29.6 6,214 91.1 2,659 39.0 125 1.8 15 - 17 years 50,365 55.6 22,475 24.8 81,708 90.2 34,978 38.6 1,515 1.7 18 - 34 years 489,643 66.0 176,195 23.7 412,226 55.5 356,480 48.0 15,407 2.1 35 or more years 33,260 64.8 13,347 26.0 42,009 81.8 14,612 28.5 731 1.4 Age not reported 900 49.9 401 22.2 1,128 62.5 714 39.5 175 9.7 

Breastfeeding women 190,186 48.8 96,544 24.8 212,132 54.5 175,038 45.0 155,910 40.0 

Under 15 years 239 38.1 239 38.2 556 88.7 215 34.4 189 30.3 15 - 17 years 5,903 37.4 4,579 29.0 13,809 87.4 5,800 36.7 5,629 35.6 18 - 34 years 160,966 48.9 81,731 24.8 165,843 50.4 153,366 46.6 136,067 41.3 35 or more years 22,113 53.2 9,519 22.9 30,782 74.0 14,569 35.0 13,375 32.2 Age not reported 965 46.8 474 23.0 1,143 55.5 1,088 52.8 650 31.5 

Postpartum women 264,107 44.7 199,813 33.8 336,812 57.0 288,826 48.9 37,282 6.3 

Under 15 years 965 32.5 1,186 39.9 2,613 88.0 1,267 42.7 155 5.2 15 - 17 years 17,901 34.1 18,810 35.8 45,014 85.7 22,372 42.6 3,018 5.7 18 - 34 years 226,488 45.7 167,679 33.8 259,937 52.4 250,105 50.4 31,901 6.4 35 or more years 16,949 47.5 11,031 30.9 26,851 75.2 13,044 36.5 2,025 5.7 Age not reported 1,804 48.1 1,108 29.5 2,397 63.9 2,039 54.4 184 4.9 

Total women 1,032,121 55.1 510,795 27.3 1,092,229 58.3 873,307 46.6 211,145 11.3 

Under 15 years 4,864 46.7 3,445 33.1 9,383 90.0 4,141 39.7 469 4.5 15 - 17 years 74,169 46.7 45,864 28.9 140,530 88.4 63,150 39.7 10,162 6.4 18 - 34 years 877,097 56.0 425,605 27.2 838,005 53.5 759,952 48.5 183,374 11.7 35 or more years 72,322 56.2 33,897 26.4 99,642 77.5 42,224 32.8 16,130 12.5 Age not reported 3,668 48.2 1,983 26.0 4,668 61.3 3,840 50.4 1,009 13.2 

Notes

Other risks include regression, transfer (nutritional risk unknown), breastfeeding mother and infant dyad, and homelessness/migrancy. a

The total women column reports only number of women in the category. b

In 1998, State WIC agencies could report up to three nutritional risks for each participant. This table examines all risks reported for every participant. When multiple risks within the same classification are and counted one time in order to accurately calculate the number and percentage of WIC participants with a specific type (or category) of risk. Nonetheless, because of the reporting of multiple risks, col
Chapter Five: Nutritional Risk 

Exhibit 5.7Number and Percent of Infant and Child WIC Participants by Age at Certification and Type of Nutritional Risk Re

Anthropometric Biochemical Medical Dietary Other Risks No 

Clinical, Health, and 

a

Participant Category andAge at Certification Number Percent Number Percent Number Percent Number Percent Number Percent Num

Percent by participant category and age

Infantsb 485,718 23.7% 77,506 3.8% 230,905 11.3% 270,857 13.2% 1,699,267 82.9% 9

0 - 3 months 396,819 21.9 32,505 1.8 194,674 10.7 179,857 9.9 1,604,936 88.6 84 - 5 months 18,374 33.6 4,599 8.4 9,511 17.4 15,142 27.7 33,179 60.6 6 - 8 months 49,876 38.8 27,251 21.2 18,392 14.3 53,359 41.5 50,959 39.7 9 - 11 months 19,364 39.2 12,736 25.8 8,065 16.3 21,775 44.1 6,723 13.6 Age not reported 1,285 26.7 415 8.6 264 5.5 725 15.0 3,469 72.0 

Children 1,385,441 33.6 1,007,429 24.4 783,081 19.0 2,815,146 68.3 241,539 5.9 24

1 year 555,272 37.8 412,602 28.1 262,632 17.9 956,120 65.1 95,794 6.5 142 years 354,960 34.3 270,058 26.1 193,057 18.7 710,052 68.6 54,190 5.2 43 years 262,070 28.6 201,685 22.0 183,621 20.0 651,664 71.0 49,388 5.4 34 years 202,239 30.2 119,731 17.9 140,646 21.0 474,270 70.9 37,230 5.6 2Age not reported 10,901 34.9 3,353 10.7 3,124 10.0 23,041 73.7 4,936 15.8 

NotesIn 1998, State WIC agencies could report up to three nutritional risks for each participant. This table examines all risks reported for every participant. When multiple risks within person, these risks are combined and counted one time in order to accurately calculate the number and percentage of WIC participants with a specific type (or category) of risk. None

risks, columns total more than 100 percent.

Other risks include regression, transfer (nutritional risk unknown), breastfeeding mother and infant dyad, infant of a WIC-eligible mother or mother at risk during pregnancy, and 

a

An infant is defined as a participant who, at certification, is under one year of age and who would be classified as a child at the age of 366 days. b
Chapter Five: 0WVTKVKQPCN 4KUM %JCTCEVGTKUVKEU KP 2% 76

Exhibit 5.8

Number and Percent of WIC Participants with Specific Nutritional Risks Reported at

Certification

WIC Participants

Type of Risk and Specific Risk Number Percent

Percent by risk type

Anthropometric 2,903,281 36.1%

Low weight for height 358,898 4.5

High weight for height 1,337,250 16.6

Short stature 477,234 5.9

Inappropriate growth or weight gain pattern 917,589 11.4

Low birthweight or premature birth 206,807 2.6

Other anthropometric 128,703 1.6

Biochemical 1,595,730 19.8

Hematocrit or hemoglobin below State criteria 1,588,314 19.7

Other biochemical test results which indicate nutritional abnormality 11,311 0.1

Clinical, Health, Medical 2,106,215 26.2

Pregnancy-induced conditions 60,258 0.7

Delivery of low-birthweight or premature infant 41,159 0.5

Prior stillbirth, miscarriage, spontaneous abortion, or neonatal death 79,329 1.0

General obstetrical risks 733,475 9.1

Nutrition-related risk conditions 606,252 7.5

Substance abuse 452,142 5.6

Other health risk 490,104 6.1

Dietary 3,959,310 49.2

Inadequate or inappropriate nutrient intake 3,684,785 45.8

Other dietary risk 461,737 5.7

Other risk 2,151,951 26.8

Regression 130,579 1.6

Transfer (nutrition risk unknown) 133,306 1.7

Breastfeeding mother and infant dyad 644,458 8.0

Infant of a WIC-eligible mother or mother at risk during pregnancy 1,541,844 19.2

Homelessness/Migrancy 5,777 0.1

Other nutritional risks 59,570 0.7

No risk reported 43,151 0.5

US WIC - total number of risks reported 14,150,880

US WIC - total number of participants 8,042,758

Note

In 1998, State WIC agencies could report up to three nutritional risks for each participant. This table examines all risks reported

for every participant. When multiple risks within the same classification are reported for one person, these risks are combined

and counted one time in order to accurately calculate the number and percentage of WIC participants with a specific type (or

category) of risk.
Chapter Five: 0WVTKVKQPCN %

Exhibit 5.9Number and Percent of Women WIC Participants by Participant Category with Specific Nutritional Risks Reported

Pregnant Women Breastfeeding Women Postpartum W

Risk Number Percent Number Percent Number P

Percent by participant category

Women in category 892,674 389,391 591,050 Anthropometric 577,828 64.7% 190,186 48.8% 264,107 

Low weight for height 77,898 8.7 13,198 3.4 23,331 High weight for height 269,548 30.2 141,720 36.4 193,739 Short stature 14,346 1.6 563 0.1 1,401 Inappropriate growth or weight gain pattern 349,807 39.2 50,307 12.9 61,541 Other anthropometric 22,804 2.6 3,564 0.9 5,606 

Biochemical 214,438 24.0 96,544 24.8 199,813 

Hematocrit or hemoglobin below State criteria 213,750 23.9 96,324 24.7 199,280 Other biochemical test results which indicate nutritional abnormality 1,176 0.1 445 0.1 962 

Clinical, Health, Medical 543,284 60.9 212,132 54.5 336,812 

Pregnancy-induced conditions 25,981 2.9 15,327 3.9 18,950 Delivery of low-birthweight or premature infant 16,282 1.8 7,368 1.9 17,508 Prior stillbirth, miscarriage, spontaneous abortion, or neonatal death 42,600 4.8 10,622 2.7 26,108 General obstetrical risks 370,126 41.5 147,399 37.9 215,950 Nutrition-related risk conditions 80,660 9.0 25,418 6.5 39,874 Substance abuse 119,100 13.3 29,319 7.5 56,316 Other health risk 31,076 3.5 25,342 6.5 46,258 

Dietary 409,442 45.9 175,038 45.0 288,826 

Inadequate or inappropriate nutrient intake 394,622 44.2 171,344 44.0 280,833 Other dietary risk 24,019 2.7 5,613 1.4 11,080 

Other risk 17,953 2.0 155,910 40.0 37,282 

Regression 48 0.0 1,026 0.3 1,577 Transfer (nutrition risk unknown) 11,583 1.3 4,683 1.2 14,172 Breastfeeding mother and infant dyad 246 0.0 151,061 38.8 5,424 Homelessness/Migrancy 630 0.1 226 0.1 244 Other nutritional risks 5,473 0.6 2,708 0.7 16,242 

No risk reported 4,827 0.5 1,488 0.4 2,564 

NoteIn 1998, State WIC agencies could report up to three nutritional risks for each participant. This table examines all risks reported for every participant. When multiple risks within the sathese risks are combined and counted one time in order to accurately calculate the number and percentage of WIC participants with a specific type (or category) of risk.
Chapter Five: 0WVTKVKQPCN %

Exhibit 5.10Number and Percent of Infant WIC Participants with Specific Nutritional Risks Reported by Age at Certification

0 - 3 Months 4 - 5 Months 6 - 8 Months 9 - 11 Months Age Not R

Risk Number Percent Number Percent Number Percent Number Percent Number 

Percent by age

Infants in age group 1,811,288 54,738 128,445 49,336 4,819 Anthropometric 396,819 21.9% 18,374 33.6% 49,876 38.8% 19,364 39.2% 1,285 

Low weight for height 59,024 3.3 1,452 2.7 4,049 3.2 3,110 6.3 190 High weight for height 55,611 3.1 6,061 11.1 15,837 12.3 6,811 13.8 440 Short stature 121,047 6.7 4,836 8.8 12,242 9.5 5,819 11.8 354 Inappropriate growth or weight gain 56,427 3.1 4,280 7.8 18,820 14.7 5,837 11.8 198 

pattern

Low birthweight or premature birth 167,243 9.2 5,230 9.6 9,920 7.7 2,393 4.9 290 Other anthropometric 54,251 3.0 1,209 2.2 2,109 1.6 320 0.6 186 

Biochemical 32,505 1.8 4,599 8.4 27,251 21.2 12,736 25.8 415 

Hematocrit or hemoglobin below 32,043 1.8 4,557 8.3 27,179 21.2 12,666 25.7 414 

State criteriaa

Other biochemical test results which 495 0.0 52 0.1 119 0.1 147 0.3 2 

indicate nutritional abnormality

Clinical, Health, Medical 194,674 10.7 9,511 17.4 18,392 14.3 8,065 16.3 264 

Nutrition-related risk conditions 59,878 3.3 3,297 6.0 7,558 5.9 5,527 11.2 129 Substance abuse 76,386 4.2 1,762 3.2 1,351 1.1 404 0.8 55 Other health risk 67,544 3.7 4,894 8.9 10,159 7.9 2,479 5.0 89 

Dietary 179,857 9.9 15,142 27.7 53,359 41.5 21,775 44.1 725 

Inadequate or inappropriate nutrient 134,359 7.4 9,644 17.6 30,751 23.9 17,847 36.2 649 

intake

Other dietary risk 49,601 2.7 6,100 11.1 25,510 19.9 4,727 9.6 113 

Other risk 1,604,936 88.6 33,179 60.6 50,959 39.7 6,723 13.6 3,469 

Regression 438 0.0 137 0.3 1,196 0.9 710 1.4 5 Transfer (nutrition risk unknown) 37,756 2.1 2,953 5.4 4,170 3.2 773 1.6 136 Breastfeeding mother and infant dyad 457,550 25.3 7,679 14.0 13,757 10.7 2,115 4.3 590 Infant of a WIC-eligible mother or 1,439,188 79.5 25,973 47.4 38,484 30.0 3,347 6.8 2,811 

mother at risk during pregnancy

Homelessness/Migrancy 894 0.0 84 0.2 147 0.1 51 0.1 2 Other nutritional risks 9,800 0.5 439 0.8 264 0.2 79 0.2 341 

No risk reported 8,061 0.4 380 0.7 546 0.4 464 0.9 160 

NotesIn 1998, State WIC agencies could report up to three nutritional risks for each participant. This table examines all risks reported for every participant. When multiple risks within the sathese risks are combined and counted one time in order to accurately calculate the number and percentage of WIC participants with a specific type (or category) of risk.

Federal WIC regulations permit State and local agencies to dispense with hematological testing for infants under six months of age, as well as for children who are found to be within no

a

blood tests should be performed on such children at least once in every twelve-month period.
Chapter Five: 0WVTKVKQPCN %

Exhibit 5.11Number and Percent of Child WIC Participants with Specific Nutritional Risks Reported by Age at Certification

1 Year 2 Years 3 Years 4 Years Age 

a

Risk Number Percent Number Percent Number Percent Number Percent Numb

Percent by age

Children in age group 1,468,580 1,034,432 917,758 668,972 31,Anthropometric 555,272 37.8% 354,960 34.3% 262,070 28.6% 202,239 30.2% 10,

Low weight for height 76,434 5.2 44,986 4.3 32,733 3.6 21,099 3.2 1,High weight for height 246,086 16.8 172,014 16.6 120,036 13.1 102,276 15.3 7,Short stature 133,428 9.1 80,312 7.8 58,987 6.4 41,900 6.3 1,Inappropriate growth or weight gain pattern 157,553 10.7 92,550 8.9 68,783 7.5 50,121 7.5 1,Low birthweight or premature birth 16,655 1.1 2,613 0.3 1,224 0.1 708 0.1 Other anthropometric 15,354 1.0 9,079 0.9 8,308 0.9 5,824 0.9 

Biochemical 412,602 28.1 270,058 26.1 201,685 22.0 119,731 17.9 3,

Hematocrit or hemoglobin below State criteria 411,342 28.0 268,453 26.0 200,189 21.8 118,767 17.8 3,

b

Other biochemical test results which indicate 2,117 0.1 2,348 0.2 2,122 0.2 1,324 0.2 

nutritional abnormality

Clinical, Health, Medical 262,632 17.9 193,057 18.7 183,621 20.0 140,646 21.0 3,

Nutrition-related risk conditions 123,886 8.4 92,135 8.9 91,903 10.0 73,191 10.9 2,Substance abuse 53,222 3.6 43,396 4.2 39,997 4.4 30,680 4.6 Other health risk 103,099 7.0 74,753 7.2 70,700 7.7 53,498 8.0 

Dietary 956,120 65.1 710,052 68.6 651,664 71.0 474,270 70.9 23,

Inadequate or inappropriate nutrient intake 875,259 59.6 669,148 64.7 623,597 67.9 454,939 68.0 21,Other dietary risk 167,315 11.4 80,813 7.8 51,201 5.6 32,948 4.9 2,

Other risk 95,794 6.5 54,190 5.2 49,388 5.4 37,230 5.6 4,

Regression 35,773 2.4 34,034 3.3 31,014 3.4 23,914 3.6 Transfer (nutrition risk unknown) 21,869 1.5 13,769 1.3 12,270 1.3 8,763 1.3 Breastfeeding mother and infant dyad 5,608 0.4 141 0.0 66 0.0 18 0.0 Infant of a WIC-eligible mother or mother at risk 28,126 1.9 171 0.0 108 0.0 89 0.0 3,

during pregnancy

Homelessness/Migrancy 1,135 0.1 944 0.1 839 0.1 576 0.1 Other nutritional risks 7,258 0.5 5,994 0.6 6,036 0.7 4,693 0.7 

No risk reported 14,075 1.0 4,034 0.4 3,556 0.4 2,521 0.4 

NotesIn 1998, State WIC agencies could report up to three nutritional risks for each participant. This table examines all risks reported for every participant. When multiple risks within the same clas

are combined and counted one time in order to accurately calculate the number and percent of WIC participants with a specific type (or category) of risk.

At certification, 36 percent of child WIC participants are one-year-old. a

Federal WIC regulations permit State and local agencies to dispense with hematological testing for infants under six months of age, as well as for children who are found to be within norma

b

tests should be performed on such children at least once in every twelve-month period.
Chapter Five: 0WVTKVKQPCN %

Exhibit 5.12Number and Percent of American Indian and Alaskan Native WIC Participants with Specific Nutritional Risks Repo

Pregnant Women Breastfeeding Postpartum

Women Women Total Women Infants 

Risk Number Percent Number Percent Number Percent Number Percent Number Percent 

Percent by participant category

Participants in category 12,506 5,996 6,940 25,442 27,656 Anthropometric 7,546 60.3% 3,304 55.1% 3,891 56.1% 14,741 57.9% 7,575 27.4% 

Low weight for height 804 6.4 191 3.2 223 3.2 1,219 4.8 822 3.0 High weight for height 4,635 37.1 2,766 46.1 3,212 46.3 10,613 41.7 2,748 9.9 Short stature 73 0.6 16 0.3 62 0.9 151 0.6 1,770 6.4 Inappropriate growth or weight gain 3,260 26.1 436 7.3 470 6.8 4,166 16.4 670 2.4 

pattern

Low birthweight or premature birth 0 0.0 0 0.0 0 0.0 0 0.0 2,266 8.2 Other anthropometric 100 0.8 25 0.4 75 1.1 200 0.8 983 3.6 

Biochemical 2,043 16.3 1,224 20.4 2,366 34.1 5,633 22.1 1,082 3.9 

Hematocrit or hemoglobin below 2,035 16.3 1,223 20.4 2,364 34.1 5,622 22.1 1,077 3.9 

State criteria

Other biochemical test results which 10 0.1 3 0.1 4 0.1 17 0.1 6 0.0 

indicate nutritional abnormality

Clinical, Health, Medical 9,044 72.3 3,623 60.4 4,765 68.7 17,433 68.5 5,070 18.3 

Pregnancy-induced conditions 625 5.0 166 2.8 247 3.6 1,038 4.1 0 0.0 Delivery of low-birthweight or 294 2.4 163 2.7 293 4.2 750 2.9 0 0.0 

premature infant

Prior stillbirth, miscarriage, 718 5.7 112 1.9 294 4.2 1,124 4.4 0 0.0 

spontaneous abortion,or neonatal death

General obstetrical risks 5,974 47.8 2,139 35.7 3,034 43.7 11,146 43.8 0 0.0 Nutrition-related risk conditions 1,473 11.8 903 15.1 815 11.7 3,191 12.5 2,733 9.9 Substance abuse 2,141 17.1 613 10.2 949 13.7 3,703 14.6 1,014 3.7 Other health risk 623 5.0 287 4.8 358 5.2 1,268 5.0 1,464 5.3 

Dietary 6,011 48.1 2,464 41.1 3,003 43.3 11,478 45.1 3,558 12.9 

Inadequate or inappropriate nutrient 5,888 47.1 2,427 40.5 2,832 40.8 11,148 43.8 3,171 11.5 

intake

Other dietary risk 191 1.5 60 1.0 192 2.8 443 1.7 478 1.7 
Exhibit 5.12 (continued)

Number and Percent of American Indian and Alaskan Native WIC Participants with Specific Nutritional Risks ReParticipant Category

Pregnant Women Breastfeeding Postpartum

Women Women Total Women Infants 

Risk Number Percent Number Percent Number Percent Number Percent Number Percent 

Percent by participant category

Chapter Five: 0WVTKVKQPCN %

Other risk 263 2.1% 2,968 49.5% 227 3.3% 3,458 13.6% 23,868 86.3% 

Regression 7 0.1 22 0.4 32 0.5 61 0.2 58 0.2 Transfer (nutrition risk unknown) 46 0.4 36 0.6 60 0.9 142 0.6 199 0.7 Breastfeeding mother and infant 14 0.1 2,917 48.7 45 0.6 2,976 11.7 7,054 25.5 

dyad

Infant of a WIC-eligible mother or 0 0.0 0 0.0 0 0.0 0 0.0 21,924 79.3 

mother at risk during pregnancy

Homelessness/Migrancy 10 0.1 1 0.0 5 0.1 16 0.1 23 0.1 Other nutritional risks 186 1.5 41 0.7 88 1.3 315 1.2 82 0.3 

No risk reported 61 0.5 16 0.3 28 0.4 105 0.4 179 0.6 

NotesAn infant is defined as a participant who, at certification, is under one year of age and who would be classified as a child at the age of 366 days.In 1998, State WIC agencies could report up to three nutritional risks for each participant. This table examines all risks reported for every participant. When multiple risks within the sathese risks are combined and counted one time in order to accurately calculate the number and percent of WIC participants with a specific type (or category) of risk.This table reports information on persons having origins in any of the original peoples of North America, who maintain cultural identification through tribal affiliation or community 
Chapter Five: 0WVTKVKQPCN %

Exhibit 5.13Number and Percent of Asian or Pacific Islander WIC Participants with Specific Nutritional Risks Reported by P

Pregnant Women Breastfeeding Postpartum

Women Women Total Women Infants 

Risk Number Percent Number Percent Number Percent Number Percent Number Percent 

Percent by participant category

Participants in category 24,914 13,425 18,600 56,940 64,400 Anthropometric 16,570 66.5% 5,544 41.3% 7,498 40.3% 29,611 52.0% 13,185 20.5% 

Low weight for height 4,212 16.9 743 5.5 1,125 6.0 6,080 10.7 1,948 3.0 High weight for height 3,697 14.8 3,625 27.0 4,119 22.1 11,441 20.1 1,641 2.5 Short stature 1,440 5.8 30 0.2 42 0.2 1,512 2.7 3,787 5.9 Inappropriate growth or weight gain 12,805 51.4 1,620 12.1 3,007 16.2 17,432 30.6 2,486 3.9 

pattern

Low birthweight or premature birth 0 0.0 0 0.0 0 0.0 0 0.0 4,609 7.2 Other anthropometric 376 1.5 66 0.5 54 0.3 496 0.9 1,997 3.1 

Biochemical 7,461 29.9 3,818 28.4 6,865 36.9 18,145 31.9 1,653 2.6 

Hematocrit or hemoglobin below 7,451 29.9 3,815 28.4 6,852 36.8 18,119 31.8 1,639 2.5 

State criteria

Other biochemical test results which 22 0.1 7 0.1 17 0.1 46 0.1 19 0.0 

indicate nutritional abnormality

Clinical, Health, Medical 13,311 53.4 7,042 52.5 9,668 52.0 30,021 52.7 8,282 12.9 

Pregnancy-induced conditions 635 2.6 534 4.0 704 3.8 1,873 3.3 0 0.0 Delivery of low-birthweight or 253 1.0 293 2.2 289 1.6 835 1.5 0 0.0 

premature infant

Prior stillbirth, miscarriage, 647 2.6 219 1.6 398 2.1 1,263 2.2 0 0.0 

spontaneous abortion,or neonatal death

General obstetrical risks 10,806 43.4 5,457 40.7 6,969 37.5 23,233 40.8 0 0.0 Nutrition-related risk conditions 1,252 5.0 567 4.2 628 3.4 2,447 4.3 1,401 2.2 Substance abuse 1,376 5.5 931 6.9 1,710 9.2 4,017 7.1 5,127 8.0 Other health risk 534 2.1 519 3.9 859 4.6 1,912 3.4 2,153 3.3 

Dietary 12,045 48.3 6,437 47.9 10,213 54.9 28,695 50.4 7,400 11.5 

Inadequate or inappropriate nutrient 11,847 47.6 6,349 47.3 9,795 52.7 27,991 49.2 6,147 9.5 

intake

Other dietary risk 303 1.2 129 1.0 461 2.5 893 1.6 1,409 2.2 
Exhibit 5.13 (continued)

Number and Percent of Asian or Pacific Islander WIC Participants with Specific Nutritional Risks Reported by P

Pregnant Women Breastfeeding Postpartum

Women Women Total Women Infants 

Risk Number Percent Number Percent Number Percent Number Percent Number Percent 

Percent by participant category

Chapter Five: 0WVTKVKQPCN %

Other risk 1,296 5.2% 5,861 43.7% 1,488 8.0% 8,644 15.2% 54,213 84.2% 

Regression 0 0.0 22 0.2 24 0.1 46 0.1 76 0.1 Transfer (nutrition risk unknown) 102 0.4 76 0.6 233 1.3 411 0.7 465 0.7 Breastfeeding mother and infant 8 0.0 4,652 34.7 172 0.9 4,832 8.5 13,981 21.7 

dyad

Infant of a WIC-eligible mother or 0 0.0 0 0.0 0 0.0 0 0.0 42,629 66.2 

mother at risk during pregnancy

Homelessness/Migrancy 18 0.1 11 0.1 1 0.0 30 0.1 64 0.1 Other nutritional risks 1,168 4.7 1,173 8.7 1,067 5.7 3,408 6.0 6,069 9.4 

No risk reported 266 1.1 82 0.6 63 0.3 411 0.7 355 0.6 

NotesAn infant is defined as a participant who, at certification, is under one year of age and who would be classified as a child at the age of 366 days.In 1998, State WIC agencies could report up to three nutritional risks for each participant. This table examines all risks reported for every participant. When multiple risks within the sathese risks are combined and counted one time in order to accurately calculate the number and percent of WIC participants with a specific type (or category) of risk.This table reports information on persons having origins in any of the original peoples of the Far East, the Indian subcontinent, Southeast Asia, or the Pacific Islands. This area inPhilippine Islands, and Samoa.
Chapter Five: 0WVTKVKQPCN %

Exhibit 5.14Number and Percent of Black (non-Hispanic) WIC Participants with Specific Nutritional Risks Reported by Parti

Pregnant Women Breastfeeding Postpartum

Women Women Total Women Infants 

Risk Number Percent Number Percent Number Percent Number Percent Number Percent 

Percent by participant category

Participants in category 194,038 58,120 149,043 401,202 498,190 Anthropometric 127,365 65.6% 30,150 51.9% 70,213 47.1% 227,728 56.8% 134,965 27.1% 

Low weight for height 15,561 8.0 1,688 2.9 5,669 3.8 22,918 5.7 21,266 4.3 High weight for height 71,681 36.9 24,546 42.2 53,907 36.2 150,135 37.4 19,130 3.8 Short stature 560 0.3 141 0.2 651 0.4 1,352 0.3 48,085 9.7 Inappropriate growth or weight gain 67,482 34.8 7,580 13.0 15,079 10.1 90,142 22.5 23,510 4.7 

pattern

Low birthweight or premature birth 0 0.0 0 0.0 0 0.0 0 0.0 59,063 11.9 Other anthropometric 4,839 2.5 237 0.4 795 0.5 5,871 1.5 9,384 1.9 

Biochemical 66,298 34.2 21,607 37.2 67,550 45.3 155,454 38.7 23,746 4.8 

Hematocrit or hemoglobin below 66,004 34.0 21,520 37.0 67,294 45.2 154,817 38.6 23,517 4.7 

State criteria

Other biochemical test results which 564 0.3 182 0.3 427 0.3 1,173 0.3 314 0.1 

indicate nutritional abnormality

Clinical, Health, Medical 107,893 55.6 28,406 48.9 84,768 56.9 221,067 55.1 38,597 7.7 

Pregnancy-induced conditions 5,002 2.6 1,728 3.0 4,109 2.8 10,838 2.7 0 0.0 Delivery of low-birthweight or 4,646 2.4 1,754 3.0 5,701 3.8 12,102 3.0 0 0.0 

premature infant

Prior stillbirth, miscarriage, 11,415 5.9 2,590 4.5 8,717 5.8 22,721 5.7 0 0.0 

spontaneous abortion,or neonatal death

General obstetrical risks 77,540 40.0 19,153 33.0 56,494 37.9 153,187 38.2 0 0.0 Nutrition-related risk conditions 13,363 6.9 3,135 5.4 8,831 5.9 25,328 6.3 12,665 2.5 Substance abuse 13,435 6.9 2,063 3.6 7,723 5.2 23,221 5.8 12,066 2.4 Other health risk 6,205 3.2 3,868 6.7 12,868 8.6 22,941 5.7 15,277 3.1 

Dietary 88,813 45.8 25,827 44.4 65,989 44.3 180,628 45.0 75,117 15.1 

Inadequate or inappropriate nutrient 84,023 43.3 24,961 42.9 63,912 42.9 172,896 43.1 50,300 10.1 

intake

Other dietary risk 7,334 3.8 1,266 2.2 2,998 2.0 11,599 2.9 27,160 5.5 
Exhibit 5.14 (continued)

Number and Percent of Black (non-Hispanic) WIC Participants with Specific Nutritional Risks Reported by Parti

Pregnant Women Breastfeeding Postpartum

Women Women Total Women Infants 

Risk Number Percent Number Percent Number Percent Number Percent Number Percent 

Percent by participant category

Chapter Five: 0WVTKVKQPCN %

Other risk 5,144 2.7% 19,494 33.5% 6,770 4.5% 31,408 7.8% 397,972 79.9% 

Regression 3 0.0 141 0.2 586 0.4 730 0.2 552 0.1 Transfer (nutrition risk unknown) 4,747 2.4 680 1.2 5,315 3.6 10,743 2.7 18,134 3.6 Breastfeeding mother and infant 30 0.0 19,064 32.8 696 0.5 19,790 4.9 73,861 14.8 

dyad

Infant of a WIC-eligible mother or 0 0.0 0 0.0 0 0.0 0 0.0 363,351 72.9 

mother at risk during pregnancy

Homelessness/Migrancy 68 0.0 11 0.0 57 0.0 137 0.0 196 0.0 Other nutritional risks 297 0.2 82 0.1 152 0.1 531 0.1 650 0.1 

No risk reported 604 0.3 132 0.2 433 0.3 1,168 0.3 1,534 0.3 

NotesAn infant is defined as a participant who, at certification, is under one year of age and who would be classified as a child at the age of 366 days.In 1998, State WIC agencies could report up to three nutritional risks for each participant. This table examines all risks reported for every participant. When multiple risks within the sathese risks are combined and counted one time in order to accurately calculate the number and percent of WIC participants with a specific type (or category) of risk.This table reports information on persons having origins in any of the black racial groups of Africa.
Chapter Five: 0WVTKVKQPCN %

Exhibit 5.15Number and Percent of Hispanic WIC Participants with Specific Nutritional Risks Reported by Participant Categ

Pregnant Women Breastfeeding Postpartum

Women Women Total Women Infants 

Risk Number Percent Number Percent Number Percent Number Percent Number Percent 

Percent by participant category

Participants in category 271,086 164,307 149,931 585,324 622,187 Anthropometric 192,269 70.9% 83,854 51.0% 63,451 42.3% 339,574 58.0% 119,774 19.3% 

Low weight for height 14,449 5.3 3,372 2.1 3,052 2.0 20,872 3.6 15,228 2.4 High weight for height 79,982 29.5 63,384 38.6 47,540 31.7 190,907 32.6 16,818 2.7 Short stature 11,109 4.1 172 0.1 135 0.1 11,417 2.0 29,165 4.7 Inappropriate growth or weight gain 149,555 55.2 22,018 13.4 16,983 11.3 188,555 32.2 15,448 2.5 

pattern

Low birthweight or premature birth 0 0.0 0 0.0 0 0.0 0 0.0 43,339 7.0 Other anthropometric 6,182 2.3 2,164 1.3 376 0.3 8,722 1.5 26,438 4.2 

Biochemical 78,866 29.1 41,686 25.4 46,965 31.3 167,518 28.6 20,259 3.3 

Hematocrit or hemoglobin below 78,697 29.0 41,646 25.3 46,902 31.3 167,246 28.6 20,070 3.2 

State criteria

Other biochemical test results which 255 0.1 102 0.1 132 0.1 489 0.1 241 0.0 

indicate nutritional abnormality

Clinical, Health, Medical 158,584 58.5 94,063 57.2 80,821 53.9 333,468 57.0 81,085 13.0 

Pregnancy-induced conditions 7,762 2.9 7,868 4.8 5,807 3.9 21,437 3.7 0 0.0 Delivery of low-birthweight or 1,995 0.7 1,286 0.8 1,497 1.0 4,778 0.8 0 0.0 

premature infant

Prior stillbirth, miscarriage, 6,317 2.3 1,983 1.2 2,974 2.0 11,275 1.9 0 0.0 

spontaneous abortion,or neonatal death

General obstetrical risks 115,615 42.6 72,301 44.0 58,203 38.8 246,118 42.0 0 0.0 Nutrition-related risk conditions 35,027 12.9 10,994 6.7 9,401 6.3 55,422 9.5 22,244 3.6 Substance abuse 16,069 5.9 9,183 5.6 8,687 5.8 33,939 5.8 32,610 5.2 Other health risk 8,109 3.0 10,822 6.6 10,640 7.1 29,571 5.1 30,398 4.9 

Dietary 102,510 37.8 67,308 41.0 67,904 45.3 237,722 40.6 66,258 10.6 

Inadequate or inappropriate nutrient 99,247 36.6 66,016 40.2 66,373 44.3 231,637 39.6 55,362 8.9 

intake

Other dietary risk 5,586 2.1 1,968 1.2 2,231 1.5 9,785 1.7 12,866 2.1 
Exhibit 5.15 (continued)

Number and Percent of Hispanic WIC Participants with Specific Nutritional Risks Reported by Participant Categ

Pregnant Women Breastfeeding Postpartum

Women Women Total Women Infants 

Risk Number Percent Number Percent Number Percent Number Percent Number Percent 

Percent by participant category

Chapter Five: 0WVTKVKQPCN %

Other risk 2,519 0.9% 70,168 42.7% 17,470 11.7% 90,157 15.4% 548,666 88.2% 

Regression 13 0.0 365 0.2 198 0.1 576 0.1 425 0.1 Transfer (nutrition risk unknown) 1,008 0.4 1,342 0.8 2,009 1.3 4,360 0.7 5,188 0.8 Breastfeeding mother and infant 67 0.0 68,992 42.0 2,235 1.5 71,294 12.2 215,874 34.7 

dyad

Infant of a WIC-eligible mother or 0 0.0 0 0.0 0 0.0 0 0.0 492,500 79.2 

mother at risk during pregnancy

Homelessness/Migrancy 309 0.1 152 0.1 110 0.1 571 0.1 565 0.1 Other nutritional risks 1,138 0.4 402 0.2 13,054 8.7 14,594 2.5 1,648 0.3 

No risk reported 1,660 0.6 708 0.4 947 0.6 3,315 0.6 2,722 0.4 

NotesAn infant is defined as a participant who, at certification, is under one year of age and who would be classified as a child at the age of 366 days.In 1998, State WIC agencies could report up to three nutritional risks for each participant. This table examines all risks reported for every participant. When multiple risks within the sathese risks are combined and counted one time in order to accurately calculate the number and percent of WIC participants with a specific type (or category) of risk.This table reports information on persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin regardless of race.
Chapter Five: 0WVTKVKQPCN %

Exhibit 5.16Number and Percent of White (non-Hispanic) WIC Participants with Specific Nutritional Risks Reported by Parti

Pregnant Women Breastfeeding Postpartum

Women Women Total Women Infants 

Risk Number Percent Number Percent Number Percent Number Percent Number Percent 

Percent by participant category

Participants in category 383,421 143,711 260,523 787,656 814,779 1Anthropometric 229,335 59.8% 65,528 45.6% 116,901 44.9% 411,764 52.3% 204,855 25.1% 

Low weight for height 42,296 11.0 7,135 5.0 13,175 5.1 62,606 7.9 27,633 3.4 High weight for height 107,522 28.0 46,161 32.1 83,717 32.1 237,401 30.1 43,144 5.3 Short stature 1,091 0.3 205 0.1 510 0.2 1,805 0.2 59,739 7.3 Inappropriate growth or weight gain 112,973 29.5 17,821 12.4 24,801 9.5 155,594 19.8 42,318 5.2 

pattern

Low birthweight or premature birth 0 0.0 0 0.0 0 0.0 0 0.0 73,887 9.1 Other anthropometric 11,268 2.9 1,067 0.7 4,306 1.7 16,641 2.1 18,966 2.3 

Biochemical 57,836 15.1 27,045 18.8 73,633 28.3 158,514 20.1 29,796 3.7 

Hematocrit or hemoglobin below 57,659 15.0 26,961 18.8 73,441 28.2 158,061 20.1 29,671 3.6 

State criteria

Other biochemical test results which 272 0.1 138 0.1 367 0.1 777 0.1 146 0.0 

indicate nutritional abnormality

Clinical, Health, Medical 250,776 65.4 77,224 53.7 153,402 58.9 481,403 61.1 96,293 11.8 

Pregnancy-induced conditions 11,615 3.0 4,890 3.4 7,928 3.0 24,433 3.1 0 0.0 Delivery of low-birthweight or 9,019 2.4 3,829 2.7 9,668 3.7 22,516 2.9 0 0.0 

premature infant

Prior stillbirth, miscarriage, 23,245 6.1 5,693 4.0 13,662 5.2 42,601 5.4 0 0.0 

spontaneous abortion,or neonatal death

General obstetrical risks 157,339 41.0 47,040 32.7 88,573 34.0 292,952 37.2 0 0.0 Nutrition-related risk conditions 29,345 7.7 9,456 6.6 19,343 7.4 58,144 7.4 36,483 4.5 Substance abuse 85,540 22.3 16,390 11.4 37,072 14.2 139,002 17.6 28,685 3.5 Other health risk 15,454 4.0 9,759 6.8 21,399 8.2 46,611 5.9 35,544 4.4 

Dietary 197,104 51.4 71,050 49.4 138,246 53.1 406,401 51.6 115,121 14.1 1

Inadequate or inappropriate nutrient 190,663 49.7 69,644 48.5 134,542 51.6 394,850 50.1 75,822 9.3 1

intake

Other dietary risk 10,591 2.8 2,183 1.5 5,103 2.0 17,878 2.3 43,120 5.3 
Exhibit 5.16 (continued)

Number and Percent of White (non-Hispanic) WIC Participants with Specific Nutritional Risks Reported by Parti

Pregnant Women Breastfeeding Postpartum

Women Women Total Women Infants 

Risk Number Percent Number Percent Number Percent Number Percent Number Percent 

Percent by participant category

Chapter Five: 0WVTKVKQPCN %

Other risk 8,533 2.2% 56,090 39.0% 11,157 4.3% 75,779 9.6% 658,870 80.9% 

Regression 24 0.0 468 0.3 725 0.3 1,217 0.2 1,348 0.2 Transfer (nutrition risk unknown) 5,613 1.5 2,505 1.7 6,461 2.5 14,579 1.9 21,391 2.6 Breastfeeding mother and infant 125 0.0 54,172 37.7 2,239 0.9 56,536 7.2 165,058 20.3 

dyad

Infant of a WIC-eligible mother or 0 0.0 0 0.0 0 0.0 0 0.0 577,493 70.9 

mother at risk during pregnancy

Homelessness/Migrancy 220 0.1 49 0.0 70 0.0 339 0.0 281 0.0 Other nutritional risks 2,561 0.7 964 0.7 1,848 0.7 5,373 0.7 2,293 0.3 

No risk reported 2,045 0.5 486 0.3 952 0.4 3,483 0.4 4,370 0.5 

NotesAn infant is defined as a participant who, at certification, is under one year of age and who would be classified as a child at the age of 366 days.In 1998 State WIC agencies could report up to three nutritional risks for each participant. This table examines all risks reported for every participant. When multiple risks within the sam

these risks are combined and counted one time in order to accurately calculate the number and percent of WIC participants with a specific type (or category) of risk.This table reports information on persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.
Chapter Five: 0WVTKVKQPCN 4KUM %JCTCEVGTKUVKEU KP 2% 90

Exhibit 5.17

Nutritional Risks Reported in at Least 15 Percent of WIC Participants 1994, 1996, 1998

1994 1996 1998

Participant Category and Type of Risk Percent by category

Pregnant women 823,605 877,748 892,674

General obstetrical risks 38.0% 39.6% 41.5%

Hematocrit or hemoglobin below State criteria 24.0 24.1 23.9

Prepregnancy high weight for height 26.4 27.5 30.2

Inadequate or inappropriate nutrient intake 45.2 41.9 44.2

Inappropriate growth or weight gain pattern 29.3 36.9 39.2

Breastfeeding women 275,159 330,177 389,391

Breastfeeding mother and infant dyad 40.1% 42.9% 38.8%

General obstetrical risks 28.7 36.2 37.9

Hematocrit or hemoglobin below State criteria 19.5 22.4 24.7

High weight for height 29.8 33.1 36.4

Inadequate or inappropriate nutrient intake 40.4 39.3 44.0

Other health risk 16.1 -- --

Postpartum women 491,999 567,913 591,050

General obstetrical risks 28.1% 35.1% 36.5%

Hematocrit or hemoglobin below State criteria 28.6 30.5 33.7

High weight for height 26.3 28.7 32.8

Inadequate or inappropriate nutrient intake 49.7 46.2 47.5

Other health risk 18.8 -- --

Infants 1,852,455 1,988,789 2,048,626

Breastfeeding mother and infant dyad 17.1% 19.3% 23.5%

Infant of a WIC-eligible mother 67.3 70.6 73.7

 or mother at risk during pregnancy

Children 3,464,632 3,982,815 4,121,017

Hematocrit or hemoglobin below State criteria 23.9% 25.1% 24.3%

High weight for height 14.7 15.0 15.7

Inadequate or inappropriate nutrient intake 58.1 59.8 64.2

Notes

A dash indicates that, for the year in question, this risk occurred in less than 15 percent of WIC participants in the certification category.

In 1994, 1996, and 1998 each State WIC agency reported up to three risks, recorded for each participant, on its automated client information system.
Chapter Five: 0WVTKVKQPCN 4KUM %JCTCEVGTKUVKEU KP 2% 91

Exhibit 5.18

Nutritional Risks Reported in at Least 15 Percent of American Indian and Alaskan Native WIC

Participants by Participant Category

Participant Category and Type of Risk Percent

Pregnant women 12,506

General obstetrical risks 47.8%

Hematocrit or hemoglobin below State criteria 16.3

Prepregnancy high weight for height 37.1

Inadequate or inappropriate nutrient intake 47.1

Inappropriate growth or weight gain pattern 26.1

Substance abuse 17.1

Breastfeeding women 5,996

Breastfeeding mother and infant dyad 48.7%

General obstetrical risks 35.7

Hematocrit or hemoglobin below State criteria 20.4

High weight for height 46.1

Inadequate or inappropriate nutrient intake 40.5

Other health risk 15.1

Postpartum women 6,940

General obstetrical risks 43.7%

Hematocrit or hemoglobin below State criteria 34.1

High weight for height 46.3

Inadequate or inappropriate nutrient intake 40.8

Infants 27,656

Breastfeeding mother and infant dyad 25.5%

Infant of a WIC-eligible mother or mother at risk during pregnancy 79.3

Children 68,041

Hematocrit or hemoglobin below State criteria 16.8%

High weight for height 25.2

Inadequate or inappropriate nutrient intake 72.5

Nutrition-related risk conditions 20.0

Total 121,140

Notes

These figures represent 15 percent or more of all WIC participants in the participant category in this racial or ethnic group.

American Indians and Alaskan Natives include persons having origins in any of the original peoples of North America, who maintain cultural

identification through tribal affiliation or community recognition (includes Aleuts and Eskimos).
Chapter Five: 0WVTKVKQPCN 4KUM %JCTCEVGTKUVKEU KP 2% 92

Exhibit 5.19

Nutritional Risks Reported in at Least 15 Percent of Asian and Pacific Islander WIC

Participants by Participant Category

Participant Category and Type of Risk Percent

Pregnant women 24,914

General obstetrical risks 43.4%

Hematocrit or hemoglobin below State criteria 29.9

Inadequate or inappropriate nutrient intake 47.6

Inappropriate growth or weight gain pattern 51.4

Prepregnancy low weight for height 16.9

Breastfeeding women 13,425

Breastfeeding mother and infant dyad 34.7%

General obstetrical risks 40.7

Hematocrit or hemoglobin below State criteria 28.4

High weight for height 27.0

Inadequate or inappropriate nutrient intake 47.3

Postpartum women 18,600

General obstetrical risks 37.5%

Hematocrit or hemoglobin below State criteria 36.8

High weight for height 22.1

Inadequate or inappropriate nutrient intake 52.7

Other health risk 16.2

Infants 64,400

Breastfeeding mother and infant dyad 21.7%

Infant of a WIC-eligible mother or mother at risk during pregnancy 66.2

Children 138,697

Hematocrit or hemoglobin below State criteria 21.8%

Inadequate or inappropriate nutrient intake 70.4

Total 260,037

Notes

These figures represent 15 percent or more of all WIC participants in the participant category in this racial or ethnic group.

This table reports information on persons having origins in any of the original peoples of the Far East, the Indian subcontinent, Southeast Asia, or

the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands, and Samoa.
Chapter Five: 0WVTKVKQPCN 4KUM %JCTCEVGTKUVKEU KP 2% 93

Exhibit 5.20

Nutritional Risks Reported in at Least 15 Percent of Black (non-Hispanic) WIC Participants

by Participant Category

Participant Category and Type of Risk Percent

Pregnant women 194,038

General obstetrical risks 40.0%

Hematocrit or hemoglobin below State criteria 34.0

Prepregnancy high weight for height 36.9

Inadequate or inappropriate nutrient intake 43.3

Inappropriate growth or weight gain pattern 34.8

Breastfeeding women 58,120

Breastfeeding mother and infant dyad 32.8%

General obstetrical risks 33.0

Hematocrit or hemoglobin below State criteria 37.0

High weight for height 42.2

Inadequate or inappropriate nutrient intake 42.9

Postpartum women 149,043

General obstetrical risks 37.9%

Hematocrit or hemoglobin below State criteria 45.2

High weight for height 36.2

Inadequate or inappropriate nutrient intake 42.9

Infants 498,190

Infant of a WIC-eligible mother or mother at risk during pregnancy 72.9%

Children 942,716

Hematocrit or hemoglobin below State criteria 31.3%

Inadequate or inappropriate nutrient intake 59.8

Total 1,842,107

Notes

These figures represent 15 percent or more of all WIC participants in the participant category in this racial or ethnic group.

This table reports information on persons having origins in any of the black racial groups of Africa.
Chapter Five: 0WVTKVKQPCN 4KUM %JCTCEVGTKUVKEU KP 2% 94

Exhibit 5.21

Nutritional Risks Reported in at Least 15 Percent of Hispanic WIC Participants by Participant

Category

Participant Category and Type of Risk Percent

Pregnant women 271,086

General obstetrical risks 42.6%

Hematocrit or hemoglobin below State criteria 29.0

Prepregnancy high weight for height 29.5

Inadequate or inappropriate nutrient intake 36.6

Inappropriate growth or weight gain pattern 55.2

Breastfeeding women 164,307

Breastfeeding mother and infant dyad 42.0%

General obstetrical risks 44.0

Hematocrit or hemoglobin below State criteria 25.3

High weight for height 38.6

Inadequate or inappropriate nutrient intake 40.2

Postpartum women 149,931

General obstetrical risks 38.8%

Hematocrit or hemoglobin below State criteria 31.3

High weight for height 31.7

Inadequate or inappropriate nutrient intake 44.3

Infants 622,187

Breastfeeding mother and infant dyad 34.7%

Infant of a WIC-eligible mother or mother at risk during pregnancy 79.2

Children 1,388,655

Hematocrit or hemoglobin below State criteria 29.1%

High weight for height 19.0

Inadequate or inappropriate nutrient intake 60.8

Total 2,596,166

Notes

These figures represent 15 percent or more of all WIC participants in the participant category in this racial or ethnic group.

This table reports information on persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin regardless

of race.
Chapter Five: 0WVTKVKQPCN 4KUM %JCTCEVGTKUVKEU KP 2% 95

Exhibit 5.22

Nutritional Risks Reported in at Least 15 Percent of White (non-Hispanic) WIC Participants

by Participant Category

Participant Category and Type of Risk Percent

Pregnant women 383,421

General obstetrical risks 41.0%

Hematocrit or hemoglobin below State criteria 15.0

Prepregnancy high weight for height 28.0

Inadequate or inappropriate nutrient intake 49.7

Inappropriate growth or weight gain pattern 29.5

Substance abuse 22.3

Breastfeeding women 143,711

Breastfeeding mother and infant dyad 37.7%

General obstetrical risks 32.7

Hematocrit or hemoglobin below State criteria 18.8

High weight for height 32.1

Inadequate or inappropriate nutrient intake 48.5

Postpartum women 260,523

General obstetrical risks 34.0%

Hematocrit or hemoglobin below State criteria 28.2

High weight for height 32.1

Inadequate or inappropriate nutrient intake 51.6

Infants 814,779

Breastfeeding mother and infant dyad 20.3%

Infant of a WIC-eligible mother or mother at risk during pregnancy 70.9

Children 1,553,170

Hematocrit or hemoglobin below State criteria 16.4%

Inadequate or inappropriate nutrient intake 68.7

Total 3,155,604

Notes

These figures represent 15 percent or more of all WIC participants in the participant category in this racial or ethnic group.

This table reports information on persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.
Chapter Five: 0WVTKVKQPCN 4KUM %JCTCEVGTKUVKEU KP 2% 96

Exhibit 5.23

Nutritional Risks Reported in at Least 15 Percent of Pregnant WIC Participants by Age at

Certification

Age at Certification and Type of Risk Percent

Under 15 years 6,825

General obstetrical risks 89.9%

Hematocrit or hemoglobin below State criteria 29.5

Inadequate or inappropriate nutrient intake 36.9

Inappropriate growth or weight gain pattern 33.7

15 - 17 years 90,568

General obstetrical risks 88.0%

Hematocrit or hemoglobin below State criteria 24.8

High weight for height 15.3

Inadequate or inappropriate nutrient intake 37.0

Inappropriate growth or weight gain pattern 34.0

18 - 34 years 742,123

General obstetrical risks 33.2%

Hematocrit or hemoglobin below State criteria 23.7

Prepregnancy high weight for height 31.7

Inadequate or inappropriate nutrient intake 46.3

Inappropriate growth or weight gain pattern 39.8

35 or more years 51,354

General obstetrical risks 72.7%

Hematocrit or hemoglobin below State criteria 25.9

High weight for height 37.2

Inadequate or inappropriate nutrient intake 27.2

Inappropriate growth or weight gain pattern 41.1

Not reported 1,804

Total Pregnant Women 892,674

Note

These figures represent 15 percent or more of all pregnant WIC participants in each age group.
Chapter Five: Nutritional Risk Characteristics in PC98 97

months are at risk because their mothers are WIC-eligible or because their mothers

were at risk during pregnancy. Dietary risks are more likely to be reported for older

infants.

The rate of dietary risk for children has increased steadily from 52 percent in 1992 to

68 percent in 1998. This shift probably reflects the impact of additional funding which

has allowed WIC to serve more children and an increasing percentage of lower priority

participants. Anthropometric risks were reported for one-third of child WIC

participants. This rate declined steadily from a high of 40 percent in 1992 undoubtedly

due to the same factors that caused the rate of dietary risk to increase. Biochemical

risks are reported for a quarter of children, with slightly higher rates among one and

two-year old participants. There are only minimal differences by age with regard to

other types of nutritional risks reported for WIC children. (See Exhibits 5.7 and 5.11.)

The increase in infants and children reported at nutritional risk due to substance abuse

needs special mention. While the total number of infants and children with this risk

remains small, reports increased from about 0.5 percent in PC94 to 3 percent in PC96

and to 4 percent in PC98. This shift can primarily be attributed to a policy change in

the California WIC program which occurred between PC94 and PC96. Infants and

children exposed to second-hand smoke are now considered to be at nutritional risk in

California; are eligible for WIC benefits; and are included in the substance abuse

category.

The patterns of risks by race/ethnicity described below are similar to findings from

PC92, PC94, and PC96. (See Exhibits 5.12 through 5.16, 5.18 through 5.22.) In all

years, the category of general obstetrical risks for pregnant women were reported with

the highest frequencies among American Indians and Alaskan Natives, Asians and

Pacific Islanders, and Hispanics. Blood measurements below State criteria occur most

often among black WIC women and least often among American Indian/Alaskan

Native and white women. Only among American Indians/Alaskan Natives and whites

was substance abuse reported for over 15 percent of pregnant WIC women. Low

prepregnancy weight for height was reported for over 15 percent of pregnant

Asian/Pacific Islander enrollees. 

Changes between PC96 and PC98 within racial/ethnic categories generally mirror the

distributions reported for all WIC women. Reported high weight-for-height increased

by 5 percentage points among American Indian women, about 2 percentage points

among Hispanic women, and about 4 percentage points among white, black, and Asian

women. Reported inappropriate weight gain also increased by 3 percentage points

among Hispanic women. Examining the entire period between 1992 and 1998, reports

of excessive weight gain have grown more common in all racial/ethnic categories.

The most commonly reported infant nutritional risk across all racial/ethnic categories

is WIC-eligible mother or mother at risk during pregnancy. In 1998, as in 1992, 1994,

and 1996, dietary risks account for the largest proportions of child nutritional risks in

every racial/ethnic category. In 1998, as in the three previous studies, black and

Hispanic children are about twice as likely to be reported as having blood measures

below State standards as compared with Native American/Alaskan Native and white

children. Substance abuse risks are highest (between 6 and 8 percent) among Asian

and Hispanic infants and children. This increase, again, results largely from

California's inclusion, in this risk category, of infants and children exposed to secondhand smoke.
 These tabulations first appeared in PC94. 2

Chapter Five: Nutritional Risk Characteristics in PC98 98

Nutrition and Poverty Status Exhibits 5.24 through 5.30 present distributions of nutritional risks by percent of

poverty. In PC98, as in PC96 and PC94, women at lower income levels generally

report higher levels of obstetrical risk; the assignment of dietary risk increases with

income. While this statistic is an interesting one, the PCs do not collect supporting

2

data that would allow its interpretation. Among infants, dietary risks increase slightly

with income. The most visible pattern among children is the general increase in

reported dietary risks and accompanying decrease in reported anthropometric risks as

income rises. Similar findings were reported in PC96 and PC94. The frequency of

blood measurements below State criteria decreases slightly with increased income for

both women and children, a pattern also evident in PC96, though not in PC94.

Anthropometric Values Weight and height are measured and recorded during the eligibility determination

process. These data are routinely collected by States, and reporting, especially for

infants, has improved over time. Since PC94, invalid or unreported data for weight for

age and height for age decreased by over 15 percentage points for infants. Reporting

for child participants has also improved since 1994.

Measurements for WIC infants and children were compared with the statistical norms

in the general population using National Center for Health Statistics-Centers for

Disease Control and Prevention standardized distributions. Exhibits 5.31 and 5.33

display numbers and percents of infants and children who fall at the upper and lower

limits of the standard distributions. The distribution of infant and child anthropometric

data by race/ethnicity are presented in Exhibits 5.32 and 5.34.

Although the data show slight increases over time in percentage of overweight infants

and children (above the ninetieth percentiles of weight for age and weight for height),

these changes may reflect lower proportions of missing or invalid anthropometric data

since 1994. If we assume participants with missing data are similar to all other

participants, then the percentage of infants above the ninetieth percentile of weight for

age increased from 14.5 percent in 1994 to 15.1 percent in 1996 and 15.4 percent in

1998. Using the same assumption, the percentage of infants above the ninetieth

percentile of weight for length increased from 13.0 percent in 1994 to 13.5 percent in

1996 and 1998.

Across ethnic categories, black infants and Asian/Pacific Islander child WIC recipients

are most likely to fall below the tenth percentile for weight for length, weight for age,

and length for age. American Indian and Alaskan Native infants and children have the

greatest likelihood of exceeding the ninetieth percentile for weight for length and

weight for age. In general, these findings replicate data reported in the 1992, 1994, and

1996 studies of WIC participant and program characteristics.

Exhibits 5.35 and 5.36 present numbers and percents of infants and children

determined to be at risk according to modal values of anthropometric criteria reported

by State WIC agencies. (See Appendix D, Exhibits D5.35A - D5.35C.) In computing

modal values, equal weight is assigned to every reporting State. 

Exhibit 5.37 presents information on anthropometric risks for breastfeeding and

postpartum women. This exhibit applies modal criteria for current weight for height

derived from the reported State-specific values. (See Appendix D, Exhibit D5.37.)
Chapter Five: 0WVTKVKQPCN 4KUM 

Exhibit 5.24Number and Percent of Women WIC Participants with Specific Nutritional Risks Reported At Certification by 

Level of Poverty

Type of Risk and Specific Risk Up to 100% 101% to 130% 131% to 185% 186% and over Income Reported Not 

as Zeroa

Number Percent Number Percent Number Percent Number Percent Number Percent Numbe

Participants in category 1,013,401 235,768 263,340 16,416 65,105 279,08Anthropometric 571,333 56.4% 131,661 55.8% 146,570 55.7% 8,926 54.4% 39,487 60.7% 134,14

Low weight for height 65,253 6.4 14,724 6.2 15,807 6.0 1,209 7.4 5,045 7.7 12,38High weight for height 340,445 33.6 79,428 33.7 85,663 32.5 4,776 29.1 22,260 34.2 72,43Short stature 10,492 1.0 2,286 1.0 2,173 0.8 68 0.4 643 1.0 64Inappropriate growth or weight gain pattern 242,741 24.0 56,658 24.0 66,341 25.2 3,711 22.6 21,351 32.8 70,85Other anthropometric 20,818 2.1 3,371 1.4 4,501 1.7 612 3.7 766 1.2 1,90

Biochemical 282,700 27.9 57,437 24.4 60,414 22.9 3,173 19.3 16,932 26.0 90,13

Hematocrit or hemoglobin below State standard 281,841 27.8 57,267 24.3 60,236 22.9 3,157 19.2 16,868 25.9 89,98Other biochemical test results which indicate 1,461 0.1 287 0.1 289 0.1 20 0.1 152 0.2 37 nutritional abnormality

Clinical, Health, Medical 604,438 59.6 132,495 56.2 143,428 54.5 9,339 56.9 36,186 55.6 166,34

Pregnancy-induced conditions 36,452 3.6 8,390 3.6 8,526 3.2 500 3.0 2,026 3.1 4,36Delivery of low-birthweight or premature infant 23,882 2.4 5,769 2.4 5,842 2.2 428 2.6 566 0.9 4,67Prior stillbirth, miscarriage, spontaneous 39,669 3.9 10,433 4.4 12,880 4.9 1,254 7.6 1,522 2.3 13,57 abortion, or neonatal deathGeneral obstetrical risks 410,350 40.5 84,217 35.7 87,178 33.1 5,002 30.5 27,560 42.3 119,16Nutrition-related risk conditions 60,736 6.0 17,085 7.2 23,018 8.7 1,089 6.6 1,811 2.8 42,21Substance abuse 120,581 11.9 25,447 10.8 26,924 10.2 2,527 15.4 7,438 11.4 21,81Other health risk 61,946 6.1 13,238 5.6 14,048 5.3 1,248 7.6 2,550 3.9 9,64

Dietary 434,250 42.9 115,024 48.8 137,575 52.2 9,007 54.9 34,883 53.6 142,56

Inadequate or inappropriate nutrient intake 417,127 41.2 110,991 47.1 133,889 50.8 8,861 54.0 34,312 52.7 141,61Other dietary risk 25,808 2.5 6,290 2.7 5,873 2.2 216 1.3 805 1.2 1,72

Other Risk 123,126 12.1 29,632 12.6 30,346 11.5 1,486 9.1 6,918 10.6 19,63

Regression 1,669 0.2 351 0.1 350 0.1 22 0.1 37 0.1 22Transfer (nutrition risk unknown) 15,824 1.6 4,185 1.8 4,578 1.7 477 2.9 1,987 3.1 3,38Breastfeeding mother and infant dyad 89,814 8.9 23,604 10.0 23,792 9.0 944 5.8 4,624 7.1 13,95Homelessness/Migrancy 712 0.1 95 0.0 71 0.0 9 0.1 71 0.1 14Other risk 17,302 1.7 2,188 0.9 2,366 0.9 83 0.5 270 0.4 2,21

No risk reported 2,837 0.3 765 0.3 948 0.4 77 0.5 690 1.1 3,56

NotesIn 1998, State WIC agencies could report up to three nutritional risks for each participant. This table examines all risks reported for every participant. When multiple risks within the same 

these risks are combined and counted one time in order to accurately calculate the number and percent of WIC participants with a specific type (or category) of risk.

Zero incomes are reported separately and excluded from these income calculations. In some reporting agencies, zero may be used to indicate missing information or adjunctive eligibility. PC

ahouseholds with missing income information and households reporting zero income. 

Not reported includes the number and percent of participants for whom no data on income, income period, or size of economic unit are reported. b
Chapter Five: 0WVTKVKQPCN 4KUM %

Exhibit 5.25Number and Percent of Infant WIC Participants with Specific Nutritional Risks Reported At Certification by Pe

Level of Poverty

Type of Risk and Specific Risk Up to 100% 101% to 130% 131% to 185% 186% and over Income Reported Not Rep

as Zeroa 

Number Percent Number Percent Number Percent Number Percent Number Percent Number 

Participants in category 1,121,622 237,342 231,839 12,198 85,556 360,068 Anthropometric 283,097 25.2% 56,184 23.7% 55,958 24.1% 3,105 25.5% 19,581 22.9% 67,793 

Low weight for height 41,115 3.7 7,386 3.1 6,940 3.0 400 3.3 2,852 3.3 9,131 High weight for height 48,674 4.3 11,308 4.8 12,406 5.4 614 5.0 3,016 3.5 8,741 Short stature 85,339 7.6 15,743 6.6 14,801 6.4 922 7.6 6,426 7.5 21,067 Inappropriate growth or weight gain pattern 45,743 4.1 9,363 3.9 10,708 4.6 640 5.2 2,207 2.6 16,901 Low birthweight or premature birth 104,816 9.3 20,078 8.5 19,609 8.5 1,148 9.4 8,081 9.4 31,343 Other anthropometric 39,544 3.5 7,207 3.0 6,366 2.7 285 2.3 2,561 3.0 2,112 

Biochemical 48,632 4.3 8,912 3.8 8,974 3.9 519 4.3 2,589 3.0 7,879 

Hematocrit or hemoglobin below State standard 48,261 4.3 8,849 3.7 8,913 3.8 517 4.2 2,531 3.0 7,787 Other biochemical test results which 476 0.0 69 0.0 71 0.0 2 0.0 67 0.1 130  indicate nutritional abnormality

Clinical, Health, Medical 146,643 13.1 25,874 10.9 24,131 10.4 1,514 12.4 9,385 11.0 23,358 

Nutrition-related risk conditions 46,933 4.2 8,771 3.7 9,222 4.0 548 4.5 1,856 2.2 9,060 Substance abuse 53,102 4.7 8,696 3.7 6,770 2.9 220 1.8 4,900 5.7 6,270 Other health risk 53,603 4.8 9,563 4.0 9,117 3.9 797 6.5 3,110 3.6 8,975 

Dietary 127,143 11.3 29,369 12.4 33,892 14.6 1,617 13.3 14,172 16.6 64,664 

Inadequate or inappropriate nutrient intake 81,525 7.3 20,210 8.5 23,042 9.9 1,024 8.4 10,429 12.2 57,020 Other dietary risk 50,870 4.5 10,244 4.3 11,993 5.2 640 5.2 4,087 4.8 8,216 

Other Risk 927,702 82.7 198,542 83.7 187,882 81.0 9,679 79.4 68,884 80.5 306,577 

Regression 1,317 0.1 329 0.1 384 0.2 22 0.2 59 0.1 374 Transfer (nutrition risk unknown) 24,085 2.1 4,874 2.1 4,324 1.9 441 3.6 5,074 5.9 6,990 Breastfeeding mother and infant dyad 260,755 23.2 61,087 25.7 59,045 25.5 2,247 18.4 22,781 26.6 75,776 Infant of a WIC-eligible mother or mother at 838,493 74.8 176,083 74.2 163,446 70.5 8,724 71.5 57,525 67.2 265,531  risk during pregnancyHomelessness/Migrancy 798 0.1 73 0.0 51 0.0 7 0.1 80 0.1 169 Other risk 5,876 0.5 1,687 0.7 2,049 0.9 55 0.5 88 0.1 1,168 

No risk reported 3,024 0.3 689 0.3 710 0.3 78 0.6 1,040 1.2 4,069 

NotesIn 1998, State WIC agencies could report up to three nutritional risks for each participant. This table examines all risks reported for every participant. When multiple risks within the same 

these risks are combined and counted one time in order to accurately calculate the number and percent of WIC participants with a specific type (or category) of risk.

Zero incomes are reported separately and excluded from these income calculations. In some reporting agencies, zero may be used to indicate missing information or adjunctive eligibility. PC

ahouseholds with missing income information and households reporting zero income.

Not reported includes the number and percent of participants for whom no data on income, income period, or size of economic unit are reported. b

An infant is defined as a participant who, at certification, is under one year of age and who would be classified as a child at the age of 366 days.
Chapter Five: 0WVTKVKQPCN 4KUM %

Exhibit 5.26Number and Percent of Child WIC Participants with Specific Nutritional Risks Reported At Certification by Pe

Level of Poverty

Type of Risk and Specific Risk Up to 100% 101% to 130% 131% to 185% 186% and over Income Reported Not R

as Zeroa 

Number Percent Number Percent Number Percent Number Percent Number Percent Numbe

Participants in category 2,433,687 528,560 530,568 24,401 71,930 531,870 Anthropometric 800,135 32.9% 174,251 33.0% 170,861 32.2% 8,301 34.0% 21,585 30.0% 210,310 

Low weight for height 112,891 4.6 21,344 4.0 21,331 4.0 1,096 4.5 2,859 4.0 17,125 High weight for height 378,686 15.6 79,864 15.1 75,096 14.2 3,052 12.5 11,739 16.3 99,046 Short stature 192,603 7.9 41,076 7.8 39,563 7.5 2,393 9.8 6,000 8.3 34,991 Inappropriate growth or weight gain pattern 188,577 7.7 47,637 9.0 50,390 9.5 2,540 10.4 3,272 4.5 77,955 Low birthweight or premature birth 11,868 0.5 3,603 0.7 2,869 0.5 269 1.1 180 0.3 2,941 Other anthropometric 25,525 1.0 5,540 1.0 5,592 1.1 409 1.7 632 0.9 957 

Biochemical 626,059 25.7 118,282 22.4 107,040 20.2 4,204 17.2 14,989 20.8 136,856 

Hematocrit or hemoglobin below State standard 622,166 25.6 117,838 22.3 106,660 20.1 4,180 17.1 14,880 20.7 136,378 Other biochemical test results which 5,703 0.2 659 0.1 534 0.1 33 0.1 169 0.2 815  indicate nutritional abnormality

Clinical, Health, Medical 537,705 22.1 92,676 17.5 85,210 16.1 5,090 20.9 11,274 15.7 51,125 

Nutrition-related risk conditions 260,092 10.7 44,649 8.4 42,863 8.1 2,345 9.6 5,469 7.6 28,492 Substance abuse 125,399 5.2 19,832 3.8 15,451 2.9 408 1.7 2,829 3.9 3,530 Other health risk 204,772 8.4 36,156 6.8 32,980 6.2 2,620 10.7 4,055 5.6 21,679 

Dietary 1,598,133 65.7 369,857 70.0 385,460 72.7 17,094 70.1 57,159 79.5 387,444 

Inadequate or inappropriate nutrient intake 1,480,291 60.8 345,911 65.4 364,978 68.8 16,381 67.1 54,585 75.9 382,590 Other dietary risk 226,550 9.3 46,105 8.7 41,721 7.9 1,626 6.7 5,645 7.8 13,325 

Other Risk 150,864 6.2 31,265 5.9 29,470 5.6 1,625 6.7 3,909 5.4 24,407 

Regression 81,242 3.3 16,632 3.1 15,455 2.9 658 2.7 846 1.2 10,610 Transfer (nutrition risk unknown) 34,899 1.4 7,742 1.5 6,415 1.2 552 2.3 2,455 3.4 5,017 Breastfeeding mother and infant dyad 3,713 0.2 856 0.2 942 0.2 36 0.1 90 0.1 400 Infant of a WIC-eligible mother or mother at 19,478 0.8 3,327 0.6 3,494 0.7 213 0.9 334 0.5 5,195  risk during pregnancyHomelessness/Migrancy 2,635 0.1 291 0.1 165 0.0 11 0.0 133 0.2 264 Other risk 13,347 0.5 3,398 0.6 3,902 0.7 190 0.8 114 0.2 3,274 

No risk reported 7,703 0.3 2,482 0.5 2,409 0.5 124 0.5 924 1.3 11,019 

NotesIn 1998, State WIC agencies could report up to three nutritional risks for each participant. This table examines all risks reported for every participant. When multiple risks within the same 

these risks are combined and counted one time in order to accurately calculate the number and percent of WIC participants with a specific type (or category) of risk.

Zero incomes are reported separately and excluded from these income calculations. In some reporting agencies, zero may be used to indicate missing information or adjunctive eligibility. PC

ahouseholds with missing income information and households reporting zero income. 

Not reported includes the number and percent of participants for whom no data on income, income period, or size of economic unit are reported. b
Chapter Five: 0WVTKVKQPCN 4KUM %

Exhibit 5.27Number and Percent of One-Year-Old Child WIC Participants with Specific Nutritional Risks Reported At CePoverty

Level of Poverty

Type of Risk and Specific Risk Up to 100% 101% to 130% 131% to 185% 186% and over Income Reported No

as Zeroa 

Number Percent Number Percent Number Percent Number Percent Number Percent Num

Participants in category 843,334 189,587 197,698 10,433 28,676 198Anthropometric 316,955 37.6% 70,273 37.1% 71,245 36.0% 3,822 36.6% 9,604 33.5% 83

Low weight for height 47,389 5.6 9,328 4.9 9,488 4.8 513 4.9 1,439 5.0 8,High weight for height 140,646 16.7 30,361 16.0 29,511 14.9 1,349 12.9 4,984 17.4 39,Short stature 80,261 9.5 17,129 9.0 16,743 8.5 1,054 10.1 2,701 9.4 15,Inappropriate growth or weight gain pattern 82,535 9.8 20,758 10.9 22,422 11.3 1,249 12.0 1,653 5.8 28,Low birthweight or premature birth 8,937 1.1 2,531 1.3 2,320 1.2 225 2.2 134 0.5 2,Other anthropometric 9,882 1.2 2,177 1.1 2,379 1.2 191 1.8 274 1.0 

Biochemical 247,548 29.4 50,155 26.5 47,509 24.0 2,093 20.1 6,878 24.0 58,

Hematocrit or hemoglobin below State standard 246,684 29.3 50,045 26.4 47,416 24.0 2,086 20.0 6,841 23.9 58,Other biochemical test results which indicate 1,439 0.2 180 0.1 150 0.1 9 0.1 52 0.2  nutritional abnormality

Clinical, Health, Medical 172,607 20.5 31,860 16.8 31,620 16.0 2,222 21.3 4,338 15.1 19,

Nutrition-related risk conditions 79,258 9.4 14,833 7.8 15,526 7.9 942 9.0 1,969 6.9 11,Substance abuse 38,429 4.6 6,448 3.4 5,390 2.7 154 1.5 1,156 4.0 1,Other health risk 67,318 8.0 12,651 6.7 12,494 6.3 1,227 11.8 1,559 5.4 7,

Dietary 526,929 62.5 126,502 66.7 136,811 69.2 7,025 67.3 22,046 76.9 136

Inadequate or inappropriate nutrient intake 473,154 56.1 115,005 60.7 126,118 63.8 6,543 62.7 20,459 71.3 133,Other dietary risk 108,729 12.9 23,521 12.4 23,022 11.6 1,124 10.8 3,464 12.1 7,

Other Risk 57,626 6.8 12,196 6.4 12,351 6.2 788 7.6 1,688 5.9 11,

Regression 22,234 2.6 4,949 2.6 4,788 2.4 220 2.1 282 1.0 3,Transfer (nutrition risk unknown) 12,767 1.5 2,946 1.6 2,672 1.4 252 2.4 1,049 3.7 2,Breastfeeding mother and infant dyad 3,400 0.4 820 0.4 912 0.5 35 0.3 76 0.3 Infant of a WIC-eligible mother or mother at 17,237 2.0 2,843 1.5 3,016 1.5 197 1.9 238 0.8 4, risk during pregnancyHomelessness/Migrancy 816 0.1 101 0.1 60 0.0 5 0.0 43 0.1 Other risk 3,719 0.4 1,107 0.6 1,474 0.7 90 0.9 32 0.1 

No risk reported 4,634 0.5 1,520 0.8 1,523 0.8 83 0.8 410 1.4 5,

NotesIn 1998, State WIC agencies could report up to three nutritional risks for each participant. This table examines all risks reported for every participant. When multiple risks within the same 

these risks are combined and counted one time in order to accurately calculate the number and percent of WIC participants with a specific type (or category) of risk.

Zero incomes are reported separately and excluded from these income calculations. In some reporting agencies, zero may be used to indicate missing information or adjunctive eligibility. PC

ahouseholds with missing income information and households reporting zero income.

Not reported includes the number and percent of participants for whom no data on income, income period, or size of economic unit are reported. b
Chapter Five: 0WVTKVKQPCN 4KUM %

Exhibit 5.28Number and Percent of Two-Year-Old Child WIC Participants with Specific Nutritional Risks Reported At CPoverty

Level of Poverty

Type of Risk and Specific Risk Up to 100% 101% to 130% 131% to 185% 186% and over Income Reported Not R

as Zeroa 

Number Percent Number Percent Number Percent Number Percent Number Percent Numb

Participants in category 612,724 133,109 133,521 5,733 18,102 131,24Anthropometric 203,282 33.2% 44,440 33.4% 43,522 32.6% 1,964 34.3% 5,353 29.6% 56,39

Low weight for height 28,771 4.7 5,474 4.1 5,558 4.2 261 4.6 684 3.8 4,23High weight for height 99,324 16.2 21,029 15.8 19,969 15.0 773 13.5 2,957 16.3 27,96Short stature 48,962 8.0 10,344 7.8 9,995 7.5 599 10.4 1,516 8.4 8,89Inappropriate growth or weight gain pattern 46,271 7.6 11,593 8.7 12,403 9.3 563 9.8 750 4.1 20,96Low birthweight or premature birth 1,308 0.2 715 0.5 289 0.2 23 0.4 17 0.1 26Other anthropometric 5,927 1.0 1,359 1.0 1,324 1.0 83 1.4 168 0.9 21

Biochemical 168,961 27.6 31,333 23.5 28,112 21.1 1,016 17.7 3,885 21.5 36,75

Hematocrit or hemoglobin below State 167,774 27.4 31,208 23.4 27,990 21.0 1,011 17.6 3,854 21.3 36,61 standardOther biochemical test results which indicate 1,705 0.3 182 0.1 171 0.1 7 0.1 52 0.3 23 nutritional abnormality

Clinical, Health, Medical 133,083 21.7 22,810 17.1 20,814 15.6 1,195 20.8 2,856 15.8 12,30

Nutrition-related risk conditions 62,367 10.2 10,746 8.1 10,183 7.6 567 9.9 1,375 7.6 6,89Substance abuse 32,693 5.3 5,082 3.8 3,977 3.0 104 1.8 732 4.0 80Other health risk 50,859 8.3 8,929 6.7 8,112 6.1 591 10.3 1,020 5.6 5,24

Dietary 405,165 66.1 93,544 70.3 97,884 73.3 4,062 70.8 14,584 80.6 94,81

Inadequate or inappropriate nutrient intake 376,053 61.4 87,902 66.0 93,324 69.9 3,965 69.2 14,083 77.8 93,82Other dietary risk 56,293 9.2 10,875 8.2 9,302 7.0 241 4.2 1,208 6.7 2,89

Other Risk 34,135 5.6 7,250 5.4 6,665 5.0 320 5.6 901 5.0 4,92

Regression 22,014 3.6 4,610 3.5 4,199 3.1 163 2.8 236 1.3 2,81Transfer (nutrition risk unknown) 8,447 1.4 1,841 1.4 1,584 1.2 123 2.1 592 3.3 1,18Breastfeeding mother and infant dyad 113 0.0 7 0.0 8 0.0 0 0.0 8 0.0 Infant of a WIC-eligible mother or mother at 111 0.0 22 0.0 18 0.0 2 0.0 11 0.1  risk during pregnancyHomelessness/Migrancy 720 0.1 84 0.1 34 0.0 5 0.1 41 0.2 6Other risk 3,305 0.5 826 0.6 925 0.7 32 0.6 25 0.1 88

No risk reported 1,165 0.2 394 0.3 342 0.3 13 0.2 220 1.2 1,90

NotesIn 1998, State WIC agencies could report up to three nutritional risks for each participant. This table examines all risks reported for every participant. When multiple risks within the same 

these risks are combined and counted one time in order to accurately calculate the number and percent of WIC participants with a specific type (or category) of risk.

Zero incomes are reported separately and excluded from these income calculations. In some reporting agencies, zero may be used to indicate missing information or adjunctive eligibility. PC

ahouseholds with missing income information and households reporting zero income. 

Not reported includes the number and percent of participants for whom no data on income, income period, or size of economic unit are reported. b
Chapter Five: 0WVTKVKQPCN 4KUM %

Exhibit 5.29Number and Percent of Three-Year-Old Child WIC Participants with Specific Nutritional Risks Reported At CePoverty

Level of Poverty

Type of Risk and Specific Risk Up to 100% 101% to 130% 131% to 185% 186% and over Income Reported Not Rep

as Zeroa 

Number Percent Number Percent Number Percent Number Percent Number Percent Number 

Participants in category 552,817 117,442 114,207 4,768 14,734 113,790 Anthropometric 154,111 27.9% 33,050 28.1% 30,966 27.1% 1,431 30.0% 3,768 25.6% 38,743 

Low weight for height 21,682 3.9 3,944 3.4 3,674 3.2 186 3.9 426 2.9 2,820 High weight for height 72,302 13.1 14,929 12.7 13,296 11.6 470 9.9 2,077 14.1 16,963 Short stature 36,229 6.6 7,813 6.7 7,349 6.4 452 9.5 1,080 7.3 6,064 Inappropriate growth or weight gain pattern 34,467 6.2 8,860 7.5 9,007 7.9 441 9.2 508 3.4 15,499 Low birthweight or premature birth 795 0.1 194 0.2 133 0.1 12 0.3 13 0.1 77 Other anthropometric 5,620 1.0 1,178 1.0 1,141 1.0 78 1.6 121 0.8 171 

Biochemical 129,227 23.4 23,250 19.8 19,717 17.3 693 14.5 2,785 18.9 26,012 

Hematocrit or hemoglobin below State 128,126 23.2 23,117 19.7 19,601 17.2 685 14.4 2,756 18.7 25,903  standardOther biochemical test results which indicate 1,563 0.3 194 0.2 140 0.1 11 0.2 40 0.3 174  nutritional abnormality

Clinical, Health, Medical 129,466 23.4 21,349 18.2 18,856 16.5 971 20.4 2,307 15.7 10,671 

Nutrition-related risk conditions 64,455 11.7 10,327 8.8 9,626 8.4 487 10.2 1,189 8.1 5,819 Substance abuse 30,589 5.5 4,639 4.0 3,536 3.1 86 1.8 555 3.8 592 Other health risk 48,802 8.8 8,457 7.2 7,312 6.4 477 10.0 818 5.6 4,834 

Dietary 376,399 68.1 85,117 72.5 86,394 75.6 3,466 72.7 12,065 81.9 88,223 

Inadequate or inappropriate nutrient intake 356,254 64.4 81,215 69.2 83,333 73.0 3,391 71.1 11,769 79.9 87,635 Other dietary risk 36,305 6.6 6,793 5.8 5,573 4.9 152 3.2 625 4.2 1,752 

Other Risk 31,839 5.8 6,507 5.5 5,712 5.0 277 5.8 754 5.1 4,300 

Regression 20,477 3.7 4,110 3.5 3,619 3.2 159 3.3 198 1.3 2,451 Transfer (nutrition risk unknown) 7,811 1.4 1,662 1.4 1,256 1.1 95 2.0 495 3.4 950 Breastfeeding mother and infant dyad 52 0.0 4 0.0 3 0.0 0 0.0 4 0.0 3 Infant of a WIC-eligible mother or mother at 75 0.0 11 0.0 8 0.0 0 0.0 6 0.0 8  risk during pregnancyHomelessness/Migrancy 641 0.1 66 0.1 46 0.0 1 0.0 29 0.2 56 Other risk 3,424 0.6 793 0.7 894 0.8 35 0.7 33 0.2 857 

No risk reported 1,083 0.2 348 0.3 308 0.3 17 0.4 168 1.1 1,632 

NotesIn 1998, State WIC agencies could report up to three nutritional risks for each participant. This table examines all risks reported for every participant. When multiple risks within the same cthese risks are combined and counted one time in order to accurately calculate the number and percent of WIC participants with a specific type (or category) of risk.

Zero incomes are reported separately and excluded from these income calculations. In some reporting agencies, zero may be used to indicate missing information or adjunctive eligib

abetween households with missing income information and households reporting zero income.

Not reported includes the number and percent of participants for whom no data on income, income period, or size of economic unit are reported. b
Chapter Five: 0WVTKVKQPCN 4KUM %

Exhibit 5.30Number and Percent of Four-Year-Old Child WIC Participants with Specific Nutritional Risks Reported At CePoverty

Level of Poverty

Type of Risk and Specific Risk Up to 100% 101% to 130% 131% to 185% 186% and over Income Reported Not Re

as Zeroa 

Number Percent Number Percent Number Percent Number Percent Number Percent Number 

Participants in category 407,863 83,478 80,380 3,275 10,015 83,962 Anthropometric 119,538 29.3% 24,865 29.8% 23,570 29.3% 1,015 31.0% 2,736 27.3% 30,515 

Low weight for height 14,251 3.5 2,387 2.9 2,405 3.0 126 3.8 290 2.9 1,640 High weight for height 62,278 15.3 12,501 15.0 11,324 14.1 413 12.6 1,649 16.5 14,111 Short stature 25,975 6.4 5,513 6.6 5,216 6.5 275 8.4 676 6.7 4,245 Inappropriate growth or weight gain pattern 24,619 6.0 6,202 7.4 6,330 7.9 280 8.5 344 3.4 12,347 Low birthweight or premature birth 496 0.1 93 0.1 73 0.1 7 0.2 6 0.1 33 Other anthropometric 4,036 1.0 814 1.0 737 0.9 56 1.7 64 0.6 115 

Biochemical 78,358 19.2 13,085 15.7 11,282 14.0 382 11.7 1,395 13.9 15,230 

Hematocrit or hemoglobin below State standard 77,619 19.0 13,009 15.6 11,233 14.0 378 11.5 1,383 13.8 15,146 Other biochemical test results which indicate 994 0.2 103 0.1 73 0.1 6 0.2 25 0.2 123  nutritional abnormality

Clinical, Health, Medical 100,798 24.7 16,158 19.4 13,459 16.7 674 20.6 1,755 17.5 7,802 

Nutrition-related risk conditions 52,411 12.9 8,276 9.9 7,111 8.8 327 10.0 920 9.2 4,147 Substance abuse 23,637 5.8 3,655 4.4 2,534 3.2 59 1.8 386 3.9 409 Other health risk 37,677 9.2 6,093 7.3 5,026 6.3 322 9.8 656 6.5 3,725 

Dietary 277,076 67.9 60,806 72.8 60,699 75.5 2,398 73.2 8,190 81.8 65,102 

Inadequate or inappropriate nutrient intake 262,875 64.5 58,143 69.7 58,772 73.1 2,346 71.6 8,000 79.9 64,804 Other dietary risk 23,759 5.8 4,451 5.3 3,378 4.2 92 2.8 344 3.4 925 

Other Risk 24,533 6.0 4,678 5.6 4,066 5.1 216 6.6 467 4.7 3,271 

Regression 16,140 4.0 2,850 3.4 2,723 3.4 112 3.4 126 1.3 1,962 Transfer (nutrition risk unknown) 5,674 1.4 1,252 1.5 856 1.1 78 2.4 299 3.0 604 Breastfeeding mother and infant dyad 13 0.0 1 0.0 2 0.0 0 0.0 2 0.0 . Infant of a WIC-eligible mother or mother at 54 0.0 13 0.0 6 0.0 1 0.0 6 0.1 9  risk during pregnancyHomelessness/Migrancy 457 0.1 37 0.0 24 0.0 0 0.0 20 0.2 37 Other risk 2,769 0.7 636 0.8 556 0.7 31 0.9 22 0.2 679 

No risk reported 743 0.2 198 0.2 203 0.3 11 0.3 110 1.1 1,257 

NotesIn 1998, State WIC agencies could report up to three nutritional risks for each participant. This table examines all risks reported for every participant. When multiple risks within the same cthese risks are combined and counted one time in order to accurately calculate the number and percent of WIC participants with a specific type (or category) of risk.

Zero incomes are excluded from these income calculations. In some reporting agencies, zero may be used to indicate missing information or adjunctive eligibility. PC98 cannot, theref

amissing income information and households reporting zero income.

Not reported includes the number and percent of participants for whom no data on income, income period, or size of economic unit are reported. b
Chapter Five: 0WVTKVKQPCN 4KUM %JCTCEVGTKUVKEU KP 2% 106

Exhibit 5.31

Distribution of Infant WIC Participants According to Selected Anthropometric Measures: a

1994, 1996, 1998

NCHS-CDC Percentilesb 1994 1996 1998

Percent by percentilec

Weight for lengthd

<3rd percentile 2.5% 2.3% 2.3%

<5th 4.9 4.7 4.8

<10th 7.8 7.7 7.8

>90th 9.2 10.3 10.3

>95th 5.0 5.6 5.7

>98th 4.0 4.5 4.5

Invalid or unreported anthropometric data 29.5 23.9 23.7 e

Weight for agee

<3rd percentile 4.6 5.1 5.5

<5th 6.4 7.1 7.5

<10th 10.5 11.7 12.4

>90th 11.4 14.2 14.9

>95th 8.0 10.0 10.7

>98th 5.2 6.5 6.8

Invalid or unreported anthropometric data 21.5 6.2 3.1

Length for aged,f

<3rd percentile 7.9 9.1 9.8

<5th 9.5 10.9 11.5

<10th 13.4 15.3 15.9

Invalid or unreported anthropometric data 25.2 7.0 4.1

WIC infants 1,852,455 1,988,789 2,048,625

Notes

Percentiles are calculated using software for pediatric anthropometry developed by the Centers for Disease Control and the World

Health Organization. See: Sullivan, M. and J. Gorstein. December 1990. ANTHRO: Software for Calculating Pediatric

Anthropometry, Version 1.01.

An infant is defined as a participant who, at certification, is under one year of age and who would be classified as a child at the a

age of 366 days.

NCHS = National Center for Health Statistics. CDC = Centers for Disease Control and Prevention. b

Percentiles reported in this table are cumulative. For example the <5th category includes those infants in the <3rd percentile, c

and the >95th category includes those infants in the >98th percentile.

It is assumed that height for an infant is recumbent length. d

 Infants less than 19.3 inches are coded as invalid by CDC software program in weight-to-length percentile calculations. e

Age is calculated in months using birthdates and dates height and weight are measured. f
Chapter Five: 0WVTKVKQPCN 4KUM %

Exhibit 5.32Distribution of Infant WIC Participants by Racial or Ethnic Characteristics According to Selected Anthropom

NCHS-CDC Percentiles American Indian or Asian or Black Hispanic White 

b

Alaskan Native Pacific Islander (non-Hispanic) (non-Hisp

Percent by characteristic

Weight for lengthc

<3rd percentile 1.7% 2.6% 2.9% 2.3% 2.0

d

<5th 3.8 5.1 5.6 4.6 4.4 <10th 6.3 8.6 8.9 7.7 7.2 >90th 14.1 10.3 8.6 11.0 10.5 >95th 8.1 5.8 4.8 6.1 5.6 >98th 6.4 4.7 3.9 5.0 4.3 Invalid or unreported 20.4 21.8 30.4 23.4 20.1 

e

anthropometric data

Weight for agef

<3rd percentile 4.7 4.1 7.5 4.5 5.2 

d

<5th 6.5 5.7 10.1 6.1 7.2 <10th 10.6 10.8 16.5 10.4 11.7 >90th 19.5 14.0 11.8 16.7 15.4 >95th 14.2 9.9 8.7 12.4 10.8 >98th 9.4 6.3 5.7 7.7 6.8 Invalid or unreported 3.4 2.2 3.7 2.4 3.3 anthropometric data

Length for agec,f

<3rd percentile 8.6 8.4 12.8 8.8 8.9 

d

<5th 10.3 10.0 14.7 10.3 10.8 <10th 14.3 13.9 19.3 14.2 15.4 Invalid or unreported 4.6 3.4 4.8 3.7 3.9 anthropometric data

WIC infants 27,656 64,400 498,190 622,186 814,77

NotesPercentiles are calculated using software for pediatric anthropometry developed by the Centers for Disease Control and the World Health Organization. See: Sullivan, M. and J. 

Software for Calculating Pediatric Anthropometry, Version 1.01.

An infant is defined as a participant who, at certification, is under one year of age and who would be classified as a child at the age of 366 days. a

NCHS = National Center for Health Statistics. CDC = Centers for Disease Control and Prevention. bIt is assumed that height for an infant is recumbent length. cPercentiles reported in this table are cumulative. For example the <5th category includes those infants in the <3rd percentile, and the >95th category includes those infan

d

 Infants less than 19.3 inches are coded as invalid by CDC software program in weight-to-length percentile calculations. eAge is calculated in months using birthdates and dates height and weight are measured. f
Chapter Five: 0WVTKVKQPCN 4KUM %JCTCEVGTKUVKEU KP 2% 108

Exhibit 5.33

Distribution of Child WIC Participants by Age According to Selected Anthropometric Measures:

1994, 1996, 1998

1 Year Old 2 or More Years Old

NCHS-CDC 1994 1996 1998 1994 1996 1998

Percentilesa

Percent by percentileb

Weight for heightc

<3rd percentile 2.2% 2.1% 1.9% 1.3% 1.1% 1.0%

<5th 3.3 3.2 3.0 2.4 2.0 1.9

<10th 7.6 7.3 7.0 5.4 4.6 4.4

>90th 20.8 21.5 23.0 13.7 14.8 16.5

>95th 13.1 13.6 14.5 8.8 9.7 11.0

>98th 10.2 10.8 11.5 6.9 7.6 8.7 d

Invalid or unreported 4.5 5.2 2.5 3.3 4.8 1.9

anthropometric data

Weight for agec,d

<3rd percentile 4.2 4.1 3.0 3.5 3.0 2.2

<5th 5.9 5.9 4.8 5.3 4.6 3.6

<10th 9.9 10.1 9.1 10.0 8.8 7.6

>90th 13.3 16.3 17.3 13.2 15.5 17.8

>95th 8.6 10.7 11.3 8.6 10.3 11.9

>98th 6.4 8.2 8.5 6.5 7.9 9.2 d

Invalid or unreported 14.8 4.7 1.3 7.8 4.9 1.4

anthropometric data

Height for agec,d

<3rd percentile 6.1 5.9 6.2 4.1 3.8 3.2

<5th 8.4 8.2 8.7 5.9 5.6 4.8

<10th 13.4 13.5 14.2 10.4 9.8 8.9

>90th 7.9 10.1 10.2 13.0 14.8 16.6

>95th 4.4 5.8 5.7 7.8 9.1 10.2

>98th 3.0 4.0 3.9 5.3 6.3 7.1

Invalid or unreported 16.5 6.5 1.8 8.4 5.4 1.4

anthropometric data

WIC children 1,384,268 1,423,566 1,468,579 1,979,761 2,550,508 2,621,162

Notes

Percentiles are calculated using software for pediatric anthropometry developed by the Centers for Disease Control and the World Health

Organization. See: Sullivan M. and J. Gorstein. December 1990. ANTHRO: Software for Calculating Pediatric Anthropometry, Version

1.01.

Age is not reported for 31,275 children.

NCHS = National Center for Health Statistics. CDC = Centers for Disease Control and Prevention. a

Percentiles reported in this table are cumulative. For example the <5th category includes those infants in the <3rd percentile, and the b

>95th category includes those infants in the >98th percentile.

NCHS-CDC reference curves for one-to-two-year-old children are based on a sample of children from Yellow Springs, Ohio, who were c

measured by researchers at the Fels Research Institute. For children aged two or more, NCHS-CDC growth reference curves are based

on a representative sample of US children.

Age is calculated in months using birthdates and dates height and weight are measured. d
Chapter Five: 0WVTKVKQPCN 4KUM %

Exhibit 5.34Distribution of Child WIC Participants by Age and Race or Ethnicity According to Selected Anthropometric Me

American Indian or Asian or Pacific 

Alaskan Native Islander Black (non-Hispanic) Hispanic White (non-Hispanic

NCHS Percentiles Old More Years Old More Years Old More Years Old More Years Old More Ye

a

1 Year 2 or 1 Year 2 or 1 Year 2 or 1 Year 2 or 1 Year 2 or 

Old Old Old Old Old 

Percent by characteristic

Weight for heightb<3rd 1.4% 0.8% 3.2% 1.2% 2.3% 1.4% 1.6% 0.8% 2.0% 

c

<5th 2.1 1.4 4.9 2.0 3.5 2.5 2.5 1.5 3.0 2<10th 4.7 3.0 10.4 4.8 7.9 5.5 6.1 3.7 7.1 4>90th 29.9 21.3 17.7 17.2 22.8 14.8 26.2 20.5 20.8 1>95th 19.9 14.0 10.8 11.6 14.6 9.7 17.1 14.3 12.6 >98th 16.2 10.9 8.5 9.3 11.6 7.5 13.7 11.6 9.8 Invalid or unreported 3.8 1.8 2.4 1.5 2.9 1.5 3.1 2.7 1.9 anthropometric dataWeight for ageb,d<3rd 2.6 1.6 4.3 2.8 3.5 2.4 2.4 1.7 3.2 2

c

<5th 3.9 2.7 6.9 4.7 5.5 3.9 3.8 2.9 5.0 4<10th 6.9 5.5 12.9 9.6 10.1 7.8 7.7 6.2 9.5 >90th 23.1 21.5 12.8 16.5 17.5 18.0 19.3 21.3 15.8 14>95th 15.8 14.5 8.1 11.3 11.6 11.9 12.9 14.9 10.1 >98th 12.2 11.3 6.1 8.9 8.8 9.1 9.9 11.9 7.4 Invalid or unreported 1.1 1.1 1.0 1.0 1.0 1.1 2.0 2.3 0.9 anthropometric dataHeight for ageb,d<3rd 5.4 2.7 7.4 4.8 6.9 2.9 6.1 3.0 5.8 

c

<5th 7.6 4.0 10.4 7.3 9.4 4.2 8.5 4.5 8.3 5<10th 12.6 7.7 17.0 12.7 14.9 7.7 14.2 8.4 13.8 1>90th 9.9 16.2 9.4 13.3 11.0 20.4 10.5 17.5 9.6 1>95th 5.3 9.8 5.5 8.1 6.3 13.1 6.0 10.9 5.3 >98th 3.4 6.8 3.7 5.6 4.3 9.3 4.2 7.6 3.5 5Invalid or unreported 3.3 1.3 2.0 1.2 1.9 1.0 2.4 2.1 1.4 anthropometric dataWIC Children 21,510 41,139 47,070 90,487 343,445 594,936 469,897 915,116 575,226 961,80

NotesAge is not reported for 5,392 American Indian/Alaskan Native children, 1,140 Asian/Pacific Islander children, 4,335 black children, 3,642 Hispanic children, 16,137 white children, and 629 of the 

NCHS = National Center for Health Statistics. Percentiles are calculated using software for pediatric anthropometry developed by the Centers for Disease Control and the World Health Orga

a

December 1990. ANTHRO: Software for Calculating Pediatric Anthropometry, Version 1.01.

NCHS-CDC reference curves for one-to-two-year-old children are based on a sample of children from Yellow Springs, Ohio, who were measured by researchers at the Fels Research Institute. 

b

growth reference curves are based on a representative sample of US children.Percentiles reported in this table are cumulative. For example the <5th category includes those children in the <3rd percentile, and the >95th category includes those children in the >98th 

c

Age is calculated in months using birthdates and dates height and weight are measured. d
Chapter Five: 0WVTKVKQPCN 4KUM %JCTCEVGTKUVKEU KP 2% 110

Exhibit 5.35

Number and Percent of Infant WIC Participants at Risk According to Several

Anthropometric Criteria

Number Percent

1998 WIC Modal Criteria

Weight for agea

Underweight 254,312 12.4%

Overweight 304,849 14.9

Weight not reported 40,656 2.0

Length for ageb

Short stature 325,799 15.9

Tall stature 228,305 11.1

Length not reported 57,151 2.8

Weight for lengtha

Underweight 159,504 7.8

Overweight 209,276 10.2

Weight or length not reported 60,756 3.0

Weight and length not reported 37,051 1.8

WIC infants 2,048,626

Notes

Anthropometric criteria are based on percentiles developed by the National Center for Health Statistics (NCHS).

Percentiles are calculated using software for pediatric anthropometry developed by the Centers for Disease Control and

the World Health Organization. See: Sullivan, M. and J. Gorstein. December 1990. ANTHRO: Software for

Calculating Pediatric Anthropometry, Version 1.01.

Calculations for modal criteria assign equal weight to every reporting State. There is substantial variation in numbers

of State WIC agencies reporting information on anthropometric criteria. For details on this topic, see Appendix D,

Exhibits D5.35A, D5.35B, and D5.35C.

Infants falling below the tenth percentile for weight for age or weight for length meet the modal criteria for underweight a

for age or length. Infants over the ninetieth percentile are considered overweight.

Infants falling below the tenth percentile for length for age meet the modal criteria for short stature. Tall stature is set b

at length for age measurements above the ninetieth percentile.
Chapter Five: Nutritional Risk C

Exhibit 5.36Number and Percent of Child WIC Participants at Risk According to Several Anthropometric Criteria

1 Year 2 Years 3 Years 4 Years Age Not Reported 

c

Number Percent Number Percent Number Percent Number Percent Number Percent 

1998 WIC Modal Criteria

Weight for agea

Underweight 133,611 9.1% 80,958 7.8% 71,380 7.8% 47,810 7.1% 1,478 4.7% Overweight 252,823 17.2 188,335 18.2 151,278 16.5 123,818 18.5 1,879 6 Weight not reported 15,425 1.1 10,780 1.0 9,557 1.0 7,850 1.2 883 2.8 

Height for ageb

Short stature 209,638 14.3 75,069 7.3 88,685 9.7 71,677 10.7 2,165 6.9 Tall stature 148,537 10.1 191,354 18.5 142,731 15.6 97,996 14.6 1,331 4.3 Height not reported 20,405 1.4 16,766 1.6 10,211 1.1 7,687 1.1 1,051 3.4 

Weight for heighta

Underweight 103,396 7.0 50,264 4.9 38,343 4.2 26,911 4.0 1,260 4.0 Overweight 320,371 21.8 159,381 15.4 150,602 16.4 123,471 18.5 5,610 17.9 Weight or height not reported 22,339 1.5 17,888 1.7 11,405 1.2 9,039 1.4 1,092 3.5 Weight and height not reported 13,492 0.9 9,657 0.9 8,362 0.9 6,497 1.0 842 2.7 

Children in age group 1,468,580 1,034,432 917,758 668,972 31,275 

NotesAnthropometric criteria are based on percentiles developed by the National Center for Health Statistics (NCHS). Percentiles are calculated using software for pediatric anthro

Disease Control and the World Health Organization. See: Sullivan, M. and J. Gorstein. December 1990. ANTHRO: Software for Calculating Pediatric Anthropometry, VeCalculations for modal criteria assign equal weight to every reporting State. There is substantial variation in numbers of State WIC agencies reporting information on anthropomsee Appendix D, Exhibits D5.35A, D5.35B, and D5.35C.

Children falling below the tenth percentile for weight for age or weight for height meet the modal criteria for underweight for age or height. Children over the ninetieth perce

a

Children falling below the tenth percentile for height for age meet the modal criteria for short stature. Tall stature is set at height for age measurements above the ninetieth 

b

Weight for age and height for age have been reported for children missing age at certification for whom, however, age at height and weight measurement could be calculat

c
Chapter Five: 0WVTKVKQPCN 4KUM %JCTCEVGTKUVKEU KP 2% 112

Exhibit 5.37

Number and Percent of Breastfeeding and Postpartum Women WIC Participants at

Risk According to Several Anthropometric Criteria

Breastfeeding Women Postpartum Women

Number Percent Number Percent

1998 WIC modal criteriaa

Current weight for height

Underweight 12,228 3.1% 22,623 3.8%

Overweight 206,419 53.0 321,760 54.4

Weight not reported 7,710 2.0 11,197 1.9

Height not reported 5,382 1.4 8,132 1.4

Weight or height not reported 10,912 2.8 13,837 2.3

Weight and height not reported 2,180 0.6 5,491 0.9

Women in category 389,391 591,050

Notes

Standard height and weight percentiles are based on the Metropolitan Life Actuarial Tables, 1959.

Calculation for modal criteria assign equal weight to every reporting State. Seventy-five State WIC agencies reported

criteria for underweight for breastfeeding women; seventy-three agencies provided criteria for overweight. For

postpartum women, seventy-one State WIC agencies reported criteria for underweight; sixty-nine agencies provided

information on overweight. See Exhibit D5.37 in Appendix D for more details.

Weight for height measurements for breastfeeding and postpartum women ten percent below standard meet the modal a

criteria for underweight for height; twenty percent above standard is overweight for height.
Chapter Five: Nutritional Risk Characteristics in PC98 113

When PC98 modal criteria are considered, over half (53.0 percent for breastfeeding

women and 54.4 percent of postpartum women) of these participant groups are

overweight. The percent of overweight breastfeeding women increased by 10

percentage points and the percent of overweight postpartum women increased by 7

percentage points between 1996 and 1998. These changes should be treated somewhat

cautiously due to unreported height data in PC96. Assuming participants with missing

data are similar to all other participants, then the percent of overweight breastfeeding

women and the percent of overweight postpartum women only increased by 3

percentage points between 1996 and 1998. 

It is interesting to compare these figures with the State-specific nutritional risks

reported in Exhibit 5.9 where only 36.3 percent of breastfeeding women and 32.7

percent of postpartum women are reported as having high weight for height. These

differences between the incidence of high weight for height in the anthropometric risks

and the reported nutritional risks could be due to two factors. One, some participants

may be overweight according to State criteria and the risk may not be recorded. Two,

reported nutritional risks use State-specific criteria to determine whether participants

are overweight while the anthropometric data use a national standard. State-specific

variations in overweight criteria coupled with State differences in the WIC population

can lead to differences in the incidence of high weight to height between the two

measures. Figures for underweight for height are about the same in both exhibits. 

Blood Measures Federal regulations allow each State to set WIC eligibility criteria for determining

nutritional risk using hemoglobin and/or hematocrit measures. States reported their

eligibility criteria for PC98; average values are presented in Exhibits 5.38 and 5.39

along with the 1989 CDC standards for anemia and modal values from PC94 and

PC96. State-by-State tables appear in Appendix D (Exhibits D5.38A - D5.38J). The

modal criteria for blood measures have changed very slightly across the States since

1994. In calculating median and modal values for hemoglobin and hematocrit criteria,

equal weight is assigned to every reporting State.

Most anemia screening occurs in WIC clinics. Three-quarters of all local agencies

report that over 90 percent of WIC participants are screened at the clinic (Exhibit

5.40). In half the local agencies, blood tests are done once a year (if previous results

were normal); 40 percent of agencies screen for anemia at each certification (Exhibit

5.41). Most agencies (90 percent) use a fingerstick to obtain blood samples and 80

percent of agencies use a hemocue to analyze the samples (Exhibit 5.42). Agencies

report that WIC personnel are trained in blood screening procedures using a variety of

methods including videos and testing subjects under supervision. Workers periodically

attend refresher training and are assessed for competency in obtaining blood samples.

As part of the minimum data set for PC98, States reported hemoglobin and hematocrit

values for women, children, and infants over six months of age. Blood measures were

reported for 70 percent of all participants. (See Exhibit 5.43.) Most of the missing

values are for infants, who are not required to be tested unless they are over six months

of age when they are certified for WIC benefits, and for children who have received

normal blood tests within the six months prior to certification. For children, Federal

regulations allow for waiving blood tests, given normal results at previous certification

appointments. In these cases, State information systems report blood measures as

missing. For PC98, States were permitted to report erythrocyte protoporphyrin values,

but only three States exercised that option, reporting on only 3,362 WIC enrollees.
%JCRVGT (KXG 0WVTKVKQPCN 4KUM %JCTCEVGTKUVKEU KP 2% 

Exhibit 5.38

State 1998 Nutritional Risk Eligibility Criteria for Hemoglobin and Hematocrit Levels

Compared with 1989 CDC Standards for Anemia

1998 WIC Program Criteria

Participant Category Minimum Maximum Median Modal 1989 CDC

Value Value Value Value Standarda

Hemoglobin

Pregnant women 

 First trimester 10.0 12.7 11.4 11.0 11.0 

 Second trimester 10.0 12.5 11.0 12.0 10.5 

 Third trimester 10.0 13.0 11.1 11.0 11.0 

 Constant criterion 10.0 12.5 12.0 12.0 __

Breastfeeding women 10.0 13.5 12.0 12.0 12.0 

Postpartum women 10.9 13.4 12.0 12.0 12.0 

Infants 9.9 12.4 11.0 11.0 __

Children

1 year old 9.9 12.5 11.0 11.0 11.0 

2 through 4 years 10.9 12.6 11.2 11.0 11.2 

Hematocrit

Pregnant women

 First trimester 32.0 38.0 34.0 33.0 33.0 

 Second trimester 31.0 38.0 33.4 32.0 32.0 

 Third trimester 32.0 38.0 33.9 33.0 33.0 

 Constant criterion 33.0 38.0 35.9 36.0 __

Breastfeeding women 33.0 39.0 36.0 36.0 36.0 

Postpartum women 33.0 39.0 36.0 36.0 36.0 

Infants 30.9 36.0 33.0 33.0 __

Children

1 year old 30.9 36.0 33.9 34.0 33.0 

2 through 4 years 32.9 37.0 34.0 34.0 34.0 

Notes

Hemoglobin values are reported in grams per deciliter. Hematocrit values are reported as percents. When WIC applicants have blood

tests values less than or equal to the State-specific criteria, they are considered to be at nutritional risk. However, only participants with

blood test values below CDC criteria are considered at risk for anemia.

For this table, calculations for means and medians include values for States setting separate criteria by age or by trimester as well as

values for States with constant criteria. Statistics reported for first, second, and third trimesters include both the States reporting criteria

on that trimester plus all constant criteria. Calculations for medians and modes assign equal weight to every state. All State WIC

agencies reported hemoglobin and/or hematocrit criteria for pregnant, breastfeeding and postpartum women, as well as for infants and

children ages 2-5. Eighty-seven States reported criteria for children less than two years of age. For additional detail on criteria, see

Exhibits D5.38A through D5.38J.

Centers for Disease Control. 1989 "CDC Criteria for Anemia in Children and Childbearing-Aged Women." Morbidity and Mortality a

 Weekly Report, 38, 22: 401-404. The CDC has not published standards for infants. However, cutoff values for one-to-two-year-old

 children can be extrapolated back to six months of age. For nonpregnant females under fifteen years of age, the hemoglobin

 standard is 11.8; the hematocrit standard is 35.5.
%JCRVGT (KXG 0WVTKVKQPCN 4KUM %

Exhibit 5.39Hematologic Criteria Commonly Used for Determining WIC Eligibility

CDC 1989 Standards for

Anemia 1994 WIC Modal Criteria 1996 WIC Modal Criteria 

a

Participant Category Hemoglobin Hematocrit Hemoglobin Hematocrit Hemoglobin Hematocrit Pregnant women First Trimester 11.0 33.0 12.0 33.0 12.0 33.0  Second Trimester 10.5 32.0 12.0 31.9 12.0 31.9  Third Trimester 11.0 33.0 10.9 33.0 11.0 33.0 Breastfeeding and postpartum women 12.0 36.0 12.0 36.0 12.0 36.0 Infants 11.0 34.0 11.0 34.0 

b a a 

Children 1 year old 11.0 33.0 11.0 34.0 11.0 34.0  2 - 4 years 11.2 34.0 11.0 34.0 11.0 34.0 

NotesFederal WIC regulations permit State and local agencies to dispense with hematological testing for infants under six months of age, as well as for children who aat their last certification. However, blood tests should be performed on such children at least once in every twelve-month period.Hemoglobin values are reported in grams per deciliter. Hematocrit values are reported as percents. When WIC applicants have blood tests values less than or equ

are considered to be at nutritional risk. However, only participants with blood test values below CDC criteria are considered at risk for anemia.

Centers for Disease Control. 1989 "CDC Criteria for Anemia in Children and Childbearing-Aged Women." Morbidity and Mortality Weekly Report, 38, 22: 401

a standards for infants. However, cutoff values for one-to-two-year-old children can be extrapolated back to six months of age. For nonpregnant females under  standard is 11.8; the hematocrit standard is 35.5.

An infant is defined as a participant who, on the day of certification, is under one year of age and who would be classified as a child at the age of 366 days. b
Chapter Five: Nutritional Risk Characteristics in PC98 116

Exhibit 5.40

Percent of Clients Screened for Anemia at Doctor’s Office or Non-WIC Clinic

Percent of Clients Percent of Local Agencies

Less than 10 percent 74.7% 

(1.94)

10 - 24 percent 7.2 

(1.42)

25 - 49 percent 2.5 

(0.85)

50 - 74 percent 2.3 

(0.85)

75 percent or more 9.1 

(1.46)

Not reported 4.1 

(0.83)

Total 100.0%

Note

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe

of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.
Chapter Five: Nutritional Risk Characteristics in PC98 117

Exhibit 5.41

Blood Screening Procedures at WIC Clinics

Procedures Percent of Percent of

 Local Agencies Paticipants

Frequency of clinic screening

At each certification 40.4% 33.7% 

(2.50) (3.83)

Once a year if previous result was normal 51.9 53.6 

(2.53) (4.47)

Other 3.9 1.9 

(0.99) (0.89)

Not reported 3.7 10.8 

(0.63) (2.12)

Total 100.0% 100.0%

Blood samples obtained using

Fingerstick 91.5% 73.4% 

(1.05) (3.34)

Venipuncture 0.8 0.8 

(0.48) (0.97)

Other 0.0 0.0 

(0.00) (0.00) 

Not reported 7.7 25.8 

(1.26) (3.30)

Total 100.0% 100.0%
Exhibit 5.41 (continued)

Blood Screening Procedures at WIC Clinics

Procedures Percent of Percent of

 Local Agencies Paticipants

Chapter Five: Nutritional Risk Characteristics in PC98 118

WIC personnel trained bya

Watching a video 38.5% 33.4% 

(2.68) (3.88)

Testing multiple subjects under supervision of trained 65.2 60.3 

instructor (2.33) (3.39)

Attending periodic refresher training 42.8 42.1 

(2.63) (4.28)

Periodic assessment of competency 47.2 40.5 

(2.72) (4.48)

Other 11.5 8.5 

(1.90) (2.72)

Not reported 9.0 26.2 

(1.25) (3.49)

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe

of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

Columns do not sum to 100 percent because respondents were permitted multiple responses. a
Chapter Five: Nutritional Risk Characteristics in PC98 119

Exhibit 5.42

Instruments Used to Test Hemoglobin or Hematocrit at WIC Clinics

Instrument Percent of Percent of Clients

Local Agencies Screened with

Using Instrument Instrument

Hemocue 79.6 73.4 

(1.92) (2.01)

Automated hematology analyzer (Coulter counter) 2.7 1.7 

(0.92) (0.64)

StatCrit 7.8 6.8 

(1.49) (1.33)

BMS hemoglobinometer 1.3 0.6 

(0.63) (0.35)

Other 9.3 6.0 

(1.44) (1.07)

Not Reported 8.6 11.3 

 (1.12) (1.44) 

Total 100.0% a

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe

of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

Column does not sum to 100 percent because respondents were permitted multiple responses. a
Chapter Five: 0WVTKVKQPCN 4KUM %

Exhibit 5.43Availability of Hematological Data for WIC ParticipantsPercent of WIC Participants by Participant Category with Specific Types of Hematological Measures

Type of Measure Pregnant Breastfeeding Postpartum Total Women Women Women Women Infants C

a

Percent by participant category

Participants in category 892,674 389,391 591,050 1,873,116 2,048,626 4Participants with test report for ...Hemoglobin 58.8% 53.1% 62.2% 58.7% 9.5% 

Hematocrit 15.9 18.8 15.9 16.5 2.6 Hemoglobin and hematocrit 16.0 11.0 11.2 13.4 0.9 

No blood test reported 9.2 17.1 10.8 11.4 87.0 

Total 100.0% 100.0% 100.0% 100.0% 100.0% 

NotesAlthough PC98 allowed States the option of reporting erythrocyte protoporphyrin test results, this item was reported for less than 0.1 percent of WIC 

does not appear in this table.

An infant is defined as a participant who, at certification, is under one year of age and who would be classified as a child at the age of 366 days. Fe

a

State and local agencies to dispense with hematological testing for infants under six months of age as well as for children who are found to be withcertification. However, blood tests should be performed on such children at least once in every twelve-month period. While WIC Program regulatand reporting blood measurements on infants, in some instances, staff at local WIC service sites complete blood tests and report test results. All suincluded in this column.
 Institute of Medicine. 1990 Nutrition During Pregnancy. Washington, DC: National Academy 3

Press.

 Findings concerning anemia rates by race/ethnicity and age are similar when missing data are 4

excluded from the percentage distributions.

Chapter Five: Nutritional Risk Characteristics in PC98 121

The results of blood tests are used by local WIC staff to determine eligibility for WIC

benefits. Applicants with blood test values at or below State-set criteria are considered

at nutritional risk and are eligible for WIC benefits.

Exhibits 5.44 and 5.45 provide information on numbers and proportions of WIC

enrollees falling below the three hematologic standards: State-specific criteria; 1998

modal criteria; and the 1989 CDC standard for anemia. Anemia rates for postpartum

women are consistently high—above 30 percent—as they were in 1992, 1994, and

1996. For children, anemia rates decrease with age according to State-specific criteria

and 1998 modal criteria. Results are similar using CDC standards, except that anemia

rates are highest for two-year old children. Note that, in computing table entries for

both women and children, percents below State and CDC standards were calculated by

excluding women and children for whom data were not reported from numerators but

including them in denominators. While percentages reported here must be treated as

representative of lower bound estimates of the prevalence of anemia in the WIC

population, these estimates may be close to the true values. Children with normal

hematocrit and hemoglobin values within the six months prior to certification are not

required to be tested and thus unreported data tend to be concentrated among children

who had normal blood values.

It would be helpful to compare PC98 findings on anemia in WIC women with

information on the US population. However, data on the prevalence of iron deficiency

among women during childbearing years are available mainly from the second (1976-

1980) National Health and Nutrition Examination Survey (NHANES II), where

findings are reported only for nonpregnant women. The sample of pregnant women is

too small for detailed analysis. Information from NHANES II indicates that between

5 percent and 10 percent of nonpregnant women display impaired iron status. Iron

deficiency anemia was found in less than 2 percent of nonpregnant US women. Not 3

all anemia is caused by iron deficiency, and WIC measures anemia more generally

without identifying iron deficiency. Nonetheless, it is likely that rates of anemia in the

WIC population are higher than rates for the general US population.

Information on anemia by ethnic category and age appears in Exhibits 5.46 and 5.47.

Interpretation of these data must include consideration of unreported data, which are

higher among Asian/Pacific Islander and Hispanic WIC women than other ethnicities.

In PC98, as in previous studies, black women and children display the highest reported

levels of anemia. American Indian or Alaskan Native and white WIC participants

reported the lowest levels of anemia. Across age and ethnic categories, percentages of

anemic children measured against CDC criteria peak at two years of age and then

decrease with age. These findings are similar to outcomes reported in all previous PC

studies beginning with PC88. Anemia rates calculated for women and children using 4

State-specific criteria generally fall within 5 percentage points of the State-reports of

participants with blood measurements below State-standards displayed in Exhibits 5.9

and 5.11. 
Chapter Five: 0WVTKVKQPCN 4KUM %

Exhibit 5.44Number and Percent of Women WIC Participants Falling Below Several Hematologic Standards

Pregnant Women

First Trimester Second Trimester Third Trimester Not Reported Women 

b

Breastfeeding P

Hematologic Standard Number Percent Number Percent Number Percent Number Percent Number Percent Num

Percent by participant category

Women in category 415,983 337,089 105,453 34,149 389,391 591State-specific criteria for WIC

eligibility

Hemoglobin 50,343 12.1% 59,924 17.8% 31,187 29.6% 81,101 20.8% 180Hematocrit 13,853 3.3 16,349 4.9 7,585 7.2 23,940 6.1 391998 modal criteriaHemoglobin 85,277 20.5 122,044 36.2 23,764 22.5 86,344 22.2 195Hematocrit 3,844 0.9 3,836 1.1 5,641 5.3 22,376 5.7 381989 CDC standard for anemiaaHemoglobin 19,157 4.6 20,644 6.1 19,052 18.1 74,933 19.2 175Hematocrit 2,652 0.6 3,836 1.1 4,149 3.9 18,507 4.8 32Blood measure not reported 41,076 9.9 30,259 9.0 8,877 8.4 1,927 5.6 68,654 17.6 67

NotesPercent below each standard includes in denominators women for whom no data were reported so that the percentages reported here represent lower bounds.Estimates reported here are additive. For example, in April 1998, blood test values reported for 19.8 percent (or 371,564) of WIC women met the CDC standards for anemia.

Centers for Disease Control. 1989 "CDC Criteria for Anemia in Children and Childbearing-aged Women." Morbidity and Mortality Weekly Report, 38, 22: 401-404. a

Not reported indicates the number and percent of participants, by participant category, for whom data were not reported on expected date of delivery or weeks gestation. b
Chapter Five: 0WVTKVKQPCN 4KUM %

Exhibit 5.45Number and Percent of Child WIC Participants Falling Below Several Hematologic Standards

1 Year 2 Years 3 Years 4 Years Age Not Repo

Standard Number Percent Number Percent Number Percent Number Percent Number Pe

Percent by age at certification

Children in age group 1,468,580 1,034,432 917,758 668,972 31,275 State-specific criteria for WIC

eligibility

Hemoglobin 274,347 18.7% 178,150 17.2% 124,760 13.6% 70,479 10.5% 0 Hematocrit 54,534 3.7 37,964 3.7 28,312 3.1 15,620 2.3 0 1998 modal criteriaHemoglobin 240,195 16.4 138,885 13.4 94,339 10.3 52,573 7.9 0 Hematocrit 67,158 4.6 41,581 4.0 31,457 3.4 17,874 2.7 0 1989 CDC standard for

anemiaa

Hemoglobin 188,833 12.9 156,111 15.1 107,272 11.7 60,241 9.0 0 Hematocrit 25,597 1.7 26,426 2.6 19,367 2.1 10,524 1.6 0 Not reportedb 122,572 8.3 96,113 9.3 89,196 9.7 69,905 10.4 8,303 2

NotesPercent below each standard includes in denominators children for whom no data were reported so that the percentages reported here represent lower bounds.Estimates reported here are additive. For example, in April 1998, blood test values for 14.4 percent (or 603,389) of WIC children met the CDC standards for anemia.

Federal WIC regulations permit State and local agencies to dispense with hematological testing for infants under six months of age, as well as for children who are found to be wHowever, blood tests should be performed on such children at least once in every twelve-month period.

Centers for Disease Control. 1989 "CDC Criteria for Anemia in Children and Childbearing-Aged Women." Morbidity and Mortality Weekly Report, 38, 22: 401-404. a

Not reported indicates the number and percent of participants, by participant category, for whom data were not reported on blood measures. b
Chapter Five: 0WVTKVKQPCN 4KUM %

Exhibit 5.46Number and Percent of Anemic Women WIC Participants by Participant Category and Racial or Ethnic Chara

American Indian or Asian or Pacific Black (non- White (non- Ethnici

Alaskan Native Islander Hispanic) Hispanic Hispanic) Repo

Number Percent Number Percent Number Percent Number Percent Number Percent Number 

Percent by ethnic category

Women in ethnic

category

25,442 56,940 401,202 585,324 787,656 16,553 

Total women 25,442 56,940 401,202 585,324 787,656 16,553 

Below CDC standard 4,364 17.2% 12,706 22.3% 123,292 30.7% 103,450 17.7% 124,290 15.8% 3,461 

a

Not reported 2,469 9.7 9,726 17.1 43,890 10.9 125,058 21.4 66,401 8.4 2,783 

b

Pregnant women 12,506 24,914 194,038 271,086 383,421 6,709 

Below CDC standard 832 6.7 2,013 8.1 28,883 14.9 18,020 6.6 19,234 5.0 508 

a

Not reported 1,389 11.1 4,222 16.9 24,867 12.8 44,328 16.4 38,064 9.9 1,491 

b

Breastfeeding women 5,996 13,425 58,120 164,307 143,711 3,832 

Below CDC standard 1,194 19.9 3,765 28.0 22,218 38.2 38,020 23.1 27,195 18.9 1,049 

a

Not reported 521 8.7 2,414 18.0 6,389 11.0 46,742 28.4 12,105 8.4 482 

b

Postpartum women 6,940 18,600 149,043 149,931 260,523 6,012 

Below CDC standard 2,338 33.7 6,928 37.2 72,192 48.4 47,410 31.6 77,861 29.9 1,904 

a

Not reported 559 8.1 3,090 16.6 12,634 8.5 33,988 22.7 16,231 6.2 810 

b

NotesPercent below each standard includes in denominators women for whom no data were reported so that the percentages reported here represent lower bounds. As noted in noteare additive.

Centers for Disease Control. 1989 "CDC Criteria for Anemia in Children and Childbearing-Aged Women." Morbidity and Mortality Weekly Report, 38, 22: 401-404. a

Not reported indicates the number and percent of participants, by participant category, for whom data were not reported on blood measure or expected date of delivery. b
Chapter Five: 0WVTKVKQPCN 4KUM %

Exhibit 5.47Number and Percent of Anemic Child WIC Participants by Age at Time of Blood Measurement and Racial or Eth

American Indian or Asian or Pacific Black (non- Ethnicity 

Alaskan Native Islander Hispanic) Hispanic Report

White (non-Hispanic)

Number Percent Number Percent Number Percent Number Percent Number Percent Number 

Percent by ethnic category

Children in ethnic

category 68,041 138,697 942,716 1,388,655 1,553,170 29,738 

Total children 68,041 138,697 942,716 1,388,655 1,553,170 29,738 

Below CDC standard 6,602 9.7% 18,152 13.1% 205,790 21.8% 193,619 13.9% 166,102 10.7% 4,126 

a

Not reported 6,507 9.6 12,609 9.1 65,179 6.9 114,235 8.2 175,707 11.3 3,550 

b

One-year-old children 21,510 47,070 343,445 469,897 575,226 11,432 

Below CDC standard 2,582 12.0 5,695 12.1 72,951 21.2 63,432 13.5 68,201 11.9 1,577 

a

Not reported 1,897 8.8 4,196 8.9 22,796 6.6 40,049 8.5 52,461 9.1 1,173 

b

Two-year-old children 15,856 35,574 231,357 354,954 389,581 7,110 

Below CDC standard 2,116 13.3 6,028 16.9 60,932 26.3 62,175 17.5 50,069 12.9 1,222 

a

Not reported 1,683 10.6 3,222 9.1 15,537 6.7 27,395 7.7 47,290 12.1 986 

b

Three-year-old children 14,348 31,582 210,324 318,877 336,929 5,698 

Below CDC standard 1,251 8.7 4,148 13.1 45,194 21.5 43,308 13.6 31,972 9.5 770 

a

Not reported 1,598 11.1 2,902 9.2 15,081 7.2 25,921 8.1 42,926 12.7 767 

b

Four-year-old children 10,935 23,331 153,255 241,285 235,297 4,869 

Below CDC standard 652 6.0 2,281 9.8 26,714 17.4 24,704 10.2 15,859 6.7 557 

a

Not reported 1,329 12.2 2,288 9.8 11,765 7.7 20,870 8.6 33,030 14.0 624 

b

Age not reportedc 5,392 7.9 1,140 0.8 4,335 0.5 3,642 0.3 16,137 1.0 629 

NotesPercent below each standard includes in denominators children for whom no data were reported so that the percentages reported here represent lower bounds. As noted in Exhibits Federal WIC regulations permit State and local agencies to dispense with hematological testing for infants under six months of age, as well as for children who are found to be wHowever, blood tests should be performed on such children at least once in every twelve-month period.

Centers for Disease Control. 1989 "CDC Criteria for Anemia in Children and Childbearing-Aged Women." Morbidity and Mortality Weekly Report, 38, 22: 401-404. a

Not reported indicates the number and percent of participants, by participant category, for whom data were not reported on blood measure. bAge not reported includes those participants for whom data were not reported on date of birth or certification date. c
Chapter Six: PC98 Nutrition Education 127

6. NUTRITION EDUCATION AND BREASTFEEDING

Nutrition education plays a crucial role in the WIC Program and is viewed as an

essential benefit, directed toward achieving positive changes in participant knowledge,

attitude, and behavior about food consumption. Federal regulations require WIC

service providers to offer participants at least two nutrition education sessions during

each certification period. Certifications tend to occur every six months, with the

exception of infants who may be certified for twelve months and pregnant women who

may be certified for the duration of pregnancy and up to six weeks postpartum.

Education on a variety of health and nutrition-related topics may be provided in

individual counseling sessions or group classes and may utilize films and videos as

teaching aids. Policies with regard to nutrition education differ within local agencies

usually depending on whether or not the participant is classified as high-risk. Such

participants include, for example, pregnant women with histories of low birthweight

babies, infants born to women with histories of alcohol or drug abuse, and infants or

children with congenital malformations. 

Local agencies are required to make nutrition education available to all clients at no

cost. However, receipt of food vouchers or checks is not contingent upon attendance

at nutrition education sessions. Virtually all WIC agencies (over 95 percent) provide

nutrition education to participants at certification (Exhibit 6.1). At the conclusion of

certification appointments, participants are scheduled for their second nutrition

education sessions, usually about eight weeks after certification. To encourage WIC

clients to attend nutrition education and for the convenience of clients, approximately

two-thirds of all local agencies schedule second nutrition education sessions to coincide

with voucher or check issuance. Agencies co-located with or providing health services

at WIC clinics may offer nutrition education at scheduled health-care appointments.

Approximately 15 to 20 percent of local WIC agencies schedule some nutrition

education to coincide with health-care appointments. Just under half of local WIC

agencies reported scheduling some separate appointments for nutrition education.

The use and importance of the food guide pyramid, the importance of healthy foods,

and the use of WIC foods in providing a healthy diet form the basis for most nutrition

education for all types of participants (Exhibit 6.2). Nutrition education sessions in

approximately 80 to 85 percent of all local agencies cover each of these topics.

Sessions aimed at postpartum women and infants emphasize formula preparation (60

percent) while education directed to children, or their caregivers, and postpartum

women stresses strategies to prevent or manage overweight problems (70 percent). 

The great majority of sessions involve discussion, counseling, and the use of written

materials, including handouts and pamphlets (Exhibit 6.3). These methods are always

used in nutrition education sessions conducted by 80 to 90 percent of local agencies.

Local agencies less frequently report using videos or slides, food demonstrations, and

food models to convey nutrition education. Computer-assisted instruction is rarely

used. 

In most agencies, nutrition education is offered only by nutritionists. Paraprofessionals

may take part in sessions offered to high-risk participants in only 17 to 18 percent of
Chapter Six: PC9

Exhibit 6.1Scheduled Nutrition Education Contacts in Local WIC Agencies By Participant Category

Participant Categorya

Pregnant Women Women Women Infants 

Breastfeeding Postpartum

Percent Percent Percent Percent of Local Percent of of Local Percent of of Local Percent of of Local Percent of Agencies Participants Agencies Participants Agencies Participants Agencies Participants 

Scheduled during

Certification 96.8% 95.8% 96.5% 95.7% 96.4% 95.7% 96.5% 95.7% 

(0.00) (0.00) (0.00) (0.00) (0.00) (0.00) (0.00) (0.00) 

Food benefit issuance 65.8 73.9 64.0 73.2 63.9 72.7 64.7 73.5 

(2.50) (4.32) (2.50) (4.35) (2.56) (4.38) (2.56) (4.33) 

Appointments or nutrition 44.7 35.6 46.4 37.3 44.2 35.4 46.3 36.6 education only (2.69) (4.40) (2.66) (4.38) (2.72) (4.39) (2.76) (4.46) Other health care 20.2 14.4 15.9 10.6 14.5 11.4 19.0 12.7 appointments (2.07) (3.49) (1.86) (3.20) (1.85) (3.24) (1.95) (3.14) Other 10.3 9.0 9.8 9.3 9.5 7.9 9.9 9.3 

(1.64) (2.16) (1.61) (2.28) (1.61) (2.19) (1.63) (2.48) 

Not reported 0.2 1.6 0.5 1.7 0.5 1.7 0.5 1.7 

(0.25) (2.22) (0.37) (2.22) (0.37) (2.22) (0.37) (2.22) 

NotesStandard errors are in parentheses.A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe of 2,203 local agen8,932 service delivery sites, and the universe of 8,042,758 participants.

Columns do not sum to 100 percent because respondents were permitted multiple responses. a
Chapter Six: PC98 Nutrition Education 129

Exhibit 6.2

Topics Emphasized in Nutrition Education Sessions

Participant Category

Nutrition Education Topics Pregnant Breastfeeding Postpartum Infants Children

Women Women Women

Percent of Local Agenciesa

Food Guide Pyramid/Food groups 86.6% 84.5% 84.6% N/A 87.3% 

(1.90) (1.99) (2.02) (1.91)

Diet for pregnancy 87.6 N/A N/A N/A N/A

(1.73)

Importance of folic acid 81.0 44.7 47.6 N/A 14.9 

(1.99) (2.62) (2.65) (2.01)

Dangers of using tobacco, alcohol, 89.3 78.0 65.5 41.7 39.7 

and/or other drugs (1.55) (2.14) (2.50) (2.66) (2.64)

Breastfeeding 96.6 87.4 34.3 47.0 N/A

(0.00) (1.71) (2.46) (2.73)

Formula preparation 32.7 19.0 62.5 65.4 N/A

(2.57) (2.20) (2.70) (2.45)

Nutritious foods for healthy mother 83.2 80.8 81.9 81.2 78.1

and baby or child (2.03) (2.17) (2.16) (2.18) (2.28) 

Using WIC foods for a healthy diet 82.9 80.2 79.5 73.7 86.2 

(2.17) (2.19) (2.27) (2.46) (1.99)

Thrifty food planning and/or 48.2 43.9 50.2 35.2 48.6 

shopping (2.64) (2.70) (2.64) (2.41) (2.63)

Strategies to prevent or manage 47.6 46.8 69.7 32.7 66.5

overweight (diet, exercise, for (2.70) (2.73) (2.42) (2.60) (2.55) 

example)

Healthy eating—taught directly to N/A N/A N/A N/A 37.8

preschoolers (2.51) 

Other topics directed specifically N/A N/A N/A N/A 16.5

to children (1.96) 

Not reported 0.3 2.1 1.0 3.0 1.3 

(0.33) (0.72) (0.54) (0.85) (0.62)

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe

of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

N/A indicates not applicable.

Columns do not sum to 100 percent because respondents were permitted multiple responses.
Chapter Six: PC98 Nutrition Education 130

Exhibit 6.3

Methods and Materials Used to Provide Nutrition Education

Methods and Materials Used. . .

Methods/Materials Always Sometimes Never Not Total

Reported

Percent of Local Agencies

Counseling/discussion 90.7% 8.6% 0.0% 0.7% 100.0%

(0.00) (1.46) (0.00) (0.54)

Written materials (pamphlets, handouts) 77.9 21.9 0.0 0.2 100.0%

(2.27) (2.27) (0.00) (0.21)

Bulletin board, flipcharts, posters 41.3 55.1 2.4 1.2 100.0%

(2.68) (2.74) (0.92) (0.63)

Food models 25.5 65.2 8.2 1.0 100.0%

(2.23) (2.50) (1.82) (0.55)

Facilitated learning 10.4 43.8 38.0 7.8 100.0%

(1.69) (2.62) (2.75) (1.56)

Videos/films/slides 7.4 84.7 6.5 1.4 100.0%

(1.38) (2.04) (1.48) (0.62)

Tests 4.1 41.1 51.6 3.3 100.0%

(1.06) (2.57) (2.65) (1.00)

Food demonstrations or tastings 1.9 60.7 34.0 3.4 100.0%

(0.65) (2.64) (2.65) (0.99)

Computer-assisted instruction 1.7 6.1 87.8 4.4 100.0%

(0.73) (1.43) (1.74) (1.01)

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe

of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.
Chapter Six: PC98 Nutrition Education 131

local agencies and to lower risk participants in 42 to 49 percent of agencies (Exhibit

6.4). Most (85 to 95 percent) nutrition education sessions, of all types, are less than

20 minutes long (Exhibit 6.5). The longest sessions (50 minutes or more) are more

likely to be group sessions.

Most (80 percent) local agencies respond to the increased needs of high-risk

participants by tailoring nutrition education services to meet their specific needs

(Exhibit 6.6). Nutrition education is generally delivered to these participants in

individual sessions—90 percent of local agencies provide some individual counseling

to high-risk participants. Approximately 60 percent provide only individual sessions

to high-risk participants; the other 30 percent provide both individual and group

sessions. Approximately half the local agencies offer high-risk participants more than

the two required nutrition education sessions. 

WIC service providers are encouraged to consider the ethnic and cultural differences

of participants. This mission includes offering nutrition education sessions in the

native languages of WIC participants. Nutrition education is available in a wide variety

of foreign languages (Exhibit 6.7). Half of all local agencies and almost half of all

service delivery sites offer sessions in Spanish. Offerings in other foreign languages

are less prevalent; no one foreign language is available in more than 5 percent of all

service delivery sites.

Breastfeeding Since 1989, with passage of the Child Nutrition and WIC Reauthorization Act (PL

101-147), breastfeeding promotion has been a particular area of emphasis for WIC.

The act earmarked a minimum of $8 million a year to be spent on breastfeeding

promotion, which has allowed State and local WIC agencies to develop a range of

strategies to increase breastfeeding incidence in WIC. Virtually all clinics offer group

sessions devoted to breastfeeding education (Exhibit 6.8). Clinics also organize

breastfeeding support groups (80 percent) to provide information and encouragement

to mothers. Approximately one-third of WIC clinics provide home or hospital visits

to breastfeeding mothers and half of all sites provide breast pumps to mothers who

request them.

PL 103-448, passed in 1994, required USDA to begin, in 1998, reporting to the

Congress on incidence and duration of breastfeeding among WIC participants. FNS,

in conjunction with the National Association of WIC Directors (NAWD) and the

Centers for Disease Control and Prevention (CDC), developed four new MDS items

to collect data on breastfeeding. These MDS items, collected for seven-to-elevenmonth-old infants, are: currently breastfed; ever breastfed; length of time breastfed;

and date breastfeeding data collected. In the past, most States did not routinely collect

data on breastfeeding. For PC96, States were asked to report this information only if

their management information systems contained the data. Beginning with PC98,

States were required to submit these data.

Exhibits 6.9 through 6.11 present the available data on breastfeeding. Not all States

were able to provide breastfeeding data, so estimates are based on a restricted sample

of States. The PC98 benchmark estimate of the national rate of breastfeeding initiation

is based on a sample of 63 States. We excluded the 25 State WIC agencies that
Chapter Six: PC9

Exhibit 6.4Nutrition Education in Local WIC Agencies By Participant Category

Participant Categorya

Pregnant Women Women Women Infants 

Breastfeeding Postpartum

Nutrition EducationProvided by

Percent Percent Percent Percent of Local Percent of of Local Percent of of Local Percent of of Local Percent of Agencies Participants Agencies Participants Agencies Participants Agencies Participants 

High-Risk Participants

Nutritionist 93.4% 96.7% 91.6% 95.6% 91.1% 95.2% 92.9% 96.8% 

(1.26) (0.66) (1.35) (0.66) (1.4) (0.95) (1.29) (0.65) 

Paraprofessional 16.7 18.0 16.9 19.8 17.4 20.0 17.7 20.2 

(1.85) (3.3) (2.42) (3.6) (2.29) (3.65) (2.27) (3.64) 

Not reported 1.4 0.3 2.9 1.4 3.2 1.9 2.2 0.4 

(2.33) (0.25) (1.34) (0.29) (1.30) (0.74) (1.59) (0.27) 

Non-High-Risk Participants

Nutritionist 83.6% 83.4% 82.5% 82.6% 80.4% 79.7% 82.2% 81.9% 

(1.96) (3.19) (1.96) (3.19) (1.99) (3.27) (1.91) (3.27) 

Paraprofessional 42.0 47.1 44.0 53.2 46.2 56.8 46.3 56.2 

(2.40) (4.29) (2.33) (4.28) (2.52) (4.12) (2.46) (4.20) 

Not reported 1.5 1.9 2.8 2.2 2.7 2.1 2.2 2.0 

(0.65) (2.23) (0.91) (2.24) (0.89) (2.23) (0.78) (2.23) 

NotesStandard errors are in parentheses.A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe of 2,203 local ageof 8,932 service delivery sites, and the universe of 8,042,758 participants.

Columns do not sum to 100 percent because respondents were permitted multiple responses. a
Chapter Six: PC98 Nutrition Education 133

Exhibit 6.5

Average Length of Nutrition Education Sessions

Type of Nutrition Education Session

 High-Risk Participants All Other Participants

Average Length (in minutes) Group Individual Group Individual

Percent of Local Agencies

Less than 10 14.8% 11.4% 18.1% 31.1% 

(2.04) (1.69) (2.22) (2.58)

10 - 19 19.9 47.5 28.8 52.9 

(2.06) (2.77) (2.51) (2.80)

20 - 29 14.2 25.4 21.2 9.6 

(1.82) (2.40) (2.16) (2.17)

30 - 39 3.9 9.7 5.1 3.3 

(0.98) (2.04) (1.28) (1.36)

40 - 49 2.7 3.9 2.1 0.6 

(1.43) (1.33) (0.79) (0.35)

50 and longer 3.3 1.9 3.1 0.6 

(2.87) (0.68) (3.04) (0.01)

Not reported 41.2 0.3 21.6 1.8 

(2.56) (0.24) (2.11) (0.70)

Total 100.0% 100.0% 100.0% 100.0%

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe

of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.
Chapter Six: PC9

Exhibit 6.6Special Nutrition Education Services Provided by Local WIC Agencies to High-Risk Participants by Partic

High-Risk Participant Categorya

Pregnant Women Women Women Infants 

Breastfeeding Postpartum

Percent Percent Percent Percent of Local Percent of of Local Percent of of Local Percent of of Local Percent of Agencies Participants Agencies Participants Agencies Participants Agencies Participants 

Type of service

Individual care plan 76.8% 82.6% 72.9% 78.0% 71.7% 76.5% 75.5% 80.8% 

(2.31) (3.99) (2.39) (4.30) (2.43) (4.37) (2.35) (4.32) 

More frequent sessions 51.1 56.3 46.5 52.4 41.3 45.9 50.2 53.6 

(2.66) (4.96) (2.60) (4.97) (2.59) (4.93) (2.56) (4.67) 

Individual counseling only 60.3 51.1 59.0 48.5 57.0 47.3 60.5 51.6 

(2.55) (4.37) (2.61) (4.38) (2.58) (4.34) (2.51) (4.31) 

Both individual counseling 34.3 46.8 33.1 46.8 32.3 45.2 32.8 45.6 and group sessions (2.49) (4.76) (2.46) (4.79) (2.51) (4.75) (2.55) (4.76) Other 2.8 4.0 2.9 5.5 2.5 3.4 2.8 3.4 

(0.90) (5.00) (0.91) (5.03) (0.86) (6.08) (0.88) (6.07) 

Not reported 1.0 2.4 2.4 3.5 3.8 5.0 1.3 2.3 

(0.58) (3.10) (0.82) (3.10) (1.03) (3.10) (0.63) (3.10) 

NotesStandard errors are in parentheses.A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe of 2,203 local agen8,932 service delivery sites, and the universe of 8,042,758 participants.

Columns do not sum to 100 percent because respondents were permitted multiple responses. a
Chapter Six: PC98 Nutrition Education 135

Exhibit 6.7

Availability of Nutrition Education in Foreign Languages at WIC Local Agencies and

Service Delivery Sites

Language Percent of Local Percent of Service

Agencies Delivery Sites a a

Spanish 50.0% 43.9% 

(2.66) (3.52)

Vietnamese 5.3 2.7 

(1.17) (0.88)

Cambodian/Khmer 1.8 0.9 

(1.39) (0.38)

Laotian 4.6 2.8 

(1.12) (0.99)

Thai 1.6 1.0 

(1.48) (0.61)

Hmong 3.8 2.1 

(1.02) (0.99)

Chinese 3.3 1.9 

(0.98) (0.86)

Haitian/Creole 2.7 1.4 

(1.07) (0.56)

French 5.7 3.6 

(0.99) (2.01)

Portuguese 1.7 0.9 

(1.29) (0.43)

Native American Language 3.9 2.6 

(1.31) (1.03)

Other 8.0 N/A

(1.61)

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe

of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

Columns do not sum to 100 percent because respondents were permitted multiple responses. a
Chapter Six: PC98 Nutrition Education 136

Exhibit 6.8

Breastfeeding Support and Promotion Services Provided at WIC Service Delivery Sites

Type of Service Percent of Service Percent of

Delivery Sites Participants a a

Group education sessions devoted solely to 97.4 98.4 

breastfeeding (0.00) (0.49)

Breastfeeding support groups 80.7 88.1 

(0.90) (1.31)

Provision of breast pumps 43.6% 66.3% 

(1.20) (2.22)

Individual counseling on breastfeeding 31.4 44.1 

(1.07) (2.48)

Home/hospital visit 30.9 39.1 

(1.11) (2.78)

Peer counseling for breastfeeding 16.7 32.4 

(0.91) (2.26)

Other 5.4 5.4 

(0.57) (1.03)

Not reported 0.6 0.3

(0.21) (0.18)

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the

universe of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

Columns do not sum to 100 percent because respondents were permitted multiple responses. a
Chapter Six: PC9

Exhibit 6.9Breastfeeding Rates for WIC Infants Aged Seven-to-Eleven Months in April 1998 by State

Ever or Currently Breastfed

WIC Infants in

Age Range Yes No 

Region and State Number Number Percent Number Percent N

Total for States reporting 740,985 307,834 41.5 392,346 52.9 

a

Northeast

Connecticut 5,720 2,339 40.9 3,342 58.4 Massachusetts 12,763 6,800 53.3 5,779 45.3 New Hampshire 2,054 768 37.4 1,015 49.4 New York 53,828 24,326 45.2 22,795 42.3 Rhode Island 2,474 765 30.9 1,691 68.4 Vermont 1,370 754 55.0 590 43.1 Pleasant Point (ME) 8 3 37.5 5 62.5 Seneca Nation (NY) 29 12 41.4 17 58.6 

Mid-Atlantic

Delaware 2,028 582 28.7 1,329 65.5 District of Columbia 2,141 844 39.4 1,018 47.5 Maryland 11,831 5,113 43.2 6,717 56.8 Pennsylvania 27,046 8,446 31.2 18,423 68.1 Puerto Rico b b b b b West Virginia 5,142 1,955 38.0 3,185 61.9 

Southeast

Florida 48,493 24,109 49.7 21,341 44.0 Georgia b b b b b North Carolina 23,723 10,004 42.2 13,548 57.1 Tennessee 19,867 4,349 21.9 15,233 76.7 Eastern Band— Cherokee (NC) 50 38 76.0 11 22.0 
Exhibit 6.9 (continued)

Breastfeeding Rates for WIC Infants Aged Seven-to-Eleven Months in April 1998 by State

Ever or Currently Breastfed

WIC Infants in

Age Range Yes No 

Region and State Number Number Percent Number Percent N

Chapter Six: PC9

Midwest

Illinois b b b b b Indiana 17,396 7,286 41.9 9,983 57.4 Michigan 27,149 10,169 37.5 14,037 51.7 Minnesota 10,181 4,280 42.0 5,826 57.2 Ohio 27,007 8,873 32.9 17,959 66.5 Wisconsin 11,165 3,508 31.4 7,521 67.4 

Southwest

Arkansas 10,442 3,504 33.6 6,298 60.3 Texas 90,839 41,494 45.7 49,063 54.0 ACL (NM) 45 22 48.9 23 51.1 Cherokee Nation (OK) 724 258 35.6 460 63.5 Chickasaw Nation (OK) b b b b b Choctaw Nation (OK) 200 18 9.0 182 91.0 Eight Northern Pueblos (NM) 31 8 25.8 20 64.5 Muscogee Creek Nation (OK) b b b b b Osage Nation (OK) 120 43 35.8 60 50.0 Otoe-Missouria (OK) b b b b b Pueblo of Isleta (NM) 60 27 45.0 29 48.3 Pueblo of San Filipe (NM) 35 20 57.1 15 42.9 Pueblo of Zuni (NM) 58 42 72.4 13 22.4 Sac and Fox Nation (OK) 29 8 27.6 18 62.1 Santo Domingo (NM) 17 4 23.5 12 70.6 
Exhibit 6.9 (continued)

Breastfeeding Rates for WIC Infants Aged Seven-to-Eleven Months in April 1998 by State

Ever or Currently Breastfed

WIC Infants in

Age Range Yes No 

Region and State Number Number Percent Number Percent N

Chapter Six: PC9

Mountain Plains

Colorado b b b b b Iowa 6,635 3,300 49.7 3,229 48.7 Kansas 5,933 3,272 55.1 2,602 43.9 Missouri 15,429 6,392 41.4 8,915 57.8 Montana b b b b b Nebraska 3,164 1,348 42.6 1,737 54.9 South Dakota 1,458 703 48.2 755 51.8 Utah 5,971 3,961 66.3 1,529 25.6 Wyoming b b b b b Shoshone-Arapahoe (WY) 98 59 60.2 25 25.5 Standing Rock Sioux (ND) b b b b b 
Exhibit 6.9 (continued)

Breastfeeding Rates for WIC Infants Aged Seven-to-Eleven Months in April 1998 by State

Ever or Currently Breastfed

WIC Infants in

Age Range Yes No 

Region and State Number Number Percent Number Percent N

Chapter Six: PC9

Western

Alaska 2,216 1,492 67.3 723 32.6 American Samoa b b b b b Arizona 15,688 9,278 59.1 6,116 39.0 Californiac 133,031 51,896 39.0 80,323 60.4 Guam 669 367 54.9 302 45.1 Hawaii 3,753 2,489 66.3 938 25.0 Nevada 4,814 2,618 54.4 2,150 44.7 Oregon b b b b b Washington 16,423 10,581 64.4 5,266 32.1 ITC—Arizona b b b b b ITC—Nevada 93 45 48.4 42 45.2 Navajo Nation (AZ) 1,371 1,066 77.8 305 22.2 

Notes

Includes those states reporting data on breastfeeding initiation for at least 75 percent of all seven-to-eleven-month-old infants. These national est

ainformation for 81 percent of all WIC infants aged seven-to-eleven-months.

State-reported data on at least 75 percent of all seven-to-eleven-month-old WIC infants and available data were used in establishing the PC98 na

binitiation rate. As originally agreed between FNS and the National Association of WIC Directors, a State-specific rate is not calculated if informatio85 percent of seven-to-eleven-month-old infants within any given State.

California’s breastfeeding initiation rate is a lower bound estimate, as previously footnoted. Upper bound estimate is 75 percent if missing data on 

cattributed positively for those not currently breastfed.
Chapter Six: PC9

Exhibit 6.10Median Breastfeeding Duration in Weeks for WIC Infants Aged Seven-to-Eleven Months in April 1998 by Stat

WIC Infants in Breastfed WIC Infants with M

Age Range Infants Breastfed Reported Breastfeeding Du

Duration W

Region and State Number Number Percent Number Percent

Total for States reporting 395,283 159,839 40.4 149,095 93.3 

a

Northeast

Connecticut b b b b b Massachusetts 12,763 6,800 53.3 6,452 94.9 New Hampshire b b b b b New York 53,828 24,326 45.2 24,310 99.9 Rhode Island b b b b b Vermont 1,370 754 55.0 733 97.2 

Mid-Atlantic

District of Columbia b b b b b Pennsylvania 27,046 8,446 31.2 7,807 92.4 West Virginia b b b b b 

Southeast

Florida 48,493 24,109 49.7 22,498 93.3 Georgia b b b b b North Carolina 23,723 10,004 42.2 9,981 99.8 Tennessee 19,867 4,349 21.9 3,863 88.8 Eastern Band—Cherokee (NC) 50 38 76.0 38 100.0 
Exhibit 6.10 (continued)

Median Breastfeeding Duration in Weeks for WIC Infants Aged Seven-to-Eleven Months in April 1996 by Stat

WIC Infants in Breastfed WIC Infants with M

Age Range Infants Breastfed Reported Breastfeeding Du

Duration W

Region and State Number Number Percent Number Percent

Chapter Six: PC9

Midwest

Illinois 35,950 10,371 28.8 10,102 97.4 Indiana 17,396 7,286 41.9 6,500 89.2 Michigan 27,149 10,169 37.5 10,156 99.9 Ohio 27,007 8,873 32.9 7,910 89.1 

Southwest

Arkansas b b b b b ACL (NM) 45 22 48.9 19 86.4 Chickasaw Nation (OK) 304 94 30.9 94 100.0 Muscogee Creek Nation (OK) 109 21 19.3 21 100.0 Osage Nation (OK) 120 43 35.8 40 93.0 Pueblo of Isleta (NM) 60 27 45.0 24 88.9 Pueblo of Zuni (NM) 58 42 72.4 40 95.2 Sac and Fox Nation (OK) 29 8 27.6 8 100.0 

Mountain Plains

Kansas b b b b b Nebraska b b b b b South Dakota 1,458 703 48.2 632 89.9 Utah 5,971 3,961 66.3 3,423 86.4 Shoshone-Arapahoe (WY) 98 59 60.2 57 96.6 Standing Rock Sioux (ND) 61 28 45.9 27 96.4 
Exhibit 6.10 (continued)

Median Breastfeeding Duration in Weeks for WIC Infants Aged Seven-to-Eleven Months in April 1996 by Stat

WIC Infants in Breastfed WIC Infants with M

Age Range Infants Breastfed Reported Breastfeeding Du

Duration W

Region and State Number Number Percent Number Percent

Chapter Six: PC9

Western

Alaska 2,216 1,492 67.3 1,451 97.3 American Samoa 545 422 77.4 394 93.4 Arizona 15,688 9,278 59.1 9,068 97.7 Guam 669 367 54.9 366 99.7 Nevada 4,814 2,618 54.4 2,573 98.3 ITC—Arizona 869 446 51.3 445 99.8 ITC—Nevada 93 45 48.4 45 100.0 Navajo Nation (AZ) 1,371 1,066 77.8 1,066 100.0 

Notes

Includes the forty States reporting data on breastfeeding initiation for at least 75 percent of all seven-to-eleven-month-old infants and duration data for 

ainfants. Since infants in these States comprise only 46 percent of all infants aged seven-to-eleven-months, duration estimates do not constitute a natio

As originally agreed between FNS and the National Association of WIC Directors, a State-specific rate is not calculated if information was available for 

beleven-month-old infants within any given State.
Chapter Six: PC9

Exhibit 6.11Estimated Breastfeeding Duration by StateNumber and Percent of WIC Infants Aged Seven-to-Eleven Months in April 1998 Breastfeeding for Six Mo

Infants Reporting Six or More Month

WIC Infants in

Age Range Lower Bound Estimate Uppe

Region and State Number Number Percent Number 

Total for States reporting 395,283 57,121 14.5 102,19

a

Northeast

Connecticut b b b Massachusetts 12,763 2,663 20.9 3,30New Hampshire b b b New York 53,828 11,135 20.7 19,15Rhode Island b b b Vermont 1,370 295 21.5 36

Mid-Atlantic

District of Columbia b b b Pennsylvania 27,046 3,064 11.3 3,88West Virginia b b b 

Southeast

Florida 48,493 8,390 17.3 13,25Georgia b b b 

North Carolina 23,723 2,232 9.4 3,74Tennessee 19,867 3,066 15.4 3,98Eastern Band—Cherokee (NC) 50 15 30.0 1
Exhibit 6.11 (continued)

Estimated Breastfeeding Duration by StateNumber and Percent of WIC Infants Aged Seven-to-Eleven Months in April 1998 Breastfeeding for Six Mo

Infants Reporting Six or More Month

WIC Infants in

Age Range Lower Bound Estimate Uppe

Region and State Number Number Percent Number 

Chapter Six: PC9

Midwest

Illinois 35,950 4,259 11.8 12,14Indiana 17,396 1,351 7.8 2,34Michigan 27,149 3,355 12.4 6,31Ohio 27,007 2,788 10.3 4,29

Southwest

Arkansas b b b ACL (NM) 45 7 15.6 1Chickasaw Nation (OK) 304 25 8.2 9Muscogee Creek Nation (OK) 109 4 3.7 2Osage Nation (OK) 120 22 18.3 4Pueblo of Isleta (NM) 60 14 23.3 2Pueblo of Zuni (NM) 58 30 51.7 3Sac and Fox Nation (OK) 29 2 6.9 

Mountain Plains

Kansas b b b Nebraska b b b South Dakota 1,458 203 13.9 29Utah 5,971 1,846 30.9 2,89Shoshone-Arapahoe (WY) 98 31 31.6 4Standing Rock Sioux (ND) 61 11 18.0 2
Exhibit 6.11 (continued)

Estimated Breastfeeding Duration by StateNumber and Percent of WIC Infants Aged Seven-to-Eleven Months in April 1998 Breastfeeding for Six Mo

Infants Reporting Six or More Month

WIC Infants in

Age Range Lower Bound Estimate Uppe

Region and State Number Number Percent Number 

Chapter Six: PC9

Western

Alaska 2,216 1,058 47.7 1,11American Samoa 545 389 71.4 53Arizona 15,688 3,912 24.9 4,82Guam 669 65 9.7 6Nevada 4,814 1,266 26.3 1,37ITC—Arizona 869 187 21.5 37ITC—Nevada 93 26 28.0 3Navajo Nation (AZ) 1,371 551 40.2 55

Notes

Includes the forty States reporting data on breastfeeding initiation for at least 75 percent of all seven-to-eleven-month-old infants and duration dat

abreastfed infants. Since infants in these States comprise only 46 percent of all infants aged seven-to-eleven-months, duration estimates do not co

As originally agreed between FNS and the National Association of WIC Directors, a State-specific rate is not calculated if information was availab

bseven-to-eleven-month-old infants within any given State.
 We have excluded these States and ITOs from our benchmark estimate of the national rate to avoid 1

the possibility of bias from incomplete information. The excluded States are: Alabama, Idaho, Kentucky,

Louisiana, Maine, Mississippi, New Jersey, New Mexico, North Dakota, Oklahoma, South Carolina, and

Virginia. The ITOs excluded are: Citizen-Potawatomi Cheyenne River Sioux, Five Sandoval, ITCOklahoma, Indian Township, Mississippi Choctaw, Omaha Santee, Rosebud Sioux, Three Affiliated, Ute

Mountain Ute, WOD and Winnebago. The Virgin Islands was also excluded. Six of the states reported

no information, and an additional two states reported information on 1 percent or less of infants. The

remainder reported information on 14 to 74 percent of infants. 

California has been included in the analysis despite some ambiguities in the data. While current

breastfeeding status is reported on virtually all seven-to-eleven-month-olds, information on initiation is

missing for nearly half those not currently breastfeeding. We have assumed that none of these infants were

breastfed, and so California’s breastfeeding rate shown in Exhibit 6.9 is a lower bound estimate.

 Breastfeeding duration was counted as missing for: 1) currently breastfed infants for whom the date 2

breastfeeding data was collected was not reported; 2) currently breastfed infants less than 22 weeks old

when data were collected; and 3) ever breastfed infants for whom duration was not reported. 

Chapter Six: PC98 Nutrition Education 147

reported information on less than 75 percent of infants aged seven to eleven months.1

WIC enrollees in reporting States and ITOs comprise 85 percent of infants aged seven

to eleven months, and data are available on 95 percent of these infants. Our benchmark

estimate is based on 81 percent of all WIC infants aged seven to eleven months.

In those States reporting breastfeeding data, 42 percent of all seven- to-eleven-monthold infants are currently breastfed or were breastfed at some time. Substantial variation

exists among States: some report more than 70 percent of infants are breastfed; in

other States less than 25 percent of infants are ever breastfed.

States were asked to provide information on the length of time infants were breastfed.

Many States could not provide these data so that estimates of breastfeeding duration

are based on a substantially restricted sample of States and not a national estimate.

Only the forty State agencies that were able to provide duration data for at least 75

percent of infants for whom breastfeeding was reportedly initiated are included in

Exhibits 6.10 and 6.11. The breastfeeding duration data are “right censored”, that is, 2

we do not know the full duration for infants who were currently breastfeeding when

their data were collected. Therefore calculating an arithmetic mean of reported duration

for both current and ever-breastfed infants would underestimate the duration for those

currently breastfed. Instead, information on duration is summarized in three statistics

which are practically unaffected by this limitation. First, the median duration is

calculated by State and for all included States combined. Nearly all WIC infants with

duration data reside in States in which at least half of ever-breastfed infants had

stopped breastfeeding by the time the data were collected. Median duration in most of

these States is therefore twenty-six weeks or less. (The exceptions are a few ITOs.)

Second, the mean duration during the first six months is calculated--a value that is

known for all infants whose data were collected at age six months or later, regardless

of current breastfeeding status. Finally, the percent who breastfed six months or more

is examined. This measure is of special interest because of the health benefits that

accrue to infants who are breastfed for at least six months.

Across the forty States reporting data, fourteen is the median number of weeks infants

were breastfed. Again, substantial variation exists among States. In some States, the

median was less than four weeks. Other agencies, notably two ITOs, report median

breastfeeding duration exceeded 26 weeks.
 Only States reporting data for at least 75 percent of seven-to-eleven month old infants are included in 3

the upper and lower bound estimates. The range between the upper and lower bounds reflects missing data

on breastfeeding initiation and duration. The upper bound also counts currently breastfeeding infants who

were between five and six months old when data were collected, as having been breastfed for six months.

 Food and Nutrition Service. 1993 Estimates of Persons Income Eligible for the Special Supplemental 4

Food Program for Women, Infants, and Children (WIC) in 1989. Alexandria, Virginia: USDA. Analyses

used data from the 1988 National Maternal and Infant Health Survey.

Chapter Six: PC98 Nutrition Education 148

Exhibit 6.11 attempts to deal with the missing data on initiation and duration of

breastfeeding by estimating lower and upper bounds for the percentage of infants

breastfed for six or more months. The lower bound estimate counts only those infants

who reported six or more months of breastfeeding. Breastfed infants for whom no

initiation and duration information are reported are assumed to have been breastfed for

less than six months. The upper bound estimates includes infants known to have been

breastfed for at least six months as well as infants for whom initiation and duration of

breastfeeding are not known. Across the forty State WIC agencies reporting

3

breastfeeding data, the proportion of infants breastfed for six or more months ranges

from a lower bound estimate of 14.5 percent to an upper bound estimate of 25.9

percent. This range is consistent with other findings about breastfeeding in the poverty

population. In 1993, USDA estimated that 14 percent of women below 185 percent

of poverty breastfed their infants for six or more months.4
Chapter Seven: PC98 Priority Levels 149

7. PRIORITY LEVELS

As described in Chapter One of this report, the WIC Program must operate within

annual funding levels established by the Congress. The number of participants served

by the program depends on the total funds available as well as on the allocation of these

funds by FNS to individual States. For each local agency, a maximum caseload is

determined based on the agency's funding level and predicted caseload turnover. When

a local WIC agency reaches this maximum participation level within available funding,

a system of priorities is followed in allocating caseload "slots" to eligible applicants.

Some agencies maintain waiting lists of eligible applicants and, as WIC openings

become available, fill them from their waiting lists.

Federal regulations define seven levels of priority for service provision in local

agencies. These levels are based on applicant categories and type of nutritional risk.

(See Exhibit 7.1.) In general, precedence is given to medically based nutritional risks

over risks based only on inadequate diet. Further, higher priority levels are assigned

to infants, pregnant women, and breastfeeding women. State agencies may create subpriorities and may expand priority levels III, IV, or V to include high-risk postpartum

women. 

Priority level distribution by participant category is presented in Exhibit 7.2, and

priority level distributions by age for infants and children appear in Exhibits 7.3 and

7.4.

States reported priority levels for 99 percent of WIC participants in 1998, 1996 and

1994, as compared with 1992 when priority was reported for 93.6 percent of WIC

participants. Between 1994 and 1998, there are virtually no changes in the proportions

of WIC women and infants assigned to priority levels I and II. In 1998, 63.6 percent

of children were assigned to priority level III (the highest child priority) as compared

with 65.7 percent in 1996—a 2 percentage point decrease. This decrease continues a

trend that began in 1994, when 68.2 percent of children were assigned to priority level

III. It may be that as enrollment has increased, WIC has been able to serve more lower

priority children. Concurrently, in 1998, priority level V shows a continued

increase—moving from 28.9 percent in 1994 to 32.8 percent in 1996 and 34.8 percent

in 1998. Priority level VII continues to have less than 1 percent of WIC child enrollees.
Chapter Seven: PC98 Priority Levels 150

Exhibit 7.1

WIC Priorities 

Priority Description

I Pregnant and breastfeeding women and infants at nutritional risk as

demonstrated by anthropometric or hematological assessment or by other

documented nutritionally-related medical condition.

II Infants up to six months of age of mothers who participated in WIC during

pregnancy, or who would have been eligible to participate under Priority I

documented medical condition. This priority may also be assigned to a

breastfeeding mother of an infant who is classified as Priority II.

III Children at nutritional risk as demonstrated by anthropometric or

hematological assessment or other documented medical condition. At State

option, this priority can also include high-risk postpartum women.

IV Pregnant and breastfeeding women and infants at nutritional risk as

demonstrated by inadequate dietary pattern. At State option, this priority can

also include homeless and migrant pregnant and breastfeeding women and

infants and high-risk postpartum women.

V Children at nutritional risk due to inadequate dietary pattern. At State option,

this priority can also include homeless and migrant children and high-risk

postpartum women.

VI Postpartum women, not breastfeeding, at nutritional risk on either medical or

dietary criteria—unless assigned to higher priorities at State discretion. At

State option, this priority can also include homeless and migrant postpartum

women.

VII Previously certified participants likely to regress in nutritional status without

continuation of supplemental foods. At State option, this priority can also

include homeless and migrant participants.
Chapter Seven: Priority Levels 151

Exhibit 7.2

Priority of All WIC Participants by Participant Category

Pregnant Women Breastfeeding Women Postpartum Women Total Women Infants Children Total WIC a

Priority Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Percent by participant category

I

b 824,109 92.3% 350,180 89.9% 4,615 0.8% 1,178,904 62.9% 1,007,476 49.2% 17,265 0.4% 2,203,645 27.4%

II 133 0.0 10,775 2.8 255 0.0 11,163 0.6 932,905 45.5 11,753 0.3 955,821 11.9

III 99 0.0 348 0.1 242,976 41.1 243,423 13.0 12,558 0.6 2,621,653 63.6 2,877,634 35.8

IV 64,585 7.2 25,591 6.6 51,012 8.6 141,188 7.5 74,301 3.6 3,410 0.1 218,899 2.7

V 167 0.0 54 0.0 16,634 2.8 16,855 0.9 3,532 0.2 1,425,315 34.6 1,445,702 18.0

VI 502 0.1 958 0.2 269,622 45.6 271,082 14.5 105 0.0 367 0.0 271,554 3.4

VII 1,628 0.2 672 0.2 2,033 0.3 4,333 0.2 3,707 0.2 21,717 0.5 29,757 0.4

No priority 1,451 0.2 814 0.2 3,903 0.7 6,168 0.3 14,041 0.7 19,537 0.5 39,745 0.5

reported

US WIC 892,674 100.0% 389,391 100.0% 591,050 100.0% 1,873,116 100.0% 2,048,626 100.0% 4,121,017 100.0% 8,042,758 100.0%

Notes

About 3.2 percent of one-year-old children are eleven-month-old infants who have been recertified as children. About 0.1 percent of WIC participants who are classified as infants are participants who are older than 366 days.

An infant is defined as a participant who, at certification, is under one year of age and who would be classified as a child at the age of 366 days. a

A small proportion of postpartum women and children may not have had their State-level records or priorities updated on State-maintained management information systems when they were certified for WIC benefits in different b

certification categories.
Chapter Seven: Priority Levels 152

Exhibit 7.3

Priority of Infant WIC Participants by Age at Certification

Age at Certificationa

0 - 3 Months 4 - 5 Months 6 - 8 Months 9 - 11 Months Age Not Reported Total Infants

Priority Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Percent by age group

I 858,709 47.4% 32,500 59.4% 87,375 68.0% 26,356 53.4% 2,537 52.6% 1,007,476 49.2%

II 894,416 49.4 15,890 29.0 18,818 14.7 1,997 4.0 1,784 37.0 932,905 45.5

III 4,274 0.2 168 0.3 235 0.2 7,833 15.9 48 1.0 12,558 0.6 b

IV 38,854 2.1 5,404 9.9 21,045 16.4 8,776 17.8 222 4.6 74,301 3.6

V 1,002 0.1 65 0.1 61 0.0 2,361 4.8 43 0.9 3,532 0.2 b

VI 58 0.0 6 0.0 15 0.0 19 0.0 7 0.1 105 0.0

VII 3,253 0.2 75 0.1 166 0.1 180 0.4 33 0.7 3,707 0.2

No priority reported 10,721 0.6 630 1.2 730 0.6 1,815 3.7 146 3.0 14,041 0.7

Infants in age group 1,811,288 100.0% 54,738 100.0% 128,445 100.0% 49,336 100.0% 4,819 100.0% 2,048,626 100.0%

Notes

An infant is defined as a participant who, at certification, is under one year of age and who would be classified as a child at the age of 366 days.

About 0.1 percent of WIC participants who are classified as infants are participants who are older than 366 days. a

Apparent inconsistencies between priorities III and V and certification as an infant may be largely due to States unable to provide historical data on priorities for some infants. b
Chapter Seven: Priority Levels 153

Exhibit 7.4

Priority of Child WIC Participants by Age at Certification

Age at Certification

1 Year 2 Years 3 Years 4 Years Age Not Reported Total Children a

Priority Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Percent by age group

I

b 15,826 1.1% 200 0.0% 160 0.0% 109 0.0% 970 3.1% 17,265 0.4%

II 10,958 0.7 75 0.0 70 0.0 40 0.0 610 2.0 11,753 0.3 b

III 972,291 66.2 679,961 65.7 554,930 60.5 401,121 60.0 13,351 42.7 2,621,653 63.6

IV 3,153 0.2 91 0.0 91 0.0 64 0.0 11 0.0 3,410 0.1

V 443,649 30.2 347,001 33.5 356,107 38.8 262,522 39.2 16,036 51.3 1,425,315 34.6

VI 105 0.0 83 0.0 89 0.0 75 0.0 15 0.0 367 0.0

VII 6,447 0.4 5,665 0.5 5,207 0.6 4,329 0.6 69 0.2 21,717 0.5

No priority reported 16,150 1.1 1,356 0.1 1,105 0.1 712 0.1 213 0.7 19,537 0.5

Children in age group 1,468,580 100.0% 1,034,432 100.0% 917,758 100.0% 668,972 100.0% 31,275 100.0% 4,121,017 100.0%

Notes

About 3.2 percent of one-year-old children are eleven-month-old infants who have been recertified as children. a

Apparent inconsistencies between priorities I and II and certification as a child may be largely due to State-level automated procedures which routinely reassign infants as children at the age of 366 days without revising b

assigned priorities.
%JCRVGT 'KIJV %JCTCEVGTKUVKEU QH 2% /KITCPV 9+% 2CTVKEKRCPVU 

8. CHARACTERISTICS OF MIGRANT WIC PARTICIPANTS

Federal regulations define a migrant farmworker as an individual whose principal

employment is in agriculture on a seasonal basis, who has been so employed within

the last twenty-four months, and who establishes, for the purposes of such

employment, a temporary abode. As part of the Minimum Data Set, States report

migrant status for all individuals enrolled in the WIC Program.

In April 1998, State WIC agencies recorded on their enrollment files 53,158

individuals who are members of migrant farmworker families. This group accounts

for less than 1 percent of the eight million Americans receiving WIC benefits—about

the same proportion as reported in 1992, 1994, and 1996. Migrant participation in

the WIC Program tends to be concentrated in a small number of States. In fact, more

than half (59 percent) of migrant WIC enrollees in April 1998 were enrolled in WIC

in California, Florida, and Texas. This distribution is similar to information reported

in 1996. See Exhibit 8.1. State-by-State tables appear in Appendix E.

In actual numbers, there was a steady increase between 1992 and 1996 in the number

of migrant WIC enrollees. However, between 1996 and 1998 actual migrant

farmworker WIC enrollment decreased by approximately 6,500 enrollees (11

percent). The decrease was concentrated in Florida, Illinois, Oregon, South Carolina,

and Washington. 

Most States provided information on migrant farmworker status for the individuals

enrolled in their WIC programs. Less than 1 percent of the total number of

individuals enrolled in WIC in April 1998 lack information on migrant farmworker

status. Given these numbers, it seems reasonable to assume that the information in

this chapter is representative of migrant WIC participants.

Exhibits 8.2 through 8.11 present information on the characteristics of migrant WIC

enrollees. Similar to information reported in earlier chapters on total WIC

enrollment, enrollment of pregnant migrant WIC women, as a percent of all migrant

WIC, is about the same in 1998 as it was in both 1994 and 1996—12 percent. WIC

enrollment of breastfeeding migrant women, as a percent of all migrant WIC women,

continued to increase from 1994 to 1996, by 2 percentage points, and from 1996 to

1998 by 5 percentage points. Similar to the national trend, the proportion of migrant

infant enrollees declined and the proportion of migrant WIC children increased

between 1992 and 1998. For migrants, most of the change occurred between 1992

and 1994; the proportions of migrant infants and children have been stable since

1994.

In general, migrant women WIC enrollees appear to be slightly older than the general

WIC population. As with total enrollment, a high proportion of migrant infants (86.6

percent) enrolled in WIC at zero to three months of age in 1998. The percentage of

infants in WIC who enrolled at age zero-to-three-months has increased steadily since

1992 for both migrant and non-migrant infants. 
%JCRVGT 'KIJV %JCTCEVGTKUVKEU QH 

Exhibit 8.1Distribution of Migrant Farmworker WIC Participants by StateApril 1998
%JCRVGT 'KIJV %JCTCEVGTKUVKEU QH 2% /KITCPV 9+% 2CTVKEKRCPVU 

Exhibit 8.2

Distribution of Migrant Farmworker WIC Participants by WIC Participant Category and Age at

Certification

Participant Category and Migrant Status Total WIC

Age at Certification Migrant Non-Migrant Not Reported Participants

Percent by participant category

Pregnant women 6,242 883,499 2,934 892,674

Under 15 years 0.7% 0.8% 0.7% 0.8%

15 - 17 years 8.7 10.2 10.6 10.1

18 - 34 years 83.9 83.1 81.6 83.1

35 or more years 6.5 5.7 6.7 5.8

Age not reported 0.2 0.2 0.4 0.2

Breastfeeding women 3,545 384,500 1,346 389,391

Under 15 years 0.2% 0.2% 0.0% 0.2%

15 - 17 years 3.5 4.1 4.7 4.1

18 - 34 years 86.4 84.6 85.2 84.6

35 or more years 9.7 10.7 10.0 10.7

Age not reported 0.2 0.5 0.1 0.5

Postpartum women 3,059 585,636 2,355 591,050

Under 15 years 0.5% 0.5% 1.0% 0.5%

15 - 17 years 7.5 8.9 9.0 8.9

18 - 34 years 83.8 83.9 81.6 83.9

35 or more years 7.7 6.0 8.2 6.0

Age not reported 0.6 0.6 0.1 0.6

Total women 12,846 1,853,635 6,635 1,873,116

Under 15 years 0.5% 0.6% 0.7% 0.6%

15 - 17 years 7.0 8.5 8.8 8.5

18 - 34 years 84.5 83.7 82.4 83.7

35 or more years 7.7 6.9 7.9 6.9

Age not reported 0.3 0.4 0.2 0.4

Infantsa 10,147 2,030,222 8,257 2,048,626

0 - 3 months 86.6% 88.5% 79.3% 88.4%

4 - 5 months 4.1 2.6 9.9 2.7

6 - 8 months 6.2 6.3 8.5 6.3

9 - 12 months 2.8 2.4 2.1 2.4

Age not reported 0.2 0.2 0.2 0.2

Children 30,166 4,080,320 10,530 4,121,017

1 year 29.6% 35.7% 36.6% 35.6%

2 years 24.9 25.1 25.8 25.1

3 years 24.9 22.2 23.3 22.3

4 years 20.5 16.2 14.0 16.2

Age not reported 0.1 0.8 0.3 0.8

US WIC 53,158 7,964,177 25,422 8,042,758

Note

An infant is defined as a participant who, at certification, is under one year of age and who would be classified as a child at the age of a

366 days.
The poverty distribution among migrants must be treated somewhat cautiously in 1

PC98 because of problems with missing income data in Texas. Data are missing for

approximately 78 percent of migrant WIC participants in the State and almost 17 percent of

all WIC migrants are enrolled in Texas.

%JCRVGT 'KIJV %JCTCEVGTKUVKEU QH 2% /KITCPV 9+% 2CTVKEKRCPVU 

The distribution of trimester of enrollment for migrant women is also similar to the

distribution for the larger WIC population. Close to half (46.9 percent) of migrant

prenatal clients enroll in WIC during the first trimester; another 38.8 percent enroll

during the second trimester (Exhibit 8.3). 

Overall, migrant WIC enrollees display a similar level of participation in other social

support programs as is observed in US WIC. However, migrant WIC enrollees are

somewhat more likely to receive food stamps and less likely to receive TANF than

the general WIC population. The percentage (41.6 percent) of migrant WIC

enrollees reporting no other program participation is only slightly higher than the

percentage (38.3 percent) found in US WIC. 

The migrant WIC population also has lower average family income; however, the gap

has become progressively smaller since 1994. Average (mean) income is 6 percent

higher in the non-migrant WIC population than in the migrant WIC population. In

1996, average income for non-migrant WIC was 12 percent higher than average

migrant income; in 1994 the comparable figure was 20 percent. Between 1994 and

1998, average migrant income increased by 47 percent while average income for

non-migrant WIC increased by only 29 percent. Nonetheless, 63 percent of migrant

WIC enrollees are at or below 100 percent of the US poverty threshold while 57

percent of non-migrant WIC enrollees fall into this category.1

The distribution of nutritional risks for migrant WIC resembles the distribution

reported for US WIC with two exceptions—anemia is more frequently reported for

migrant WIC women and substance abuse is less frequently reported for migrant

WIC women. Migrant children also show somewhat higher rates of anemia, but the

distribution for anthropometric measures among migrant children is similar to the

distribution reported for children in the larger WIC population.

The priority distribution for migrant WIC is similar to the distribution reported for

US WIC. However, infant, child, and postpartum migrant WIC participants are

somewhat more likely to have higher (medically based) priorities than the overall

population. In contrast, pregnant and breastfeeding migrants are more likely to be

assigned dietary-based priorities than are members of the general WIC population.
%JCRVGT 'KIJV %JCTCEVGTKUVKEU QH 2% /KITCPV 9+% 2CTVKEKRCPVU 

Exhibit 8.3

Distribution of Migrant Pregnant Women WIC Participants by Trimester of Enrollment

Trimester of Enrollment Number Percent

First trimester 2,927 46.9%

Second trimester 2,424 38.8

Third trimester 713 11.4

Trimester not reported 176 2.8

Total migrant pregnant women 6,242 100.0%
13.5%

17.0%

31.5%

26.6%

48.4% 48.3%

0%

10%

20%

30%

40%

50%

60%

Percent of WIC Participants

TANF Food Stamp Medicaid

Migrant US

%JCRVGT 'KIJV %JCTCEVGTKUVKEU QH 2% /KITCPV 9+% 2CTVKEKRCPVU 

Exhibit 8.4

Number and Percent of Migrant WIC Participants with Reported Participation in Other

Programs at Certification

Migrant WIC participants reported receiving Percent of All

benefits from ... Number Migrant WIC

Temporary Assistance to Needy Families (TANF), 6,333 11.9%

Food Stamp, and Medicaid Programs

TANF and Food Stamp Programs 232 0.4

TANF and Medicaid Programs 474 0.9

Food Stamp and Medicaid Programs 7,924 14.9

TANF only 119 0.2

Food Stamp Program only 2,256 4.2

Medicaid Program only 11,003 20.7

Do not participate in other programs 22,111 41.6

Not reported 2,707 5.1

US Migrant WIC 53,158 100.0%

Notes

Not reported indicates the number and percentage of participants for whom no data regarding participation in Medicaid,

TANF, and Food Stamps are reported.
%JCRVGT 'KIJV %JCTCEVGTKUVKEU QH 

Exhibit 8.5Mean and Median Annualized Family or Economic Unit Income of WIC Participants by Participant Category and 

Pregnant Breastfeeding Postpartum

Women Women Women Total Women Infants 

Migrant Farmworkers 6,242 3,545 3,059 12,846 10,147 

Average (mean) income $11,645 $11,913 $11,135 $11,607 $11,374 Median income $10,572 $11,052 $10,400 $10,572 $10,400 Percent with income reported 78.9% 81.6% 74.5% 78.6% 71.1% Percent with income reported as zero 3.5 2.6 3.0 3.2 5.2 

a

Percent with income not reported 17.5 15.8 22.5 18.2 23.7 

b

Non-migrants 883,499 384,500 585,636 1,853,635 2,030,222 

Average (mean) income $12,019 $13,631 $11,546 $12,216 $12,018 Median income $11,076 $12,996 $10,400 $11,400 $10,948 Percent with income reported 82.0% 83.9% 79.7% 81.7% 78.4% Percent with income reported as zero 4.2 2.9 2.8 3.5 4.2 

a

Percent with income not reported 13.8 13.2 17.5 14.8 17.4 

b

Migrant status not reported 2,934 1,346 2,355 6,635 8,257 

Average (mean) income $10,370 $11,049 $8,420 $9,836 $8,989 Median income $8,320 $9,620 $5,400 $7,524 $6,214 Percent with income reported 71.0% 77.5% 71.3% 72.4% 54.9% Percent with income reported as zero 2.1 1.9 1.5 1.8 1.3 

a

Percent with income not reported 26.9 20.6 27.2 25.7 43.8 

b

US WIC 892,674 389,391 591,050 1,873,116 2,048,626 

NotesState and local WIC agencies may collect data on weekly, monthly, or annual incomes. For reporting and analysis, annualized incomes have been computed.Also note that income calculations include only those participants for whom State agencies reported data on income, income period, and size of economic unit.In 1998, a State WIC agency could report actual income or could report an income range. Both types of data are included in the calculations of mean and median incomes.

Zero incomes are reported separately and excluded from these mean and median calculations. In some reporting agencies, zero may be used to indicate missing information 

a

distinguish between households with missing income information and households reporting zero income.Not reported indicates the percentage of participants by participant category for whom no data on income, income period, or size of economic unit are reported. b
%JCRVGT 'KIJV %JCTCEVGTKUVKEU QH 

Exhibit 8.6Distribution of Percent of Poverty Level of WIC Participants by Participant Category and Migrant Status

Percent of Poverty Pregnant Breastfeeding Postpartum Total Level Women Women Women Women Infants Ch

Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent 

Cumulative Cumulative Cumulative Cumulative Cumulative 

Percent of total women Percent by pa

Migranta0 - 50 24.2% 24.2% 25.7% 25.7% 26.9% 26.9% 25.3% 25.3% 25.9% 25.9% 28.0% 51 - 100 34.5 58.7 40.5 66.2 34.0 60.8 36.0 61.3 31.4 57.3 37.2 101 - 130 10.4 69.1 9.3 75.6 7.6 68.4 9.4 70.7 7.8 65.1 8.4 131 - 150 4.3 73.4 3.3 78.8 2.9 71.3 3.7 74.4 3.0 68.1 3.1 151 - 185 5.0 78.4 2.7 81.6 3.0 74.3 3.9 78.3 2.9 70.9 2.8 186 - 200 0.2 78.7 0.0 81.6 0.0 74.4 0.1 78.4 0.1 71.0 0.1 201 - 225 0.1 78.8 0.1 81.6 0.1 74.4 0.1 78.5 0.1 71.1 0.1 226 - 250 0.0 78.8 0.0 81.6 0.0 74.5 0.0 78.6 0.0 71.1 0.0 Over 250 0.1 78.9 0.0 81.6 0.0 74.5 0.0 78.6 0.0 71.1 0.0 Income reported as 3.5 82.5 2.6 84.2 3.0 77.5 3.2 81.8 5.2 76.3 1.6 zerobNot reported 17.5 100.0 15.8 100.0 22.5 100.0 18.2 100.0 23.7 100.0 18.9 

c

Total migrant WIC 6,242 3,545 3,059 12,846 10,147 30,166 Non-Migrant0 - 50 24.8 24.8 23.0 23.0 30.9 30.9 26.3 26.3 28.6 28.6 28.7 51 - 100 27.3 52.1 32.2 55.1 25.4 56.3 27.7 54.1 26.1 54.8 30.3 101 - 130 12.9 65.0 14.0 69.1 11.3 67.6 12.6 66.7 11.6 66.4 12.9 131 - 150 7.0 72.0 7.0 76.1 5.5 73.1 6.5 73.2 5.5 71.9 6.3 151 - 185 8.9 80.9 7.2 83.3 5.9 79.0 7.6 80.8 5.8 77.8 6.7 186 - 200 0.5 81.4 0.3 83.5 0.3 79.3 0.4 81.2 0.2 78.0 0.3 201 - 225 0.3 81.7 0.1 83.7 0.2 79.5 0.2 81.4 0.1 78.2 0.1 226 - 250 0.2 81.8 0.1 83.8 0.1 79.6 0.1 81.5 0.1 78.3 0.1 Over 250 0.2 82.0 0.1 83.9 0.1 79.7 0.2 81.7 0.1 78.4 0.1 Income reported as 4.2 86.2 2.9 86.8 2.8 82.5 3.5 85.2 4.2 82.6 1.7 zerobNot reported 13.8 100.0 13.2 100.0 17.5 100.0 14.8 100.0 17.4 100.0 12.9 

c

Total non-migrant WIC 883,499 384,500 585,636 1,853,635 2,030,222 4,080,320 
Exhibit 8.6 (continued)

Distribution of Percent of Poverty Level of WIC Participants by Participant Category and Migrant Status

Percent of Poverty Pregnant Breastfeeding Postpartum Total Level Women Women Women Women Infants Ch

Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent 

Cumulative Cumulative Cumulative Cumulative Cumulative 

Percent of total women Percent by pa

%JCRVGT 'KIJV %JCTCEVGTKUVKEU QH 

Migrant status not

reported

0 - 50 28.7 28.7 31.4 31.4 44.1 44.1 34.7 34.7 31.7 31.7 48.3 51 - 100 20.1 48.7 25.3 56.7 13.9 58.0 18.9 53.7 12.9 44.7 18.4 101 - 130 8.1 56.9 11.1 67.8 6.3 64.3 8.1 61.7 5.5 50.1 7.5 131 - 150 5.2 62.1 5.0 72.8 3.0 67.3 4.4 66.1 2.2 52.3 3.7 151 - 185 6.8 68.8 3.6 76.4 3.3 70.6 4.9 71.0 2.2 54.5 3.6 186 - 200 0.8 69.7 0.3 76.7 0.3 70.9 0.5 71.5 0.2 54.7 0.3 201 - 225 0.7 70.4 0.2 77.0 0.3 71.1 0.5 72.0 0.1 54.8 0.3 226 - 250 0.4 70.8 0.3 77.3 0.1 71.3 0.3 72.3 0.0 54.8 0.2 Over 250 0.2 71.0 0.2 77.5 0.0 71.3 0.2 72.4 0.1 54.9 0.1 Income reported as 2.1 73.1 1.9 79.4 1.5 72.8 1.8 74.3 1.3 56.2 0.8 zeroaNot reported 26.9 100.0 20.6 100.0 27.2 100.0 25.7 100.0 43.8 100.0 16.7 

b

Total migrant status not reported WIC 2,934 1,346 2,355 6,635 8,257 10,530 

NotesPoverty level calculations are based on income, income period, and household size as reported by State WIC agencies. 

The percent of migrants with missing income information increased from 7.4 percent in 1996 to 19.6 percent in 1998 primarily due to increased non-reporting in Texas (income is m

a

observed changes in the poverty distribution between 1996 and 1998 must be treated cautiously.Zero incomes are reported separately and excluded from these income calculations. In some reporting agencies, zero may be used to indicate missing information or adjunctive el

b

between households with missing income information and households reporting zero income.Not reported indicates the percentage of participants by participant category for whom no data on income, income period, or size of economic unit are reported. c
%JCRVGT 'KIJV %JCTCEVGTKUVKEU QH 2% /KITCPV 9+% 2CTVKEKRCPVU 

Exhibit 8.7

Nutritional Risks Reported in at Least 15 Percent of Migrant Farmworker WIC Participants

by Participant Category

Participant Category and Type of Risk Percent

Pregnant Women 6,242

General obstetrical risks 36.9%

Hematocrit or hemoglobin below State standard 25.7

High weight for height 27.7

Inadequate or inappropriate nutrient intake 42.1

Inappropriate growth or weight gain pattern 42.3

Breastfeeding Women 3,545

Breastfeeding mother or infant dyad 33.7%

General obstetrical risks 34.7

Hematocrit or hemoglobin below State standard 30.4

High weight for height 32.4

Inadequate or inappropriate nutrient intake 44.3

Other health risk 15.3

Postpartum Women 3,059

General obstetrical risks 32.0%

Hematocrit or hemoglobin below State standard 37.0

High weight for height 26.1

Inadequate or inappropriate nutrient intake 45.9

Other health risk 18.5

Infants 10,147

Breastfeeding mother or infant dyad 32.6%

Infant of a WIC-eligible mother or mother at risk during pregnancy 68.6

Children 30,166

Hematocrit or hemoglobin below State standard 29.6%

High weight for height 18.1

Inadequate or inappropriate nutrient intake 61.9

Total 53,159

Note

Risks shown each represent 15 percent or more of all migrant WIC participants in the participant category.
%JCRVGT 'KIJV %JCTCEVGTKUVKEU QH 

Exhibit 8.8Number and Percent of Migrant Farmworker WIC Participants with Specific Nutritional Risks Reported by Participa

Pregnant Women Postpartum Women Total Women Infants 

Breastfeeding Women

Number Percent Number Percent Number Percent Number Percent Number Percent Nu

Percent by participant category

Participants in category 6,242 3,545 3,059 12,846 10,147 3Anthropometric 3,834 61.4% 1,511 42.6% 1,084 35.4% 6,430 50.1% 1,953 19.2% 1

Low weight for height 312 5.0 77 2.2 72 2.4 461 3.6 182 1.8 High weight for height 1,728 27.7 1,150 32.4 797 26.1 3,675 28.6 388 3.8 Short stature 228 3.7 16 0.5 10 0.3 254 2.0 405 4.0 Inappropriate growth or weight gain pattern 2,643 42.3 400 11.3 301 9.8 3,343 26.0 361 3.6 Low birthweight or premature birth 0 0.0 0 0.0 0 0.0 0 0.0 585 5.8 Other anthropometric 31 0.5 5 0.1 1 0.0 37 0.3 358 3.5 

Biochemical 1,623 26.0 1,077 30.4 1,137 37.2 3,836 29.9 719 7.1 

Hematocrit or hemoglobin below State standard 1,606 25.7 1,077 30.4 1,133 37.0 3,815 29.7 673 6.6 Other biochemical test results which indicate 19 0.3 1 0.0 4 0.1 24 0.2 46 0.5  nutritional abnormality

Clinical, Health, Medical 3,430 55.0 1,929 54.4 1,779 58.2 7,138 55.6 1,578 15.6 

Pregnancy-induced conditions 167 2.7 148 4.2 91 3.0 406 3.2 0 0.0 Delivery of low-birthweight or premature 124 2.0 48 1.4 91 3.0 263 2.0 0 0.0  infantPrior stillbirth, miscarriage, spontaneous 164 2.6 49 1.4 108 3.5 321 2.5 0 0.0  abortion, or neonatal deathGeneral obstetrical risks 2,303 36.9 1,229 34.7 980 32.0 4,512 35.1 0 0.0 Nutrition-related risk conditions 750 12.0 220 6.2 180 5.9 1,150 9.0 232 2.3 Substance abuse 349 5.6 143 4.0 155 5.1 647 5.0 506 5.0 Other health risk 404 6.5 544 15.3 567 18.5 1,515 11.8 923 9.1 

Dietary 2,943 47.1 1,681 47.4 1,525 49.9 6,149 47.9 1,443 14.2 2

Inadequate or inappropriate nutrient intake 2,629 42.1 1,572 44.3 1,405 45.9 5,606 43.6 1,007 9.9 1Other dietary risk 612 9.8 199 5.6 192 6.3 1,003 7.8 543 5.4 

Other risk 570 9.1 1,427 40.3 440 14.4 2,437 19.0 8,773 86.5 

Regression 0 0.0 10 0.3 4 0.1 14 0.1 6 0.1 Transfer (nutrition risk unknown) 174 2.8 81 2.3 135 4.4 390 3.0 677 6.7 Breastfeeding mother or infant dyad 0 0.0 1,195 33.7 18 0.6 1,213 9.4 3,309 32.6 Infant of a WIC-eligible mother or mother at 0 0.0 0 0.0 0 0.0 0 0.0 6,962 68.6  risk during pregnancyHomelessness/Migrancy 193 3.1 89 2.5 70 2.3 352 2.7 415 4.1 Other nutritional risks 213 3.4 128 3.6 223 7.3 564 4.4 707 7.0 

No risk reported 67 1.1 20 0.6 23 0.8 110 0.9 103 1.0 

NotesAn infant is defined as a participant who, at certification, is under one year of age and who would be classified as a child at the age of 366 days.In 1998, State WIC agencies could report up to three nutritional risks for each participant. This table examines all risks reported for every participant. When multiple risks within a clathese risks are combined and counted one time in order to accurately calculate the number and percent of WIC participants with a specific type (or category) of risk.
%JCRVGT 'KIJV %JCTCEVGTKUVKEU QH 2% /KITCPV 9+% 2CTVKEKRCPVU 

Exhibit 8.9

Number and Percent of Anemic Migrant Farmworker WIC Participants by Participant

Category

Migrant WIC Participants

Number Percent

Migrant WIC women 12,846

Total women 12,846

Below CDC standard 2,497 19.4% a

Not reported 1,862 14.5 b

Pregnant women 6,242

Below CDC standard 465 7.4 a

Not reported 852 13.7 b

Breastfeeding women 3,545

Below CDC standard 947 26.7 a

Not reported 510 14.4 b

Postpartum women 3,059

Below CDC standard 1,085 35.5 a

Not reported 500 16.3 b

Migrant WIC children 30,166

Total children 30,166

Below CDC standard 5,126 17.0 a

Not reported 2,553 8.5 b

One-year-old children 8,916

Below CDC standard 1,430 16.0 a

Not reported 732 8.2 b

Two-year-old children 7,517

Below CDC standard 1,669 22.2 a

Not reported 623 8.3 b

Three-year-old children 7,507

Below CDC standard 1,260 16.8 a

Not reported 634 8.4 b

Four-year-old children 6,188

Below CDC standard 767 12.4 a

Not reported 564 9.1 b

Age not reported 37 0.1

Notes

Percent below each standard includes in denominators WIC participants for whom no data were reported so that the percentages reported here

represent lower bounds.

Federal WIC regulations permit State and local agencies to dispense with hematological testing for infants under six months of age, as well as for

children who are found to be within normal ranges at their last certification. However, blood tests should be performed on such children at least

once in every twelve-month period.

Centers for Disease Control. 1989 "CDC Criteria for Anemia in Children and Childbearing-Aged Women." Morbidity and Mortality Weekly Report, a

38, 22: 401-404.

Not reported indicates the percentage of participants, by participant category, for whom data were not reported on blood measure or expected b

date of delivery.
%JCRVGT 'KIJV %JCTCEVGTKUVKEU QH 2% /KITCPV 9+% 2CTVKEKRCPVU 

Exhibit 8.10

Distribution of Infant and Child Migrant Farmworker WIC Participants According to

Selected Anthropometric Measures

Children

NCHS-CDC Percentiles 2 or more a

Infants 1 Year Old Years b

Percent by percentilec

Weight for height d,e

<3rd percentile 2.0% 1.3% 0.6%

<5th 4.2 2.2 1.1

<10th 7.0 5.0 2.9

>90th 11.3 27.8 19.7

>95th 6.3 17.9 13.5

>98th 5.0 14.6 10.8

Invalid or missing anthropometric data 27.7 4.7 3.7 f

Weight for aged,f

<3rd percentile 4.1 2.2 1.8

<5th 5.6 3.4 2.9

<10th 10.0 7.2 6.4

>90th 90.0 19.8 18.6

>95th 95.0 13.3 12.9

>98th 98.0 10.3 10.3

Invalid or missing anthropometric data 9.0 3.4 3.0

Height for aged,e,g

<3rd percentile 7.4 5.9 3.6

<5th 8.5 8.5 5.7

<10th 12.1 14.7 10.2

>90th 10.8 8.9 13.9

>95th 5.3 5.0 8.1

>98th 4.4 3.3 5.5

Invalid or missing anthropometric data 10.8 4.3 3.1

WIC Migrant Participants 10,146 8,916 21,212 

Notes

Percentiles are calculated using software for pediatric anthropometry developed by the Centers for Disease Control and the World

Health Organization. See: Sullivan M. and J. Gorstein. December 1990. ANTHRO: Software for Calculating Pediatric

Anthropometry Version 1.01.

 Age is not reported for 39 migrant children.

NCHS = National Center for Health Statistics. CDC = Centers for Disease Control and Prevention. a

An infant is defined as a participant who, at certification, is under one year of age and who would be classified as a child at the b

age of 366 days.

Percentiles reported in this table are cumulative. For example the <5th category includes those infants in the <3rd percentile, c

and the >95th category includes those infants in the >98th percentile.

NCHS-CDC reference curves for one-to-two-year-old children are based on a sample of children from Yellow Springs, Ohio, d

who were measured by researchers at the Fels Research Institute. For children aged two or more, NCHS-CDC growth reference

curves are based on a representative sample of US children.

It is assumed that height for an infant is recumbent length. e

Infants less than 19.3 inches are coded as invalid by CDC software program in weight-to-length percentile calculations. f

Age is calculated in months using birthdates and dates of height and weight measurement. g
%JCRVGT 'KIJV %JCTCEVGTKUVKEU QH 2% /KITCP

Exhibit 8.11Priority of Migrant Farmworker WIC Participants by Participant Category

Pregnant Women Breastfeeding Postpartum

Women Women Total Women Infants Childre

Priority Number Percent Number Percent Number Percent Number Percent Number Percent Number P

Percent by participant category

I 5,530 88.6% 3,063 86.4% 30 1.0% 8,623 67.1% 5,666 55.8% 44 II 0 0.0 107 3.0 1 0.0 108 0.8 3,644 35.9 45 III 0 0.0 3 0.1 1,362 44.5 1,365 10.6 66 0.7 20,243 IV 566 9.1 315 8.9 383 12.5 1,264 9.8 383 3.8 23 V 2 0.0 0 0.0 32 1.0 34 0.3 23 0.2 9,129 VI 2 0.0 17 0.5 1,129 36.9 1,148 8.9 0 0.0 1 VII 79 1.3 13 0.4 16 0.5 108 0.8 138 1.4 243 

No priority reported 63 1.0 27 0.8 106 3.5 196 1.5 227 2.2 439 US WIC 6,242 3,545 3,059 12,846 10,147 30,166 

NotesIn the migrant WIC population, about 1.5 percent of one-year-old children are eleven-month-old infants who have been recertified as children. About 0.1 percent of migrant as infants are participants older than 366 days.

A small proportion of participants may not have had their State-level records or priorities updated on State-maintained management information systems when they were 

a

certification categories.
Chapter Nine: PC98 Local WIC Agency Operations 169

9. LOCAL WIC AGENCY OPERATIONS

WIC services are delivered in each of the fifty States, the District of Columbia,

American Samoa, Guam, Puerto Rico, and the American Virgin Islands. In 1998,

thirty-three Indian tribal organizations also served as State WIC agencies. While State

agencies allocate funding and set policies and procedural guidelines, services are

delivered to WIC participants by local WIC agencies and their service sites. In 1998,

2,203 local agencies provided services to WIC participants at an estimated 8,932

service delivery sites. It is important to point out again that local WIC estimates

presented in this report are based on data from a survey of a sample of local WIC

agencies. Standard errors for all estimates are included in each exhibit. Sampling and

estimation are described in Chapter One. 

As discussed in Chapter One, most local WIC agencies are health agencies, primarily

State or county health departments, generally providing WIC services to clients within

their neighborhoods. Virtually all service delivery sites operated by local agencies are

full-service sites (Exhibit 9.1). Specific features of site operations reflect, in part,

characteristics of the agency and its participants. While 53 percent of the service

delivery sites are open part-time and 46 percent rotate staff among several service

delivery sites, these clinics tend to be smaller than average. The percents of WIC

participants served by sites with these characteristics are only 19 and 22 percent,

respectively. Larger service sites tend to offer extended hours of operation. Slightly

more than one-quarter of sites are open extended hours; half of all WIC participants are

served by these sites. Although two-thirds of all participants are served by sites located

near public transportation, relatively few of the smaller sites have bus or subway routes

nearby. To help alleviate transportation obstacles, 41 percent of the local agencies

(serving 32 percent of participants) offer home visits. 

To encourage participation, and help ensure that clients receive needed services, most

local WIC agencies attempt to contact participants who miss scheduled appointments

(Exhibit 9.2). Contact is most likely to be made if a certification appointment is

missed; only 5 percent of local agencies report no followup when clients miss

certification appointments; 11 percent do not follow up when clients neglect to pick up

their checks or vouchers; and 16 percent do not follow up when nutrition education

appointments are missed. The most common methods of followup are postcards and

telephone calls. There is some increase in use of autodialers for missed certification

appointments with 6.4 percent of local agencies reporting their use in 1998 compared

to 1.4 percent in 1996.

Federal funds provide WIC benefits and pay administrative costs for the WIC Program.

Exhibit 9.3 displays the allocation of federal nutrition services and administrative

(NSA) funds to various WIC functions. On average, 48 percent of sites’ NSA funds

are used for client services, which include the costs of certification, benefit issuance,

and referral to health and social services. Nutrition education accounts for an average

of 24 percent of sites’ funds, while an average of 9 percent are devoted solely to

breastfeeding support and promotion. The remaining 20 percent of funds are used for

general administrative functions such as overhead and clerical support. 
Chapter Nine: PC98 Local WIC Agency Operations 170

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Chapter Nine: PC98 Local WIC Agency Operations 171

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Chapter Nine: PC98 Local WIC Agency Operations 172

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Chapter Nine: PC98 Local WIC Agency Operations 173

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Chapter Nine: PC98 Local WIC Agency Operations 174

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Questions on the availability of health and social services are not identical in the 1988, 1996, 1

and 1998 surveys, making comparisons over time difficult.

Chapter Nine: PC98 Local WIC Agency Operations 175

Access to Health Care The local WIC service agency serves as a link between participants and appropriate

and Social Services health-care providers and social services. WIC agencies are charged with helping

participants obtain and use preventive health-care services which can be provided onsite or via referrals to other agencies. This mission is an important WIC benefit and

is seen by WIC professionals as essential for improving the health of participants.

Exhibits 9.4 and 9.5 present data on the availability of various health services at WIC

service delivery sites, as well as referral procedures. Most WIC service sites (70

percent) report on-site availability of some type of pediatric care; 48 percent offer both

well-baby care and immunizations. Just under half of WIC service sites report on-site

availability of family planning services. Other medical services, including routine adult

health services, obstetrical and gynecological care, and dental care, tend to be provided

off-site. WIC agencies generally provide referrals for each of these services on an as

needed basis. WIC’s continuing link with health care is demonstrated by these referrals

and by the co-location with pediatric care available to 72 percent of WIC participants.

Adult health care is co-located with WIC in agencies serving over one-third of WIC

participants. Patterns in 1998 are similar to findings reported by the 1988 and 1996

surveys of local agencies. 

1

During the past decade, WIC has worked with other federal agencies, particularly the

US Department of Health and Human Services, to create networks of care providers to

ensure that WIC participants receive the services they need. At the local level, this

strategy is seen in referring WIC participants to a wide range of social services. For

example, in 1998, most local agencies assisted WIC participants with TANF, food

stamps, Medicaid, substance abuse counseling, child support and child care (Exhibits

9.6 through 9.9), if needed. Although enrollment for these services is primarily off-site,

some agencies do offer on-site services as well. Medicaid enrollment is offered at onequarter of the sites, servicing 29 percent of participants. Substance abuse counseling

is available at 16 percent of the sites.

Staffing Local WIC Agencies As discussed in preceding chapters, the WIC caseload increased substantially during

the 1990s, though the rate of growth slowed between 1996 and 1998. Several items

on the local agency survey attempt to determine the impact of these changes on staffing

at the service delivery level. Two-thirds of local agencies report they have sufficient

professional staff to support WIC operations, two-thirds have sufficient

clerical/support staff, and 56 percent have sufficient para-professional staff (Exhibit

9.10). Whether or not they have a sufficient number of staff, most local agencies report

that existing staff possess appropriate skills (Exhibit 9.11).

Half of the local WIC agencies report difficulty hiring professional staff. The most

common reasons are lack of competitive salary and benefits (41 percent) and lack of

qualified applicants (36 percent). Poor working conditions for professional staff are

reported in 9 percent of local agencies in 1998, down from 15 percent in 1996. See

Exhibits 9.13 and 9.14. These agencies report less difficulty in hiring paraprofessional and clerical staff. Most WIC agencies report that they have no difficulties

retaining professional (69 percent), para-professional (58 percent), or clerical/support

(77 percent) staff (Exhibit 9.15). The most commonly cited problems with regard to

retaining staff are: low salary and benefits; lack of upward mobility; workload; and

low morale (Exhibit 9.16). Twenty percent of local WIC agencies report using
Chapter Nine: PC98 Local WIC Agency Operations 176

Exhibit 9.4

Provision of Health Services at WIC Service Delivery Sites by Type of Service

Type of Service Service Provided Provided based Information

Available to all on individual Not not

On-Site participants need provided reported

Referrals. . .

Percent of Service

Delivery Sites Percent of Service Delivery Sitesa

Pediatric care

Well-baby care and 47.5% 22.6% 60.6% 13.3% 3.6% 

immunizations (1.25) (0.92) (1.07) (0.73) (0.44)

Immunizations only 22.7 10.6 48.1 27.5 13.8 

(1.12) (0.64) (1.09) (0.97) (0.80)

b

Any pediatric care 70.2 33.2 51.6 1.3 13.9

(1.12) (1.03) (1.10) (0.30) (0.81)

Family planning 47.1 12.0 80.6 3.8 3.6 

(1.23) (0.82) (0.95) (0.46) (0.41)

Routine adult health services— 30.6 10.0 69.6 14.7 5.6 

regular checkups, immunizations, (1.19) (0.82) (1.07) (0.85) (0.46)

minor illnesses

Obstetrical and gynecological care 30.0 12.4 78.2 6.1 3.3 

(1.18) (0.88) (1.01) (0.63) (0.40)

Dental care 13.0 10.4 77.5 8.4 3.7 

(0.82) (0.84) (1.00) (0.69) (0.43)

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe

of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

Rows do not sum to 100 percent. Most sites that offer services on-site also provide referrals for these services when needed. a

Includes sites that provide referrals for both well-baby care and immunizations to all participants. b

 
Chapter Nine: PC98 Local WIC Agency Operations 177

Exhibit 9.5

Provision of Health Services for WIC Participants by Type of Service

Type of Service Service Provided Provided based Information

Available On- to all on individual Not not

Site participants need provided reported

Referrals. . .

Percent of

Participants Percent of Participantsa

Pediatric care

Well-baby care and 51.1% 21.5% 60.9% 14.5% 3.0% 

immunizations (2.66) (1.76) (2.22) (1.41) (0.65)

Immunizations only 20.9 12.6 47.5 26.4 13.5 

(1.98) (1.31) (2.50) (2.03) (1.58)

b

Any pediatric care 72.0 34.1 51.1 1.1 13.7

(2.82) (2.10) (2.46) (0.41) (1.62)

Family planning 55.1 12.6 80.4 3.9 3.1 

(2.46) (1.33) (1.86) (1.28) (0.50)

Routine adult health services— 34.6 7.9 70.2 16.2 5.7 

regular checkups, immunizations, (2.35) (1.10) (2.95) (3.04) (0.82)

minor illnesses

Obstetrical and gynecological care 39.7 12.6 80.6 3.5 3.2 

(2.46) (1.74) (1.94) (0.73) (0.64)

Dental care 20.7 7.5 80.2 9.1 3.2 

(2.00) (1.23) (1.92) (1.44) (0.55)

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe

of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

Rows do not sum to 100 percent. Most sites that offer services on-site also provide referrals for these services when needed. a

Includes sites that provide referrals for both well-baby care and immunizations to all participants. b
Chapter Nine: PC98 Local WIC Agency Operations 178

Exhibit 9.6

Availability of Social Services at WIC Service Delivery Sites by Type of Service

Type of Service On-Site Available Off-Site mile Radius Reported Total

Enrollment Enrollment Not Available Information

Available Available On-Site, but Within 30- Not

Service Not

Percent of Service Delivery Sites

TANF 5.7% 82.3% 6.1% 5.9% 100.0%

(0.65) (1.01) (0.65) (0.60)

Food Stamps 6.6 88.6 3.2 1.6 100.0%

(0.70) (0.89) (0.52) (0.32)

Medicaid 26.1 69.2 2.7 2.0 100.0%

(1.10) (1.18) (0.49) (0.34)

Child support enforcement 3.1 85.2 7.7 4.0 100.0%

(0.52) (0.94) (0.71) (0.47)

General assistance 4.9 76.2 12.4 6.5 100.0%

(0.62) (1.06) (0.81) (0.57)

Other food assistance programs 6.0 86.7 4.2 3.1 100.0%

(0.59) (0.87) (0.57) (0.41)

Child care assistance 5.8 85.0 4.9 4.3 100.0%

(0.60) (0.93) (0.62) (0.46)

Substance abuse counselinga 15.6 76.1 6.1 2.2 100.0%

(0.92) (1.10) (0.65) (0.37)

Community or migrant services 6.6 69.5 16.1 7.8 100.0%

(0.69) (1.15) (0.87) (0.64)

Indian health services 3.0 27.1 58.4 11.5 100.0%

(0.36) (1.07) (1.15) (0.77)

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe of 2,203

local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

Includes alcohol, tobacco, and other substance abuse. a
Chapter Nine: PC98 Local WIC Agency Operations 179

Exhibit 9.7

Availability of Social Services for WIC Participants by Type of Service

Type of Service On-Site Available Off-Site mile Radius Reported Total

Enrollment Enrollment Not Available Information

Available Available On-Site, but Within 30- Not

Service Not

Percent of Participants

TANF 7.3% 84.7% 2.6% 5.4% 100.0%

(1.35) (1.66) (0.67) (0.89)

Food Stamps 7.7 90.2 0.8 1.3 100.0%

(1.40) (1.43) (0.26) (0.29)

Medicaid 29.3 67.8 0.6 2.3 100.0%

(2.27) (2.27) (0.22) (0.36)

Child support enforcement 2.6 89.4 5.3 2.6 100.0%

(0.69) (1.16) (0.88) (0.34)

General assistance 5.8 78.4 9.2 6.6 100.0%

(1.31) (1.89) (1.51) (0.94)

Other food assistance programs 5.5 89.8 1.6 3.1 100.0%

(1.06) (1.25) (0.43) (0.57)

Child care assistance 4.4 88.6 2.2 4.7 100.0%

(1.09) (2.95) (0.54) (3.03)

Substance abuse counselinga 15.1 80.2 2.2 2.5 100.0%

(1.94) (2.02) (0.57) (0.51)

Community or migrant services 5.6 74.9 13.1 6.3 100.0%

(1.03) (1.91) (1.40) (1.03)

Indian health services 0.7 36.0 52.1 100.0%

(0.19) (2.92) (2.72)

11.1 

(1.30)

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe of 2,203

local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

Includes alcohol, tobacco, and other substance abuse. a
Chapter Nine: PC98 Local WIC Agency Operations 180

Exhibit 9.8

Referral Procedures for Social Services at WIC Service Delivery Sites by Type of Service

Type of Service Participants Need Referrals Reported Total

Referrals Referrals

Provided Provided Based Information

 to All on Individual No Not 

Percent of Service Delivery Sites

TANF 29.4% 57.4% 3.0% 10.2% 100.0%

(0.96) (1.10) (0.42) (0.73)

Food Stamps 32.1 63.0 1.4 3.5 100.0%

(1.01) (1.08) (0.23) (0.45)

Medicaid 32.6 63.1 0.5 3.8 100.0%

(1.01) (1.07) (0.18) (0.45)

Child support enforcement 18.6 67.6 4.4 9.4 100.0%

(0.82) (1.05) (0.52) (0.71)

General assistance 9.6 67.3 5.9 17.2 100.0%

(0.62) (1.15) (0.55) (0.92)

Other food assistance programs 11.3 81.8 1.0 5.9 100.0%

(0.69) (0.90) (0.27) (0.59)

Child care assistance 9.2 80.0 5.0 5.8 100.0%

(0.65) (0.92) (0.50) (0.53)

Substance abuse counselinga 13.7 79.8 2.7 3.8 100.0%

(0.70) (0.91) (0.43) (0.47)

Community or migrant services 7.4 70.0 4.5 18.1 100.0%

(0.58) (1.07) (0.51) (0.95)

Indian health services 3.5 33.1 14.1 49.3 100.0%

(0.35) (1.02) (0.97) (1.18)

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe of 2,203

local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

+PENWFGU CNEQJQN VQDCEEQ CPF QVJGT UWDUVCPEG CDWUG C
Chapter Nine: PC98 Local WIC Agency Operations 181

Exhibit 9.9

Referral Procedures for Social Services to WIC Participants by Type of Service

Type of Service Participants Need Referrals Reported Total

Referrals Referrals

Provided Provided Based Information

 to All on Individual No Not

Percent of Participants

TANF 36.3% 55.2% 0.9% 7.6% 100.0%

(2.73) (2.62) (0.27) (0.99)

Food Stamps 39.4 58.1 0.7 1.7 100.0%

(2.76) (2.76) (0.21) (0.45)

Medicaid 40.5 56.9 0.4 2.3 100.0%

(2.75) (2.72) (0.22) (0.42)

Child support enforcement 23.6 66.3 4.0 6.1 100.0%

(1.95) (2.18) (0.72) (0.82)

General assistance 12.6 64.6 6.4 16.4 100.0%

(1.50) (2.87) (0.94) (2.85)

Other food assistance programs 12.6 83.2 0.7 3.5 100.0%

(1.26) (1.37) (0.31) (0.50)

Child care assistance 8.2 80.2 5.9 5.8 100.0%

(1.03) (2.86) (0.87) (2.94)

Substance abuse counselinga 19.2 77.2 1.5 2.2 100.0%

(3.08) (2.93) (0.33) (0.45)

Community or migrant services 5.8 71.6 5.2 17.3 100.0%

(0.96) (2.16) (0.73) (1.99)

Indian health services 1.5 33.9 14.6 50.0 100.0%

(0.49) (2.74) (1.60) (2.66)

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe of 2,203

local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

+PENWFGU CNEQJQN VQDCEEQ CPF QVJGT UWDUVCPEG CDWUG C
Chapter Nine: PC98 Local WIC Agency Operations 182

Exhibit 9.10

Staffing in Local WIC Agencies by Type of Staff

Staffing levels at WIC agency are described as . . . Percent of Percent of

 Local Agencies Participants

Professional staff

More than sufficient 7.7% 2.2% 

(1.26) (0.66)

Sufficient 60.1 55.8 

(2.58) (4.80)

Less than sufficient 30.0 41.2 

(2.46) (4.78)

Not reported 2.2 0.8 

(0.88) (0.72)

Total 100.0% 100.0%

Para-professional staff

More than sufficient 4.6% 2.4% 

(1.02) (0.52)

Sufficient 51.1 55.0 

(2.54) (4.38)

Less than sufficient 17.7 24.9 

(2.20) (3.80)

Not applicable 15.1 11.4 a

(1.77) (2.85)

Not reported 11.4 6.3 

(1.80) (1.89)

Total 100.0% 100.0%
Exhibit 9.10 (continued)

Staffing in Local WIC Agencies by Type of Staff

Staffing levels at WIC agency are described as . . . Percent of Percent of

 Local Agencies Participants

Chapter Nine: PC98 Local WIC Agency Operations 183

Clerical/support staff

More than sufficient 8.2% 4.3% 

(1.30) (5.17)

Sufficient 58.2 59.3 

(2.59) (4.66)

Less than sufficient 28.7 33.5 

(2.41) (4.69)

Not reported 4.9 2.9 

(1.18) (0.82)

Total 100.0% 100.0%

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe

of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

Type of staff not used. a
Chapter Nine: PC98 Local WIC Agency Operations 184

Exhibit 9.11

Staff Skills and Experience in Local WIC Agencies by Type of Staff

Agency staff skills are described as . . . Local Agencies Participants 

Percent of Percent of

Professional staff

More than appropriate 42.6% 31.6% 

(2.65) (4.38)

Appropriate 54.5 65.5 

(2.62) (4.41)

Less than appropriate 1.7 2.4 

(0.84) (9.82)

Not reported 1.2 0.5 

(0.62) (0.39)

Total 100.0% 100.0%

Para-professional staff

More than appropriate 18.7% 11.3% 

(1.94) (1.99)

Appropriate 48.2 66.1 

(2.54) (3.96)

Less than appropriate 4.6 5.3 

(1.19) (2.26)

Not applicable 15.1 11.4 a

(1.77) (2.85)

Not reported 13.5 6.0 

(2.10) (1.72)

Total 100.0% 100.0%
Exhibit 9.11 (continued)

Staff Skills and Experience in Local WIC Agencies by Type of Staff

Agency staff skills are described as . . . Local Agencies Participants 

Percent of Percent of

Chapter Nine: PC98 Local WIC Agency Operations 185

Clerical/support staff

More than appropriate 23.8% 13.3% 

(2.11) (2.85)

Appropriate 68.6 81.7 

(2.26) (2.90)

Less than appropriate 3.9 2.4 

(1.01) (1.13)

Not reported 3.7 2.6 

(0.97) (0.78)

Total 100.0% 100.0%

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe

of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

Type of staff not used. a
Chapter Nine: PC98 Local WIC Agency Operations 186

Exhibit 9.12

Staff Hiring in Local WIC Agencies by Type of Staff

Local WIC agency has hired new staff members Percent of Percent of

during the last twenty-four months Local Agencies Participants

Professional staff

Yes 56.9% 77.7% 

(2.55) (4.25)

No 36.0 18.5 

(2.39) (4.07)

Not reported 7.1 3.7 

(1.53) (1.59)

Total 100.0% 100.0%

Para-professional staff

Yes 30.1% 56.0% 

(2.41) (4.40)

No 35.5 21.5 

(2.44) (3.84)

Not applicable 15.1 11.4 a

(1.77) (2.85)

Not reported 19.2 11.0

(2.13) (2.20)

Total 100.0% 100.0%

Clerical/support staff

Yes 50.7% 72.9% 

(2.48) (3.55)

No 40.1 22.5 

(2.46) (3.42)

Not reported 9.2 4.6 

(1.81) (1.58)

Total 100.0% 100.0%

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe

of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

Type of staff not used. a
Chapter Nine: PC98 Local WIC Agency Operations 187

Exhibit 9.13

Level of Difficulty Reported by Local WIC Agencies in Recruiting and Hiring Staff

Level of difficulty reported by local WIC Percent of Percent of

agencies in recruiting and hiring staff Local Agencies Participants

Professional staff

Difficult 51.2% 61.7%

(2.57) (4.71)

Not difficult 44.8 37.3

(2.66) (4.84)

Not reported 4.1 1.0

(1.04) (0.52)

Total 100.0% 100.0%

Para-professional staff

Difficult 21.4% 23.2% 

(2.13) (3.88)

Not difficult 48.4 56.3

(2.51) (4.42)

Not applicable 15.1 11.4 a

(1.77) (2.85)

Not reported 15.1 9.1 

(2.00) (2.17)

Total 100.0% 100.0%

Clerical/support staff

Difficult 17.6% 21.0% 

(2.02) (4.17)

Not difficult 74.9 75.6 

(2.29) (4.04)

Not reported 7.5 3.4 

(1.35) (1.23)

Total 100.0% 100.0%

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe

of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

Type of staff not used. a
Chapter Nine: PC98 Local WIC Agency Operations 188

Exhibit 9.14

Difficulties Reported by Local WIC Agencies in Recruiting and Hiring Staff

Difficulties reported by local WIC agencies in Percent of Percent of

recruiting and hiring staff Local Agencies Participants a a

Professional staff

No problems 34.7% 27.0% 

(2.53) (4.17)

Salary and/or benefits not competitive 40.8 49.6 

(2.63) (5.05)

Lack of qualified applicants 36.0 46.5 

(2.55) (4.52)

Labor shortage 11.4 18.4 

(1.90) (4.04)

Hiring freeze 11.3 13.3 

(1.77) (3.29)

Poor working conditions 8.7 7.4 

(1.99) (2.41)

Safety of the facility and/or neighborhood 2.6 8.7 

(0.76) (2.77)

Other 5.1 9.0 

(1.26) (2.71)

Not reported 6.5 3.7 

(1.31) (2.18)

Para-professional staff

No problems 34.3% 39.9% 

(2.59) (4.60)

Salary and/or benefits not competitive 16.6 24.5 

(2.01) (4.39)

Lack of qualified applicants 14.7 17.8 

(2.02) (3.93)

Hiring freeze 8.4 7.9 

(1.67) (2.45)

Poor working conditions 3.1 3.6 

(1.36) (3.59)

Labor shortage 2.0 3.9 

(0.78) (2.29)

Safety of the facility and/or neighborhood 0.6 3.2 

(0.37) (2.11)

Other 3.6 6.3 

(1.08) (2.09)

Not applicable 15.1 11.4 b

(1.77) (2.85)

Not reported 18.4 11.9 

(2.14) (2.41)
Exhibit 9.14 (continued)

Difficulties Reported by Local WIC Agencies in Recruiting and Hiring Staff

Difficulties reported by local WIC agencies in Percent of Percent of

recruiting and hiring staff Local Agencies Participants a a

Chapter Nine: PC98 Local WIC Agency Operations 189

Clerical/support staff

No problems 56.7% 53.5% 

(2.61) (4.46)

Salary and/or benefits not competitive 21.3 27.3 

(2.24) (4.50)

Lack of qualified applicants 12.2 16.9 

(1.76) (4.14)

Hiring freeze 10.1 12.0 

(2.05) (2.96)

Poor working conditions 6.0 4.1 

(3.11) (3.20)

Labor shortage 1.6 3.8 

(3.11) (2.55)

Safety of the facility and/or neighborhood 1.0 2.5 

(0.49) (2.12)

Other 3.9 5.5 

(1.16) (2.22)

Not reported 11.1 6.2 

(1.73) (1.78)

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe

of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

Column doesrd not sum to 100 percent because respondents were permitted multiple responses. a

Type of staff not used. b
Chapter Nine: PC98 Local WIC Agency Operations 190

Exhibit 9.15

Level of Difficulty Reported by Local WIC Agencies in Retaining Staff

Level of difficulty reported by local WIC Percent of Percent of

agencies in retaining staff Local Agencies Participants

Professional staff

Difficult 28.1% 34.9% 

(2.48) (4.08)

Not difficult 69.4 63.7 

(2.38) (4.19)

Not reported 2.5 1.5 

(0.84) (0.28)

Total 100.0% 100.0%

Para-professional staff

Difficult 12.2% 14.3% 

(1.76) (3.21)

Not difficult 58.4 64.5 

(2.46) (4.19)

Not applicable 15.1 11.4 a

(1.77) (2.85)

Not reported 14.2 9.9 

(2.15) (2.54)

Total 100.0% 100.0%

Clerical/support staff

Difficult 19.0% 26.8% 

(2.09) (4.53)

Not difficult 77.1 71.0 

(2.17) (4.42)

Not reported 3.9 2.2 

(0.96) (0.69)

Total 100.0% 100.0%

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe

of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

Type of staff not used. a
Chapter Nine: PC98 Local WIC Agency Operations 191

Exhibit 9.16

Difficulties Encountered by Local WIC Agencies Retaining Staff

Difficulties encountered by local WIC agencies Percent of Percent of

retaining staff Local Agencies Participants a a

Professional staff

No problems 47.2% 43.4% 

(2.71) (4.96)

Salary and/or benefits not competitive 34.2 39.3 

(2.50) (4.66)

Lack of upward mobility 28.7 33.8 

(2.42) (4.54)

Workload 19.7 25.9 

(2.15) (3.91)

Low morale 7.7 12.5 

(1.42) (3.11)

Poor working conditions 7.2 7.4 

(1.60) (3.26)

Safety of the facility and/or neighborhood 3.9 8.7 

(1.02) (2.99)

Other 4.4 5.0 

(2.98) (1.16)

Not reported 5.9 2.8 

(1.30) (1.50)

Para-professional staff

No problems 38.8% 42.7% 

(2.74) (5.13)

Salary and/or benefits not competitive 17.9 20.2 

(2.17) (3.99)

Lack of upward mobility 17.1 25.9 

(2.06) (4.49)

Workload 12.1 16.7 

(1.73) (3.48)

Low morale 7.5 12.8 

(1.50) (3.31)

Poor working conditions 5.9 5.8 

(1.41) (2.67)

Safety of the facility and/or neighborhood 2.0 4.6 

(0.78) (2.23)

Other 1.3 1.4 

(2.71) (0.31)
Exhibit 9.16 (continued)

Difficulties Encountered by Local WIC Agencies Retaining Staff

Difficulties encountered by local WIC agencies Percent of Percent of

retaining staff Local Agencies Participants a a

Chapter Nine: PC98 Local WIC Agency Operations 192

Not applicable 15.1 11.4 b

(1.77) (2.85)

Not reported 16.8 11.1 

(2.09) (2.48)

Clerical/support staff

No problems 53.2% 50.2% 

(2.76) (4.79)

Salary and/or benefits not competitive 24.9 28.1 

(2.38) (4.64)

Lack of upward mobility 21.7 31.6 

(2.35) (5.02)

Workload 19.1 28.9 

(2.18) (4.38)

Low morale 12.1 18.4 

(1.79) (3.75)

Poor working conditions 8.8 7.7 

(1.68) (2.86)

Safety of the facility and/or neighborhood 2.6 3.9 

(0.90) (2.12)

Other 3.3 1.6 

(1.34) (0.61)

Not reported 7.6 5.5 

(1.35) (1.66)

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe

of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

Column does not sum to 100 percent because respondents were permitted multiple responses. a

Type of staff not used. b
Chapter Nine: PC98 Local WIC Agency Operations 193

volunteers to supplement paid WIC staff within the past year, although in most

agencies, volunteers were not an important part of program operations (Exhibit 9.17).

Work space in three-quarters of service delivery sites is deemed adequate by local

agency personnel. The other quarter report inadequate space for current staffing and

caseload levels (Exhibit 9.18). This is an improvement since 1996 when 30 percent of

agencies reported inadequate space.
Chapter Nine: Local WIC Agency Operations PC98 194

Exhibit 9.17

Use of Volunteers to Deliver WIC Services

Percent of Percent of

Local Agencies Participants

Use of volunteersa

Replace WIC staff for a few days at a time 1.2% 1.3% 

(2.27) (0.89)

Replace WIC staff for more than a month 1.1 2.0 

(0.55) (0.95)

Supplement paid WIC staff 20.2 25.3 

(2.35) (3.78)

Do not use volunteers 78.5 72.7 

(2.19) (3.92)

Not reported 0.8 0.9 

(0.49) (1.01)

Importance of volunteers

Critical 0.8% 1.7% 

(3.02) (1.77)

Very important 3.9 5.9 

(1.33) (2.33)

Convenient help 13.6 15.7 

(1.92) (3.09)

Not important 2.2 3.2 

(0.69) (0.50)

Necessary for public relations but a drain on 0.0 0.0 

administration (0.00) (0.00) 

Do not use volunteers 78.5 72.7 

(2.19) (3.92)

Not reported 1.0 0.7 

(0.57) (0.21)

Total 100.0% 100.0%

0QVGU

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe

of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

%QNWOPU FQ PQV UWO VQ  RGTEGPV DGECWUG TGURQPFGPVU YGTG RGTOKVVGF OWNVKRNG TGURQPUGU C
Chapter Nine: Local WIC Agency Operations PC98 195

Exhibit 9.18

Physical Space at WIC Service Delivery Sites

Physical space at service delivery site is Percent of Service Percent of

described as . . . Delivery Sites Participants

Adequate 76.4% 74.8% 

(1.14) (2.05)

Inadequate 22.5 24.8 

-1.13 -2.04

Not reported 1.1 0.5 

-0.27 -0.21

Total 100.0% 100.0%

Notes

Standard errors are in parentheses.

A total of 460 local WIC agencies responded to the PC98 Summary of Local Programs. Responses are weighted to reflect the universe

of 2,203 local agencies, the estimated universe of 8,932 service delivery sites, and the universe of 8,042,758 participants.

Adequate physical space is defined as sufficient and appropriate space for the numbers of staff and participants and for their program

responsibilities.