|About the Book|
Decades of research have resulted in near-unanimous praise for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), most notably for its impact on birth outcomes. Clinical research reveals a disconnect between most WICMoreDecades of research have resulted in near-unanimous praise for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), most notably for its impact on birth outcomes. Clinical research reveals a disconnect between most WIC analyses and the consensus among health practitioners: effective interventions for preterm birth, itself an outcome of interest as well as a factor influencing birth weight, remain unknown.-Two papers comprise this dissertation. The first reexamines the relationship between WIC and birth outcomes using data from the Pregnancy Nutrition Surveillance System (PNSS). We show that the longer women delay participation, the lower the rates of low birth weight and preterm birth. The large adjusted differences in outcomes between prenatal WIC participants and those who do not enroll until postpartum are largely driven by late-term enrollees, women already having longer gestations for reasons unrelated to WIC. We also look at the association between WIC and fetal growth retardation, an outcome more plausibly affected by maternal nutrition, health referrals, and counseling, particularly anti-smoking advice. We find a positive impact of WIC on fetal growth, though program effects are much smaller than previously estimated and are not consistently supported by corresponding changes in maternal behavior such as prenatal smoking and weight gain.-The second paper more closely examines the relationship between smoking and the timing of WIC participation. Overall, we find that, compared with third-trimester enrollees, first-trimester participants are more likely to report smoking pre-pregnancy and at WIC enrollment. We do not find a consistent impact on smoking at points WIC can influence: in the last three months of pregnancy or at postpartum. We do find that women who enroll in the first and second trimesters are more likely to smoke before pregnancy and as of WIC registration compared with third-trimester enrollees. The greater propensity of early enrollees to smoke points to an opportunity for the program to systematically influence significant numbers of smokers during the first part of their pregnancies.