proportion of individuals with a major depressive disorder and dysthymia (less severe clinical depression), as well as some individuals who suffer from depressive symptoms but who do not satisfy the diagnostic criteria (Eaton and Kessler, 1981). The CES-D has been extensively validated and correlates well with other self-reported depression measures and with clinical ratings of depression. It has been used in many previous studies of low-income populations and evaluations of demonstration programs including the JOBS evaluation, the evaluation of the Teenage Parent Demonstration (in progress), and the evaluation of the Comprehensive Child Development Program (DHHS, 1994b).

Recommendation for Maternal Depression

Depression presents health and nutrition risks to the mother and her children, and a suitable method for identifying the risk is available. There is a theoretical basis for benefit from participation in the WIC program. Therefore, the committee recommends use of maternal depression as a nutrition risk criterion for women in all state WIC programs. This is a recommendation for a new nutrition risk criterion.

Battering

Battering refers to violent assaults on women by their husbands, exhusbands, boyfriends, or lovers (Rudolf, 1990).

Prevalence of and Factors Associated with Battering

The prevalence of physical assault of pregnant women has been estimated to be around 8 percent among a random sample drawn from public and private clinics and between 7 and 11 percent among nonrandom samples drawn from university obstetrics clinics (Newberger et al., 1992). In a prospective study of 1,203 pregnant women, 24 percent reported experiencing physical or sexual abuse during the previous year (Parker et al., 1994). In another prospective study of 275 women, 19 percent reported experiencing moderate or severe violence during pregnancy; this increased to 25 percent during the postpartum period (Gielen et al., 1994). Data from the 1990 and 1991 Pregnancy Risk Assessment Monitoring System (PRAMS) suggested that the prevalences of battering (self-reports of being physically hurt by a husband or partner during the 12 months prior to delivery) were 6.1, 3.8, 6.9, and 5.1 percent for Alaska, Maine, Oklahoma, and West Virginia, respectively (CDC, 1994).

Two studies identified young maternal age, late prenatal care, substance abuse, poverty, a low level of education, a history of emotional problems, and



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