Making Policies for Children: A Study of the Federal Process (1982)

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The Special Supplemental Food Program for Women, infants, and Children John R. Nelson, Jr INTRODUCTION By any measure, the Special Supplemental Food Program for Women, Infants, and Children (WIC) makes an intriguing study of the policy-making process. Enacted by Congress in 1972, it was a $20-million pilot program designed to provide specified food supplements to a few thousand pregnant women, lactating mothers, infants, and preschool children determined by health clinics to be nutritionally "at risk." Plagued over its 7-year history by litigation, impoundments, a presidential veto, controversial evalua- tions, and fiscal austerity, WIC nonetheless reached 2.5 million people at an annual cost of $750 million by the close of fiscal 1980. It is touted by administrators at the U.S. Department of Agriculture (USDA), congressional supporters, and public advocates as the most successful health or welfare program in the federal government. Congress has reenacted it three times with near unanimity. It represents one of the very few major programs greatly expanded under the Carter administration. This chapter traces the evolution of federal policy toward pregnant women, infants, and children in the areas of health care and nutrition. It pursues the historical strands that led to the creation of WIC, from the New Deal to the Great Society programs of the 1960s. This chapter then focuses on WIC's direct antecedent, the Commodity Supplemental Food Program, which was initiated in 1968. In sequential sections, WIC's origins in Congress, its difficulties with the USDA and the Office of Management and Budget (OMB), its days in federal court, and the evaluations of its efficacy are examined. Throughout the case study, particular attention is accorded to the role of research and evaluation in policy making. 85

86 CHILD NUTRITION: THE NEW DEAL TO THE GREAT SOCIETY Direct federal financial support for feeding children began with a conversation between Harry Hopkins, admini- strator for the Federal Emergency Relief Administration, and Frederick I. Daniels, director of New York's Emergency Relief Administration. The first 100 days of the Roose velt administration had just ended. Hopkins had been made czar of the federal relief and employment programs. Daniels had asked him if some of the $200 million appro- priated for relief could subsidize New York's financially strapped school lunch program. Hopkins agreed to match every two state dollars with one federal dollar. Concom itantly, the Reconstruction Finance Corporation agreed to loan money to support lunch programs in Mississippi. The Work Projects Administration (WPA) subsequently supported local lunch programs with their personnel. The crucial metamorphosis, however, which carried the nascent programs beyond the demise of these New Deal agencies into the 1960s, came with the linkage of school lunches to the disposal of farm surpluses.) Section 32 of the Agricultural Adjustment Act of 1935 provided a compensatory fund from tariff revenues to increase farm incomes. The theory was that industrial tariffs compelled farmers to spend more money on their equipment than they would have to in a situation of free international trade. The law instructed the USDA to spend these revenues to increase the price levels of farm commodities by encouraging "the domestic consumption of such commodities." Backed by Section 32 funds, the number of schools serving lunches grew to over 3,800, serving 342,000 children in 1937.2 The Surplus Marketing Corporation provided not only lunches but also food for relief agencies, institutions, and, in 1939, a food stamp program. Piloted in Rochester, New York, food stamps spread quickly throughout the country, reaching 4 million people by 1941. The USDA also began to provide lunch milk to school children for a penny or free of charge in mid-1940 and expanded their distribution to 417,000 children in 18 months.3 The great expansion of federally supported school lunches did not occur until late 1940. In August of that year, the WPA and the Surplus Marketing Administration of the USDA issued a directive to all regional, state, and local personnel involved in federal food programs. It began rather succinctly: "Recent violent disruptions in world distribution of American farm products and the

87 prospects of added losses of markets make imperative the development of new outlets for American surplus food- stuffs." The directive specified three areas of expan- sion: food stamps, direct distribution of commodities, and school lunch programs. They sought to increase the coverage of the lunch program n to not less than six million children during the 1940-41 school term"--fully half of the school population.4 It was a goal that they came within 800,000 children of achieving. By fiscal 1943 the USDA was spending over $18 million annually on school lunches and the commodities that local distribution centers received. (For funding, participation, and legis- lative data, see Appendixes B and C.) Well before the USDA distributed food for lunches, or for any other purposes, it had published numerous pamph- lets on nutrition and diet, e.g., Food for Children (1931), Milk for the Family (1933), and Meals and Recipes for Lunches (1936). . When it entered the food distribution business, the stream of booklets became a torrent. The Bureau of Home Economics (later the Bureau of Human Nutrition and Home Economics) published over 50 pamphlets in the 1940s dealing specifically with school lunches. The USDA also provided nutrition and production data to the military for diet planning during the World War II. In 1933 the Programs Planning Division of the USDA began coordinating crop production with human nutritional requirements. The onset of World War II brought the first serious and extensive application of nutritional needs to crop production: If crops were planted according to their nutritional value, then any potential tension between what was distributed as surplus and what was nutritious would dissipate .5 World War II stimulated a flurry of nutrition-related activities. At President Roosevelt's request, the National Research Council established the Food and Nutrition Board in May 1941. The board drew together existing research, previous standards, and USDA data to develop recommended dietary allowances (RDA) for persons by age, sex, and level of activity. The original RDA covered calories, protein, calcium, iron, and some vitamins; it specified, in a preliminary manner, the nutritional needs of pregnant women, infants, and lactating mothers. Subsequent reports described the "staggering n extent of malnutrition in antebellum America "It is obvious," one report concluded, "that an appalling proportion of families were receiving what might with considerable understatement be called an unsatisfactory

88 diet." Guided by these recommendations, the USDA launched a nationwide campaign to improve the diets of Americans. To abet this effort, it expanded the Bureau of Home Economics into the Bureau of Human Nutrition and Home Economics, and created a Nutrition and Food Conservation Branch of the Food Distribution Administration to incorporate all food-related activities in the federal government. Internationally, USDA officials organized the United Nation's Interim Commission on Food and Agriculture, which issued, among other things, worldwide standards for human nutrition .6 The lunch program in particular, and the feeding of children in general, did not come under congressional scrutiny until 1943, when the USDA requested a $50- million appropriation for the program's continuance. The war had absorbed the agricultural surplus and rendered direct commodity distribution impossible. Only commercial purchases could maintain the program. Secretary of Agriculture Claude Wichard proposed legislation to the White House through the Bureau of the Budget to create a permanent lunch program. He stressed the necessity of adequate food distribution to children in the face of wartime rationing/and working mothers. He suggested the President convene a national committee on child nutrition. Other USDA officials contacted the Bureau of the Budget to support Wichard. War Food Administrator Marvin Jones explained that the lunch program ensured "proper distribu- tion of the civilian food supply during the war" and "expanded markets for agricultural products and . farm surplus during peacetime." A USDA memorandum stressed malnutrition as evidenced by the high rates of draft rejections. In sum, Wichard and the USDA had, by 1943, not only presented all the arguments that would be offered subsequently to support the program but had also identified in their choice of a child nutrition committee all the important elements of what came to be the political coalition for feeding children.7 The complex preparation for maintaining a lunch program developed out of a postwar planning commission on agricul- ture that met in July 1943. The commission anticipated strong economic growth after the war and made four assump- tions about agricultural policy: first, that large postwar incomes could maintain a strong market for farm products and adequate diets for Americans; second, that farmers should anticipate expanding their output of commodities to meet this demand; third, the food stamp and school lunch programs would compensate for any slack · ~

89 in normal market outlets; and fourth, as a result of these factors, little production restriction would be necessary. Though by no means the principal instrument of farm policy, agricultural policy makers considered the lunch program an integral tool of price stabilization.6 While the administration prepared permanent legisla- tion, the congressional agriculture committees permitted a temporary appropriation to continue the program. Congress approved of the appropriation as a wartime exigency to ensure food distribution to children. Congressional concerns about funding the program beyond the end of the war resulted in the House rejection of an appropriation to extend it pending hearings on formal legislation. A peacetime program awaited the full legislative process and consideration of the whole issue of agricultural stabilization and the feeding of children.9 Within the administration a disagreement erupted between the War Food Administration (representing the USDA) and the Federal Security Agency (representing the Office of Education) over administrative jurisdiction of the proposed School Lunch Program (SLP). The Federal Security Agency argued that as a program functioning within the school system for an educational purpose, the SLP should come under the Office of Education. War Food Administrator Marvin Jones disagreed. "I cannot too strongly emphasize," he wrote, "that, although the educational aspects of this are very significant, the operational meaning of the program is that it is providing food. It is a food program in wartime providing proper distribution of food, and in peacetime expanding markets for agricultural products and providing orderly removal of farm surplus."~° That the USDA prevailed indicates to some degree that the administration assigned a higher priority to the farm disposal aspect of the program than to the educational aspect. With regard to nutrition- related activities, however, the USDA was the logical choice: It was by far the preeminent federal agency involved in nutritional research and information dissemination. Inertia and the relative clout of the executive and congressional entities involved in the SLP also contributed to the USDA's victory. With the onset of congressional hearings in late 1944 through 1945, a nascent children's feeding coalition became evident. Various farm organizations and their representatives served as the bulwark of continued federal funds for lunches. School lunches, the National Farmers

Do Union argued, were "a big market farmers cannot afford to lose. . . ." USDA officials also stressed the need to maintain outlets for surplus farm products, which were again becoming a problem in May 1945. Indeed, the program, as Senator Richard Russell noted, "grew up out of the disposition of surplus agricultural commodities, and no one had ever seriously discussed any bill providing for a federal school-lunch program prior to that time." In a brief House Agriculture Committee exchange the "main objective" of the program could not be clarified. Repre- sentative Harold Cooley believed that the primary objective was the disposal of surplus agricultural commodities and feeding school children was "just collateral." The majority, however, stressed it as a "two point" program: surplus disposal and children's feeding. 2 The dual stress enabled program promoters to draw a broad range of support outside agriculture. The children's feeding coalition encompassed nonfarm groups that included school administrators, who had a direct financial stake in continued federal funding, organized labor, PTAs, social organizations, professional nutritionists, and medical experts. - . . .. In their testimony before the House Agriculture Committee, many nutritionists pleaded for a flat national commitment to children's nutrition regardless of agricultural surpluses. The surgeon general made an extraordinary plea, in terms of need, for a national policy to combat malnutrition when he described Americans as "poorly fed." Another official of the U.S. Public Health Service noted that pregnant women and infants would be an excellent target population for . · . nutritional aid. The committee ignored his comment ana all other suggestions to modify or expand federal aid based on nutritional need beyond the lunch program. Such innovations from the depression era as food stamps and the school milk program were not revitalized. The ideologi- cally conservative Congress of 1946 authorized only a limited federal role in nutritional welfare." 3 Support for the program, particularly among southern members of Congress, stemmed from several factors other than farm incomes. The primary basis was the enormous popularity of the lunch Program among constituents throughout the nation. ~ was an inherently appealing activity. Even those few members of Congress opposed to federal support praised school lunches as an eminent state or local endeavor. In addition, there was the problem, conceived in terms of national security rather than social welfare, of Second. feeding school children

91 malnutrition in America, demonstrated by selective service rejection. General Lewis Hershey, the Selective Service director, testified that 40 to 60 percent of those rejected for military service had defects related to nutritional deficiencies. Overall, this meant that roughly 1 of every 10 draft-age males was sufficiently malnourished to preclude induction. Nutrition-related rejections were concentrated in poor southern states and were much higher among blacks, though this revelation evoked little congres- sional comment. The South, too, faced the problem of newly consolidated rural schools that required busing children, making it impossible for them to return home for lunch. Regardless of the school's distance from home, the absence from home of working mothers during the war made a home lunch difficult in all parts of the nation.) 4 The School Lunch Act of 1946 set the basic terms under which the lunch program operated into the early 1960s. Funding for the first decade remained around $80 million per year. In light of the explosion of the school popula- tion and inflation, this constant funding level represented a continuous decline in federal participation. Federal funds were paid as matching grants in a ration declining from 1:1 to 1:4 over a 5-year period. This ratio was adjusted according to the extent to which a state's per capita income varied from the national average--an advan- tage to the South. Finally, the legislation provided for nutritional standards, nondiscriminating discounts or free meals to poor children, nonprofit programs, and priority Purchases of commodities in surplus. The preamble of the act "declared [it] to be the policy of Congress, as a measure of national security, to safeguard the health and well-being of the nation's children and to encourage the domestic consumption of nutritious agricultural commod- ities. . . ." The policy statement struck a balance between the two major interests of the children's feeding coalition.~5 In 1946 the USDA issued detailed nutritional require- ments for school lunches. They divided the lunches into three types and provided a declining scale of reimburse- ment dependent on the lunch's nutritional adequacy. Type A supplied one third to one half of the daily nutrient needs of a child. Type B supplied roughly one third of a child's daily needs. Type C was one half a pint of milk. A more complete lunch yielded a higher federal subsidy. The local school or district chose the exact composition of the meal with an eye to what commodities were in surplus. Although this practice often precipitated a

92 . jejune diet, the nutritional regulations did limit abuse of the mandate that required the use of commodities in surplus. 6 Prior to the 1960s, Congress enacted only one other federal program related to feeding children: the Special Milk Program (SMP). As the Korean War ended, the USDA's Commodity Credit Corporation found itself accumulating milk at an increasing rate. In 1954 its price support operations absorbed 10 percent of the total milk supply-- more than triple its acquisitions of the year before. Milk prices declined, and national farm incomes suffered from this weakness of its largest single component. Not only production increases wrought from mechanization, but also a decade-long decline in per capita milk consumption had created a crisis for the dairy industry. Their organi- zations turned to Congress and the USDA. The result was a revival of the depression era school milk program, renamed the Special Milk Program, a $50-million "domestic disposal program" to ease dairy surplus by providing subsidized milk to school children in addition to lunch milk. When the SMP came up for a supplementary appropriation and renewal in January 1956, the USDA proposed a 20 percent increase in the appropriation and an expansion of the program into nonschool areas devoted to children. As in the initial legislation, the burden of congressional testimony came from USDA officials and dairy organizations. The passage of the new law increased SMP funding by 20 percent in fiscal 1956 and by 25 percent more in fiscal 1957. More significantly, the new law extended the SMP to nursery schools, day care centers, summer camps, settlement houses, and "similar non-profit institutions devoted to the care and training of under-privileged children on a public welfare or charitable basis." 7 By 1959, gross federal spending exceeded $210 million on the lunch and milk programs operating in a wide variety of settings. Although both programs were administration initiatives, their maintenance and expansion became the hobbyhorse of Congress. In the final two years of the Eisenhower admini- stration, the huge surplus of the Commodity Credit Corporation, which had directly stimulated the SMP, began to ease. Coupled with a general fiscal conservatism, these circumstances led the administration, through the USDA, to oppose any increases in the SLP and seek a retrenchment of the SMP. The issue involved more than a change in farm surplus or fiscal policy. An important reason for the stagnation of nutrition programs for children in the 1950s was the decision to use that surplus

93 abroad as an instrument of foreign policy (P.L. 480 and the Food for Peace Program). This decision reflected the exigencies of international relations and the impact domestic disposal was purported to have on prices. "The commodities contemplated to be set aside," Agriculture Secretary Benson explained, "are so large that it is not anticipated any substantial portion can be disposed of through domestic channels without disrupting markets and our future price support programs. The only solution to the problem," he concluded, "lies in recourse to distri- bution abroad." The nature of the agricultural market and foreign policy combined to prevent the expansion of the programs. Indeed, had it not been for Congress, the programs would have been curtailed. Against the administration's proposed cuts assembled the now familiar agricultural lobbies, school admini strators, PTAs, and newly formed food service organ~za- tions. At their prompting, citizens inundated Congress with protest letters over the cuts. Farmers did not want subsidized markets reduced nor did parents, educators, or service workers want reduced federal aid or increased costs. The SMP alone accounted for 2 percent of the aggregate fluid milk consumption and probably much more in terms of establishing the habit of drinking milk among children. One of every two school children drank SUP milk. The lunch program purchased $750 million in agricultural products. One of every three school children ate SLP lunches. Overall, approximately one third of the lunch costs were born by the federal government. When the administration attempted to retrench and restrain appro- priations for these programs on the grounds of the improved farm situation, it was overwhelmingly defeated in Congress. There was simply no support for the cuts and a phalanx opposed to them.~9 The administration's challenge did lead supporters of these programs to begin to rethink their heavy reliance on the farm surplus situation for justification. The surplus tended to have an amorphous quality, given form only in terms of the relationship of price to parity. The separa- tion of children's feeding programs from the "surplus" could well mean even higher prices for farmers without the usual criticisms of price support programs. To the various agricultural interests and their representatives, stressing nutritional need in these programs or allowing more input to educators and health specialists would not hamper the programs in their role as a market. Indeed, if need and nutrition were given sway, perhaps the programs might

94 . expand beyond the constraints of surplus and parity. No farmer would turn down a price higher than parity. More- over, the support of members of Congress from nonfarm states would come more easily for food assistance than for price support. As long as it was not used to curtail any price support programs, nutritional need was a method of disposing of surplus agricultural products that was accept- able to the agricultural interests. The reorientation of federal feeding from surplus disposal toward nutritional need occurred slowly during the 1960s. The farm interests receded in preeminence and the educators, nutritionists, physicians, social workers, and service organizations moved into the forefront of federal policy for feeding children. Although federal policy leaned more toward nutrition than agriculture, the programs still drew political strength from their impact as a subsidy to American agriculture. For this reason they received a great deal of congressional support that would otherwise have been hostile to social welfare measures. On the other hand, a great deal of support that otherwise would have opposed farm subsidies found no objec- tion to feeding needy children and adults. In public opinion polls, food stamp programs (and by inference other feeding programs) enjoyed much greater popular approbation than either cash subsidies for the poor or price supports for farmers (see Appendix A). The Eisenhower administration was the last to argue for alterations in children's feeding programs based exclu- sively on changes in farm prices. When Kennedy assumed office, the USDA ceased its opposition to extension of the SMP and expansion of the SLP. Instead, the USDA became an advocate of reform and larger appropriations. Expansionist fiscal policies and an effort to restructure program allocations to reflect better participation rates and nutritional needs led the administration to propose increasing the funding of the SLP and changing the 1946 allocation formula. The old formula used per capita income and the school-age population as the bases for apportionment of federal funds, regardless of the actual participation rate. States therefore found it more financially advantageous to keep participation rates down. Congress revised this formula to reflect participation rates and followed an administration initiative to include a specific appropriation for needy children and schools. By 1962 the SLP and the SMP had been expanded to over $260 million and directed more toward need. This subtle shift in emphasis alienated no one, for funding was adjusted

95 upward based on need. No middle-class children were dropped. Aggregate program expenditures on farm products rose. An expanding economic pie would bring the "other America" into the affluent society. 2 o Under the auspices of the Johnson administration, political recognition of America's poor people reached a level unattained since the prewar depression. The new administration's stress on need coupled with the burgeoning financial drain of the war in Vietnam spawned a White House drive to reorder the priorities in children's feeding programs and cut back the SMP by 80 percent in fiscal 1967. The drive commenced with Bureau of the Budget's directives to the USDA to withhold $3 million of the SMP appropriation for fiscal 1966. The reaction from the dairy and education interests was swift and predictable. Bureau of the Budget Director Charles Schultze wrote to outraged representatives and senators of "the increased Vietnam defense requirements" and the subsequent decision to hold SMP expenditures down to $100 million in fiscal 1966. Schultze felt compelled to inform the President of the vehement opposition to this S1' get cut and the ~nev~- able outcry against the $79 million cut proposed for fiscal 1967. In defense of this cut he added, "Why subsidize milk for wealthy Montgomery County school children"' He sought to restrict the SMP to needy children and schools without any lunch program. Aside from the losses to the dairy industry, the only problem the Bureau of the Budget foresaw was that schools with few needy children might drop the SMP if federal reimbursement were available only for the needy. The net savings of $65 million and the war demands on the budget outweighed these concerns. Whatever the merits of the arguments, Congress was not impressed. The thrust of the argument before Congress was that "the dairy situation is greatly improved now from what it was in 1954 . . . [and] the diversion of milk to avoid adding to surplus inventories is no longer a compelling oD~ecc~ve.-- The only remaining justification for a milk subsidy was financial need. The remaining $21 million provided adequately for needy children in the program. 2 2 Congress parried with the argument that need, though significant, could not be used to curtail a subsidy program. "This is," Representative Sisk told Agriculture Secretary Freeman, "no way to cure the ills of our dairy industry. . . ." SMP defenders added that middle-class children could be malnourished as well as poor ones. Finally, to the administration's exigencies-of-war plea, ~a

96 Senator Gruening retorted "perhaps today we should be talking about having both milk and napalm. ·~2 3 The mangled cliche had made the point; Congress would allow no $80-million cutback in the SMP.2 4 Although retrenchment of these programs was all but impossible, expansion on the basis of need was relatively easy. The Johnson administration's Great Society programs geared toward needy children drew support from agricultural interests, educators, nutritionists, food service organiza- tions, and social welfare groups. The first comprehensive legislation related to the feeding of children, the Child Nutrition Act of 1966, allocated funds for reduced-price and free lunches, construction of lunch facilities, and a pilot program for needy children. Revived in 1960 and made permanent in 1964, the Food Stamp Program (FSP) joined the SMP as the only program that provided food for poor children and their families outside the school context. Although direct distribution of commodities did precede and continue as a noninstitutional, in-kind nutritional aid to children and poor families in general, the FSP was the only federal program that provided non- commodity nutritional assistance to children outside an institutional context.25 In 1967, the year following passage of the Child Nutrition Act, Agriculture Secretary Freeman testified before the House Agriculture Committee for expansion of the FSP and extension of the SLP into preschool and nonschool child care institutions serving needy children. He spoke of the "dual objectives" of the programs: "(1) To get food to people who need it, . . . and (2) to build up the demand for the [farm] production that we are capable of making." The National Welfare Rights Organization joined agricultural interests in support of these changes. The hearing also marked the first time that an agricultural committee of either the House or the Senate had allowed an organization representing needy recipients to testify. There was, however, open hostility between the National Welfare Rights Organization and Senate committee members. Despite this uneasy connection, an avenue had been cleared for feeding the poor and subsidizing the farmers. When the media, the public, and the federal government "discovered" the extent of hunger in America, food aid to the needy supplanted the Commodity Credit Corporation and overshadowed the middle-class subsidies endemic to the SLP and the SMP as the principal domestic outlet for surplus farm products .2 6

97 Programmatic Antecedents The Johnson administration's highly orchestrated commitment to feeding America's hungry children and adults rendered it particularly vulnerable to the public and congressional pressures brought to bear in 1967 and 1968. Senate hear- ings on hunger in Mississippi, chaired by Iowa Senator Clark and presided over by several presidential aspirants, revealed severe malnutrition. Charges of allowing blacks to be starved out of the South and choosing guns over food cut deeply into the administration's credibility in its war on hunger and undermined its already hard-pressed military policy in Vietnam. The approach of an election year fueled administration fears that Republican leaders might n take advantage of the issue to embarrass the administration and present the [Republican] Party in a new humanitarian image. ·~2 7 One blow followed another as private research groups issued publications such as Hunger, U.S.A. and Your Daily Bread and CBS televised its "Hunger in America" documentary, all of which alleged widespread incompetence and callousness in administration food programs, especially by the USDA. Public pressure culminated in the Poor People's Campaign .2 ~ Confronted by this political pressure as well as the November election, the administration attempted to strike a balance between wartime fiscal constraints and the now ineluctable demands for action. Freeman viewed the demands as partisan attacks on the administration-- calculated to discount all its achievements of recent years. Still, in direct response to this pressure, he expanded the FSP and improved the quality of the food available to the poor. Finally, he proposed $15 million "supplementary commodity packages to improve the diets of 150,000 mothers, 100,000 infants, and 200,000 young children. n2 9 This final proposal became the centerpiece of the administration's response.30 Why the Supplemental Food Program (SFP) emerged as the central response is complex. In the 1967 Senate nutrition hearings, Harvard University's Robert Coles, among others, raised the issue of the potential for permanent physical damage to malnourished infants and small children. Physicians working in the Maternal and Child Health Service of the U.S. Department of Health, Education, and Welfare testified to the health problems attributable to malnutri- tion. The Children's Bureau, as noted above, had also been advocating a supplemental food package for high-risk groups. In early 1968 a "citizens" board of inquiry into

98 hunger and malnutrition specifically recommended supple- ments to the diets of pregnant women and infants. All of these finds were reinforced by the subsequent House and Senate hearings on malnutrition.3~ The seriousness of the problem cannot alone explain the administration's choice; hunger among adults was an equally serious problem Food aid to pregnant women, infants, and very young children had a clearly delimited target group, a group that had a strong emotional appeal. There was a strong health rationale as well as a social welfare imperative. Existing health clinics and direct distribution outlets could handle the food packages. Since it was aid in kind, there was little basis for charges of "chiseling." More- over, the administrator of USDA's Consumer and Marketing Service, Rodney E. Leonard, had a strong interest in nutritional aid for pregnant women and infants.32 His interest, as well as the concern for the target group in the secretary's office, had been fostered in large part by research detailing permanent damage as a result of mal- nutrition in infants.33 Above all, such aid was cheap relative to other proposals for federal offensives against hunger. To feed over half of the target population of 2.1 million would cost only $42 million--a fraction of the costs of other food aid proposals. It possessed a dramatic hue in the same sense that initial expectations for Head Start envisaged taking the "ghetto" out of the child. Supplemental food for pregnant women and infants offered the future as a salve for the present. As one official noted, "ballooning" aid to pregnant women and infants was not a real solution to the problem of widespread hunger. Nonetheless, the administration chose it as a politically viable and fiscally sound response to public and congressional pressure. In the closing months of the Johnson administration, Leonard and his staff implemented the SFP. Physicians, nurses, or "other competent personnel" would prescribe nutritious food packages for pregnant women, infants, and preschool children who qualified for family food assist- ance. Initial plans called for an annual expenditure of $7.3 million to reach 250,000 people in fiscal 1969. The package would include foods rich in protein, vitamins, minerals, and iron to meet the nutritional deficiencies cited most often in hearings and studies of the target group.3 4 Even with the change in administrations, prospects for the SFP remained good. In his first month of office, Nixon had been struck by a news summary of the congressional hearings into hunger. What particularly .

99 interested the President was that "unborn children and infants are said to suffer permanent brain damage from malnutrition. . . . n He asked HEW Secretary Robert Finch and USDA Secretary Clifford Hardin for recommendations to deal with the problem. Nixon suggested "a strong statement . . . followed by some symbolic action now and a long-range program later. .~3 5 His interest in infant nutrition continued at least into March. In a memorandum to Nixon, domestic adviser Daniel P. Moynihan summarized the research into mental retardation and malnutrition. Although Moynihan noted that there was still some question about the severity of malnutrition required to produce retardation, he strongly affirmed the seriousness of the problem, adding, "once again, your concern for the first five years of life is turning out to be critical. ''3 6 The Urban Affairs Council, including Moynihan, Hardin, and Finch, issued a statement calling for the expansion of the SFP. The President's concerns translated into several other actions: an interagency task force on food programs for the poor, rapid inauguration of local supplemental food programs, and announcement of a December White House Conference on Food, Nutrition, and Health--the "symbolic action now." In July the task force issued a report, which recommended among other things ending the exclusive right of health clinic personnel to certify SFP eligibility. Although they acknowledged that this reform might lessen incentives for visiting clinics, they reasoned that the extent of health care facilities for the poor would limit the SFP and prevent needy recipients from receiving benefits .3 7 By spring 1969, Hardin and Richard Lyng, the assistant secretary of marketing and consumer affairs, who presided over the food programs, had begun a strong campaign to expand the SFP. Lyng wrote Moynihan that the research evidence linking infant and prenatal malnutrition to retardation "fully justifies our proposals to give highest priority to eliminating serious malnutrition among expec- tant mothers, infants, and small children." Moynihan enthusiastically concurred.38 In testimony before the Senate Select Committee on Nutrition and Human Needs, Hardin requested additional funds for the SFP. He proposed expansion of the FSPs into every American county, consolid- ation of the USDA's food programs into a new Food and Nutrition Service, and a pilot voucher program within the SFP "to eliminate some of the logistical problems involved in providing the supplemental food packages by taking full advantage of the private food marketing system. tt3 9

100 Hardin's proposed pilot voucher program developed from discussions among Lyng, Howard Davis of the Food Distribu- tion Division, and other USDA personnel. As a commodity program, the SFP presented several problems to the USDA in terms of policy and logistics. The decision to make food stamps the primary federal food assistance program com- mitted the USDA to replacing its direct distribution apparatus within normal commercial channels. It was incongruous to retrench direct distribution in general while expanding one relatively small in-kind distribution program. Moreover, wherever direct distribution was changed over to food stamps, the costs of storing, trans- porting, and distributing supplemental food packages became prohibitively expensive--increasing in some areas to 50 percent of the total food costs. Finally, a success- ful voucher SFP could be integrated into the FSP as bonus stamps for pregnant and lactating women, infants, and small children.40 One other, less prominent consideration was a White House idea to consolidate all welfare programs, including food assistance, within one administrative agency. Incorporating the SFP into food stamps would accord well with any transfer of the Food and Nutrition Service to another department.4~ The SFP received a serious setback when a study of the District of Columbia's program, commissioned by the Food and Nutrition Service, appeared in April 1970. In the study, the USDA's Economic Research Service found that distribution costs averaged 35 percent of parcel costs and that the transportation problems of participants reduced package pick-up to 60 percent of the certified population. Most damaging of all, the study revealed that the foods were used by all members of the household. Since the food was not consumed by the target group, it represented a food subsidy to the entire family that food stamps could provide. These findings reinforced the resolve of Lyng and Food and Nutrition Service Director Edward Hekman to consolidate the SFP with food stamps or, at the very least, make it into a voucher program.4 2 Thus, between February and May 1970, the USDA announced the start of pilot food certificate programs in five different areas. It also commissioned a study of the pilot program by David Call of Cornell University's Graduate School of Nutrition.4 3 In April 1970 the USDA prohibited any expansion of supplemental food programs into counties in which the newer FSP operated. They dropped children who were one to five years old from the SFP and eliminated powdered eggs, potatoes, and peanut butter from the packages. Four months

101 later the USDA impounded a $20-million appropriation for fiscal 1972; enrollment fell 20 percent. Indeed, all the child nutrition programs experienced financial constraint in fiscal 1971 and fiscal 1972. Employing its regulatory powers, the USDA slowed the expansion of these programs in an effort to fulfill the administration's goal of fiscal restraint.4~ The FSP would, Lyng wrote, "eliminate the need for specialized programs" and pare the government's welfare outlays.4 5 By 1971 the future of any federal program targeted to indigent pregnant women and infants rested on the pilot certificate programs, which were straightforward enough. Local welfare and health offices issued free booklets of 25-cent coupons, which could be spent for milk, infant formula, and baby cereal. Pregnant women received $5 per month through one year postpartum, and those with infants received $10 per month for one year. All food stamp or public assistance recipients were eligible, as were those referred to the program by local health clinics. Others were required to apply through local welfare offices. The program underwent evaluation between August and December 1970.4 6 Call's evaluation employed a 24-hour recall method to obtain information on the daily food intake of participants. Cross-sectional data were collected for five sample groups: food stamp and certificate recipients, food stamp recipients alone, certificate recipients alone, certificate recipients referred by clinics, and persons receiving no food aid. The sample size included one quarter of the Chicago program's participants and one half of the participants in Bibbs County, Georgia--roughly 500 women and infants. The findings devastated the program: The pilot program did not significantly increase the quantity of milk and formula intakes _ ~ ~ o~ l~l~"l~= . . . nor did it Increase their nutrient intakes. The program did not successfully increase the milk intakes of either pregnant women or mothers of infants in a consistent fashion. By implication, the income elasticity for program foods of the target families is very small, i.e., near zero. From the study the Food and Nutrition Service concluded that the pilot program "significantly influenced neither

102 the qualitative nor the quantitative aspects of the diets of the recipients." They prepared to abandon the specialized food programs.4 7 Hekman and Lyng believed that the Economic Research Service study and Call's evaluation had demonstrated the ineffectiveness of the SFP and the voucher program. They were expensive to operate, of dubious nutritional value, and not target-specific. Both science and fiscal restraint dictated retrenchment of the program; politics, however, did not. Every regulatory step the USDA took to curb the SFP evoked numerous protest letters from local health and welfare organizations and particularly vitriolic attacks by Senator Phillip Hart and Senator George McGovern. In the 1972 election year, jobs and economic growth replaced fiscal austerity in administra- tion policy. Slack purse strings and a desire not to alienate potential voters reversed some of USDA's reductions in the SFP. The Food and Nutrition Service expanded a few supplemental food programs and, employing a regulatory nuance, ceased to close programs in food stamp counties of key Southern states. A few foods previously removed from the packages were restored. That these reprieves were only temporary was nevertheless evident to nutritional aid advocates--if for no other reason, because an avowed opponent of all food assistance programs, Earl Butz, had recently been designated secretary of the USDA.48 The Beginnings of WIC Although the USDA had concluded that targeting programs to pregnant women and infants was ineffective, physicians in community clinics, children's lobbyists, state social services departments, and other supporters of such a program believed that the problem lay in the design and implementation of existing programs. The idea, they argued, remained medically and programmatically sound. To sustain their claim, advocates cited two successful local programs: one in St. Jude's Hospital in Memphis, Tennessee, and another in Baltimore associated with Johns Hopkins University. Maryland's Department of Employment and Social Services had applied in June 1972 for USDA funding of statewide infant formula programs based on the Baltimore project. Lyng rejected the application on the basis of Call's findings. In an appeal, Rita Davidson, secretary of Maryland's Department of Employment and

103 Social Services, criticized the pilot certificate program on several grounds. She attacked the program's failure "to determine the biological effects on the target group" and the nutritional status of participants. Davidson also cited the pilot program's lack of an educational component directed toward altering the buying patterns of participants and its failure to encourage the use of iron- enriched formulas for infants. Finally, she circulated copies of her letter and Lyng's response to Maryland's congressional delegation.49 Constituent concerns had created the proper ambience in Congress for support of a program targeted to pregnant women and infants. It was, however, the growing body of research into the relationship of malnutrition to mental development that inspired the WIC program. The role of nutrition in pregnancy had been a matter of controversy since World War II. Wartime studies of pregnant women receiving a prescribed diet had revealed a decline in stillbirths and infant mortality. A 1950 review by the National Research Council of maternal and child health had noted the high correlation among race, low income, and hiah infant mortality, which was attributed to mal . ~ _, nutrition and poor health care. During the 1950s, further research had questioned the strength of the connection between prenatal nutrition and infant health, particularly assertions that wartime diet alone led to lower infant mortality. During the 1960s, better laboratory techniques and more sophisticated theories enabled scientists to develop a clearer idea of the relationship between pre- natal nutrition and infant health. In November 1963 a seminal article by Dr. Joaquin Cravito appeared in the American Journal of Public Health, suggesting that nutri- tion had a direct and significant impact on mental development in young children. His thesis provoked additional research into the relationship of nutrition and mental development.50 Cumulative findings grew throughout the late 1960s and early 1970s; they affirmed with animal and human studies that nutrition was indeed critical to brain development in the fetus and infant at least until the age of two. HEW provided research funds to the Committee on Maternal Nutrition of the National Research Council's Food and Nutrition Board for a series of studies on prenatal nutrition. In 1970 the Food and Nutrition Board published a major report, Maternal Nutrition and the Course of Pregnancy, making seven major recommendations: (1) provide better-quality maternal care, including

104 nutrition; (2) accord infants, adolescents (as potential pregnancies), and pregnant women a higher priority in low-income family supplements; (3) strengthen nutritional curricula in medical schools; (4) add more nutritionists to community health facilities; (a) provide more education on nutrition; (6) disseminate more information on nutri tion; and (7) provide for the special needs of adolescent pregnancies in schools. Popular dissemination of research findings on the effects of malnutrition on brain develop- ment became so dramatic in presentation that the National Research Council's Food and Nutrition Board felt obligated to issue a position paper on the "Relationship of Nutri tion to Brain Development and Behavior" in June 1973. The board warned that "popularized summaries of results of research . . . frequently tend to misinterpret the effects or are overly simplistic in interpretation of cause and effect." _ Although the paper reaffirmed the crucial role of nutrition in mental development, it also stressed that environmental factors were equally if not more important to mental development.5~ By early 1970s the research on nutrition and mental development had reached all those concerned with food assistance programs. In August 1970 the Office of Child Development (OCD) of HEW proposed a 3-year, $2.5-million demonstration project on prenatal nutrition. Similar in design to the USDA's voucher project, the demonstration was never funded, due to cuts in OCD's research and demonstration budget. Continuing research into prenatal nutrition did impress two men, James Thornton, a staff member of the Senate Agriculture Committee, and Rodney Leonard, president of the Community Nutrition Institute. Since his tenure at USDA's Consumer and Marketing Service, Leonard had evinced a strong interest in nutrition aid to pregnant women and infants. Thornton had been struck by the research and the results that St. Jude's Hospital and the small Baltimore project obtained with selected food assistance to malnourished infants. In July 1972 they went to Senator Hubert Humphrey with a summary of the problem and a proposal for a federal program to aid pregnant women and infants. Humphrey's involvement as vice president in foreign food aid and his general humanitarian concerns for hungry children made him receptive to the proposed program, and he agreed to introduce it.s 2 During hearings before the Senate Subcommittee on Agricultural Research and General Legislation on H.R. 14896, the child nutrition bill, Humphrey submitted an

105 amended bill, S 3691, which included provision for a Special Supplemental Food Program for Women, Infants, and Children (WIC). Testifying on behalf of this bill, Humphrey cited the supplemental food program in Detroit and the Baltimore project as examples of maternal and infant feeding. He noted the repeated efforts of the Food and Nutrition Service to cut the programs and the need for a new congressional mandate. Though targeted to similar groups, WIC aid would be in the form of vouchers for specified foods known to be essential to proper nutrition. Medical examination and certification would supplant the income standard as the chief criterion of eligibility. Finally, the bill provided $20 million annually over two years. This funding level was guaranteed by Section 32 tariff revenues regardless of congressional appropriations.s 3 To support WIC, Humphrey brought in David Paige of Johns Hopkins University to testify on the effects in infant malnutrition on mental development. Paige noted the substantial improvements in infants who were fed iron-enriched formulas in a Baltimore project. Several local administrators of supplemental food programs added ~ he i r car t to the WTC amendment. Thornton and Leonard displayed photographs and X rays dramatizing brain damage from severe infant malnutrition and showed a film about the infant nutrition program at St. Jude's Hospital. They presented this visual evidence to committee members and key staff.5 4 WIC amendment. ~ ~ ,= ~ The USDA also became aware of Humphrey's Deputy Assistant Secretary Phillip Olsson wrote to Senator Robert Dole, a Republican committee member, about the feasibility study of the pilot program and the evalua- tion of the Washington, D.C., supplemental food program-- ostensibly to provide materials "relevant . . . in your consideration of the various child feeding bills," but in reality to block WIC'S report out of committee.sS Senator James Allen, the subcommittee chairman, requested an official USDA response to the WIC amendment. Assistant Secretary Lyng responded with three principal objections to WIC: the target groups included children up to age four, not just infants in the critical year of need; the ambiguity of the low-income, nutritionally at-risk criteria for eligibility; and the similarity of the program to the pilot certificate project discredited by Call's study.56 Questions raised by the USDA, the lack of more thorough hearings, and the conservative nature of~its members led

106 the committee to bring the child nutrition legislation to the full Senate without the WIC amendment. Aided by a vivid photographic display of emaciated infants and their underdeveloped brains, Humphrey engaged in a floor fight to pass the amendment. In the full Senate, Senator Allen and Senator Miller led the battle against the WIC amend- ment. Miller read the damning conclusions of Call's evaluation of the pilot program. Humphrey responded that Call's evaluation did not extend to medical data and faulted his methodology. Allen noted that WIC duplicated the SFP and had not been subjected to adequate committee hearings. Humphrey countered that the use of medically prescribed foods in WIC was unique to the program. In the midst of the exchange, Senator Carl Curtis offered an amendment to the program that specified a medical evalua- tion by the USDA and the U.S. General Accounting Office (GAO). With Curtis's provision, WIC passed the Senate by a 67-16 vote.s 7 Failing in the Senate, Lyng wrote to Representative Albert Quie, a House Republican on the Education and Labor Committee to urge that WIC be deleted in conference. He again cited ineffectiveness, duplication, and the lack of adequate congressional consideration as reasons to reject the Senate version. Humphrey, however, had already convinced Carl Perkins, the chairman of Quie's committee, to support his amendment. The conference committee retained the program, and both chambers approved the amended child nutrition bill. WIC survived, but only as a two-year experimental program subject to a rigorous evaluation prior to any extension or expansion.58 In many respects the WIC legislation was unique among children's feeding programs. It specified the protein and vitamin content of the foods to be made available to participants and outlined the target population in terms of medical requirements for eligibility. These technical requirements also strongly suggest the significant role that nutritional research played in the design of the program. Medical monitoring and general health care were integral elements. The bill mandated annual evaluation reports to Congress by the USDA and the GAO to determine the benefits of nutritional assistance and make recommen- dations with regard to its continuation. Finally, unlike all other feeding programs, results were to be measured, not only by the number of participants or the quantity of foods distributed, but also by the improvement in the health of the target population. Since the problem, the solution, and the evaluation that delimited the WIC

107 program were scientifically based, WIC held out a concrete promise of being either a demonstrable success or an incontestable failure.59 The legislation reached the President's desk in mid- September 1972. WIC represented only a small fraction of the overall child nutrition programs. The bill contained the unassailable SLP and passed without dissent in Congress. With the election only six weeks away, a veto would have been not only politically damaging but also futile. When Lyng wrote to OMB Director Casper Weinberger, he recommended that Nixon sign the bill. Turning to WiC, Lyng noted that "while this is a provision to which we initially indicated our opposition, we believe that subsequent modifications and an opportunity to fully evaluate the program make the provision acceptable." Lyng was confident that a scientific evaluation would prove WIC as ineffective as the pilot certificate and the supplemental food programs. Weinberger concurred in Lyng's recommendation. Research, he noted, had demon- strated the need for adequate nutrition at early stages in an infant's development, though Weinberger doubted the efficiency of programs in this area. The bill, however, possessed a veto-proof majority and touched the emotional issue of hungry children. There were, he concluded, no alternatives to presidential concurrence. Nixon signed the measure, praising the programs it authorized.60 WIC's enactment presented two problems to Lyng: how to obey the law without spending more money on special food programs he considered ineffective and how to deal with the mandate for a medical evaluation. He proposed to resolve the first problem by directing WIC programs into SFP areas, thus balancing WIC expenditures with SFP reductions. With regard to the medical problem, Lyng decided to attempt a transfer of the program to the U.S. Department of Health, Education, and Welfare (HEW). Explaining to HEW Undersecretary John G. Veneman that the medical orientation and the need for medical evaluation were "far beyond the abilities or resources of the Depart- ment of Agriculture," he offered the WIC program to HEW as part of its maternal and child health programs.6 2 Although enthusiastic in their support of the WIC program, HEW concluded that no legal basis for the transfer existed, and the appropriate congressional committees were unwilling to provide one. Health personnel from HEW did offer to help the Food and Nutrition Service design the program and its evaluation. 6 3

108 The evaluation was of critical importance, for, according to the law, it would determine the future of WIC. Several relevant actors had different conceptions of precisely what the program and its evaluation should contain. Once the President signed the bill, Humphrey, Thornton, and Leonard assembled a group of nutritionists and physicians to prepare a set of guidelines for the USDA in implementing the program. Humphrey and Carl Perkins jointly forwarded these guidelines to Agriculture Secretary Butz in late December 1972. "The committee stresses," their memorandum concluded, "the need for this program for at least 5 years to enable a vertical study to gather neurointegrative data. ·~6 4 Butz, of course, ignored the five-year suggestion. William Morrill, OMB's assistant director, reminded Butz that the proven ineffectiveness of existing programs of this kind and "the potential cost of reaching all the people in this target group gives great importance to the required evaluation. ·~6 5 Beyond these concerns, Hekman and Clayton Yeitter, Lyng's successor, had to consider the postelection budgetary retrenchment that the administra- tion had mandated.6 6 Above all, there was the distaste of the Food and Nutrition Service, on whose shoulders fell the administration of what they conceived to be a health program. Other actors, however, soon upstaged the lot. The Advocates and the Courts Two events in spring 1973 drew WIC out of the depths of the Food and Nutrition Service and into the light of the federal courts. The first was a Redbook magazine article by Virginia M. Hardman, titled "How to Save Babies for Two Dimes a Day." Her piece detailed the St. Jude's Hospital project of feeding malnourished infants. Punc- tuated by a series of before-and-after photographs of a malnourished infant undergoing treatment, the article pointed toward a 75 percent decrease in infant mortality among project participants. Hardman recounted the rela- tionship of malnutrition to brain cell deficiency and the relative costs of preventive nutrition and hospital care. She quoted physicians attacking the USDA's reduc- tions in supplemental food packages and limitations on food stamp allotments. Finally, the article urged all readers to write Secretary Butz or their congressional representatives to demand that the USDA implement P.L.

109 92-433 and "end delays in feeding hungry children." Redbook's circulation approached 5 million. Butz himself received over 200 letters.6 7 A more significant event occurred in spring 1973, when the delay in implementing WIC came to the attention of Ronald Pollack, director of the Food Research and Action Center, which was then a public interest law firm based in New York and Pollack its founding attorney. As far as he could ascertain, the USDA planned to implement WIC as a $5- or $6-million pilot health program sometime in fiscal 1974. Even this limited program would be executed only grudgingly. Pollack, for his part, envisioned WIC as the inception of a major federal feeding effort directed at pregnant women and infants. Only litigation could bring such an effort to fruition.6B Pollack and a colleague, Roger Schwartz, decided on a strategy to use the USDA's recalcitrance to maximize WIC's expansion. The key to their strategy was obtaining a federal court order mandating expenditure of all WIC appropriations on a cumulative basis. If they could legally compel the USDA to spend all $40 million author- ized for fiscal 1973 and fiscal 1974, the annualized expenditures of the final month of fiscal 1974 would at the very least effectively double the program's size. Moreover, every departmental delay would compress further the time available for the expenditure. Thus, if the USDA failed to begin funding WIC projects until January 1974, it would have to spend the $40 million in the six months remaining in the fiscal year. The annualized expenditure would be $80 million by the end of fiscal 1974, and a $20 million program would be quadrupled in size .6 9 In June 1973, Pollack and Schwartz filed a class action suit on behalf of potential WIC beneficiaries in the District of Columbia federal court. Submitting affidavits from Humphrey and other members, they sought to prove that Congress intended to feed needy pregnant women and infants with the authorized funds, not to sponsor a small, complex medical experiment. They asked Judge Oliver Gasch to order the USDA to promulgate WIC regulations immediately, accept local applications for funding programs, and carry over the unspent $20 million to fiscal 1974. Since Humphrey and Thornton had anticipated resistance on the part of the USDA in implementing WIC, in drafting their bill they had deliberately included mandatory language and secured the appropriation through Section 32 funds. They did this to ensure that if WIC fell victim to

110 . impoundment and administrative delays, litigation over its implementation would be successful. It was, and on June 20, Gasch granted the injunction and ordered the USDA to publish regulations for WIC by July 6, 1973. In a final hearing he ordered the unspent $20 million carried over and added to the fiscal 1974 authorization.70 Complying with the court order, the Food and Nutrition Service issued final regulations in July, but due to time constraints took the extraordinary step of refusing prior public comment on them. Though they fulfilled the court order and incorporated the nutritional requirements of the legislation, critics believed the regulations to be a form of impoundment through obfuscation. Lack of public comment and the requirement of extensive demographic data made the application process very cumbersome. The Food and Nutrition Service also planned to designate pilot areas by September 1, 1973, and begin feeding operations one month later. The October date was crucial to con- ducting an adequate medical evaluation by the end of fiscal 1974.7i Despite these plans, which the USDA had prepared for Gasch's scrutiny, Food and Nutrition Service Director Edward Hekman still resisted implementing the program. He wrote Yeutter that "it is clear to us that Agruculture is not the appropriate administrator of this program--and that the effort to administer here can only harm both the Department and the program." Yeutter responded that WIC was probably here to stay and that the Food and Nutrition Service should "make this program work as smoothly as possible." Although political considera- tions precluded him from saying so at the time, Yeutter supported WIC.7 2 Hekman recognized that the court decision had trans- formed WIC radically. From "a small pilot program designed only to provide medical evaluation of food intervention" to a feeding program, WIC would double in size between fiscal 1974 and fiscal 1975, if the court did not modify its injunction. Hekman requested that the U.S. Department of Justice ask Gasch to stay the carryover mandate. The Food Research and Action Center, too, was preparing to return to court--this time to obtain a civil contempt citation against Secretary Butz for failing to name any WIC grantees. In the ensuing legal confrontation in October, Pollack argued that regardless of annualized program level, Congress had intended all $40 million to be spent and the USDA had failed to obey the law and the court. Noting that the jails were overcrowded and that Butz was probably incorrigible anyway, Gasch declined to

111 cite Butz for contempt. He did, however, reaffirm his order that the USDA spend all $40 million authorized for WIC in fiscal 1974. In the remaining months of 1973 the Food and Nutrition Service named 143 grantees, and it began funding the program in January 1974.7 3 WIC's operation was relatively simple. The Food and Nutrition Service provided cash grants through a U.S. Department of Treasury letter of credit to approved state health departments and Indian tribes for distribution to approved local clinics. Participants included pregnant women to six weeks postpartum, lactating women to one-year postpartum, and infants and children to four years of age. Eligibility rested on three criteria: residence in the approved project area; qualification for a clinic's free or reduced health services; and determination by a compe- tent professional to be at nutritional risk due to anemia, inadequate growth or nutritional pattern, or a history of high-risk pregnancies. A woman and her children would come to the clinic to be certified as eligible and would be placed in the program's delivery system. Food could be delivered through vouchers, home delivery, direct distribution, or any combination of the three. The types of foods were restricted to iron-fortified infant formula or cereal, fruit juice, milk, cheese, eggs, and vegetable juices. WIC allowed 10 percent of the program costs for local administrative expenses. Finally, the Food and Nutrition Service contracted with Joseph Endozien of the University of North Carolina's School of Public Health for a detailed medical evaluation.7 4 By the close of fiscal 1974, WIC was operating at an annualized level approaching $100 million. Due to expire in June, congressional supporters proposed an extension of WTC through fiscal 1975 with a $100-million authoriza- tion level. To their original arguments about the critical role of nutritional aid to the target groups, supporters added the USDA's attempts to scuttle the program and the need to allow sufficient time for a proper evaluation. To the program's benefit, Congress was waging a major battle with the administration over impoundments; WIC had been a significant legal victory in this confrontation. Finally, to fund the program at any lower level would involve expunging some pregnant women and infants--a politically unwise move in any contingency. As McGovern noted, this authorization level "represents little more than maintenance of the status quo." In conference the Senate funding level, $131 million, and that of the House, $70 million, were reconciled. Congress

112 voted overwhelmingly to renew WIC and mandated expendi- ture of the $100 million plus any carryover funds in fiscal 1975 .7 5 Richard L. Feltner, Yeutter's replace- ment as assistant secretary for marketing and consumer affairs, wrote OMB Director Roy Ash that USDA favored signing the child nutrition bill, including WIC. He explained that WIC's annualized level was approximately $100 million and that the almost unanimous support of Congress made a veto pointless.7 6 OMB's budget examiners vigorously opposed WIC's expan- sion "to a level of unsubstantiated perpetuation." The 150 percent increase in funding "would eliminate vestiges of the original demonstration character [and] lock the Food and Nutrition Service into a program whose effectiveness is highly questionable." In his recommendation to the President, OMB's assistant any director noted the staff's objections, but acquiesced to a higher political reality. "On the merits, and in terms of its effects on the budget, HR 14354 [the WIC authorization] is clearly undesirable. However, in view of the wide- spread support for 'programs to feed hungry children,' as evidenced by the congressional votes, a veto of this legislation would most likely be overridden and would therefore be counterproductive. t'7 7 The President signed the bill into law. To ensure that the USDA spent the entire authorization and any unused fiscal 1974 funds, the Food Research and Action Center returned to court in July and obtained Gasch's order stipulating these expendi- tures. Defeated in court and in Congress, Feltner and Hekman, working with OMB, began to rethink their approach. Several policy imperatives were still operative in the USDA: elimination of direct commodity distribution, avoidance of any federal responsibility for delivery systems, and, above all, reduction of food assistance costs. Feltner and Hekman had resigned themselves to the fact that WIC was no longer a pilot but a permanent program. Their problem was that Congress had mandated the maintenance of the SFP in any area that chose to retain it, despite the replacement of direct distribution programs with food stamps. Local SFP administrators were bringing pressure on the USDA through Congress to provide additional federal funds to support the increased delivery costs, once direct distribution programs ended. Faced with further increases in what was already an enormously expensive program to administer, Feltner believed that the only way to reduce outlays and avoid involvement in commodity delivery systems was to replace the SFP with

113 WIC. He hoped to facilitate this replacement by quickly approving Georgia's applications for WIC programs in order to solicit the aid of Senate Agriculture Committee Chairman Herman Talmadge of Georgia in removing congres- sional constraints on the USDA's elimination of SFP.78 Whatever savings the changeover from the SFP to WIC might achieve represented a small fraction of the $2- billion child nutrition programs. Only a wholesale reorganization of these programs would yield any substan- tial savings. Toward this goal the OMB prevailed on Feltner to accept a block grant proposal similar to Title XX of the Social Security Act. Each state would receive sufficient funds to provide one third of the recommended dietary allowance for all its needy children. State officials could then decide how to allocate those funds. Overlapping programs and some federal administrative costs would be eliminated. The proposal would reduce outlays by $500 million. Moreover, it would take the USDA to a large extent out of the food assistance business--something Secretary Butz ardently desired. There were, however, serious difficulties in any legislative realization of the proposal.79 A grand reorganization, such as block grants, risked opening the child nutrition programs to an equally grand expansion by congressional supporters. Without concrete proposals for each nutrition program, committee advocates could discard the administration's proposal outright and substitute legislation antithetical to budget restraint. Practically all relevant interests groups, particularly educators, food service organizations, health admini- strators, PTAs, and agricultural lobbies, would resist any decentralization that might vitiate their influence on programs and policy. Terminating these federal programs would subject the administration to the political onus of abandoning the nation's children. Moreover, the Watergate scandal, which resulted in a Republican debacle in the midterm election, had brought a new infusion of liberal Democrats into a Congress already weighted against the administration. Finally, the legislation would have to pass through the House Education and Labor Committee, whose chairman, Carl Perkins, considered the SLP his special child. In retrospect it is not difficult to understand why Feltner had second thoughts about intro- ducing the block grant proposal in 1975. OMB, however, decided to go ahead.~° The 94th Congress ignored the administration's pro- posal; no bill containing it was introduced. Instead,

114 . Feltner's worst fears were realized. The House and the Senate produced child nutrition bills that exceeded administration requests by $1 billion. In the House, Representative Perkins offered a child nutrition bill, which included a 3-year, $200-million WIC authorization; the Senate version provided a $300-million authorization. Both bills had been written in large part by the Food Research and Action Coalition. Since the Endozien evaluation had not been completed, advocates within and outside Congress relied on a program survey of WIC clinics by the Senate Select Committee on Nutrition and Human Needs. Local clinics reported substantial birth-weight gains and declines in anemia, stillbirths, and infant mortality among participants. Their written reports, supplemented by testimony at committee hearings, were convincing. Indeed, Congress revised the language of law establishing WIC. Its preamble now read: "The Congress finds that substantial numbers of pregnant women, infants, and young children are at special risk in respect to their physical and mental health by reason of poor or inadequate nutrition or health care, or both. . . . [T]he purpose of this program . . . is to provide supplemental nutritious food as an adjunct to good health care during such critical times. . . ." The tentative tone of the earlier legislation was gone. After the first floor debate over WIC in 1972, no real congressional controversy surfaced over subsequent expansions of the program. Evidence of WIC's success, the political appeal of feeding infants and pregnant women, and the attention focused on funding levels for the huge SLP combined to facilitate WIC's unmolested passage through Congress. The single issue the program raised was the funding authorization. Though not an entitlement program in the strict sense due to its spending ceiling, the WIC legislation did guarantee the entire authorization with Section 32 funds. Regardless of House Appropriation Committee action, WIC would receive all the funds authorized and the USDA would be compelled to spend them. Some members of Congress had problems with this method of appropriation. It circumvented the House Subcommittee on Agricultural Appropriations. It also violated provisions of the Budget Control Act, which sought to replace executive impoundment with congressional spending ceilings. Finally, mandated spending might cause unwise expansion of the program merely to obey the law. Supporters responded that such a worthwhile program required guaranteed funding in the face of the USDA's

115 continuing resistance to implement WIC according to the wishes of Congress. Entitlement supporters triumphed; the USDA's recalcitrance had again resulted in expansion of the program.8 2 Once disagreements over the lunch subsidy were resolved, Congress passed the child nutrition legislation by large majorities. As it had all along, the USDA opposed passage due to the high costs. In their view the lunch subsidy increase was inflationary. They wanted WIC extended only one year, pending Endozien's evaluation report. Butz advised the President to veto the bill. OMB concurred; the legislation cost too much, aided children who were not in need, and expanded WIC pre- maturely. On October 3, 1972, Ford vetoed it, citing inflationary pressures and the concomitant dangers of recession. WIC itself went unmentioned in his veto message. Within four days, Congress overrode the veto and the $250-million WIC program became law.B 3 The administration's whole approach to child nutrition programs was in shambles. The USDA complained to OMB that "had the Department been in a position to discuss specific amendments on their merits, nothing of this magnitude [of budget increase] would have occurred, but, of course, the Department was in no such position, having been compelled to argue against all existing programs for a block grant." Republicans in Congress were also incensed by OMB's approach. Minority leader John Rhodes wrote the President a letter criticizing the tactics of OMB and the administration. "It is difficult," he railed, "for Republicans to sustain a veto or become enthusiastic under these kinds of circumstances. Late transmittals of the proposal, lack of proper groundwork, and the absence of congressional input accounted for the dismal vote of 397 to 18 overriding the veto."8 4 The revised WIC legislation expanded the program in several respects. WIC now included children up to five years of age. Congress ordered the secretary of agri- culture to "take affirmative action to insure that programs begin in areas most in need of special supple- mental food." The law required him to convene an advisory committee of representatives from the Maternal and Child Health Service, the Center for Disease Control, the U.S. Public Health Service, the American Academy of Pediatrics, the National Research Council, the American Dietetic Association, the American Public Health Association, and others "as the secretary deems appro- priate," to suggest the best methodology for evaluating

116 . the health benefits of WIC. The law also established the National Advisory Council on Maternal, Infant, and Fetal Nutrition, consisting of six state, local, and federal WIC administrators from various geographic regions, two parent recipients, two physicians, one retail food distri butor, and two HEW and two USDA employees experienced in maternal and child nutrition. The council would study WIC and any related program and report annually to Con- gress and the President its findings and recommendations. Finally, the legislation authorized a funding level of $250 million from fiscal 1976 through fiscal 1978. Defeated in Congress, OMB formulated a scheme to decelerate WIC's expansion and reduce costs in fiscal 1977. They suggested to the USDA a continuation of the now familiar tactic of replacing the SFP and pilot certificate programs with WIC to offset expenditures and cuts. Their new idea, however, rested on a fiscal quirk: the transition quarter. In 1976 the federal government changed its fiscal year from July through June to October through September. Due to the transition, there would be a three-month hiatus during July, August, and September 1976. Instead of prorating the appropriation for WIC (the standard procedure), OMB required that the USDA - spread the S250-million authorization over five quarters-- a procedure that cut the program by 20 percent. After discussions with Feltner and Hekman, Butz informed OMB Director James Lynn that the USDA could not legally compel an SFP area to switch to WIC. Moreover, the aggregate caseload of the SFP, the pilot certificate program, and WIC would exceed the $250-million level and invite a funding increase. Butz suggested instead elimination of the pilot certificate program and a 25 percent reduction in the SFP; he did agree to spread the authorization over five quarters.Bs The consequent slowdown in WIC's expansion did not go undetected. The program's growth had spawned an informal network of health clinics and clients participating in the program. Coordinated in Washington by Stefan Harvey of the Children's Foundation, letters, phone calls, and meetings could be employed to make key members of Congress aware of problems in the program. The American Academy of Pediatrics had also lent its prestige to WIC. When the five-quarter spread of WIC's funds became known, supporters complained to Congress and obtained a House resolution ordering the Food and Nutrition Service to spend $250 million in fiscal 1976. In Senate committees, McGovern and Kennedy attributed this impoundment to

117 election-year politics. The President, they argued, was merely responding to Reagan's conservative challenge in the primaries. As evidence they compared Ford's loudly trumpeted fiscal conservatism regarding programs to aid children with his well-publicized, avid support of the largest peacetime military budget in history. Despite this resolution and congressional committee badgering of USDA officials, the pace of expansion remained measured.86 Confronted by the USDA's intransigence, the Food Research and Action Coalition, in consultation with other advocates, brought another class action suit in federal court, Durham et al. v. Butz et al. Pollack again argued that the USDA had failed to execute the law. He asked Judge Gasch to enjoin the USDA from withholding WIC funds and order them to spend all the authorized money plus any previously impounded funds. The transition quarter, he insisted, should be included on a pro rata basis. Gasch concurred and ordered the USDA to spend $562.5 million plus any carryover funds from fiscal 1974 and fiscal 1975 before September 1978. The judge further required the Food and Nutrition Service to submit quarterly reports to the bench and to the Food Research and Action Coalition detailing WIC's progress. In signing the consent decree, the USDA agreed to distribute funds using the Title V formula of the Social Security Act and to recover all unspent funds each quarter for redistribution to states capable of increasing their WIC caseloads further.8 7 Program Evaluations Delayed for over a year, the long-awaited University of North Carolina medical evaluation of WIC appeared in July 1976. Under the direction of Joseph Endozien, 100 clinics in 14 states provided data from periodic examinations of WIC participants between February 1974 and May 1975. They examined pregnant women every trimester and infants at birth, 6 months, and 11 months. Clinics measured weight gain, birth weight, height, head circumference, anemia, infant mortality, and prematurity. Dietary intake was recorded through 24-hour recall. In all, the study included 6,300 infants and 5,400 women. The data were collected and analyzed at the university. Endozien concluded that infants in WIC envinced increases in weight, height, head circumference, and mean hemoglobin concentration; anemia decreased. With the exception of eggs, intake of foods provided through the WIC program

118 rose for participants. According to the evaluation, the program was an unmitigated success. Despite its scope, the evaluation had begun and remained under a cloud. AS early as September 1973, the GAO issued a report to Congress questioning the practi- cality of any medical evaluation of WIC. Again in December 1974, the GAO restated their concerns over the value of any evaluation. There were four salient problems "inherent in human nutrition evaluations": (1) lack of precise definitions of good health and adequate nutrition by which to measure deviations, (2) lack of precise deter- mination of the types or quantities of nutrients necessary to improve nutrition status and assess the impact of supplemental foods, (3) lack of control groups to allow accurate attribution of the causes of improvement in test groups, and (4) lack of adequate indicators of mental development to ascertain improvement in infant development due to the program. The GAO concluded that these problems "cannot practically be overcome and must be recognized as precluding a conclusive determination of the program's benefits."89 An earlier draft of the report had recommended cancel- lation of the evaluation contract. It found Endozien's data unreliable due to variations in the clinic personnel taking participants' measurements. To forestall this recommendation the USDA went to staff of the Senate Select Committee on Nutrition and Human Needs and convinced them to pressure the GAO into dropping it. It was deleted, but a subsequent report did proffer such a recommendation. Continuing criticism of the evaluation led Feltner to contact President William C. Friday of the University of North Carolina, complaining that reviewers had found that the evaluation "lacks scientific credibility in some essential areas of the study." Endozien, he continued, had not been sufficiently responsive to these criticisms. The money, time, and importance of the evaluation demanded a better product. Friday responded that changes would be forthcoming.90 Some minor alterations and its multi- million-dollar investment finally induced the USDA to release the evaluation to Congress in spring 1976. Concomitantly, Feltner forwarded to Congress another USDA-commissioned study of WIC's delivery system. Con- ducted by the Urban Institute in April 1975, the study evaluated the efficacy of WIC's operation as a service provider to its target group. The institute sampled 96 clinic administrators and 3,600 participants in a nation- wide survey of WIC. Rich in detail, the study found 80

119 percent of the participant households used WIC foods for family meals. Although 63 percent of the clinics pro- vided nutritional counseling, only 12 percent of the participants indicated they had learned anything about better nutrition. The study noted increases in clinic visits for participants: 14 percent for women, 27 percent for infants, and 77 percent for children. These increases resulted from the requirement of most local clinics that all WIC participants enroll in health programs. The average monthly cost per participant was $20 for food and $4.92 for administration. The study observed that people with the lowest incomes tended to have difficulties in visiting clinics and thus often failed to participate. However, it also found that 96 percent of the partici- pants were satisfied with the program.9i Ostensibly, these two evaluations armed Feltner and the USDA with powerful weapons to retard WIC's expansion. The GAO and some members of the scientific community had repudiated Endozien's medical evaluation. The Urban Institute study had reaffirmed Call's basic findings that targeting food to specific family members was ineffective and nutritional instruction had failed to alter sharing among family members. Yet Feltner declined to make any recommendation based on the evaluations. The USDA was committed to the administration's grant proposal for child nutrition programs. Although privately Feltner discussed the possibility of incorporating WIC into food stamps, he made no public comment on specific programmatic changes for fear of undermining the administration's proposal. The USDA's refusal to relent on the block grant position allowed the advocates and the courts to dictate the course of WIC.9 2 The third and most recent nationwide study of WIC became available in late 1977. Produced for the Food and Nutrition Service by the Center for Disease Control in HEW, the work analyzed medical data submitted by WIC clinics throughout the country on 5,692 children. In many respects the study replicated Endozien's evaluation. In the wake of the flap over the Endozien evaluation, the Center for Disease Control carefully qualified its conclu- sions by noting the strong possibility of sampling and measurement errors. States submitting data, the study noted, "represent some of the better WIC programs." The study warned that "these data must not in any way be considered representative of the WIC Program as a whole." Having made these qualifications, the study found that children entering WIC evinced a high prevalence of anemia,

120 linear growth retardation, and excessive weight. One year of program participation improved hemoglobin and hemato- crit values, increased weight-to-length ratios and linear growth, decreased proportion of infants with low birth weights, and curbed some overeating. The study suggested that more stress be given to nutritional education as a necessary adjunct to food assistance in combating mal- nutrition. The researchers were very cautious in present- ing their findings, but it was their conclusions, not their reservations, that received all the attentions 3 To supporters of WIC the study by the Center for Disease Control and the Endozien evaluation simply rein- forced their convictions about the program's effective- ness. They attributed questions concerning the scientific credibility of these studies to the nitpicking to which any evaluation of this size and complexity was vulnerable. From the Urban Institute's work they pointed to the sharp rise in clinic visits as further evidence of WIC's value. Supporters pushed for more nutritional education to curb the sharing of WIC foods among family members. With much the same perspective they reinterpreted Call's evaluation of the pilot program. In passing, Call's study had noted the prevalence of anemia among program participants; WIC advocates forgot Call's evaluation and instead seized on the anemia findings to bolster their case. An evaluation that had questioned a program's efficacy was thus trans- formed into a nutritional survey that affirmed its need- From the advocates' perspective it was just as difficult to disprove WIC's benefits as to prove them. As long as the need remained Incontestable, which indeed it did, a programmatic response directed at pregnant women and infants could not be proven by science to be a political mistake.9 4 The Carter Years In the year of Proposition 13, perhaps the Democrati presidential victory can be best viewed as a change of men rather than of measures. The new men and women in ,c the USDA, however, presaged significant changes in nutrition policy. Bob Bergland, the new USDA secretary, noted at the outset that he was "firmly committed to a broad-constituency department which includes a compre- hensive food and nutrition policy." He created a new assistant secretary for food and consumer affairs--a position filled by Carol Tucker Foreman, former president

121 of the Consumer Federation of America. Lewis Straus, director of the National Child Nutrition Project in New Jersey, became administrator of the Food and Nutrition Service. Two of Foreman's principal staff members, Robert Greenstein and Jody Epstein, worked in the Community Nutrition Institute and the Children's Foundation, respec- tively, before very different joining USDA. These people represented backgrounds from such agricultural econo- mists as Lyng, Yeutter, and Feltner, who had presided over nutrition and food assistance programs in prior years.9s Many of these personnel changes were made possible by the new assistant secretary's office. Bergland had separated the Food and Nutrition Service from its former place under the assistant secretary for marketing and consumer affairs. This move allowed the assistant secretary presiding over the Food and Nutrition Service to concentrate on food assistance and nutrition instead of on marketing soy beans or cotton. The Ford administra- tion's block grant proposal was dropped as was any thought of incorporating WIC into the FSP. Indeed, now that the advocates who had been fighting for food assistance and nutrition programs were in power, the USDA accorded WIC a new status as its leading initiative against malnutrition. Despite an auspicious beginning, three serious challenges threatened WIC in the first years of the Carter administration. The first came in the form of a short article on WIC by Joel Solkoff in the New Republic. Based loosely on his brief work with the congressional Joint Economic Committee, Solkoff presented a sketch of WIC's development and impact that in attempting to be iconoclastic, sounded sophomoric. His attitude toward the problem was ambiva- lent; he at once ridiculed an effort to deal with a problem he admitted to be serious. Moreover, he seemed to conclude, though Its ambiguous prose precludes defini- tive judgment, that WIC was a necessary and useful program after all. Ordinarily such an analysis would be rewarded bv obscurity. That issue of the ~ , however, ,~, was devoted entirely to the Carter administration s first months in office. Solkoff's piece also found its way into the Washington Star. Consequently, a synopsis of = _ ~_e _~ ~ ADA ~ ho ~r==iA=nE tic Cook Carter, White House aide Lynn Daft told Foreman, was Upset by it.9 6 Immediately after its publication, Deborah Norelli, the leader of the Joint Economic Committee project on WIC in which Solkoff had participated, wrote to Bergland to nab AL L-lL;l~: L~CZ-1IC~ CHIC ~ ·=~-~''~

122 repudiate the article and its connection to committee findings. "Mr. Solkoff's article," she told the secretary, "misrepresented our research findings in both its substance and tone." Project findings "did not suggest that WIC was either a wasteful or ineffective program." It "has been a valiant effort to achieve a monumental objective." The implication of Norelli's letter was clear: Solkoff had been more interested in selling a manuscript than in analyzing a program. At Foreman's suggestion, Bergland forwarded Norelli's letter to the White House. The matter was laid to rest.9 7 The second challenge to WIC surfaced in a HEW reorganization memorandum submitted to OMB in 1977. Prepared by the Office of the Assistant Secretary for Planning and Evaluation and the Bureau of Community Health Services, the memorandum stated that n in HEW's view, it is essential that the Special Supplemental Food Program for Women, Infants, and Children be administered directly by HEW. . . ." Beginning with a historical sketch of nutri- tional aid to pregnant women and infants, which heavily stressed HEW's role, the memorandum focused on four reasons why the program should be transferred: it is basically a health program; interdepartmental administra- tion caused duplication and confusion at the local level; monies from the Bureau of Community Health Services supported much of WIC's administrative costs; and the USDA had not demonstrated, until recently, any great concern for WIC.98 At stake were several things, primarily the question of who should spearhead the expansion of community health services. WIC regulations mandated that each program area provide health services to participants. Rapid extension of WIC programs had seized the initiative, to some extent, from the Bureau of Community Health Services in extending clinical services throughout the country. WIC's popularity in Congress and among health advocates made it a compelling acquisition; it would add more than $500 million to the budget of the Bureau of Community Health Services. There was also, according to staff of the Food and Nutrition Service, some jealousy among the professionals of the Bureau of Community Health Services at the success of the preventive and self-care orientation of WIC's nonprofessional administration under the Food and Nutrition Service. Finally, there was great appeal to health care providers in a program that contained health costs through prophylactic feeding.99

123 These plans of the Bureau of Community Health Services for WIC went nowhere. The USDA wanted to retain WIC as its showpiece of food assistance programs. Its admini- strators were enthusiastic supporters of the program. Key members of Congress and the relevant committee staffs opposed transferring a successful, politically popular program for any reason not divinely ordained. Advocates in the Children's Foundation and the Food Research and Action Center also opposed turning WIC over to HEW, since their brethren now occupied the chairs of authority at the USDA. Everyone involved in WIC, outside the Bureau of Community Health Services, was reluctant to see it assimilated into the health services leviathan at HEW. The program survived its second challenge.~°° The final challenge was the legislative authorization of WIC due to expire at the close of fiscal 1978. The process of renewing the program and its budget was less a battle than an interaction among USDA administrators, advocates, and members of Congress to reach a consensus on the shape of WIC over the next few years. At the outset there was unanimity on more than doubling the program's funding level in fiscal 1979. the Durham decision dictated this increase. In large part By September 1978, WIC's annualized expenditure reached $440 million. There were other issues involved in the funding level, the most important of which was WIC's authorization for fiscal 1980. Fiscal 1980 would be the first year in which the provisions of a court order would not determine the annualized expenditure level. Without this impetus, Conoress would have to decide the extent of WIC's expan _ sion on the program's merits and not simply to avoid cutting participants. Since the USDA took the budget one year at a time, this question devolved largely on Congress. The USDA did have a significant role in WIC's fiscal 1979 budget. Foreman originally proposed $614.S million, but in response to Bergland's concerns about spending scaled it down to a $600-million request with a $550- million "minimum line." She explained to Bergland that WIC was critical and expansion was necessary. In an attachment, probably prepared by program personnel, WIC was described as "perhaps the most effective nutrition and health program operated by the federal government today." The attachment cited the evaluations by Endozien, the Center for Disease Control, and the Urban Institute (for clinic visit increases) to support the budget request. It also noted two recent state health

124 department studies in Arizona and Oregon that reported improvements in birth weight, anemia, and infant mortal- ity. Although Foreman's plea convinced Bergland, OMB reduced WIC's funding to the minimum figure of $550 million and, subsequently, to $535.5 million.~°~ Perhaps the more controversial departmental decision was to drop entitlement language from their proposed bill. Generally speaking, entitlement legislation requires the dispensation of benefits to any person or institution meeting the prescribed legal requirements. The authorization itself creates a legally enforceable claim to benefits and preempts the appropriations process. Both the court decisions and the language of the 1975 legislation had accorded WIC entitlement status up to the authorization ceiling. The principal justification of this language was the Ford administration's relentless efforts to eliminate the program. Since the USDA had turned completely about on WIC, there was little reason to continue entitlements to protect the program from administrative recalcitrance. Still, WIC's strongest supporters, the Children's Foundation and the Food Research and Action Coalition, convinced Senator Muriel Humphrey, Senator George McGovern, and Senator Robert Dole to preserve the entitlement language in the bill they introduced. Entitlement, they believed, would maximize the recipient population.) 02 Humphrey's bill differed from that of the administra- tion in two other respects. It specified authorizations of $650 million in fiscal 1979 and $850 million in fiscal 1980 and provided for the maintenance of three- and four-year-olds in the program. To deal with OMB budget reductions the USDA proposed to exclude children over two from participation. Foreman attributed this revision in part to an effort to reduce program redundancy, though only half of the children to be eliminated from WIC received any other federal food assistance. More impor- tant, she approved the revision to make the best use of limited resources. She pointed out that research on malnutrition and brain development had demonstrated that critical cellular growth occurred prior to a child's third birthday. Children under three were therefore the most vulnerable to permanent neurological damage from malnutrition.~° 3 Foreman explained her reasoning to the Senate Select Subcommittee on Nutrition and Human Needs in testimony on the administration bill. Senator Dole and Senator Bellmon emphasized that this change would leave most needy three

125 and four-year-olds without any food assistance. It would cause older preschool children to share food with their younger siblings still in WIC and result in less food for the most critical age groups. "I tend to be kind of a tightfisted budgeteer," Bellmon admitted, but "not to the point of letting a 4-year-old go hungry, if they are needing food." Foreman expressed her empathy with his point of view but added, "if you have a limited number of dollars, you have to make choices." "I am not," Bellmon responded, "going to be the one who stands up on the Senate floor and says that we are letting 4-year-olds go hungry. . . . [We] will have an amendment to feed these kids." Congress retained children up to age five in WICK 04 The funding question was not resolved so easily. It soon became evident that program supporters would not settle for less than a four-year authorization to secure WIC's future. Without entitlement language, however, the authorization would act only as a ceiling; actual funding levels would be subject to appropriations. Enthusiasm for WIC was much greater in the House Education and Labor Committee and the Senate Subcommittee on Nutrition than in their respective appropriations committees. In terms of both principle and power, the appropriations committees disliked any legislation that circumvented their purview. Consequently, the House Appropriations Committee proposed to amend the WIC bill reported out of the Education and Labor Committee to disclaim specifically any entitlement provision. In the Senate Appropriations Committee, Senator Thomas Eagleton amended the Senate bill to reduce the fiscal 1979 authorization to $550 million and the entitlement provision to two years, fiscal 1979 and fiscal 1980. Despite "seriously consider[ing] deleting entitlement altogether," Eagleton's committee concluded that the unusual history of WIC--impoundments, litigation, and court decisions--constituted "good and compelling reasons to retain a 2-year entitlement."~°S The two amended bills passed their chambers without opposition and went into conference in the preadjournment pandemonium of October 1978. Basically, the bills differed in the entitlement provision and in the authoriz- ation levels. The House provided $650, $850, $900, and $950 million from fiscal 1979 through fiscal 1982; the Senate provided $550, $800, $900, and $950 million over the same years. In conference the negotiations were not so much between the Senate and House as among House members. Carl Perkins, chairman of the House Education

126 and Labor Committee, agreed to rescind a provision in the child nutrition bill, of which WIC was a part, mandating expansion of school breakfast programs within the states. In return, House Appropriations Committee representatives acceded to the entitlement language and the Senate's authorization levels. The bill passed both houses by voice voted 6 Congress's confidence in WIC is reflected not in the fiscal 1979 authorization, which the annualized partici- pation level of fiscal 1978 had largely determined, but in the fiscal 1980 authorization of $800 million. In effect they elected to double the program over current levels with the fiscal 1980 authorization and guarantee that increase by entitlement. The effective organiza- tional work of the Children's Foundation rallied constitu- ent support for WIC. Its link to the SLP legislation undoubtedly helled ensure passage. Though the infant . formula companies and milk producers supported the program, their impact was minimal. WIC's political success was due to the Mom-and-apple-pie appeal of feeding medically and financially needy infants, children, and pregnant women as well as the persuasive scientific evidence that it reduced mortality, prematurity, anemia, and the possibility of neurological damage. Moreover, the program promised to reduce future health care costs "For every day," one physician testified, "that I can keep a baby inside a well-functioning uterus, I can save somebody $600, because that is the cost in my hospital to maintain a premature infant in our intensive care nursery." A potential savings of $30 billion Her vear, it was argued, could be realized with the elimination of nutrition-related illnesses.~° 7 The purported evidence of WIC's salutary impact on health care cannot be overemphasized in explaining the program's backing in Congress and the USDA. Suggestions from some local WIC administrators to drop the medical requirements for participation were rejected. Congres- sional supporters wanted to maintain WIC under the medical penumbra to avoid any welfare stigma. Though all agreed that low income was the surest criterion of medical need for nutritional aid, very few WIC advocates wanted to forsake the politically persuasive scientific data on its efficacy that the medical requirement yielded. Writing to Secretary Bergland, McGovern and Humphrey summed up the source of the program's appeal to policy makers: "We believe WIC is the best conceived of all the food delivery programs. It is the most target specific and health

127 oriented of all the programs, its effects can be specifi- cally evaluated, and its participants have made available to them a full range of preventive health services."~°8 Toward the end of October 1978 the child nutrition legislation went to the White House for signature. Although it was only a small portion of overall expendi- tures for child nutrition in past years, WIC would account for one quarter of those outlays within two years. The program's fiscal 1979 authorization level, which exceeded the administration budget by $15 million, presented little difficulty. In fiscal 1980, however, the authorization rose another $250 million--a level guaranteed by entitle- ment. The fiscal 1980 figure exceeded OMB allowances by $200 million. OMB recommended that the President veto the WIC extension. ~ ~ . Since Carter had publicly committed himself to severe budget reductions in social welfare programs to curb inflation, following this advice became a real possibility. Robert Greenstein, of Assistant Secretary Foreman's staff, prepared two letters for Bergland's signature, one for OMB Director James McIntyre and another for Domestic Affairs Advisor Stuart Eizenstat, recommending that the President sign the bill. Though following similar lines of argument, the letter to Eizenstat was more comprehen- sive and politically astute. Expanding WIC, Greenstein argued, had resulted from a major policy decision within the USDA to concentrate resources on the most effective nutritional programs. Medical evidence of WIC's effects attested to striking reductions in anemia, mortality, and low birth weight. To counterbalance this budget increase, the USDA was determined to reduce expenditures for the nonneedy or the less effective SLP by $130 million. Greenstein cited an upcoming Congressional Budget Office study that demonstrated that lunches did not improve the nutritional status of children from households with incomes more than twice the poverty level. "The findings should in the current atmosphere of concern over aovern ment spending, make it possible to secure strong and influential support on Capitol Hill" for this reduction, he noted. He concluded that this savings and a $50- million cut in the fiscal 1980 WIC authorization would compensate for the increase mandated in the legislation. In closing, Greenstein noted that after fiscal 1980, all WIC authorizations were subject to regular appropriations procedures and therefore more open to fiscal management.~09

128 . The letter to Eizenstat pointed out the political realities of the situation. WIC possessed broad congressional support spanning the ideological spectrum. A veto would only invite criticisms that the President was insensitive to human suffering, inept at choosing where to cut spending, and shortsighted in ignoring the potential savings in health care costs afforded by a prophylactic nutritional program. Moreover, a veto would be challenged as the first order of business in the 96th Congress; it would poison the administration's efforts, as it had destroyed the Ford administration's efforts, to reduce costs in less effective child nutrition programs. "In Congress, even in the current political atmosphere, the WIC program is a 'motherhood and apple pie' issue . . . [because it] has one of the most remarkable records of achievement of any domestic social program." A veto, Greenstein's letter concluded, was foolhardy.~° After obtaining McGovern's assurance that WIC's fiscal 1980 authorization would be pared by $50 million, Carter signed the child nutrition bill into law in November 1978. NOTES t Bruce McClure, Secretary, Federal Emergency Relief Administration to Frederick Daniels, July 7, 1933, "Policy," Old General Subject Series, 69, NA; Children and Youth, III, 1437. 2 P.L. 74-320; Hearings before the Senate Committee on Agriculture and Forestry, 78:2 (May 2-5, 1944), 8; Studies of Human Need, Senate Select Committee on - Nutrition and Human Needs, 92:2 (June 1972), 45-46. 3 Baker, Century of Service, 182-188. Murry R. Benedict explains the USDA movement into food distribution: "The early [pre-1935] emphasis on reduced production gave rise to much pub' ic opposition. . . . There was a growing feeling both within and outside government that more attention needed to be given to supplying adequate food to all groups, instead of curtailing production when the overall supply was no more than adequate to provide a good diet for the entire population." He further notes that nutritional research reinforced this "feeling." Farm Policies of the United States, 1790-1950 (New York, 1953), 384-386. 4 H. R. Tolley, Surplus Marketing Administration, USDA, to Colonel F. C. Harrington, WPA Commissioner, March 22, 1940, General Subject Series, RG 69, NA;

129 Florence Kern, Acting WPA Commissioner, and H. C. Albin, Chief Distribution and Purchase Division of the Surplus Marketing Administrations, August 1, 1940, ibid. 5 these and other booklets are collected in Box 1, Food and Nutrition Records, RG 462, NA; Baker, Century of Service, 229, 304, 325. 6 The Food and Nutrition of Industrial Workers in Wartime (Washington, D.C.: Committee on Nutrition in Industry, NRC-NAS, 1942), 4-11; Food and Nutrition Board, Recommended Dietary Allowances (Washington, D.C.: NRC-NAS, 1943), 1-11; Food and Nutrition Board, Inadequate Diets and Nutritional Deficiencies in the United States: Their Prevalence and Significance (Washington, D.C.: NRC-NAS, 1943), 1-7, 35; Baker, Century of Service, 324-325; Conner, "History of Standards," 109-111. 7 Claude Wichard to Wayne Coy, Assistant Director, Bureau of the Budget, February 18, 1943, and attachments, "School Lunch Program: S29," Series 39.1, RG 51, NA; Marvin Jones, War Food Administrator, to Harold D. Smith, Director, Bureau of the Budget, November 26, 1943, ibid. Also see drafts of school lunch legislation in Food and Nutrition Records, Box 17, RG 462, NA. ~Baker, Century of Service, 321. 9P.L. 78-129. t° administrator, Federal Security Agency, to F. J. Bailey, Assistant Director, Legislative Reference, Bureau of the Budget, October 27, 1943, "School Lunch Program: S29," Series 39.1, RG 51, NA; Marvin Jones to Harold D. Smith, November 26, 1943, and February 14, 1944, ibid. Shearings before the Senate Committee on Agriculture and Forestry, 78:2 (May 2-5, 1944), 34, 188. t2 Hearing before the House Committee on Agriculture, 79:1 (March 23-May 24, 1945), 232. 3 Ibid., passim (especially page 32). ~ 4 Ibid., 34-41; Hearings before the Senate Committee on Agriculture and Forestry, 78:2 (May 2-5, 1944), 12; also see the summary of the floor debate in the Congressional Quarterly Almanac: 1946 (Washington, D.C., 1947), 37-42, and Marvin Jones to the Senate Committee on Agriculture and Forestry, May 2, 1944, "School Lunch Program: S29," Series 39.1, RG 51, NA. (Henceforth, the Congressional Quarterly Almanac is cited as Ad.) Is House of Representatives Report 684, Committee on Agriculture, 79:1 (June 5, 1945), passim; P.L. 79-396. ~ 6 All the lunch regulations are collected in Box 16, Food and Nutrition Records, RG 462, NA.

130 ~ 7 Hearing before the Senate Committee on Agriculture and Forestry, 83:2 (March 15-17, 1954), 321-515; Bureau of the Budget Memorandum, Resources and Civil Works Division to the Director, November 16, 1964, "C&MS, SLP; SMP, General," Series 61.1, RG 51, NA; P.L. 83-690; Hearings before the Subcommittee on Dairy Products of the House Committee on Agriculture, 84:2 (January 24, 1956), 1-3; ibid., (June 13, 1956), 15-22; P.L. 84-465; CQA: 1956, 442-443. i8 Benson to Joseph M. Dodge, Bureau of the Budget Director, February 27, 1954, "T5-11," Series 52.1, RG 51, NA; Dodge to President, November 30, 1953, ibid.; Minutes of the Interagency Committee on Agricultural Surplus Disposal, September 13, 1954, et seq., "75-11/2," ibid. For the early foreign policy question see Edward S. Mason, Deputy Special Assistant to the President, to Frederick J. Lawton, Bureau of the Budget Director, and enclosures, July 12, 1950, and Lawton's response, July 21, 1950, Box 63, Series 47.3, ibid.; Bureau of the Budget Memorandum, Agriculture-Interior Branch to the Director, March 16, 1950, "T5-24/50.1," ibid. In the last memo the author wrote: "The primary reason the Government now holds or will acquire such surplus commodities is 'price support,' not 'welfare, health, or security."' ~9 Hearings before the Subcommittee on Dairy and Poultry of the House Committee on Agriculture, 86:1 (March 17, 1959), 22-25, 29-35 (May 20, 1959), 30 (January 20, 1960), 9-11, 24-25, 39, 48-51; Hearings before the Subcommittee on General Education of the House Committee on Education and Labor, 86:2 (August 23, 1960), 6-8, 38-41, and passim. 2 ° Hearings before the Subcommittee on General Education of the House Committee on Education and Labor, 78:1 (August 31, 1961), 7-14; Hearings before the Subcommittee on Dairy and Poultry of the House Committee on Agriculture, 87:1 (April 11, 1961), 12 95.; Studies of Human Need, 51-60; CQA: 1962, 222-223. 2 ~ Bureau of the Budget Memorandum, Resources and Civil Works Division to the Director, November 16, 1964, "C&MS, SLP, SMP, General," Series 61.1, RG 51, New Executive Office Buildings Records (henceforth, NEOB); Bureau of the Budget Memorandum, Resources and Civil Works Division to the Director, November 24, 1964, ibid.; Elmer B. Staats, Deputy Director of Bureau of the Budget, to Senator Winston L. Prouty, January 14, 1966, ibid.; Charles Schultze, Bureau of the Budget Director to

131 President Johnson, January 15, 1966, ibid.; White House Memorandum, Henry Wilson to Charles Schultze, February 19, 1966, ibid.; Bureau of the Budget Memorandum, Resources and Civil Works Division to Mr. Hughes, February 17, 1966, "Nutrition Programs--Legislation," ibid. The executive branch memoranda on this issue are voluminous. 2 2 Hearings before the Subcommittee on Dairy and Poultry of the House Committee on Agriculture, 89:2 (February 18, 1966), 1-51. 23 Ibid. (June 24, 1966), 29. 2 4 Hearings before the Subcommittee on Agricultural Production, Marketing and Stabilization of Prices of the Senate Committee on Agriculture and Forestry, 89:2 (May 12, 1966), 2-42; P.L. 87-823. 2 5 Wilbur J. Cohen, Undersecretary of HEW to Joseph Califano, February 2, 1966, "Nutrition Programs--Legislation," Series 61.1, RG 51, NEOB; Hearings before the Select Subcommittee on Education of the House Committee on Education and Labor, 89:2 (March 9, 1966), 6-17, 50; CQA: 1966, 328-333. 2 6 Hearings before the House Committee on Agriculture, 90:1 (March 15, 1967), 7-13, 27-36, 62-70, 96. 2 7 Bureau of the Budget Memorandum, Resources and Civil Works Division to the Director, July 14, 1967, "Nutrition Programs--Legislation," Series 61.1, RG 51, NEOB. 2 ~ Orville L. Freeman to President Johnson, June 29, 1968, ibid.; Bureau of the Budget Memoranda, Resources and Civil Works Division to the Director, July 19, 1967, and August 4, 1967, ibid.; Bureau of the Budget Memorandum for Ivan Bennett, February 12, 1968, ibid.; Bureau of the Budget Memorandum, Natural Resources Programs Division to the Director, February 20, 1968, and April 25, 1968, ibid. Bureau of the Budget Memorandum on White House Meeting, Natural Resources Programs Division to the Director, May 3, 1968, ibid. 2 9 Freeman to the President, June 29, 1968, ibid.; Bureau of the Budget Memorandum, Peter Lewis to the Director, June 21, 1968, ibid.; Hearings before the Subcommittee on Education of the House Committee on Education and Labor, 90:2 (January 18, 1968), 4-9, 10-21, 100-113. 3 ° Bureau of the Budget Memorandum, Director Zwick to the President through Joseph Califano, July 1, 1968, "Nutrition Programs--Legislation," Series 61.1, RG 51,

132 NEOB; Bureau of the Budget Memorandum, Gladieux to Files (RE: Carlson Memo of September 25, 1968) October 2, 1968, ibid.; Bureau of the Budget Memorandum, Director Zwick to Joseph Califano and enclosures, November 8, 1968, ibid. 3 ~ Hearings before the Senate Committee on Labor and Public Welfare, 90:1 (July 11 and 12, 1967), 1-63; Hearings before the House Committee on Education and Labor, 90:2 (May 21-23, 27-29, and June 3, 1968), passim; Hearings before the Senate Committee on Labor and Public Welfare, 90:2 (May 23, 29, June 12, 14, 1968), passim. 3 2 Reference slip, March 28, 1968, "Nutrition," RG 462, NA. 3 3 The pattern of nutritional research is derived from discussions with Food and Nutrition Board, NRC-NAS, staff members and a bibliographic review of the dates of relevant articles. 3 4 Enclosures in Freeman to Representative Jamie L. Whitten, December 6, 1968, "Nutrition," RG 16, NA; Freeman to John Gardner, August 22, 1968, "Farm Program 8," ibid. See also the memoranda Dr. Aaron M. Altschul, Special Assistant for International Nutrition Improvement, to the Secretary, April 30, May 6, and May 17, 1968, "Nutrition," ibid. Altschul's attention to domestic nutritional problems was a significant indicator of the shift within the USDA of nutritional expertise from foreign to domestic food assistance. Experience with foreign programs was also significant for Hubert Humphrey's proposal of WIC in 1972 (interview: Congressional Committee Staff). 3 5 Alexander Butterfield, Deputy Assistant to the President, to Secretary Hardin, January 30, 1969, "Farm Program 8-1-1," RG 16, NA. 3 6 March 17, 1969, "Nutrition," ibid. 3 7Coordination of Federal Food Programs for the Poor, July, 1969, "Farm Program 8," ibid. 3 ~ March 21 and 24, 1969, "Nutrition," ibid. 3 9 text of Testimony, May 9, 1969, ibid. 4 °Lyng to Davis, June 26, 1969, "Farm Program 8," ibid. 4 ~ See especially Erhlichman to Hardin, September 2, 1969, and Hardin's response, "Farm Program 8-1," ibid.; Edward J. Hekman to Lyng, January 13, 1970, "Nutrition," ibid. 4 2 Food and Nutrition Service: Program Evaluation Status Report, no date, RG 462, NA; Lyng to Governor John Dempsey, June 26, 1970, Farm Program 8," RG 16, NA.

133 43 USDA news release, March 31, 1970, "Farm Program 8," RG 16, NA. 4 4 Senate Select Committee on Nutrition and Human Needs, To Save the Children, 93:2 (Washington, D.C., . 1974), 17-29. 45 Lyng to Susie Hendrix, Detroit SFP Coordinator, May 10, 1971, "Farm Program 8" RG 16, NA. 46 Robert E. Wunderle and David L. Call, An Evaluation of the Pilot Food Certificate Program (April - 1971), 1-2. 47 Ibid., 2-9; Food and Nutrition Service: Program Evaluation Status Report, no date, RG 462, NA. 4 ~ This political transformation of the Food and Nutrition Service can be traced through numerous correspondence between congressmen and the secretary's office in "Farm Program 8 [1971 and 1972]," RG 16, NA. 49 Lyng to Davidson, June 30, 1972, and his reply, July 26, 1972, ibid. 5 ° World Health Organization, Nutrition in Pregnancy and Lactation (Geneva WHO Technical Series Report $302, - 1965); Committee on Maternal Nutrition, Maternal Nutrition and the Course of Pregnancy: Summary Report (Washington, D.C.: Food and Nutrition Board, NRC-NAS, 1970), 2-16; Joaquin Cravioto, "Application of Newer Knowledge of Nutrition on Physical and Mental Growth and Development," American Journal of Public Health, 53(November 1963):1803-1812. st rood and Nutrition Board, The Relationship of Nutrition to Brain Development and Behavior (Washington, D.C.: NRC-NAS, 1973). 52 Carolyn Harmon, OCD Executive Assistant, to Emerson Eliot, OMB, August 13, 1970, "OCD: Early Childhood R & D," RG 51, NEOB; Interview: Congressional Committee Staff. S 3 Hearings before the Senate Agriculture Committee's Subcommittee on Agricultural Research and General Legislation, 92:2 (July 28, 1972), 26-32. In 1961 the Kennedy administration had employed Section 32 funds to circumvent hostile appropriations committees in implementing the authorized, but unfunded, Food Stamp Program. 54 Ibid., 69-88; Interview: Congressional Committee Staff. ss august 1, 1972, "Farm Program 7," RG 16, NA. S 6 August 14, 1972, "Farm Program 8," ibid. 57 Congressional Record: Senate, August 16, 1972, 28S88-28S92.

134 ; Lyng to Quie, August 31, 1972, "Legislation " RG 16, NA. 58 Ibid. (S. 3691), 5 9 CQA: 1972, 538-542; Hearings before the Subcommittee on Agricultural Research and General Legislation of the Senate Committee on Agriculture and Forestry, 92:2 (July 28, 1972), 5-32, 47-49, 68-76, 81-87; and Public Law 92-433, Section 17. 6 ° September 18, 1972, "OMB," RG 16, NA. 6 1Lyng to Weinberger, November 22, 1972, ibid. 62 November 24, 1972, and enclosures, "HEW," ibid. See also Gerald F. Combs, Nutrition and Food Safety Coordinator, to Ned D. Bayley, Director of Science and Education, HEW, January 5, 1973, "Nutrition," RG 16, Records in the Office of the Secretary, USDA; cited hereafter as OS/DA. 6 3 Richard L. Seggel, Assistant Secretary for Health, to Clayton Yeutter, February 2, 1973, "Farm Program 8," RG 16, OS/DA; and Yeutter to Seggel, March 23, 1973, ibid. 64 December 22, 1972, "Legislation General," RG 462, Supplemental Food Division Records, USDA; cited hereafter as SFD/DA. The emphasis is in the original document. 6 5 November 7. 1972. "Farm Proaram 8 " RG 16, OS/DA. e ~ --Hehman to Yeutter, Memorandum on Legislation, January 18, 1973, "Nutrition," ibid. 67Redbook (April 1973):68-75. 6 B Interview: FRAC. The case was actually filed by the Center on Social Welfare Policy and Law because of doubts concerning FRAC'S legal standing. 6 9 Interview: FRAC. 7 0 Ibid.; and Dotson et al. v. Butz et al. (June 20, 1973). 7 ~ To Save the Children, 30-31; CQA: 1973, 550-552; CQA: 1974, 503-505; Federal Register, 38 (July 11, 1973), 1847-1851; and James H. Kocher, Acting Deputy Administrator, ENS, to W. F. Moss, Assistant to the Secretary for Intergovernmental Affairs, July 6, 1973, "Farm Program 8," RG 16, OS/DA. 7 2 September 6, 1973, and Yeutter's response September 7, 1973, ibid. For Yeutter's unspoken support see his letter to Carol T. Foreman, October 7, 1977, "Farm Program 7," ibid. 7 3 Hekman to Yeutter, September 19, 1973, "Farm Program 8," ibid.; P. Royall Shipp, Acting Administrator, ENS, to Yeutter; December 10, 1973, ibid.; and Interview: FRAC. 74 Federal Register 38:132 (July 11, 1973), 18447-18451 .

135 7 Congressional Record: Senate, May 21, 1974, 15860-15862; and Congressional Record: House, June 13, 1974, 19064-19065. 76 June 21, 1974, "Legislation," RG 462, SFD/DA. 7 70MB: Legislative Reference File T5-10/74.3, RG S1, NEOB. 7 Notes for OMB Meeting, RE: WIC/SFP, July 14, 1974, "OMB," ibid.; Feltner to Paul O'Neil, Associate Director of Human and Community Affairs, OMB, July 23, 1974, "Farm Program 9," RG 16, OS/DA. 79 Feltner to O'Neil and enclosure, December 11, 1974, RG 16, OS/DA. 8°Ibid.; and Interview: FRAC. arsenate Select Committee on Nutrition and Human Needs, WIC Program Survey: A Working Paper (Washington, D.C, 1975); and P.L. 94-105. 82CQA: 1975, 669-676; Interview: Committee Staff. Congressional ~ 3 See the files on "Legislation (S. 882)" and "Legislation (HR 4222)," RG 16, OS/DA; OMB: Legislative Reference File T5-10/75.5, RG 51, NEOB; and Ford's Veto Message: HR 4222, October 3, 1975, Public Papers of the President: Gerald R. Ford (Washington, D.C.: 1977), item 609. 84 OMB: Legislative Reference File T5-10/75.5, RG 51, NEOB. IS Joseph R. Wright, Assistant Secretary for Administration, to Feltner, December 1, 1975, "Farm Program 7," RG 16, OS/DA; and Butz to Lynn, December 19, 1975, ibid. 86 Interviews: FRAC and the Children's Foundation; Hearings before the Senate Select Committee on Nutrition and Human Needs, 94:2 (March 30, 1976), 1-50; and see note 15. 87 Interview: FRAC. The consent decrees are appended to Senate Report 95-884, 122-135. B ~ Joseph C. Endozien et al., Medical Evaluation of the Special Supplemental Food Program for Women, Infants and Children (WIC) (July 15, 1976), passim. 89GAo, Observations on Evaluation of the Special Supplemental Food Program (December 18, 1974), i-iv. resee September 1974 correspondence in file "GAO," RG 16, OS/DA; Feltner to Friday, March 26, 1976, and Friday's response, "Farm Program 7," ibid. 9iThe Urban Institute, Efficiency and Effectiveness in the W.I.C. Program Delivering System (Washington, D.C.: USDA Misc. Publication #1338, September 1976), pablum.

136 . 92 Feltner to Hekman, June 28, 1976, "Legislation General," RG 16, OS/DA; and Feltner to Speaker Carl Albert, April 15, 1976, "Farm Program 7," ibid. 93 CDC Analysis of Nutritional Indices for Selected WIC Participants (June 1976), passim. 9 4 Interviews: USDA, Children's Foundation, and FRAC. 9s Bergland to OMB Director James McIntyre, February 1, 1978, "Nutrition," RG 16, OS/DA; and Interviews: USDA and Children's Foundation. 96 "Strictly from Hunger," New Republic (June 11, 1977), 13-15; Foreman to Bergland, July 6, 1977, "Farm Program 7," RG 16, OS/DA. 9 7 Norelli to Bergland, June 22, 1977, "Farm Program 7," RG 16, OS/DA; and Bergland to Daft, July 11, 1977, ibid. 98 Memo on Reorganization, Califano to OMB, 1977 [provided by BCHS-HEW Personnel]; and Interview: BCHS-HEW. 99Interviews: USDA and BCHS-HEW. Reinterviews: FRAC, Children's Foundation, USDA, and congressional committee staff. foreman to Bergland, September 6, 1977, "Appropriations (FNS)," RG 16, OS/DA; and Jerome A. Miles, Acting Director of Budget, Planning and Evaluation, to Bergland et al., December 9, 1977, ibid. ~ 02 Elmer B. Staats, Comptroller General, to Senator Thomas Eagleton, April 13, 1978, "Legislation General," RG 462, SFD/DA; Interview: Children's Foundation; and R' chard D. Lieberman, Senate Committee on Appropriations Staff Member to Foreman, February 28, 1978, "Farm Program 7," RG 16, OS/DA. ~ 0 3 Foreman to Representative Bob Traxler, May 15, 1978, "Organization (FSQR)," RG 16, OS/DA. ~ 04 Hearings before the Senate Agriculture Committee's Subcommittee on Nutrition, 95:2 (April 12, 1978), 330-339. ~ 0 5 House Report 95-1153 and Senate Report 95-1020 for H.R. 12511 and S. 3085, respectively. ~ 0 6 Interviews: congressional committee staff, Children's Foundation, and USDA. ~ 0 7 The prophylactic feeding argument can be traced through Hearings before the Senate Select Committee on Nutrition and Human Needs, 94:2 (March 30, 1976), 1-39, 48-50, 69; Hearings before the Subcommittee on Elementary, Secondary and Vocational Education of the House Committee on Education and Labor, 94:2 (August 30, 1976), 632-701; and Hearings before the Subcommittee on

137 Nutrition of the Senate Committee on Agriculture, Nutrition and Forestry, 95:2 (April 6, 1978), 195, from which physician's comment about the "well-functioning uterus" is drawn. ibid.; Interview: USDA; Senators Hubert Humphrey and McGovern to Bergland, February 17, 1977, "Farm Program 7," RG 16, OS/DA; and Hearings before the Subcommittee on Nutrition of the Senate Committee on Agriculture, Nutrition and Forestry, 9S:2 (April 6,110-12, 1978), passim. The evidence-of-success argument was dominant in all congressional floor debates. ~09 Bergland to McIntyre, October 30, 1978, "Legislation (S. 3085)," RG 16, OS/DA. its Bergland to Eizenstat, October 30, 1978, "Nutrition," RG 16, OS/DA.

. Appendix A GALLUP PUBLIC OPINION POLLS, 1935-1971 I. Relief and Welfare Month/Year 9/35 Relief expenditures. Too little: 9% Too great: 60% Just right: 31% 12/36 Approve of government's reduction in relief expenditures? YES 60% NO 40% 4/37 Reduce relief expenditures further? YES NO 56% 44% 4/37 Do away with WPA and give only direct cash relief? YES 21% 4/37 NO 79% Should state/local governments pay greater share of relief costs? YES NO 62% 38% 12/37 Relief for work or just cash? Work Relief Direct Cash 90% 10% 138

139 12/37 Is it government's responsibility to pay living expenses of those needy out of work? YES NO 69% 31% 3/38 Reliefers getting as much as they should? YES NO 71% 29% 3/38 Will U.S. have to continue relief appropriations permanently? YES NO 67% 33% 5/39 How given? Work relief 89% Cash relief 11% 5/34 Greatest FDR Worst FDR Accomplishments Accomplishments Relief/WPA 28% Relief/WPA 23% Banking reforms 21% Spending policy 16% CCC 11% Farm policy 12% SS 7% Foreign policy 6% Farm program 5% Labor policy 6% 7/39 Do you favor a law requiring able-bodied reliefers to work at any job? YES 81% Reliefers only? YES 64% NO 19% NO 36% 2/40 FDR proposed cut of 20% in relief expenditure. Approve Disapprove 59% 41% 20% cut in public work. Approve Disapprove 38% 62% 30% cut in farm payments. Approve Disapprove 52% 48%

140 8/61 Increase community voice in relief regulations: 55% Continue federal control as is: 29% No opinion: 16% 8/61 Physically able must work somewhere in public park, etc. for relief. Favor oppose No opinion 85% 9% 6% August 1961 November 1964 82% 12% 6% 1/69 Equalize welfare payments across the nation. Good idea: 77% Poor idea: 15% No opinion: 8% 6/71 Compel large firms to hire welfare recipients and pay three fourths of the salary with federal funds. YES NO NO OPINION 67% 27% 6%

141 II. Food Stamps/Child Health Month/Year 8/37 Should federal government help state/local governments aid mother at childbirth with medical care? YES 81% NO 19% 10/39 Food stamps for relievers. Approve: 62% Disapprove: 26% No opinion: 12% Food stamps for families earning $20 per week or less? Approve: 57% Disapprove: 43% 3/69 Food stamps free to families making les than $20 per week? Favor: 68% Oppose: 25% No opinion: 7% s 3/69 Food stamps for families earning $20-60 per week at reduced cost. Favor: 60% Oppose: 31% No opinion: 9%

142 III. Farm Aid Month/Year 9/49 Federal purchase of eggs/potatoes to support prices. Eggs Approve Disapprove Neutral 25% 61% 4% No opinion 10% Potatoes 30% 58% 4% 8% Federal guarantee of price for farmers Approve: 49% Disapprove: 45% No opinion: 6% 7/53 7/53 Federal government should continue to buy and store farm products to keep farm income up? Should: 72% Should not: 20% No opinion: 8% Should the President be allowed to send surplus food to famine nations? Should Should not: No opinion: 72% 20% 8% 8/55 What should federal government do with surplus food it has? Give it away: 76% Sell it: 14% Destroy it: 2% Give it to what country? U.S.: Needy country: Specific country (India, Korea, etc.): 50% 14% 36%  8/55 Give some to USSR as goodwill gesture? Good idea: 30% Poor idea: 60% Unsure: 6%

143 Sell at reduced price to USSR? Good idea: 46% Poor idea: 44% Unsure: 10% 12/55 Idea of "soil bank," paying farmer not to grow? Good idea: 29% Poor idea: 47% Unsure: 24% Farmers only asked. Good idea: 49% Poor idea: 32% Unsure: 19% 8/61 Reliefer must take any job offered at going wage. August 1961 November 1964 Favor 84% 85% Oppose 10% 7% No opinion 6% 8% 8/61 Persons coming to new area must prove they are not doing so to obtain relief before it is granted. August 1961 November 1964 Favor 74% 69% Oppose 16% 22% No opinion 10% 9% 8/61 Force mother to name illegitimate child's father in court. August 1961 November 1964 Favor 73% 64% Oppose 16% 24% No opinion 11% 12% 11/64 Overall feelings on welfare. Favorable: 43% Mixed: 45% Abolish it: 6% No opinion: 6%

144 11/64 Amount of money spent in your area on welfare. Too much: Not enough: About right: No opinion: 20% 18% 33% 29% Guaranteed annual incom 9/65 5/6812/68 Favor 19% 36%32% Oppose 67% 58%62% No opinion 14% 6%6% Guaranteed work to each family wage earner of certain income. Favor 78% Oppose 18% No opinion 4% May 1968 December 1968 79% 16% 5%

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