Women, Infants, and Children: But What About the Men? –Read Holman

The Special Supplemental Nutrition Program for Women, Infants, and Children program (WIC) is one of the most successful federally funded nutrition programs in the United States. In subsidizing particular nutritious foods, this policy addresses pregnant women and children classified as “nutritiously needy”. Since its full rollout in 1974, numerous studies have shown WIC to increase the likelihood of a healthy birth outcome, improve the cognitive development of children, raise the probability that the child will have a regular health care provider and be up to date on immunizations (1). Better enrollee health is evidenced also by a reduction in Medicaid costs during a child’s first 60 days of life (2). Enrollment has steadily grown from 88,000 in 1974 to nearly 8.1 million in 2006. Impressively, WIC currently serves 45% of all infants born in the US(3).

Despite its successes, the program has not gone without its critics. Many have criticized that the foods available to enrollees are not all appropriate(4), that it pushes infant formula feeding (5), that the program is inadequately funded (6,7), and for other reasons (8,9). However no records have been found that critique WIC in its effects on certain male populations from a social and behavioral science viewpoint.

The evidence indicating the importance of male (or father or father-figure[1]) involvement is heavily documented (10). Studies have shown that children raised with a male figure in the household are, as examples, more likely to be breastfed (11), have a lower rate of incarceration (12), and have better performance in school (13). Yet nearly 25% of all children in the US live in single-mother households with the percentage of black children doing so at nearly 50% (14).

While the WIC program has been incredibly successful in providing needed help to children, basic social and behavioral theory can highlight how WIC unintentionally labels men as secondary to the health and wellbeing of children. This results in unintentional negative effects on the male population and on children by reinforcing social norms of how we address child wellbeing.

WIC program labels men as secondary

Perhaps because of the low rate of male involvement, we have become enamored in the mother-child relationship. Universities have departments of Maternal and Child Health. Many non-profit organizations for child wellbeing are defined as maternal-and-child-health organizations. And the phrases ‘father-and-child-health’ and ‘single-father’ are rarely heard and even difficult to roll off the tongue.

According to the Food and Nutrition Service (FNS), the government agency responsible for administering WIC, the program’s mission is:

To safeguard the health of low-income women, infants, and children up to age 5 who are at nutrition risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care. (15)

To be eligible for benefits one must qualify financially, be classified as nutritiously needy (as determined by a health professional), reside in the US, and be one of the following: a pregnant woman, a postpartum woman, a breastfeeding woman, an infant, or a child under the age of 5. The focus of this policy is undoubtedly on the child, and the fact that FNS categorizes enrollment data between pregnant women, infants, and children reinforces this notion (15). Pregnant women and breastfeeding women – and I think this is an unfortunate reality – are too often only helped for the sake of their unborn or infant who in their innocence have our sympathy. Politically, the emphasis of this subsidization program has to be on the child for it to pass social scrutiny and have the bipartisan support it has had since its inception.

Women are an obvious and necessary component in the fight to reduce gaps in child health between groups of different socioeconomic strata. Many factors contribute to the actuality that women bear the bulk of raising our children today, including a patriarchal history and the reality that women, to state the obvious, are tied to the child during pregnancy in ways that men simply are not. Single mothers working hard for the betterment of their children receive quite a bit of deserved social emotional support and sympathy. However fathers are viewed differently by society. This discrepancy is a norm woven into our culture and our collective unconscious. It is easy to allow the important focus on the mother-child relationship is be so focused that fathers get overlooked.

So what about the men? Are men even eligible for WIC?

It turns out men are eligible. Or more specifically their children are: A father can apply for nutritional help for his infants and/or children. However both the program name and the advertised program’s eligibility criteria fail to indicate this fact. I would even go so far as to argue that the program’s official name – The Special Supplemental Nutrition Program for Women, Infants, and Children – suggests that men were not even on the radar when the program was developed. Who is this special supplemental nutrition program for? – Women, Infants, and Children. It’s the natural first instinct upon reading the name to assume that men, since they are not listed with the rest of the family, are not eligible to apply. In mentioning women but not men, the program title labels fathers as secondary.

Aside from the program’s title, the eligibility criteria are also at issue. Indicating that all children under the age of 5 are eligible encompasses the listed categories of infants, breastfeeding women, and postpartum women (since infants are and all breastfeeding and post-partum women must have children under the age of 5). Why specify that breastfeeding and post-partum women are eligible but not specify that men with infants or children are eligible?

Further, FNS makes a clear distinction that a woman can be non-breastfeeding and apply (16). This is even more disheartening. Is there a difference between a non-breastfeeding mother and a non-breastfeeding father? In terms of their ability to provide nutrition for the child, the answer is clearly no. WIC subsidizes infant formula, and mothers and fathers are equally capable of purchasing this formula and feeding their children. Therefore in specifying that a non-breastfeeding woman can apply for her child, a father is given the impression that he cannot. This is more evidence that WIC unintentionally labels fathers as secondary to the wellbeing of children.

The begging question then is: What are the effects of labeling fathers as secondary? Social and behavioral theory highlights how labeling fathers as secondary has negative effects on children, on the male population, and on the much larger social discussion regarding child wellbeing.

WIC has negative effects on children

First and foremost, the WIC program as advertised may unintentionally hinder a single father’s access to the program. As indicated above, both the program name and advertised eligibility criteria suggest that men may not be able to apply. The eligible child cannot receive the needed nutrition to better development if the labeled father never applies. This goes against the very mission of the program.

Deeper, all negative effects on the male population (as described below) directly transfer to harming the children of this population as well. The relationship between a father’s health and a child’s health is as cyclical as that of the mother’s to the child’s: Each affects the other. In labeling a father as secondary and reinforcing negative behaviors, WIC hinders his ability to address the needs of the child. A prominent negative behavior reinforced is his denial of a pregnancy and/or refusal to support the child financially or emotionally, an all too common occurrence (17). A woman justifiably may be financially forced sue for child-support therein reducing the father’s ability to contribute to his own finances.

WIC has negative effects on the male population

One particular social and behavioral theory can help highlight how the WIC program can have negative effects on many men. The Stigma Theory of behavioral modeling claims that the self-identity and behaviors of a particular group are influenced by the labels society gives that group. So according to this theory, WIC’s implication that men are secondary to child wellbeing is followed by the logical conclusion that men are not equipped with the skills to care for children and thus second-rate caregivers. This stigmatization, the reduction of the male population to the stereotype, has decisively harmful effects. Discrimination, both direct and indirect, occurs in the presence of stigmas (18). Direct discrimination contains the overt acts that we commonly connect with discrimination, for example, denying housing to the mentally ill, showing racial preferences in hiring, or favoring mothers in cases of child custody. Indirect (also called structural) discrimination is not so obvious. It is not any one person discriminating against a father but the social stigma around fathers that puts in place barriers mothers do not have. The WIC program’s name hindering a father’s access as discussed above fits in perfectly here. These acts of discrimination may be conscious or (more commonly) unconscious.

Like other stigmas, one’s conception of a father’s role in caring for children is developed early in life. For someone who places stigma on fathers (perhaps one who grew up without one) and then later becomes a father himself, these conceptions become personal, internalized, and lead to the fear of rejection. This can result in low self-esteem (19, 20), depressive symptoms (21), a compromised quality of life (22), unemployment and loss of income (23, 24).

It has also been suggested that a major avenue for disease in stigmatized populations is in the generation of stressful situations (19). Stigma induced stress reinforces negative behaviors – the very behaviors that brought on the stereotype – by lowering a father’s self-efficacy, the notion that in order for one to try a new behavior, that person must believe that he can perform that behavior. But those who are stigmatized self-identify with that stigma and are inclined to perform only those behaviors that fulfill that identity. Thus men who see themselves as secondary to child wellbeing perpetuate the respective behaviors, as they are reluctant to attempt new ones. This is all detrimental to the health of these stigmatized men.

WIC effects society’s discussion on the father’s role

Another behavioral theory of the social and behavioral sciences revealing how WIC may have negative effects on children is the Agenda Theory. This theory indicates that before an issue can be addressed it must be recognized. A recent example of this is in the maintenance of our country’s infrastructure: Officials had been arguing for years that the nation’s highways and bridges needed to be better addressed. But these people were largely ignored until August of this year when the collapse of Interstate-35W in Minnesota put the issue on the minds of the public and public officials. Immediately following the collapse, federal and state officials ordered all similar bridges to undergo safety reviews (25). Most often it takes a sudden tragedy to put an issue on the radar.

Given the lack of a public tragedy surrounding stigmatized fathers that has stimulated conversation, the movement to bring fathers back into the picture is nascent and has crept along slowly. And in labeling fathers as secondary, WIC hinders this movement by helping keep men off of the agenda of ensuring child wellbeing.

While addressing women is indeed essential, there is a dearth of programs and policies that recognize the role men can play. Indeed the surprise of the phrase ‘single-father’ indicates how society is so ill-equipped to deal with him. Among the best companies in the US, 86% offer paid maternity leave for greater than two weeks while only 15% offer paid paternity leave (26). And despite recent changes in laws that previously had favored maternal custody, child custody decisions still favor the mother (27).

If the program was named FIC for Fathers, Infants, and Children, the loud and needed reaction by mothers everywhere would be: Hey what about us? So where are the men? Recently steps have been made that indicate a greater awareness of the issue. Father specific programs are growing and emphasizing that a good father is not necessarily “more like mom” (28,29). In addition federal legislation has been proposed to increase funding for grants that promote responsible fatherhood (30,31), and a number of states have implemented paid parental leave without differentiating between the sexes (26).

WIC can help break social norms

Is WIC responsible for keeping men off of the agenda, or is the program merely a symptom of a society that places fathers as secondary? It is more complex than this false dichotomy: The WIC program is a product of a society that labels fathers as secondary, so in reality the two factors reinforce each other. The point here is that the WIC program as advertised reinforces the social norms labeling fathers as secondary and, therefore, hinders the advancement of ensuring and bettering child wellbeing.

There is no doubt that the benefits of the WIC program grossly outweigh the negative effects mentioned here, but that is no reason to ignore these qualms when the solution can be so easy. As a widely publicized federal program, this program is in a unique leadership position where small, simple changes can have drastixc effects. After seeing that the negative effects are all based from the labeling fathers as secondary, an approach that either emphasizes fathers or deemphasizes mothers could be effective at putting greater equality in our view of both parents. One possibility may be in changing the name of the program to The Special Supplemental Nutrition Program for the Unborn, Infants and Children. This title recognizes that the focus is on the children, born and unborn, and doesn’t alienate any guardian. Mothers, fathers, grandparents, and other legal guardians all approach this title on the same plane. Obviously, this has to be coupled with advertising specifying that all of these guardians of infants and children should feel encouraged to apply for their eligible child. These new measures cause change in neither program structure nor in program financing. Further, there are no changes in how the program is run. In simply changing the name and the way it is advertised we can address detrimental social norms head on.

While changing the name of the program and listed eligibility criteria will not change the stigma surrounding fathers, doing so will at least not perpetuate it. And at best, it may open the eyes of many and spark the dialogue needed to help ensure the health and wellbeing of our children.

REFERENCES

1. About WIC: How WIC Helps [homepage on the Internet]. United States Department of Agriculture, Food and Nutrition Service [updated 2006 Jul 07]. Available from: http://www.fns.usda.gov/wic/aboutwic/howwichelps.htm#diet%20outcomes.

2. Devaney B, Bilheimer, L, Schore, J. Medicaid Costs and Birth Outcomes: The Effects of Prenatal WIC Participation and the Use of Prenatal Care. Journal of Policy Analysis and Management. Vol.11 No.4, 1992 Autumn. pp. 573-592.

3. About WIC: WIC At A Glance [homepage on the Internet]. United States Department of Agriculture, Food and Nutrition Services [updated 2005 Oct 10]. Available from: http://www.fns.usda.gov/wic/aboutwic/wicataglance.htm.

4. Proposed Criteria for Selecting the WIC Food Packages: A Preliminary Report of the Committee to Review the WIC Food Packages. Published by the Institute of Medicine of the National Academies. The National Academies Press, Washington, D.C. 2004. Available from: http://books.nap.edu/openbook.php?record_id=11078&page=R1.

5. Kent G. WIC’s Promotion of Infant Formula in the United States. International Breastfeeding Journal. Vol.1, 2006. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1481608.

6. Estimating Eligibility and Participation for the WIC Program: Final Report. Committee on National Statistics, Division of Behavioral and Social Sciences and Education. Published by National Research Council of the National Academies. Eds Ploeg M and Betson D. The National Academies Press, Washington, D.C. 2003. Available from: http://books.nap.edu/openbook.php?record_id=10804&page=R1.

7. Mydans S. U.S. Food Program Tightens Its Belt and Millions on Welfare Feel Pinch. The New York Times. 1990 Jun 02. Available from: http://query.nytimes.com/gst/fullpage.html?res=9C0CE7DD163AF931A35755C0A966958260&sec=&spon=&pagewanted=all.

8. Black M, Frank D, Skalicky A, Casey P, Zaldivar N, Meyers A. Special Supplemental Nutrition Program for Women, Infants, and Children Participation and Infants’ Growth and Health: A Multisite Surveillance Study. Journal of Pediatrics. Vol.114 No.1, 2004 Jul, pp. 169-176. Available from: http://pediatrics.aappublications.org/cgi/content/full/114/1/169.

9. Letter to the Editor: Food Program for Poor Mothers and Children Hasn’t Worked. The New York Times. 1991 May 04. Available from: http://query.nytimes.com/gst/fullpage.html?res=9D0CE2D81038F937A35756C0A967958260.

10. Father Facts, Fifth Edition. Published by The National Fatherhood Institute. 2007.

11. Susin L, Giugliani E, Kummer S, Maciel M, Simon C, Silveira L. Does Parental Breastfeeding Knowledge Increase Breastfeeding Rates? Birth. Vol.26 No.3, 1999 Sep. pp 149-156.

12. Harper C, McLanahan S. Father Absence and Youth Incarceration. Journal of Research on Adolescence. Vol.14 No.3, 2004 Sep. pp. 369-397.

13. Nord C, West J. Fathers’ and Mothers’ Involvment in Their Children’s Schools by Family Type and Resident Status. A Statistical Analysis Report of the United States Department of Education, National Center for Education Statistics. Vol.3 No.2, 2001. Available from: http://nces.ed.gov/programs/quarterly/vol_3/3_2/q2-5.asp.

14. Children’s Living Arrangements and Characteristics: March 2002. United States Census Bureau. 2003. Available from: http://www.census.gov/prod/2003pubs/p20-547.pdf.

15. About WIC: WIC’s Mission [homepage on the Internet]. United States Department of Agriculture, Food and Nutrition Service [updated 2006 Jul 07]. Available from: http://www.fns.usda.gov/wic/aboutwic/mission.htm.

15. Special Supplemental Nutrition Program for Women, Infants and Children: Data as of October 26, 2007. United States Department of Agriculture, Food and Nutrition Service. Available from: http://www.fns.usda.gov/pd/37WIC_Monthly.htm.

16. Women, Infants, and Children [homepage on the Internet]. United States Department of Agriculture, Food and Nutrition Service [updated 2007 Oct 26]. Available from: http://www.fns.usda.gov/wic/.

17. Charting Parenthood: A Statistical Portrait of Fathers and Mothers in America. Child Trends. [last updated 2006 Jun 09]. Available from: http://fatherhood.hhs.gov/charting02/index.htm.

18. Link B, Phelan J. On Stigma and Its Public Health Implications. Available from: http://www.stigmaconference.nih.gov/FinalLinkPaper.html.

19. Stigma and HIV/AIDS: A Review of the Literature. Eds Brimlow D, Cook J, Seaton R. United States Department of Health and Human Services, HIV/AIDS Bureau. 2003 May. Available from: http://hab.hrsa.gov/publications/stigma/front.htm.

20. Link B, Struening E, Neese-Todd S, Asmussen S, Phelan J. Stigma as a Barrier to Recovery: The Consequences of Stigma for the Self-Esteem of People with Mental Illnesses. Psychiatric Services. Vol.52, 2001 Dec. pp1621-1626. Available from: http://psychservices.psychiatryonline.org/cgi/content/full/52/12/1621.

21. Link B, Struening E, Rahav M, Phelan J, Nuttbrock L. On stigma and its consequences: Evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. Journal of Health and Social Behavior. Vol.38:, 1997. pp. 177-190.

22. Rosenfield S. Labeling Mental Illness: The effects of received services and perceived stigma on life satisfaction. American Sociological Review. Vol.62, 1997. pp. 660-672.

23. Link B. Mental patient status, work, and income: An examination of the effects of a psychiatric label. American Sociological Review Vol.47, 1982. pp. 202-215.

24. Link B. Understanding labeling effects in the area of mental disorders: An assessment of the effects of expectations of rejection. American Sociological Review. Vol.52, 1987. pp. 96-112.

25. Hampson R, Cauchon D, Overber P. Officials see new urgency to improve USA’s bridges. USA Today. Posted 2007 Aug 07. Available from: http://www.usatoday.com/news/nation/2007-08-02-bridge-cover_N.htm?loc=interstitialskip.

26. Lovell V, O’Neill E, Skylar O. Maternity Leave in the United States: Paid Parental Leave is Still Not Standard, Even Among the Best U.S Employers. Published by the Institute for Women’s Policy Research. 2007 Aug. Available from: http://www.iwpr.org/pdf/parentalleaveA131.pdf.

27. Stamps L. Matenal Preferences in Child Custody Decisions. Journal of Divorce & Remarriage. Vol.37 No.1, 2002 Dec 17. Available from: http://www.haworthpress.com/store/ArticleAbstract.asp?sid=VGQQC42H8Q4P9P3HXQPBGLX2HE9PBTC1&ID=27319.

28. Boot Camp for New Dads. Operated by the New Fathers Foundation, Inc. Homepage at: www.bcnd.org.

29. The Nuturing Father’s Program. Operated by the Center for Growth and Development, Inc. Homepage at: http://www.nurturingfathers.com/.

30. A bill to amend title XIV of the Social Security Act to ensure funding for grants to promote responsible fatherhood and strengthen low-income families, and for other purposes. S.1626, 110^th Congress. Introduced 2007 Jun 14.

31. To amend title IV of the Social Security Act to ensure funding for grants to promote responsible fatherhood and strengthen low-income families, and for other purposes. H.R.3395. 110^th Congress. Introduced 2007 Aug 03.

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[1] For the purpose of simplicity in this paper, the term father will be the primary term used to designate all those who may play the fatherly role. Some studies investigating variances in outcomes in children with different father types do find significant differences, but the presence of any fatherly figure has been consistently shown to lead to better child outcomes as compared to children raised with no father.