Association for Public Policy Analysis & Management

One of the largest programs benefiting low-income pregnant and postpartum mothers is the Special Supplemental Nutrition Program for Women, Infants, and Children, commonly referred to as WIC. This federal program is administered by the United States Department of Agriculture and provides nutritional support to eligible mothers and their children who are deemed to be at “nutritional risk” by a healthcare professional. Since its inception in 1972, WIC has expanded to include program supports for participating mothers that include more than the traditional nutritional vouchers for food. The WIC program now includes other components such as peer-to-peer counseling for moms who choose to breastfeed, healthcare referrals, nutrition counseling, and other educational supports. Many of the services offered by WIC to improve birth and health outcomes could also influence the probability of smoking cessation among participating smokers. 

In 2013 alone, 8.3 million mothers participated in the WIC program. The formal and informal prenatal care given through program participation provides low-income mothers with benefits that are designed to improve health outcomes for maternal and child health. Previous literature has failed to look at the effect of WIC participation on smoking behavior of low-income mothers. Our study examines the relationship between WIC participation and prenatal smoking behavior using data from 40 states in the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2002 through 2009. To the extent that prenatal care provides education and support for tobacco cessations to pregnant mothers who are also smokers, we expect to see WIC participation have a positive effect on the quit rate for program participants, relative to low-income non-participants. To address the self-selection bias, we use a propensity score matching technique to predict the probability of the respondent’s program take-up. 

Prenatal smoking is a persistent public health concern that adversely affects mother and child. Although strides have been made toward decreasing the incidence of smoking while pregnant, it is estimated that eleven percent of mothers will smoke throughout the duration of their pregnancy. Maternal and child health outcomes related to smoking include low birthweight, preterm delivery, and even infant death. A disproportionate percentage of pregnant women who use tobacco are low income, many of whom have limited access to healthcare and prenatal care. Research has shown that prenatal care can be effective in smoking cessation, leading women to quit during their pregnancy. Brief interventions have the potential to have lifelong implications for maternal and child health. After controlling for selection, our findings indicate that WIC participation significantly increases the probability that a woman will quit smoking during her pregnancy.