FOR THE doctors, counselors, dieticians and legislators involved with maternal and infant feeding programs, it's time to circle the wagons. This group is taking a hard look at budget proposals affecting social programs and wondering why the U.S. Department of Agriculture--which runs the Women, Infants and Children supplemental foods program--isn't doing the same.
The USDA has neglected to convene a group called the National Advisory Council on Maternal, Infant and Fetal Nutrition. This 21-member council is designed to gather professionals from all over the country to monitor the WIC program -- and a sister program involving the distribution of government-purchased commodity foods to "high risk" mothers -- "to determine how the program may be improved." (High risk, determined by such factors as low economic background, youth and chronic illness, predisposes women to having low-birthweight babies, who typically need intensive care treatment and have higher incidence of mortality).
WIC, a social program which government and university studies show to be cost-effective, provides vouchers to "high risk" pregnant women and mothers of infants to exchange for items such as formula, milk, iron-fortified cereal and orange juice.
Present law requires the USDA to call annual meetings of the advisory council, but the department has not done so since President Reagan took office.
Critics complain that the USDA refuses to call a meeting because officials don't want to hear the experts attack administration proposals; that under the Ford and Carter Administrations, the advisory council met frequently -- two to three times a year -- and had what Sen. Thomas Eagleton (D-Mo.) called "a rather distinguished record." Mary Jarratt, assistant secretary of agriculture in charge of food and consumer services, says these critics "are making a mountain out of a molehill."
Based on past reports, said Jarratt, she would expect the council to make general recommendations such as "increase funding" or "increase resources" -- advice that comes as no surprise and on which she cannot act. At a recent Senate appropriations subcommittee hearing, she told the senators that although the USDA "may indeed be in violation" of the law requiring the council to meet, "we had trouble getting the group together."
To the council members, as well as to Eagleton and health professionals involved with maternal and infant feeding programs, this "trouble" appears particularly ill-timed. Right now, said one ex-council member, "it's as critical as any time in the programs' history." With the president proposing to consolidate WIC and the Maternal and Child Health program into a block grant, and cutting the entire budget for the two programs by $300 million (in 1983 the combined programs would get $1 billion; 1982 WIC funds alone are $934 million) for fiscal 1983, many believe council meetings are more important now than ever before, that members could identify inefficiencies and could help the USDA determine priorities. Current members do not agree with Jarratt's assertion that their advice would be too general.
"What the council members are unable to do now is voice their opinions based on experience," said Stefan Harvey, a former member of the advisory council. "Equally importantly, they are unable to study how the programs are currently operating. The USDA no longer has advice from the experts who know the day-to-day operations of the program."
The MCH-WIC block grant proposal will have "a profound impact on the states that have to implement that program," said Dr. Dan Blumenthal, council member and pediatrician from Atlanta. "I don't understand how the department can not want the WIC administrators' input before they push the proposal through."
But Jarratt maintains that she has already gathered expert advice from many sources, including a meeting of WIC administrators last fall. And this advice, she said, doesn't cost the department (and thus taxpayers) $9,000 per meeting -- the estimated cost of bringing the advisory council together.
USDA administrator Sam Cornelius testified at the hearing that the council has not met because, "We want to be certain that the committee is well-structured." Cornelius was not available to explain the meaning of "well-structured," but his assistant, Sandra Schlicker, said the department wants "well-qualified" people to fill seven empty slots on the current council before it convenes. The law, however, specifies that 11 members "constitute a quorum," so filling all the open seats isn't imperative to the assembling the council.
At the hearing, Eagleton offered his own explanation as to why the council had not yet been convened. "The reason you don't want them to meet -- I don't blame you; if I were in your position I wouldn't want to meet with them either -- is that they are going to blow you out of the water," the senator told Cornelius and Jarratt. "They are going to tell you what you are doing to nutrition in this country. They are going to tell it to you sort of like it is."
Betsy Clark, council member and Oregon's WIC program manager, concurred. She said the "only conclusion" she can reach "is that the advice of the council would not correspond with the administration's needs." Clark allowed that there is "need to cut the national budget, and we need to discuss budget priorities." But, she added, "It's important to have a forum where those ideas can be discussed and kicked around on their merits rather than just being ignored."
If the WIC advisory council has been ignored, said Jarratt, it has not been intentional. The Omnibus Reconciliation Act of 1981 (which combined 21 health programs into four block grants--maternal and child health, preventive care, primary care and mental health and substance abuse) and other budget-cutting measures have commanded her attention, and the advisory council did not top her list of priorities, she explained. The council is scheduled to meet in July (five other scheduled meetings during the last 18 months have been cancelled). But, she said, "the council is not the end-all . . . it's not the only force that impacts policy." The law does not compel the USDA to follow the advice of the council.
The law does require the council to meet, however. Whether for reasons of willful negligence, as Eagleton asserts, or simple oversight, the advisory council has not been able to discuss ways to save and to improve the integrity of one of the most popular social programs the federal government administers.