Metaphors of Relief: High Risk Pregnancy in a Context of Health Policy for the "Undeserving" Poor

This paper explores an enrollment problem in the Special Supplemental Nutrition Program for Women, Infants and Child (WIC) in one American city, and how varying perceptions of the program held by clients and providers can be mined for problem sources and solutions. My work began in the late 1990s and continued into 2000 as local health department administrators were growing increasingly concerned about heightened and steady rates of infant death, and had harnessed themselves to statistical data suggesting that prenatal enrollment in certain public health programs would lower these rates. Among low income women who lived in the city and who were at risk for poor birth outcomes, participation in the program was inconsistent and less than expected when compared to other regional and national WIC programs, suggesting that institutional adjustments of the mid-1990s were more effective in some places than others. Described are different frames of reference held by WIC providers and potential clients to explain why there is discord between what WIC providers aim to accomplish with their clients and what clients expect from the program. In turn, I ask the question, how can frames of reference be used to reveal important problems in service delivery?