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April 13, 2021
Patricia Collins lives in Georgetown, South Carolina, and works at a grocery store. The 58-year-old’s own children are adults, but she’s now raising her 3-year-old granddaughter on a tight budget. Using benefits provided by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Collins buys her granddaughter milk, bread, peanut butter, vegetables, and more.
“Food is expensive,” she said. “The WIC program, with the type of food I can get for her, it helps. She’s a healthy little girl.”
Unlike the Supplemental Nutrition Assistance Program’s (SNAP) broad approach to alleviating hunger for all Americans, WIC is targeted, limited to specific nutritious foods, and includes health screenings and nutrition education. Over the past decade, between 6 and 9 million mothers and children like Collins’ granddaughter received benefits each year, including close to half of the infants born annually in the U.S. But because the program is tiny compared to SNAP—in 2020, WIC costs were $5 billion compared to SNAP’s $79 billion—it has rarely been in the spotlight.
Now, with the pandemic and a new administration in Washington, that’s starting to change.
In early March, Agriculture Secretary Tom Vilsack mentioned WIC repeatedly during a press event in which his message centered on expanding the U.S. Department of Agriculture’s (USDA) approach to food insecurity to include an emphasis on what he called “nutrition insecurity.” He cited data indicating that only half of the individuals eligible for WIC are participating and said getting them “on board” was crucial to help vulnerable populations during critical periods.
“It’s women, infants, and children,” Vilsack said. “That is an incredibly important subset where we really have to focus, because if kids start off well, if they get the proper nutrition and begin to learn at a very early age the opportunities for nutritious, delicious food that involves fruits and vegetables and whole grains and so forth, then, over time, they become consumers of those products.”
The American Rescue Plan Act passed by Congress in March included $880 million to temporarily boost WIC benefits during the pandemic, while also investing in long-term upgrades. And at the end of last month, the Senate Committee on Agriculture, Nutrition, and Forestry held a hearing to kick off the long-overdue Child Nutrition Reauthorization (CNR) process, during which WIC was a central focus alongside changes to school meal programs.
Many Washington insiders did not expect Congress to take up CNR this year, given the Biden administration’s ambitious legislative agenda on pandemic relief, infrastructure, and climate change, but food insecurity, health, and disease risk—especially for low-income families and BIPOC communities—have taken center stage during the pandemic. At the same time, social distancing disruptions have led to long-overdue changes to WIC operations, including new digital program components and the possibility of virtual appointments, experts say.
“[The pandemic presented] a chance to revisit how we deliver services and how our services fit in with broader nutrition assistance. And the shift from food security to nutrition security is really demonstrative of a recognition that the food that we provide families . . . has an impact on the healthcare system and healthcare costs,” said Brian Dittmeier, senior public policy counsel at the National WIC Association (NWA). “This year is really an inflection point for the WIC program.”
The USDA began operating WIC through state agencies in 1974, and it’s currently the third-largest federal nutrition program after SNAP and the National School Lunch Program. From the beginning, it was set up to provide food and nutrition assistance to mothers during and after pregnancy and children in their earliest years to improve infant and maternal mortality rates and support healthy growth and development.
“WIC really stands at the intersection of food insecurity and public health,” Dittmeier explained. “We’re not just a benefit program, we have integrated clinical services.”
Mothers qualify during pregnancy and for up to a year after, and children qualify until age five, with eligibility based on enrollment in other federal programs such as SNAP and Medicaid or by income and nutritional risk criteria. Health screenings—including blood tests that check metrics like iron levels—are required, and WIC counselors, many of them registered dietitians, also provide nutrition education and breastfeeding support.
Participants are assigned one of seven food packages and can spend their monthly benefits, about $40 on average, on a specific list of foods. The packages were updated in 2009 based on changes in the last CNR (which resulted in the Healthy, Hunger Free Kids Act) to include a range of healthy foods. Infants generally get formula and later, baby food, while older children can get foods including dairy products, eggs, fruits and vegetables, and whole wheat bread. Roughly 48,000 retail vendors accept WIC benefits (compared to 248,000 retailers that accept SNAP), 22 state agencies allow benefits to be redeemed at farmers’ markets, and the Farmers Market Nutrition Program provides recipients in some states with additional benefits to be spent on produce at markets, capped at $30 per year.
WIC’s impacts have been studied more than any other nutrition program. There is strong evidence that the program reduces the risk of preterm birth, low birth weight, and infant mortality, and that the effect is even greater for Black infants. Research also shows WIC participation is associated with healthier diets for children, and that the 2009 changes led to increased intake of healthy foods including fruits and vegetables and whole grains.
Although studies show that mothers enrolled in WIC breastfeed at lower rates compared to non-participants, it’s unclear whether that is related to other differences in the population served by WIC. The program has made several changes since the early ‘90s to emphasize the benefits of breastfeeding and make the practice easier for participants. Between 1998 and 2018, the percentage of WIC moms who initiated breastfeeding has increased by 30 percent to 72 percent. That’s compared to an estimated 84 percent of infants nationally who have ever been breastfed.
“One of the most effective investments the federal government can make to reduce food insecurity and obesity in early childhood, improve birth outcomes, and support breastfeeding mothers is to increase access to WIC,” said Lee Savio Beers, a pediatrician and the medical director for Community Health and Advocacy at Children’s National Hospital, during the Senate Hearing on CNR.
In 2011, coverage of eligible WIC participants peaked at 64 percent; it then began steadily declining. By 2017, the program was only reaching an estimated 51 percent of those eligible. While there is no clear explanation for the decline, advocates and WIC administrators point to several contributing factors.
Zoë Neuberger, a senior policy analyst at the nonpartisan Center on Budget and Policy Priorities who specializes in WIC, said that first, mothers might not know about WIC and that there are also common misconceptions about eligibility, such as the fact that children are only eligible until age one. But the high-contact nature of enrollment and certification is likely a bigger factor.
“Families typically have a minimum of two in-person appointments a year, and it’s quite common for there to be four to six appointments, depending on various factors,” Neuberger said. “They can be short, they can be long. Sometimes you have to bring your kids. There’s a lot involved.”
For working mothers, that process can present challenges. When Beers sees patients at Children’s National Hospital who might be eligible for WIC, she has the benefit of sending them right across the hall to a WIC clinic housed in her medical center, but that kind of efficiency is rare.
Before the pandemic, telephone and video appointments were almost unheard of, but the USDA issued waivers, and many WIC clinics shifted to virtual operations. “The paradigm for how services are being provided has changed a lot, and I hope that once the pandemic is over and the waivers are no longer in effect, there will be opportunities to move the program in the direction of offering more flexible ways to enroll,” Neuberger said.
Dittmeier said that given the burdens of accessing clinical services, mothers might also be weighing whether the time required to access the benefits is worth it, especially if they have to leave work. And while advocates say the program’s strength is its science-based food requirements, that also makes it more restrictive, as shopping requires finding specific eligible items at a given store. In Maryland, for example, WIC participants with canned fish included in their food packages are allowed to buy chunk light tuna or pink salmon, but not albacore, white tuna, or red salmon. Whole wheat pastas must be in one-pound packages and made by one of nine brands.
The program has also been slow to modernize. Most agencies are not using digital documents; the USDA gave state agencies a 2020 deadline to replace paper vouchers with EBT cards.
Finally, the Trump administration reduced the number of immigrants accessing the program, according to Douglas Greenaway, NWA’s president and CEO. “All of the background noise and the disparaging conversations around immigration really did not help or encourage, in fact, it frankly discouraged immigrants to seek out access,” he said. “We have to promote it and advertise it to make people aware that it’s available to them.”
Changes are coming, starting with the American Rescue Plan Act. The legislation makes funding available for states to temporarily raise WIC benefits specifically used for fruits and vegetables from the current amount of $9–$11 per month to up to $35 per month. Those increases will end in September, but the law also created a $390 million fund for the USDA to use over the next three years for “outreach, modernization, and innovation.”
“Modernizing access to the program, the ways that participants can interact with staff, the shopping experience . . . all of these seem like the kinds of activities that could be supported with the new funding,” Neuberger said, while noting that the USDA has yet to clarify how the agency will use the funds directed at WIC.
During the March press event, Secretary Vilsack said the agency plans to address why half of eligible individuals are not participating. He brought up a number of possible solutions to expand access and participation by considering whether benefit levels were appropriate, expanding online purchasing, and increasing outreach to communities of color.
Meanwhile, witnesses at the CNR hearing told senators that priority should be given to establishing better connections between doctors’ offices and WIC clinics as well as integration of Medicaid and SNAP with WIC. Heidi Hoffman, Colorado’s state WIC director, said that more could also be done to expand WIC access on tribal lands. “We believe that tribal health and the tribal farm economy can be enhanced with WIC support, by creating access to healthcare and a market for rural vendors and farmers,” she said.
Both Hoffman and Beers emphasized the need for technological upgrades and streamlined systems and said the changes made to allow for remote enrollment during COVID-19 should be made permanent. “The clearest lesson we’ve learned is we can’t return to the model designed 40 years ago,” Hoffman said.
The NWA is confident that provisions of the WIC Act—which was introduced in the House on March 18 and has strong bipartisan support—are likely to get wrapped into the CNR. Those updates would extend an infant’s certification from one to two years to reduce the burden of recertification, extend postpartum eligibility for mothers from one to two years, and move the cutoff for children from five to six years old. “We want to catch the kids who are caught in that space between aging out of WIC and gaining access to school meals,” Greenaway said.
And unlike SNAP, which prompts nearly continuous battles between Democrats and Republicans, WIC has long been supported by lawmakers on both sides of the aisle, Neuberger said. Improving it, then, seems within reach.
“It is really important to try to reach more eligible families, because the benefits of participating are so well-documented,” she said. “And it’s just a huge missed opportunity that there are low-income families that aren’t getting the benefits.”
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