Do Regulations Designed to Promote Nutrition Make WIC Food Lists Too Restrictive? | Civil Eats

Do Regulations Designed to Promote Nutrition Make WIC Food Lists Too Restrictive?

The program aims to address nutrition gaps among low-income women, infants, and children, but hyper-specific requirements for food and state variations can make shopping complicated. 

Mother and baby grocery shopping.

April 9, 2024 update: Today, USDA finalized updates to the WIC package, solidifying multiple changes intended to increase flexibility and convenience for participants. That includes adding canned beans and canned fish to packages, increasing whole grain selections, and broadening package size and non-dairy options for yogurt. Most notably, the agency made a COVID-initiated boost in fruit and vegetable benefits permanent, which will more than double the produce dollars available to children and mothers each month.

November 17, 2022 update: Today, the USDA proposed major changes to the WIC food package. In a call with reporters, Agriculture Secretary Tom Vilsack emphasized the updates were intended to improve “flexibility” and “choice” to “make it easier to reach those who are not served by the program but are eligible.” In addition to making a pandemic-era boost to fruits and vegetable benefits permanent, the changes will allow participants to choose a wider variety of grains including cornmeal and quinoa, more non-dairy options, canned beans in addition to dried, and canned fish. They will also increase flexibility in package sizes, such as allowing families to choose individual yogurts instead of only a large tub. The proposed rule will be open for public comment from November 21 through February 21, 2023.

For low-income parents who turn to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to help feed their kids, moving to a new state could make accessing the benefits confusing.

In Louisiana, those parents can buy soy milk in place of cow’s milk with their WIC cards, but they can’t buy tofu. In California, tofu is allowed; however, if they buy the Azumaya brand, they can get silken, firm, or extra firm, but they can only buy silken tofu if it’s the Nasoya brand. In Iowa, if their food package includes eggs, they’ll have to buy large, and the label can’t include any special health claims like cage-free or non-GMO. In Maryland, they can choose medium or large eggs, and organic and cage-free are okay—but, if a store brand carton is available, they must buy that. Those complications are only the start.

Using analyses done by the National Academies of Sciences, Engineering, and Medicine, WIC targets specific nutrient deficiencies among American infants and their parents.

Many federal programs vary across the country due to differences in the way each state administers them. But unlike Supplemental Nutrition Assistance Program (SNAP), which aims to reduce overall hunger, WIC is restrictive by design. Using analyses done by the National Academies of Sciences, Engineering, and Medicine (NASM), the program targets specific nutrient deficiencies among American infants and their parents.

Advocates say the focused nature is what makes it effective. For example, evidence that the program reduces the risk of preterm birth, low birth weight, and infant mortality is strong. But the strict nutrition requirements and hyper-specificity of WIC-approved food shopping lists from state to state can also be confusing for those doing the shopping.

Nearly half of the people eligible for WIC don’t enroll, and a 2019 Food Research & Action Center (FRAC) report identified frustration with the limited range of approved foods and brands in some states as one of the main barriers to participation. In 2020, when the pandemic led to shortages of many items in grocery stores, WIC participants struggled to find approved foods on shelves. The complicated requirements can also shut out smaller food companies, since only the most well-resourced food companies tend to have the resources necessary to manage (and lobby around) the requirements.

Now, as resources and energy shift toward improving WIC’s reach and impact, policy experts and advocacy groups are talking about how to add more flexibility, choice, and ease to the program. For example, one recommendation NASM made in a 2017 report intended to inform updates to WIC was to “encourage state agencies to authorize as many food options as feasible.” Similarly, the 2019 FRAC report on “making WIC work better” says that updates to the food packages should focus on “increasing participant choice and flexibility,” among other goals.

The challenge, advocates say, will be ensuring that those changes don’t undermine WIC’s ability to deliver on its health outcomes. “We are supportive of creating more choice within the food package, as long as the food package remains consistent and aligned with nutrition science,” says Brian Dittmeier, the senior director of public policy at the National WIC Association (NWA), a WIC advocacy group that lobbies for support for the program in Washington and works closely with state-level WIC administrators nationwide.

WIC Food at the Federal Level

In Washington, attention to WIC began increasing a little over a year ago and has continued to build: After announcing a focus on “nutrition security” shortly after taking office in 2021, Secretary of Agriculture Tom Vilsack directed additional funding to the program and announced steps to modernize WIC to increase enrollment. This March, Vilsack said the U.S. Department of Agriculture (USDA) is working on an overdue update to the WIC food package. Finally, a potential Child Nutrition Reauthorization is on the horizon, as is the White House Conference on Hunger, Nutrition, and Health; both will likely have real implications for WIC.

Like nutrition requirements on school meals, the specifications are intended to promote health.

The country’s infant formula crisis over the past several months has also thrust the program into the spotlight. More than half of the baby formula purchased in the U.S. is paid for through WIC. Since its design involves each state selecting one company to provide all WIC formula at a discount, experts and lawmakers questioned whether the system had contributed to consolidation in the industry, making it vulnerable to shortages.

But the WIC-approved food lists don’t function in the same way. At the federal level, the USDA creates food packages using the nutrition science and analysis provided by NASM. Packages include a selection of healthy foods that vary based on whether the recipient is an infant, child, or pre- or postpartum mother. A package for a child between the ages of one and four, for example, includes fruits and vegetables, juice, milk, eggs, whole wheat bread, and either beans or peanut butter. Each of those food items then has a specific quantity and nutrition requirements attached to it. That same child is eligible for 36 ounces of cereal per month, for instance, but that cereal can’t have more than 21.2 grams of sugar and must have at least 28 milligrams of iron per 100 grams.

Like nutrition requirements on school meals, the specifications are intended to promote health. However, school nutrition directors can build meals around the requirements, while WIC directors have to apply theirs to the food that is already available at the grocery store. For example, two current requirements around bread and yogurt quantities both NWA and FRAC would like to see changed in the name of flexibility: Based on the quantities set by the USDA, states could only allow WIC participants to buy bread in one-pound (or 16-ounces) packages, which were almost non-existent. Packaged bread loaves are typically 20 (and sometimes 18- or 24) ounces. Some companies started making one-pound whole wheat bread to sell through WIC, but those products are much harder to find.

Similarly, the USDA’s WIC requirements specify yogurt as an acceptable substitute for milk in certain packages, but only 32 ounces, exactly, is allowed. As a result, WIC recipients can only buy large tubs, and sometimes stores don’t stock those.

“When you break down the [smaller] individual container sizes, sometimes they don’t add up to 32 ounces,” Dittmeier explains. “In our view, we should move that to a range, so individual package sizes can add up to a range of 30- to 32 ounces, and that creates more flexibility [for states] to authorize and work with a broader range of manufacturers to get more products on the food lists.”

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Organizations are communicating these recommendations to the USDA as the agency gears up to revise the WIC food package, and big food companies are no doubt paying attention, too. According to Geraldine Henchy, the director of nutrition policy and early childhood programs at FRAC, corporate pressure and the political maneuvering it leads to hasn’t affected WIC as much as it has other nutrition programs, like the National School Lunch program. But that doesn’t mean food companies and industry associations haven’t tried to influence the packages in the past.

In 2014, the National Potato Council lobbied to get white potatoes added to WIC’s acceptable fruits and vegetables, and members of Congress went to bat for the potato lobby. Henchy said Congress failed in their overall attempts to gain legislative control over what should and shouldn’t be in WIC, an outcome advocates feared would threaten the program’s basis in nutrition science and open it up to future political battles. Instead, the potato question was sent back to NASM to be evaluated through the scientific process. In the end, however, they got their way: NASM approved white potatoes as an addition.

Still, companies including Danone and General Mills, which make foods featured prominently on WIC lists, lobby around WIC in Washington annually. As the program gets more funding and attention, “WIC is nervous about the impact of industry,” Henchy said.

“We didn’t want this to be a company that just serviced the most affluent ZIP codes in America.”

States’ Role in WIC Food Lists

Comparatively small food companies that want to get their products onto states’ WIC food lists face an uphill battle.

Getting their organic baby food into the program was a key goal for entrepreneur and Annie’s alum John Foraker and actress Jennifer Garner, two of four founders of Once Upon a Farm. “We didn’t want this to be a company that just serviced the most affluent ZIP codes in America,” Foraker said.

But to meet packaging and cost requirements, Once Upon a Farm had to design a new line of products. Instead of its usual pouches, the fruit-and-vegetable blends are called “bowls” to more closely match the packaging of traditional jarred baby foods. And the recipes are slightly simplified to eliminate the most expensive ingredients; Think Apple-Banana-Kale instead of Apple-Banana-Kale-Hemp Seeds.

Each state takes the USDA requirements and food packages and makes its own list of specific foods approved for purchase with WIC dollars. Some specifications are made by type and others are made by exact brand and product. States can also offer substitutions authorized by USDA for some items, but they don’t have to.

“The complexity of every state doing a different flavor is the hardest part,” Foraker said. Some states review foods on a rolling basis, while others only review new foods in batches, sometimes over a period as long as every few years, he said. Some states, he found, don’t allow USDA-certified organic foods on their lists at all, so he skipped those. In the end, he spent countless hours working on one state at a time, and the bowls are now available to WIC participants in five states: New York, Connecticut, Florida, Texas, and Michigan. Foraker said it took “well over a million dollars and a few years” to get to that point—and the effort continues.

Cost is the main driver behind the decisions each state makes, Henchy said, but FRAC’s position is that some states are too restrictive and could add more choices and make it easier for additional brands to be added. In its 2019 report, the organization identified frustration with the limited range of approved foods and brands in some states as one of the main barriers to participation, and one of the USDA’s current goals is to increase enrollment.

“I was really not able to find much of it. And if I couldn’t find it, I just gave up on [redeeming WIC benefits].”

States can make it easier for more brands to get on their food lists, Henchy said, and can offer more substitutions. “Offering a constrained set of options—for example, no peanut butter or yogurt and only a limited number of allowable WIC cereals—can have an impact on recruitment and retention. The limitations may create a barrier to participation by diminishing the value of the available children’s food package, making it harder to find authorized foods, and/or increasing the risk of an embarrassing WIC foods check-out experience,” she wrote in the report.

To that end, while some states look like they’re marketing certain brands by including photos of certain yogurts and juice bottles, experts say the images are actually meant to help WIC recipients navigate the lists. In other words, rather than checking grams of sugar in each box of cereal or reading a long list of specific product names, a visual of a box of Honey Kix does the job.

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In a study by researchers at the University of Tennessee published in 2021, WIC participants in Tennessee told interviewers that they had trouble finding approved foods because retailers stocked them inconsistently. When panic buying and supply chain disruptions cleared out shelves, that challenge was exacerbated. “I usually go to the store once or twice a week, and in March [2020] I had to go a lot more to try to get what I needed,” one 28-year-old woman said. “I was really not able to find much of it. And if I couldn’t find it, I just gave up on [redeeming WIC benefits].”

To address the issue, the USDA provided waivers at the time that allowed for some added flexibility within the food package. In Tennessee, for example, milk with any fat content was allowed. However, study participants said while those flexibilities were helpful “in theory,” they weren’t always clearly communicated or easier to navigate.

A Whole New Era

Participants in the study also said that the ability to use their benefits online would likely eliminate some of the complications. And as the digital future accelerates, apps and online shopping could make the process much simpler. “You can have filters through retailer platforms that identify WIC-approved items and . . . match the balance of the benefits with the products that the retailer sells,” Dittmeier explained.

However, it won’t be an easy shift. Currently, states certify individual store locations to sell through WIC, so certifying an online retailer with many locations will be a challenge to work out. There is also the question of state lines, especially with national online retailers.

In 2021, the USDA partnered with the Gretchen Swanson Center for Nutrition to run online ordering pilot projects. Four states have begun developing systems, and they are expected to be ready for WIC recipients to begin testing in spring of 2023. Overall, Dittmeier cautioned that it’s going to take quite a while.

“SNAP was able to scale up its purchasing pilot and make online shopping available to more than 90 percent of its participants in a matter of months at the beginning of the pandemic, but they were only able to do so because they had seven years of planning that went into that pilot project,” Dittmeier said. “Now, keep in mind that WIC is a more complicated transaction than SNAP.”

Currently, apps like the WIC Shopper, which allows participants to scan foods to see if they are approved, do help with some challenges, but they’re not available in all states. Still, those who work on improving WIC are excited about this moment in time. They see it as a long hoped-for opportunity to talk about both WIC’s many benefits and how to make it better.

“USDA is listening,” Henchy said, who sees the upcoming White House Conference on Hunger as a critical chance to bringing parents into the room to talk about their experiences navigating the byzantine program. “We want to get WIC participants into those listening sessions, and we want them to be central to [the conversation],” she said.

Lisa Held is Civil Eats’ senior staff reporter and contributing editor. Since 2015, she has reported on agriculture and the food system with an eye toward sustainability, equality, and health, and her stories have appeared in publications including The Guardian, The Washington Post, and Mother Jones. In the past, she covered health and wellness and was an editor at Well+Good. She is based in Baltimore and has a master's degree from Columbia University's School of Journalism. Read more >

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