Thursday, June 23, 2011

WIC Works

In fiscal year 2010, the USDA spent approximately $94.8B on congressionally mandated food and nutrition assistance programs.  The bulk (72%) went to SNAP (food stamps), followed by School Lunch (11%).  The WIC program accounted for approximately 7% of the expenditures. WIC served 9.2 million people per month in 2010.

What is WIC? WIC is the common name for the Special Supplemental Nutrition Program for Women, Infants and Children.  Its mission is “To safeguard the health of low-income women, infants, and children up to age 5 who are at nutrition risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care.” 

But wait.  Isn’t this what SNAP is for?  Not exactly.  Compared to SNAP:
  • WIC serves a much more tightly-defined population – just low-income, nutritionally at risk:
    - Pregnant women
    - Breastfeeding women (up to infant’s 1st birthday) 
    - Nonbreastfeeding postpartum women (up to 6 months after the birth of an infant or after pregnancy ends)
    - Infants (up to 1st birthday). WIC serves 45-50 % of all infants born in the United States. 
    - Children up to their 5th birthday.
  • WIC is NOT an entitlement program.  States receive a specific amount of money and can only enroll participants until their funding runs out.
  • All WIC services are tailored to the client’s health and nutritional status.  WIC requires nutrition education, health monitoring, and regular appointments with WIC nurses at specific sites. 
  • WIC vouchers supplement the client’s diet and may only be used for specific amounts of WIC-authorized foods. 
These last two features of WIC are the reason community nutritionist David Holben at the University of Ohio said that he prefers the WIC model for supplemental food programs.  

Ever since meeting Professor Holben, we’ve looked forward to visiting and learning about WIC from those who administer the program at the local level.  We got our chance in Duluth, MN, where we met with Public Health Nurse Supervisor Luzette Samargia. 

Luzette has been part of the WIC program since about 1978 when it was first introduced in this part of Minnesota.  As part of her duties, Luzette now manages the County WIC program for the Department of Public Health and Human Services in St. Louis County, Minnesota’s largest county, which stretches from Duluth and Lake Superior in the south, through the Iron Range (Hibbing and Virginia), to the Canadian border in the north.

Luzette manages about 27 public health nurses and 3 dieticians, who as part of their jobs are highly trained to provide WIC health checks, breastfeeding encouragement, nutrition counseling for mothers and their young children, and appropriate WIC food vouchers.  They do extensive outreach in community forums, hospitals, and newspapers to ensure that WIC reaches as many of those eligible as possible.  Currently, about 4500 women, infants, and children receive WIC services in St. Louis County.  And when a woman or child is no longer eligible for WIC, they ensure that any continuing needs are met  by following up with regular home visits or by referring the client to other services. 

When a pregnant woman or mother of young children wants WIC services, she typically calls the public health office and is screened for eligibility.  The Minnesota Department of Health also has a simple on-line tool for assessing eligibility.  Then she comes in to one of 4 WIC locations around the county.  There she and her infants or young children meet with a public health nurse, who does the routine health checks, including height, weight, and routine blood work for children over age 6 months.  The nurse assesses the family’s nutritional risks and needs and provides tailored  nutrition counseling, using a variety of materials developed specifically for use by WIC mothers.   Then the mother receives vouchers for WIC foods and learns about the process for using them.  The WIC mother signs the vouchers once when she receives them. 
One section of Minnesota's WIC Shopping Guide
She takes the WIC Shopping Guide with her to the store.  This guide helps her to find the WIC-approved items that can be purchased with the voucher.  For example, pictured here is the section on fresh vegetables.

At the register, she separates the WIC foods from other items she may be purchasing with SNAP benefits or with her own cash.  The cashier checks the WIC items against the voucher, asks the woman to sign the voucher again, and keeps it for processing by the store.  This somewhat complex process will be simplified within a few years, as the USDA is mandating that all states move to the use of electronic benefits cards for WIC by 2020.

Does WIC work?  Luzette felt strongly that her WIC program has positive effects on those it serves.  National studies are somewhat mixed (see The WIC Program: Background, Trends, and Economic Issues, 2009 Edition).  But studies generally agree that WIC has positive impacts on healthy infants, such as mean birthweights, which also leads to savings in Medicaid costs. 

WIC has generally not been found to significantly change food patterns of participants or to reduce the incidence of obesity.  Thus, WIC programs are increasing their focus on nutrition education.  And in 2009 the WIC nutrition advice and foods available with WIC vouchers were completely updated in accordance with current USDA guidelines.  For example, WIC vouchers may now be used for fresh fruits and vegetables, more whole-grain products are required, and only milk with 2 percent or lower fat content is authorized for women and children age 2 and older.

Another reported issue with WIC is that WIC mothers may be less likely than non-WIC mothers to breastfeed their babies.   It’s not clear whether this difference is due to a sampling bias (WIC mothers may differ from non-WIC mothers in other ways related to the choice of whether to breastfeed) or whether the WIC program actually causes more mothers to choose bottle feeding due to factors such as WIC subsidies for infant formula. 

But we are glad to see that locally, regionally, and nationally, WIC programs are stepping up efforts to increase breastfeeding.  In St. Louis County, certified lactation specialists are available in each office and more public health nurses are becoming certified.  All WIC mothers are given advice about appropriately advancing their infant’s diet.  The new Minnesota WIC Shopping Guide offers simple reasons for breastfeeding and strong encouragement, including a reference to La Leche League.  Women who are fully breastfeeding  receive larger portions of WIC foods and also receive vouchers for canned tuna and salmon.  And at the federal level, when Congress reauthorized WIC as part of the Healthy, Hunger-free Kids Act of 2010, the bill included additional incentives for states to more strongly encourage breastfeeding. 

In short, we believe that WIC is evolving to be a very good model for providing need-based and outcome-based, supplemental nutritional assistance.

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