The Special Supplemental Nutrition Program for Women, Infants and Children (abbreviated as WIC) is a federal assistance program of the Food and Nutrition Service (FNS) of the United States Department of Agriculture (USDA) for healthcare and nutrition of low-income pregnant women, breastfeeding women, and infants and children under the age of five. (See Child nutrition programs.) The eligibility requirement is a family income below 185% of the U.S. Poverty Income Guidelines. If a person participates in other benefit programs, or has family members who participate in the Food Stamp Program, Medicaid, or Temporary Assistance for Needy Families, they automatically meet the eligibility requirements. This program is unrelated to the USDA's Food Stamp Program. Currently, WIC serves 53% of all infants born in the US.^[1]

History[link]

In 1968, a group of physicians described to the Department of Health, Education and Welfare and the USDA that young women, often pregnant, came to their clinics with various ailments that were caused by a lack of food. The doctors would prescribe needed foods, with the prescription acting as a sort of food voucher. WIC’s program beginnings surface in 1969, when the White House Conference on Food, Nutrition, and Health recommended that special attention be given to the nutritional needs of low-income pregnant women and preschool children ^[2]

WIC was formally created by an amendment to section 17 of the Child Nutrition Act of 1966 on September 26, 1972.^[3] The legislation (P.L. 92-433, sponsored by Senator Hubert Humphrey (D) of Minnesota) established the Special Supplemental Food Program for Women, Infants, and Children (WIC) as a 2-year pilot program. Eligibility was limited to children up to age 4 and excluded non-breastfeeding postpartum women. By the end of 1974, WIC was operating in 45 states. On October 7, 1975, WIC was established as a permanent program (P.L. 94-105). Eligibility was extended to non-breastfeeding women (up to 6 months postpartum) and children up to 5 years of age. However, all participants must be deemed to be at nutrition risk and with inadequate income (however, what constituted inadequate income was not defined). In 1978, P.L. 95-627 defined nutrition risk and established income eligibility standards that were linked to the income standards associated with reduced price school meals. Another income standard change took place in 1989, when P.L. 101-147 established similar income eligibility for Food Stamp, Medicaid, and AFDC participation, thus lowering the WIC income standard and simplifying the application process. WIC began to promote and support breastfeeding women in the late 1980s, and in 1989 Congress mandated $8 million be used specifically for that purpose. Also in 1999, the WIC program standardized nutrition risk criteria for program eligibility and began assigning individual nutrition risk priority levels.

Eligibility[link]

In order to apply for the WIC assistance program, one must be a pregnant woman, breastfeeding for up to one year, postpartum for up to six months, or have young infants (0–1 years old) and children (under 5 years old) with specific nutritional needs.^[4]

After meeting these basic eligibility requirements, applicants must also satisfy the following criteria to receive assistance:^[5]

Income

Family income must be at or less than 185% of the current federal poverty level. This is around $45k for the median income of a family of four.^[6]

Residence

Must be a resident of the county to which they are applying for assistance.

Nutrition risk

Must have a nutritional risk assessment by a qualified health professional. The Nutritional evaluation is based on height, weight, and growth assessment; hematocrit or hemoglobin levels; general health history; and a diet assessment.

WIC Services[link]

General services[link]

Once applicants meet the eligibility requirements, they can expect to receive WIC assistance in the following four areas:^[7]

Supplemental food

Food checks or an EBT card are issued to program participants that allow them to buy nutritious food that meets their needs at stores that have contracted with the government to accept these checks in exchange for merchandise.

Nutrition education

WIC participants are offered free health and nutrition education classes which help them understand their specific nutrition needs and learn about health prevention and improvement strategies.

Access to healthcare and other social services

Program participants receive guidance and assistance in accessing other important services such as prenatal programs, immunizations and child clinics, and drug and alcohol treatment programs.

Breastfeeding support

Program participants also receive guidance and support materials from Certified Lactation Educators about the benefit of breastfeeding and proper breastfeeding techniques.

Nutrition education and anemia screening[link]

The WIC program is among the services offered by the Ricardo Salinas Health Center on General McMullen Drive in southwestern San Antonio, Texas.

Nutrition education ranges various topics including healthy eating, appropriate infant feeding, and breastfeeding. Additionally, the WIC program also screens for anemia in participants over 12 months old. Depending on the state, nutrition education is provided via a Registered Dietitian, an individual with a bachelors degree in nutrition or related field, or another certified professional authority. WIC agencies are required to stress the long-term benefits of nutrition education, although participating in this education is not compulsory for WIC recipients.^[8]

Check/Voucher & EBT card[link]

WIC participants often receive a monthly check or voucher, or more recently an EBT card. The USDA implemented new rules in 2006 that required foods to be more price-competitive. This has resulted in the closure of many "WIC Only Stores". Formerly, these stores charged the maximum permitted under the program, charging up to 16% more than regular stores for the same food.^[9] However, the WIC program is one of the most cost-effective government programs. A study of birth outcomes showed benefit-to-cost ratios ranging from $1.77 to $3.13 in Medicaid costs saved for each $1 spent on WIC.^[10]

The WIC check/voucher is a specially designed check that is compatible with retail point-of-sale check readers and printers. The front of the check displays the recipient’s name and recipient number, a begin use- and an end-use date, a list of allowable items to be purchased with the check/voucher, including the quantity and/or maximum weight of the allowed items listed. The WIC recipient can choose if they want only some or all of the items listed on the check. The check also has an area for the cashier to enter the sale total, and an area for the recipient to sign the check/voucher at the time of use. The checks make use of MICR for enhanced security and ease of processing.

Alternately, many States (notably Texas and Nevada) have moved away from a paper system of checks and vouchers. The conversion of the WIC program to EBT cards has automated a great deal of the process and provides better care for the children and mothers currently using WIC. The cards are similar to consumer credit/debit cards but are exclusively used for purchasing WIC-approved items.

Items provided[link]

The food items provided by WIC are juice (single strength), milk, breakfast cereal, cheese, eggs, fruits and vegetables, whole wheat bread, whole grain items including brown rice and tortillas, fish (canned), legumes (dry), and peanut butter. The program also provides tofu, soy milk, and medical foods for children and women with various metabolic or other diseases. Since the white potato was deemed less nutritious than other produce, the WIC commission banned white potatoes from the list, causing protests.^[11] Organic fruits, vegetables, legumes and grains are covered under WIC while organic milk, cheese, juice, peanut butter and eggs are not covered under the program.

Responsibilities of recipients[link]

The usual responsibilities of a WIC recipient are:

• Being responsible for the WIC check/voucher and the recipient's WIC identification card. In many cases, a WIC check/voucher cannot be replaced if the check is damaged or lost.
• Using the WIC check/voucher within the specified date range.
• Selecting only the specified items on the check/voucher. The items also must be WIC-allowed items. For instance, a WIC check/voucher holder purchasing a gallon of milk may be asked to select the lowest cost product (usually store brand and not the premium brand) and must get a gallon container, not two half-gallon containers. In the case of a check stating "Two Quarts {2%, 1%...}," however, one can get a half gallon container instead of two quart-sized containers. This varies from state to state.
• Must not exceed a certain sale amount (this is not used for all WIC checks/vouchers, depending on local/state regulations).
• Being courteous with retail personnel during a WIC transaction.

Literature review[link]

Nutrition requirements[link]

A woman, infant or child must meet two standards to be eligible to receive WIC benefits: (1) nutritional risk and (2) income disparity. Yet according to Peter Germanis and conservative AEI scholar Douglas J. Besharov in the SAGE Evaluations Review Journal, these two requirements often fall short in determining the real eligibility for WIC participants. They assert that the idea of “nutritional risk” is too broad of a concept. WIC’s current definition of nutritional risk includes different medical conditions such as anemia and low or overweightness. The definition also includes the mother’s history, age, past pregnancy complications, and inadequate diet ^[12]

While some of the nutritional risk standards are clear, Besharov and Germanis further point out that the majority of people on WIC do not clearly exhibit these symptoms or history. They still might have nutritional risk, but they do not meet the definition outlined in the policy. Despite the definition of nutrition risk, the Institute of Medicine’s Committee on Scientific Evaluation of WIC Nutrition Risk Criteria pointed out that many states have used “generous” cut-off points and “loosely defined risk criteria.” Their research concluded that because the judgment of nutritional risk is left up to the discretion of the doctor, many participants who only partly need WIC’s assistance often take the spots of those with greater need.

In Feeding the Poor: Assessing Federal Food Aid, P.H. Rossi (1988) states that these gaps are often a result of unreliable tools or methods to measure nutrition risk, along with a lack of clarity in the definition of risk. In the study, Rossi took what are called “street-level bureaucrats” and applied them for WIC. These people were either at marginal or no nutrition risk, yet they were accepted easily into the WIC program. This practice essentially turns eligibility into solely a matter of income.^[13]

Income requirements[link]

The second eligibility standard for participation in the WIC program—income level—also allows for much subjectivity. In theory, to qualify for WIC services, a family must have an income that meets or is less than 185% of the current federal poverty level. While this definition seems straight forward, Besharov and Germanis describe many instances in which WIC participants with incomes above this level still received services. This could be due to the rapid growth of WIC in the past 30 years. Many WIC staff members have reported that because of the rise in funding, local income testing procedures have become less thorough (2000).

Besharov and Germanis aren't the only ones who have noticed discrepancies in the WIC income eligibility requirement. A USDA study demonstrated that 5.7% of WIC participants were not eligible because their income was too high (see U.S. General Accounting Office 1999, 23). Because of this evidence, the USDA believes that WIC can reduce funding and still meet the needs of those who truly are in need of assistance ^[14]

Conversely, the same report explained that some members of the USDA have concluded that the current method for estimating eligibility is flawed and reports a much lower number of eligible citizens than actually exists. The method is flawed because it measures income on an annual basis instead of a monthly basis. When the researchers compared monthly income to annual income, they found that the number of income-eligible people increased dramatically a monthly evaluation level. (46-54% increase for infants, and 34-36% increase for older children. No mention of the effect on mothers was mentioned). They concluded that if income were measured monthly, then a larger number of families would be eligible to participate in WIC ^[15]

Other research suggests that instead of redefining WIC eligibility requirements, policymakers should better advertise how lenient the requirements are. In a study published in 2005, Craig Gundersen, a professor in the Department of Nutritional Science at the University of Illinois at Urbana-Champaign, found that many parents stop using WIC funds to care for their children after their children reach the age of one year. However, over 35% of these children are in families that are below the poverty line. Only one in nine non-participating children nationwide are ineligible for WIC aid. The research suggests that parents are unaware that children up to five years of age are still eligible for WIC services; consequently, their children are not getting necessary nutrition.^[16]

To combat this phenomenon, Gundersen suggests that if policymakers want to reach those most in need, they need to target this group of people who were once on WIC and left, not new recipients. His research shows that families that have never received WIC assistance have monthly family incomes $797 higher than those who have left the program and $1215 higher than those currently on the program. Clearly, the people who were once on WIC and left have greater need than most of those who have never sought WIC aid.

Other programs' effect[link]

Eligibility for participation in the WIC program has been affected by a number of Federal programs and policy changes since the 1980s. The Federal government has gradually increased its control over WIC program policies, which has resulted in a move away from State program control. For instance, the nutritional risk criteria which had previously been instituted by the state cutoffs were standardized by the Federal Government in 1999 ^[17]

In 1989, the Child Nutrition and WIC Reauthorization Act increased the amount of eligible program participants by allowing groups such as Medicaid, Aid to Families with Dependent Children (AFDC), Temporary Assistance for Needy Families (TANF), and those qualified for food stamps automatically became eligible for WIC assistance. Allowing these groups to be eligible, in effect, raised the income eligibility threshold for WIC services. Participants in the WIC program are now viewed as those that are inherently eligible because of an income at 185% below the poverty line, or adjunctively eligible through eligibility and participation in the aforementioned programs. Interestingly, research has identified an increase in health benefits among WIC program participants that could offset the additional costs of Medicaid in the future. Changes in welfare benefits are also estimated to increase the adjunctive eligibility rate.

WIC program participation can be affected by an introduction of new programs or changes to existing policy of programs that affect women, infants and children. The WIC program assists 73 percent of eligible infants, 38 percent of eligible children, and 67 percent of eligible pregnant and postpartum women (Bitler & Scholz, 2002). Where services increase under the TANF program, a specific segment of participants in the WIC program, such as infants, have shown a decrease in participation. Implementation of the TANF program accounts for a 9.8 percent reduction in WIC program participation.

In addition to current programs that affect eligibility and participation in the WIC program, many states distribute waivers that extend program rules, change work requirements, and extend program timelines that affect eligibility and participation in WIC.^[18]

Internal programs' effect[link]

WIC’s impact is affected by internal programs. Some scholars assert that the spending structure needs to be adjusted so a greater number of eligible individuals can receive WIC services. Transferring some spending to other parts of the program is under consideration.

Besharov and Germanis argue that a sustained effort to make the program more effective should begin with a policy debate about WIC’s role and impacts. “WIC’s rigid spending rules, for example, prevent local programs from spending more than about 30 minutes for nutritional education every 6 months with clients." In the article “WIC Reauthorization: Opportunities for improving the Nutritional Status of Women, Infants, and Children (2002), authors Fox, McManus, and Schmidt from the George Washington University, say local WIC agencies are required to make nutrition education available to participants at least twice in each six-month certification period. The initial nutritional session is usually conducted during the intake appointment with the individual, and subsequent sessions are typically offered in a group format lasting about 10 to 15 minutes. These education sessions are optional rather big baby than mandatory (2003). This practice raises questions about the efficiency of WIC spending. People doubt the legitimacy of the 30-minute nutritional education since it’s too short to play a part in improving the participant’s nutritional status. Therefore, it’s reasonable to ask: Would it be more effective and efficient if the spending for this session is transferred to other useful areas?

Based on the data mentioned by Alison Jacknowitz from American University and Laura Tiehen from U.S. Department of Agriculture in their article “Transitions into and out of the WIC Program: A Cause for Concern?”,^[19] in 2002 the average retail value of the WIC food benefit for infants ages 4–12 months was $100.37 per month; the average retail value of the child food benefit was $39.29 per month (Institute of Medicine, 2006). The higher retail value of the WIC food benefit for infants is due to the inclusion of infant formula. Since the WIC program encourages breast feeding, it raises a question similar to the foregoing: Would it be more effective and efficient if some of the spending on infant formula is transferred to drawing more participation of WIC, making more people eligible for this program?

References[link]

1. ^ http://www.fns.usda.gov/wic/aboutwic/wicataglance.htm
2. ^ White House Conference on Food, Nutrition, and Health, 1970
3. ^ http://plannedparenthoodosbc.org/wic/wicabout.asp
4. ^ USDA,Food and Nutrition Service. (2011, October 07). Program Data. Retrieved from http://www.fns.usda.gov/pd/wicmain.htm
5. ^ Orange County Health Care Agency, 2011
6. ^ USDA,Food and Nutrition Service. (2011, October 07). Program Data. Retrieved from http://www.fns.usda.gov/pd/wicmain.htm
7. ^ Orange County Health Care Agency. (2011). Public health services. Retrieved from http://ochealthinfo.com/public/nutrition/wic
8. ^ "Error: no |title= specified when using {{Cite web}}". http://www.fns.usda.gov/wic/lawsandregulations/WICRegulations-7CFR246.pdf. 
9. ^ http://www.signonsandiego.com/uniontrib/20040704/news_1n4wic.html
10. ^ Devaney, Barbara (7 December 2007). "WIC Turns 35: Program Effectiveness and Future Directions". National Invitational Conference of the Early Childhood Research Collaborative. http://www.earlychildhoodrc.org/events/presentations/devaney.pdf. Retrieved 21 February 2012. 
    Citing: Devaney, Barbara; Bilheimer, Linda; Schore, Jennifer (1992). "Medicaid costs and birth outcomes: The effects of prenatal WIC participation and the use of prenatal care". Journal of Policy Analysis and Management 11 (4): 573–592. DOI:10.2307/3324956. PMID 10121542. 
11. ^ http://www.fns.usda.gov/wic/benefitsandservices/foodpkgregs.HTM
12. ^ Besharov, D. J., & Germanis, P. (2000). Evaluating WIC. Evaluation Review 24(2), 123-190. Retrieved from http://erx.sagepub.com/content/24/2/123.full.pdf html
13. ^ Rossi, P. H. (1998). Feeding the poor: Assessing federal food aid. Washington, D.C.: AEI Press.
14. ^ Fox, H. B., McManus, M. A., & Schmidt, H. J. (2003). WIC reauthorization: Opportunities for improving the nutritional status of women infants and children. National Health Policy Forum. 1-35. Retrieved from http://www.nhpf.org/library/background-papers/BP_WIC2_8-03.pdf(National Research Council, 2003).
15. ^ Fox, H. B., McManus, M. A., & Schmidt, H. J. (2003). WIC reauthorization: Opportunities for improving the nutritional status of women infants and children. National Health Policy Forum. 1-35. Retrieved from http://www.nhpf.org/library/background-papers/BP_WIC2_8-03.pdf(National Research Council, 2003).
16. ^ Gundersen, C. (2005). A dynamic analysis of the well-being of wic recipients and eligible non-recipients. Children and Youth Services Review, 27(1), 99-114. Retrieved from http://www.sciencedirect.com/science?_ob=MiamiImageURL&_cid=271857&_user=456938&_pii=S0190740904001665&_check=y&_origin=&_coverDate=31-Jan-2005&view=c&wchp=dGLzVlS-zSkzS&md5=2d9ae3ca8df9d37baf621253f16da7fb/1-s2.0-S019074090
17. ^ Swann, C. A. (2010). WIC Eligibility and Participation: The Roles of Changing Policies, Economic Conditions, and Demographics The B.E. Journal of Economic Analysis & Policy 10(1), 1-37 Retrieved from http://www.bepress.com/bejeap/vol10/iss1/art21
18. ^ Swann, C. A. (2010). WIC Eligibility and Participation: The Roles of Changing Policies, Economic Conditions, and Demographics The B.E. Journal of Economic Analysis & Policy 10(1), 1-37 Retrieved from http://www.bepress.com/bejeap/vol10/iss1/art21
19. ^ Jacknowitz, A., & Tiehen, L. (2009). Transitions into and out of the WIC program: A cause for concern. Social Service Review. 83(2), 151-183. Retrieved from http://www.jstor.org/stable/pdfplus/10.1086/600111.pdf?acceptTC=true

External links[link]

• "WIC". Food and Nutrition Service. http://www.fns.usda.gov/wic/. Retrieved November 23, 2005. 
• "WIC at a Glance". http://www.fns.usda.gov/wic/aboutwic/wicataglance.htm. Retrieved June 23, 2008. 
• "WIC: Women, Infants, Children Program". http://plannedparenthoodosbc.org/wic/wicabout.asp. Retrieved October 9, 2008. 
• "Texas EBT WIC: Electronic Benefits Transaction Program". http://www.dshs.state.tx.us/wichd/ebt/ebt1.shtm. Retrieved January 30, 2009. 
• National WIC Association, a non-profit organization is support of the WIC program
• WIC programs