May 2009 

Reauthorizing a Strong WIC Program

Every day, doctors and other health professionals refer women and children to WIC knowing it improves children’s health. While research has shown that WIC decreases children’s risk of costly health problems and developmental delays, only 57 percent of those eligible are enrolled. At a time when hundreds of billions are being spent to stimulate the economy, we must not forget that our future economic success depends on the health and healthy development of our youngest citizens and future work force. As Congress considers reauthorization of child nutrition programs, we urge our nation’s leaders to examine the evidence that WIC is a highly effective program.

Children’s HealthWatch has found that:

• Children under age three who receive WIC are more likely to be in good health.
• Children who are eligible for WIC but do not receive it due to access problems are more likely to be:

• In poor health
• At risk for developmental delays
• Food insecure
• Underweight
• Short for their age

• WIC has an especially powerful effect on the health of children younger than 12 months.

Who is eligible for WIC and what does the program provide?

WIC provides women and children with scientifically-selected, nutrient-rich foods as well as information on healthy eating and referrals to health care. Since its launch in 1974 with 88,000 participants, the program has grown to meet the nutritional needs of nine million women and children: 49 percent are children ages one to five, 26 percent are infants under age one, and 25 percent are pregnant, postpartum and breastfeeding women.

To participate, households must meet income eligibility criteria (at or below 185% of the US Poverty Income Guidelines) and state residency requirements and be determined to be at “nutritional risk” by a health professional. Conditions recognized as posing a nutritional risk include anemia, under/overweight and food insecurity.

WIC participants receive monthly vouchers to purchase foods high in the essential nutrients often dangerously lacking in the diets of low-income families. These include infant formula and cereal, eggs, milk, cheese, fruit, canned tuna and carrots. Foods that can be purchased using WIC vouchers are identified in seven “food packages.” Culturally appropriate foods are included to accommodate families of different backgrounds. To align WIC with current nutritional guidelines, the Institute of Medicine recommended changes in the food packages that will be implemented in 2009. The contents of the packages vary depending on the age of the child, whether the mother is pregnant, has recently given birth or is breastfeeding, and the nutritional and health status of the mother and child.

WIC links women and children with health care by integrating its services with others that are necessary for children’s well-being. WIC’s public health workers, for example, screen all immunization records of infants and children under age two and provide referrals to immunization services and nutrition education.

WIC Participant Characteristics

Women

• Pregnant - 11%
• Postpartum - 7%
• Breastfeeding - 7%

Infants 

• Under One Year Olds - 26%

Children

• One Year Olds - 17%
• Two Year Olds - 13%
• Three Year Olds - 11%
• Four Year Olds - 8%

Source: USDA, 2006

What does research show about WIC’s effectiveness?

The latest scientific evidence tells us that much of the foundation for children’s future health and academic potential is established in the womb and during the first three years of life. By providing a nutritious diet during pregnancy and early childhood, WIC protects the bodies and the brains of millions of children.

New research by Children’s HealthWatch shows that:

Children under age three who receive WIC are more likely to be in excellent or good health than eligible children who do not receive WIC due to access problems. They are also more likely to be:

• Food secure
• Have a healthy height and weight for their age

The access problems reported by mothers of children who did not receive WIC include:

• Limited hours at some WIC offices
• Difficulty getting to WIC office to pick up vouchers
• Transportation problems
• Lack of a permanent address

WIC has its most protective effect on children younger than 12 months of age. This is when their brains more than double in size if the nutritional building blocks are provided.

WIC decreases the risk of developmental delays in young children. Children are considered at risk for developmental delays when there are significant concerns about their ability to speak and understand language, their fine and gross motor skills, social/emotional behavior, or ability to learn in school.

WIC has a positive effect on children’s health in both working and non-working families. Children’s HealthWatch found that children in income-eligible working families that do not receive WIC are more likely to be food insecure, more likely to live in households that lack adequate heating or cooling, and more likely to live in unstable housing situations. These findings support maintaining current income eligibility guidelines and not lowering them as has been recently suggested.

Children’s HealthWatch findings are consistent with a long history of research showing WIC to be effective in protecting young children’s health and development. Earlier research has shown that WIC:

• Decreases the rate of low birth weight by 44 percent. Low birth weight is associated with many health complications, such as respiratory, heart, and intestinal problems, bleeding in the brain and vision loss.
• Increases the rate of breastfeeding among WIC participants by 23 percent. Breastfed babies are more likely to be at a healthy weight and score higher on IQ tests.
• Reduces the percentage of children with anemia by 12 percent.5 Children with anemia can suffer from delays in cognitive development.
• Increases the mean intake of iron in children. An iron deficient diet can lead to stunted growth and learning and behavioral problems.
• Improves rates of childhood immunization.
• Increases the likelihood of a child having a regular source of health care.

WIC Improves Child Health and Developmental Outcomes

Source: Children’s HealthWatch Data, 2008

How will the recession affect WIC enrollment?

As the recession deepens, more pregnant and postpartum women will turn to WIC. USDA data show that between February 2008 and February 2009 there was a four percent increase in WIC participation nationally; many states had increases of between six and ten percent. The Obama administration has taken steps to address this increase by providing $500 million for WIC in the American Recovery and Reinvestment Act.

The situation must continue to be monitored carefully as women and children are likely to stay in the program longer, food prices may continue to rise, and recent food package updates may increase costs. Given these potential pressures on the budget, it is encouraging that the President’s FY10 budget calls for full WIC funding “to serve all eligible individuals.”

Is WIC Cost Effective?

Research has shown that every $1 spent on WIC results in savings of between $1.77 and $3.13 in health care costs in the first 60 days after an infant’s birth. The program has the highest rating possible from the U.S. Office of Management and Budget’s Program Assessment Rating Tool (PART), an assessment based on a program’s goals, results, and management. WIC’s superior rating is attributable to its measurable impacts on key health outcomes, the efficient use of program funds and its success in achieving long-term performance goals. 

Protecting America's Future

As part of the reauthorization of WIC, we recommend that Congress:

• Direct the Secretary of Agriculture to provide the full complement of WIC foods recommended by the Institute of Medicine (IOM). Current food packages provide only three quarters of the amount of fruits and vegetables the IOM determined was necessary for children and only four-fifths of the amount the IOM recommended for women. Investment in the nutritional quality of WIC foods is critical.
• Mandate coordination between local WIC offices and hospitals with significant maternity services. Making sure new mothers receive information about WIC will help ensure the program reaches more eligible families and that new mothers have access to breastfeeding support. Locating WIC offices or placing employees in these hospitals is clearly optimal.
• Accommodate the needs of working mothers by extending WIC office hours and allowing some nutrition education to be done electronically. Enhancing access to WIC services will ensure that eligible mothers and children are more likely to enroll and remain in the program.

During the appropriations process, we recommend that Congress:

• Fund WIC at a level that adequately supports states in meeting the needs of eligible women, infants and children and supports full implementation of the IOM recommendations. Federal support has not always kept pace with the need for the program and inflation in food costs.
• Increase funding for nutrition services and administration. Current funding is insufficient to maintain WIC Nutrition Education services in times of prolonged economic recession as funds become more urgently needed for vouchers. Nutrition services are central to WIC’s effectiveness in health promotion and need to be adequately funded.
• Decrease barriers to application and reapplication. Include funding for outreach to mothers regarding required documentation, hot line numbers and websites to facilitate WIC sign-up, and translation services for those with limited English proficiency