The Supplemental Nutrition Program for Women, Infants and Children (WIC) provides federal grants to states for supplemental foods, health care referrals and nutrition education for low-income, pregnant and postpartum women, infants and children up to age five who are found to be at nutritional-risk. Based on recommendations from the Institute of Medicine, the foods available to participants in the WIC program underwent a significant overhaul in 2009 to better align nutrient intake among WIC participants with the latest dietary guidelines. An essential part of these changes were efforts to ensure participants had greater access to fresh fruits and vegetables. 

Whether the more than 9 million participants served by the WIC program each month will benefit from these changes depends largely on their acceptance of and willingness to purchase the new types or varieties of food available through their WIC vouchers. Results from the 1998 National Survey of WIC Participants found high participant-satisfaction with the amount and type of foods offered through the former WIC food packages, and subsequently, a high rate of clients purchasing all their WIC foods (“complete buys”) among those who were satisfied.

If participants are dissatisfied with the amount and types of foods offered, or do not understand the benefits of the new foods, they may not redeem their WIC vouchers or they may not purchase all of their prescribed foods. This would not only be to the detriment of the participants, but would defeat the purpose of implementing the most dramatic changes made to the WIC food packages since the program’s inception.

There is, however, good news. A recent study conducted by Altarum Institute and funded by the U.S. Department of Agriculture, which administers the WIC program, found that more than 18 months after implementation of the food package changes, WIC participants overwhelmingly accepted the new food package. Evidence to support this conclusion includes participants’ redemption of the revised food vouchers (90 percent) and thoughts and opinions shared by participants during a series of focus groups. Additionally, more than three-quarters of WIC participants made use of the new cash value vouchers, which are issued specifically for the purchase of fruits and vegetables. Overall, these positive findings are consistent with other research that also found high levels of satisfaction and indicate that WIC participants are purchasing and consuming more nutritious foods as a result of the food package changes.

Despite the generally positive response to the food package changes, the Altarum study found notable decreases in some WIC food redemptions or less than ideal redemptions of specific WIC foods. These decreases were disproportionate among some WIC subpopulations. For example, while many of the measures used for this study demonstrate a high level of acceptance of the new food package, there was an increase from baseline in the proportion of participants who did not use any food vouchers (almost 5 percentage points). This change was seen across all participant categories and racial and ethnic groups, but appears to impact black and Native American participants the most.

While qualitative information gleaned from focus groups point to a high degree of satisfaction with the WIC foods, Altarum also found that other factors—such as the availability of particular food items, food voucher interpretation and issues that arise at the checkout counter—may help explain some of the decreases observed in the study.

Up to now, much of the focus of state implementation of the new WIC food package was around the logistics of making the new foods available, including changes in computer systems, educating grocery store employees and informing clients about the changes. To maximize the benefit of this major policy change, we believe states may now want to focus more effort on providing positive nutrition messages at the time of food benefit issuance to help clients understand the benefits of the new food package, how to use these foods in their everyday diet and assist them with any logistical or attitudinal barriers to purchasing and using the new foods. 

Ongoing research is needed to examine client use of the new foods to assure that efforts to encourage benefit usage are working. We are conducting similar studies to the one in Wisconsin in a number of other states, including Michigan, Kentucky and Nevada, which should help address some of these issues and provide a fuller picture of attitudes to the new WIC food package.

Why is all of this important? Because WIC starts low-income infants and children on the right nutritional path. And due to the reach of the WIC program, these changes have the potential to positively and substantially influence the obesity rates among the next generation. For this reason, it is critical that every effort be made to ensure the WIC program succeeds in reaching its target audience and that its participants are knowledgeable about, accepting of and have access to the nutritious foods offered through the program.

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All postings to the Health Policy Forum (whether from employees or those outside the Institute) represent the views of the individual authors and/or organizations and do not necessarily represent the position, interests, strategy, or opinions of Altarum Institute. Altarum is a nonprofit, nonpartisan organization. No posting should be considered an endorsement by Altarum of individual candidates, political parties, opinions, or policy positions.