Last week, the USDA extended a series of flexibilities in the Special Supplemental Nutrition Program for Women, Infants, and Children for the duration of the Covid-19 public health emergency. The waivers for the program, commonly known as WIC, have allowed participants to apply for benefits remotely rather than in person, and expanded both pickup options and the scope of eligible products.
Advocates celebrated the decision, which came just before the waivers were set to lapse. Still, barriers to WIC access hardly began with Covid-19. Now some advocates say the USDA should make the current flexibilities permanent, arguing that the pandemic’s economic toll will likely outlast its implications for public health.
“The economic fallout of this will last for months, and probably years,” said Lisa David, president and CEO of Public Health Solutions, which supports low-income New York City families and is the largest WIC provider in New York State. “Nutrition is essential for health, and has lifelong consequences, including chronic illness and low academic achievement. The disparities are painful to see.”
WIC stands out among food-assistance programs. It not only directs pregnant women and new mothers to a fixed set of healthy foods for themselves and their infants and young children, it provides counseling on prenatal nutrition and breastfeeding and advice for managing illnesses such as diabetes or asthma. It is prescriptive and broadly supportive in ways other programs are not.
SNAP and school meals, for instance, while critical to food-insecure families, do not necessarily incentivize healthy eating because they don’t set parameters or provide guidance on what constitutes a healthy diet. Research shows that WIC reduces childhood obesity, both because it helps kids develop a diet rich in fruits and vegetables at an early age and because it promotes breastfeeding, which is critical to preventing obesity and a host of other diseases and allergies. WIC also offers peer counseling on infant feeding practices, immunization screening, healthcare access, and academic performance — areas of child development where low-income kids face significant disparities.
The pandemic has not only exacerbated inequalities along economic and racial lines, it has revealed the striking social determinism of health in the United States. The co-morbidities for Covid-19 — including obesity, diabetes, and asthma — often stem from nutritional or environmental disruptions that begin at a young age.
According to a survey Public Health Solutions conducted among WIC participants in August, 80 percent of respondents had a change in employment status due to Covid-19; even with the current waivers, half of those surveyed reported difficulty finding WIC products such as formula and nutrient-rich cereals at the grocery store. Respondents also expressed concerns over health, housing, and employment; nearly half said they were worried about not having enough to eat.
The challenges pandemic-related flexibilities were designed to address — notably, the requirement that participants enroll at clinics in person — are not unique to the past six months. WIC enrollment has declined steadily in the past decade. Although that might stem in part from reduced need — food security improved during the period, progress that Covid-19 has largely reversed — enrollment among eligible families remains low; only half registered for the program in 2017, the most recent statistics available, meaning millions of low-income mothers have gone without assistance.
One of WIC’s strengths is that it offers participants a support system. When Marleny, a 28-year-old single mother from Queens — she preferred to use only her first name — had her first child, she felt isolated in the weeks after giving birth. “At the WIC clinic, they were very friendly, and already knew my name when I came in,” she told me. “They made me feel welcome, like they work closely with the community.”
But not all WIC recipients have the time or means to visit clinics in person. In-person visits “foster strong relationships,” but also mean that “participating in WIC takes more time, which can be extremely scarce for low-income mothers with young children,” Zoe Neuberger, a senior policy analyst at the Center on Budget and Policy Priorities, wrote in a 2017 report. In some cases, long wait times dissuade participants from continuing enrollment; others have cited inadequate WIC options at grocery stores and confusion about what products WIC covers — leading to “embarrassing checkout experiences” — as reasons for leaving the program.
“Over the past several years, WIC had already seen a decline in participation due to challenges with transportation, childcare, or work conflicts,” said Brian Dittmeier, senior public policy counsel at the National WIC Association.
These hurdles are particularly acute in rural states, which already offer limited prenatal and maternal support. Fewer than half of rural county hospitals offer obstetric care, for instance, and rural healthcare facilities often lack access to nutritionists or weight management experts.
“The waivers have really been a game changer. We are seeing across the country increases in participation, with some states posting double-digit increases in participation since February,” Dittmeier said.
“We are absolutely keen to make remote access an option for states to allow participants maximum flexibility to access WIC services,” added the Rev. Douglas Greenaway, president and CEO of the National WIC Association.
Beyond remote access, some clinics have begun exploring ways to streamline the enrollment process, including online appointment scheduling and mobile or online tools that help participants find clinics or authorized stores. But these innovations haven’t been made across the board, and alone they’re often insufficient. “Business procedures are just as important as technology to streamlining,” Neuberger wrote in her report. “For example, to make full use of the availability of electronic documents, staff must routinely ask participants about them, and applicants must be told before appointments that they can share information available online or a photo of a document.”
Awareness is also a major concern — about the program in general, and also about eligibility requirements. That was the case for Marleny, the Queens mom, who had not even heard about WIC until after she started taking her daughter to a pediatrician. “I was buying formula out of pocket, and couldn’t breastfeed because I wasn’t producing milk,” she said, noting that her daughter has allergies and needs a specific, more expensive formula. “WIC offers lactation classes, so I can take those to try to breastfeed. There’s a lot of stuff to help me as a new mother that I didn’t even know existed.”
Women concerned about their immigration status also often shy away from the program, concerned that receiving benefits could undermine their application for permanent residency or, particularly under the Trump administration, lead to detention or deportation. “Every single time there’s been a new anti-immigrant policy, we get people saying, ‘Take me out of the program, I haven’t spent this money, take it back, take my name out of the system,’ ” said Lisa David of Public Health Solutions.
She said the next federal stimulus package should do more than make remote access a permanent feature. “We need to improve awareness, boost enrollment, and increase the value of WIC cash vouchers for fresh produce,” especially given the long-term consequences for income. “These are fundamental, day-to-day needs. When you lose income, the whole underpinning of a healthy family is at risk.”