Increasing WIC participation by improving access

October 29, 2020
Rachael Zimlich, RN, BSN
Rachael Zimlich, RN, BSN

Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.

Access is a problem when it comes to Special Supplemental Program for Women, Infants, and Children (WIC) participation, with many low-income families living in food deserts where WIC-approved goods are hard to find.

Millions of Americans live in areas where fresh, healthy foods are hard to come by, and where government nutrition programs offer little or no access. A new report investigates how living in a food desert impacts participation in the Special Supplemental Program for Women, Infants, and Children (WIC) nutrition program, and what might help improve access to these programs.

The report, published in the Journal of the Academy of Nutrition and Dietetics, investigated how enabling WIC participation at discount stores could help expand access to the national program.1

“Many low-income neighborhoods do not include a full-service grocery store. In these communities, discount variety stores (DVS) can be convenient points of food access,” says Lauren A. Wallace, DrPH, MPA, assistant professor in the Department of Public Health Sciences at the University of North Carolina Charlotte and lead author of the study. “However, to our knowledge no identified DVS are authorized to accept WIC benefits.”

The problem the research team investigates centers around an access issue. About 23.5 million Americans live in food deserts—or areas where it is difficult to get access to affordable and healthy foods like fresh fruits and vegetables. In these areas, grocery stores are limited, and discount stores that have few fresh foods or fast food restaurants dominate. Roughly half of the people who live in food deserts are also low income, making it that much more difficult to travel or have food delivered from areas outside their immediate residence, according to the US Department of Agriculture. This leads to higher rates of food insecurity and more nutrition-related health problems, like diabetes.

For the most vulnerable populations, like pregnant women and infant children, living in a food desert where there are few stores that participate in programs that can help—like WIC—makes the problem of access even more pronounced.

“Beneficiaries of WIC are low-income by definition. Many low-income folks live in low-income communities. Currently, most WIC authorized stores are grocery stores that often operate in middle- and higher-income communities,” Wallace explains. “As a result, WIC beneficiaries must travel outside of their community to benefit from WIC. Extending the types of stores that offer WIC access provides participants with increased access to WIC benefits.”

The WIC program is the third largest nutrition assistance program in the United States, according to the report, with more than 7.3 million participants receiving free supplemental food packages each month. The package comes in the form of vouchers that participants can use at grocery stores to receive infant formula or nutrient-dense foods. The WIC benefits can’t be used on everything, and people who have trouble accessing the healthy foods the program is supposed to supply will also have trouble participating in the program.

Participation in the WIC program has been dropping since 2011, according to the report. This decline has been blamed in part to access problems, as there are few large food stores that participate in WIC in the low-income communities the program is meant to serve. Discount variety stores like pharmacies, convenient stores, and dollar stores are more common in many of these areas, but none of these carry much in the way of fresh products.

There are also administrative issues in the WIC program that could exacerbate the access problem. State agencies that manage the WIC program are responsible for authorizing WIC vendors that participate in the program. New rules have been put in place for this authorization process, including a requirement to carry more fresh fruits and vegetables, and more dairy items. These requirements can be a challenge for smaller stores to meet, especially if they don’t have the space or consumer demand to make it worthwhile to carry these products. These added requirements can make it more difficult for smaller stores to participate in WIC, therefore preventing many of the stores located within food deserts to be authorized as a WIC location.

Beyond these issues, Wallace says there are even challenges for larger food stores, should participants be located near to one. The WIC regulations vary from one state to the next, and even larger national or regional grocers can have trouble navigating WIC rules in more than one state. Finally, she says that WIC state agencies sometimes have limited capacity to handle vendor compliance, and this might limit the state from recruiting additional food stores into the WIC program.

The research team followed one discount store chain through the process of joining the WIC program, providing insight on many of the challenges, drawbacks, and benefits to participating in the program. Wallace says the study highlights the need for more research on how availability of stores that accept WIC who participate in the program—as well as how to make it easier for stores and participants to utilize WIC.

Pediatricians can help, too, by helping to point families who can benefit from WIC in the right direction in terms of participation and ways to use the program in their area.

“It’s is a cost-effective program that improves maternal and child health,” Wallace says. “However, WIC participation has been declining in recent years. If clinicians could screen for and encourage WIC enrollment, that could lead to healthier birth outcomes and better nourished children.”

Reference

1. Wallace L, Morris V, Hudak K, Racine E. Increasing access to WIC through discount variety stores: findings from qualitative research. J Acad Nutr Diet. 2020;120(10):1654-1661.e1. doi:10.1016/j.jand.2020.03.001