Move Aside Formula, Here Come the Fruit and Veg: Changes to the WIC Food Package

by Sarah Olliges

“WIC- Isn’t that the program that gives away infant formula?” say the woman at the coffee counter, when I ask if she knows the program.  Well, not exactly.  They actually provide vouchers for a variety of foods, as well as nutrition education and health care referrals.  WIC (or the Special Supplemental Nutrition Program for Women, Infants, and Children) also covers 50 percent of all US infants!  This is a program that has the potential to make a big difference in the lives of its clients.  Started in the 1972, this program has recently undergone a revision in the types of foods that it offers the clients.  The food package (i.e., the group of food items clients receive) has been revised to include more whole grains, less fat, and more fruits and vegetables.  According to Elaine Mazgelis, RD, Nutritionist and Breastfeeding Coordinator at the Cambridge/Somerville WIC office, the client response to the packages has been “overwhelmingly positive.”

The WIC Program

WIC was created by Congress to improve the health of women, infants and children at the urging of the White House Conference on Food, Nutrition, and Health, chaired by Tufts’ own Jean Mayer.  At the time, doctors testified that malnutrition, including anemia, was a problem among low income pregnant women.  A system of food “prescriptions” was adopted, to be distributed based on need.  WIC is run by the United States Department of Agriculture (USDA) and implemented at the state level.  All funding comes from the federal level, where Congress budgets a certain amount each year.  There is an established ranking system, to prioritize aid to those that need it the most.  In theory, all that are eligible and apply may not receive aid if there is not enough funding.  However, in practice, in the past decade, there has been adequate funding and eligible people are not turned away.  Currently only 57% of those eligible participate.  If participation increased, then prioritization would once again become important.  Participants must be under 185% of the poverty line, be a pregnant or breastfeeding woman or an infant or child under age 5, and have a nutritional risk.   Most participants (67% in 2006) are at or below the poverty line and ¾ are infants or children.

WIC may be best known for providing free infant formula to mothers, but it also provides supplemental foods, nutrition education, and referrals to health services.  The food package was originally intended to supplement the client’s normal diet and provide specific nutrients that are often deficient in low income children and whose deficiency negatively affects the physical growth and cognitive development of those children (iron, protein, calcium, Vitamin C).  Each food in the package was chosen to fill a specific void.  In 2004 the USDA asked the Institute of Medicine (IOM) to review the current WIC package and to suggest revisions to reflect current nutrition science, the USDA’s dietary guidelines, suitability of foods for low-income participants with limited cooking facilities, and cultural food preferences.

IOM Review and New Packages

The IOM had quite a task.  Not only did the USDA want a new and improved food package, they also wanted the new packages to be cost-neutral:  they couldn’t cost anymore that the current packages.  The new food packages, presented in the IOM document WIC Food Packages: Time for a Change, reflect current nutrition science by removing many of the high fat, high calorie items and replacing them with lower fat items.  A major shift in the packages was to include a voucher for fruit and vegetables.  These vouchers are provided at a dollar value, and can be used to purchase fresh, frozen, or canned vegetables.  The IOM also took into account racial and ethnic diversity in the WIC population and recommended certain substitutions be allowed such as tortillas, beans, and soymilk.  Overall, the new food package decreases saturated fat, sugar in the form of fruit juice, and increases the consumption of whole fruits and vegetables and whole grains.  The new packages also attempt to encourage breastfeeding by providing some formula for partially breastfed babies and special foods to exclusively breastfed babies (after 6 months) and their mothers.  The USDA made some small changes to the packages recommended by the IOM, and the new packages were implemented in October of 2009.  The changes made by, category of participant, can be seen in the accompanying table A Comparison of the Old and New WIC Benefit.

How have things changed

Ms. Mazgelis of the Cambridge/Somerville WIC office reports that the changeover to the new food packages has been “relatively seamless”.  She says the participants are pleased with the new fruit and vegetable vouchers, though some ask if they can trade the vouchers for more milk (the new package reduced the amount of milk given).  Others report that the baby food provided to breastfed babies after 6 months is “just too much”.

The biggest challenge for participants has been the switch from whole milk to 1 or 2%.  Many WIC recipients are not used to the taste and are struggling to get used to the different milk.

Other issues with the new WIC package include educating groceries and other food outlets about the new foods and the vouchers, which is done in part by WIC staff visiting a store when there is a complaint.  Stores and participants are provided with an approved list of foods -which, incidentally, does not include white potatoes.  One thing that has been hard for both the grocery managers and participants to find is the one pound loaf of whole wheat bread, which is an uncommon loaf size.  Still, at least in the Cambridge and Somerville area, the transition seems to be going smoothly.

Although the transition seems to be going well in Somerville and Cambridge, the new package has brought up some questions and concerns nationwide, in particular the fruit and vegetable vouchers.  In many places there are “WIC only” stores, which only carry items on the approved WIC lists (different in each state).  Questions have arisen about whether these stores will be able to stock fruits and vegetables.  It is also unknown whether these vouchers will be able to be used at Farmer’s Markets.  WIC already has a Farmer’s Market Voucher program in some locations, and it is unclear yet whether participants will be able to take vouchers to the markets as well.

Still, all in all, these changes seem to be a positive step forward for WIC.  As long as folks can get used to the taste of low fat milk!

A Comparison of the Old and New WIC Benefit

Package Old Benefit New Benefit
1- Infants 0-3 months Formula provided if not breastfeeding Expands category to include infants up to 6 months to reflect the age when other foods should be introduced

Provides some formula for partially breastfeeding infants

2- Infants 4-11 Months These infants eligible for formula, juice, and infant cereal Age range changed to 6-11 months, eliminates juice, lowers formula amount and adds baby food fruits and vegetables

Provides more baby foods including baby food meat to infants that have been fully breastfed

3- Women, Infants, and Children with medical nutritional needs Provides medical foods if needed Provides medical foods in addition to foods in other packages
4-  Children Age 1 up to 5th birthday Includes Milk, Cheese, Eggs, Dried Beans or Peanut Butter, Fruit Juice, and Dried Cereal $6/ month cash voucher for Fruits and vegetables

Reduces milk, cheese, egg, and juice allotment

Requires whole grain cereals

Provides whole grain allotment (corn tortillas, wheat bread, oatmeal, etc)

Allows canned beans to be substituted for dried

5- Pregnant and Partially Breastfeeding women (up to 1 year) Same and Category 4 $10 / month cash voucher for Fruits and vegetables

Other adjustments same as Category 4

6- Postpartum Women up to 6 months (non-breastfeeding) Same and Category 4 $10 / month cash voucher for Fruits and vegetables

Other adjustments same as Category 4

7-  Exclusively Breastfeeding Women Same as category 4 and includes canned fish $10/month Cash Voucher for fruits and vegetables

All adjustments in Category 4; also increases fish amount

** New package allows for the substitution of lactose-free milk or soy milk and tofu for the milk and cheese prescription.  The soy products must have a medical documented need before they can be prescribed.

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