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Running head: POLICY ANALYSIS: WIC 1

Policy Analysis: Women, Infants, and Children (WIC)

Michelle Loding

Wayne State University

SW 4710

October 12, 2015

POLICY ANALYSIS: WIC 2

Policy Analysis: Women, Infants, and Children (WIC)

Image retrieved from: www.consumeraffairs.com

According to The Social Work Dictionary (Barker, 2014, p. 326), policy practice is

defined as “In social work, professional efforts to influence the development, enactment,

implementation, modification, or assessment of social policies, primarily to ensure social justice

and equal access to basic social goods.” The enactment of any policy requires there to be a need

within a system. A system can be defined as “a combination of elements with mutual reciprocity

and identifiable boundaries that form a complex or unitary whole. Systems may be physical and

mechanical, living and social, or combination of these. Examples of social systems include

individual families, groups, a specific social welfare agency, or a nation’s entire organizational

process of education.” (Barker, 2014, p. 422). When these two definitions are combined it shows

the need for a certain social group to be able to receive benefits that are a necessity to survival.

In examining the myriad of different social policies that our nation has put into motion, the ones

that show some of the most basic of needs are with the issues of nourishment. Everyone should

have access to healthy foods, which is a basic human right. Further breaking down the policies,


the most undeniable group that needs the access to healthy foods are women, infants and

children. The policy that is in place for that is called WIC (Women, infants and children).

WIC provides food and services to pregnant and postpartum women, infants up to 12 mo

of age, and children 1-5 yr of age. In addition to belonging to one of these categories, an

individual must also meet two other criteria to be eligible to receive WIC: (1) live in a

household with income at or below 185% of the Federal poverty guideline or be enrolled

in another assistance program (i.e., Food Stamp Program, Temporary Assistance for

Needy Families [TANF], or Medicaid) and (2) be assessed as nutritionally at risk. Two

major types of nutritional risk are recognized for WIC eligibility: (1) medically based

risks such as anemia, underweight, or history of pregnancy complications or poor

pregnancy outcomes and (2) diet-based risks such as failure to meet dietary guidelines.

Pregnant women certified as eligible do not have to recertify eligibility until 6 wk

postpartum. WIC food packages are designed to provide participants with protein,

calcium, iron, and vitamins A and C. The food package for pregnant women contains

milk and/or cheese, eggs, cereal, peanut butter and/or dried beans, and fruit or vegetable

juice. (Tiehen & Jacknowitz, 2008, para. II).

In order to have healthy development of the brain, correct nutrition needs to begin in the womb.

When there is limited access to the appropriate foods needed for an embryo to make the proper

elements for development, problems begin to transpire. Things like spina bifida,

malnourishment, and even infant demise can happen if a pregnant woman does not have the right

to the suitable foods she needs. This paper will examine all aspects of the WIC policy/program

from the need to institute the policy, history of WIC, and the ultimate goals of having this policy

in place.


In the late 1960s, during the presidency of Lyndon B. Johnson, the federal government

focused a great deal of attention on helping low-income Americans. The 1967 National

Nutrition Survey revealed that many lower income children suffered from anemia and

inadequate growth. These conditions can adversely affect brain size and cognitive ability.

The study showed that children got off to a poor start both physically and mentally

because they didn't have enough to eat or they didn't eat the right foods. Some children

also suffered because mothers did not get adequate nutrition during their pregnancies. In

1972, Congress passed a bill sponsored by Senator Hubert H. Humphrey (D.Minn.) to

create the Special Supplemental Nutrition Program for Women, Infants, and Children.

Congress funded the program for two years and put the U.S. Department of Agriculture

(USDA) in charge of it. ("WIC History," n.d., para. 1).

In the early growth of the policy, there was much support from the nation to keep this

pilot program in effect. When the effectiveness of the program was evaluated after the first few

years, there was a resounding effect on the health and well-being of the participants. Both

mothers and infants were healthier. "The earliest evaluation, Edozien et al. [1979], was a

national effort that involved over 50,000 women, infants, and children at 19 WIC projects in

14 states. Outcomes from clinical examinations and laboratory samples collected between 1973

(just a year after the inception of WIC) and 1976 for current WIC participants were compared

with similar measures for new WIC enrollees collected at the time of their enrollment. The

primary study finding was that WIC participation resulted in increased birthweight." (Devaney,

Bilheimer, & Schore, Fall 1992, p. 573). This was the outcome that legislators wanted to see,

healthy babies being born to healthy mothers, and mothers with children having access to food.


With all states then beginning to develop and hone how the WIC program was being run in their

respective states, the policy was put into motion.

There are restrictions put into place in order for a woman and her children to

qualify for WIC help. As stated earlier, the main criteria to qualify for WIC is need and income.

Like many policies that are in play today, income is a major factor in getting the resources a

person needs. “Pregnant, postpartum, and breastfeeding women, infants, and children up to age

5 are eligible. They must meet income guidelines, a State residency requirement, and be

individually determined to be at “nutrition risk” by a health professional or a State or locally

trained health official. To be eligible on the basis of income, applicants’ income must fall at or

below 185 percent of the U.S. Poverty Income Guidelines (currently $44,123 for a family of

four). A person who participates or has family members who participate in certain other benefit

programs, such as the Supplemental Nutrition Assistance Program, Medicaid, or Temporary

Assistance for Needy Families, automatically meets the income eligibility requirement." ("WIC

Eligibility Requirements," n.d.). Also, with WIC, it is intended as a nutritional supplement

program, not as the main source of nutrition for the recipients. Since there are vouchers for

things like peanut butter, milk, and juice, the majority of protein, fruits, and vegetables are to be

supplied by the beneficiary.

WIC is a three-part program: (1) vouchers to purchase specific high-nutrition foods to

supplement diets, (2) nutritional and health counseling, and (3) referrals to healthcare and

social-service providers.

WIC's food "packages" are meant to supplement the recipients' diet, not to meet their

entire food or dietary needs. High in protein, calcium, iron, and vitamins A and C, they


are designed to provide the nutrients often lacking in the diets of the populations targeted

by WIC. Packages typically include iron-fortified infant cereal and formula, juice, milk,

cheese, eggs, peanut butter, and beans. Many WIC agencies tailor food packages to meet

the nutritional deficiencies of individual WIC clients. For example, if it is known that a

WIC participant has high cholesterol, the standard food package may be modified

accordingly.

In 1996, the average WIC food package was worth about $45 per month, costing the

government only $31 because of manufacturers' rebates on infant formula. This is across

all WIC recipients, however. The total value of the two WIC food packages provided to a

postpartum mother and her newborn can exceed $100 a month. (Besharov & Germanis,

Winter 1999, para. 4).

As it is most often misunderstood about policies put together by the state that low-income

individuals or families rely upon to make ends meet, “WIC is not an entitlement program as

Congress does not set aside funds to allow every eligible individual to participate in the program.

WIC is a Federal grant program for which Congress authorizes a specific amount of funds each

year for the program. WIC is administered at the Federal level by FNS, administered by 90 WIC

state agencies, through approximately 47,000 authorized retailers, (and) WIC operates through

1,900 local agencies in 10,000 clinic sites, in 50 State health departments, 34 Indian Tribal

Organizations, the District of Columbia, and five territories (Northern Mariana, American

Samoa, Guam, Puerto Rico, and the Virgin Islands).” ("WIC Eligibility Requirements," n.d.).

All too often there is a shame involved in asking the government for help. Many times people do

not want to get involved in the red tape that being enrolled in a federal or state policy program


entails. Here is a table of current income guidelines.


The table comes courtesy of The United States Department of Agriculture Food and Nutrition

Service in a policy memorandum from Debra R. Whitford, Director, Supplemental Foods

Division, and written April 1, 2015.

Sifting through the data and peer reviewed journals and articles, it is hard to find a

definitive answer if the WIC program works. There are many pros and cons to being involved in

this policy. The outcome is, and always will be, an increase in health awareness and raising a

healthier generation of children. “WIC provides a number of services that may affect birth

outcomes, including nutrition assessments, counseling and education, breastfeeding promotion

and support, immunization screening, connections to Medicaid, and referrals to prenatal care and

social services. We sought to reassess whether prenatal participation in WIC services reduced

rates of prematurity and infant mortality overall, as well as among African American

participants. Previous studies, as well as an assessment of services provided by WIC, suggest

that WIC participants will have improved birth outcomes compared with their non-WIC

counterparts and that WIC may reduce racial disparities among participants.” (Khanani, Elam,

Hearn, Jones, & Maseru, 2010, p. S205). Like with most outcomes that can be researched on the

internet and within publications, there are positive and negative findings. The study from the

above quote was, obviously, a positive finding in that infant mortality rates were improved

among WIC participants. There are also many other positive qualities that were pointed out that

WIC helps to provide. Those positives include breastfeeding advocacy and support and

information regarding immunizations. In a personal interview with Mrs. Danielle Korth of the

Lapeer County Early Head Start program, she was a proponent of these positives also. (D.

Korth, personal communication, September 30, 2015). Mrs. Korth talked extensively about the

support groups and peer counselors that support breastfeeding that are available through some


WIC offices. She also said that since there has been a decline in parents immunizing their

children, some WIC office hold informational meetings including showing videos of children

with communicable diseases that could be prevented from utilizing immunizations. This is in an

effort to thwart preventable diseases from resurfacing across the nation. A few WIC offices offer

the immunizations to the children right there too. Mrs. Korth is very knowledgeable in all the

government policies and programs surrounding children and their families since she has a

Master’s in Education and holds many certifications from the state in various disciplines ranging

from proper car seat instillation to food safety. When asked, specifically, about the WIC

program, Mrs. Korth only had positive things to say how the families she works with benefits

from the help with providing food to their loved ones. Most of the families involved with the

Early Head Start program, do benefit from other government run programs like WIC. (D. Korth,

personal communication, September 30, 2015).

With the positives of any program or policy, do come the negatives. "Results of

this study show the strength and efficacy of WIC as a public health intervention that mitigates

marked health disparities seen in an African American population. Further, we have identified

prenatal smoking as a factor that may have counteracted a beneficial effect of WIC participation

in White women. The need for increased emphasis on smoking cessation among WIC

participants should be further investigated. Our findings provide a strong rationale to develop

greater outreach and education about the WIC program within local communities." (Khanani et

al., 2010, p. S208). Unfortunately, this was not an isolated incident found in one study. There

were numerous peer-reviewed studies and articles that were found to show the negative effects of

smoking on infant birth weight and mortality. “In the end, we find that prenatal participation in

WIC is positively associated with fetal growth, though the association is difficult to support with


substantive changes in maternal behavior and health. We conclude that, at least with respect to

birth outcomes, WIC works, but on fewer margins and with less impact than has been

claimed by policy analysts and advocates. We also argue that linking the success or failure of

WIC to its impact on birth outcomes may be myopic. Greater emphasis on affecting lifelong

habits such as smoking, or behaviors with known benefits to mother and child, such as

breastfeeding, iron supplementation, and childhood immunizations, may be sufficient to justify

additional funding.” (Joyce, Racine, & Yunzal-Butler, Spring 2008, p. 300). Included in the

same article, “We find modest effects of WIC on fetal growth, inconsistent associations between

WIC and smoking, limited associations with gestational weight gain, and some relationship with

breastfeeding. A WIC effect exists, but on fewer margins and with less impact than has been

claimed by policy analysts and advocates.” (Joyce et al., Spring 2008, p. 277). This is something

that would need to be further evaluated and documented. It seems that there, perhaps, needs to

be a bigger focus on getting participants in WIC to stop smoking. Smoking is one of the leading

contributors to low birth weight in infants and one of the causes of being born prematurely.

There is also a matter of people using the program improperly or unfairly. According to the

Code of Federal Regulations ("Title 7-Agriculture," 2013, sec. 246.2):

Participant violation means any intentional action of a participant, parent or caretaker of

an infant or child participant, or proxy that violates Federal or State statutes, regulations,

policies, or procedures governing the Program. Participant violations include

intentionally making false or misleading statements or intentionally misrepresenting,

concealing, or withholding facts to obtain benefits; exchanging cash-value vouchers, food

instruments or supplemental foods for cash, credit, non-food items, or unauthorized food

items, including supplemental foods in excess of those listed on the participant's food


instrument; threatening to harm or physically harming clinic, farmer or vendor staff; and

dual participation.

It is a requirement of the program, and also the law, to report any changes in income, household

size, address, or participation in other programs. If any of these changes occur and the

participant did not report them to the proper authority in a timely manner, a discontinuation of

benefits and/or fines and an appearance in court may result by these indiscretions.

Reviewing the overall picture of the policies and procedures that allow WIC to operate, it

is a program that is working. There have been updates and changes to which foods are allowed

and how the foods can be purchased, but the ultimate goal remains the same, nutritional

supplement for women, infants, and children. “WIC is one of the fastest-growing food and

nutrition assistance programs. In fiscal year 1980, WIC served 1.9 million women and children

at a cost of $725 million. Today, WIC annually serves 74 million women and children at a cost

of $5 billion. In recent years, WIC has come under intense scrutiny for its rapid expansion and

increased coverage of children.” (Buescher et al., Jan. 2003, p. 145). Although this is an

expensive program, the benefits of having a healthy nation far outweigh the risks of raising

medical costs associated with poor nutrition.

The finding of higher use of well-child services among children on WIC is important,

given that the overall use of preventive services among children on Medicaid is low.

Among all of the children in our study, only about half received any EPSDT (Early

Periodic Screening, Diagnosis, and Treatment) care in each year. These findings are in

contrast to those of the National WIC Evaluation, based on an older data set, which did

not indicate more frequent use of preventive health services among preschool children on

WIC. The study findings also suggest that greater use of well-child and other diagnostic


services by child WIC participants may increase the diagnosis and treatment of common

childhood illnesses, which in turn leads to an overall higher use of health care services.

These findings are consistent with the goals of the WIC program, one of which is to serve

as an adjunct to good health and to counsel WIC participants on the importance of

preventive health care. Children participating in WIC should have stronger links to the

health care system, resulting in higher overall use of health care services. (Buescher et

al., Jan. 2003, p. 148).

All these systems, from WIC to health care, are put in place to provide the best possible care to

families. By using the programs, and continually updating the policies, there is a better future

for the children in our nation. Specifically, children who may not have any other options than to

get a hand up in life. “Not only was child WIC participation associated with increased use of

preventive care, but it also was associated with increased use of almost all kinds of health care

(including emergency room and inpatient care) and increased diagnosis and treatment of

common childhood illnesses, including otitis media, gastroenteritis, upper and lower respiratory

infections, and asthma.” (Buescher et al., Jan. 2003, p. 148). By giving, what otherwise may

have been discarded child, a chance to live a healthy life and to be physically fit by participating

in a program like WIC, it gives everyone a better quality of life. The overwhelming evidence

shows that the current policy is working. It provides the necessary ingredients to deliver children

with greater successes in continued health throughout childhood. By reducing the need for

medical care in later years, it benefits the overall population in relation to health care costs.

“Mission Statement – The mission of the Michigan WIC Program is to improve health outcomes

and quality of life for eligible women, infants and children by providing nutritious food, nutrition

education, breastfeeding promotion and support, and referrals to health and other services. To


this end: Delivery of services and supports are to be provided in a caring, respectful, efficient and

cost effective manner. Delivery of services shall be provided in a culturally competent and

confidential manner. The WIC Program shall assure the broadest possible access to services,

supports and food.” (Michigan Department of Health and Human Services website, 2014,

expression 1.02). Looking over the whole WIC Policy Manual, it shows that the state has taken

the utmost care in laying out the policies and procedures in order to get the proper care and value

to the ones who need it most. By reading over the above mission statement again, one can see

the best interest of the people involved in the program are taken to heart by the legislators who

are protagonists of the program. WIC supports the care of mothers and infants in the earliest

stages of bonding by giving new (and prior) mothers educational materials on things like

breastfeeding and immunizations. WIC is not a singular program, only providing food vouchers

to those who qualify, but also offer referrals to other programs such as Early Head Start and state

run health services.


References

About WIC-WIC at a Glance. (n.d.). Retrieved from http://www.fns.usda.gov/wic/about-wic-

wic-glance

Barker, R. L. (2014). The social work dictionary (6 ed.). Washington, DC: NASW Press.

Besharov, D. J., & Germanis, P. (Winter 1999). Is WIC as good as they say? Public Interest,

134(), 21-36. Retrieved from

http://search.proquest.com.proxy.lib.wayne.edu/docview/222103991?accountid=14925

Buescher, P. A., Horton, S. J., Devaney, B. L., Roholt, S. J., Lenihan, A. J., Whitmire, J. T., &

Kotch, J. B. (Jan. 2003, January 2003). Child Participation in WIC: Medicaid Costs and

Use of Health Care Services. American Journal of Public Health, 93(1), 145-150.

Retrieved from http://search.proquest.com.proxy.lib.wayne.edu/docview/215102704?

accountid=14925

Devaney, B., Bilheimer, L., & Schore, J. (Fall 1992). Medicaid Costs and Birth Outcomes: The

Effects of Prenatal WIC Participation and the Use of Prenatal Care. Journal of Policy

Analysis and Management, 11(4), 573. Retrieved from Retrieved from


Joyce, T., Racine, A., & Yunzal-Butler, C. (Spring 2008). Reassessing the WIC effect: Evidence

from the Pregnancy Nutrition Surveillance System. Journal of Policy Analysis and

Management, 27(2), 277-303. http://dx.doi.org/IO.IOO2/pam.2O325

Khanani, I., Elam, J., Hearn, R., Jones, C., & Maseru, N. (2010). The Impact of Prenatal WIC

Participation on Infant Mortality and Racial Disparities. American Journal of Public

Health, suppl. Supplement 1, 100.S1, S204-9. Retrieved from



Michigan Department of Health and Human Services website. (2014).

http://www.michigan.gov/mdhhs/0,5885,7-339-71547_4910_48542-191418--,00.html

The Code of Federal Regulations. (2013). Retrieved from http://www.gpo.gov/fdsys/pkg/CFR-

2013-title7-vol4/xml/CFR-2013-title7-vol4-part246.xml#seqnum246.2

Tiehen, L., & Jacknowitz, A. (2008, October). Why Wait?: Examining Delayed WIC

Participation Among Pregnant Women. Contemporary Economic Policy, 26(4), 518-538.


WIC Eligibility Requirements. (n.d.). Retrieved from http://www.fns.usda.gov/wic/wic-

eligibility-requirements

WIC History. (n.d.). Retrieved October 1, 2015, from

http://www.nutritionnc.com/wic/history.htm

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