Casaubon's Book

WIC on the Chopping Block

Over the years I’ve written a great deal about SNAP/Food Stamps and other hunger alleviation programs, but I’ve never written anything specifically about WIC, which I have tended to lump in with other food programs. I’ve been thinking, however, a lot about WIC lately, because it has come on the budget chopping block in the US – along with other food security programs including the CSFP which serves low income seniors and the emergency food program that provides commodities to emergency food pantries. While Republicans restored funds for military bands, they took them out, as is customary, from low income elderly people, children and the hungry. About a billion dollars is set to come out of food security programs, including 868 million from WIC alone.

While I have mostly lumped programs to reduce food insecurity together, WIC Is significantly different from SNAP – its targets are children. The goal is to provide good nutrition *along with* nutritional education, lead screenings, anemia screenings and other basic medical supports. Moreover, WIC Is precisely the program that people who hate food stamps and think that all poor folk do is use them for soda and lobster should love. The food permitted on WIC is very limited – fruit juices, canned fish, peanut butter, milk, eggs, fruits and vegetables, beans, and infant formulas. You can’t buy candy or luxury food items – this is the bare basics program for folks who like to peer into the shopping cart of anyone swiping an EBT card. Moreover, you can’t enroll without also receiving nutritional information.

For this reason, historically WIC has been popular – and for the moment it is running a budget surplus, due in large part to a decline in the price of milk – milk costs represent 20% of the WIC food cost expenditures. In the very near term, cutting WIC isn’t a crisis. In the longer term, where more and more people struggle (and we’ve seen in the last couple of months that the economic crisis is not over), it is a serious issue.

WIC serves pregnant women and children under five years old – the ages at which nutritional sufficiency is most critical for brain development and long term good health. At last count, almost half the nation’s infants were on WIC which serves people up to 185% of the poverty level.

A number of studies have shown that WIC is associated with better birth outcomes for at risk populations – children whose mothers are on WIC prenatally and after birth tend to have higher birth rates, lower infant mortality (and US infant mortality rates among poor infants are a scandal) and fewer premature births. WIC has repeatedly shown to return well – every dollar spent on WIC reduces health care and other costs between 1,77 and 3.50, depending on which study you take.

Anyone with a child under five who is eligible for SNAP can get WIC as well, and of course, the programs are all inter-connected. Cut back on WIC and the former recipients will increase demand at local food pantries for emergency food. Moreover the fundamental benefit of WIC has been its tying of subsidies to nutritional education and programs that also support child health like lead and anemia screenings.

WIC does have issues. Like SNAP, it tends to operate as a subsidy upon the industrial food system – indeed, because WIC purchasers have little choice in what they purchase, WIC operates disproportionally. WIC purchasers are generally required to buy the lowest cost item, and 2/3 of all states explicitly disallow organic foods. Many states have brand limitations that functionally require WIC parents to purchase their food from larger supermarkets.

While WIC does have a farmer’s market program – the Farmer’s Market Nutrition Program, it represents a comparatively tiny portion of WIC’s budget (and is potentially at risk given current cuts) at only about 20 million to cover 46 States, Indian Nations and Territories. It is not available everywhere, and only fresh fruits and vegetables can be purchased – not milk, cheese, dried beans, grains or juices – even though these items are permitted under WIC.

The impact of the FMNP has been quite good – more than 70% of WIC participants who received coupons had never been to a farmer’s market before, and at least one study found that even after their WIC participation ended, more than half of the participants who received farmer’s market coupons continued visiting. Families that received farmer’s market coupons consumed significantly more fruits and vegetables than families that did not. It is a program worth expanding – for both the benefits of a viable food system and for the participants, but this is unlikely in a budget-cut scenario.

Other criticisms of WIC are that despite its emphasis on breastfeeding education and support, and the fact that it give preference in program inclusion and greater quantities of food to nursing mothers, its breastfeeding programs seem to have made little difference – or even to slightly discourage breastfeeding. Because the population served by WIC is less likely to nurse in general, it is hard to gauge exactly how much impact all of WIC’s work and emphasis on nursing has had, but a GAO study suggested at best, it was moot – and the availability of free formula may actually discourage nursing.

No one wants to risk poor infant development by restricting formula access – at the same time, we know that nursing has a greater remunerative return than WIC on short and long term child health, as well as being a way of cutting the budget without harming families – programs that increased the emphasis on nursing and incentivized nursing further might save WIC more – infant formula represents a significant portion of its overall budget.

Other criticisms of WIC are related to the subsidizing of industrial food – WIC has been shown to be a contributing cause for older children with its emphasis on high fat foods like whole milk and peanut butter. At the time WIC was created, the main concern was putting weight on poor children – 40 years later, obesity and its health consequences are a major concern for the population that WIC serves. Again, this seems a clear indication that expansion of programs like the FMNP could help enormously – and an emphasis on high quailty food, rather than quantity might make sense.

WIC’s emphasis on the foods of a conventional American diet has also raised issues when trying to meet the needs of low income immigrant populations. WIC has been criticized for its emphasis on milk (1/5 of total food expenditures) and its lack of alternative for cultures that don’t have a dairy emphasis or have large numbers lactose intolerant children. Peanut butter, canned fish and other foods that aren’t necessarily part of many cultural experiences are often offered preferentially over equally healthy or healthier foods typical of other communities and cultures. Communities whose traditional foods are not supported derive less benefit from WIC – and thus we all derive less benefit for WIC. There are also significant arguments against imposing a high fat, high salt American diet on immigrant families.

This is a major issue, since children of immigrants represent the fastest growing share of WIC population. What WIC has done well is convince immigrant populations, particularly at-risk undocumented immigrants that applying for WIC is safe – which is good, because every premature infant or low birth weight baby born in the US costs us considerably more than money spent on WIC. It is in our interest to see immigrant populations making full use of the WIC program because their use reduces overall costs in the net.

Most of the problems in WIC could be resolved by permitting a wider range of food, emphasizing quality as well as adequate quantity, and expanded breastfeeding supports. Moreover, an expansion of the FMNP could operate to save money in several ways – not only by reducing overall health care costs due to larger vegetable and fruit consumption and by serving at-risk populations better, but also because some 64% of American small farmers are WIC eligible themselves, and my best estimate from the data available (there is no clear recent data I can find, this is based on some consolidated state findings) is that about 30% of American farmers are presently receiving WIC – re-routing dollars back to the people who grow the food is a win-win situation.

In a nation with rapidly expanding health costs and few tools to contain them, cutting WIC is completely insane. WIC needs the resources to expand and shift its mission – the foods that were primarily essential in 1971, when WIC was founded are no longer the right primary foods. WIC’s failures, however, are not fundamental – they are failures based on their origin in a 1970s hunger response culture, and could be updated – at little cost. In the long term, it might even cost less per person.

WIC itself has an essential mission – and one that will only grow more urgent in a society of declining resource availability. Keeping and child mortality low, and ensuring fewer health costs – both in the near term in infancy and childhood, and over a lifetime, is one of the things we can do for little cost. In _Depletion and Abundance_ I document at some length how nations with low health care spending have been able to keep lifespans and infant mortality rate comparable to our own with tiny percentages of our own spending. Uniformly, those nations put their resources into food and reproductive care, as WIC does. If we were to protect and expand any single US social welfare program WIC would be it – it should not be on the chopping block, despite its imperfections.

Sharon

Comments

  1. #1 koyote_ken
    July 14, 2011

    This is a major issue, since children of immigrants represent the fastest growing share of WIC population. What WIC has done well is convince immigrant populations, particularly at-risk undocumented immigrants that applying for WIC is safe – which is good, because every premature infant or low birth weight baby born in the US costs us considerably more than money spent on WIC
    Several things Republicans either hate or don’t give a crap about: Immigrants and “born” children. Their mantra is get rid of the immigrants and keep the fetuses. That’s why this program will soon be history.

  2. #2 nunyer
    July 14, 2011

    Twenty-some years ago, I was newly divorced, heavily pregnant, working two waitressing jobs, and *very* grateful for WIC. Let’s figure that I used about $150/month for 18 months for a total cost (minus administrative overhead) of around $3000.

    Now I have my master’s degree, and I have paid in many many thousands of federal taxes over the years. One would think the Republicans would recognize this significant return on the WIC investment as good economic sense.

    Who are the legislative decision makers here? Who can we contact to support WIC?

  3. #3 Brandie
    July 14, 2011

    I am no fan of WIC in its current form, and I say that as a former recipient of it. The whole program needs an overhaul and needs to have some common sense injected into it, but that’s too much to hope for from government. I’ve heard so many women (uneducated, immigrant women) say, “why should I breastfeed when I can get formula for free?” These are people who have no good reason to formula-feed, they just want to take advantage of what they see as a benefit available to them. My solution: WIC should require a doctor’s note/prescription before handing out formula. That would save plenty of money and be much better for babies.

  4. #4 badgergirl
    July 14, 2011

    As a poor, newly unemployed (due to the time I had to take off for the birth) young woman who was unable to breastfeed due to lack of milk, I was placed on WIC by the clinic doctor immediately. I would have had to give up my baby if I hadn’t had the formula help. Women who are prevented from breastfeeding due to some legitimate reason other than demonstrable medical need can’t get doctor’s notes. Even women who can demonstrate medical need don’t always have access to doctors. I say that it’s better to hand out formula than to turn up our noses at lazy welfare mothers and make it hard for those with legitimate needs. After all, WIC is an assistance program, not a sword of Damocles to hold resentfully over the head of those who we THINK MIGHT be taking advantage of the system.

  5. #5 Sharon Astyk
    July 14, 2011

    Brandie, Badgergirl, I can see both sides of this one – it is true that most low income people wouldn’t find it easy to get medical scripts. At the same time, there’s considerable evidence that we are not successfully encouraging breastfeeding, especially among those who can least afford the health and other costs of this. Given that a number other nations hover around 94-93% successful nursing initiation rate, the reality is that most mothers can nurse. At the same time. no one wants to see any baby go hungry. There are, however, a number of spaces between “starve poor babies” and “pass out the formula.”

    Sharon

  6. #6 Liz
    July 14, 2011

    Great post, Sharon. And I would especially love to see the Famers Market Nutrition Program expanded. It’s a very small benefit – $25 per May-November season in DC, and we’re probably one of the more generous jurisdictions – but judging from how many of the yellow coupon folders I see at my neighborhood farmers markets, it’s very popular. (Also, 16 DC farmers’ markets now accept food stamps!)

  7. #7 Sarah
    July 14, 2011

    I would suggest that the biggest reason you’re going to see women on WIC using formula more is the fact that they need to get back to work sooner than women who have better financial support. One of the best ways that we might fix this is changing how much paid time off after birth is provided (most places if you’re lucky you get 6 weeks unpaid!). If you make it more difficult to get formula you could have a bigger problem in that the women are going to struggle to work or go to school.

    * I mention this as I have watched my younger sister who is on WIC struggle to find work she can do as a nursing mother (with little education she’s stuck with jobs that can’t/won’t provide the facilities or time needed to pump even).

  8. #8 Susan in NJ
    July 14, 2011

    I just got back from a conference where Hilda Solis, U.S Secretary of Labor, specifically mentioned workplace issues of women who breast feed as something she would like to see addressed.

  9. #9 Brandie
    July 14, 2011

    For the record, I didn’t say anything about lazy welfare mothers – you misunderstood my objection, Badgergirl. Nor did I say women needing WIC should have to pay for a private doctor. As for non-medical reasons why a mother can’t breastfeed, it would be simple enough to determine what exceptions could reasonably be made for the purposes of WIC, but the default should be to expect mothers, especially if they don’t work outside the home, to breastfeed. As Sharon says, almost all women could breastfeed their children, and that includes the vast majority of those who claim to have insufficient milk. (Obviously I don’t know what your issue was, Badgergirl, but it’s a much-abused self-diagnosis.) I don’t want any baby to go hungry – I’m a mother too – but what do you think happens when the formula runs out before the end of the month? In the families I’ve seen, they water it down to make it last. Handing out formula no-questions-asked does more harm than good to babies, in my opinion.

  10. #10 badgergirl
    July 14, 2011

    I didn’t say women who couldn’t afford private doctors, I said women without access to doctors, such as illegal immigrants who feel unsafe (due to risking deportation, or language issues) taking advantage of public health services.

    As for your insinuation that I diagnosed myself with milk production problems, it was actually the doctor who did that; I was so inexperienced and without support that I did not realize for the first week that I wasn’t producing enough.

    The answer to watering down formula is to make sure there is enough in the first place to feed babies.

    And you can take your la leche legion crap and stuff it back up the hole it came from.

  11. #11 Brad K.
    July 15, 2011

    Sharon,

    Another way to fix the whole thing, is to assure that there is enough affluence and food for all mothers and infants, and the rest of us, too. I am still pondering how to make that happen; peak oil and the current debt deflation crisis don’t make it any simpler. Please don’t wait for my solution . .

    I have my doubts, though, that “mainstreaming” unmarried mothers is the right path. In the past such methods as forced marriage, homes for unwed mothers, and simply turning your back on women not blessed with marriage (that is, “out of sight, out of mind”) were used. None of them feels respectful, not of the mother, the child, or the community.

    I don’t think that the current marketplace is respectful of men or women, parents or childless, and “at work” may not be a responsible choice for many people. Except we are all inveigled to live in a corporate-friendly community, with corporate-friendly services and housing and expectations. Which ties most of us into a corporate style occupation.

    There are some family friendly businesses and other workplaces. But not enough.

    And maternity leave cannot be the answer, not when it imposes costs on someone else, with no productivity in return. It doesn’t matter that much whether the employer pays maternity leave directly, or all tax payers foot the bill; paid maternity leave increases the costs of the workforce. Reduce an employer’s profits and you dismantle her/his ability to provide jobs. In addition, entitlements like this burden the community; add enough burdens, and you lose the employer, the community, personal opportunity, and support for the child and family.

    And I have to wonder, if we are working at the problem from the wrong end. Why not focus on young people, and encourage sound and early marriage, avoiding the decadence of the “perpetual dating” scene. Currently early marriages are fraught with hazards; we as a nation and society have failed to teach our children why to have children, and why a sound mate-prospect and co-parent candidate must have a strong character, honesty, integrity, sound emotional relationships, a good reputation, and a family background that lends itself to a good family life. We fail to impress them that a fancy car, flirtatious manners and dress, and popularity at dating are all danger signals, with regard to any ensuing family life.

    Until family life in America gets turned around, perhaps WIC will continue to address one of the important needs.

  12. #12 scidog
    July 15, 2011

    the right wants the care and feeding of the poor in private hands,the church to be exact.now the poor are beholden to a religious group and not the nation as a whole for support.support they need because the right created the very problems that make people “poor” as in the working poor for one tiny example.

  13. #13 Ian
    July 15, 2011

    “At last count, almost half the nation’s infants were on WIC which serves people up to 185% of the poverty level. ”

    Maybe they should get off their asses and get a job.

  14. #14 Geomom
    July 15, 2011

    @Ian–I wasn’t aware there were many job opportunities for infants.

  15. #15 Sharon Astyk
    July 15, 2011

    Sure there are, Geomom – test subject! ;-).

    Badgergirl, we actually do have a civility policy here, and I’d appreciate it if you’d address the issue, rather making insults.

    I didn’t read Brandie’s comment as “you self-diagnosed low milk” but as making the (correct) observation that many mothers worry because newborns nurse frequently that they aren’t making enough milk and switch to formula. That’s actually pretty clear from the medical literature.

    At the same time as others rightly point out, establishing nursing requires support and time off to do it – and that still leaves 6 or so percent of all mothers who can’t nurse. And yes, immigrant women who are concerned about doctors are a real concern – it is a balancing act. I do think that formula is an inferior substance – there’s no medical question about it. It should be available – but it isn’t necessarily a service *especially* to poor women who can least afford the health consequences of not nursing and also who then are vulnerable to budget cuts at their expense. It is easy to say “great, let’s just give out more formula” but women would be less dependent on political matters if they could provide food for their children themselves.

    This is a tough issue, and nursing and ability to nurse and access to nursing tends to get a lot of people deeply upset because it is so personal and important. I’d like to try and keep it civil, though.

    Sharon

  16. #16 Nicole
    July 15, 2011

    Brad, I agree with parts of your comment, but I don’t think pressuring people into early marriage is helpful at all. Growing up I was pressured relentlessly to be a good girl and compete for a man and start squirting out babies. Fortunately I refused — half of my age-mates who didn’t are divorced with children and most of the women have less education and less ability to compete for the kinds of jobs they need to support their children.

    1/3 of teen marriages end in divorce by age 25 and greater than half are expected to divorce. Who pays for uneducated women who can’t find a financially sustaining job (or any job) and care for children simultaneously? Me and you.

    Societies with early marriage traditions almost always treat women as servants and commodities, not equal partners — and that includes contemporary western religious traditions that value marriage and fetus’ above all else, but don’t value the 50% of the equation that makes it biologically possible.

  17. As a nutritionist and as a parent WIC is both wonderful and horrifying. We get it for our younger foster son due to his age (our income is irrelevant as a foster child is considered a family of one, with an income of zero or whatever the state foster care subsidy is – either way, they are low income regardless of foster parent income). What is important to remember is WIC is very much interwoven with agribusiness and food manufacturing. Companies bid for WIC contracts, and their prices (and bare minimum nutrition requirements) are what determine which product is picked to be covered under WIC. I was appalled when I discovered that in the state of NJ, you MUST pick peanut butter that contains added sugars (including HFCS) and oils… You MUST pick bread that has HFCS if you want it to also be kosher (there may be one or two brands covered that don’t use HFCS but they are not kosher)… Weight Watchers bread is covered (it is very low calorie, therefore not a good choice for a potentially malnourished child)… All kinds of cereals are covered that contain more sugar than I would want to see fed to a young child… Organic milk is not allowed even if it’s on sale cheaper than the milk they cover… We cannot choose soy or rice milk despite being cheaper than cow’s milk…. Kosher cheese is not available in our state either, btw (I think it may have been at one time) So while I appreciate WIC, I do not appreciate that the implication is that because you’re poor you can’t choose to feed your children healthy food. You are too poor (and dumb, I feel they imply) to get to decide that HFCS doesn’t belong in your kid’s peanut butter. Also, having spent time in WIC offices both as a client and as a nutrition student shadowing WIC nutritionists, I have seen some amazing breastfeeding education and support offered. I would be surprised if breastfeeding rates among low-income women weren’t improved at all by WIC – There are incentives given to women who breastfeed such as receiving more food (and more types of food). BTW, since you mentioned whole milk – They only give whole milk up to age 2. After that they switch to 2%.

    BTW, medical scripts for formula makes no sense – Because the main reason low-income women are feeding their babies formula is not because they are offered free formula checks, but rather a) lack of family and cultural support and education… and b) WORKING LOW WAGE JOBS THAT CANNOT ACCOMMODATE BREASTFEEDING MOMS. Those of us working in offices or from home might be able to imagine how we could manage breastfeeding while working – But imagine working at McDonalds or in a factory or as a janitor. How would that work, exactly? If we want to see breastfeeding rates increase, we need to be a lot more proactive and creative than just making formula harder to obtain.

  18. #18 Your Future
    July 16, 2011

    It’s about time to cut these overpopulation-producing liabilities. Chop away!

  19. #19 Delpasored
    July 20, 2011

    This is a bit late to post, but most families on WIC are working families. Many military families are on WIC. When we were stationed at Okinawa there was a WIC office on base and on every Naval base I’ve been on since. Be careful making assumptions about lazy people or unmarried mothers being the majority of WIC recepients. Two parent families, single moms and single dads have children on WIC.

    As for WIC having not inproved BF rates, not all states and not all WIC offices put the same effort into promoting BF. It is important to provide professional support to BF moms. This means not just education, but help from a IBCLC to clients who are having problems. Help by loaning pumps for BF problems or hospitalized infants and pumps for going back to work or school. Not all offices have these, some offices none of the above. Especially needed is the expertice of an IBCLC, but with cutbacks I bet BF help will be the first thing to go.