Running head: POLICY ANALYSIS: WIC

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

Michelle Loding
Wayne State University
SW 4710
October 12, 2015
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

POLICY ANALYSIS: WIC

mechanical, living and social, or combination of these. Examples of social systems include
individual families, groups, a specific social welfare agency, or a nations 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).

POLICY ANALYSIS: WIC

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

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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.

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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

POLICY ANALYSIS: 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

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entails. Here is a table of current income guidelines.

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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

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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
Masters 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

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12

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

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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

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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

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15

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.

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References

About WIC-WIC at a Glance. (n.d.). Retrieved from http://www.fns.usda.gov/wic/about-wicwic-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.
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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
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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
http://search.proquest.com.proxy.lib.wayne.edu/docview/215084477?accountid=14925

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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/CFR2013-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.
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WIC Eligibility Requirements. (n.d.). Retrieved from http://www.fns.usda.gov/wic/wiceligibility-requirements
WIC History. (n.d.). Retrieved October 1, 2015, from
http://www.nutritionnc.com/wic/history.htm