Review of WIC Food Packages Improving Balance and Choice: Final Report (2017) / Chapter Skim
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2 The WIC Program: Changes Since the Last Review and Continuing Challenges
2 The WIC Program: Changes Since the Last Review and Continuing Challenges
Pages 51-108
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From page 51... ...
This chapter presents a review of changes in the food packages themselves as well as the numerous other changes that have occurred since 2006 and that could potentially affect any updates to the WIC food packages. These include changes in the number and types of WIC participants, economic factors such as participants' food expenditures and the costs of the program, and dietary guidance.
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From page 52... ...
The information presented below and throughout this chapter is based on key findings from these and other studies. Challenges to Implementation of the 2009 Food Package Changes Implementation of the 2009 food packages involved challenges at the federal, state, and local agency levels, as well as for vendors and manufacturers.
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From page 53... ...
to 59 ounces CVV: A new food instrument based Permission for "split tender" so that on a fixed cash value participants can cover any overage with cash (USDA/FNS, 2014a) Federal/State CVV: A new food instrument Education to staff, participants, and based on a cash value; difficult for vendors participants to select an amount of produce that exactly matched the value State agency CVV in lieu of jarred infant food No resolution; some states have not vegetables and fruits (currently fresh implemented the option because of only)
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From page 54... ...
Manufacturer Specific size or product with At higher cost, modified production the WIC food specification not streams to manufacture the required available product; or prohibitive cost so the product is not manufacturedc NOTES: CVV = cash value voucher; EBT = electronic benefit transfer; ND = No data are available as to whether this continues to be a challenge; UPC = Universal Product Code; USDA-FNS = U.S. Department of Agriculture's Food and Nutrition Service.
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From page 55... ...
(2010) demonstrated that nutrition education alone led to increased consumption of low-fat milk and whole grains even before the 2009 changes to the WIC food packages.
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From page 56... ...
Although most states maintained WIC services, some offered modified services; program recovery was slow in some states, lasting up to a year. In addition to these demographic and economic changes that may have influenced WIC participation between 2010 and 2015, the committee considered whether the food package changes initially implemented in 2009 may have contributed as well.
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From page 57... ...
SOURCE: USDA/FNS, 2016b. The results suggest no significant difference between participation before versus after implementation of the new food packages.
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. Of note in the figures below, the percentage of WIC participants who reported being white increased between 2006 and 2014 by a few percentage points (see Figure 2-3a)
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Number of Participants Of All WIC Number of Participants Of All WIC Group or Subgroup Nationwide Of Women Participants Nationwide Of Women Participants Nationwide 8,772,217 8,023,742 Total women 2,205,594 -- 25 1,923,171 -- 24 Pregnant women 986,433 45 11 772,151 40 10 Postpartum women 634,372 29 7 557,464 29 7 Partially BF women NR -- -- 345,371 18 4 Fully BF women NR -- -- 248,186 13 3 BF women 584,789 27 7 593,557 31 7 Of Infants Of All WIC Of Infants Of All WIC Participants Participants Total infants 2,272,626 -- 26 1,939,740 -- 24 FF infants NR -- -- 1,340,943 69 17 Partially BF infants NR -- -- 349,113 18 4 Fully BF infants NR -- -- 249,684 13 3 Total children 4,293,997 -- 49 4,160,832 -- 52 NOTES: BF = breastfeeding/breastfed; FF = formula-fed; NR = not reported.
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From page 60... ...
WIC household income is generally much lower than the qualifying income requirement of not more than 185 percent of the federal poverty-to-income ratio. In 2014, 74 percent of all WIC participants
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. This 74 percent figure represents an increase from 2006, when 67 percent of WIC participants had household incomes that fell at or below the federal poverty guideline (USDA/FNS, 2007b)
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From page 62... ...
. Food Expenditures of WIC Participants The committee was tasked with planning and implementing an analysis of food expenditures for the WIC-participating population using national data.
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From page 63... ...
. The share of WIC food items in FAH expenditures was higher for WIC-participating households than for the other households (18 percent overall for WIC-participating households, and 13 percent and 13.5 percent of total FAH expenditures for the low-income and higher-income non-WIC-participating households, respectively; p = 0.01)
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WIC expenditures as share 5.8 (0.9) of total food expenditures (all WIC-participating households)
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From page 65... ...
At the level of purchase and acquisition events, as shown in Table 2-5, the average value of WIC expenditures as a purchase event was $21.74. Expenditures for most WIC food items were larger when WIC vouchers were used at the shopping event (WIC Paid >0)
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and When WIC Is Not Used (WIC Paid = 0) Non-WIC, Non-WIC, Income ≤185% Income >185% WIC Participating Households (Pregnant or Child <5)
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0.01 (0.01) Infant formula 3.21 (1.23)
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WIC Paid >0 WIC Paid = 0 N = 1,967 N = 252 N = 1,715 N = 1,055 N = 826 Total food at home (FAH) expenditure in 29.54 (1.37)
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0.00 (0.00) Infant formula 0.74 (0.20)
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From page 70... ...
Comparable households with higher-income spent more than WIC-participating households both in total and for FAH and FAFH. WIC-participating households spent more on identified WIC food items in a week than did comparable households with income less than 185 percent of the poverty-to-income ratio.
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From page 71... ...
. This may result, in part, from differences in breastfeeding behavior related to racial and ethnic groups, maternal education and age, and WIC participation (CDC, 2010)
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Other available data indicate that between 2004 and 2008, breastfeeding prevalence was lower for WIC-participating women compared to WIC-eligible, nonparticipating women, with substantial differences across racial/ethnic groups (CDC, 2010)
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. The Ross Laboratories Mothers' Survey is a large national survey conducted by Ross Laboratories, a manufacturer of infant formula.
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. However, it was not pos sible to determine whether these improvements resulted from the food package changes themselves, the enhanced breastfeeding promotion and support activities begun at about the same time, or both.
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The food packages for breastfed infants from 0–1 month of age have no formula, or (at the state's option) up to one can of powder infant formula in the container size that provides closest to 104 reconstituted fluid ounces on a case-by-case basis.
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From page 76... ...
However, as a result of budget constraints, breastfeeding support resources are not universally available to all women participating in WIC who choose to breastfeed. Effects of the 2009 Food Package Changes on the Choice to Breastfeed The food packages implemented in 2009 were designed to encourage exclusive breastfeeding by allowing very limited issuance of infant formula to breastfeeding women in the first 30 days postpartum.
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From page 77... ...
. The results of this study also indicated that although issuance of the full breastfeeding package was higher in the first month after implementation of the 2009 food packages, the transition of infants out of this package and into a partially breastfeeding or fully formula-feeding package occurred at a significantly faster rate compared to before implementation of the 2009 food packages.
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. WIC PROGRAM COSTS OVER TIME Any changes to the food packages to be recommended by the committee are required to be cost-neutral so the current average food package cost (with adjustments for inflation)
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Values reflect rebates on infant formula and, to a lesser extent, infant food. SOURCES: USDA/FNS, 2016b (years 2008–2015)
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. Additionally, between 2007–2008 and 2011–2012 (periods immediately before and after the 2009 food package changes)
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a During this time period, the revised food packages were conceived by the Institute of Medicine committee (see IOM, 2006)
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a During this time period, the revised food packages were conceived by the Institute of Medicine committee (see IOM, 2006)
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From page 83... ...
food supply with implications for the revised food packages can be attributed to the influence of WIC itself. For example, since the Child Nutrition and WIC Reauthorization Act of 2004, which included provisions for infant formula manufacturers to bid for state WIC contracts, manufacturers have been bidding for formulas supplemented with the fatty acids docosahexaenoic acid (DHA)
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From page 84... ...
, the 2010 DGA reorganized the vegetable food group into five TABLE 2-13 USDA Food Intake Patterns for Kcal Levels of Interest: Comparison of 2005 and 2015–2020 DGA Kcal Pattern 1,300a 2,300b 2,600 2015– 2015– 2015– Food Group Units 2005 2020 2005 2020 2005 2020 Fruits c-eq/d 1¼ 1¼ 2 2 2 2 Vegetables c-eq/d 1½ 1½ 3 3 3½ 3½ Dark green c-eq/wk 1½ 1 3 2 3 2½ Red/orange c-eq/wk 1 3 2 6 2½ 7 Dry beans and peasc c-eq/wk 1 ½ 3 2 3½ 2½ Starchy c-eq/wk 2½ 3½ 6 6 7 7 Other c-eq/wk 4½ 2½ 7 5 8½ 5½ Grains oz-eq/d 4½ 4½ 7½ 7½ 9 9 Whole grains oz-eq/d 2¼ 2¼ 3¾ 3¾ 4½ 4½ Other grains oz-eq/d 2¼ 2¼ 3¾ 3¾ 4½ 4½ Protein Foods d 3½ 3½ 6¼ 6¼ 6½ 6½ Meat, poultry, eggs oz-eq/wk 16½ 29½ 31 Seafood oz-eq/wk 5 9½ ↓e 10 Nuts, seeds, soy (oz-eq/wk) oz-eq/wk 2½ ↑ e 5 5 Dairy c-eq/d 2 2½ 3 3 3 3 Oils g/d 17 17 30 30 34 34 Limits for: Calories for Other Uses f kcal 171 105 326 315 410 380 (% of calories)
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From page 85... ...
In summary, the major change in the DGA since the 2005 edition relevant to this review is the reformulation of the vegetable subgroups. This reformulation has already resulted in the committee's recommendation that WIC participants should be allowed to acquire white potatoes with their CVV (IOM, 2015)
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= nutrient of public health concern; nutrients of public health concern are those shortfall nutrients that are linked to adverse health outcomes.
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. Eggs, a primary source of cholesterol in the American diet, are currently included in the WIC food packages for children and women.
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. THE WIC PARTICIPANT EXPERIENCE TODAY The WIC participant experience today, illustrated in Figure 2-6, is influenced by a number of factors related both to the food packages themselves and to the WIC environment.
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From page 89... ...
(2012) found that the availability of fresh fruit and vegetables at authorized WIC retailers increased significantly after the 2009 package changes for African-American culturally specific vegetables and fruits, but not for Latino culturally specific vegetables and fruits.14 Redemption of WIC Foods In addition to published studies of the acceptability of the 2009 food packages, the committee also examined state data on foods actually purchased (i.e., from states that have implemented the EBT system)
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90 WIC participant experience Nutrition counseling, Knowledge education, BF support, Food preferences Storage about WIC referral to health care available WIC foods WIC-eligible WIC foods issuedc WIC shopper WIC foods Certifiedb consumed by individual (EBT/vouchers) in store purchased target person Motivations/ WIC foods Food available in store preferences barriersa Motivations/ Never barriersa WIC shopper WIC foods WIC foods not certified doesn't use not purchased consumed by EBT/voucherd target person Product on Manufacturer makes EBT/voucher Vendor stocks WIC-compliant food WIC foods Retail food State decides environment Vendor product requirements certified authorization State WIC regulations USDA WIC regulations IOM 2006 report recommendations WIC administrative process
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From page 91... ...
NOTES: This figure is a theoretical representation; it does not consider effects of other individual or household resources. a Potential participant barriers may include lack of access to transportation to the WIC site and/or the vendor, time required to visit a WIC site, inconvenient WIC clinic hours, lack of knowledge about the program, or lack of preference for WIC foods, among other barriers.
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From page 92... ...
g Average and range include data from Wyoming, late 2015 to early 2016. h Food package IV-A is for children ages 1 to less than 2 years.
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From page 93... ...
For foods provided in more than one food package, it was not possible to determine if redemption was different among food packages. There were not enough data to determine whether states with high concentrations of particular racial and ethnic groups have higher redemption for specific items (e.g., tortillas or beans are common Hispanic staples)
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Prior to the food package revisions, a survey administered to parents and caretakers of WIC participants in New York State found that issues with food procurement (store policies, food availability) and the WIC food packages (adequacy, satisfaction with the items)
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From page 95... ...
WIC Participant Shopping Venues The types of stores from which WIC benefits are typically redeemed is relevant when considering the availability of WIC foods in specific store types and food package changes that may affect small and large vendors differently. Based on the most recent ERS evaluation (USDA/ERS, 2016c)
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Nationwide Distribution and Costs of Food As part of its consideration of changes to the food packages, the committee evaluated information on the cost and national distribution of foods (including to low-income neighborhoods)
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Changes in Breastfeeding Breastfeeding prevalence among WIC participants is Prevalence lower than that of other low-income women. Evidence is inconclusive about whether the 2009 food package changes affected the choice to breastfeed.
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. KEY FINDINGS AND CONCLUSIONS This chapter includes a review of the many WIC programmatic and other environmental changes of relevance to the review of food packages.
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2012. Positive influence of the revised Special Supplemental Nutrition Program for Women, Infants, and Children food packages on access to healthy foods.
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2011. The effects of changes in WIC food packages on redemptions: Final report.
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2006. WIC food packages: Time for a change.
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2015. Review of WIC food packages: An evaluation of white potatoes in the cash value voucher: Letter report.
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2016. Review of WIC food packages: Proposed framework for revisions: Interim report.
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2015. The impact of the 2009 Special Supplemental Nutrition Program for Women, Infants, and Children food package revi sions on participants: A systematic review.
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2011a. The infant formula market.
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From page 106... ...
: Revisions in the WIC food packages; Final Rule, 7 C.F.R.
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From page 107... ...
2012. Fruit and vegetable availability and selec tion: Federal food package revisions, 2009.
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