WIC (Women, Infants, and Children) 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.