By Sarah Ovaska-Few
Fewer women and children in North Carolina are taking part in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a federal program designed to ensure low-income women, babies and children get needed nutrients in their diet.
The slide is worrisome, given that the WIC program has long only captured a portion of those who are eligible.
“The numbers are dropping, and I honestly don’t think the needs are dropping,” said Catherine Sullivan, a UNC Chapel Hill professor who heads the Carolina Global Breastfeeding Institute and tracks nutritional issues in the state’s maternal and infant populations.“We have many issues with malnutrition.”
The decline isn’t isolated to North Carolina but part of a larger years-long slide in participation across the country. WIC serves expecting and new mothers, as well as their children under five-years old, who live in households with income levels of less than 185 percent of the federal poverty level, or approximately $47,000 for a family of four. The average household receives about $41 in food benefits each month, according to the U.S. Department of Agriculture, which administers the WIC program.
In North Carolina, there’s been a 15 percent drop in the number of WIC participants from the 2014 fiscal year to now, and a 23 percent drop from 2008, according to average statewide WIC caseload numbers provided by the N.C. Department of Health and Human Services. The state had an average of 210,175 women and young children participating so far this year.
The state hasn’t seen as steep a drop-off as the nation as a whole, where participation levels of women, infants and young children dropped by 27 percent from 2008 to now, according to an analysis of USDA data.
Immigrant families part of WIC decline
The decline has been exacerbated in the last three years by concerns in immigrant communities that taking part in public benefit programs could draw the attention of immigration enforcement or jeopardize green card applications, according to Rev. Douglas Greenaway, the president and CEO of the National WIC Association, an advocacy group that tracks national policy and seeks to boost participation levels.
“During the presidential election, there was this heated rhetoric which has continued since this administration took office against immigrants, particularly, and against undocumented immigrants especially,” Greenaway said.
That rhetoric and deportation actions around the country have translated to hesitation for some to sign up for benefits like WIC, which is one of the few federal benefits programs that doesn’t take immigration status into account. Greenaway has heard anecdotal reports of immigrant families around the country suddenly dropping out of WIC, or even trying to pay back prior benefits, out of concern it could put their families at risk of deportation. That concern was compounded last year when a draft of a proposed “public charge” rule was leaked to the press about how lower-income immigrants could have prior use of public benefit programs held against them in the immigration process. WIC was not included on that list of potentially affected programs, but coverage of the proposed rule was significant in the Spanish-language media.
There’s a myriad of other reasons at the root of these drops, in addition to the growing fears in immigrant communities, about accessing public benefit programs. Other root causes include dropping birth rates and a strengthening economy that means families may not be as hard-pressed to put the food they need on the table, Greenaway said. WIC also has requirements such as regular nutritional education sessions that can be difficult for working families who may not have dependable transportation or child care to meet, he said.
Then there’s also the stigma that federal programs like WIC continue to carry where a cashier in a local grocery store may embarrass – intentionally or not – an individual trying to use WIC benefits at a check-out line.
“Accessing the program and the benefits requires a measure of courage and swallowing some personal pride to walk through the door to get those benefits,” Greenaway said.
The national group is trying to combat that decline by launching digital and print advertising campaigns in many states, including North Carolina, to increase awareness of the program to those who stand to benefit.
Additional nutrition for growth
WIC is unlike other food assistance benefits such as Supplemental Nutrition Acceptance Program (SNAP), or food stamps, where families get monthly allotments of money to buy food based on income thresholds. With WIC, each eligible family is essentially prescribed specific food items such as infant formula, milk, whole-grain snacks or fruits and vegetables with the idea that the tailored food assistance will improve overall nutrition. Participants also receive education in nutrition and have to show they’ve taken part in those efforts in order to qualify for the financial benefits.
The intent is to give young children and women who are pregnant, breastfeeding or who have recently given birth the additional nutrients they need to help growing babies and toddlers. The program is also a strong proponent of breastfeeding, and benefits are tailored to ensure that breastfeeding mothers are able to get the nourishment and nutrients they need to help their babies grow. WIC benefits can continue through the children’s early years when the brain is rapidly developing.
A study published this summer by a team from the Centers for Disease Control and Prevention found that obesity rates among preschoolers enrolled in WIC dropped after the program began to include more fruits, vegetables and whole grains. WIC also cut back in recent years on the amount of juice allowed and switched from covering high-fat milk to low-fat milk for older toddlers.
The dropping WIC participation numbers are concerning for state health officials like Kelly Kimple, a pediatrician who heads DHHS’ maternal and children’s health division.
The drop in WIC enrollment rates comes as North Carolina, through DHHS and with the backing of Gov. Roy Cooper, launched its ambitious early childhood action plan last year, which lists multiple ways the state is pushing to improve children’s well-being and eliminate the long-present health disparities between North Carolina’s different racial and ethnic groups.
A federal analysis estimated that just over half of North Carolina’s eligible women and children were receiving WIC benefits in 2016, an accessibility rate that puts it above several neighboring states in the Southeast but below places such as Maryland, Rhode Island and California where 60 to 70 percent of eligible participants accessed benefits.
“Obviously this trend is concerning,” Kimple said. “Our focus is to reverse that trend.”
Kimple said the state is aware of concern in the immigrant and Latino population and is trying to make clear that immigration status doesn’t matter when it comes to WIC.
“These families are eligible, and we don’t ask if you are undocumented or not,” she said. “The focus is on the health of women and children – we don’t even ask what their status is, and we wouldn’t share it.”
Another way the state is trying to boost WIC participation is through routine needs assessment screenings that will happen with the upcoming switch to Medicaid managed care. The state also recently launched NCCARE360 in several counties, designed to be a new one-stop shop care network that will make it easier for struggling North Carolinians to connect with resources they need to thrive.
Boosting WIC in NC
Some individual county WIC offices are working to try and enroll more women and children into the program.
In Alamance County, the WIC office participates in community events to try to spread the word about the program. It also created a “lactation station” to set up at summer festivals to give women a shaded, more private area to breastfeed their babies while also promoting the program, said Nicole Alston, the Alamance County WIC Director.
The WIC office coordinates closely with the county-run Children’s Dental Health Center that operates on a sliding scale, with families at the dental office frequently directed to WIC and vice versa.
But even with those and other outreach efforts, Alston said she has trouble meeting target numbers set by state and federal agencies.
“We’re not sure if people just have more work and feel they won’t be WIC-eligible, so they won’t apply,” said Alston, who used WIC herself after giving birth to her eldest child before she was in her current position.
Many women also don’t realize their children can receive benefits up to age 5, as many tend to roll off the program at a year old when infants typically start shifting to more solid foods and away from formula and breast milk, Alston said.
The state also moved to an electronic WIC system in 2018, a change that meant people could buy just what they need and use an electronic card that looks similar to a debit or credit card at the checkout line. Previously, people had to use a paper voucher and get everything on their lists – which could mean getting multiple gallons of milk or multiple blocks of cheese at one grocery story visit while having to get every single item prescribed to them, whether it would get eaten or not.
The new system has made things easier, but DHHS officials haven’t seen a corresponding jump in usage that they expected would come once word got out about the easier-to-use eWIC program.
“We were hoping that after the full implementation of eWIC we would start to see some increased participation,” Kimple said.
Alston, the Alamance County WIC director, was happy to see the switch to electronic vouchers, as well as a new online app which allows women to meet their educational requirements without necessarily having to come into an office every three to four months.
There’s also a way for people to check their remaining benefits with smart phones or even scan items in grocery stores to ensure products are WIC-eligible before going to check-out lines.
She hopes the word will continue to get out to eligible families.
“It’s a wonderful program,” said Alston. “We really do help a lot of people”
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Good piece because it outlines the multiplicity of the interconnectedness of WIC participation variables. What I didn’t see was some kind of examination or prediction about the impact of the privatization of Medicaid- both as an indicator of plan performance and as a social determinant of health valuation. If privatization is supposed to provide greater incentives for better outcomes, WIC would seem to be Ground Zero.
Thanks for reading, and for your comment Allen. In reporting, I did not find precise projections /predictions from DHHS of how WIC usage levels would change once the assessment of needs pieces were put in place. That may change, of course, once managed care is phased in and there’s more of a focus how programs like WIC will boost long-term health benefits. The evidence is there that WIC works, part of why I was a bit surprised to find it is so underutilized in the state (and in other states).
WIC has been declining years before Trump and the immigrants. People don’t want to be told what to eat. All they want is the food and formula. They don’t like people pushing breastfeeding when they want to bottle feed. I worked in WIC 32 years. Women are having fewer babies, decline in military families, transportation issues and not wanting to wait has made the decline.