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Supporting a Healthy Early Childhood During the COVID-19 Pandemic

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is one of the nation’s largest federal nutrition programs, serving approximately 6.3 million people, including about half of all infants born in the United States. WIC helps low-income pregnant, postpartum, and breastfeeding women, infants, and children up to age 5 achieve and maintain a healthy weight by providing healthy foods and nutrition education; promoting breastfeeding and supporting nursing mothers; and providing healthcare and social-service referrals. 

The COVID-19 pandemic has made it more difficult for WIC participants to access their standard benefits, and for new participants to enroll. To get a better picture of WIC during this time, we spoke with Georgia Machell, PhD, senior director of research and program operations for the National WIC Association (NWA), and Geri Henchy, director of nutrition policy and early childhood programs at the Food Research Action Center (FRAC). Below is a transcript of the conversation. 

How has WIC been a support to families during the COVID-19 pandemic?

Georgia: WIC has continued to operate, which has been extremely helpful to families who rely on it for access to healthy food, breastfeeding support, nutrition education, and referrals. In response to social distancing protocols, WIC agencies across the country have been working tirelessly to shift what has been primarily an in-person program for over 40 years, to remote service provision. The flexibilities in the Families First Coronavirus Response Act have enabled WIC services to be provided in new ways. For example, the physical presence requirement has been waived in WIC certification. Traditionally participants would go into a clinic to have height and weight measures taken as part of a certification appointment. Obviously, those things are not safe to do in the current environment, and so WIC is doing remote certifications in a number of innovative ways. Our understanding is that most certifications are happening by phone, however we’ve heard from some of our members about drive-thru WIC clinics that are being set up in various places. Participants pull up to the WIC clinic in their car, call the number, and clinic staff come out and do a certification.  

WIC clinics are rapidly innovating, which is important in these times. It is important to be able to provide services remotely, extend the certification periods, and extend batch issuance for EBT benefits so that folks don’t have to come back to clinics to get certified or call back to continue those processes. 

Geri: I think that WIC has been a tremendous support to families during the COVID-19 pandemic. Even before the pandemic, WIC has been important to 6 million families and children. We know that WIC is a program that supports eating healthier and being healthier and can help reduce a child’s risk for obesity.  

As important as it was before, it’s even more important now because we know most people are stuck at home. We’ve already seen several studies showing a significant increase in food insecurity since the start of the COVID 19 pandemic, and reports of decreased dietary quality. WIC’s role in helping to improve food security and dietary quality, and to support overall health, is even more important now because of the circumstances surrounding this public health crisis. This is true for families already on WIC and for the many people who are newly eligible due to having recently lost their jobs and being thrust into dire circumstances.  

And that’s why the things that Georgia is talking about — where WIC is trying to adapt quickly to being able to serve in this new environment — are really important. For WIC, as with many other things, it’s been a race against time. When states first started social distancing and shutting things down, some states didn’t deem WIC as essential, so they shut WIC down. This meant that people couldn’t get services.  

Imagine, a mother brings her new baby to WIC for a scheduled appointment to enroll in the program, but the doors are locked due to a state having shut down the clinic. What is this mom supposed to do? While these obstacles did surface during the start of the pandemic, now we are seeing that because of the waivers and other progress that’s been made that it’s possible to enroll participants over the phone.  I’m not sure that they can serve everyone by phone yet, but I think there is a lot of innovation that’s going on and I am really happy about it. 

And a theme that’s really come forward for me is partnerships. I really think all of these partnerships — that the National WIC Association has with its members, that we have with our anti-hunger members — are proof of how everyone has worked together and employed their expertise to make sure that WIC can keep serving people during this pandemic. And I’ve really thought that’s one good thing that I see coming out of this. We all care about continuing to support the health of low-income communities and newly eligible communities. And we’ve really been able to work together with a big massive effort to make sure people can still get on the program. 

Data

Obesity Rates Drop Among Young WIC Participants

Between 2010 and 2016, the obesity rate among children ages 2 to 4 who participate in WIC declined significantly nationwide and in 41 states and territories, according to data from the Centers for Disease Control and Prevention (CDC). The Robert Wood Johnson Foundation produced a special report examining how WIC can help give children a healthy start in life.

Read the Full Report

How have the relief packages that Congress has passed so far impacted WIC?

Geri: Georgia referenced the crucial waivers that have recently been passed, including the waiver allowing WIC to serve people without their being physically present in the clinic. There are also technical waivers that USDA has issued that have helped WIC move forward.   

Two of the other things we really care about in terms of the waivers are, making it easier for enrollees to get their benefits electronically and allowing states to offer clients flexibility in WIC food package choices to accommodate supply chain disruptions.  

Since WIC benefits are on EBT cards now for most states, WIC benefits can simply be downloaded remotely allowing participants to have their benefits even if the WIC office is closed due to COVID-19. It’s important for states to keep moving forward on that, and it shows the value of having upgraded the technology for benefit issuance to EBT because it’s a lot harder in places where they haven’t done that.  

Regarding food availability, in some places, not all of the foods that are normally part of the WIC food package are available, so states can make some changes to help connect participants to healthy food during these urgent circumstances. In some ways, it seems like the states should be given even more leeway on this front. For example, there’s a WIC requirement that you can buy bread if it’s whole-grain and weighs one pound, but some WIC participants can’t find this exact product because of the supply chain disruption. It’s my impression that USDA is saying, “Well if you can find some whole grain pasta or some of the other things on the list, then you can’t substitute out a larger size bread.” And I think it would be better and easier for people if the state WIC people were allowed to have more flexibility in their waivers around the WIC food package than it appears to me that they have.  

Georgia: I think that we share similar concerns and we obviously want to make sure that, first and foremost, people can access the foods that they’re eligible to purchase with their WIC benefits, and if those foods are not available, that there are appropriate alternative options. Sometimes those foods are not available because of supply chain issues or because of stockpiling, so we definitely want to encourage the use of waivers to increase the range of foods that are available to WIC participants at this time.  

Going back to the issue around what’s happening in the retail setting, we’ve also been doing a bit of myth-busting over the past few weeks. For example, we’ve seen some messaging on social media in the past few weeks that’s tried to discourage people from shopping at the beginning of the month because that’s when WIC benefits are issued. The National WIC Association has been clear with our messaging that we don’t want to discourage people from shopping at any specific time of the month and that benefits are issued at different times in different places. And so that people should be respectful neighbors and be mindful that when you are shopping during whatever time of the month, if there are foods that are WIC-eligible (with a shelf tag that says WIC), be mindful that there could be someone who really needs them in the coming days and weeks. 

story

How WIC Gives Children a Healthy Start, Preventing Obesity in Early Childhood

In summer 2019, to better understand the decline in obesity among young WIC participants, we spoke with Georgia Machell and Jim Weill, president of FRAC.

Read the Interview

The WIC shelf tags have garnered a lot of attention in the past few weeks. There have even been celebrities like Michelle Obama and Kerry Washington reminding their twitter followers too, “Please look out for the WIC shelf tags and be mindful about these things.” So yeah, it’s certainly been interesting, but again, we’re just really trying to promote respectfulness and mindfulness when you are shopping. 

How have shortages of staples at grocery stores impacted families who use WIC? 

Georgia: It’s difficult to say exactly how widespread that is. I will say that we are having weekly conversations with state WIC directors and others to try and keep an ear to the ground on what different folks are experiencing in different places, and like many things in WIC, the experiences are different across the country.  

With regards to infant formula, unlike other foods, there are no alternatives to formula. Whenever there are formula access issues, there is concern that families may try to make their own formula or overly dilute formula to make it go further. These are dangerous and potentially life-threatening practices. The National WIC Association is providing messaging around this issue for WIC agencies to share with participants.  

Geri: Yes, it does vary a lot, and we get the same thing when we’re checking in with our network of anti-hunger advocates. For example, in Wisconsin, they have plenty of milk with various fat percentages, but in many other places, certain milk varieties are not available.  Participants can’t get nonfat milk, so they’ve got to shift to low-fat or full-fat milk. That is one of the most common things that people have waivers for. And then in some places, the shelves are cleared out. But in other places, they’re not.  

One place overall that seems to have more problems than others is rural areas.  To the extent that the supply chain is disrupted, it can really be an issue in rural areas.  People in rural areas are having to go a long way to get to the store and then their local stores are having supply chain issues. And I see Georgia nodding because that is something we’re really hearing about. Looks like you’re hearing about it too. 

Georgia: Yeah, definitely. And I will say that we’ve been particularly mindful of rural communities, both in thinking about the immediate response and the implications of COVID, but then also in thinking about some of the innovations that we know are going to be implemented over the coming weeks and months to increase access to WIC services remotely. There’s a positive long-term implication there for rural communities for whom we know transportation and physical access has always been a barrier to accessing WIC services. So as awful as this situation is, if we think about the kind of long-term implications of innovation, there’s certainly something there that suggests that there could be positive for access to rural communities to services like WIC. We just need to make sure the impact of these changes to service provision is measured and current waivers are extended.  

Geri: I think that a lot of the issues around client-facing technology are coming to the fore here. So states or local agencies that have been thinking about that and trying to work toward that are in a better position than those who haven’t and who may be smaller and have fewer resources to start with. We’re definitely seeing that people are able to use telehealth and FaceTime to talk to WIC offices. And the other part of that really is whether people are going to be able to move forward with online ordering.  

Yes, we have positive progress being made, it’s a race against time, and everybody’s trying to do the best they can to make sure to serve everyone. But these things will have longer-term implications. And I will say also that, going back to your original question, one of the things that we’re seeing now is there are remarkable differences in impacts related to race and ethnicity.  

We know that certain populations are being hit much harder than others in terms of mortality with the COVID-19 virus. We also know what that means for all of the food programs, including WIC, and we want to make sure that vulnerable populations are served. I think that all of these waivers that we have from USDA, all of these partnerships, and all this hard work will help us reach all of the communities that need to be reached, ensure that individuals understand how to get the critical WIC services that they need, now, starting from that first contact, by phone or internet, to the shopping experience being successful. 

As we move forward, the traditional role of WIC in supporting health and wellness in all of these different communities grows in importance. That’s why I think it’s good that everyone’s working together to move forward, including using all of their different resources and partnering with each other, to reach everyone who needs to be helped. You normally don’t see the kind of rapid change in a program that we’re seeing right now within WIC. 

Policy Recommendations

Women, Infants, and Children (WIC) Program

The Family First Coronavirus Response Act provides $500 million in additional funding for WIC to improve access to nutritious foods among pregnant women with low incomes or mothers with young children who lose their jobs or are laid off due to the COVID-19 pandemic. 

Learn More and See Policy Recommendations

Are there other changes that you think would be needed either in the short term to help respond to the pandemic or longer-term shifts in WIC that you are working on, will continue to work on, despite the coronavirus?

Geri: I feel like this is a good time to put some more fruits and vegetables in the WIC food package. That would help meet a need right now during the pandemic, but it would also put us in a good position for the permanent revisions to the food package down the line, which are Congressionally-mandated and should be happening soon.  

Georgia:  I’m glad that you brought up the food package because that’s definitely something that’s top-of-mind, especially as we’re thinking about how folks are struggling to access aspects of it right now.  

NWA recognizes the good work being done by FNS career staff and WIC staff on the ground.  We are really hoping that the waivers that currently in-place and being approved will be extended beyond May.  

We’re in the midst of this focusing event right now and a number of the things that WIC leaders are working tirelessly to implement in a very short timeframe are things that have been in the pipeline for a while and they’re just having to do it in an expedited timeline and with the pressure of knowing that we’re about to have an influx of new WIC participants as well. 

I think that in the short term, one of the things that we’re encouraging our members to really engage with is having some unified messaging. I think there has been some confusion about whether WIC is open and the National WIC Association has put together a really good toolkit for WIC agencies to use. Some of our core messages say that WIC is here for you in the COVID-19 crisis. Your EBT benefits will not be canceled. Infant formula companies are not giving out free formula, because that was something that was one of those myths that were kind of floating around online that we felt like we needed to address quickly. And then also to just be respectful and not stockpile WIC foods.  

We’re keeping in really good communication with one another, which our members are good at doing, and the National WIC association plays a really important role in terms of convening people. As this pandemic unfolds in different time frames in different places, it’s really important that we’re listening to each other and making sure we’re all working together to continue to support access to WIC.