empowering women, infants, and children in the wake of the covid-19 pandemic.
A study on the reach and effectiveness
of the programmatic changes WA WIC adopted due to the COVID-19 pandemic.
A study on the reach and effectiveness
of the programmatic changes WA WIC adopted due to the COVID-19 pandemic.
The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) aims to safeguard the health of vulnerable low-income women, infants, and children who are at nutrition risk by providing nutritious foods, nutrition education, health assessments (including child body weight), breastfeeding promotion and support, and referrals to health and social services.
Nearly seven million pregnant women, breastfeeding women, non-breastfeeding postpartum women, infants, toddlers, and children up to age five are served across the United States.
From 2019–2020 Washington (WA) WIC served between 135,000 to 120,000 mothers, infants, and children; almost half of all infants born in WA state.
WIC participation is associated with healthier diets, increased purchases of healthy foods, better infant feeding practices, and improved rates of infant morbidity and mortality.
Despite program benefits, only half of eligible individuals enroll in WIC, because of challenges associated with having to be physically present at WIC offices for appointments and limited foods meeting WIC eligibility requirements. The COVID-19 pandemic made these challenges even more difficult. The outbreak created econimic conditions that increased rates of severity of food insecurity among vulnerable families.
WA’s WIC program has been actively re-tooling service delivery prior to and at the outset of the COVID-19 pandemic to overcome participation barriers and decrease delays related to services. Beginning in March 2020, the Families First Coronavirus Response Act was passed by congress, which allowed WA WIC to offer remote certifications based on waivers:
•Physical presence waiver
•Remote food benefit waiver
•Separation of duties waiver
•Proofs (documents) for ID,
residence and income waiver
And moving into April 2020, WA WIC expanded its list of allowable foods by 800+ items. Together, these changes allowed eligible households to safely enroll in WIC and participate in nutrition and breastfeeding counseling through phone or video. They also could have a broader access to eligible foods in the midst of food shortage.
WA WIC COVID-19 RESPONSE TIMELINE
While all WA WIC participants experienced the WIC adaptions, there appeared to be some variation in how different populations experienced the changes. Starting with the effect on participation, the overall children participation increased the most. The increase may be due to the fact that children were home during lockdown and therefore couldn’t have access to school lunch and WIC was a way for them to acquire a meal.
In proportion to the declining birth rates, infant participation stayed consistently the same.
Overall show rates for appointments increased all around. Because of appointments being provided remotely, WIC was able to meet their participants where they were at.
The WIC study participants were highly satisfied with remote services because they removed long-standing barriers, such as not having to secure childcare or bring children to appointments as well as the need for gas and transportation, saving on travel time. Half of the study participants mentioned that they would take appointments away from home and that allowed them to do work or run errands at the same time, which was very convenient.
In addition to being safe for the pandemic, remote services helped busy moms who either just had a baby or toddlers running around. The moms felt more comfortable recieving services over the phone and mentioned that they felt the calls were personalized.
There was a steady increase in redemption going into 2020, but due to the COVID-19 pandemic, the rates decreased over 10% from March to April 2020. With the expansion of the WIC food list as a response, redemption rates drastically went back up following the expansion which would otherwise could of been worse without the changes.
Changes in redemption rates for WIC foods before and after the food list expansion were variable, showing improvements for some but little change or decrease among others; it is difficult to determine how factors including pandemic-related food shortages impacted these rates.
It’s important to note that there was mixed awareness about the expansion, but those who were aware were very pleased. Based on study participant interviews, cheese, cereal, yogurt, and milk were the most appreciated foods from the expansion list. The general comment is that there are more cheese items that are kid-friendly and packaged in convenient forms; there are more cereal varieties that include types that kids like; yogurt includes more flavors; and milk is available in additional sizes.
Study participants raised some concerns regarding different aspects of the programmatic changes. For remote services the common concern was that it was difficult to get information on weight and iron levels. The mothers and staff also missed the social interaction they had in-person. They also acknowledged that certain sensitive topics like domestic violence is better discussed in-person.
For the food list, there were inconsistencies and confusion related to what foods were “allowable.” It was difficult to determine when new foods were added, and some transactions failed because items deemed not-allowable.
It’s important to acknowledge these setbacks and address them moving forward.
The WIC study participants and staff liked the switch to remote, now it’s up to the WIC program to dial that in and advocate for any further resources to achieve those changes. WIC had to transition to remote quickly. Now those services need some adjustments: like allocating resources to further develop and improve remote services by exploring the creation of “how to” videos, and re-thinking how to overcome language barriers.
WIC should continue with a hybrid model. This allows participants to fully access remote services with an option to also have in-person visits for more information they appreciate and desire. Continuing to expand the food list will also be beneficial as well as exploring other platforms like online food shopping would be helpful to the WIC population.
Keeping track of the changes and evaluating them to see which to continue and how to optimize is a crucial part of the process. The women, infants, and children deserve to be given the utmost opportunity to be empowered.
“I hope we can keep doing some of these [changes]...to keep that access and equity in place.”
-WIC Staff
The study was a partnership between the University of Washington and Washington State Dept of Health (WA DOH) WIC program. Twelve focus groups with WIC staff were conducted including 52 participants (10 state and 42 local staff). 11 agencies were represented, including a mix of urban, rural, and mixed counties along with tribal areas. Focus groups were conducted in Dec 2020 to Feb 2021. Semi-structured interviews were conducted with 40 WIC participants across 20 WIC agencies in Mar to Apr 2021. The sample of WIC participants was designed to be a mix of rural, urban, and tribal populations. 30 interviews were conducted in English and 10 in Spanish. Quantitative data from 2017-2021 were provided by the WA DOH team. Funding was provided through a Healthy Eating Research, COVID-19 Rapid-Response Funding Opportunity via the Robert Wood Johnson Foundation.
The UW study team consists of Jennifer J. Otten, the Food Systems Director and an Associate Professor in Nutritional Sciences and Environmental and Occupational Health Sciences (DEOHS) at UWSPH, Emilee Quinn, a Research Scientist in the Department of Health Services, Chelsea M. Rose, Research Coordinator in the Department of Epidemiology, Evelyn Morris, MPH candidate in the Nutritional Sciences Department, and Annie Vuong, Visual Communication Design undergraduate student.
The WA DOH study team includes Brittany Tybo, Deputy Director, Office of Nutrition Services, Cathy Franklin, WIC Improvement Project Coordinator, Jean O’Leary, WIC Nutrition Coordinato, Terri Trisler, Local Program Operations Supervisor, and Anh Tran, Research, Analysis & Evaluation Unit Supervisor.