WICked

There were three men in my class during nursing school. One was very handsome and had a master’s in public health, one was a good-lookin’ musician who witnessed the long, painful death of a beloved family member when he was young, and the third guy… well, he ate a lot of cheese. Lots of cheese. Everyday. Like, a pound of cheese in his lunch, alongside a weird variety of other foods.

I asked him what the deal was with all the cheese one day. He looked at me, a little shyly, beneath long eyelashes (why is it that men always get the long, thick lashes?) “Well, my wife applied for WIC awhile back, and one of the few quality things you can buy with WIC is cheese.”

WIC, or the Special Supplemental Nutrition for Women, Infants and Children program, is  a program funded by the U.S. Department of Agriculture intended to supplement the diets of low-income moms and kids. A few years ago, people realized that the food packages available through WIC were devoid of key nutrients such as whole grains and fresh produce, so the USDA has recently changed the guidelines for WIC food packages to include healthier options. Through regulation of food packages, WIC aims to affect the dietary quality and habits of participants. WIC is not intended to be the primary source of food or simply general food assistance for participants. “Rather, WIC food benefits are scientifically based and intended to address the supplemental nutritional needs of a specific population–low-income pregnant, breastfeeding, non-breastfeeding postpartum women, infants and children up to five years of age who are at risk”  (USDA, 2007). Food package guidelines are intended to give state’s considerable flexibility in designing food packages to meet their population’s specific needs. In addition to food supplementation, WIC also provides nutritional assessments, counselling, referral, and other services.

The issue of WIC resurfaced recently in my life when a classmate and I discussed a project she’s working on to increase access to locally grown produce and locally produced foods via WIC. This prompted one of those “I know, right?” conversations in which I shared an anecdote of recently noticing that the only WIC-approved cereals at my local grocery stores were chocolate-blasted corn crushers or whatever. After vigorously applauding her efforts, I addressed my mounting curiosity on the subject of WIC-approved foods by consulting a trusted Internet colleague, Dr. Google. A list of currently approved foods for New Mexican WIC participants can be found here, while comparison of old WIC food packages to new WIC food packages is here. And though I’m not claiming that putting cocoa-covered sugared corn bombs into the hands of toddlers is the absolute best use of public money, I did learn that those cereals (which now have to have a whole grain content of at least 51%) are an extremely important source of iron for WIC participants, and so the whole whole-grain-or-not debate is really secondary to the nutritional goal of iron supplementation. Most remarkably, my classmate’s goal of increasing access to healthy, local foods has already begun to surface here in New Mexico with WIC’s farmers market program. I couldn’t find any information on whether or not the farmer’s market program has increased the currently inadequate fresh fruit and vegetable consumption (Ponza et al., 2004) among participants, though.

Now, I am grateful that WIC exists. But, like my classmate, I believe if WIC exists, it should exist in the most effective form possible for participants and for the community. Which means there’s still work to be done. For example, WIC moms are less likely to breastfeed than eligible non-participants (Jacknowitz, Novillo & Tiehen, 2007; Ponza et al., 2004). Whether this is because moms who enroll in WIC are less likely to breastfeed in the first place (perhaps they are more likely to work outside the home than their eligible non-participant counterparts?) or because WIC makes infant formula available is unclear. Much of WIC’s interventional energy is aimed at promoting breastfeeding through support (for instance, moms who breastfeed exclusively receive a heftier food-package benefit than non-breastfeeding moms) and education, so this finding is worrisome. Of course, this begs the question, what is really the best way to promote breastfeeding in this population? Does it have more to do with the available food packages or education/support services or with perhaps with other factors that we can’t hope to address with a program like WIC?

Joyce, Racine & Yunzal-Butler (2008) wrote an illuminating article on the matter of how effective WIC programs actually are in terms of reducing adverse birth events and improving health of women and children. They essentially conclude that, although the success of WIC has been overstated, modest effects on fetal growth and emphasis on positive lifelong habits justify continued funding of the program. They say that more emphasis should be placed on reducing smoking among WIC moms, promoting breastfeeding, establishing positive life-long habits, and providing support— in essence, the educational and social support services are just as important as the food packages provided by WIC.  Which simply illustrates how nutrition doesn’t exist in a vacuum, and seemingly cut-and-dry programs designed to increase the amount of protein available to pregnant or breastfeeding women or calories to growing children must address numerous not-so-cut-and-dry factors like culture preferences/practices, education, and the tendency to select cheese over swiss chard at the grocery store..