A mixed-methods evaluation of changes to WIC’s value and user-friendliness: impacts on young children’s WIC utilization

• In Event: Transforming WIC: Policy Shifts and Impacts

Abstract

Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has long been associated with better health outcomes for participants, but participation among eligible children drops sharply after a child’s first birthday. Policy changes to WIC that occurred during the COVID-19 pandemic, including waivers to allow for remote services and an increase in the cash-value benefit for fruits and vegetables, may have made the program easier to use and increased perception of its value. In partnership with Massachusetts’ state WIC agency (MA WIC), we sought to test whether these policy changes were associated with increased benefit redemption and retention of children beyond infancy.

Methods: We used an explanatory sequential mixed methods design. For quantitative analyses, we used an interrupted time series analysis of n=972,190 households to estimate, from 2017-2022, whether trends in monthly CVB redemption and trends in the monthly proportion of those who had been enrolled as infants being retained in WIC changed from before to after the COVID-era policy changes. We also conducted semi-structured interviews with n=26 MA residents who participated in both WIC and SNAP during 2020-2021 to explore the relationship between SNAP and WIC policy changes, and used a framework analysis approach, guided by Kumanyika’s 2019 Getting to Equity framework, to qualitatively analyze interview data. We then integrated qualitative and quantitative data.

Findings: The remote service waivers were associated with significant, substantial monthly increases in the proportion of 1-, 2-, 3-, and 4-year old children retained, echoing qualitative findings that these waivers meaningfully reduced burdens associated with maintaining participation. Meanwhile, the increased CVB as a result of the American Rescue Plan Act was associated with an immediate and dramatic increase in the amount of cash spent per household on fruits and vegetables, also echoing qualitative findings about the importance of this benefit increase. No meaningful differences in estimated impact were seen by race, ethnicity, maternal education, or primary language. Qualitative data suggested that participants experienced the WIC CVB increase as being distinctly helpful, while changes to SNAP were seen as simply keeping pace with increased food costs; participants also noted WIC’s benefits extended beyond nutrition and suggested that both programs are necessary for household health.

Conclusion. Policies to reduce administrative challenges for WIC participants were associated with improved utilization for young children; meanwhile, an increase to WIC benefits for fruits and vegetables was associated with increase spending on fruits and vegetables. Participants found changes to WIC and SNAP policies to be complementary, not duplicative. Changes should be made permanent and expanded upon to further improve benefit uptake.

Author

• Erica Kenney, Harvard University
  Presenting Author