Increasing Access to the Safety Net During Pregnancy: Evidence from an RCT

• In Event: New Research on Childhood Exposure to the Safety Net

Abstract

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a cornerstone safety net program for pregnant people in the US. Though half of people giving birth are eligible, WIC is significantly underenrolled. We tested a new approach to connect low-income pregnant people to WIC resources. In the US, 95% of people under 40 have smartphones and use of pregnancy tracking apps is common. We partnered with a popular app company to implement an RCT designed to support enrollment in WIC. 

Advantages of this design are multiple. This app reaches a wide body of people “where they are,” with a diverse user base based on geography, income, and education. People use these apps to track their menstrual cycles, identify fertile windows, and avoid pregnancy or become pregnant, as well as to track infant development. New users are continually signing up for the app. 

Pregnancy app users were invited to take a survey to learn about free pregnancy resources. Participants in the treatment group were given information suggesting they were eligible for WIC, what WIC provides, and a link to enroll at a local WIC clinic. The control group was given a prompt about nutrition in pregnancy and a link to an ACOG website. Respondents were reinterviewed 1-3 months after the pregnancy due date. 

6,879 pregnant people who were WIC-eligible based on reported information about their households - and who were not WIC-enrolled at the time of recruitment - enrolled in the study and completed the prenatal survey. At present 1,435 of these participants have also completed their pregnancy and the postnatal survey, which asks detailed questions about pregnancy, delivery, and infant health in the case of live birth. Analysis of incoming study data is ongoing as people give birth. 

Early results indicate that people exposed to the WIC educational intervention may be more likely to enroll themselves (46.5% vs. 42.8%, p=0.16) and their infants (38.1% vs. 34.8% p=0.19) in WIC. Participants in the treatment group were more likely to know that WIC offers breastfeeding support in addition to resources for infant formula (64.9% vs. 59.0%, p=.024). Common reasons reported for not enrolling included concerns about eligibility (39.3%) and not knowing much about WIC (21.8%). 

This study is the first to experimentally test approaches to encourage WIC use, evaluate WIC impacts in pregnancy with exogenous variation in WIC use, and identify barriers to WIC uptake in the era of digital recruitment. Apps may provide a low-cost, scalable way to educate millions of people about US safety-net resources and support their use during pregnancy.

Author

• Marianne Bitler, University of California, Davis
  Presenting Author