The WIC Program
Patterns: An Investigation of Delayed Entry & Early
Exit--Despite the health benefits of WIC participation, many
eligible women do not participate during pregnancy, and many
households exit WIC when a participating child turns 1 year old.
Using the first two waves of the Early Childhood Longitudinal
Study-Birth Cohort (ECLS-B), this study shows that households that
are more economically advantaged are more likely to delay entry
into the program or exit after a child turns 1 year old. (December
Rising Infant Formula
Costs to the WIC Program: Recent Trends in Rebates and Wholesale
Prices--This study estimated that 57 to 68 percent of all
infant formula sold in the United States was purchased through WIC,
based on 2004-06 data, and that formula costs to the WIC program
have increased. Typically, WIC State agencies receive substantial
rebates from manufacturers for each can of formula provided through
the program. After adjusting for inflation, net wholesale prices
increased by an average 73 percent for 26 fluid ounces of
reconstituted formula between States' contracts in effect in
December 2008 and the States' previous contracts. As a result of
the increase in real net wholesale prices, WIC paid about $127
million more for infant formula over the course of a year.
The WIC Program:
Background, Trends, and Economic Issues--This report presents
comprehensive background information on the WIC program-how the
program works, its history, trends, and the characteristics of the
population served. Also examined are current issues facing WIC,
focusing mainly on those with important economic implications.
WIC and the Battle
Against Childhood Overweight--The number of children at risk of
being overweight has grown in the past two decades, as has the
number of young children whose families participate in the WIC
Program. Are these increases connected? The answer appears to be
"no." However, children in low-income families, especially
low-income, Mexican-American families, are more likely to be
overweight. (April 2009)
Between the WIC Program and the Farm Sector--In fiscal 2008,
the $4.6 billion of food purchased with vouchers from WIC generated
$1.3 billion in farm revenue. Because WIC participants would have
purchased some of these foods with their own money in the absence
of the program, the net addition to farm revenue from WIC is
estimated at $331 million and the net increase in
full-time-equivalent farm jobs at 2,640. The study uses an
Input-Output Multiplier Model to derive these estimates and assumes
that recent revisions in the WIC food packages were implemented in
all States. (March 2009)
Informing Food and
Nutrition Assistance Policy: 10 Years of Research at ERS--Since
1998, Congress has provided funds to ERS to study and evaluate the
Nation's domestic food and nutrition assistance programs. ERS has
become the premier source of food and nutrition assistance research
in the United States, sponsoring over 600 publications on a wide
range of topics related to food and nutrition assistance. This
report highlights some of the key research conducted during the
FANRP program's first decade. (December 2007)
Recent Trends and Economic Issues in the WIC
Infant Formula Rebate Program--Over half of all infant formula
sold in the United States is purchased through the Special
Supplemental Nutrition Program for Women, Infants, and Children
(WIC). Typically, WIC State agencies obtain substantial discounts
in the form of rebates from infant formula manufacturers for each
can of formula purchased through the program. This analysis
suggests that retail markup accounts for most of the cost to WIC of
infant formula in most States. Both retail markup and net wholesale
price, however, have increased over time, with the recent increase
coinciding with the introduction of higher priced supplemented
infant formulas. (August 2006)
WIC and the Retail Price of Infant
Formula--Rebates from infant formula manufacturers to State WIC
agencies support over one-quarter of all WIC participants. However,
WIC and its infant formula rebate program may significantly affect
the infant formula prices faced by non-WIC consumers. This report
presents findings from the most comprehensive national study of
infant formula prices at the retail level. For a given set of
wholesale prices, WIC and its infant formula rebate program
resulted in modest increases in the supermarket price of infant
formula, especially in States with a high percentage of WIC
formula-fed infants. However, lower priced infant formulas are
available to non-WIC consumers in most areas of the country, and
the number of lower priced alternatives has increased. (January
Variation in WIC Food Package Costs: The Role of Food Prices,
Caseload Composition, and Cost-Containment Practices--Food
prices within States affect average monthly costs of State food
benefits packages provided by the WIC program more than variations
in WIC caseload composition do. In addition, cost-containment
practices by State WIC agencies provide different levels of cost
savings in different areas, contributing to interstate variation in
benefits package costs. This study is one of the few to examine the
degree to which food prices, caseloads, and cost-containment
practices influence costs of State WIC food benefits packages.
Because limited data exist on the actual food items that WIC
participants purchase, the study used a scanner dataset of
supermarket transactions and other sources to estimate the average
monthly cost of WIC food benefits in several areas. (January
Contractor and Cooperator
Effects of Changes in WIC Food Packages on Redemptions--This
study of Wisconsin participants in the Special Supplemental
Nutrition Program for Women, Infants, and Children (WIC) found that
the vast majority of WIC participants used some or all of their
food instruments 18 months after WIC food package changes were
implemented. Most participants purchased all of the prescribed
foods, and more than three-quarters of WIC participants used their
cash value vouchers (CVVs) for fruits and vegetables. However, the
percentage of WIC participants making full purchases with their
traditional food instruments decreased compared to the baseline.
The change in the proportion of participants who did not use any
food instruments was found across all participant categories and
racial/ethnic groups, but appears to have affected non-Hispanic
Black and non-Hispanic American Indian/Alaska Native participants
the most (December 2011).
of the WIC Program on the Infant Formula Market--This research
examines the impact of providing infant formula through the WIC
program on the wholesale price of infant formula. The findings show
that providing free formula to low-income families is the primary
factor in the growth in real wholesale prices of formula but that
sole-source contracts not only have reduced the cost of formula to
the Government but also have mediated wholesale price growth.
Factors Associated with Iron Status Among WIC Infants and Toddlers
in Rural West Virginia--Iron deficiency severe enough to cause
anemia may affect children's ability to grow and learn and,
consequently, their lifelong productivity and earnings. This study
conducted blood screenings of infants and toddlers ages 6-24 months
participating in The Special Supplemental Nutrition Program for
Women, Infants, and Children (WIC) in West Virginia. Results show
that 12 of the 57 infants and toddlers (21 percent) were iron
deficient, considerably more than the 4 of 49 (8 percent) with
anemia. Because routine screenings are unable to detect iron
deficiency before it progresses to anemia, primary prevention of
iron deficiency is the only option that may be universally applied.
Expert feeding recommendations-such as introducing iron-rich
complementary foods after 6 months of age and limiting consumption
of milk among children ages 12-24 months to no more than 24
ounces-are useful for promoting adequate intake of
readily-available iron and may help prevent iron deficiency.
An Assessment of the Impact of Medicaid Managed
Care on WIC Program Coordination With Primary Care
Services--Coordination between the Special Supplemental
Nutrition Program for Women, Infants, and Children (WIC) and
Medicaid has been an important component to ensuring access to
primary care services for WIC clients. This study examines how
increased use of managed care in the Medicaid program has affected
WIC program coordination efforts. According to the study sample, 72
percent of State Medicaid agencies report that Managed Care
Organizations (MCOs) are required to inform their members about
WIC. About 43 percent of State WIC agencies sampled in the study
have a formal agreement with a State Medicaid agency, generally
revolving around data sharing, referrals, and provision of special
metabolic infant formulas. The agreements, however, often lack
specific details on how services should be coordinated. Some local
WIC agencies and MCOs have implemented innovative approaches to
coordination such as including Medicaid staff at WIC clinics to
help clients with enrollment, information sharing to promote
targeted outreach efforts, helping clients identify providers and
resources, and transportation costs paid by MCOs for WIC clients to
attend WIC appointments. (September 2007)
Using Point-of-Purchase Data To Evaluate Local WIC Nutrition
Education Interventions: Feasibility Study--The effect of
nutrition education-an important component of many Federal food
assistance programs-on participants' food consumption behavior is
difficult to ascertain. This study finds that combining
point-of-purchase data with State data on the Special Supplemental
Nutrition Program for Women, Infants, and Children (WIC) is a
feasible method to assess behavioral changes in WIC participants.
The major obstacle to using these data to evaluate WIC participant
food-purchasing behaviors is the recruitment of a large enough
sample of stores for a representative sample of WIC participants.
Effects of Food Assistance and Nutrition Programs
on Nutrition and Health: Volume 3, Literature Review--This
report provides a comprehensive review and synthesis of published
research on the impact of USDA's food and nutrition assistance
programs, including WIC, on participants' diet and health outcomes.
The report is one of four volumes produced by a larger study,
including Volume 1, Research Design; Volume 2, Data Sources; and Volume 4, Executive Summary of the Literature
Review. (December 2004)
Amber Waves, ERS's magazine, is a window into the
agency's broad research program, covering production agriculture,
food safety and nutrition, the food industry, rural economies,
agricultural trade, and farm-related environmental issues.
Published four times a year in web and print editions, Amber
Waves contains in-depth feature articles, research findings,
previews of research in the works, and statistics, including a
variety of articles related to WIC and other food and nutrition
assistance programs. The following articles are particularly
relevant to WIC:
RIDGE (formerly Small
Grants) WIC Projects
FANRP's RIDGE Program has funded several research projects of
relevance to WIC, including those listed below:
Kavanagh, K., and C. Springer. Attitudes or Income? What Determines Whether
Mothers in the WIC Program Dilute or Concentrate Baby Formula .
Kavanagh, K. Prevalence of Accurately Reconstituted Infant
Formula in the WIC Population and in the Non-WIC-Eligible
Population: Exploring Maternal Knowledge, Attitudes, and Practices
of Infant Formula Preparation.
Brown, B., and T. Burns. Implementing Strategies That Increase Healthy Food
Consumption in Local Grocery Stores on a Northern Plains Indian
Gittelsohn, J., and M. Qi. Understanding the Impact of Food Assistance
Program Usage on Diet Among American Indians.
Maalouf, Z., and K.G. Dewey. The Use of the New World Health Organization
Growth Standards To Identify Trends and Determinants of Overweight
in WIC Infants and Children.
Odoms-Young, A., S. Zenk, and N. Chavez. WIC Vendor Access and Fruit and Vegetable
Availability in Northern Illinois.
Lofton, K., and C. Connell. Examining Relationships Among Obesity, Food
Insecurity, Stress, and Emotional Eating in Low-Income Caregivers
of Head Start Children.
Laraia, B.A., M. Bentley, and J. Borja. Food Security and Feeding Strategies.
Ziol-Guest, K.M., and D.C. Hernandez. Women, Infants, and Children (WIC): Effect on
Infant Feeding Practices and Children's Health and
Metallinos-Katsaras, E., J. Kallio, A. Must, P. Wilde, and K.
Gorman. A Longitudinal Study of Food Insecurity on
Overweight in Preschool Children.
Bitler, M., and J. Currie. Medicaid at Birth, WIC Take Up, and Children's
Outcomes. A Final Report to the IRP/USDA Small Grants Program .
Chatterji, P., K. Bonuck, S. Dhawan, and N. Deb. WIC Participation and the Initiation and Duration
of Breastfeeding .
Swann, C. The Dynamics of WIC Prenatal Participation .
Yunzal-Butler, C., T. Joyce, and A. Racine. "Maternal Smoking
and the Timing of WIC Enrollment: A Response to Davis, Lazariu and
Sekhobo," Maternal and Child Health Journal 14(3):474-77,
Ziol-Guest, K., and D. Hernandez. "First- and Second-Trimester
WIC Participation Is Associated with Lower Rates of Breastfeeding
and Early Introduction of Cow's Milk during Infancy," Journal
of the American Dietetic Association 110(5):702-09, May
Hoynes, H., M. Page, and A. Stevens. Is a WIC Start a Better
Start: Evaluating WIC's Impact on Infant Health Using Program
Introduction, National Bureau of Economic Research Working
Paper 15589, December 2009.
Jacknowitz, A., and L. Tiehen. "Transitions Into and Out of the
WIC Program: A Cause for Concern?" Social Service Review
83(2):151-83, June 2009.
Yunzal-Butler, C., T. Joyce, and A.D. Racine. "Maternal Smoking
and the Timing of WIC Enrollment," Maternal and Child Health
Journal, epub February 2009.
Tiehen, L., and A. Jacknowitz. "Why Wait? Examining Delayed WIC
Participation Among Pregnant Women," Contemporary Economic
Policy 26(4):518-38, October 2008.
Kavanagh, K., R. Cohen, M. Heinig, and K. Dewey. "Educational
Intervention to Modify Bottle-feeding Behaviors among
Formula-feeding Mothers in the WIC Program: Impact on Infant
Formula Intake and Weight Gain," Journal of Nutrition Education
and Behavior 40(4):244-50, July/August 2008.
Fitch, C.W., M.S. Cannon, G.E. Seidel, D.A. Krummel. "Dietary
Factors Affecting Iron Status of Children Residing in Rural West
Virginia," West Virginia Medical Journal 104(3):19-22,
Joyce, T., A. Racine, and C. Yunzal-Butler. "Reassessing the WIC
Effect: Evidence from the Pregnancy Nutrition Surveillance System,"
Journal of Policy Analysis and Management 27(2):277-303,
Ishdorj, A., H. Jensen, and J. Tobias. "Intra-Household
Allocation and Consumption of WIC-Approved Foods: A Bayesian
Approach," Advances in Econometrics, Vol. 23: Bayesian
Econometric Methods, pp. 157-182, S. Chib, B. Griffiths, G.
Koop, and D. Terrell, eds, Emerald Group Publishing Limited,
Jacknowitz, A., D. Novillo, and L. Tiehen. "Special Supplemental
Nutrition Program for Women, Infants, and Children and Infant
Feeding Practices," Pediatrics 119(2):281-89, February
Swann, C. "The Timing of Prenatal WIC Participation," The
B.E. Journal of Economic Analysis & Policy 7(1), January
Whitaker, R., S. Phillips, and S. Orzol. "Food Insecurity
and the Risks of Depression and Anxiety in Mothers and Behavior
Problems in Their Preschool-Aged Children," Pediatrics
118(3):e859-68, September 2006.
Whitaker, R., and S. Orzol. "Obesity Among US Urban Preschool
Children: Relationships to Race, Ethnicity, and Socioeconomic
Status," The Archives of Pediatrics & Adolescent
Medicine 160(6):578-84, June 2006.
Herman, D.R., G.G. Harrison, and E. Jenks. "Choices Made by
Low-Income Women Provided with an Economic Supplement for Fresh
Fruit and Vegetable Purchase," Journal of the American
Dietetic Association 106(5):740-44, May 2006.
Rose, D., J. Bodor, and M. Chilton. "Has the WIC Incentive to
Formula-Feed Led to an Increase in Overweight
Children?" Journal of Nutrition 136(4):1086-90, April
Skalicky, A., A. Meyers, W. Adams, Z. Yang, J. Cook, and D.
Frank. "Child Food Insecurity and Iron Deficiency Anemia in
Low-Income Infants and Toddlers in the United States," Maternal
Child Health Journal 10(2):177-85, March 2006.
Dennison, B., L. Edmunds, H. Stratton, and R. Pruzek. "Rapid
Infant Weight Gain Predicts Childhood Overweight," Obesity
14(3):491-99, March 2006.
Murphy, S., J. Foote, L. Wilkens, P. Basiotis, A. Carlson, K.
White, and K. Yonemori. "Simple Measures of Dietary Variety Are
Associated with Improved Dietary Quality," Journal of the
American Dietetic Association 106(3):425-29, March 2006.
Edmunds, L., M. Woelfel, B. Dennison, H. Stratton, R. Pruzek,
and R. Abusasha. "Overweight Trends among Children Enrolled in the
New York State Special Supplemental Nutrition Program for Women,
Infants and Children," Journal of the American Dietetic
Association 106(1):113-17, January 2006.
Bonuck, K., M. Trombley, K. Freeman, and D. McKee. "Randomized,
Controlled Trial of a Prenatal and Postnatal Lactation Consultant
Intervention on Duration and Intensity of Breastfeeding Up to 12
Months," Pediatrics 116(6):1413-26, December 2005.
Schneider, J., M. Fujii, C. Lamp, B. Lonnerdal, K. Dewey, and S.
Zidenberg-Cherr. "Anemia, Iron Deficiency and Iron Deficiency
Anemia in 12-36-Month Old Children from Low-income Families,"
American Journal of Clinical Nutrition 82(6):1269-75,
Bitler, M.P., and J. Currie. "Does WIC Work? The Effects of WIC
on Pregnancy and Birth Outcomes," Journal of Policy Analysis
and Management 24(1):73-91, Winter 2005.
Nord, M., and E. Leibtag. "Is the 'Cost of Enough Food' Lower in
Rural Areas?" The Review of Regional Studies
35(3):291-310, Winter 2005.
Bitler, M.P., and J. Currie. "The Changing Association Between
Prenatal Participation in WIC and Birth Outcomes in New York City:
What Does It Mean?" Journal of Policy Analysis and
Management 24(4):687-90, Fall 2005.
Joyce, T., D. Gibson, and S. Colman. "The Changing Association
Between Prenatal Participation in WIC and Birth Outcomes in New
York City," Journal of Policy Analysis and Management
24(4):661-85, Fall 2005.
Bitler, M., and J. Currie. "Medicaid at Birth, WIC Take Up, and
Children's Outcomes. A Final Report to the IRP/USDA Small Grants
Program," Institute for Research on Poverty, Discussion
Paper No. 1246-02, February 2002.
Chatterji, P., K. Bonuck, S. Dhawan, and N. Deb. "WIC
Participation and the Initiation and Duration of Breastfeeding,"
Institute for Research on Poverty, Discussion Paper No.
1246-02, February 2002.