THE STATE OF WIC HEALTHIER PREGNANCIES, BABIES, AND YOUNG CHILDREN DURING COVID-19 FEBRUARY 2021 ACKNOWLEDGMENTS The National WIC Association (NWA) is the non-profit voice of the The W.K. Kellogg Foundation (WKKF), founded in 1930 as an 12,000 public health nutrition service provider agencies and the independent, private foundation by breakfast cereal innovator and over 6.3 million mothers, babies, and young children served by the entrepreneur Will Keith Kellogg, is among the largest philanthropic Special Supplemental Nutrition Program for Women, Infants and foundations in the United States. Guided by the belief that all children Children (WIC). NWA provides education, guidance, and support to should have an equal opportunity to thrive, WKKF works with WIC staff; and drives innovation and advocacy to strengthen WIC as communities to create conditions for vulnerable children so they can we work toward a nation of healthier families. For more information, realize their full potential in school, work and life. visit www.nwica.org. The Kellogg Foundation is based in Battle Creek, Michigan, and works throughout the United States and internationally, as well as with sovereign tribes. Special attention is paid to priority places where there are high concentrations of poverty and where children face significant barriers to success. WKKF priority places in the U.S. are in Michigan, Mississippi, New Mexico and New Orleans; and internationally, are in Mexico and Haiti. For more information, visit www.wkkf.org. NWA BOARD OF DIRECTORS Berry Kelly, MBA Samantha Blanchard Beth Honerman Chair Nutrition Coordinator Nutrition Coordinator Director, Bureau of Community Nutrition Services WIC Nutrition Program South Dakota Department of Health South Carolina Department of Health and Maine Department of Health and Human Services Environmental Control Robin McRoberts, MBA, MS, RD Regina Brady Director, Community Programs Sarah Flores-Sievers, BS, MPA WIC Director Visiting Nurse Association of Central Jersey, Chair-Elect Thames Valley Council for Community Action, New Jersey WIC and Farmers Market Director Connecticut Public Health Division/Family Health Bureau Carol Raney New Mexico Department of Health Sarah Brett, MS, RDN Nutrition Coordinator Nutrition Coordinator Indiana State Department of Health Beth Beachy Oregon WIC Program Chair Emeritus David Thomason Director, Birth to Five Division LaKeisha Davis Director, Nutrition and WIC Services Tazewell County Health Department, Illinois WIC Director Kansas Department of Health and Environment Swope Health Services, Missouri Meaghan Sutherland, MS, RD, LDN, CLC Paul Throne, DrPH, MPH, MSW Secretary Karen Flynn Director, Office of Nutrition Services Nutrition Education Specialist, WIC Program WIC Director Prevention and Community Health Massachusetts Department of Health Vermont Department of Health Washington State Department of Health Melinda Morris, MS, RDN, IBCLC Kate Franken, MPH, RD Jody Shriver Treasurer WIC Director, Child and Family Health WIC Project Coordinator, Muskingum County WIC Program Manager Minnesota Department of Health Zanesville-Muskingum County Health Boulder County Public Health, Colorado Department, Ohio Mitzi Fritschen, MEd, RD, LD Douglas Greenaway, MARCH, MDIV WIC Branch Chief Laura Spaulding, RDN President & CEO Arkansas Department of Health WIC Supervisor National WIC Association Deschutes County Health Services, Oregon Paula Garrett, MS, RD Stephanie Bender Director, Division of Community Nutrition Tecora Smith Nutrition Coordinator Virginia Department of Health WIC Director Bureau of Women, Infants, and Children Northeast Texas Public Health District, Texas Pennsylvania Department of Health Angela Hammond-Damon, IBCLC e-WIC Project Deputy Director Christina Windrix Sarah Bennett Division of Health Promotion Nutrition Coordinator WIC Director Georgia Department of Public Health Oklahoma Department of Health Buncombe County, North Carolina Rhonda Herndon, MS, RD/N, LD/N Bureau Chief, WIC Program Services Florida Department of Health 2 TABLE OF CONTENTS INTRODUCTION .....................................................................................5 CHAPTER FOUR: HEALTHY AND MODERN Recommended Policy Actions ....................................................5 OPTIONS FOR WIC SHOPPERS ....................................................... 30 New Options at Checkout.............................................................. 30 CHAPTER ONE: THE CASE FOR WIC ................................................7 The WIC Transaction and Electronic Benefit Transfer/e-WIC .... 30 Overview of WIC’s Comprehensive Nutrition Services ...............7 The Need for Online Purchasing............................................ 31 Access to Healthy Food ..............................................................7 Alternative Checkout Models ................................................. 32 Nutrition Education ....................................................................7 Finding WIC Foods at the Store ................................................... 33 Breastfeeding Support ...............................................................8 Store Placement ...................................................................... 33 Health Screenings ......................................................................8 Shopper Education .................................................................. 33 Referrals ......................................................................................8 Ensuring Program Efficiency and Integrity ................................ 34 Program Impacts on Health Outcomes .........................................8 Holding Vendors Accountable................................................ 34 Birth Outcomes ...........................................................................8 Containing Costs ...................................................................... 35 Breastfeeding Rates ...................................................................9 Child Nutrition Outcomes ..........................................................9 CHAPTER FIVE: ENHANCING EQUITY IN WIC ............................. 36 Return on Investment ................................................................... 10 WIC’s Equity Roots ........................................................................ 36 Healthcare Cost Savings ........................................................ 10 Racial Disparities in Maternal and Child Health ....................... 37 Economic and Societal Impacts ............................................. 11 Maternal and Infant Mortality ................................................ 37 Military Readiness ................................................................... 11 Breastfeeding Rates ................................................................ 38 Addressing Anti-Black and Anti-Indigenous SPOTLIGHT: WIC’S RESPONSE TO COVID-19 .............................. 12 Racism and Implicit Bias ........................................................ 38 Emergency Waiver Authority ....................................................... 12 Empowering Tribal Services ........................................................ 39 Participation Impacts of Remote Services ........................... 13 Social Determinants of Health ..................................................... 41 Shopping Challenges .............................................................. 14 Ensuring Family Economic Security ..................................... 41 Economic Relief.............................................................................. 15 Prioritizing Community Health .............................................. 41 CHAPTER TWO: WIC’S ROLE IN IMPROVING NUTRITION ......... 16 CHAPTER SIX: PARTNERSHIPS WITH FARMERS ....................... 43 WIC Food Packages ....................................................................... 16 WIC’s Impact on the Farm Sector ............................................... 43 Food Package Review Process .............................................. 16 WIC at Farmers Markets .............................................................. 44 Pending USDA Review ............................................................ 17 Infant and Child Food Packages ............................................ 18 APPENDIX: STATE PROFILES OF WIC SERVICES ...................... 46 Adult Food Packages ............................................................... 18 Nutrition Education........................................................................ 18 WORKS CITED ................................................................................. 138 Breastfeeding Promotion ............................................................. 19 Breastfeeding Peer Counselor Program .............................. 21 CHAPTER THREE: CONNECTING FAMILIES WITH WIC AND HEALTHCARE........................................................ 22 Certifications and Clinic Processes ............................................. 22 Physical Presence Requirements ......................................... 22 Online Certification Tools ........................................................ 23 Income Limits and Adjunctive Eligibility .............................. 24 WIC Participation and Funding Trends ....................................... 25 Barriers to WIC Participation ................................................. 25 Increased Pressures on WIC Funding .................................. 26 Partnerships