The federal program to feed pregnant women and children, WIC, is a bureaucratic nightmare.

The Federal Program to Feed Pregnant Women and Children Is a Bureaucratic Nightmare

The Federal Program to Feed Pregnant Women and Children Is a Bureaucratic Nightmare

What to eat. What not to eat.
Nov. 30 2016 11:08 AM

The Federal Government’s Program to Feed Pregnant Women and Children Is Terrible

WIC is supposed to provide nutritional support to low-income families. Instead it turns grocery shopping into a bureaucratic nightmare.

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The WIC Program can turn every trip to the grocery store into a bereaucratic nightmare.

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The woman in front of me in the supermarket line had grabbed the wrong kind of milk. She was paying with a voucher from the Women, Infants, and Children Program, a form of federal nutrition assistance, and she had whole milk, when her voucher specified low-fat. The cashier sent a bagger to get the right kind of milk. The long line halted. The cashier shot me an exasperated look. “Can you believe this?” her expression asked me. Actually, I could. I was using WIC, too, and had been hoping as I waited that this time, I’d finally done it right and would avoid the humiliation that came with grabbing the wrong milk or cheese or cereal: the pointed dirty looks from the people behind me in line paying with real money; the apologetic glances from the cashier to the customers; the sighs of impatience.

Before using WIC, I understood it to be much, much better than the nation’s other food assistance program, the Supplemental Nutrition Assistance Program (also known as SNAP or food stamps). WIC has strict requirements for purchases, with a goal of providing nutritious foods specifically for pregnant and nursing women and children under 5. I could use my WIC vouchers for formula, milk, cheese, juice, grains, fruit, veggies, or beans. The brands and sizes I could buy were spelled out in a WIC buying guide, right down to the kind of eggs allowed: only white, no brown, no eggs from cage-free chickens.

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Food stamps, on the other hand, can be used more or less without restriction. Right now, any food item can be purchased with the swipe of a SNAP debit card, including candy, cake, and soda. SNAP’s leniency has been blamed for exacerbating the obesity crisis and wasting taxpayer dollars. Bills inspired by the so-called success of WIC have been proposed in the House and in state legislatures to restrict SNAP purchases and ban items ranging from soda to crab legs.

Despite an odd reverence for the program from the left and the right, claims that WIC restrictions make for better health are hard to prove, in part because of selection bias. Experiments to test how well WIC works would raise ethical problems, because forming control groups would mean denying WIC to otherwise eligible women and children. So evaluations of WIC compare groups of people who are different aside from their WIC participation, making it difficult pinpoint the effect of the program. After noting this ongoing problem, a recent review of research from the U.S. Department of Agriculture Food and Nutrition Service presented results best described as ambiguous. Some studies do suggest that WIC may improve (somewhat) the eating habits of the poor women and children in the program. Others suggest that people in the program don’t eat less calories (though they do, of course, use WIC to purchase food that the program defines as healthful). The review noted a surprising lack of information about the specifics of how people on WIC eat, despite it being the federal government’s best-researched nutrition program.

Regardless of their much-touted differences, then, WIC and SNAP programs may ultimately serve the same function in regard to diet, namely offering low-income people resources to buy more food. But only WIC is frustrating enough to make a grown woman cry in the aisles of Target. The difference in participation rates for both programs drives that contrast home. Nationally, less than half of families eligible for WIC get benefits, compared with the 83 percent of eligible people who participate in SNAP, according to a 2016 analysis by demographer Kristin Smith.* The gap in participation rates is all the more striking because SNAP income cutoffs are much lower than WIC cutoffs, meaning that more people are eligible for WIC. A family of two with a monthly income of $2,470 qualifies for WIC, but a similar family must earn no more than $1,736 to qualify for SNAP.

The low participation rate is a reasonable response to stumbling blocks like the WIC buying guide, which is 30 pages long in my home state of California. This is what using WIC was like for me: I’d make a list using the absurdly long booklet while my five-month-old napped and go to store when she woke up. I’d head over to the infant aisle and take out my WIC folder, which held my vouchers and recorded my signature, and carefully make four different piles of formula and baby food in my cart. I’d place each pile separately on the belt when I went to pay, because only one voucher is allowed per transaction, and put a voucher on top of each pile. Then I’d cross my fingers, hoping with every beep of the scanner that I hadn’t broken an unknown rule, like mixing brands (you buy one Gerber jar, you buy only Gerber jars) or combining fruit or veggies with meat (formula-fed babies aren’t eligible for meat). Once that part was over, I’d hope that the cashier had a pen, because I had to sign each check separately in front of him or her so he or she could compare my signature to the one on the folder.

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At some point in this process, my daughter would start head-butting me from her baby carrier. One of her earliest words was “done!” howled at me when we walked through the doors of the superstore where I used WIC; a periodic chant of despair as I made piles of food and cross-checked: “Done, done, done!” After she graduated from formula to solid food, I was done too. I quit WIC, a choice I had because I could afford it. I only qualified for WIC because my wife and I adopted our baby through the state. Enrollment in the program was a benefit that came with her adoption. Breast-feeding wasn’t an option for us, and because formula is breathtakingly expensive, WIC could save us upward of $200 a month. After she turned 1 and could drink milk, though, the benefit dropped dramatically to about $50 a month.

I did try to stick with the program. We’re not wealthy, and any money we saved on formula meant more activities for the baby—music classes or a museum membership or a weekly baby gym class. But staying with WIC proved impractical in yet another way, because choice is crucial to parents feeding picky toddlers. It was pretty hard to square the very specific list of WIC eligible purchases with the desires of my 1-year-old. My daughter wouldn’t eat half of what I was allowed to buy with WIC checks, effectively halving the amount of my (already small) benefit. She wanted Babybel cheese, not mozzarella sticks, she wouldn’t touch the four bananas we were allotted every month, and she really liked meat.

I also had to go to the WIC office to pick up my checks, where I was peppered with flyers for parenting classes and surrounded by “breast is best” posters. When I called for an appointment, hold music coaxed to me to eat more fiber. Then, when my daughter turned 1, the WIC office wanted blood, and not in the metaphorical sense. The people there wanted to stick a needle into her tiny arm and fill a syringe with her blood to test her for lead before they would turn over my vouchers or for me to turn over her medical records to prove she had been tested for lead. They asked for her immunization forms. They wanted to tell me not to give my daughter juice before she was a year old and to make sure she was drinking water from a sippy cup and not a bottle. I grew up in a family without a lot of money, and I’ve been the kid in this scenario, watching well-meaning bureaucrats condescend to my mom. I felt ashamed and angry then and now wondered why I was allowing my daughter watch me endure the same kind of treatment.

I’ve covered poverty and health for years as a journalist, so this wasn’t just personal. I had an anthropological fascination with the WIC office and the complex infrastructure intended to compel low-income women in a very particular health direction. I was intrigued by the certainty of the nutrition advice on offer, when no such certainty should exist, especially in the case of intimately personal decisions like whether to breast-feed and for how long. According to WIC, every mother physically capable of breast-feeding should do so for one year. The tone deafness of the advice is painful—poor working women probably have life circumstances the least amenable to breast-feeding—but it fits well with the overbearing ethos of the program. Kidding just a little, I called WIC my part-time job when I was on family leave taking care of my daughter, but how did full-time working mothers manage this? Especially when relatively few stores bother to meet the stringent requirements for accepting WIC payments?

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One way these moms cope is by shopping at WIC stores, corner shops where WIC is the only accepted form of payment. Often, the stores are right next door to the WIC offices, all of their foods are on the approved buying list, and they have been faulted for price gouging the government as part of their business plans. That’s pretty easy because of how WIC is structured. There were limits on what items I could buy, but how much I spent wasn’t regulated. WIC stores make quick money by charging the government inflated prices for bread, milk, cheese, and juice.

Much has been made of the corporate profits SNAP provides for makers of junk food. As the example of these corner stores suggest, though, WIC is ripe for capitalist shenanigans, too. WIC restrictions force participants to buy particular brands, which funnels money to corporations like Nestle, one of a handful of baby food purveyors that make the arbitrary 4-ounce serving size required by WIC in California. WIC participants purchase more than half of the infant formula sold in the U.S., a bonanza for formula manufacturers. WIC and SNAP alike bolster the bottom lines of processed food manufacturers and superstores, because those entities supply much of America’s food, not because poor people buy too much soda and too many crab legs.

To be clear, though I’m knocking WIC, I have no doubts that the government should help low-income mothers feed themselves and their kids. But if the federal government really wants to help parents, it should trust them to make their own purchasing decisions instead of forcing them to spend hours navigating the intricacies of WIC as it currently exists. Luckily, we already have a program in place that respects the dignity and autonomy of its recipients. It’s called SNAP, and it works, despite the measly $1.44 allowance per meal. Food stamps should be the model for WIC, not the other way around.

*Correction, Dec. 8, 2016: This article originally misstated that half of people eligible for WIC get benefits. Half of eligible families receive the benefits. (Return.)

Heather Tirado Gilligan is a health reporter and editor based in Oakland, California.