Additional Fruit and Vegetable Vouchers for Pregnant WIC Clients: An Equity-Focused Strategy to Improve Food Security and Diet Quality

Abstract

Women with low household income and from racial/ethnic minority groups are at elevated risk of food insecurity. Food insecurity during pregnancy is associated with overall less healthy diets, lower intake of the pregnancy-supportive nutrients iron and folate, and significant variations in diet across the course of a month. The goal of this study was to explore the impact of an ongoing $40/month supplement for fruits and vegetables (F&Vs) provided to pregnant people enrolled in the Special Supplemental Nutrition Program for Women and Children (WIC). Our primary outcome was food insecurity using the USDA 6-item survey, and our secondary outcome was dietary intake of F&Vs based on the 10-item Dietary Screener Questionnaire. Participants in intervention and comparison counties completed surveys at enrollment and approximately three months later (n = 609). Mean ± SD food insecurity at baseline was 3.67 ± 2.79 and 3.47 ± 2.73 in the intervention and comparison groups, respectively, and the adjusted between-group change from baseline to follow-up in food insecurity was 0.05 [95% CI: −0.35, 0.44] (p > 0.05). F&V intake (in cup equivalents) was 2.56 ± 0.95 and 2.51 ± 0.89 at baseline in the two groups, and the adjusted mean between-group difference in changes from baseline was −0.06 [−0.23, 0.11] (p > 0.05). Recruitment and data collection for this study coincided with the most intensive of America’s COVID relief efforts. Our results may indicate that small increases in highly targeted food resources make less of a difference in the context of larger, more general resources being provided to individuals and households in need.

Food insecurity and its socioeconomic and health determinants in pregnant women and mothers of children under 2 years of age, during the COVID-19 pandemic: A systematic review and meta-analysis

“…The publications date from 2020 to 2022, with six cross-sectional articles ( 14 – 19 ) and four longitudinal articles ( 20 – 23 ). The studies were developed in different continents: America ( 14 , 16 – 19 , 23 ); Africa ( 14 ); Asia ( 15 , 21 , 22 ).…”

“…Considering the sample, the studies evaluated pregnant women ( 15 , 17 , 19 ), pregnant and postpartum women ( 14 ), and mothers of children under 2 years of age ( 16 , 18 , 20 – 23 ). The sample number ranged from 68 ( 18 ) to 6,592 women ( 17 ) ( Table 1 ).…”

“…The instruments used to assess Food Insecurity were direct methods, based on perception scales. Five studies used shortened versions: Abrams et al ( 20 ) adopted two questions that addressed the concern that food might be lacking and the lack of money to buy food in the last 12 months; Avalos et al ( 17 ), adopted the shortened version (2-item) of the Hunger Vital Sign screener; Rosenberg et al ( 18 ) used the shortened version (2-item) of Household Food Security Survey (HFSS); Ridberg et al ( 19 ), adopted a 6-item version of food security survey developed by United States Department of Agriculture; Agampodi et al ( 15 ) developed a validation study of a reduced scale of the Latin American and Caribbean Scale (ELCSA), which is composed of eight questions ( Table 2 ).…”

Factors Associated with Vegetable Consumption among Pregnant Women Attending Primary Health Care Facilities in Patani Local Government Area of Delta State, Nigeria

“…tion about nutrition intake during pregnancy which may result into mother and baby health outcomes [16]. On the contrary, other research findings showed that financial incentives can increase vegetable purchasing as well as consumption for people experiencing food insecurity and low income [17]. Social support such as spouse eating vegetable together with his pregnant partner can create an enabling environment for prenatal vegetable behaviour change [18][19][20].…”

Navigating Nutrition Inequities

“…Participants perceived an imbalance between abundant dairy and cereal and inadequate benefits for fruits and vegetables 37. In addition, a pilot study of a fruit and vegetable voucher intervention program found that voucher recipients were more food-secure, had an increased consumption of fruits and vegetables, and had a lower risk of preterm birth than pregnant WIC participants who gave birth before the fruit and vegetable vouchers were implemented 38…”