Caregiver Perspectives on Underutilization of WIC: A Qualitative Study

Abstract

OBJECTIVES: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal program that improves the health of low-income women (pregnant and postpartum) and children up to 5 years of age in the United States. However, participation is suboptimal. We explored reasons for incomplete redemption of benefits and early dropout from WIC. METHODS: In 2020–2021, we conducted semistructured interviews to explore factors that influenced WIC program utilization among current WIC caregivers (n = 20) and caregivers choosing to leave while still eligible (n = 17) in Massachusetts. By using a deductive analytic approach, we developed a codebook grounded in the Consolidated Framework for Implementation Research. RESULTS: Themes across both current and early-leaving participants included positive feelings about social support from the WIC clinic staff and savings offered through the food package. Participants described reduced satisfaction related to insufficient funds for fruits and vegetables, food benefits inflexibility, concerns about in-clinic health tests, and in-store item mislabeling. Participants described how electronic benefit transfer cards and smartphone apps eased the use of benefits and reduced stigma during shopping. Some participants attributed leaving early to a belief that they were taking benefits from others. CONCLUSIONS: Current and early-leaving participants shared positive WIC experiences, but barriers to full participation exist. Food package modification may lead to improved redemption and retention, including increasing the cash value benefit for fruits and vegetables and diversifying food options. Research is needed regarding the misperception that participation means “taking” benefits away from someone else in need.

California WIC Participants Report Favorable Impacts of the COVID-Related Increase to the WIC Cash Value Benefit

“…Changing the CVB component of the WIC food package provided WIC families with additional resources to reduce the burden of how much they spent for FV and minimize any detrimental impacts on diet quality associated with the COVID-19 pandemic. Prior to the CVB changes, one study in Massachusetts conducted a qualitative analysis on caregiver perspectives of the WIC program and factors that led to underutilization, finding that for many the FV benefit was the main reason for continued enrollment but, the set amount of USD 9/USD 11 per month was insufficient [ 18 ]. This study is among the first to evaluate the impact that two changes to the CVB amount (USD 35 in June 2021 and adjustment to USD 24 in October 2021) have had on satisfaction, purchasing habits, and diet quality for WIC families.…”

“I Think That’s the Most Beneficial Change That WIC Has Made in a Really Long Time”: Perceptions and Awareness of an Increase in the WIC Cash Value Benefit

“…The Cash Value Benefit (CVB) is a component of the food package for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) that can be used for fresh, frozen, or canned fruits and vegetables without added sugar, salt, or fat. Prior to the pandemic, the CVB was USD 9–11/month/person, an amount that many WIC participants and nutrition experts deemed insufficient [ 42 , 43 , 44 , 45 ]. In June 2021, the USDA temporarily increased the CVB to USD 35/month/person, initially for four months.…”

Caregivers’ Perceived Impact of WIC’s Temporary Cash-Value Benefit (CVB) Increases on Fruit and Vegetable Purchasing, Consumption, and Access in Massachusetts

“…To address poor nutritional access among low-income families with young children, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was first piloted in 1972. Beyond nutrition education, breastfeeding support, and referral services, WIC provides over six million enrolled participants [ 8 ] with a monthly “food package” which is disbursed as an Electronic Benefit Transfer (EBT) Card for the purchase of eligible foods from WIC-approved retailers [ 9 ]. Since 2009, a Cash-Value Benefit (CVB) [ 10 ] has been offered as part of most food packages, which provides participants with a small, fixed dollar allowance to be spent on fruits and vegetables.…”