The Revised WIC Food Package and Child Development: A Quasi-Experimental Study

Abstract

BACKGROUND AND OBJECTIVES: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), one of the largest US safety net programs, was revised in 2009 to be more congruent with dietary guidelines. We hypothesize that this revision led to improvements in child development. METHODS: Data were drawn from a cohort of women and children enrolled in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood study from 2006 to 2011 (Shelby County, TN; N = 1222). Using quasi-experimental difference-in-differences analysis, we compared measures of growth, cognitive, and socioemotional development between WIC recipients and nonrecipients before and after the policy revision. RESULTS: The revised WIC food package led to increased length-for-age z scores at 12 months among infants whose mothers received the revised food package during pregnancy (β = .33, 95% confidence interval: 0.05 to 0.61) and improved Bayley Scales of Infant Development cognitive composite scores at 24 months (β = 4.34, 95% confidence interval: 1.11 to 7.57). We observed no effects on growth at age 24 months or age 4 to 6 years or cognitive development at age 4 to 6 years. CONCLUSIONS: This study provides some of the first evidence that children of mothers who received the revised WIC food package during pregnancy had improved developmental outcomes in the first 2 years of life. These findings highlight the value of WIC in improving early developmental outcomes among vulnerable children. The need to implement and expand policies supporting the health of marginalized groups has never been more salient, particularly given the nation’s rising economic and social disparities.

Effects of the revised WIC food package on women’s and children’s health: a quasi-experimental study

“…For instance, prior studies have found that the revision led to improvements in proximal outcomes including dietary quality and access to healthy foods [6,9]. Additionally, a smaller number of studies have looked at perinatal health in sub-national samples [14][15][16]. As a specific example, one previous study found positive improvements in gestational weight gain following the revision [14].…”

“…Second, we evaluated change in parent-reported health similar to the question for adults described above. Finally, results from a systematic review suggest that improvements to overall dietary quality led to improvements in mental health for children [ 31 ], while another study found that the 2009 WIC revision improved child development outcomes among recipient children [ 16 ]. Therefore, we additionally evaluated changes to children’s mental health, which was measured for children aged 2–3 years with the Mental Health Indicator (MHI) score.…”

“…Since the 2009 WIC revision was implemented, several studies have documented the positive effects of the new food package on retail food availability [6][7][8][9], women's and children's dietary quality [9][10][11][12][13], and maternal nutrition [6]. There has been less research on downstream health effects, with studies in California and South Carolina finding improvements on perinatal and birth outcomes [14,15] and studies in Tennessee finding improvements in children's growth and cognitive development [16]. No studies to our knowledge have examined the downstream effects of the revision on women's and children's health at a national level.…”

The effect of the 2009 WIC revision on maternal and child health: A quasi‐experimental study

“…[21][22][23][24] Research on health outcomes has been limited, with a handful of studies finding that the revised WIC program improved maternal and child dietary quality, [25][26][27][28] GWG, infant birth weight, and measures of child growth and development. [29][30][31] Select studies involved rigorous, quasiexperimental designs, but used small samples or narrow geographies. Further research is needed to evaluate the effects of the revised WIC program in a more generalised sample to inform national policymaking.…”

“…Prior studies have found that the revised WIC program was associated with increased availability of healthy foods at neighbourhood stores 19,20 and increased household expenditures on healthy foods 21–24 . Research on health outcomes has been limited, with a handful of studies finding that the revised WIC program improved maternal and child dietary quality, 25–28 GWG, infant birth weight, and measures of child growth and development 29–31 . Select studies involved rigorous, quasi‐experimental designs, but used small samples or narrow geographies.…”