After 30 years, WIC vouchers finally covered fresh produce. New PTBi research shows improvements in maternal and infant health

Rita Hamad is an Assistant Professor in the Department of Family and Community Medicine and the Philip R. Lee Institute for Health Policy Studies at UCSF, and Policy Lead for the California Preterm Birth Initiative. Her study in JAMA Pediatrics Association of Revised WIC Food Package With Perinatal and Birth Outcomes shows that when WIC added $10 of fruits and vegetables to its monthly food package, and switched to low-fat milk and whole-grain bread, women had lower rates of preeclampsia, which is a condition associated with high blood pressure and other dangerous effects during pregnancy and delivery.

What is the issue that your study is addressing?

We know that there are racial disparities in preterm birth and other birth outcomes in the US. In this particular study, we were looking at whether policy revisions to WIC (which is the federal Special Supplemental Nutrition Program for Women, Infants, and Children) can affect birth outcomes. WIC provides low-income mothers and kids with vouchers to purchase food at the grocery store. These vouchers are very specific about what types of food and even what brands can be purchased.

Rita Hamad at a WIC in San FranciscoRita Hamad at a WIC in San Francisco

In 2009, the food package was revised to make it healthier. Fruits and vegetables were added, as well as low-fat milk and whole grain bread. We were interested to see whether these improvements in nutrition would improve birth outcomes in California. To my knowledge, this is the first time that anyone has looked at the effects of this revised WIC food package on birth outcomes. 

What did families receive before the policy change?

Before the policy change, families received no fruits and vegetables. There was a category of fruits and vegetables that WIC offered, but it consisted entirely of juice, about a cup a day, and we know these days that drinking juice is almost like drinking soda. People were also purchasing white bread and whole milk, which aren’t as nutritious. WIC was designed back in the 1970s, and since then our understanding of nutrition has advanced. The 2009 revision was the first major food change to the policy in thirty years. People are now given $10 a month that can be spent on fruits and vegetables. That is actually such a small amount, but it's more than the zero dollars that were given before the revisions went into effect.

What did you find?

check out counter at a WIC

We found that women who received the revised WIC food package had less preeclampsia, which is a condition associated with high blood pressure and other dangerous effects during pregnancy and delivery. We also found that they were more likely to gain the recommended amount of weight during pregnancy and have pregnancies closer to full term. Their children were also more likely to have healthier birth weights.

What can we learn from this study?

We know that people who have low incomes experience difficulties purchasing healthy food. This is because fruits, vegetables, and healthy foods tend to be more expensive and can be harder to find than buying fast food or processed food. If we as a society increase our investment in improving the nutrition of low-income pregnant women, this could potentially improve not only their health but also the health of their children and families. Also, improving the health of infants is associated with lifelong health improvements, possibly leading to improvements in the health of entire communities over time. The findings from the study suggest that policymakers should consider expanding on this benefit to ensure that all kids can grow up healthy.

What do you hope this contributes to the conversation around preterm birth?

We know that preterm birth is a really challenging problem. We know that sometimes when we make changes to the healthcare system, the people who benefit most are already more advantaged. These people may have better access to child care, transportation, and whatever else. What we really need are policies that specifically target the most disadvantaged or vulnerable populations. WIC is just such a policy. This study suggested that it can be an important policy to reduce disparities in birth outcomes.

Can you talk about why it's important to research past policies?

I think there are a lot of policies out there that policymakers design with very good intentions. However, we don't always go back and evaluate them. This is a perfect example. This policy change took place ten years ago and yet this is, to our knowledge, the first study to look at the birth outcomes that resulted. Without this work, we don’t know if policies have the intended impact. We also need this data for justification when the government conducts a cost-benefit analysis, so we can document the program’s benefit to society.

What does this study mean to you, personally?

I'm also a family medicine doctor. I see pregnant moms and their kids in clinic. I’ve seen how challenging it is for a family to have a mom or a child with health problems. Many times, as a clinician, it's hard to change the circumstances your patients are living in. Many families’ problems can't be addressed with a pill or more information. We need to change the social context that they're living in. I conduct policy research to understand if we can improve the health of families at the population level. As a researcher, it is fulfilling to be able to show the potential power of such population-level interventions.

Read the full paper

Association of Revised WIC Food Package With Perinatal and Birth Outcomes