Fruit and Vegetable Vouchers Lowers Risk of Preterm Birth, Study Finds

Findings from Fruit and Vegetable Vouchers in Pregnancy: Preliminary Impact on Diet & Food Security are described by the author and PTBi policy researcher, Hilary Seligman. Additional authors include Ronit Ridberg, Sanjana Marpadga, Melissa Akers, and Janice Bell. Photo credit: EATSF

Please describe your research findings.

We provided pregnant people enrolled in WIC with $40 worth of vouchers redeemable for fruits and vegetables every month while they were pregnant. Compared to non-pregnant people enrolled in WIC who were not receiving the vouchers, people receiving the vouchers were more food secure and ate a healthier diet. These people also had a lower risk of pre-term birth, although other things besides the voucher could explain the improvement in preterm birth rate.

We need this type of data in order to educate policymakers on what changes the WIC program should be considering in the future.

Hilary Seligman, PTBi Researcher and Author

Center for Vulnerable Populations, UCSF

What is important or unique about this study?

Fruit and vegetable voucher programs that allow people to choose their own foods at the grocery store can be easily scaled into other communities, and, importantly, are not restricted by the strict eligibility criteria of federal nutrition programs (like WIC and SNAP/CalFresh). These programs may be an important strategy for communities seeking to better support mothers during pregnancy.  It is not clear, however, whether such programs improve outcomes. We wanted to understand whether a fruit and vegetable voucher system could support dietary intake and food security during pregnancy and, if so, whether it might create more equitable preterm birth outcomes.

What is already known about this topic, and how do your findings add to or change this existing knowledge?

Women experiencing food insecurity have a challenging time affording healthy foods and are more likely to experience poor birth outcomes as well.  Voucher programs can support food security and a healthier diet among people who are not pregnant, but they have rarely been investigated among people who are pregnant. 

Our findings are important for two reasons. First, people enrolled in WIC already receive a fruit and vegetable benefit but the dollar value of this benefit is very low. Our findings allow us to understand the extent to which an increase in this benefit might help WIC better achieve its goals. We need this type of data in order to educate policymakers on what changes the WIC program should be considering in the future.  Second, voucher programs are feasible for local communities to self-fund. For example, the EatSF program that provided the vouchers for this study is funded by the City and County of San Francisco as well as numerous local donors. Our findings can help local communities decide how to allocate funding by showing where investments can improve food security and birth outcomes. It is important we invest our money in programs that support equity.

How does your research impact current clinical practice? How does your research impact patients?

Research such as this helps us advocate for continued EatSF funding for pregnant people who are food insecure or at risk of food insecurity. In San Francisco, WIC continues to provide EatSF vouchers to pregnant people. EatSF also seeks to reach pregnant people who are not enrolled in WIC by working with community partners such as Black Infant Health.

What should researchers/providers/patients/public health workers/etc. do as a result of these findings

A healthy diet is critical to a healthy pregnancy!  We must continue to advocate for programs and policies that ensure all pregnant people have access to healthy foods so that we are supporting our babies from their very first days.  This means being a voice for SNAP (CalFresh), WIC, and other community strategies for eliminating food insecurity in the US.  No pregnant woman and no child should go to bed hungry in the US, but isolated voices have not fixed this problem. We need everyone—public health workers, patients, providers, and researchers—to stand united in advocating for reliable, consistent access to healthy, nutritious food.