The importance of adequate nutrition for our most vulnerable, including pregnant women, children, and families with infants, is an ever-present issue. The federal government has two multi-billion dollar programs designed to alleviate hunger and poor nutrition; the Special Supplemental Nutrition Program for Women, Infants and Children (better known as WIC); and, the Supplemental Nutrition Assistance Program (SNAP, formerly known as the food stamp program). With the imminent reauthorization of the legislation for WIC, the Child Nutrition Act, now is the time to review how these programs work, and consider areas where improved coordination and possible integration are possible.  This article is written with a focus on WIC and SNAP, both of which are administered by the US Department of Agriculture (USDA).

WIC Background

During the presidency of Lyndon B. Johnson and the “War on Poverty”, the federal government focused on helping low income Americans.  The 1967 National Nutrition Survey revealed that many lower income children suffered from anemia and inadequate growth, which affect brain size and cognitive ability.  The study concluded that children often faced physical and mental challenges because they didn’t have enough to eat or they didn’t eat the right foods. Some children suffered because mothers didn’t get adequate nutrition during their pregnancies.

In 1972, Congress passed a bill authored by Senator Hubert H. Humphrey (D. Minn.) to create the Special Supplemental Nutrition Program for Women, Infants, and Children.  Congress funded the program for two years and placed the program under the authority of USDA.   

The WIC Program was last authorized by Congress in 2004 to operate through September 30, 2009, and subsequently extended an additional year.  WIC continues to be available throughout the U.S. and its territories through periodic continuation language endorsed by Congress.  The program is administered by state agencies responsible for public health.

With a 2009 estimated budget of more than $6 billion, WIC provides services to more than 9 million women, infants and children monthly.  Families with incomes at or below 185% of poverty, with pregnant women, infants or children under 5 years of age, are eligible to apply for WIC.  Shockingly, nearly half of all infants in the U.S. participate in the WIC program.  A family of two with a total income of $26,955 or less would qualify for WIC enrollment. WIC is a 100% federally funded program; however, it is designated as a discretionary program rather than an entitlement program, a distinct difference from SNAP.

A discretionary program receives a designated amount of funding from Congress.  Unless additional funding is made available, the program must  operate within the allocation. If the number of eligible families exceeds available funding, then a waiting list is established with priority given to families based on the life stage of the children.

WIC is Special
WIC provides participants with supplemental food prescriptions, nutrition education, and referrals to health and social services as needed.  WIC also actively encourages and supports breastfeeding of infants as the first choice for feeding. Because WIC offers free pregnancy tests, pregnant women often go to their local WIC office before going to their doctor.  For many children and families, WIC is a major resource for healthy child development, with information on immunizations, lead poisoning, safe sleep positions, and car seats.  It also offers breastfeeding supports such as peer advocates, lactation consultants and breast pumps.

A notable nutrition benefit of WIC is the specific food benefits correlated to the life stage of the participant.  For example, pregnant women receive foods high in the protein, iron, folic acid, calcium, and vitamins important for fetal growth and development, as well as increased energy (calories) to assure a healthy pregnancy.  While a breastfed infant may not directly receive any WIC food benefits, their mother will get an enhanced food package to assure adequate milk production and availability. 

The foods provided by WIC for women and older children include milk, cheese, eggs, dried and canned beans, or peanut butter, tuna/salmon, high iron and whole grain cereals, pure fruit juices high in vitamin C, whole grain breads and tortillas. These foods are offered in amounts consistent with the recommended nutrient intake for the individual.

An exciting new offering initiated just a few months ago is the inclusion of fruits and vegetables in the WIC package. Many states now include just fresh fruits and vegetables, while others offer all forms – fresh, frozen and canned. 

For infants, breastfeeding is considered the preferred source of nutrition. However, for non-breastfed infants, iron-fortified infant formula and cereal are provided, as well as fruits, vegetables and meats for older infants. Infant juice was discontinued with the food package change this fall, consistent with recommendations from the American Academy of Pediatrics. 

Recently developed criteria from the Institute of Medicine  include the following goals:
1)    Reduce the prevalence of inadequate and excessive nutrient intakes in participants;
2)    Contribute to an overall dietary pattern consistent with the Dietary Guidelines for Americans (for individuals 2 years and older);
3)    Contribute to an overall diet consistent with established dietary recommendations for infants and children younger than 2 years of age, including encouragement of and support for breastfeeding;
4)    Offer foods available in forms suitable for low-income persons who may have limited transportation, storage and cooking facilities;
5)    Offer foods that are readily acceptable, widely available, and commonly consumed; take into account cultural preferences; and provide incentives for families to participate in the WIC program; and
6)    Give consideration to the impacts that changes in the package will have on vendors and WIC agencies. 

The recent change to the WIC food package was the first complete revision of the food benefits since WIC began over 30 years ago.

Just as important as the contents of the WIC food package is the functioning of the WIC program within stores authorized to accept WIC benefits. Many states issue WIC food coupons to be used only by the WIC participant between designated effective and expiration dates for a specific amount of a specific type of food . 

Several states provide WIC checks that function much like WIC coupons. Some states (fewer than 10) offer WIC benefits through electronic benefit transfer (EBT) cards. Much like common debit cards provided by banks and other financial institutions, EBT simplifies WIC participation.  The food prescription is still there, but participants can shop as often as they like until their benefits are used or expired. Contrast this with WIC coupons where participants lose any remaining value on the unused portion of the coupon. With EBT, participants’ food benefits are updated in real time so participants can always have an accurate balance.  EBT also allows WIC participants to shop like others not on WIC, reducing or eliminating the stigma that may exist with coupons or check exchanges.  USDA is promoting EBT use across the country,  providing additional funding to states interested in making this change.  There were 44,458 stores authorized to accept WIC coupons, checks or EBT at the end of 2005.

The WIC program’s funding formula requires that approximately 75% of the funds be used for food benefits and 25% for nutrition and administrative services.  In 2009, participants spent approximately $4.66 billion on WIC foods; a significant economic benefit for WIC-authorized stores.  The addition of fruits and vegetables to the WIC program has huge implications for the amount of money spent on fresh fruits and vegetables.

An additional benefit is the WIC Farmers’ Market Nutrition Program (FMNP), which offers fresh, locally grown produce during the growing season.  Funds are made available to agencies to offer food benefit instruments (coupons, checks, or EBT) for use to purchase a designated dollar value of produce from farmers, farmers markets or roadside stands.  The program was started to promote the use of locally grown fruits and vegetables in young families.  This program is also available to low income senior citizens via the Senior Farmers’ Market Nutrition Program.  WIC FMNP exists in 46 agencies across the country.

Special Nutrition Assistance Program (SNAP)

The first Food Stamp Program (FSP) ran from 1939 through 1943 under the administration of Milo Perkins, and was credited to the work of Secretary of Agriculture Henry Wallace.  The program allowed people on relief to buy orange stamps equal to their normal food expenditures. For each $1 worth of orange stamps, 50 cents worth of blue stamps were received. , Orange stamps could be used to buy any food, while blue stamps were used to buy food determined by USDA to be in surplus.  The program reached approximately 20 million people at its peak during the four-year period, and was available in nearly half of U.S. counties at a total cost of $262 million.

Nearly 20 years lapsed between the first FSP and the start of pilot food stamp programs.  It was President Kennedy’s first Executive Order in February of 1961, fulfilling a campaign promise to expand food distribution.  These pilot programs eliminated the special stamps for surplus foods, focusing instead on increasing the consumption of perishables. In 1964, the FSP received permanent authorization.  Many additional provisions were implemented, including development of eligibility standards by states, prohibitions against discrimination, and shared responsibility for funding administration costs between states and the Federal Government. 

Participation on FSP grew over time, with legislative changes in the 1970’s that expanded availability and fine-tuned program eligibility. By 1974, FSP was a nationwide program with nearly 14 million people participating.  Unlike WIC, FSP is an entitlement program; the state and federal government must enroll all individuals eligible for the program, and identify resources to support the resulting enrollment.

SNAP Today
The Food Stamp Program has undergone many changes over time, including the recent name change to the Supplemental Nutrition Assistance Program. The name change recognizes the elimination of stamps in 2002 in favor of electronic benefit transfer systems (EBT), which are now used by all states. In EBT systems, food stamp recipients apply for their benefits in the usual way, filling out a form at their local food stamp office.   Once eligibility and benefit level are determined, an account is established in the participant’s name, and food stamp benefits deposited electronically in the account each month.  A plastic card, like a bankcard, is issued and a personal identification number (PIN) assigned or chosen.  As EBT creates an electronic record of each transaction and reduces the volume of lost or stolen benefits, EBT may help cut back on food stamp fraud. 

Like WIC, SNAP is administered by USDA. However, SNAP is authorized by the Farm Bill rather than the Child Nutrition Act; and, the most recent Farm Bill, the Food and Nutrition Act of 2008, maintains SNAP through 2012.   Congress designed the Food and Nutrition Act “to strengthen the agricultural economy; to help to achieve a fuller and more effective use of food abundances; to provide for improved levels of nutrition among low-income households through a cooperative Federal-State program of food assistance to be operated through normal channels of trade”.. 

The requirements of the Act are spelled out in nearly 130 pages of program-defining language including this policy declaration: ”…Congress hereby finds that the limited food purchasing power of low-income households contributes to hunger and malnutrition among members of such households.  Congress further finds that increased utilization of food in establishing and maintaining adequate national levels of nutrition will promote the distribution in a beneficial manner of the Nation’s agricultural abundance and will strengthen the Nation’s agricultural economy, as well as result in more orderly marketing and distribution of foods.  To alleviate such hunger and malnutrition, a supplemental nutrition assistance program is herein authorized which will permit low-income households to obtain a more nutritious diet through normal channels of trade by increasing food purchasing power for all eligible households who apply for participation.”

To be eligible for SNAP benefits, children and adults must live in a household with an income at or below poverty level, and seniors must have an income below 130% of the poverty level. For a family of four in the contiguous U.S., the poverty level is considered to be an annual income of $21,200. Participants can be certified to receive benefits for up to 12 months, and a 24-month certification is available for the elderly or disabled.. 

The benefit allotment is determined by comparison calculations of the household with the cost of the "thrifty food plan” diet. , Nutrition education is also provided.  The benefits can be used to purchase foods from retailers participating in SNAP, and a wide variety of foods may be purchased including breads, cereals, fruits, vegetables, meats, fish, poultry and dairy products.  Seeds and plants that produce food for consumption can also be purchased.  Non-allowed purchases include: beer, wine, liquor, cigarettes, tobacco, nonfood items, vitamins, medicines, foods that will be eaten in the store and hot foods. The average monthly SNAP benefit was about $101 per person and about $227 per household in FY 2008.

A fiscal year 2006 study found that nearly half of all participants are children 18 years or younger; 61% of them live in single parent households.  The study found that the average gross monthly income per SNAP household is $673, while 43% of participants are white, 33% are African-American, 19% Hispanic, 2% Asian and 2% Native American, with less than 1% of unknown race or ethnicity.

In 2008, SNAP had 28.4 million participants monthly at an annual cost of $34.6 billion.  SNAP participation fluctuates with the economy, and poor economic conditions have pushed enrollment to a record high.  This has put considerable stress on many state social service departments that administer SNAP.  There were over 175,000 authorized retailers for SNAP in 2008, with more than $34.4 billion of SNAP redemptions.

The Farm Bill provided $20 million in mandatory funding for a project to test point of purchase incentives for healthful foods and authorized appropriations for other similar projects.  Food and Nutrition Service staff of USDA writes rules, or regulations to implement the Act and changes in it, and publish those rules in the Federal Register, which is available on line at www.fns.usda.gov/FSP/.

Implications of Two Food Programs

So, why do we have the two food programs, both WIC and SNAP?  While both offer resources for food and serve low-income households, the programs have distinct differences in approach and target populations.  WIC offers specific healthy foods required for women and children under five years of age during critical developmental periods. Though WIC is available to low-income families, it is not unusual for WIC participants to be employed at low paying jobs. The program requires that authorized WIC stores have healthy foods available for purchase. WIC connects its participants with other health and social resources that support good health and quality of life. 

SNAP is available for those at the very lowest end of poverty, including children through 18 years, adults and even seniors.  Clearly, formal coordination between programs can help to ensure that low income pregnant women have access to both WIC and SNAP, regardless which program they contact first.  Families with young children on SNAP should apply for WIC and once children age out, continue to access other available resources, such as school feeding programs.

Can the WIC model of stocking specific foods by stores be used as criteria for SNAP retailer authorization?  Considering the large number of retailers participating in SNAP, this could help influence the quality of foods available to the public, particularly those in low-income communities.  The recent addition of fruits and vegetables to the WIC food package may offer an opportunity to study the influence of this policy on community food consumption. 

In my home state of Michigan, nearly 20% of children live in poverty.  Nationally nearly half of all infants participate on WIC.  All of these families need access to healthy foods.  A real opportunity exists to provide access to healthy foods and shape healthy eating through these two billion-dollar programs with a common goal: to improve the nutrition and health of those most in need.