WIC Program Provides Improved Health Outcomes for Mothers and Babies

Researchers at Johns Hopkins University School of Medicine in Baltimore have found an association between a family's enrollment in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and improved birth outcomes and lower infant mortality.

Since 1972, WIC, a federal grant program, has provided supplemental food, infant formula, breastfeeding support and supplies, and referrals to other social services to low-income pregnant people and postpartum mothers and their children up to age 5. In addition, the program offers nutrition education and encourages prenatal visits and preventive child well visits, checkups and immunizations. In 2009, with input from healthcare providers, WIC updated its food assistance to provide more nutritious foods for mothers and their children.

The Johns Hopkins review was part of a larger, multipart project by the U.S. Department of Agriculture (USDA), which funds WIC, exploring the health outcomes of WIC-participating mothers, their births and their infants. The review looked at 20 completed studies and found multiple positive benefits of WIC enrollment.

"What we found is that WIC participation is likely to be associated with a lower risk of preterm birth, low birth weight and infant mortality," said Michelle Ogunwole, M.D., Ph.D., an assistant professor of medicine at Johns Hopkins and one of the authors of the review.

The research also found higher rates of childhood immunizations among WIC participants compared with those who qualified for WIC but didn't enroll in the program.

How WIC helps moms and babies

Rachel B. Prete, D.O., a board-certified pediatrician and director of quality of newborn care at Winnie Palmer Hospital for Women & Babies in Orlando, said WIC has offered relief to her as a physician, particularly when she has to prescribe specialty formula for babies living in low-income households.

"Formula alone is expensive, but when I have to send the patient home on a specialized formula, which is two to three times the cost of a regular formula, having the WIC program there really helps the likelihood that this child is going to be successful and healing from their illness and thriving from a nutritional standpoint," Prete said.

Prete added that the WIC program has come a long way in supporting breastfeeding, too, by providing more healthy foods to nursing mothers, as well as education, breast pumps and other equipment, and access to lactation consultants. It has evolved to see breastfeeding as a key element of infant nutrition.

"WIC has really done a good job of really making sure they're treating all facets of infant nutrition and maternal nutrition," Prete said.

What's next for research?

While the gold standard for scientific research is the randomized controlled trial, Ogunwole explained this type of study isn't ethical for studying social safety-net programs such as WIC. You can't give aid to one group and withhold it from another when both groups need it. So the researchers relied on the next best approach: a systematic review of as many existing studies as they could find that looked at WIC participants over a certain time frame compared with people who qualified for WIC but didn't enroll in the program.

Ogunwole and the other researchers whittled roughly 10,000 potential studies down to just 20 that met their inclusion criteria. Then they crunched the numbers and delved into the data to see what they could find.

While the results found a clear beneficial association, what the researchers couldn't see is something Ogunwole focuses her research on and hopes can be explored further in the future: issues of healthcare inequity by race, specifically those affecting Black mothers. She also hopes to look at more qualitative studies in addition to the data-driven quantitative ones to get a more personal sense of how the program affects people's lives.

"As a health-equity researcher, I actually think qualitative studies are extremely important," she said. "They provide a lot of nuance, trying to understand people's experiences with WIC."

Qualitative research can also provide more understanding of existing barriers that may block or limit people's access to the program.

"We always have to think about how we can make WIC more accessible," Ogunwole said. "How can we make sure that the locations are strategically placed in the communities that are historically marginalized? How can we make sure that the WIC workforce is diverse and, when possible, that it's concordant with the communities that it serves?"

For what the review did find, however, Ogunwole said it's heartening as a physician to see the strength of WIC's capacity to refer low-income mothers and their children to social services that can help them, in addition to the food the program provides.

For Prete, the review provided new insights, as in the positive association between WIC participation and an increase in childhood vaccinations and primary-care visits. It also underscored some of her previously held beliefs about the program.

"I think it reconfirms everything that we, as healthcare providers, already know about WIC: that we think it's an asset to women, infants and children and that [the benefits] may go beyond the scope of just nutrition," Prete said.