The Whole Package.

A Federal Food Program Gets Supplemental Common Sense

The Women, Infants and Children (WIC) program, run by the U.S. Department of Agriculture (USDA), is undoubtedly one of the success stories of nutrition intervention in the United States. It provides healthy foods to over nine million participants in every state in the U.S., the District of Columbia, 32 Indian Tribal Organizations, Puerto Rico, the Virgin Islands, American Samoa and Guam, as well as nutrition education and access to health care and social services. An increase in birth weights, growth rates, intellectual development and medical care has been the measurable result.

Low-income women who are pregnant or breastfeeding, and infants and children up to age five determined to be at dietary risk, are eligible for the program. Among the benefits received by the women, who have an average annual income of just over $12,000, are vouchers that may be exchanged for specific foods at any of approximately 45,000 authorized food stores nationwide.

WIC foods are intended to supplement key dietary nutrients--namely, protein, calcium, iron and vitamins A and C. Seven different food packages have been tailored to meet the various needs of participants, but all are restricted to some combination of cereals, fruit juice, eggs, milk, cheese, peanut butter, dried beans and infant formula. Each state may designate the brand names allowed within each category, but USDA and Congress still determine each category and the amounts of food within them.

The food package has changed only slightly since the program was first implemented in 1974. In 1991, tuna and carrots were added to supplement the diets of breastfeeding women. Certain minor adjustments may be made by state agencies, such as the substitution of lactose-free milks, low-fat cheeses, and low-sugar cereals. But although the USDA's own 2000 Dietary Guidelines lists tortillas, rice, tofu and soymilk as good sources of nutrition, these items, as well as yogurt and fruits and vegetables, are still not permitted under federal guidelines.

"We are really bound by what the USDA allows," says Mandeep Punia, public health nutrition consultant for the California WIC program. "There are certain things we would like to introduce," says Punia, "but because they don't have the same nutrient density, we can't provide them." While certain populations may be more accepting of tortillas, for instance, they don't contain as much iron as cereals, she says, and, therefore, can't be part of the package. "But if participants aren't using the foods we're providing, it defeats the purpose," says Punia.

A 1999 USDA review of WIC participants revealed that infants and children generally met all nutrient recommendations, but mothers came up short in several categories, like iron, calcium, vitamin C, folic acid and overall intake of calories. One reason, the report concludes, is that they are either not consuming or buying the entire food package. Punia suggests that the USDA instead determine key nutrients for the whole package, and then let state programs decide how to best meet those nutrient needs.

Direct from the Farm

Since 1992, the Farmer's Market Nutritional Program (FMNP) has been filling the gap in WIC food packages left by fruits and vegetables. In participating states, WIC clients are given extra coupons (typically $10 to $20 a year) to purchase fresh, locally grown produce directly from farmers at FMNP-approved markets. Whereas almost all state WIC programs are run by health agencies, the FMNP is alternately run by both health and agriculture agencies, reflecting its dual role: to improve the diet and health of participants and supplement the income of small farmers.

"For a small program, it has a tremendous impact," says Zy Weinberg, executive director of the National Association of Farmers Market Nutritional Programs. In 1999, approximately $14 million in revenue went to 11,439 farmers in 1,800 markets, which were frequented by 1.5 million women and children. For 57 percent of these WIC participants, it was the first time they had ever visited a farmer's market, and 80 percent ate more fresh produce year round as a result.

"Getting families who do not consume a recommended amount of fruits and vegetables to change their behavior requires more than just a TV message," says Bob Lewis, chief marketing representative for the New York Department of Agriculture and Markets.

There are 225 markets in the New York program, including 42 in New York City that reach areas like Washington Heights and the South Bronx, where there is typically high incidence of health problems, poor nutrition and chronic disease. Customers there may buy foods restricted by their supermarket vouchers because of farmers like Ken Migleorelli, who owns a farm in Tivoli, New York, and now grows ethnic greens for the more diverse Harlem market. The program has greatly increased respect for both the farmers and families receiving government assistance, says Lewis.

While a portion of the foods found at the farmers markets may be grown organically, many WIC participants don't have that option at the store. "This is an at-risk population and they need to have the best foods," argues BrightSpirit, a mother of six, who recently dropped out of WIC, although she still qualifies financially. "I could not have fed my children the quality of food that I have without the WIC program," she says. "But then 18 years ago when I started, food was safer than it is now."

Washington State has recently responded to consumer requests by decided to allow the purchase of two brands of organic milk, Horizon and Organic Valley, for a two-year trial period. (Milk is 25 percent of Washington's WIC program, consuming $22 million a year alone.) With changes to the WIC program, Donna Rice, of the Sustainable Food and Farming Network, hopes that education on the health and environmental aspects of organics will improve as well. "It shouldn't be a niche product for a certain population," she says.

Washington is not the first state to experiment with sustainably grown food. California allowed free-range eggs at one time, but changed the policy because of financial burdens to the program. Oregon cut organics from its program in 1997. "If the nutritional content is about the same, and the only difference is that environmentally it's a good thing to do, we still need to reach as many people as we can," argues Punia. "If you choose the most expensive items, you will be able to serve less people. That's just math."

Though it won't alter the arithmetic for organics, changes to the food package are in the works. A proposed rule may amend federal regulations to include the addition of nutrient-dense vegetables, the substitution of canned beans for dried, soy milks for dairy, and foods to accommodate the cultural eating patterns of participants. Typical of government programs, there will be a formal rule-making process, including a public comment period with subsequent review. CONTACT: USDA Food and Nutrition Service, [phone], www.fns.usda.gov/wic/.