Making the Special Supplemental Nutrition Program for Women, Infants, and Children easier to access remotely was linked to rising retention, while boosting fruit and vegetable benefits alone did not further increase enrollment.
Study: Remote Services, Benefits, and Program Retention Changes Among Young Children in WIC. Image credit: Studio Romantic/Shutterstock.com
A recent study found that declining retention in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) reversed following the introduction of remote access, but increasing the cash value of program benefits was not associated with further changes in retention. The study was published in the journal JAMA Network Open.
Why WIC participation drops sharply after infancy
The WIC program aims to improve the health of children in low-income households by increasing access to nutritious foods and providing nutrition and breastfeeding support, nutrition education, and referrals to healthcare services. It serves over six million pregnant and postpartum women, infants, and children.
Its beneficial impacts have been documented, including lower food insecurity among children, better birth outcomes, and improved cognitive development. However, despite over 75% of eligible infants participating nationwide, participation drops steeply over time, to 25% among eligible children at four years of age.
Previous studies have identified several potential reasons for this decline, including the program's complexity: the need to repeatedly provide evidence of eligibility, arranging time off from work, transportation, and childcare for WIC clinic visits, and the relatively complicated process of using food package benefits. In addition, users may perceive post-infancy benefits as being of lower cash value.
Following the coronavirus disease 2019 (COVID-19) pandemic and resulting economic crisis, two policy changes were made in 2020 and 2021. The first introduced remote WIC services and benefit administration, while the second increased the cash-value benefit (CVB) available for purchasing fruits and vegetables.
The current study estimated the likelihood of WIC postinfancy retention rates for children up to four years of age. It also assessed a secondary outcome combining retention with redemption of any WIC food-package benefits.
Researchers track six years of WIC retention
The researchers conducted a repeated cross-sectional study using an interrupted time-series analysis of six years of Massachusetts WIC administrative data on 238,482 children who participated in WIC. In the baseline year, the dataset included 105,782 children, with the mean age being 17 months.
Between January 2017 and March 2020, retention declined by 0.006 percentage points per month. In March 2020, 96% of eligible children aged 1-11 months were retained in the program, versus 68%, 56%, and 48% for children aged 12-23 months, 24-35 months, and 36-47 months, respectively.
Intervention effects
After remote services were introduced, the retention trend reversed, though at different rates when stratified by age.
In the and 36-47 months, respectively. Infant retention (children aged 1-11 months) was already high and showed no statistically significant change. The increase in the cash-value benefit was not associated with changes in retention rates overall.
However, when both retention and benefit usage were combined as a secondary outcome, increased cash-value benefits were associated with small immediate increases in this outcome among children in the two intermediate age strata (12-35 months). These increases were 2.85 percentage points among children aged 12-23 months and 3.03 percentage points among those aged 24-35 months, after which levels remained stable.
However, the introduction of remote services was not associated with changes in the secondary outcome. The changes in retention trends did not differ significantly by race or ethnicity, maternal education, or language spoken at home.
A qualitative study conducted in parallel with this analysis showed that participants appreciated remote services as removing participation barriers. Conversely, pandemic-related disruptions to supply availability and in-person shopping might have limited corresponding increases in benefit usage, as suggested by the same study.
Similar results have been reported in earlier studies that showed, for instance, that the use of electronic cards instead of paper vouchers to facilitate ease of use was associated with a 9% increase in participation. Some states introduced remote access to benefit delivery during the pandemic and registered higher WIC participation rates than states that allowed only in-person benefit reloading.
Pandemic changes complicate the remote services picture
The study is limited to Massachusetts, and it excluded children who first enrolled in WIC after infancy so the researchers could accurately calculate population-level retention estimates. This limits the generalizability of the study to all WIC-participating children, as well as to populations outside Massachusetts. There was no comparison group.
The causes underlying these changes might have been pandemic- or policy-related, though other policy changes assessed here did not show an association with retention rates.
Other social support policy changes were also introduced in March 2020 to help low-income households cope with pandemic-related hardships. However, the authors argued that these might instead have been expected to reduce WIC retention by making participation less economically imperative, the reverse of what was actually observed.
The increased cash value benefits were implemented alongside the pre-existing remote service waivers. Therefore, the researchers could not determine whether the cash-value benefit increase would have affected retention plus benefit use in the absence of remote services. Future studies should evaluate the impact of these policies in more controlled settings.
Remote access may help families stay with WIC
The study suggests that implementing remote access to WIC services was associated with increased retention, whereas increasing the cash-value benefit was not associated with further changes in retention. The latter was associated with small immediate increases in both retention and benefit use, however, among children aged 12-35 months.
The authors recommend, therefore, that “Policy efforts to streamline WIC services and make remote services permanent, such as the More Options to Develop and Enhance Remote Nutrition in WIC Act of 2025 should be prioritized.”
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