TABLE 2-16, Changes and Challenges Since the IOM 2006 Review: Key Findings and Conclusions - Review of WIC Food Packages

Challenge or Environmental Change Evaluated	Finding(s) and Conclusion(s)
Adaptation to the 2009 Food Package Implementation	State and local agencies, vendors, and manufacturers were largely able to adapt; some continuing challenges are related to sizes available in the marketplace. Consideration to the feasibility of potential food package changes from the perspective of states, local agencies, vendors, and manufacturers is critical for implementation success. Evidence indicates that targeted nutrition education in advance of food package changes can result in positive behavior change. This strategy could be applied at the state level to future food package changes.
Changes in WIC Participation	WIC participation has been declining since 2010, although the proportions of participants according to food package categories have remained consistent. The underlying cause of the decline is not clear but is not related to the 2009 food package changes (see Appendix F). Attention to retention of the program's value and reduction of participation barriers is warranted. Inasmuch as children ages 1 to less than 5 years comprise the majority of the WIC-participating population, changes to this food package (IV) will have the greatest effect on overall program costs for food.
Food Expenditures of WIC Participants	WIC benefits cover an important share of food expenditures for participating households. Despite some limitations to the data, the new evidence shows WIC-participating households spend more on WIC food items than do other households with low income.
Changes in Breastfeeding Prevalence	Breastfeeding prevalence among WIC participants is lower than that of other low-income women. Evidence is inconclusive about whether the 2009 food package changes affected the choice to breastfeed.
Associations Between WIC Participation and Breastfeeding	WIC participation was associated with a lower likelihood of breastfeeding initiation, duration, and exclusivity. Available data indicate that breastfeeding promotion and support among WIC participants is associated with the choice to breastfeed. These activities may improve breastfeeding prevalence in WIC when linked closely to food package changes. Evidence suggests that the 2009 food package policy that limited formula in the first month resulted in more women being issued the full formula-feeding package. Allowing a greater degree of flexibility in formula issuance in the first month may better support any degree of breastfeeding for women who choose a mixed-feeding option.
Ability of the Current Food Packages to Meet Participants' Needs	The current food packages offer a degree of flexibility both at the state and participant level. Available information suggests that the current food packages are satisfactory and meet needs, but redemption data suggest that improvements can be made.
Changes in Dietary Guidance	Key changes to the Dietary Guidelines for Americans, guidance for individuals less than 2 years of age, and to Dietary Reference Intakes have been made since the IOM 2006 review. These changes may have implications for both amounts of and specifications for foods in the WIC food packages.
Nationwide Availability of WIC Foods	The marketplace has expanded substantially since 2006 and now includes a wider variety of dairy and grain products, which may have improved the nationwide availability of foods that meet WIC specifications. Although most WIC participants shop at larger stores, smaller stores may be the only option for some WIC participants. Availability of WIC foods at both types of stores remains important.

Challenge or Environmental Change Evaluated

Finding(s) and Conclusion(s)

Adaptation to the 2009 Food Package Implementation

State and local agencies, vendors, and manufacturers were largely able to adapt; some continuing challenges are related to sizes available in the marketplace. Consideration to the feasibility of potential food package changes from the perspective of states, local agencies, vendors, and manufacturers is critical for implementation success. Evidence indicates that targeted nutrition education in advance of food package changes can result in positive behavior change. This strategy could be applied at the state level to future food package changes.

Changes in WIC Participation

WIC participation has been declining since 2010, although the proportions of participants according to food package categories have remained consistent. The underlying cause of the decline is not clear but is not related to the 2009 food package changes (see Appendix F). Attention to retention of the program's value and reduction of participation barriers is warranted. Inasmuch as children ages 1 to less than 5 years comprise the majority of the WIC-participating population, changes to this food package (IV) will have the greatest effect on overall program costs for food.

Food Expenditures of WIC Participants

WIC benefits cover an important share of food expenditures for participating households. Despite some limitations to the data, the new evidence shows WIC-participating households spend more on WIC food items than do other households with low income.

Changes in Breastfeeding Prevalence

Breastfeeding prevalence among WIC participants is lower than that of other low-income women. Evidence is inconclusive about whether the 2009 food package changes affected the choice to breastfeed.

Associations Between WIC Participation and Breastfeeding

WIC participation was associated with a lower likelihood of breastfeeding initiation, duration, and exclusivity. Available data indicate that breastfeeding promotion and support among WIC participants is associated with the choice to breastfeed. These activities may improve breastfeeding prevalence in WIC when linked closely to food package changes. Evidence suggests that the 2009 food package policy that limited formula in the first month resulted in more women being issued the full formula-feeding package. Allowing a greater degree of flexibility in formula issuance in the first month may better support any degree of breastfeeding for women who choose a mixed-feeding option.

Ability of the Current Food Packages to Meet Participants' Needs

The current food packages offer a degree of flexibility both at the state and participant level. Available information suggests that the current food packages are satisfactory and meet needs, but redemption data suggest that improvements can be made.

Changes in Dietary Guidance

Key changes to the Dietary Guidelines for Americans, guidance for individuals less than 2 years of age, and to Dietary Reference Intakes have been made since the IOM 2006 review. These changes may have implications for both amounts of and specifications for foods in the WIC food packages.

Nationwide Availability of WIC Foods

The marketplace has expanded substantially since 2006 and now includes a wider variety of dairy and grain products, which may have improved the nationwide availability of foods that meet WIC specifications. Although most WIC participants shop at larger stores, smaller stores may be the only option for some WIC participants. Availability of WIC foods at both types of stores remains important.

From: 2, The WIC Program: Changes Since the Last Review and Continuing Challenges

Review of WIC Food Packages: Improving Balance and Choice: Final Report.

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee to Review WIC Food Packages.

Washington (DC): National Academies Press (US); 2017 May 1.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

TABLE 2-16Changes and Challenges Since the IOM 2006 Review: Key Findings and Conclusions