WIC

The Supplemental Nutrition Program for Women, Infants, and Children (WIC) was first piloted in 1972 and then made permanent in 1974.^[1] At its inception in 1974, approximately 88,000 people received WIC benefits.^[2] Participation rose gradually over the years with the highest usage occurring in 2010 with 9,175,000 recipients.^[3] By 2013, participation dropped to 8,663,000.

WIC is administered by the USDA to provide grants to state agencies, which administer the benefits through authorized WIC retailers.^[4] Unlike SNAP, WIC is considered a discretionary program and not an entitlement program.^[5] Congress does not set aside funds to allow every eligible individual to participate in the program but rather appropriates a specific amount of funds each year for the program. When the program is funded enough to cover all applicants, it functions like an entitlement program, but if not, the program operators must

BOX 4.2

History of American Indian Commodity Issues

There are 566 federally recognized American Indian and Alaska Native tribes and villages in the United States.⁸ The U.S. Constitution recognizes tribes as a distinct entity, allowing Congress to “regulate commerce with foreign nations, and among the several states, and with the Indian tribes.”^b The United States Supreme Court has explained that, “Indian tribes are ‘domestic dependent nations' that exercise ‘inherent sovereign authority.'”¹¹

The Food Distribution Program on Indian Reservations (FDPIR) began in 1977 as an alternative to the Supplemental Nutrition Assistance Program (SNAP) to assist American Indians who do not have easy access to SNAP offices or authorized food stores.¹¹ This applies to families and the elderly living on or near Indian reservations and Oklahoma Tribal Jurisdictions. (Oklahoma does not have reservations.) As of 2014, there were approximately 276 tribes receiving benefits under FDPIR through 112 Indian tribal organizations and five state agencies.⁸ The USDA, however, had already begun purchasing and providing commodity foods to American Indians in the 1930s under what was called a USDA Donated Foods Program.^f

In recent history, American Indians have among the highest rates of obesity and diabetes in the United States. These diseases were not found among American Indian communities prior to the 1930s. One group in particular, the Pimas, have among the highest rates in the world.^gh The Pimas traditionally lived along the Gila River in Arizona and used irrigation to raise crops of corn, squash, and two species of beans. They also fished, hunted local game, and gathered wild crops.^iJ In the 1860s and 1870s, settlers began moving into the lands north of the Pima homeland and diverted water away for cattle ranches, farmland irrigation, and daily life in the arid climate.^k The Gila river was reduced and the Pimas suffered; initially, they were starvingJ The federal government, through the military, began distributing commodity foods of white flour, lard, and sugar to the Pimas.^m These foods were very different from their traditional diet. The Pimas began to cook “fry bread,” which is flat bread deep fried in lard, and which is now considered a traditional food of American Indians.¹¹ In the 1920s the government built what became known as the Coolidge Dam, which further depleted water supplies to the Pimas.⁸

In the 1930s the commodity list increased to include staple items of bacon, lard, cheese, and beans, and then more additions were made a couple of decades later to include canned meats, vegetables, fruit, dry cereals, and dried or evaporated milk.^p The high prevalence of diabetes and obesity among the Pimas is partially attributed to the commodity program.

The FDPIR now has a list of about 70 food products among which recipients can choose.^q FDPIR participants eligible to participate in SNAP may participate in both programs but not within the same month.^r American Indians live below the poverty level at a greater rate than the rest of the U.S. population.⁸ Access to food stores can be a problem in Native American communities. For example, in 2008, there was one small market on the Gila River Reservation and the full service supermarket was an hour outside of town.¹ This partially drives participation in FDPIR rather than SNAP for certain groups.

In the Agricultural Act of 2014, Congress required the USDA and the FDA to permit “the donation to and serving of traditional food” to licensed child care facilities, child nutrition programs, senior meal programs, and hospitals, clinics, and long-term care facilities that primarily serve American Indians.¹¹ The definition of “traditional food” includes wild game meat, fish, seafood, marine mammals, plants, and berries.^v The stated purpose for providing access to traditional foods in these food service programs is “to encourage increased

BOX 4.2

Continued

consumption of traditional foods to decrease health disparities among Indians, particularly Alaska Natives and to provide alternative food options for food service programs.”^w

^aUnited States Department of the Interior. Indian Affairs FAQ. http://www.bia.gov/FAQs/ ^bU.S. Constitution. Article 1, Section 8

^cMichigan v. Bay Mills Indian Community, 134 S. Ct. 2024, 2030 (2014).

^dFood Distribution Program on Indian Reservations. Fact Sheet. June 2014. http://www.fns.usda. gov/sites/default/files/pfs-fdpir.pdf

^eFood Distribution Program on Indian Reservations. Fact Sheet. June 2014. http://www.fns.usda. gov/sites/default/files/pfs-fdpir.pdf

^fCommodity Distribution Procedures Handbook. Oklahoma Department of Human Services. 2003.

^gMary Story, Marguerite Evans, Richard R. Fabsitz, Theresa E. Clay, Bonnie Holy Rock, and Brenda Broussard The Epidemic of Obesity in American Indian Communities and the Need for Childhood Obesity-Prevention Programs. American Journal of Clinical Nutrition. 1999;69(4):747S-754S.

^hJovana J. Brown. Enduring Legacies Native Cases. Evergreen State College. http://www. evergreen.edu/tribal/cases/

Jovana J. Brown. Enduring Legacies Native Cases. Evergreen State College. http://www. evergreen.edu/tribal/cases/

^JUNNATURAL CAUSES is inequality making us sick? Bad Sugar. Annotated Transcript.

^kJovana J. Brown. Enduring Legacies Native Cases. Evergreen State College. http://www. evergreen.edu/tribal/cases/

UNNATURAL CAUSES is inequality making us sick? Bad Sugar. Annotated Transcript. ^mUNNATURAL CAUSES is inequality making us sick? Bad Sugar. Annotated Transcript. ⁿUNNATURAL CAUSES is inequality making us sick? Bad Sugar. Annotated Transcript. ^oUNNATURAL CAUSES is inequality making us sick? Bad Sugar. Annotated Transcript. ^pUNNATURAL CAUSES is inequality making us sick? Bad Sugar. Annotated Transcript.

^qFood Distribution Program on Indian Reservations. Fact Sheet. June 2014. http://www.fns.usda. gov/sites/default/files/pfs-fdpir.pdf

^rFood Distribution Program on Indian Reservations. Fact Sheet. June 2014. http://www.fns.usda. gov/sites/default/files/pfs-fdpir.pdf

^sMary Story, Marguerite Evans, Richard R. Fabsitz, Theresa E. Clay, Bonnie Holy Rock, and Brenda Broussard The Epidemic of Obesity in American Indian Communities and the Need for Childhood Obesity-Prevention Programs. American Journal of Clinical Nutrition. 1999;69(4):747S-754S.

^tUNNATURAL CAUSES is inequality making us sick? Bad Sugar. Annotated Transcript. ^u113 P.L. 79, Sec. 4033 (2014). ^v113 P.L. 79, Sec. 4033 (2014). ^w113 P.L. 79, Sec. 4033 (2014).

figure out a system to prioritize funding. For discretionary programs such as WIC, the options range from reducing benefit levels, establishing wait lists, shutting down after the funds are exhausted, or prioritizing spending among potential recipients.^[6]

Congress authorizes funding for the WIC program for education, medical referrals, and financial benefits for food to low-income, nutritionally at risk pregnant, breastfeeding, and postpartum women, as well as infants and children up to age five years. Because WIC is not an entitlement program, if the government does not have enough funding to provide WIC benefits for all those in need, the USDA directs state WIC agencies to provide benefits through the following priority levels: (1) Pregnant women, breastfeeding women and infants at nutritional risk as related to medical conditions that demonstrate the need for supplemental foods; (2) Infants of WIC participants who participated during pregnancy, up to six months of age, and infants up to six months of age born to women who were not WIC participants during pregnancy but whose medical records document that they were at nutritional risk during pregnancy; (3) Children at nutritional risk as demonstrated by documented medical conditions; (4) Pregnant women, breastfeeding women, and infants at nutritional risk because of an inadequate dietary pattern; (5) Children at nutritional risk because of an inadequate dietary pattern; and (6) Postpartum women at nutritional risk.^[7] States have the option of expanding the program to a seventh category: Individuals certified for WIC solely due to homelessness or migrancy, or previously certified participants who might regress in nutritional status without continued provision of supplemental foods.^[8]

WIC provides vouchers to recipients to obtain only the foods in a preestablished food package, called the WIC food package, from authorized WIC vendors. Some states have moved to EBT cards,^[9] while other states are experimenting with a single EBT card that allows access to WIC and other program benefits such as SNAP on one card.^[10] All states are required to transition to EBT cards for WIC by October 1, 2020.

Congress directs the USDA to “conduct a scientific review of the supplemental foods available under the program and amend the supplemental foods available, as necessary, to reflect nutrition science, public health concerns, and cultural eating patterns,” as frequently “as necessary to reflect the most recent scientific knowledge, but not less than every 10 years.”^[11] In 2005, the Institute of Medicine issued a report, WIC Food Packages: Time for a Change suggesting the USDA revise the WIC food package to match dietary guidance for infants and young children and encourage a healthier diet. Based on the IOM report, the USDA issued interim rules to align food packages with more recent nutrition science, promote breastfeeding, increase food options for participants, and provide state agencies with flexibility.^[12] WIC state agencies were required to implement the changes by October 2009 and succeeded in doing so. The USDA issued the final rule updating the nutritional requirements in March 2014.

Different foods are provided to each category of participant. WIC foods include infant cereal, iron-fortified adult cereal, fruit or vegetable juice, eggs, milk, cheese, peanut butter, dried and canned beans, peas and legumes, canned fish, soy-based beverages, tofu, fruits and vegetables, baby foods, yogurt, whole wheat bread, and other whole-grain options.^[13] White potatoes are not permitted unless they are an ingredient (but not the primary ingredient) of otherwise approved baby food.^[14] Some state agencies permit organic foods on their foods lists. WIC education promotes breastfeeding as the optimal source of nutrition for infants, but if a woman does not breastfeed, WIC provides iron-fortified infant formula. WIC may also cover special infant formulas and medical foods if prescribed by a physician to address a medical condition. Food must be provided free of charge.^[15]

Federal law requires the state agency to develop and implement uniform criteria to authorize WIC-approved retailers.^[15] The state must consider the business integrity of a vendor and may not authorize stores that engage in prohibited acts, such as providing reduced-cost lottery tickets to recipients. The state must also establish minimum requirements for the variety and quantity of foods that a vendor must stock, including a mandatory minimum of two different fruits, two different vegetables, one whole grain cereal authorized by the state agency, and infant formula purchased from sources permitted by the state agency.^[15] A side benefit to the updated, more nutritious WIC food package is that it significantly improved the availability and variety of healthy foods in WIC-authorized retailers, which benefits all consumers in the community.^[18]

The WIC Farmers’ Market Nutrition Program (FMNP) operates through a federal-state partnership with states, federally recognized tribal organizations, and U.S. territories.^[19] Unlike WIC, not all states participate in FMNP. In addition to regular WIC benefits, this program provides WIC participants with coupons that can be redeemed at farms, farmers’ markets, or roadside stands that have been approved by the state agency for fresh fruits and vegetables. States can put further restrictions on the program, for example, by requiring the purchase of locally grown produce. As mentioned, white potatoes are not permitted under the traditional WIC food package; likewise, they are the only fresh vegetable excluded from the FMNP.^[20]

• [1] United States Department of Agriculture. About WIC. http://www.fns.usda.gov/wic/about-wic-wics-mission
• [2] WIC Program. National Level Annual Summary: FY 1974-2013. http://www.fns.usda.gov/sites/default/files//pd/wisummary.pdf Available for Updating: http://www.fns.usda.gov/pd/wic-program
• [3] WIC Program. National Level Annual Summary: FY 1974-2013. http://www.fns.usda.gov/sites/default/files//pd/wisummary.pdf Available for Updating: http://www.fns.usda.gov/pd/wic-program.
• [4] United States Department of Agriculture. About WIC. http://www.fns.usda.gov/wic/about-wic-wic-glance
• [5] David A. Super. The Political Economy of Entitlement. 104 Columbia Law Review. 2004^33.
• [6] David A. Super. The Political Economy of Entitlement, 104 Columbia Law Review. 2004; 633.
• [7] 7 CFR 246.7.
• [8] 7 CFR 246.7 .
• [9] http://www.fns.usda.gov/wic/wic-ebt-activities
• [10] http://www.fns.usda.gov/wic/wic-electronic-benefit-transfer-ebt-one-card-considerations
• [11] 42 USCS § 1786.
• [12] Federal Register 79(42), page 12274 (March 4, 2014).
• [13] 79 Federal Register 12274 (March 4, 2014).
• [14] 79 Federal Register 12274, 12284 (March 4, 2014).
• [15] 7 CFR 246.12.
• [16] 7 CFR 246.12.
• [17] 7 CFR 246.12.
• [18] T. Andreyeva, J. Luedicke, A. E. Middleton, M. W. Long, M. B. Schwartz. Positive Influenceof the Revised Special Supplemental Nutrition Program for Women, Infants, and ChildrenFood Packages on Access to Healthy Foods. Journal of the Academy of Nutrition and Dietetics.20121112(6)1850-858.
• [19] http://www.fns.usda.gov/fmnp/overview
• [20] http://www.nal.usda.gov/wicworks/Topics/FarmersMarketsFinalRuleFactSheet.pdf