For more than a decade, Code for America has been talking directly to those impacted by government services to understand how they navigate programs and problem solve amidst various bureaucratic hurdles. When the pandemic hit, we were curious to know how people’s experiences with those services changed—for better and for worse—and were particularly interested in seeing how the usual in-person processes for public benefits applications and renewals looked different in a world that was suddenly much more virtual. We were especially interested in how this affected Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), the nutrition program for pregnant and postpartum people and young children.
Many safety net programs have in-person components, but WIC has traditionally required more than most. Pre-pandemic, clients were required to report to their local office every few months for appointments. Weigh-ins and iron level checks, nutritional counseling, and recertifications all happened face-to-face. Clients in some states also needed to pick up paper vouchers or reload their EBT cards in person. And of course, a core aspect of WIC is spending benefits for food and infant formula in person at the grocery store.
While these in-person experiences sometimes helped foster warm client-staff relationships and offered community for new parents, they were also a significant burden for many clients, and many parents leave WIC when their children are still eligible. We wanted to hear about the client experience, shared in their own words.
And then the pandemic hit. Remote services became feasible for the first time, as existing agency efforts to modernize the program kicked into high gear. The Food and Nutrition Service (FNS) issued a number of impactful policy waivers, allowing local agencies to offer more remote and flexible services.
In summer 2021, seeing the excitement and need, Code for America initiated a four-month discovery process to learn how we might support states in using technology to improve WIC service delivery. WIC provides important nutrition and health support, but is vastly underutilized—only 50% of eligible participants use the program, and participation is lowest among families with children over age 1, who leave the program at times of recertification even though they are still eligible. If we want to reverse declining enrollment trends, we have to hear directly from clients about the challenges they face.
What we wanted to find out
At Code for America, we explore both the systems at play as well as the individual experience of participants. Some of this comes through the partnership between quantitative and qualitative data. We explore the overall quantitative trends—coverage, redemption, and retention rates—that tell us what is happening. Then, we use that information as a guide in building out a qualitative research plan that will tell us why these trends are occurring.
For instance, early on in our desk research, we found WIC coverage rates from across the country. When we recruited participants for in-depth interviews, we started with the states on the far ends of that range so we could identify themes among participants who were from states with very high and very low coverage. In New Hampshire, a state with a very low coverage rate, we heard about the slow roll out of EBT cards and the hardship of shopping with vouchers. In Wisconsin, a state with a much higher coverage rate, a pregnant woman was impressed by the support she received from a lactation consultant via text message in anticipation of her baby’s birth.
In total, we interviewed about 30 WIC-eligible adults across 17 states and Puerto Rico, in both English and Spanish. We talked with people who happily participated in WIC until their children aged out, as well as those who dropped out early. We also recruited people who are eligible for WIC, but had decided not to participate. We wanted to understand:
- What are the benefits of participating in WIC for you and your family?
- What are the barriers you face in order to enroll and stay enrolled?
- How have those barriers changed due to the COVID-19 pandemic?
Here’s what we heard.
In-person appointments are a burden
Through our research we were able to confirm what many working with WIC already knew: the ability to attend appointments remotely has had a significant positive impact on clients. Pre-pandemic, in-person appointment frequency was one of the top client complaints about the program. But when we spoke to clients who participated during the era of remote appointments, not a single one mentioned this as a pain point.
Remote appointments didn’t always meet all of a participant’s needs. This may have reduced the value of WIC offerings like nutritional counseling, but it didn’t necessarily lead directly to drop-off.
Enrolling in WIC is the easy part…
Participants had a range of experiences enrolling in WIC, but the majority were able to enroll easily and smoothly.
A minority of the people we talked to had some challenges enrolling. Like many public benefits, the application process can be lengthy and, at times, confusing.
…but shopping is difficult
One thing we heard loud and clear is that shopping with WIC is difficult, time consuming, and embarrassing. The WIC program dictates precise items, sizes, and brands that make the shopping experience into something like a treasure hunt, which can be both time consuming and stigmatizing. These existing challenges were compounded by the pandemic. Participants were less willing or able to spend time at the grocery store, and unlike out-of-pocket or SNAP grocery shopping, the complexity of WIC makes it difficult to get help from others.
Getting a range of perspectives
To fully understand the impact of any public benefit program, we have to think holistically about our research methods and ensure that they’re appropriate to reach everyone who we need to hear from. In this case, we knew that Spanish-speaking WIC participants would have a unique perspective—and that we needed to hear from them to get an accurate and equitable picture of the WIC experience today. Puerto Rico has the highest WIC enrollment of any state or territory and data from the Food and Nutrition Service shows that the “Hispanic/Latino” population has a higher coverage rate than other racial/ethnic groups. So we worked with a Spanish language research consultant to adapt our English language protocols for Spanish-speaking WIC participants. While Spanish speaking clients had many of same experiences as English speaking clients, some of those outside of Puerto Rico faced language access challenges:
“If I have to make an appointment, sometimes the person that speaks Spanish isn’t there. I have to wait for her to call me back. That’s the only problem there is for me. It’s not 100% certain that the person that speaks Spanish will be available to help.”
“I think the biggest challenge for Latinos accessing WIC might be that there aren’t many Spanish-speakers in WIC offices. Also, Hispanic people might think that they need a social security number to get WIC benefits, and sometimes they don’t have transportation to go into a WIC office.”
“The office building I go to there is only one woman who can speak Spanish. She is there to help Spanish-speakers. But it’s only one person.”
“I think every WIC office is different. The office I go to, there are always Spanish-speakers available. I think that’s because I live in an area with more Latinos, I think that’s why.”
Unlike programs like SNAP and Temporary Assistance for Needy Families (TANF), WIC allows enrollment for people regardless of their immigration status. This gives WIC a unique opportunity to serve families with undocumented members.
“I don’t necessarily think that undocumented people know about WIC. Unless they know someone like a close friend that knows about these types of programs, but I don’t think so. I myself didn’t know that undocumented people could use WIC because they don’t announce or advertise that.”
Understanding pain points and highlights
WIC is a complex, variable program, and clients have a complex, personal relationship with it. While individual components can and should be improved, these changes must be understood as part of the holistic WIC experience. When eligible families are deciding whether or not to participate in WIC, they are weighing the value of the program against the costs of participating. To visualize this decision making process, we developed a metaphor of weights on a scale.
The weight of each element is determined by a combination of the client’s personal circumstances and the quality of service they receive from their local agency. Reversing declining enrollment trends means tipping the balance of scales for enough people. This can be achieved by increasing the value of WIC, or decreasing the cost (or ideally both!).
From our research, we know that WIC is a program that is hugely beneficial to the people who can easily access it—but we also know that there are scores of families left behind by administrative burdens, confusing enrollment requirements, and limitations on the way they can use their benefits. All this means that WIC is a program with great potential—potential it can only reach by listening to clients and centering their voices in the design and implementation process for each iteration of the program. By putting those with lived experience at the center, programs like WIC can more effectively reach those who need it most.
Are you a representative of a state WIC program, or curious to hear our best practices and learnings from our Safety Net work? We would love for you to get in touch.