The COVID-19 pandemic has accelerated the digital transformation of nearly every sector of our society from business, to education, to healthcare. Yet technology remains underutilized in America’s safety net programs, which is a missed opportunity to help those in need during times of significant hardship.
Major public health initiatives like the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) — a federal food assistance program serving 6.2 million pregnant women, breastfeeding and postpartum women, infants and children under the age of five — have faced challenges during the pandemic, especially in communities of color which were already at disproportionate risk for food in security. Participants struggled to access benefits during the greatest health and economic challenge of the past 25 years when essential components of the program — like shopping in person for WIC eligible foods, enrolling or attending in-person recertification clinic appointments to maintain eligibility — became difficult due to to lockdowns, food supply shortages and the closure of agency clinics.
To keep the program operating during this national crisis, the US Department of Agriculture (USDA) granted emergency waivers that allowed many WIC services to be delivered remotely. Yet the temporary nature of these waivers may limit the program’s ability to continue to meet the needs of the current generation of WIC participants — Millennials and Gen Z parents — who are tech-savvy and social media-oriented.
Efforts to update the WIC program with client-focused technology began with the Healthy, Hunger-Free Kids Act of 2010. This legislation required that WIC’s food benefit distribution method transition from cumbersome and stigmatizing paper vouchers to electronic benefit cards (EBT) by October 2020 Subsequently, research found WIC agencies that did not transition to EBT by that date experienced higher attrition rates during the pandemic. This underscores yet again the importance of modernizing WIC, a program that feeds our future: Nearly half of all infants in America participate.
Increasing enrollment and retention in WIC is more important than ever. Hunger and economic insecurity have increased significantly during the pandemic. It’s estimated that as many as 45 million people, including 15 million children, experienced food insecurity in 2020. Additionally, childhood obesity rates have risen during this time period.
For over 45 years, WIC has served as an indispensable resource for low-income families providing access to healthy foods, breastfeeding counseling, nutrition education and referrals to other health services. Research has found many positive health outcomes for WIC participants including reductions in food in security and infant mortality as well as decreased health care costs. Nutritionally at-risk infants and children participating in the program have improved cognitive development and growth rates. Studies have also found significantly increased rates of childhood immunization and of having a regular source of medical care associated with WIC participation.
But despite WIC’s track record of accomplishments, the program faces challenges. In 2019, only 57 percent of eligible people participated in WIC. Alarmingly, as children grow older, fewer participate in the program with a sharp decline after infancy. While 98 percent of eligible infants are enrolled in WIC, less than 25 percent of eligible 4-year olds and receive benefits. Boosting retention in the program must be a priority and integrating new technologies into WIC can help.
Several years ago, leaders from the WIC Health and Technology Initiative — a project of New America, the MIT Media Lab and the Harvard TH Chan School of Public Health — convened experts in public health, nutrition, design and technology to identify interventions to “wire WIC with the best available technology, exploring a range of opportunities to leverage mobile phones, apps, the internet, social media, texting, video-conferencing and other platforms. Recommendations included technology solutions for simplifying program administration, boosting enrollment, enhancing participants’ shopping experiences, providing online education, innovating service delivery, reducing the high attrition rate from WIC and seamlessly cross-enrolling participants in other federal assistance programs including SNAP, TANF and Medicaid .
When first introduced, the proposed modifications to WIC seemed ahead of their time but the COVID-19 pandemic heightened the urgency to create a more user-friendly, technology-enabled WIC program. Several of the initiative’s and other organizations’ recommendations have since been implemented by USDA or are currently being piloted.
Early feedback suggests families enrolled in WIC welcome a hybrid model with a mixture of in-person and digital services. During the pandemic, participants have reported high satisfaction with phone appointments (96 percent), interactive texting (96 percent), online education (94 percent), email (93 percent) and video appointments (80 percent). Particular features of WIC, however, which involve point-of-care services — such as checking an infant’s hemoglobin levels or instructing a mother on breastfeeding — may best be administered if retained as in-person services.
Online ordering is the next frontier for updating the WIC shopping experience. Doing so would allow participants to purchase their food in the same way that many other Americans shop today. Three new USDA projects involving multiple WIC agencies have begun piloting e-shopping and mobile ordering. However, widespread adoption is limited since online purchasing is currently prohibited under current WIC regulations
The USDA has indicated that it will initiate rulemaking this spring to integrate online ordering and transactions into the program. Another step forward, for which there is broad support in the WIC community, would be to codify through pathways the pandemic-era waivers which provided greater flexibility in administering the program. Doing so might open the door for novel digital strategies to enroll eligible participants in WIC, redeem food benefits with mobile pay and home delivery, recertify beneficiaries and deliver services remotely. Formalizing cross-enrollment digitally using a common portal with other federal assistance programs, including SNAP and Medicaid, is another way to boost enrollment and extend WIC’s impact. Breaking down the bureaucratic silos through interoperable platforms and data sharing between these programs can streamline enrollment processes for eligible people and foster coordination across our nation’s vital medical and nutrition assistance federal programs.
Fortunately, the American Rescue Plan invested $390 million for WIC outreach, innovation and modernization. However, more resources are needed to fund research and development in the program’s technological infrastructure moving forward. Importantly, all technology implemented in WIC should prioritize participants’ privacy and security as well as be linguistically and culturally sensitive.
From this public health crisis has come an opportunity to modernize WIC. As the COVID-19 pandemic has been underscored, WIC’s continued success will depend on the program’s ability to adapt to serve new generations of beneficiaries through the addition of user-friendly digital platforms and services. Now is the time to strengthen the program as an important component of ensuring that all children have a fair and just opportunity for a healthy start in life.
The lessons learned during the pandemic provide a foundation for building a more “wired” WIC program to better address the needs of families, decrease food insecurity as well as obesity, enhance equity and promote health among all people in the United States now and in the years ahead.
Rear Admiral Susan Blumenthal, MD, MPA (ret.), former US Assistant Surgeon General, is a Senior Fellow in Health Policy at New America, a Visiting Professor at the MIT Media Lab, and a Clinical Professor at Georgetown and Tufts University Schools of Medicine. Emily Stark is a Research Associate in Health Policy at New America. Walter C. Willett, MD, Dr. PH is Professor of Epidemiology and Nutrition at Harvard TH Chan School of Public Health.