The Importance of Federal Waivers and Technology in Ensuring Access to WIC During COVID-19

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a nutrition assistance program that promotes the health of pregnant and postpartum women, infants, and children up to aged five years who are nutritionally at risk and live in households below 185% of the federal poverty level (FPL).1 Unlike other federal nutrition assistance programs, WIC reduces structural barriers to healthy eating by providing monthly food benefits while simultaneously promoting good nutrition through regular individualized nutrition counseling and nutrition education. The effectiveness of WIC has been demonstrated by extensive research illustrating improved health outcomes for the women, infants, and children served by the program.2 5 As the third largest US Department of Agriculture (USDA) nutrition assistance program, WIC served about 6.9 million participants per month in fiscal year 2018, including almost half of all infants born in the United States.1 WIC caseloads have been declining in recent years,6 with recent studies documenting factors such as longer duration of breastfeeding, higher financial need, and relevance of nutrition education associated with program retention.7,8 The COVID-19 pandemic, however, has substantially increased food insecurity and the need for food assistance across the United States.9 As the pandemic continues, it has become clear that both federal program waivers enacted by the USDA to allow flexibilities in WIC and technology supporting remote contact with low-income families are essential for continuing to meet the elevated demand for the program while also protecting the health of WIC participants and personnel. Notable racial and ethnic disparities were evident in household food insecurity: among low-income households in April and May 2020, 38% of Latino and 36% of Black compared with 22% of Asian and 16% of White households experienced food insecurity.11 The differential burden of food insecurity by racial/ethnic group mirrors the rates of illness from COVID-19 experienced throughout the United States, with COVID-19 disproportionately affecting low-income communities and communities of color.12 FEDERAL WAIVERS AND TECHNOLOGY Federal waivers issued by the USDA have made remote WIC services possible.13 Physical presence waivers removed requirements for in-person clinic visits at enrollment or recertification and provided the flexibility to postpone bloodwork and weight and height or length measurement requirements ty