People in the community rely on many different programs and services for help in their daily lives. For women and infant children, there is the WIC program. This program offers many different benefits to help with nutrition, immunizations, and ensuring safety for its clients .
Boundaries of the community
The WIC program targets their efforts on women and infant children up to age five. The WIC program is nationwide, but in Illinois, the offices are assigned by county. I spoke to Shelly at the Sangamon County WIC office and she states, “you don’t have to live in the county where you receive benefits”. This means that the boundaries are very permeable, and people may seek benefits wherever they are available. She also informed me that the Sangamon County WIC office services both Sangamon and Menard counties. Most of the people seeking services are low-income families or single parents with infants and children. While the name implies help to women, men may also bring their infants and children to WIC for assistance.
Goals of the community
The mission of WIC is to “safeguard the health of low-income women, infants, and children up to age 5 who are at nutrition risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care” (USDA, 2018). The Special Supplemental Nutrition Program for Women, Infants, and Children – known as WIC – provides low-income pregnant women, new mothers, infants, and children with nutritious foods, nutrition education, and improved access to health care to prevent nutrition-related health problems in pregnancy, infancy, and early childhood” (Food Research ; Action Center, 2017). WIC also provides Federal grants to states for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children who are found to be at nutritional risk (USDA). The goals of the local WIC office are to “provide healthy foods, advice and referrals to pregnant, postpartum, and breastfeeding women so that they can stay strong and help their children” (Sangamon County Dept. of Public Health, 2018).
Physical and psychosocial characteristics
WIC was established as a pilot program in 1972, made permanent in 1974, and is administered at the Federal level by the Food and Nutrition Service of the U.S. Department of Agriculture (USDA, 2018). At the state level, most WIC programs provide vouchers that participants use at authorized food stores (USDA). There are about 46,000 merchants nationwide that accept WIC vouchers (USDA). In talking with Shelly at the Sangamon County WIC office, she told me that the program is income based, and has been in service since 1974 when the WIC program was permanently established. There is a table on the Sangamon County Department of Public Health (SCDPH) website that gives the Illinois WIC income eligibility guidelines so that people may go online to see if they qualify. For instance, a family of 4 cannot earn more than $45,510/year to qualify. The site offers an online application and contact information to make an appointment. The WIC program is not concerned with religion, education, occupation, marital status, or family composition for qualification. They do help to provide services to all family members including assistance with rent, utilities, and immunizations (Shelly, 2018). WIC looks for eligibility based on two major nutritional risks also. Those two types are medically-based risks such as anemia, underweight, history of pregnancy complications, or poor pregnancy outcomes, and dietary risks such as inappropriate nutrition/feeding practices, or failure to meet the current Dietary Guidelines for Americans (USDA).
Subsystems and suprasystems
The local WIC office operates under the Federal USDA regulations. This means that the Federal government makes the guidelines, the state receives them, and then the local offices must implement them. Shelly told me that our local WIC office has certified lactation counselors employed to help mothers with breastfeeding. They also offer breastfeeding classes to participants. WIC is administered by 90 state agencies, with services provided at a variety of clinic locations including, but not limited to, county health departments, hospitals, schools, and Indian Health Service facilities (USDA, 2018).
Since WIC is administered through the USDA, each state receives grants from them yearly. In 2018, Illinois received a total of $201,106,488 and of that, $145,459,995 was for food (USDA, 2018). WIC legislative requirements are contained in Section 17 of the Child Nutrition Act of 1966 and I have included the link for reference https://www.fns.usda.gov/sites/default/files/CNA_1966_12-13-10.pdf (USDA). WIC Regulations are published by the Federal Register in the Code of Federal Regulations, 7 C.F.R. Part 246 (USDA). WIC offers many different food packages to participants based on age, nutritional needs, pregnancy status, breastfeeding status, etc. The first rules for these packages were established in 1980, but have since been revised to reflect updated nutritional guidelines from the American Academy of Pediatrics and can be found at https://www.federalregister.gov/documents/2014/03/04/2014-04105/special-supplemental-nutrition-program-for-women-infants-and-children-wic-revisions-in-the-wic-food. This update reflects the values and needs of the community and the willingness of the Federal government to meet those needs. “In April 2014, 9.3 million women, infants, and children participated in WIC. The full fiscal year 2014 appropriation for the program was $6.72 billion” (FNS, 2014). In April 2014, 9,303,253 women, infants, and children participated in WIC (FNS). Approximately half (53.3 percent) of WIC participants in April 2014 were children (see figure ES.2). Infants accounted for 23.0 percent of participants and women accounted for 23.6 percent (FNS). Women were divided further into three categories: pregnant (9.6 percent of all participants), breastfeeding (7.4 percent of all participants), and postpartum (6.6 percent of all participants) (FNS). Most (86.0 percent) of the pregnant women participating in WIC in April 2014 were aged 18 to 34, as were 84.4 percent of breastfeeding and 87.3 percent of postpartum women. Only 3.4 percent of women WIC clients were aged 17 or younger. Most (91.4 percent) infant WIC participants were certified for WIC benefits during their first 3 months of life (FNS). WIC legislation allows income eligibility requirements to be met by participation in means tested programs (Medicaid, Temporary Assistance to Needy Families (TANF), and the Supplemental Nutrition Assistance Program (SNAP)) (FNS). In April 2014, 72.8 percent of WIC participants reported receiving benefits from at least one of these three national public assistance programs that classified them as adjunctively income eligible for WIC, down from 74.6 percent in 2012 (FNS). In 2014, almost threequarters (74.2 percent) of all WIC participants reported incomes below the Federal poverty guideline (FNS).
In 2014, Illinois had 97 local WIC agencies which accounted for 5.28% of all local agencies nationwide, and had 3.23% of all U.S. WIC participants (FNS, 2014). The Sangamon County WIC office is located within the Sangamon County Health Department building and allows for easier access to other assistance offices. Shelly states that immunizations are offered at the same location, utility assistance (LIHEAP) is in the same building, and an office to help with rental assistance are all centrally located. This makes it much easier for participants to receive the help they need without having to drive to multiple locations. Since some participants don’t have access to private transportation, availability of these services together is a must. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is funded by the United States Department of Agriculture’s Food and Nutrition Section (USDA FNS) and administered through the Illinois Department of Human Services, Bureau of Family Nutrition (BFN) (Springfield Urban League (SUL), 2013). Per the 2013 Illinois WIC Policy and Procedure Handbook, “Allocation of WIC Funds (Effective: April 2015) Once the amount of funds available to Illinois for the WIC program is determined: A. The Department allocates awards to Local Agencies through a grant review process. B. Administrative funds are allocated by use of a formula based on standardized costs per caseload. C. The Department – Local Agency Grant Agreement serves as the legal basis for disseminating funds to local programs. Grant agreements must be signed and properly obligated through the Department and the Illinois Comptroller. Payments are scheduled on a monthly basis (IL WIC PPM AD3). All payments will be reconciled based on submitted documentation. Failure of the Provider to submit documentation may result in a reduction to the total award. Food funds are specifically allocated by the U.S. Department of Agriculture (USDA) to the Department. Such allocation is for food expenditure only and cannot be used for administrative expenses” (SUL, 2013). Sangamon County is the 10th largest Health Department in Illinois with an annual budget of $8.4 million which serves a population of over 200,000 (SCDPH, 2018). The most difficult part of the disbursement of funds is ensuring a budget is in place for the state because if there isn’t a budget, then funds won’t be distributed and participants will not receive benefits. In Sangamon County, there are two hospitals, multiple walk-in clinics, and multiple physician offices to seek care for women, children, and the community in general. The local WIC office does assist with referrals to other agencies and providers for health care services for participants. Springfield has many businesses and receives money from property taxes. Persons who receive Medicaid/Medicare may receive a free cab ride to their WIC appointment by making arrangements through First Transit 1-877-725-0569 (SCDPH). This service is helpful to community members that need transportation to appointments. The Illinois Department of Public Health Director is Nirav D. Shah, M.D. The Sangamon County Health Department Director is Jim Stone. The Sangamon County Department of Public Health is a very valuable community resource that offers many different health screenings, flu clinics, educational classes, and help with free or discounted medications (SCDPH). There are multiple schools throughout the county and churches that offer free or reduced lunches and food pantries to receive free food.
Health behavior and health status
Beginning in April 1999, FNS established national standards for determining nutritional risk using hemoglobin and hematocrit measures based on recommendations from CDC (FNS, 2014). The local WIC office monitors participants every 3 months before approving additional benefits (Shelly, 2018). They check a hemoglobin level at age 1, and annually thereafter. They also perform a nutritional risk assessment annually to help determine how much assistance is needed. In the most recent Illinois Morbidity and Mortality Bulletin (2017) it states:
• Overall age-adjusted mortality rates for all causes combined have declined consistently for males and females.
• Life expectancies have been increasing for both sexes. • For the 2009-2015 time period, seven of 10 leading causes of death for Non-Hispanic Whites have declined; however, mortality rates for chronic lower respiratory disease, accidents, and Alzheimer’s disease have increased.
• One of the possible reasons for the increase in accidental deaths may be related to the significant increase in opioid overdose deaths in recent years. Further research is needed to quantify the contribution of drug overdose deaths to accidental deaths and to loss of life expectancy in Illinois.
• The infant, neonatal, and post-neonatal mortality rates declined consistently in Illinois. These findings on life expectancies by sex and age-adjusted death rates by sex were consistent with those at the national level, although the increase in life expectancies and decline in standardized mortality rates for Illinois were higher than those for the nation. As I drove through different areas of Sangamon County, I observed houses and neighborhoods. Many houses were neatly kept, but some were in disarray. Most towns have schools, banks, grocery stores, taverns, post offices, some local eateries, and clothing stores. Some of the rural areas do not have these amenities and houses look to be much older and in need of repairs. Many of the rural areas had more farms and therefore less crowding. In the city of Springfield, I observed many nicer homes, but there are older areas and poor areas of housing throughout. Many homes needed to cut their grass or had scattered trash, kids’ toys, junk cars in the yards in the poorer areas. There are many registered waste haulers in Sangamon County and a list of them can be found on their website. There is city provided water and sewer to homes in the city limits, and some outlying areas have sewer or septic. The total population for Sangamon County in 2017 was 197,465 (Suburbanstats.org,2018). The air, food, and water quality seems to be adequate in Sangamon County. There are multiple vendors that sell food and accept WIC coupons, so food is readily accessible to participants.
Level of health of the community
Nutritional needs vary throughout the stages of our lives. For pregnant women, they should consume about 1800 calories per day in the first trimester, 2200 calories per day the second trimester, and 2400 calories per day in the third trimester (medlineplus.gov,2018). For lactating women, they need to consume about 1800-2200 calories per day, but if very active, then may need to increase intake by 450-500 calories per day (National Institute of Child Health and Human Development, 2017). Infants need approximately 450-575 calories per day from 1-3 months, 500-650 calories/day age 4-6 months, 600-750 calories/day ages 7-9 months, and 700-850 calories/day ages 10-12 months (NICHD, 2017). Caloric intake will only continue to increase with age, and that means added costs for food. Some children will have food allergies and require special diets which can mean increased cost. WIC recognizes the needs of low-income families and supplies money to help provide food. They also allow substitutions with soy, tofu, and special infant formulas to help with any allergies or special needs (USDA, 2018).
Interventions provided by agency, community, or suggested by student
According to Dr. Jay Hoecker at Mayo Clinic and the American Academy of Pediatrics “exclusive breastfeeding for the first 6 months after birth is recommended and then breastfeeding in combination with solid foods until 1 year as the gold standard” (2018). He justifies this response by stating that “breast milk contains the right balance of nutrients for your baby and boosts your baby’s immune system” (2018). Breastfeeding can be tiresome and difficult. Patients need to be reminded to get plenty of rest, nurse in a calm environment, ensure proper nutrition for themselves, and be advised that most hospitals and some doctors offices have lactation counselors on staff to assist them. Moms should be reminded that if breastfeeding is unsuccessful, they can use formula and their baby will still receive proper nutrition. The local WIC office will check postpartum patients’ hemoglobin levels to check for anemia and call their doctors office so that treatment can be given. Some suggestions are to eat an iron rich diet and start an iron supplement daily at 325mg. Patients should also be advised to start a stool softener as iron can be very constipating. Increased fluid intake, especially water can also be beneficial. They can also screen for postpartum depression and inform the patients doctor or make referrals to counselors. If medication is needed, participants may return for assistance with cost of script. Nurses at the WIC office meet with patients to do nutritional risk assessments and determine eligibility for funds. They help with referrals to other providers for care of women, infants, and children. Nurses counsel patients on the importance of keeping appointments with providers to ensure appropriate care, do teaching regarding breastfeeding and immunizations, and inform patients of classes offered for free that they may attend for health promotion. Since the WIC office is located in the health department building, access to other services including immunizations is readily available. Nurses can advise participants of child proofing their homes to help avoid injuries from falls, helping ensure that participants have electricity by offering referrals to LIHEAP (utility assistance), advising breastfeeding moms of their rights to pump at work to keep their milk supply for their infant, and making sure they have family support for healthy growth and development. Nurses must always advocate for the patient’s best interest. The nurses at the WIC office can do this by providing information on authorized retailers that accept vouchers so that participants have food for their families. The nurse can also empower the patient with information on other community resources available to assist them with their needs. Sometimes participants can find help with local churches, and maybe find their faith again. A sense of belonging to any community can be beneficial for people. Nurses must also ensure that participants know their rights for benefits through the programs in which they are enrolled to receive maximum benefits for themselves and their family.
Many women, infants, and children rely on WIC to help ensure proper nutrition for growth and pregnancy. But WIC offers many other services such as lactation counselors, referrals to other agencies and to healthcare providers. Knowing that there are resources available to help with food assistance is reassuring. We all need to eat to be healthy. But knowing there are people there to help you and your children to be cared for as a whole is invaluable.