Katie Ferraro (1s):

Hey guys, Katie here real quick. If you need to stock up on feeding gear for your baby, I just wanted to let you know that ezpz is having a huge Easter sale. So ezpz is the company that makes the original silicone suction mats and bowls that I use for baby led weaning. Plus they have BLW spoons and the open cup all designed by their feeding expert, Dawn Winkleman. Who's been a regular guest here on the podcast. So for Easter, you guys can get 20% off everything at ezpz with my affiliate discount code, KATIEEASTER and that's good now through Monday, April 18th. So my regular code is usually only good for 10% off. So this bump up to 20% off everything site-wide, it's pretty nice. Plus there's no minimum that you need to buy to get that 20% discount.

Katie Ferraro (42s):

So it's a great time to stock up or you, I have a baby shower to buy for. I love giving the ezpz FIRST FOODS set or for one-year-old birthday presents size up to the ezpz mini feeding set the code again is KATIEEASTER for 20% off everything at ezpzfun.com.

Darlena Birch (60s):

But with this new recommendation that NASEM made, the proposed CVB substitution would be $10 plus half of the jarred infant foods or $20 and no jarred infant food is for all infants ages, six to 11 months.

Katie Ferraro (1m 12s):

Hey there I'm Katie Ferraro Registered Dietitian college nutrition professor and mom of seven specializing in baby led weaning here on the Baby Led Weaning Made Easy Podcast. I help you strip out all of the noise and nonsense about feeding, leaving you with the competence and knowledge you need to give your baby a safe start to solid foods using baby led weaning. Hey guys, welcome back. I'm really excited about today's interview it's with Darlena Birch. She is a dietitian who is also the senior manager of public health nutrition for the National WIC Association. Now, if you're not familiar with the WIC program, that's the United States Department of Agriculture's Special Supplemental Nutrition Program for Women, Infant and Children.

Katie Ferraro (2m 1s):

She's going to talk a little bit about what sort of benefit WIC provides, but it's basically if you're income eligible and you are a pregnant breastfeeding postpartum mom or a child up until your fifth birthday, you can receive benefits to purchase wholesome, healthy foods that are nutritionally appropriate for your life stage. Right now we're in a very interesting period with the WIC program where there are proposed changes to the wick food package. So a pretty substantial subset of our audience either works for WIC or is a WIC participant. And Darlena will be sharing a little bit about the statistics, but basically in the United States, more than half of all babies born in this country are in the WIC program.

Katie Ferraro (2m 43s):

So this is a really important topic that affects the way infants are being fed and WIC educators do wonderful work to help share the latest research about making sure babies are being fed in ways that are developmentally appropriate with the right types of foods, meeting their feeding and their developmental. So I'm really excited to get to chat with Darlena because what happens? And this was the case with government stuff. There's a thousand page report outlining all of the proposed changes to the wick food package. And I know you guys do not have time to read a thousand page report. So I went through the chapter that was about food package two, which is for infants six to 11 months of age and itemized all of the proposed changes.

Katie Ferraro (3m 23s):

And I'm interviewing Darlena to ask her what's the National WIC Association stance on some of these changes, because I think for the most part, they're really good recommendations. Are they going to go into effect with the revision of the WIC package is kind of the big question. So Darlena is a dietitian as I mentioned, she's a senior manager in public health nutrition for the national WIC association. She's going to explain what they do, give you a little bit of background as far as like how she got here. So if you're a dietitian and you're listening, I know you all have to learn about WIC in your education. I think a lot of times we kind of space out about the policy stuff, but here's a real life practitioner who worked at every level of WIC from a small agency in a rural setting, which she'll tell us about up to the highest levels of making policy.

Katie Ferraro (4m 6s):

And she is going to break down the thousand page report and tell us a little bit more about the proposed changes coming down the pike for WIC. So this one is for the WIC participants, for those of you who work with the WIC program, or if you're interested in nutrition policy or the massive government program that provides nutrition assistance for women, infant and children, I think you'll really enjoy this interview. It's definitely longer than we normally do. And Darlena, and I spent a lot of time preparing for this interview and kind of finalizing the question. So I'm not going to cut a lot of it out because I think everything she said was valuable. And I want to make sure that you guys get the whole package as far as no pun intended, the national wig associations opinions go regarding the proposed changes to the wick food package that we will be seeing not really super soon, but sometime hopefully in the very near future.

Katie Ferraro (4m 54s):

So with no further ado, let's get started with Darlena Birch, she's talking about Proposed WIC Food Package Changes for Infants in the WIC program.

Darlena Birch (5m 6s):

Thanks for having me here today, Katie.

Katie Ferraro (5m 8s):

Okay. I know there is a lot going on in the WIC program, both behind the scenes and with participants. And before we dive in, could you just give us a little bit of your background and how did you come to work in your current position at the national WIC association?

Darlena Birch (5m 23s):

Yeah, so my whole career has actually been in WIC. I started out working as a local agency director for a rural county on the Arizona New Mexico border. I was the local agency with director to agreement county WIC, and the entire population of that county was 8,600 people. So prior to I'd always lived in urban or suburban environments and working that job was my first exposure to rural America. And so it was very interesting just having to adjust to a different way of living a different pace of living and seeing the challenges and struggles that rural America faces. And I remember when I was running this local agency, we would get these policies that are given to us from the state office.

Darlena Birch (6m 6s):

And a lot of those policies made sense for urban suburban clinics. But when it came to rural clinics, a lot of times I felt like we were at a disadvantage because we were a much smaller agency. We didn't have the same staffing that the larger clinics did. So a lot of the policies that would be pushed through, I often felt like kind of neglected the challenges that rural environments face.

Katie Ferraro (6m 26s):

Like how so? Like from an education standpoint, like you need this many educators to do this program or,

Darlena Birch (6m 32s):

Or like, I think something that sound, this is going to sound very WIC specific, but just separation of duties. So one example is my clinic. We only had two staff for the entire county and in WIC separation of duties means that the person that's issuing the benefits cannot be the person that hands it to the participant. Like it's just a

Katie Ferraro (6m 52s):

Hard with. Yeah,

Darlena Birch (6m 54s):

Yeah, yeah. It was just an, especially if, if my staff member called out then there was just the one person

Katie Ferraro (6m 59s):

Darlena. Were you a Registered Dietitian at this time? Or were you a degreed nutritionist?

Darlena Birch (7m 3s):

Yeah, I know I was a dietitian. This was like, I went straight from undergrad to grad school. So this was my first job working as a dietitian and working professionally as a whole.

Katie Ferraro (7m 11s):

So two people in a WIC office, you're running a WIC agency as a new Registered Dietitian, kind of just thrown to the wolves literally

Darlena Birch (7m 18s):

More or less. Yeah. Yeah. You know, the state tried to support me as much as they could and the state staff were helpful, but it is hard because I was three hours away from the state office, like in this town where I didn't know anybody where I didn't, I had some exposure to WIC and undergrad and in grad school, during rotations, at the end of the day, it was not the same as like being handed this like 20 plus chapter of policy, procedure, manual, and being like, this is the regulation, like start your agency. So that was definitely a challenge.

Katie Ferraro (7m 45s):

And how many WIC participants were you serving at that time in a community?

Darlena Birch (7m 49s):

The caseload workload, like our monthly caseload was 250 participants. So very small, very small caseload, which is why technically I remember one of the state personnel telling us that at two people, we were overstaffed.

Katie Ferraro (8m 3s):

Like we

Darlena Birch (8m 4s):

Really should have only had one person running the entire agency, but it just wasn't feasible to do that. So yeah, very small rural town where everyone knew everyone.

Katie Ferraro (8m 14s):

I feel like a lot of people would have quit after that first job experience. And yet you continue to climb the ladder at WIC. So where did you go after the, the local agency?

Darlena Birch (8m 23s):

Yeah, I ended up going to the state office because when I took this job at the local agency, I knew it was temporary. I didn't know how long I'd be there, but I also wanted to have a bigger say in the policy that was being brought down to the locals because, you know, I had my own concerns when the state office was giving us the policy. So I went to the state office for Arizona. So I went from the small town to Phoenix, the capital of the state and worked as an issues and consultant at the state office for like five WIC clinics across the state. And so from there, I remember like thinking, okay, now I'll have a bigger say in the policy and procedure. Great. Can't wait. And then I realized that the policy and procedure that the state was giving to the locals was coming from the Western region of USDA.

Darlena Birch (9m 7s):

So it was like, I wanted to have a bigger impact on policy, but at the same time, like there wasn't too much we could do with the policy because I learned that the state wasn't the one that was coming up with it either.

Katie Ferraro (9m 19s):

Did you just skip the region and go to national? Like I see where this is going.

Darlena Birch (9m 22s):

Yeah, yeah, yeah. Okay. So by the time as the state of Arizona, I knew I either wanted to work for the national WIC association or USDA, but I felt like, you know, I just needed to kind of get my foot into the region. Right? So NWA and USDS in the DC area, I actually ended up going to the state of Maryland, where I worked at the training center there. And so the, some states have training centers for the new hires that come in through WIC. And so Maryland WIC has a very organized training structure for the different staff of their WIC programs. So I was at the local agency in the world town for one year. I was at the state of Arizona for about a year and a half, and then went to Maryland for one year and then eventually got a job at the National WIC Association. So that's like my long kind of like journey over to NWA was just kind of hopping across the country until an opportunity opened up and I was able to apply.

Katie Ferraro (10m 11s):

But I love that you were working at the ground level, seeing how WIC operates, which it can be really frustrating working inside of any institution, but particularly government institutions. And yet you realize if you're not a part of the solution, you're a part of the problem. And that's something I always teach young dietitians. We have a dietetic internship program and we work with a lot of, you know, this first time job as a dietitian. I tell him, listen, if you have an issue with you local, or your state dietetic association, or the powers that be, you can quit and give up. But if you truly believe in the work that either you're doing at this job or with WIC, if you're not a part of the solution, you're just a part of the problem. And what can you do to be a part of a leadership. So I think it's amazing that you stuck it out. And now you're at the national WIC association for those who may not be familiar.

Katie Ferraro (10m 55s):

Could you just explain what the NWA is and why it's not connected with the USDA? Because you said you had two options there. I go, national WIC association or USDA if USDA runs WIC, why wouldn't you go to USDA?

Darlena Birch (11m 6s):

Yeah, absolutely. So USDA, the United States Department of Agriculture is the federal agency that operates the WIC program. The national WIC association, isn't a government entity. So whereas USDA has the jurisdiction to right implement and enforce WIC policy. The national WIC association does not, but there's often confusion like participants and even some staff will confuse us for being a federal agency. And we're not where the nonprofit advocacy and lobbying voice of the WIC program, the way that WIC is written in federal legislation, we're not guaranteed funding every year. And so we have a public policy team that I work on that helps to ensure WIC receives adequate funding that helps really just protect the program.

Darlena Birch (11m 46s):

Fortunately, WIC is a bipartisan program. So both sides of the aisle support this program, which is always a useful tool for the program as a whole. And so yeah, at the national WIC association, one of the best parts about being an NWA is that we're not restricted by the red tape that our state and local staff are. So we are able to go meet with Congress and basically just really talk about how great this program is. And so my work very much deals with our members. So we're a member based organization. So all about 88 or 89 state WIC agencies are members of NWA. And the way we got to that number is there's 50 states. There's about I think, 33 Indian tribal organizations and then five US territories.

Darlena Birch (12m 29s):

So that's how we have such a high number of state agency members. And then we also have local clinics with their local staff or members of our program or of our organization as well.

Katie Ferraro (12m 39s):

Did you do advanced trading and policy? Because another thing a lot of dietitians complain about is like, we have to learn about nutrition policy and if you're not a policy person, it can be dry confusing as a nutrition educator. It's very challenging to teach. If you haven't lived it your whole career, like you have, what training do you have to work at the policy level as a dietitian for people who are listening, who might be interested in taking that career path as well?

Darlena Birch (13m 3s):

Yeah. I have absolutely no training, no like formal,

Katie Ferraro (13m 6s):

Except having worked for WIC your entire career, which is like the best trading there is.

Darlena Birch (13m 10s):

Yes. Yes. And I would say like, even at the local level though, like, I didn't think about Congress, so I guess to kind of finish out my journey, right. I end up at the national WIC association because I was like, okay, like these are the two entities that I'll have like the biggest say in policy. Right. But realizing that basically by the time it ended up at NWA that it's Congress, it's Congress, that's like setting this policy for the program. And so just being like, oh, I thought like, I would eventually have more say, but then like, do I have to become a politician? Like I don't, that's not where I want my career to be at all. So

Katie Ferraro (13m 40s):

Never say never Darlena I would go for you, right, registered Dietitian, you have an MBA and isn't the general sentiment though, in Congressman, I agree, like nothing is bipartisan, except nobody wants to be the politician who takes money away from low-income and pregnant women, infant and children who are in this program. And we're going to talk a little bit about what, what does, but I've always learned that like the general sentiment is like, people love WIC because WIC works.

Darlena Birch (14m 5s):

Yes, absolutely. You are 100% correct. And at the end of the day, yeah. It is the reason why we're such a successful program is because we have support from both sides of the aisle.

Katie Ferraro (14m 14s):

Like no one else can say that, honestly, like that's why nutrition is so awesome.

Darlena Birch (14m 19s):

Yeah. Yeah. But yeah. So back to like my background in policy, you know, even at the local agency level, like in my mind it was the state, right. And then I got to the state and then in my mind it was USDA. And then I got to national WIC association and I realized that even USDA, you know, yes, they set the policy and they can enforce and implement it. But very much they are also more or less at the whims of Congress. And so, you know, just kind of realizing that the, of the day, like it's Congress, that's setting everything, but it was definitely a learning curve for me, by the time I got to the national WIC association, just learning to be very cognizant the words I would say, because depending on what Congress person you're talking to, you have to reframe what you're talking about. And that was actually frustrating to me as a dietitian, because if I think that we should be reducing juice in the food package, I don't see why.

Darlena Birch (15m 4s):

Like, I can't just say like, great, we're reducing juice in the,

Katie Ferraro (15m 8s):

Because he might be supported by the juice lobby. Is that what you're saying?

Darlena Birch (15m 12s):

Yeah. Yeah. And so I remember like one time I did like type up a talking point for something and it, it had to do with juice and yeah, it was our CEO was like, oh, well, yeah, that's great. But you know, for this specific instance, we can't use that. And so that was a little frustrating for me just because I feel like nutrition shouldn't have a political agenda behind it, but you know, the truth of the matter is that there are industries that benefit from the WIC food package. So just having to like reframe your talking points and understanding the policy process, and there's still a lot to,

Katie Ferraro (15m 45s):

And we're still in a country where the same government agency that sets farm subsidy policy is this also the same agency that out of the other side of their mouth is telling Americans how much to eat of X, Y, or Z. And I know other countries have to say laugh at us, but like, there is an inherent conflict of interest there where the people who make the food and the people who tell the people, which foods to eat, if they're in the same agency, like there is definitely going to be strife and conflict and you kind of live it everyday at WIC.

Darlena Birch (16m 10s):

Yeah. For the most part, I think one of the good things is that, and we'll talk about this a little bit later is that the WIC food package is very much scientifically based. And so I think that as the years have gone on, we've been able to really protect the scientific integrity of the Wickford package. And we have been able to really stand behind the science in the face of industry interests. And so I do think that, yeah, we do a lot to really just, I think ultimately protect the nutritional wellbeing of program participants.

Katie Ferraro (16m 36s):

And I love that you mentioned the food package is science-based, we're going to get to that. And speaking of something unscientific, we did a really unscientific Instagram poll the other day and stories, and it looks like about 25% of our audience who is participating at the time on Instagram, at least our WIC participants or WIC educators, but for people who are listening, who may not be familiar with WIC quick overview, what does WIC do and how does it work and who does it serve?

Darlena Birch (16m 60s):

Yeah. So, like I said earlier, the actual name of the program is Special Supplemental Nutrition Program for Women, infants and children, but obviously WIC is much more concise. And so this is a program that's run federally by the USDA, and it's a public health nutrition program where they provide nutrition, education, nutritious foods, breastfeeding support, and healthcare referrals for income eligible, women who are pregnant or postpartum infants and children upstage a five. So again, to kind of reiterate who the program participants are, it's income eligible women. Those women are either pregnant, breastfeeding, or postpartum, it'll be infants and then children up until their fifth birthday. And so some of the participation requirements for WIC is that you need to meet income guidelines and it's meaning that you're less than or equal to 185% of the poverty level, or if you're they call it adjunctively eligible.

Darlena Birch (17m 53s):

Basically if you participate in certain other programs, then you are automatically eligible to participate in WIC. There needs to be at least one documented nutrition, risk, and applicants need to reside in the state that they're applying into. And just to kind of give a high-level overview of how you would get enrolled into the program is, you know, a participant would come into the clinic and they would have their intake taken, which is basically their income would be verified. Their identity and their state of residence would be confirmed. They would then have their anthropometrics taken. So it would be the height, weight, and a finger poke to screen for iron cause. One of the biggest assets of wikis that we do iron like academia screaming. And if I talk a little bit more about the history of the wit program later on in this interview, you'll get a better sense of why that is such an integral piece of the program.

Katie Ferraro (18m 40s):

Okay. So Darlena, if I get signed up for WIC and I am eligible and now I'm enrolled and I go to my WIC clinic and I, I received the benefit or it's electronic in my state as the case may be when I go to my store and I want to use that benefit, what kind of foods can I purchase as a participant in the WIC program?

Darlena Birch (18m 59s):

It depends on what category you are, right? Whether you're breastfeeding, pregnant, or postpartum women, infant, or child, but in general, these are the foods that you could expect to get. You would be able to get breakfast, cereal, canned fish cheese, a egg infant formula. We talked a lot, but we'll talk a lot about the CVB. So fresh vegetables and fruits, there is juice then, you know, infant foods, if you're an infant. So if it's cereal, meat, vegetables, and fruits, you'd be able to get your dairy. So milk. There's also peanut butter for those who have a cow's milk protein allergy or intolerance, you'd also be able to get a soy alternative. There's also tofu. And you also would be able to get things like whole wheat bread and other grains, like pastas, as well as yogurt.

Katie Ferraro (19m 43s):

But you just can't go into the store, Willy nilly. Like you kind of can with your food stamp benefit and you can't buy Reese's pieces cereal, and you can't buy regular soda, right? Like there are WIC approved foods based on nutrient standards.

Darlena Birch (19m 57s):

Yes, yes. And so, and I can speak to personal experience too, from being at the state level is that there are nutritionists and dieticians that work at the state level and in the regulation, food manufacturers have to apply to get their product approved for the wick food package. So in the federal regulations, it states the nutrient requirement for each food category. So for cereal, it has to meet X number of iron requirement. Can't exceed a certain amount of sugar, just different regulations like that. And so at the high level, there are dietitians and nutritionists that are looking at these regulations and then looking at the nutrition label of the product and approving it based on that. And then that's how certain foods and brands get into the WIC food package.

Darlena Birch (20m 38s):

So yes, you can not just by

Katie Ferraro (20m 41s):

Flaming hot cheetos are not on the WIC package. I was supposed to tell parents though, cause I have seven small kids and you're like, how do you pick a cereal? You're a dietician. It's like two cheat sheet just walked down the aisle at the grocery store. And if it says a WIC approved cereal, my kids know that that's the one that they can have, even if you're not in the WIC program, WIC approved foods are foods that are packed with nutrition that are good for children. And it's kind of a good cheat sheet, especially for cereals. If you see WIC, I mean, there's so few WIC approved cereals because most cereals are packed with too much sodium and sugar and not enough iron, so not appropriate.

Darlena Birch (21m 14s):

Absolutely. Absolutely. Even my own mom pointed that out once when I first started working in which she didn't really know anything. And as she learned more, she was like, oh, Hey, I saw like I was in the grocery store. I noticed the wick tax. She was like, yeah, all those foods are really healthy. And I was like, yeah, it's one of the great things about the WIC program.

Katie Ferraro (21m 29s):

One statistic that always blows my mind is that WIC serves just over half of all infants in the United States. So in 2014, for example, 54% of all infants in the U S received WIC benefits. And that's, that's not just WIC eligible, that's actual recipients. And it's amazing. So could you speak a little to the demonstrated outcomes of the WIC program and especially for infants, how does participation in WIC improve nutrition outcomes for infants?

Darlena Birch (21m 51s):

Yeah, so there is a lot of research that shows WIC participation is associated with lower preterm birth and infant mortality. Specifically one study found that babies born to WIC participants are 16% less likely to die in the first year of life. And that's a big deal considering that the infant mortality rate in the U S is nearly twice as high as rates in other developed countries. And so it's just really important for us to make the public aware of that because elevating WIC means that we are able to help babies and young children in this country thrive. Additionally, WIC promotes breastfeeding among participants through our breastfeeding peer counseling program. And all WIC staff are required to complete breastfeeding training ranging from clerks to coordinators and each local agency will offer free lactation consultant services to prenatal and breastfeeding families.

Darlena Birch (22m 37s):

And this specific program is actually associated with an increased rate of breastfeeding initiation and due to the strengthening and expansion of Wix breastfeeding support promotion services. The percentage of WIC moms have initiated breastfeeding has increased dramatically from 42% in 1998 to 72% in 2018. So it's been a big increase ever since we really started to promote breastfeeding within the WIC program. And because of this program to WIC has been able to improve breastfeeding rates among a diverse group of low-income women. In this program, specifically, peer counselors are especially effective at increasing breastfeeding initiation and duration rates among black moms. And not only are breastfeeding moms able to participate in the WIC program longer and receive a specialized enhanced food package, but breastfed infants in the program also benefit from breastfeeding as well.

Darlena Birch (23m 25s):

And so the benefits of breastfeeding specific to infants include reduced risk of obesity, lower respiratory infections, type one, diabetes, asthma SIDS, ear infections, childhood cancers, eczema, orthodontic problems, and brain development. So just a lot of benefits to infants participating in this program.

Katie Ferraro (23m 44s):

And you mentioned the advocacy for breastfeeding. I speak at many of the state WIC associations every year for their annual conventions or different training programs teaching about infant feeding and baby Led Weaning. And I just got off, we were doing the North Carolina meeting and I was talking with the WIC director. They are just getting ready for this meeting. And she was saying, we're going through the slides. And I show a lot of videos of babies eating. And she said, Hey, Katie, I just want to check real quick that you don't have any videos of bottle feeding. I said, no, I'm showing open cup feeding, but can I ask why? And she goes, oh, in our state North Carolina, it's not every state, we're actually not allowed to show in education bottle feeding because it could be contra-indicated with our breastfeeding efforts. And I thought that was really interesting. I know it varies from state to state, but now I'm kind of scrubbing my presentations to make sure there's no bottle feeding in there.

Katie Ferraro (24m 28s):

And that we are obviously always promoting breastfeeding to the greatest extent possible, but acknowledging that, you know, breast milk or formula is still the primary source of nutrition for babies age six to 12 months. And we're going to talk about the foods again in a second, but I want to just jump back in time real quick. In 2006, I was a relatively new dietitian and I distinctly remember hearing all the buzz about the first ever proposed changes to the wick food package, which they didn't go into effect until 2009, but everyone was talking about the reduced amount of juice in the program. So juice was the big news, but that round of revisions led to upper limits for things like sugar and yogurt in the WIC program and whole grain inclusion for breads. But it also ushered in the era of wick fruit and vegetable cash value voucher or the CVV.

Katie Ferraro (25m 8s):

Could you briefly explain what the CVV is and how it works?

Darlena Birch (25m 12s):

Yes. So the cash value voucher, or I refer to it as the cash value benefit CVB, they're the same thing. It's a dollar value that is issued to WIC participants that can be used for the purchase of fresh frozen or canned vegetables and fruit. And as you stated, this was first introduced in the WIC program around 2009 and allowed for women to receive $11 in the benefit to purchase fresh vegetables and fruits. And then children received nine. One of the biggest victories of wick was that the national WIC association was successful in increasing the dollar value of the CVB in response to the COVID-19 pandemic. So in the first few weeks of the pandemic representatives, Kim Schrier and right introduce the WIC benefit flexibility during COVID-19 act, it was a bipartisan measure that would provide additional target assistance for WIC families to purchase more fruits and vegetables.

Darlena Birch (26m 1s):

And the bi-partisan Schrier right proposal was passed as part of the American Rescue Plan Act in March, 2021. So this provision increased the monthly vegetable and fruit benefit to $35 per month per participant, which was a significant increase above the prior values that I mentioned earlier of $9 per month, per child, and $11 per adult. So successful implementation of this benefit bump over the summer of 2021, really encouraged Congress to extend the benefit increase in the continuing resolution passed on September 30th. And in that legislation, Congress actually reset the vegetable and fruit benefits in accordance with the 50% of recommended intake under the dietary guidelines for Americans. This is also levels that were recommended by the 2017, from the national academies of sciences, engineering and medicine, which I'll talk about later.

Darlena Birch (26m 47s):

But the second phase of the WIC benefit bump has resulted in $24 per month, per child, $43 per month for pregnant and postpartum women. And then $47 per month for breastfeeding participants.

Katie Ferraro (26m 59s):

Is that total or is that on top? Like that's just for fruits and vegetables or that for all foods?

Darlena Birch (27m 4s):

No, no fruits and vegetables alone, separate from everything else,

Katie Ferraro (27m 8s):

Calling it, the cash value benefit versus cash value voucher. Is that a semantic thing or do you choose benefits over voucher? Because we're moving away from an era of like actually having a ticket and a WIC food coupon as more states are moving towards electronic benefit transfer. So we call it a benefit, not a voucher.

Darlena Birch (27m 25s):

My suspicion is it's the latter. I haven't ever actually looked up the reason, but we are moving over to EBT. The majority of states at this point have rolled over to the electronic benefits transfer. So I suspect that the reason why we call it CVB is because it is a benefit. It is not an actual yeah, like check that you're holding in your hands.

Katie Ferraro (27m 45s):

So today we're at a very interesting period in the WIC program, looking to the next round of Proposed WIC Food Package Changes who says when and how the WIC food packages get revised and what sort of timeframe are we looking at here?

Darlena Birch (27m 58s):

So as mandated by the healthy Hunger-Free kids act of 2010, the WIC food package must be reviewed every 10 years, the USDA contracts and independent committee, which I referenced earlier, the national academies of sciences, engineering, and medicine to conduct the scientific review. So the latest review is actually finished in January of 2017. And this report is actually over 900 pages. So it's a very hefty report, but the parts of the report that were relevant specific to the wick food package is actually chapter six. There's some interesting information about like research and research needs in WIC and chapter 11 of that report. So if there's two chapters you want to look at, definitely look at chapter six and if you have extra time, chapter 11,

Katie Ferraro (28m 40s):

But honestly Darlena the people it's in the pockets. Like I don't have time to read all the original source documents. So thank you for interviewing Darlena from the national WIC association who will summarize, how did foods actually get changed?

Darlena Birch (28m 49s):

Absolutely. So, yeah, the nascent review process ensures that the food package is science-based and aligned with the most up-to-date dietary guidelines for Americans. It also ensures that it meets the nutritional needs of WIC families and ensures that it's culturally appropriate and includes foods that appeal to WIC families. So ultimately this process just ensures that the foods, including the wick food package are scientifically proven to supplement the nutrients lacking in the participant diet. So while nascent does conduct a scientific review every 10 years and provides recommended changes to the WIC food package, it's up to USDA to determine which recommendations will be implemented into the food package itself. There is no timeline that USDA must follow in reviewing NASEM's report and implementing the recommended changes, but we anticipate the USDA food package rule to be dropping in April, 2022.

Darlena Birch (29m 39s):

So ultimately I just want to give a high-level overview of steps that we can anticipate in this, what we call the USDA rule making process. So USDA will publish an interim rule and accept public comments again, that we expect that part to happen in April, 2022 USDA will then respond to all public comments and make any changes to its interim food package rule based on the comments that it receives, it will then publish an interim final rule, which will then they'll also accept public comments. At that point in time, USDA will sponsor our public comments and make changes to this interim final rule based on those comments. And then USDA will publish a final rule. So it's basically three different times that USDA will be publishing a rule, an interim role and interim final rule.

Darlena Birch (30m 25s):

And then the final rule. And in between those three steps, there will be two public comment period.

Katie Ferraro (30m 31s):

So you shared with me all of the source documents. We did a ton of preparation for this interview, and I really appreciate you explaining it because I think it can be really confusing. Sometimes policy people just speak a different language, and I love that you're a dietitian or real life practitioner who also gets the policy stuff. And so when we were kind of diving deep looking, if, especially for my audience, I was looking really specifically at food package two, which captures infants six to 11 months, which is where most of my audience has babies in that range. And I'm, I'm reading these documents and I'm nodding along like, yes, good idea. Like, of course that makes so much sense. So real high level. Can you tell me how the national WIC association is, or is not aligned with the committee's recommendations to change this wick food package? Because some of them are pretty substantial changes.

Katie Ferraro (31m 12s):

Are you guys in agreement?

Darlena Birch (31m 13s):

Absolutely. The national WIC association is in strong alignment with the committee's recommendation, but the WIC benefit bump for vegetables and fruit introduces the opportunity for WIC to have an ever larger impact on shaping participant diets. So the NASEM report sought to provide 50% of recommended intake across food categories, but even with the revisions, the constraints of cost neutrality, inhibited Nissan from recommending sufficient amounts of fruits, vegetables, seafood, poultry, eggs, and whole grains to reach that 50% threshold. So NWA is supportive of building on the progress of the WIC benefit bump to ensure that you stay can issue higher amounts of nutritious foods in alignment with the intent and structure of Mason science-based recommendation.

Darlena Birch (31m 53s):

So basically what we're saying is that one of the factors that nascent has to consider when they're making recommendations is cost neutrality, meaning any change they make has to be like cannot increase or decrease the value of the wick food package. It has to stay within a certain range.

Katie Ferraro (32m 9s):

There's so many changes in these documents in so many things that might change in her kind of speculating, but you guys kind of know will happen. And I want to go through and just get your pulse check on what each of the individual recommendations for six to 11 month olds on the committee report. The stated intent was to quote, align the amounts of infant foods with American academy of pediatric recommendations. Now, my audience is pretty familiar with AAP recommendations. We talk a lot about them here on the podcast and inside of my programs. I know you're a dietitian and a policy person. So I'd just love your thoughts on each of those infant feeding the specific recommended changes to the WIC one. So I'm going to go through each of them and just, you know, if you could summarize in under a minute, how do you feel about this first one being the amount of infant cereal are reduced?

Katie Ferraro (32m 49s):

And so the recommendation is to quote, reduce the amounts of infant cereal across food package two for all infants, personally, Katie speaking, I think this is awesome because WIC is coming down from 150% of the AAP recommendations to a hundred percent. Darlena what's the rationale for reducing cereal as far as you're concerned.

Darlena Birch (33m 7s):

Yeah. And so one thing I do also want to point out before I respond to that specific talking point is one of the things that we need to keep in mind as we go through these recommendations, as I stated earlier, is that the NASEM recommendations had to balance benefit issuance across all food packages. And one of the key concerns is that the infant food package is more substantial than the child food package, which we contributes to the drop-off of participating children at age one in WIC. We see a drop-off when they turn age one. And so in seeking to reverse this balance, especially with the WIC benefit, bump some of the reductions in the six to 11th month range, which we will talk about later will fuel the added value for children and women and provide a more balanced experience across the program.

Darlena Birch (33m 48s):

So specific to reducing the amounts of infant cereal within the wick food package. One of the focal criteria for inclusion in the WIC food package was that packages provide a balanced supplement to the diets of women and children. So the rationale was that WIC needs to provide supplemental amounts of food, right? So obviously 150% is not a supplemental amount. The current food package provides widely vary proportions of required nutrients and recommended food groups. And so this was an effort to better balance that and absolutely the National WIC Association agrees with this recommendation.

Katie Ferraro (34m 20s):

Okay. Another recommendation is that the amount of jarred infant food, vegetables, and fruits for fully breastfed infants is reduced. So we're basically going from 256 ounces to 128 ounces a month. And for context, you guys that's like going from 64 jars of baby food to 32 jars per month per baby. So that's going to free up some funds for sure. And I'm just curious, how does the national WIC association envision those funds being reinvested in the program? Will it go directly to infants or to the bigger kids to the CVB to education? What do you think? Or is that just something we figure out later?

Darlena Birch (34m 51s):

It'll definitely go to the CVB, the report they state the rationale for the recommended reduction in jarred vegetables and fruit for breastfed infants was that the current amounts of more generous for fully breastfed infants than other infants. And there appears to be no nutritional rationale for providing more vegetables and fruits to fully breastfed infants compared to the other category.

Katie Ferraro (35m 11s):

I know I always thought that was weird. Like it seemed a little like you're penalizing formula feeding parents, but like from a nutrition standpoint, this needs to be evidence-based breastfed babies. Don't quote, unquote, need more vegetables and fruits than formula fed babies. So it's smart to get rid of it.

Darlena Birch (35m 24s):

Yes, absolutely. And that was the committee's rationale and the recommendation, they just recommended providing the same amount of jarred vegetables and fruits to all infants.

Katie Ferraro (35m 32s):

And we're not taking away fruits and vegetables. We can swap them out with fresh fruits and vegetables using the CVB.

Darlena Birch (35m 38s):

Yes, absolutely. The decision from the committee allowed them to provide further support to the breastfeeding diet by moving the savings from jarred infant vegetables and fruits to a significantly enhanced CVB for both partially and fully breastfeeding women. So they were able to basically by reducing the amounts of the jarred vegetables and fruit that are issued to infants, give that benefit to the fully and partially breastfeeding moms in.

Katie Ferraro (36m 2s):

Do you know if you're not breastfeeding because you can, or you choose not to, would you still have reduction in jarred foods and the opportunity to spend that money on fresh fruits and vegetables via the CVB? Or is it a totally different set of rules if you're not breastfeeding

Darlena Birch (36m 14s):

Off the top of my head, this recommendation is reducing the amount of jarred vegetables and fruits for breastfeeding infants, because it is more than what a formula fed infant is receiving. So I don't think there was a change at all in the amount of issuance to formula fed infant because as we just discussed, like there wasn't really a scientific basis for why they were getting more in the first place, but in this report, they do recommend an increase to the CVB for postpartum women as well. But I think the way that they were able to move the funds was in other recommended changes to the way food package.

Katie Ferraro (36m 44s):

Okay. So talking more about infant food and vegetables, there's another recommendation that infant food, vegetables and fruits may be substituted with the CVB. So I loved reading what the cost analysis in the committee report. So the cost of four ounce of infant jarred food and fruit, fruits, and vegetables is about 64 cents. Comparing that to the composite average cost of like the most popular fruits and vegetables purchased by WIC participants was 55 cents per cup equivalent serving. So this is essentially a cost neutral move. If these recommendations become reality, do you envision it freeing up money for families to purchase more fresh fruits and vegetables and have to rely less on the jarred foods?

Darlena Birch (37m 18s):

Yes, it absolutely will. In the current food packages, infants ages nine to 11 months may receive either a $4 if they're partially breastfeeding or $8, if they're fully breastfeeding CVB in place of half of the jarred vegetables and fruits. But with this new recommendation that NASEM made, the proposed CVB substitution would be $10 plus half of the jarred infant foods or $20 and no jarred infant foods for all infants ages, six to 11 months

Katie Ferraro (37m 44s):

In all of the food packages, there was a recommendation that the CVB be used to purchase all authorized forms of vegetables and fruits. And as curious, what forms of fruits and vegetables can currently be purchased with the CVB and then what's being proposed because I love the idea of more canned and frozen from an access standpoint, but also there's cost considerations. There's texture opportunities for babies as we move away from jarred foods. Any thoughts there?

Darlena Birch (38m 6s):

Yeah. So currently the federal regulations for the program require that both fresh vegetables and fruits be authorized by state WIC agencies, canned frozen, or dried vegetables, and fruits may also be authorized to offer a wider variety and choice for participants, but the fresh is mandated in the federal regulations for the program. With regards to this specific recommendation, you mentioned that infant CVB may only be used to purchase fresh vegetables or fruits and limiting the infant CVB to only fresh vegetables and fruits just creates a significant burden for participants and local agencies and not to get too technical. But this is particularly in states where their EBT systems do not readily accommodate the issuance of fresh, only benefits for vegetables and fruits when they already authorize a benefit along multiple forms of vegetables and fruits for women and children.

Darlena Birch (38m 51s):

So what this specific recommendation is saying is that all forms of vegetables and fruit should be authorized for purchase with the CVB for women and children like that also has to apply to the infant CBV as well. Right? So the nutritional value of processed vegetables and fruits can be comparable to that, of the fresh forms and the different ways of preparing infant foods from various forms, whether it be fresh, frozen, or canned offers the opportunity to create infant foods of varying textures that are suitable to the developmental stage of that infant and also meets cultural needs. So all in all NWA isn't supportive of this recommendation,

Katie Ferraro (39m 26s):

Another recommendation, the amount of jarred infant food meat for fully breastfed infants is reduced. And I didn't realize before I started researching, to what extent jarred meat is one of the, and this is a quote from the report least well-accepted foods in the WIC package for infants. So Darlena what other naturally occurring sources of iron do. WIC educators encourage for babies six months and beyond besides jarred meat and rice cereal,

Darlena Birch (39m 48s):

The WIC educators encourage participants to cook other foods such as cooking and mashing high iron foods, including ground meats, beans, peas, lentils, spinach, tofu, et cetera. They also encourage caretakers to offer age appropriate vegetables and fruit that are high in vitamin C at the same meal, to help with iron absorption. And then WIC educators also provide education on the importance of not giving too much milk to their infants at that one-year mark basically when they go from infant to being a toddler, because when they make that switch from breast milk or formula to cows milk, oftentimes we see that that toddler now gets a lot of milk, but that milk actually competes with iron absorption. So there's a lot of various factors that WIC educators try to discuss with, with participants to ensure that that infants are getting the iron that they need.

Katie Ferraro (40m 36s):

And I think that message is getting across. For sure. I know we do a ton of education with our students about the importance of limiting cow's milk. Cow's milk is fine if you drink it with too much of a good thing is not a good thing in. Sometimes parents are like, well, how can milk, you know, reduce iron absorption? Well, it takes up valuable room in the toddler stomach, at which point they're not hungry for the nutritious variety of foods that you're offering because they're full of milk. So I love that the messaging is starting in infancy about watching out for milk consumption after each one.

Darlena Birch (41m 1s):

Absolutely.

Katie Ferraro (41m 2s):

Okay. Darlena, there's a recommendation that fish may be substituted for a portion of jarred infant food meat, and with every iteration of the wick food package. I love seeing more variability and more accommodation for substitutes. So for example, like there's substitutes for vegan and vegetarian families, or for families that have allergies or food intolerance. And I do love this possibility about fish being substituted for jarred infant meat in the WIC program. Fish is one of the big nine allergenic foods. We want babies to be offered fish early and often along with the other allergenic foods to help reduce the risk of food allergy down the road. Just curious about allergenic foods, how do WIC educators currently counsel about allergenic food introduction, especially we've talked offline previously about, you know, peanut, there's a lot of research supporting early introduction of peanut, and yet there's not currently a provision for infant foods containing peanut in the food package to, for WIC babies who are six to 11 months.

Katie Ferraro (41m 54s):

How does the national WIC association feel about this? Or how are you guys dealing with this reality?

Darlena Birch (41m 59s):

Yeah. So with regards to your question about WIC educators, they do provide guidance regarding the introduction of allergenic foods. In general, I anticipate that it varies from local agency to local agency and state to state, but we'll give the standard advice of introducing new foods. One at a time. They also will highlight that unless a healthcare provider states, otherwise you do not need to avoid the common food allergens while you are pregnant or breastfeeding. And then introducing common food allergens to babies after six months is okay. And the case of peanut allergies, giving foods containing ground or powdered peanuts may even lower the risk of developing an allergy. So it does not increase the chance of a baby developing a food allergy, which we do have to do a lot of education out to kind of reeducate moms, especially if they've already had a child that was where they were previously told something different, right?

Darlena Birch (42m 44s):

Cause we know that this new guidance is relatively new. So in WIC, we're still trying to face that transition as well with regards to like peanuts in the wick food package. I mean, there, isn't a peanut provision, as you stated for infants, but we do offer peanut butter, but again, that's a choking hazard issue. And so I think one of the larger concerns with peanuts outside of allergy is just choking hazards as a whole. So, you know, it's not to say that we couldn't possibly see some type of peanut product being offered in the food package in the future, but it's just largely going to be based on what the nascent committee concludes as important, what the science is saying. Obviously we know now the science says that introducing peanuts around the time you start introducing solid foods to your infant is a great way to prevent the allergy.

Darlena Birch (43m 27s):

So we'll see what happens in the next iteration of the wick food package.

Katie Ferraro (43m 31s):

And you mentioned choking risk, which I know each year when I'm presenting to the state directors about the different topics that I'll be speaking on for WIC associations throughout the country. Some of the most interested in topics like the things they want to hear the most about are choking risk. And there are plenty of ways that we can thin peanut butter out to make it safe for babies to sell feed farts, starting from six months of age on they're interested in that they're interested in high iron foods. So like how can we stop this idea that the only way Babies can get iron is from iron-fortified rice cereal. There's lots of other iron containing foods. Babies can safely eat. And then the allergens are right up there as well because new research is starting to demonstrate that we think the protective window for introducing allergenic foods to help prevent food allergy closes at 11 months of age.

Katie Ferraro (44m 13s):

And so it is important from six to 11 months of age, that infants are being introduced to these allergenic foods in a way that is safe. And that also provides important nutrition like iron, because of course you have the big nine allergenic foods. Half of them approximately are animal containing foods that do have iron in them, which is a great way. We're doing multiple things once here, right? We're doing textures, we're doing iron, we're doing the allergenic foods. And I think that's why it's so important that the WIC educators continue to get this message across to parents because there's a lot of things going on between six to 11 months. And it's, it's a lot to deal with. So Darlena, I know you're here on behalf of the national WIC association. I'm not sure if you're allowed to answer this personally, but is there anything that you, as a long time, WIC employee who has worked at every level in the organization, anything that you think got missed or anything additional you would like to see change regarding food for infant six to 11 months at WIC that isn't in this committee report?

Darlena Birch (45m 4s):

Honestly, I can't say I can think of anything additional that should be changed regarding the WIC food package for six to 11 months. We consistently hear from folks that more benefits for that six to 11 month age for early introduction is something that they would really like to see. And this is consistent with the DJ's, but it's not covered by NASEM. So again, to protect the scientific integrity of the WIC food package, we just are looking forward to what the next NASEM committee is going to recommend. And personally, that's something I'm looking forward to as well. You know, I'm very excited to see what changes USDA will implement, what they're going to put in their interim role. And so I'm just mostly looking forward to a revised wick food package that incorporates all of the changes that need some made by

Katie Ferraro (45m 46s):

Of all these changes. And they all work, I think, to help improve nutrition outcomes, to meet babies where they're at developmentally, as far as the types of foods that they can eat. And then also being, having culturally appropriate options because the wick food package it's different in different parts of the countries. And I'm not sure if everyone knows that if you have a second, could you just share how the WIC benefit might differ depending upon where you live in the United States?

Darlena Birch (46m 11s):

Yes. As Katie just mentioned, the WIC food package varies from state to state. There are federal regulations about what is, and isn't in the wick food package, but then states can and can tailor it based on their needs. So in some states you could get goat's milk, but in other states you won't be able to, because we also know that the cultural diversity of the WIC participant base changes from state to state. So in some states you'll be able to get like plain milk. And in other states you might have more milk options. It really just depends on where you go in, where you live. And so that was also something that tended to be kind of confusing. When I was moving from like state to state working at the state level was remembering like the changes in the way food package, or like sometimes confusing my policies, but yeah, states really have a fair amount of flexibility in what foods they can allow in the wick food package.

Darlena Birch (46m 59s):

A perfect example is that CVB, all states have to offer that fresh option, but most states also offer like a canned option, a frozen option, but not every state does. So it really just depends on where you are in the US

Katie Ferraro (47m 13s):

So Darlena thank you so much for kind of breaking down within this report. And I'm just curious for listeners who are participants or who are advocates of the WIC program, what can we do to help ensure that these proposed changes to the WIC food package do indeed go into effect?

Darlena Birch (47m 29s):

So advocacy is absolutely key. As stated earlier, there will be multiple public comment periods where the public is able to submit a comment. So I'm not sure how many listeners out there know, but federal agencies solicit public comment all the time. And it's called a public comment because anyone can submit a comment and provide their thoughts and feedback on a proposed regulation. And I will be leading the process of drafting model comments regarding proposed changes to the WIC food package. And that model will actually be made available for our members in the WIC community to submit on behalf of their organization. But like I said, a public comment can be submitted by an organization or by you as an individual member of society. And so really just advocating, I think the best way to ensure these changes to the food package, go through a submitting that public comment when USDA is putting out the call for the public comment,

Katie Ferraro (48m 18s):

And we will link to all of the public comments and be updating them. Because as Darlena explain, this is kind of a multi-phase process. Everything will be very obvious where to go to submit your own comment either from the public standpoint or if you're associated with WIC, we'll put that on the show notes page for this episode. So if you guys go to blwpodcast.com and you search WIC, you'll go to the page where you can then submit your own comment, depending upon which phase of the review process we're in. Well Darlena thank you so much for taking the time to break this down. I know a lot of it's really confusing, but our audience is so interested in seeing WIC succeed and wit participants. And also really again, meeting the babies where they're at, right. Making sure that we're offering developmentally appropriate foods cause Babies can eat so many more foods that we oftentimes give them credit for.

Katie Ferraro (49m 1s):

So thank you again for joining us. I really appreciate it.

Darlena Birch (49m 3s):

Thank you so much, Katie.

Katie Ferraro (49m 5s):

Well, I hope you guys enjoyed that interview with Darlena Birch. I really love her outlook because sometimes policy people, it gets so wonky. They like start speaking a different language with a bunch of acronyms. And if you don't work at that level with them, you're like, what are you even talking about from the minute I met Darlena I was like, oh my gosh, this is the person I have to interview from the national WIC association, because I really want to have a deep dive on what these proposed changes are, because this is really important stuff that affects, like I said, more than half of all the infants born in the United States are in this program. And to be honest, I hear from a lot of you guys who are WIC participants and a lot of WIC educators as well. I'm very grateful to have the opportunity to speak. I think I've spoken to almost every WIC state association at this point to teach about baby led weaning and to talk about the research that supports this approach.

Katie Ferraro (49m 51s):

And a lot of times the moms who are participants or the WIC educators will say, yeah, but there's so much jarred baby food. What do we do with it? So we have a lot of materials where we've developed different recipes that we can use the jarred baby food to help make different textured foods that Babies can sell feed. But also the reality is is that there should be the opportunity. All babies should have the opportunity to eat developmentally appropriate types of foods, lots of different types of foods, be it canned or frozen or fresh, or if you prefer jarred. So I really appreciate Darlena taking the time to kind of come and break down. Some of these changes that I hope we will be seeing in the future. I know it's not the near future. We understand how slow these processes. I mean, when she was describing the commenting period alone, I was like, oh my gosh, we're gonna have to keep updating the show notes to make sure that we're linking to the right place.

Katie Ferraro (50m 34s):

If you do want to participate in the public comment period, which is its own kind of landscape in and of itself. But if you head to the show notes for this episode, BLWpodcast.com/220, I'll link up all of the resources, including the source documents. For those of you that might be policy nerds, and want to read more about these proposed changes. It'll all be online. BLWpodcast.com/220. Thanks so much for listening and I'll see you next time.