The Special Supplemental Nutrition Program for Women, Infants and Children — better known as WIC — reaches an extraordinary share of American families. An estimated 41% of all U.S. infants participated in the federal nutrition program in fiscal year 2025, according to the U.S. Department of Agriculture.
In Missouri, where more than 300,000 households experience food insecurity, WIC provides nutritious foods, nutrition education, breastfeeding support and healthcare referrals to eligible pregnant and postpartum women, infants and children younger than 5 who meet income and nutritional-risk requirements. Unlike other food assistance programs, WIC benefits can be used only for specific foods that meet nutritional requirements, including milk, eggs, whole grains, fruits and vegetables, infant formula and baby foods.
A federal systematic review of 98 studies linked prenatal WIC participation to lower risks of preterm birth, low birth weight and infant mortality, as well as better diets for pregnant women and children.
But receiving WIC benefits does not always mean families can easily use them. Researchers at Washington University in St. Louis are examining the obstacles that can stand between WIC benefits and the food families bring home.
Most efforts to increase WIC redemption focus on participants. This pilot examined a less-studied strategy: engaging retailers, who serve as the connection point for obtaining food benefits.
With support from the Missouri Foundation for Health, WashU researchers worked with Missouri WIC and Operation Food Search to survey nearly 2,900 Missouri WIC participants about their shopping experiences. Their feedback shaped retailer training tested at 44 Missouri stores as part of Operation Food Search’s WIC Innovation Project.
The training significantly increased retailers’ confidence in handling WIC-related tasks but did not increase benefit redemption, raising broader questions. The study, “Assistance Needed in Aisle 1: Engaging Retailers to Increase WIC Redemption,” was published in the American Journal of Health Promotion.
Todd Combs, first author of the study and a research assistant professor at WashU Bursky Public Health, examines how retail and other built environments can influence behavior and health. Bursky Public Health co-authors include Amanda Gilbert, Eden Mersiehazen, Abel Regassa, Tyler Frank and Sarah Moreland-Russell. Brown School co-authors include Dan Ferris, Jason Jabbari and Stephen Roll. Angie Oesterly of the Missouri Department of Health and Senior Services also is a co-author.
Combs offers insight into the everyday experience of using WIC and what people unfamiliar with the program may not understand.
What’s it like to shop with WIC?
WIC customers shop much as everyone does, but they must choose from specific approved foods, brands and package sizes.
The WICShopper app has made things easier by allowing families to check their balances and view the approved-foods list. Families also appreciate the cash-value benefit for fruits and vegetables, a set dollar amount that can be used for fresh or frozen produce.
But participants also reported challenges locating approved brands, finding them out of stock and encountering problems at checkout, such as approved foods not being identified correctly in a store’s system. Transaction errors can cause delays and contribute to the stigma WIC customers experience. When an approved product is out of stock, families may have to make repeated trips. Participants also reported transportation and technology barriers that made it harder to shop with WIC and to register or recertify.
How much WIC assistance goes unused in Missouri, and what can that mean for women and young children?
Fewer than half of eligible Missourians participated in WIC in 2023 — just 43%. Among those who were enrolled during the study period in late 2025, average monthly redemption rates were around 60% per household. Unused benefits expire rather than carry over to the next benefit period.
WIC plays a crucial role in supporting food and nutrition security for tens of thousands of Missourians. When families cannot use all their benefits, they lose access to foods and services intended to support nutrition during pregnancy and early childhood.
Other studies found that families with children who redeemed less than half their WIC benefits were two to five times less likely to recertify than families with higher redemption rates. Without recertification, families lose access to both food benefits and WIC’s other nutrition and health services.
How did the retailer training respond to those challenges, and what did the pilot reveal?
The one-hour, in-person training taught employees, managers and owners to identify WIC-approved foods, review receipts, troubleshoot checkout errors, stock and code eligible products and help customers use the WICShopper app.
After the training, retailers reported significantly greater confidence in handling WIC-related tasks, although benefit redemption did not increase during the study period. We examined only two months of redemption data before and after the training, however, and changes in utilization patterns may take more time to emerge.
What broader changes could help families fully use their WIC benefits?
Families called for more education for customers and retailers, including training on the WICShopper app, as well as better access to WIC offices and online certification. They also recommended extending the flexible cash-value model used for fruits and vegetables to other foods and offering online ordering or delivery.
The WashU team, Operation Food Search and Missouri WIC continue to collaborate on projects to increase WIC participation, benefit redemption and retailer engagement.
What do people misunderstand about WIC and the families who use it — particularly when problems occur at checkout?
Many people think WIC participants receive all their food for free. In reality, WIC is a supplemental nutrition program that covers only certain healthy foods. It might cover all an infant’s formula needs, for example, but it does not provide all the fruits and vegetables recommended by dietary guidelines.
Stereotypes surrounding poverty and public assistance also persist. When WIC used paper vouchers, transactions took longer and involved a visibly different form of payment. WIC cards and updated payment systems have addressed many — but not all — of those challenges.
WIC customers can still feel scrutinized when problems occur at checkout. An incorrectly coded item or misunderstanding about an eligible product can turn into a public and stigmatizing experience. Be patient. The customer is trying to buy approved food for her family under a complicated set of rules.
Why should all Missourians care when families cannot fully use their WIC benefits?
The impacts of WIC underutilization go beyond participating families and those who are eligible but not enrolled. Unused WIC benefits are unmet needs in the community.
Better nutrition during pregnancy and early childhood is important for immediate and long-term health. Think fewer ER visits and lower rates of preventable disease. This can mean greater school readiness, less strain on health and social support systems, and reduced inequality later in life.
The small amounts invested in protecting and maintaining the health of more children go much further than the large amounts we spend later addressing the consequences of not doing so.
