WIC of Utah County: Serving the Hispanic Community
Introduction
The supplemental nutrition program for women, infants, and children, known as WIC was established in 1974 by the USDA’s Food and Nutrition Service (FNS). Since its beginnings, WIC has expanded quickly and currently offers nutritional supplements, counseling, and referrals to other health services at no cost to more than 8 million individuals throughout the United States (Olivera, 2002).
The aim of this report is to provide information focusing on the following: 1) the Utah County WIC program in general, including specifics of the qualification process, benefits, program policies, etc… 2) more specifically, the involvement of the Hispanic population in Utah county with WIC, and the involvement of WIC in Utah county with the Hispanic community. And further, what can be done to maximize the number of Hispanic women and children who benefit from WIC.
Reasons for the specific focus on the Hispanic community are also two-fold. First, the Hispanic population in Utah County is growing rapidly. Second, it is realized that cultural differences and their ramifications may largely predispose the Hispanic population as a group in which many could benefit from the WIC program.
Overview: National and Local Demographics Associated with WIC
Nationally, the demographic make-up of WIC participants has changed over time. According to the FNS, in 1998 32% of those enrolled in WIC were Hispanic, indicating an increase of approximately 9% in a six year period. For comparison, whites comprised the majority of participants at 39%, and blacks followed the Hispanic population at 23%; although enrollment percentages for blacks and whites actually declined during the same time period. From these data it can be seen that the Hispanic population comprises a major portion of WIC participants. Further, in the United States, the Hispanic population is currently seeing the most amount of growth of any minority group (Olivera 2002).
When the federal census was taken in 2000, it was reported that there were 25,791 people of Hispanic or Latino ethnicity living in Utah county; approximately 7% of the total county population. It was also reported that 17, 138 (4.7%) of the total population were not U.S. citizens and that of that group, 62% (14,338) had been born in Latin American countries (U.S. Census Bureau, 2000). It should also be noted that the actual numbers of Hispanics living in Utah County are most likely even higher than what was reported.
For children in general, it was determined that 3,309 families living in poverty in Utah county had children under the age of 5. Of these families, 651 were headed by single females (U.S. Census Bureau, 2000). Unfortunately, race and ethnicity statistics are not available in relation to children or poverty but it can reasonably be assumed that a fair portion could be of Hispanic heritage because of the relationship seen between poverty, ethnicity, and education level.
For example, nationally within the Hispanic population it was determined that 41% of children under 18 were living below the poverty level. For educational attainment of persons between the ages 25-64, Hispanics had the highest percentage of any race of those with less than 12 years of school at 45% (U.S. Department of Health and Human Services, 2000). Combined, these factors indicate that many Hispanic women and children, both nationally and in Utah County, are experiencing less than desirable socio-economic conditions which also impact overall health. The goal of the WIC program is to minimize and even eliminate the extent to which economics and ethnicity negatively impact health and nutrition among its target population.
Needs of the Hispanic Population in Utah County
In order for Utah county WIC programs to most fully serve the Hispanic community, specific needs due to language and culture must be addressed. Further, it has been observed that misconceptions held by many Hispanic families concerning WIC and the effect their participation will have upon their immigration status are also gaps which need to be bridged in order to increase the efficacy of WIC in serving the Utah County Hispanic community.
In Utah County, according to the 2000 census, it was reported that 24,457 individuals (7.5% of the total population) indicated Spanish as the language spoken in the home. Of those, 10,403 (3.2% of the total population) also reported fluency in English as “less than very well” (U.S. Census Bureau, 2000). The ability to communicate in English could reasonably affect involvement with WIC in numerous ways including a possible association with language spoken and lower economic status, and ability to communicate with WIC clinic staff and understand WIC literature.
Cultural differences exist, not only between whites and Hispanics, but also among Hispanics of differing ethnicities, (i.e. Mexicans and Argentines) and families within the same ethnicity. Culture can have a huge impact on practices and beliefs concerning health including breastfeeding, food preferences and preparation methods, and knowledge of nutritional health which are all areas covered by WIC. It could also be expected that health practices would also be affected by the length of time an individual or family has lived in the United States and the extent to which they choose to adopt the “American” culture, thus accounting for differences seen even within families of the same cultural background.
Finally, misunderstandings regarding WIC and immigration laws were pointed out by Christie Hinton, director of the Payson WIC clinic, as another determinant of Hispanic’s use of WIC (personal interview, August 8, 2003). Many Hispanics are under the impression that their participation in WIC could be reported to the Immigration and Naturalization Service (INS) and thus reflect negatively on their ability to obtain U.S. citizenship. This is due to the belief of the U.S. government that those who reside in the United States should do so self-sufficiently so that immigrants are not coming here “looking for a hand-out”. In reality, citizenship does not affect who can and cannot participate in WIC and no questions are asked in relation to citizenship. WIC does not report any information to the INS, nor can the INS request information from WIC. Receiving WIC benefits does not in any way affect immigration, yet many Hispanics believe otherwise and are thus deterred from receiving benefits which they both need and qualify for.
Current Programs in Effect: WIC Programs Related to the Hispanic Community
Utah county WIC clinics serve approximately 14,000 women, infants, and children total. As mentioned above, statistics are not gathered regarding ethnicity or citizenship; however, knowing the language that is spoken in the households of WIC participants is indicative of the Hispanic population enrolled. The following table was compiled from information received from the Utah County Health Department (personal interview, August 8, 2003). Other figures and tables also referenced in this section can be found at the end of this report.
Languages Spoken in Households ServedClinic / English / Spanish / Another Language / % speaking
Spanish
Provo / 2,390 / 750 / 50 / 23.5%
Orem / 1,733 / 5578 / 20 / 24.8%
Payson / 850 / 182 / 3 / 17.6%
American Fork / 1,064 / 93 / 3 / 8%
Anyone applying for WIC must meet nutritional, financial, and residential requirements. Nutritional requirements include the following: 1) pregnancy 2) post-partum within 6 months if not breast feeding or within 1 year if breastfeeding, and 3) infants and children under the age of 5. Financial requirements differ depending on household size (refer to figure 1). Finally, you must live within Utah County boundaries to meet residential requirements. WIC requires certain documents as proof of the above three criteria to be brought to the initial appointment in order to begin the application process (refer to figure 2). In addition, each person applying must be present in order to receive basic health and nutrition screening, or have the same completed and an official form signed by a physician. A medical and diet history will also need to be completed for each person applying.
As a supplementary program, WIC does not provide all foods, but has selected foods that are both economical and provide specific nutrients as supplements to the diet. WIC provides the following: milk, cheese, eggs, iron-fortified cereal, frozen juice, dried beans, peanut butter, and infant formula. All items might not be available for all WIC clients, but instead they may purchase the foods in the specific amounts indicated on the voucher obtained from the clinic. WIC dieticians issue vouchers indicating which foods and in which amounts may be obtained after an evaluation of the client’s health and needs.
There are numerous other guidelines pertaining to the program which also must be observed in order for someone to remain with WIC. Any violation of WIC guidelines can result in an individual’s removal from the program (refer to figure3). There is no specific time limit to which someone may receive WIC benefits, just as long as they meet the requirements.
Once someone qualifies for WIC, they must do two things: 1) every two months, attend a 45 minute class taught by a WIC dietician. Classes cover a variety of subjects and are taught in Spanish on a regular basis. At this time participants receive their food vouchers. 2) Every six months each participant will also meet with a WIC dietician. At this time the dietician will check to assure that the participant continues to meet the 3 criteria for qualification (nutritional, financial, and residential). They will also check the growth of the child/children and give nutritional consultation. These appointments last about 1 ½ hours and are also offered in Spanish.
Overall, many efforts have been made to serve Hispanic women and children as they participate in WIC. Additional services offered through WIC including breastfeeding support, literature, application forms, videos, recipes, etc…are available in Spanish as well. Marilyn Walton, director of the Provo WIC clinic, mentioned that all four WIC clinics in Utah County have someone on staff who speaks Spanish at all times. In addition, each clinic also schedules days and times when there are an increased number of clinician staff who speak Spanish available in order to more efficiently serve Hispanic clients. In total there are 9 WIC dieticians and 5-6 office staff members, spread throughout the four clinics in Utah County, who speak Spanish fluently (personal interview, August 8, 2003).
Solutions and Conclusions: Increasing Hispanic WIC Beneficiaries
In general, WIC clinics and programs in Utah County seem well organized to adeptly serve Hispanic participants and there are many women, infants, and children enjoying better health because of the services they receive from WIC. Yet the question remains, what can be done to reach more who are in need?
At this time there are not any efforts within WIC to advertise the program publicly. Currently, most new clients are the result of referrals from two sources: 1) other low or no-cost health programs (Baby your Baby, Medicaid, food stamps, etc… WIC also provides referrals to these programs) and, 2) friends and family of current or past WIC participants. The later trend is especially noticed within the Hispanic community. Fortunately, many of those who are eligible are reached in these ways and according to Christie Hinton, the Utah County WIC program is near its maximum capacity with respect to funding at this time. However, Hinton also feels that there are many, especially within the Hispanic population who are not aware of WIC or who feel that they would not qualify, even though they are in need of WIC’s benefits. Hinton believes that programs to promote WIC publicly would be beneficial (personal interview, August 8 2003). For the purpose of the following proposals, it will be assumed that WIC funding and resources (clinics, dieticians, etc…) would be sufficient to handle and influx of new participants.
Many may be surprised by the income requirements for WIC eligibility. In Utah County, the average household size is approximately four persons. In order to qualify for WIC financially, a household of four must make less than $33,485 annually (Utah County Health Department, 2002). According to the 2000 census, nearly 13% of total Utah County residents would meet the financial requirement and could possibly benefit from WIC (U.S. Census Bureau, 2000). Many with incomes low enough to qualify may believe otherwise, and still others may not even be aware of WIC. This is a general observation which would most assuredly be found within the Hispanic population as well.
Because many Hispanics are not native to Utah County, or even the United States, they may be even less aware of what WIC is, compared to someone who has lived in the United States for a longer amount of time. Advertising directed toward the Hispanic community, in a general attempt to let them know that a supplemental nutrition program for women and children is even available, might be the first step. This should be designed with the target population, Hispanic women, in mind. Informative posters in Spanish promoting WIC could be placed in locations where women frequent- the check stands of grocery stores and drug stores, or on buses for example. Radio advertisements could also be produced. In order to assure that these efforts would reach the target population, the locations would need to be strategic with some observation and planning beforehand to determine which stores and bus routes seem to have the most Hispanic customers. Obviously radio advertisements would be placed on Hispanic radio stations. These would simply be efforts to let Hispanic women know that they and their children may qualify for a supplemental nutrition program and encourage them to find out if they do.