National studies have long confirmed that a woman's participation in WIC from early in her pregnancy is associated with improved birth outcomes, including fewer preterm births, better birth weights, and fewer infant deaths.

The Institute of Medicine (IOM) reported over a decade ago that women who do not receive early and adequate prenatal care are more likely to deliver premature, growth retarded or low birth weight infants [see Notes and Data sources, below].

The IOM further reported that prenatal WIC participation is associated with significant nutritional and health benefits, as well as improved birth outcomes, and associated savings in healthcare expenditures, especially within the first 60 days after birth [see Notes and Data sources, below].  

Despite these important health and economic benefits, however, national studies have found that "a number of pregnant women delay enrollment [in WIC] until after [giving birth]", especially among households with higher incomes, and those with private insurance [USDA/ERS; see Data sources, below].

There are a number of additional, documented risk factors that impact timely enrollment in WIC, including the lack of transportation or childcare for older children, school or work schedules, family income being too high to qualify for WIC while the woman is still working, lack of familiarity with the Program and its eligibility criteria, lack of family or partner support, etc.

Socioeconomic factors that adversely impact the timing of WIC enrollment include young maternal age, non-white race, low maternal education, poverty, and single marital status [AAP & ACOG; see Data sources, below].  Too, the full impact of COVID on the provision of prenatal services has yet to be determined, beyond knowing of its negative effects nationwide.

Data review:

First Trimester Enrollment in WIC improved slowly over the early years of tracking this Program Outcome, approaching the target through the mid-2000s, then surpassing it through 2015.  By 2017, however, First Trimester Enrollment had dropped into the mid-high teens, and by 2020-2021, both first- and second-trimester enrollment had fallen further still, very possibly due to restrictions imposed by the coronavirus pandemic.  By nine months into 2022, the statewide average had fallen to 12.3%, and ranged, at the Local Agency level, from 0.0% to 29.4%.

These rates are significantly below the Healthy People (HP) 2010 & 2020 targets for prenatal care beginning in the first trimester of pregnancy - set at 90.0% & 77.9%, respectively - a reasonable proxy measure for WIC participation during the first trimester of pregnancy.  For 2030, Healthy People increased its 2020 target only slightly to 80.5% in the face of worsening data nationwide [see Notes on Healthy People, below].

CT WIC has served a monthly average of 2,500 - 3,000 pregnant women over the past three (3) years, with an average of 13% - 17% enrolling during their first trimester of pregnancy; the highest percentage (32% - 38%) enrolled in their second trimester during this period.

NOTES:

Data:  Connecticut WIC data are current as of year-end 2022 and are updated quarterly.  

Notes: 

• Data gap:  There is a data gap from December 2015 through March 2017 where the CT WIC Program had no access to data on this Performance Measure while the Program was building, then transitioning over to, a new Management Information System (MIS).
• The Institute of Medicine, or the IOM, is now known as the National Academy of Sciences, Engineering and Medicine - NASEM.
• National Healthy People Objectives:  HP2010:  16-6a. Prenatal care: beginning in first trimester; target = 90.0%.  HP2020:  MICH-10.1. Increase the proportion of pregnant women who receive prenatal care beginning in the first trimester; target = 77.9%.  HP2030:  MICH-08. Increase the proportion of pregnant women who receive early and adequate prenatal care; target = 80.5%.

Data sources: 

• USDA/FNS.  WIC Nutrition Risk Criteria #334 (Lack of or Inadequate Prenatal Care); 2011.
• IOM/NAS.  WIC Nutrition Risk Criteria:  A Scientific Assessment.  pp. 208-209, 2009.
• USDA/ERS.  WIC Participation Patterns.  US Department of Agriculture, Economic TResearch Service, Report Number 109.  45 pp, December 2010.
• American Academy of Pediatrics (AAP) and American College of Obstetrics and Gynecologists (ACOG).  Guidelines for Perinatal Care.  Washington, DC.
• Seeking Early Care:  The Role of Prenatal Care Advocates.  Medical Anthropology Quarterly.  14 (2):  127-137.

Primary role:  referrals to the WIC Program.

Principal partners:
- Local hospitals, medical clinics and healthcare providers; DSS (CT Department of Social Services - Medicaid/HUSKY A); community health centers (CHCs), school-based health centers (SBHC) and federally qualified health centers (FQHCs);
- Current and former WIC participants and their friends, family, neighbors and faith communities;
- Other health- and social-service programs that serve the state's low income population.

Funding agency:

- US Department of Agriculture (USDA) 

Use of social media and extensive networking and collaboration between WIC and other healthcare and social-service providers - as well as between current and former WIC participants and members of their own networks - are useful strategies for encouraging timely enrollment in WIC.

WIC also seeks to locate its clinic sites, and to adapt its clinic hours, to the locations and scheduling needs of local residents, including evening and/or weekend hours, with monthly clinics held at part-time satellite sites. The selection of WIC-authorized grocers, too, is accomplished with the numbers, schedules and distribution of WIC participants in mind.

State WIC Agency (CT Dept of Public Health):

• Monitor First Trimester Enrollment by WIC Site, as well as by participants' town of residence and race/ethnicity.  Monthly.
• Monitor access to clinic sites and to WIC-authorized vendors; adjust schedules and/or locations (budget permitting), as appropriate.  Ongoing.
• Ensure local WIC staff are as linguistically and culturally representative as possible of the population they serve.  Monitor annually.

State & Local WIC Agencies:

• Survey participants who enrolled in WIC later in their pregnancies to determine factor(s) that impacted their timing; implement new and/or revised outreach techniques, based on survey results.  Periodically.
• Update social media strategies and participant training/educational methodologies.  Periodically.
• Modify annual Local Agency plans as needed, based on program monitoring and evaluation results.  Ongoing.