Access to and Satisfaction with the Women, Infants, and Children (WIC) Program: Differences Across Race, Ethnicity, Income, and Urbanicity among Missouri Residents

Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal nutrition assistance program aiming to address food insecurity and improve health. Participation varies across marginalized groups (eg, Black, Hispanic, low-income, rural), likely due to WIC access barriers and satisfaction, limiting WIC's impact on health disparities. Objective: Assess WIC access and satisfaction across marginalized groups to understand determinants of WIC participation in Missouri, where food insecurity is high (11% overall, 12% Hispanic, 26% Black) and WIC participation low (41%). Methods: This cross-sectional study used data from the Missouri WIC Experience Survey (April 2022–June 2022). Bivariate and multivariate logistic regression assessed access (eg, clinic wait times, clinic hours, clinic location) and satisfaction (eg, nutrition education, meeting dietary needs, shopping experience) across race/ethnicity, income, and urbanicity. Results: The sample (n = 2232) consisted of 69% White, 16% Black, and 8% Hispanic WIC-eligible households. Most had monthly incomes of $4000 or less (69%) and 32% lived in rural areas. Black households had 75% higher odds of experiencing barriers compared to White households. Compared to urban households, rural households experienced 30% lower odds of being satisfied overall with WIC, but 75% higher odds of being satisfied with WIC meeting dietary needs. Hispanic households had 85% higher odds than White households of being satisfied with WIC. Conclusions: Findings offer considerations for addressing WIC access and satisfaction. WIC design and implementation should focus on barriers to access for Black households and improving overall satisfaction with WIC among rural and low-income households.