Negotiating shame versus dignity-based service provision and policymaking in the Women Infant & Children Public Health Nutrition and Breastfeeding Program

Background: Psychosocial meanings of wealth and poverty go beyond the material, with poverty defined as a shameful and corrosive social relation characterized by a lack of voice, disrespect, humiliation and reduced dignity and self-esteem. Little attention has been paid to the implications of the poverty/shame nexus for the design of effective anti-poverty measures – including policies directed at maternal and child health. 

Objectives: To investigate the perspectives and experiences of provider and recipients (“participants”) of WIC programs located in Massachusetts.

Methods: Data was collected through individual interviews with providers and recipients and through observation of participant-recipient interactions at intake sessions and activities at a WIC office operating out of a federally qualified health center in MA.

Findings: Our findings highlight the need for advanced training for WIC staff focused on respectful communication. We also note key themes around staff support, namely in the areas of clear and realistic work expectations (i.e. especially in the realm of paperwork and documentation), number of staff supported at the site, continuous training opportunities, and work/life balance. Shame-proofing modifications directed at recipients include more individualized/personalized follow-up by an assigned caseworker and attention to how discretion is used in food supplement decisions and the provision of nutritional education. 

Conclusion/Discussion: Shame is an important dimension to consider when developing and delivering measures around nutrition and food security. Attention to this dimension across the spectrum of professional practice will enhance the effectiveness of these measures by promoting human dignity and social cohesion.