Only 12 women were aged 20 years or under. To answer our research question concerning the potential contribution of food vouchers to reducing nutritional inequalities for women and young children, we present relevant findings under two major themes.
The first is accessibility of Healthy Start which subsumes the framework -themes of eligibility, awareness of the programme, and the application process. The second is the framework theme using food vouchers, which includes the sub-themes of influence of Healthy Start vouchers on food choices and accessing retail outlets. Direct quotes from participants are shown in italics. There was consensus across participants that the eligibility criteria were clear for families who were in receipt of qualifying welfare benefits.
Half of respondents to the online consultation thought that the criteria were about right while a third thought more women should be eligible. However, both women and practitioners said that the eligibility criteria relating to qualifying tax credits were confusing and that the household income threshold for families receiving tax credits was too low and discriminated against those in low paid work.
Comments included:. When I was working I was worse off. I get vouchers and other support. London workshop participant. So people on a low income have to cut back everything Sylheti-speaking focus group participant.
The system Healthy Start is not successful because I have five kids. My husband is self-employed-sometimes he has loads of work and sometimes we have to scrimp and sometimes he has no work. I want to be able to access the vouchers when my husband has no work Yorkshire and Humber workshop participant, rural. This was especially confusing for women under 18 years old because Healthy Start is a universal benefit for this group during pregnancy but is means-tested after birth and following their 18 th birthday.
I get working and child tax credits. I did get the vouchers when I was pregnant but after the baby was born they said the scheme was not available anymore. Many practitioners were concerned that those with uncertain immigration status e.
A key factor in whether eligible women register for Healthy Start and receive food vouchers is their awareness of the programme. Only a quarter of respondents to the online consultation thought that the women they saw were already aware of their eligibility for Healthy Start, highlighting the importance of practitioners giving women Healthy Start information. However, not all women were told about Healthy Start by their midwife or health visitor and a few women had not found out about Healthy Start until their child was over two years old.
Women did not appear to be aware of the scheme from other sources such as leaflets on benefits and tax credits or through government helplines when applying for benefits and tax credits.
This was particularly evident among women who did not speak English. Practitioners corroborated the difficulty of publicising Health Start to women who do not speak English and those with poor literacy, because of the lack of information in languages other than English or in non-written formats. Consequently some busy health practitioners, usually community midwives and health visitors public health nurses , targeted information to those they judged to be eligible.
However, many participants were concerned that eligible families were missed because incorrect assumptions were made about their economic circumstances or because their circumstances changed - just over half of consultation respondents agreed that they could easily identify women who were eligible, and some were reticent about asking women about their financial circumstances.
In addition, while most practitioners suggested their responsibility was to provide information about the programme, a minority viewed their role as gatekeepers of eligibility, expressing concern that some women may abuse the system. Many practitioners recommended that all women should be informed about Healthy Start and that awareness among the general population should be raised.
Biggest issue we are having is to differentiate between those not working [from those who are working] — all health professionals feel the same, nurses, doctors etc. According to the reports of women and practitioners, the barriers to registering for Healthy Start described in the previous sections were exacerbated by a cumbersome application process. Women who did not speak English or with poor literacy described problems with completing the application forms.
One Urdu-speaking participant brought a letter from the Healthy Start issuing department to the focus group because she could not understand it. Several women described applying once and being refused and applying a second time and being accepted and they did not understand the reasons for this. Some women assumed that if they did not hear from the issuing department it meant that they were ineligible whereas others had followed up their claims successfully.
I got the information and filled in the forms but I never got a reply back. Urdu-speaking focus group participant. In the week the vouchers come we can eat vegetables telephone interviewee from Traveller community. The majority of women reported that the vouchers enabled them to buy better quality and a greater variety of fruit and vegetables.
One woman from a Traveller community described how, when she no longer received vouchers, she could not experiment with different types of fruit because she could not afford waste. Many women said they would buy similar amounts of milk, fruit and vegetables even if they did not get the vouchers; however the vouchers helped them to manage better financially. Others reported that they bought less fruit and vegetables once the vouchers ceased. The vouchers were also said to provide a reminder of the need to eat a healthy diet, and to help establish good habits for the future.
Get your kids used to it and demand it of you London workshop participant. Several young mothers said that Healthy Start provided them with resources for food to which they would not otherwise have access. One young mother who lived with her parents said the food vouchers were the only income she had. A pregnant teenager described the impact of the vouchers on her diet and health. Yorkshire and Humber teenage workshop participant, urban. While many women and practitioners felt that the vouchers made a difference to family budgets, there was consensus that the voucher value should keep pace with the rising cost of food, so that the potential to improve family diets was not undermined.
A few women suggested that the money would be better added to welfare benefits instead of provided as food vouchers. However, others thought this risked the money not being spent on children.
This suggested the vouchers had more value to her than cash. Women who were formula feeding their babies spent all their vouchers on formula and commented that the vouchers did not cover the whole cost. There were different opinions among practitioners; some felt that allowing vouchers to be used for infant formula incentivised women to formula feed whereas others thought that women should have access to resources to feed their infants regardless of their infant feeding decisions.
Some of the latter group felt the value of the vouchers should be increased to cover the entire cost of infant formula. We are not health police and if mothers decide to formula feed that is their choice and they should have access to resources to feed their babies London practitioner focus group participant. Most women spent their vouchers at major supermarkets; for many this was the most convenient and cost-effective option. However, many women and practitioners highlighted problems with the range and location of retail outlets that accepted Healthy Start vouchers.
Location was a particular problem for families living in rural areas where visiting a supermarket could involve a lengthy and costly journey. Some women and practitioners suggested the vouchers should be valid for online shopping as an alternative. Rural area, some women have to travel up to 11 miles, often by bus, to spend vouchers - not cost effective. Many women would have preferred to spend their vouchers in small shops or market stalls but found most were not registered to redeem the vouchers.
Women from minority ethnic backgrounds suggested they could not find culturally acceptable fruit and vegetables in supermarkets and that local shops and market stalls were not registered. Shops [small independent retailers] would not want to get involved in the form-filling or probably they are not aware of the scheme. Sylheti-speaking focus group participant.
A related problem for many women was not knowing which retail outlets in their area were registered. Women were reluctant to ask shopkeepers because asking the question identified them as being poor and receiving benefits. This stigma could also be experienced in supermarkets as some women described feeling judged by retail staff or other customers. Practitioners were aware of these problems and while some were wary of the workload involved, others had successfully worked with local retailers to encourage them to register for Healthy Start.
It would be good if cheaper market stalls could take vouchers but would it be a lot of administration? It would make such a difference London practitioner focus group participant. Where there has been community buy-in for food outlets there have been real positives e.
Our results show that both beneficiaries and practitioners valued the contribution of Healthy Start food vouchers to improve the diets of pregnant women, mothers and young children under four years-old in low-income families. Women reported that food vouchers increased the quantity and range of fruit and vegetables eaten by them and their children.
This was said to improve the quality of family diets while receiving food vouchers and to establish good habits for the future. The influence of food vouchers appeared to have particular salience for teenage pregnant women who may not otherwise have had autonomy or access to resources to buy nutritious food. Thus our study supports findings from WIC that food vouchers increase intake of fruit and vegetables [ 5 , 41 ]. However participants highlighted concerns that could compromise the potential for Healthy Start vouchers to reduce nutritional inequalities.
For those eligible for the programme, barriers to registration meant that not all those who could benefit from food vouchers received them. These barriers included complex eligibility criteria that are difficult for women and health practitioners to understand, inappropriate targeting of information about the programme by health practitioners to those they judge to be eligible and low level of awareness of the programme among the general population.
Additionally a complex application process led to some potential beneficiaries losing out and caused delays in receiving time-limited vouchers for others.
Complex bureaucracy is a feature of means-tested benefits and often leads to low uptake and frequent administration errors as experienced by many of the participants in our study [ 49 ].
From our study, access to the programme was particularly challenging for several groups of eligible women. According to the CDC, one in ten babies is born premature, the leading cause of infant death. The Healthy Start Program was established in to work to improve birth outcomes in communities with high rates of infant mortality and other complications. Nav Search Submit. Search Close. Home Newsroom Press Releases. October 23, Print Email Like Tweet.
Pregnant women under 18 are also eligible, regardless of whether they receive benefits. The scheme includes food vouchers and vitamin supplements. Healthy Start was introduced in to replace the previous Welfare Food Scheme. The Healthy Start supplements for women contain vitamins C and D and folic acid. Vitamin C is included because of the strong social class gradient in intake. Vitamin D is included because of the increased need for it in pregnancy and while breastfeeding.
Women from minority ethnic groups may be at greater risk of deficiency 'Scientific review of the Welfare Food Scheme'.
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