Healthy Start: The Use of Welfare Food Vouchers by Low-Income Parents in England

Abstract

The Healthy Start scheme provides food welfare to pregnant women and children under four years old in the UK. The Government provides vouchers to families living on a low income that can be exchanged for infant formula, plain cow's milk and fresh or frozen fruit and vegetables. This article reports on a qualitative study of parents using Healthy Start in England. Interviews were conducted with 107 parents from thirteen areas in England. Most found the scheme easy to use, but some vulnerable groups were unable to access the scheme. The vouchers provided a vital source of food at times of crisis, and put purchase of fruit and vegetables within reach for some. Parents reduced stigma by using self-service tills and by only visiting retailers known to accept the vouchers. Healthy Start provides additional protection by sitting outside of other social security benefits. To continue to provide this essential protection, their value should be reviewed and increased.

A realist review to explore how low-income pregnant women use food vouchers from the UK’s Healthy Start programme

“…Fifty full-text articles were excluded based on the assessment of relevance (n=33) or because they were not primary studies (n=15) or the findings were duplicated (n=2). Therefore, 38 primary studies were included in this review: four UK studies on Healthy Start 6 7 15 16 and 34 US studies on WIC 17–50 (see online PRISMA Flow Diagram and online supplementary file 1 ).…”

“…A total of 25 studies reported women’s nutritional outcomes: three studies on Healthy Start and 22 studies on WIC. The Healthy Start studies reported perceived outcomes only; some women said they consumed more cow’s milk, fruits and vegetables after receiving Healthy Start vouchers, 6 7 16 whereas other women said the vouchers ‘freed up money to do other things’ and ‘helped them to manage better financially’ (p 59). 7 The WIC studies were published between 1981 and 2015, but the most useful data was extracted from two studies comparing women’s diets before and after the 2009 WIC revisions when the ‘cash value vouchers’ for fruits and vegetables were introduced (there was no allowance for fresh fruits and vegetables before 2009).…”

“…Women who value healthy eating and aspire to eat well during pregnancy (context) 47 are more likely to perceive Healthy Start vouchers as an opportunity to achieve health benefits for themselves and their unborn baby (mechanism). 6 The vouchers alleviate the financial barrier associated with healthy eating and make healthy foods seem more affordable (mechanism). 6 Therefore, women who value healthy eating are more likely to prioritise healthy eating (mechanism) and use Healthy Start vouchers to increase consumption of target foods—fruits and vegetables or cow’s milk (outcome).…”

“…5 However, qualitative studies have indicated a range of experiences, motivations and perceived outcomes, with not all low-income women using the vouchers to improve their diets. 6 7 This review was undertaken to explore how low-income pregnant women use Healthy Start food vouchers, the potential impacts of the programme, which women might experience these impacts and why.…”

Has the UK Healthy Start voucher scheme been associated with an increased fruit and vegetable intake among target families? Analysis of Health Survey for England data, 2001–2014

“…Conversely, it has been demonstrated that people may compartmentalise spending, mentally allocating some income to specific products, even where there are no restrictions on elements of income 27. Some HS participants reported that the vouchers acted as a reminder of the importance of a healthy diet, and that they bought less F&V once they stopped receiving vouchers 28. In addition, participants reported that the vouchers enabled them to buy a wider range and quality of vegetables, something that may not result in a measurable increase in quantity of F&V consumed but is arguably a positive outcome 10 28.…”