MIDIRS Essence > March 2010 > Midwifery News

Getting off to a healthy start

Originally posted on Mar 2010

Healthy Start is a UK-wide statutory scheme to improve the health of pregnant women and families on benefits or low incomes and pregnant under-18 year olds. Families who are supported by the scheme receive vouchers to spend on milk, fresh fruit and vegetables. Along with the vouchers they are also sent coupons which they can exchange for Healthy Start vitamins in their local area.

Healthy Start provides a nutritional safety net and encourages breastfeeding and healthy eating. PCTs and health boards are responsible for making vitamins available and, through voucher mailings, the scheme also provides ongoing health information on nutrition and breastfeeding as well as handy recipes, hints and tips.

Healthy Start provides:

- Vouchers which can be used to buy milk, fresh fruit and fresh vegetables:

• Pregnant women receive one voucher per week (worth £3.10)


• Babies under one receive two vouchers per week (worth £6.20)


• Each child aged between one and four receives one voucher per week (worth £3.10)

- Coupons which can be exchanged for Healthy Start vitamins:

• Women’s tablets containing vitamins C, D and folic acid


• Vitamin drops for children containing vitamins A, C and D

Focus on vitamins

Taking Healthy Start vitamin supplements while pregnant or breastfeeding can make a vital difference to those at risk of particular vitamin deficiencies.

The importance of vitamins:

Folic acid: This can help prevent neural tube defects (NTDs) such as spina bifida in unborn babies. It is very difficult to get enough folic acid from food alone so women trying to get pregnant, and pregnant women up until 12 weeks are advised to take 400mcg of folic acid a day. Folic acid is also important for cell formation, especially red blood cells.

Vitamin D: This is needed for the absorption of calcium and phosphorous. A deficiency can cause bone deformities in children and bone pain, tenderness and muscle weakness as a result of osteomalacia in adults. As sunlight is the main source of vitamin D, it’s hard to get enough, especially in winter.

All pregnant and breastfeeding mothers are advised to take supplements of 10mcg a day. Those who cover up for religious or cultural reasons and those with darker skin and younger women are particularly at risk. Taking a supplement during pregnancy will ensure a mother’s own requirement for vitamin D is met and will build adequate fetal stores and help prevent the development of rickets in children.

Vitamin C: Lower income families tend to have less vitamin C in their diet. Vitamin C protects cells and there is also evidence it can help the body absorb iron from food.

Vitamin A: This has a number of important functions – it helps with vision in dim light and also boosts immunity, as well as supporting healthy skin. Vitamin A is not recommended for pregnant women and is only contained in Healthy Start children’s drops.

Research and guidance

There are a number of recommendations and research studies which relate to Healthy Start:

Guidance from the Scientific Advisory Committee on Nutrition (SACN) states that Healthy Start vitamins can help to improve the health of children, pregnant women and new mothers. Vitamins can also help to provide adequate nutrition, avoid risk of deficiency and future illness.

See www.sacn.gov.uk for more information.

The National Institute for Health and Clinical Excellence (NICE) Public Health Guidance 11: Maternal and child nutrition contains a number of recommendations for health professionals working with women and young children that relate to Healthy Start. It states that health professionals should advise pregnant women, new mothers and families about suitable vitamin supplements to take, such as Healthy Start vitamins, and ensure they receive an application form as soon as possible.

The guidance makes specific recommendations on folic acid and vitamin D supplements during pregnancy and on vitamin A, C and D supplementation for young children.

The full guidance can be found at http://guidance.nice.org.uk/PH11

The role of the midwife

Midwives play an essential role in helping to educate pregnant women about breastfeeding, having a balanced diet and supporting them to lead a healthier lifestyle. This includes talking to them about the Healthy Start scheme.

Research shows that if a health professional introduces a beneficiary to the scheme they are more likely to understand the health benefits for both themselves and their child, and to make best use of their vouchers.

Midwives need to countersign Healthy Start application forms and are encouraged to use this as an opportunity to offer advice on breastfeeding and healthy eating when doing so.

Who qualifies?

Women from the 10th week of pregnancy and families with children under four qualify if the family is receiving:

• Income support


• Income based Job-seekers Allowance


• Income related Employment and Support Allowance


• Child Tax Credit without Working Tax Credit (except run-on) AND a family income of £16,040 (2009/10) or less.

All pregnant women who are under 18 years old when they apply will qualify until their baby is born. They can continue to get vouchers and vitamins through the scheme if they are in a family which meets the criteria above.

What do I do next?

• Find out how Healthy Start vitamins are distributed in your PCT.



• Order Healthy Start application forms (HS01) and materials to promote Healthy Start from www.healthystart.nhs.uk or by calling 0300 123 1002.



• Order the health professionals guide to Healthy Start (HS52) from www.healthystart.nhs.uk.



• Talk to those who might be eligible about the benefits of the scheme and encourage them to apply.



• Families can call 0845 607 6823 to see if they are eligible and to order an application form. They can also download a form from the Healthy Start website.



• The Healthy Start website has lots of useful information about the scheme and an interactive tutorial. You can also see what materials are being sent out to beneficiaries. Visit www.healthystart.nhs.uk

Department of Health | Photo Credit: Department of Health

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