PREGNANT women were missing-out on free fruit and vegetables in Scotland because of difficulties filling in forms.

A project in NHS Lothian discovered issues as simple as using the wrong colour ink to complete the paperwork meant mothers on benefits were not getting vouchers which can be exchanged for vitamins and healthy foods.

Midwives who misunderstood the process had also made it more complicated, according to the research.

The project, which guided midwives on what to do and referred eligible women to welfare rights advisors for help with applications, increased uptake of the vouchers by more than 13%. By going through their other entitlements the advisors ultimately boosted the family budgets of those involved by an average of £4,500.

Project leader Dr Graham Mackenzie, a consultant in public health medicine for NHS Lothian, said it was a "life-changing" sum of money.

He explained: "We know from midwives and welfare rights advisors that families are having to make very difficult decisions about feeding themselves, paying for their flats and paying for things many of us take for granted...

"This work has been feeding the brains and bodies of unborn children and that is invaluable really."

Healthy Start vouchers are available for low income families across the UK to help them eat well, but at least 25% of those who could use them miss out.

Dr Mackenzie's team began looking at the reasons why some pregnant women were not receiving the vouchers in one part of Edinburgh in 2014. He said: "When we worked with a very experienced midwife in one area which we identified had low uptake of these fruit and vitamin vouchers, we found this very experienced midwife had misunderstood some parts of the application process and built in extra steps that were not necessary."

Further research found half the midwives in the area had similarly over-complicated the process - for example delaying signing forms until late in the pregnancy in case the mother miscarried. His team disseminated information on how the midwives should handle the voucher applications, simplifying it .

However, the team also discovered about two-thirds of pregnant women struggled to complete their sections of the form.

Dr Mackenzie said applications were being rejected because the ink was the wrong colour, writing had strayed outside the printed boxes and the lower case had been used when capitals were required. Other problems included women being unable to read the form, their partners being reluctant to complete their section and people forgetting to post the document.

Dr Mackenzie said if they had attempted to try to improve the application process itself it would have taken years, so they focused on helping the women apply successfully.

They set up a system where all pregnant women in North Edinburgh who said they had money worries were automatically referred to Granton Information Centre. Advisors from the centre, funded by the Scottish Legal Aid Board, contacted the women and arranged to help them access the available support.

By rolling out their approach the team increased the number of women receiving Healthy Start food and vitamin vouchers in the Lothians overall by 13.3% at a time when voucher receipt fell 8.4% across the rest of Scotland.

A paper on the findings, which are described in the journal BMJ Quality Improvement Reports, says: "This work has demonstrated that low income pregnant women need support to apply for entitlements during pregnancy. Healthy Start is one of the simplest parts of the welfare system, but sign up was poorly understood and completed. Even when midwives had mastered their part of the sign up process, women frequently needed more support to complete the application."