The slow progress on reducing global anemia, low birth weight, and stunting prevalence − and the approaching deadlines around the World Health Assembly Global 2025 targets − present an urgency to implement proven quality nutrition interventions for women.
There is so much more we can do to support access to such interventions, which can greatly improve the health and wellbeing of women and babies. One of these proven solutions is providing women in low and middle income countries (LMICs) with micronutrient supplementation, either iron and folic acid supplements (IFAS) or multiple micronutrient supplements (MMS) − a daily dose of 15 vitamins and minerals − during pregnancy.
According to emerging global evidence, MMS leads to additional improved birth outcomes compared to IFAS, may reduce the risk of stillbirths and neonatal deaths, and supports improved overall health and nutritional status of women. In addition, MMS is very cost-effective, with an unprecedented return on investment. So, should countries transition from IFAS to MMS?
Since 1968, IFAS has been recommended during pregnancy in LMICs to reduce the risk of low birth weight, maternal anemia, preterm birth, and other complications. Despite the new evidence in favor of transitioning to MMS – and support for MMS from the World Health Organization in populations with high prevalence of nutritional deficiencies − global guidance that clearly recommends such a transition is lacking. This has resulted in low levels of adoption and uptake of MMS as part of national health policies, even in contexts where the transition would result in more positive health outcomes. Nutritional International has been working closely with governments for more than a decade to strengthen the health systems and improve the coverage and adherence to IFAS among pregnant women, and is currently supporting 10 countries across Africa and Asia.
Many countries are now exploring the feasibility of transitioning from IFAS to MMS, and are asking for support in understanding the cost of MMS and value for money – and for tools they can use to make informed decisions.
In response to requests from governments for a guidance on both the financial impacts and health outcomes of the IFAS to MMS transition, Nutrition International partnered with Limestone Analytics to develop an innovative comprehensive and generalizable model for calculating the cost-effectiveness of transitioning from IFAS to MMS. This methodology was initially applied to three countries of high malnutrition burden in South Asia (Pakistan, India, and Bangladesh.)
The model was then used to develop the Nutrition International MMS Cost-Benefit Tool. This is an easy to use, online, knowledge translation tool that analyzes the value for money of transitioning to MMS and helps decision-makers to answer the policy question: “is antenatal MMS better value for money than IFAS?”
Currently, analyses are available for 12 countries in Africa and Asia. In all cases, the findings showed with high certainty that MMS is very cost-effective and generates additional positive health outcomes for infants compared to IFAS. The tool also allows countries to use their own data to generate a customized report.
The transition and scale-up of MMS is an opportunity not only to increase progress towards the WHA 2025 targets, but also to prioritize women’s nutrition as part of national nutrition and health programs and strengthen maternal nutrition globally.