The evidence base for Multiple Micronutrient Supplementation (MMS) for pregnant women has been built up over 20 years and demonstrates that MMS significantly reduces the number of babies born with low birth weight, babies who are small for their gestational age or that are stillborn in low- and middle-income countries.
Replacing iron-folate supplementation with MMS provides an opportunity to strengthen nutrition-specific interventions provided during antenatal care (ANC) services in combination with other proven nutrition interventions such as dietary counseling for healthy eating and appropriate weight gain during pregnancy.
To provide a robust answer to feasibility and cost-effectiveness questions that policy and decision-makers may have, it is recommended to support the introduction of MMS with implementation research. This aligns with the WHO guidance that MMS implementation needs to be done in the context of rigorous research.
Implementing agencies that have started introducing MMS in national delivery platforms have in general followed a three-phased approach consisting of:
1) The Exploration phase aims to prepare an enabling environment for the introduction of MMS. It may consist of landscape analysis to understand the specific context and feasibility of introducing MMS, as well as advocacy activities leading to MMS policy recommendations and a consensus on the need and feasibility to introduce MMS at a small scale.
2) The Initial Implementation phase entails the actual introduction of MMS, to demonstrate its feasibility through a pilot in a specific context. Well-designed implementation research supports the development of efficient and effective implementation strategies to optimize coverage, acceptance, and utilization of MMS.
3) The Scale-up phase takes place when policymakers decide to scale up MMS implementation to the national or sub-national level, based on the results of the demonstration pilot. This requires robust planning and integration of the new intervention in the system’s processes.
The interactive map below aims to summarize the situation related to impact studies, implementation research, demonstration pilots, and scaling up activities at the country level.
The map will be regularly updated based on new information. You can help us and inform us about new developments here.
The map classifies countries into four categories in which category 1 indicates countries where an MMS impact study has taken place, but where (exploration of) MMS introduction is not yet happening. Categories 2 to 4 are consecutive implementation phases, with Category 2 including countries that are taking a first exploratory step to build the enabling environment, Category 3 including countries where initial implementation has started, and Category 4, the final step to scale-up delivery to the population of pregnant women with poor diets, high maternal undernutrition and high risk for babies born with low-birth-weight or being small-for-gestational-age, or stillbirths. In case an MMS impact study has taken place in countries of categories 2-4, this will be referenced on the country page.