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Multiple Micronutrient Supplementation

MMS is efficacious, safe, cost-effective, and affordable.

Over the past five decades, iron and folic acid (IFA) supplementation has become a core component of antenatal care for pregnant women around the globe. While iron and folic acid are critical nutrients, we now know that they are not the only nutrients that pregnant women may need to support their health and the health of their child.

The United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP) is an established multiple micronutrient formulation containing 15 vitamins and minerals, including iron and folic acid in recommended dosages.

More than 20 years of research provided clear evidence that multiple micronutrient supplementation (MMS) is more effective than IFA supplementation to prevent adverse birth outcomes. The past two years have seen progress in MMS policy development and implementation research in a number of countries. Now is the time to accelerate implementation and address key issues such as ensuring effective and equitable coverage and a sustainable supply of high-quality, affordable MMS.


Compared to IFA supplementation, MMS better ensures that babies are born healthy, and it has the greatest benefits when taken by malnourished women.


The 2020 Nutritional interventions update to the WHO antenatal care recommendations for a positive pregnancy experience recommends the use of MMS containing iron and folic acid in the context of rigorous research.

The WHO guideline is based on the 2019 Cochrane review of clinical trials comparing MMS to IFA alone, and a further analysis on a subset of that only used the UNIMMAP-MMS formulation in comparison with IFA. This analysis showed:

  • Maternal anemia: UNIMMAP-MMS containing 30 mg of iron offer similar benefits on maternal anemia compared with IFA (containing 30mg or 60mg of iron).
  • Low Birth Weight (LBW): UNIMMAP-MMS reduce the risk of LBW by 13% in comparison with IFA.
  • Small-for-Gestational-Age (SGA): UNIMMAP-MMS reduce the risk of being born SGA by 9% in comparison with IFA.

Furthermore, a meta-analysis by Smith et al., 2017 found similar results as above but also included a number of sub-group analyses demonstrating significant additional benefits of MMS:



A transition from IFA to MMS will require focused, collective action from stakeholders across the globe, and it will result in real, multi-generational, much-needed impacts.