Writing recently in the journal Nutrition, policymakers who attended the Second Africa Maternal Nutrition and MMS Technical Meeting shared a framework for introducing and accelerating maternal nutrition interventions, particularly multiple micronutrient supplementation (MMS) for prenatal health.
The 2024 meeting was partly funded by Vitamin Angel Alliance.
“Vitamin Angels has played a leading role in advancing MMS introduction across the region,” said Lucy Kanya, PhD, Africa regional technical director at Vitamin Angels. “We are directly supporting national implementation efforts in countries like Uganda, Kenya (particularly in Makueni County), and Zambia. We also supplied MMS for key implementation research in Kenya and Uganda, helping generate the evidence needed for broader scale-up.”
Beyond these efforts, Vitamin Angels supports MMS distribution in several countries across Africa, including the Democratic Republic of Congo, Nigeria, and Malawi through partnerships with organizations like UNICEF.
Other funders of the meeting included the Children’s Investment Fund Foundation, Kirk Humanitarian, the Gates Foundation, Eleanor Crook Foundation, and Helen Keller International.
The MMS advantage
Multiple micronutrient supplementation (MMS) is a once daily nutritional supplement made from vitamins and minerals formulated for pregnant women. MMS also works as well to prevent anemia in pregnant women as iron and folic acid, reducing the risk of stillbirth, low birth weight, preterm birth and small for gestational age.
For women who begin pregnancy anemic, MMS can reduce six-month infant mortality by 29%. MMS can also lower the risk of giving birth to preterm infants. For mothers who consumed prenatal MMS, they gave birth to infants who grew healthier by 12 months of age as compared to those who took iron-folic acid. Those infants were less likely to experience stunting.
In 2021, the World Health Organization added MMS to its Essential Medicines List.
“Scaling up MMS to 90% coverage in lower middle-income countries has been projected to contribute to better educational attainment and economic success, with a cumulative increase in lifetime income of $18.1 billion,” the policymakers wrote. “Taken together, the overall evidence supports the need to adopt MMS as the standard antenatal supplementation intervention, which can be paired with other complementary interventions in certain contexts.”
Moving forward
The meeting called for several actions, including the establishment of national taskforces to include drug regulatory bodies, ministries of finance, health management information systems teams and supply chain experts to help create local MMS policies.
“Given that MMS programming is largely implemented via [African National Congress] platforms, a national taskforce or advisory group that includes appropriate representation from reproductive/maternal health stakeholders provides a forum for updating national guidelines and clinical protocols including those that need to be in place for treating anemia in the context of an MMS intervention, advising on the consumption of MMS during the postpartum period, and utilizing other supplements such as calcium alongside MMS,” the policymakers explained.
Additionally, they noted cultural norms should be addressed when trying to implement MMS. For example, health workers in Mali found it challenging to administer MMS when husbands of pregnant women were skeptical about the supplementation, perceiving it a drug. They thought medicines should not be taken during pregnancy.
Tailored training packages for midwives and other healthcare professionals, as well as counselling materials, are needed to address concerns and the perceived harm of MMS, the policy makers wrote.
“Over the past 18 months, we’ve seen meaningful momentum across multiple countries, with progress varying by context,” Dr. Kanya said. “In Kenya, the government has taken a significant step forward by launching a national MMS implementation research agenda and establishing a Technical Working Group to guide scale-up. At the sub-national level, Makueni County became a leader by officially launching the first public sector MMS program integrated into antenatal care, with support from Vitamin Angels.”
Uganda is also advancing with the ministry of health incrementally scaling MMS based on evidence generated through implementation research led by Vitamin Angels and Johns Hopkins University, alongside in-country partners, Dr. Kanya added.
In Malawi, its ministry of health, supported by UNICEF, is introducing MMS in five districts, with plans to expand further. Meanwhile, countries including Zambia, Ethiopia, Rwanda, Nigeria, Mali, Sierra Leone, and Senegal are progressing at different stages, from early planning to active implementation.
While shifts in U.S. foreign aid have created challenges across global health programs, partners throughout the ecosystem have stepped up to help sustain momentum, Vitamin Angels said. One notable partner is The Church of Jesus Christ of Latter-day Saints, whose support for Transforming Lives Through Nutrition—a consortium between Vitamin Angels, Helen Keller Intl, and iDE—has been instrumental in advancing MMS programs in several countries.
Several challenges remain, however. According to Vitamin Angels, long-term supply is a key concern, particularly given the current lack of MMS manufacturing capacity on the African continent. Policy adoption is also still limited, with relatively few countries formally including MMS in national guidelines.
“There is a continued need for context-specific research to identify effective, scalable implementation strategies,” Dr. Kanya said. “Additionally, questions around the current MMS formulation, such as iron dosage, highlight the importance of ongoing evidence generation and clear communication with policymakers. Addressing these challenges will be essential to ensuring sustainable, large-scale impact.”
Source: Nutrients. doi: 10.1016/j.nut.2025.112911. “Scaling up antenatal multiple micronutrient supplementation in Africa: A unified call for action”. Martin N. Mwangi et al.
