Introducing Antenatal Multiple Micronutrient Supplements: Lessons Learned From Implementation Research in Bangladesh, Burkina Faso, Madagascar and Tanzania

Micronutrient deficiencies affect two-thirds of reproductive-age women globally, with pregnant women in low- and middle-income countries at higher risk due to greater nutritional needs and limited diets. Multiple micronutrient supplements (MMS) have shown greater benefits than iron-folic acid (IFA) during pregnancy, but WHO currently limits recommendations to humanitarian or research settings. This study synthesises experiences of implementation research designed to support and document the transition from IFA to MMS for pregnant women in Bangladesh, Burkina Faso, Madagascar and Tanzania, providing insights for scaling up MMS programming globally. This qualitative study used key informant interviews and reviews of key policies, proposals, and project materials. Purposive sampling identified 16 key informants involved in the project design, implementation, or funding at country, regional, or global levels. Semi-structured questionnaires guided discussions on themes including project planning, policy environment, community engagement, logistics, and monitoring. Qualitative descriptive analysis of interview transcripts and documents identified key themes and insights. Findings revealed context-specific successes and challenges in transitioning to MMS, highlighting the unique opportunity to strengthen antenatal care (ANC) systems. Key informants emphasised the importance of context specific situational analysis and tailored interventions, strong policy support, community engagement, robust supply chains, sustainable financing, effective monitoring systems, and collaboration among stakeholders. The experiences from this project contribute to the evidence base on MMS implementation. They demonstrate that the transition from IFA to MMS should be leveraged to enhance services and advocate for a health systems-wide approach, moving beyond isolated interventions, to foster more impactful and integrated improvements within ANC.