Promoting Adherence to the Use of Multiple Micronutrient Supplements (MMS): Implementation Research Learnings from Community Field Trials in Ethiopia and Nigeria

Taking multiple micronutrient supplements (MMS) during pregnancy provides vitamins and minerals essential for a healthy pregnancy. In many countries, in accordance with WHO guidelines, MMS is beginning to replace iron folic acid (IFA), the standard of care for many years. Meta-analyses of randomized controlled trials show that, compared to IFA, pregnant women's consumption of at least 90 tablets of MMS leads to greater reductions in low birth weight, small-for-gestational-age births, and stillbirths, without increasing adverse effects, and with greater cost-effectiveness. For any country to make this transition effectively, frontline workers and pregnant women themselves must also be convinced about the necessity of taking MMS and motivated to do so. New products, of course, do not land in a cultural vacuum. Rather, when introduced in society, they can encounter resistance because of perceived barriers and uncertainty about the product itself. They can also upset the family power dynamics, and extant norms may serve as barriers to adoption. While evidence about the effectiveness of MMS is beginning to accumulate, less is known about factors that affect adherence to MMS guidelines. A broader understanding is needed about how environmental characteristics (e.g., political will), household dynamics (gender norms), product characteristics (taste or smell), and individual-level factors (self-efficacy) jointly affect adherence. This panel discusses these issues based on findings from two randomized trials promoting MMS (in Ethiopia and Nigeria), a qualitative study of the product itself, and the underlying human-centered design that informed the interventions.