Over 32 million pregnant women around the world have anemia every year, a condition that limits the blood's capacity to transport oxygen to the body's cells.
This is a staggering number not only for women but also for their newborns. When a pregnant woman is undernourished, the growing fetus will compound the mother's health status as well as be impacted by that status.
The world is not ignorant to this critical health challenge, though progress to address it has been anemic to say the least.
Iron-folic acid (IFA) supplements have been recommended by the World Health Organization since 1968 to address maternal anemia and improve birth outcomes in the many countries where anemia is a public health concern.
Despite this recommendation, very few women are receiving and taking the recommended dose of IFA supplements during pregnancy, and anemia continues to have detrimental outcomes on maternal and child health.
However, with a recent increased focus on maternal and newborn health, iron-folic acid programs are starting to receive much needed attention by the global health community, including governments.
As IFA interventions are reprioritized as part of maternal health initiatives, the composition of the supplement itself is being reconsidered. Pregnant women may benefit from more than just iron and folic acid supplements, as the diets and environments that have put them at risk of anemia may also be contributing to suboptimal intakes of other micronutrients. For example, millions of pregnant women suffer from vitamin A deficiency, zinc, and iodine, suggesting supplements could help fill the dietary gaps at the same time.
Recent evidence has found that multiple micronutrient supplements may have additional benefits beyond those of IFA supplements, such as further reducing low birth weight and low-for-gestational age. An estimated 15 million babies are born of low birth weight each year, putting them at increased risk of neonatal mortality. In 2013, 4.6 million deaths occurred within the first year of life, with many of those occurring in the first month after birth. While this rate is on the decrease, it is definitely an area that must be addressed quickly and in consideration with maternal health.
There are many questions to explore as to how to best reach pregnant women for their health and for their newborns. Could MMS be part of the global solution?
Given the potential benefits in switching to multiple micronutrient supplements, it may seem obvious to recommend that countries make this transition; however, the financial, supply management, logistical implications for programs are huge, especially for many national IFA programs in developing countries that have struggled to achieve high coverage, timely uptake and adherence.
There will be issues for procurement, supply management, questions from health care workers and concerns from pregnant women in their families who may not feel they are at risk of anemia and give a low value to IFA.
The World Health Organization, UNICEF and the Micronutrient Initiative have convened a meeting of global technical and program experts to learn from the experiences with IFA and provide lessons learned and guidance for countries considering a shift to multiple micronutrient supplements.
The consultation will look at experiences from low, middle and high income countries, drawing on best practices in each. It will bring together leading experts to learn more about the possibilities of MMS.
It isn't enough to merely provide a product. Through our ongoing work we have learned to invest and develop innovative strategies that also encourage and support women to take the recommended supplements.
Whether or not the supplement contains IFA or Multiple Micronutrients, the benefits for moms and babies will be limited unless women have timely access to the supplements through respectful ante natal care or community-based delivery platforms.
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