The simple solution closing the prenatal nutrition gap

Millions of pregnant women lack access to basic nutrition support. Multiple micronutrient supplements offer a low-cost, evidence-based way to improve maternal and newborn health globally.

Multiple micronutrient supplements improve maternal health, reduce the risk of low birth weight, and give newborns a stronger start in life. Photo: Charlie Cordero for Project HOPE, 2025

In December 2025, I visited a health clinic in Cúcuta, Colombia, a few kilometres from the Venezuelan border. As I stepped into the waiting area, a teenage girl emerged an exam room, her face tense as she waited to find out whether she was pregnant. Around her, the clinic was full of women and families who had crossed the border in search of care that is often out of reach at home.

When I spoke with the girl’s doctor a few minutes later, I asked what she wished she could offer her patients, like the teenage girl. Without hesitation, she said vitamins—something simple, yet often unavailable, that could make a life-changing difference for both mothers and their babies.

Malnutrition during pregnancy

It is estimated that more than 1 billion girls and women around the world are undernourished. This becomes especially dangerous during pregnancy, when higher levels of essential micronutrients like iron, folate, zinc, and iodine are needed for foetal development and maternal health.

When these micronutrient needs during pregnancy are not met, the consequences can be dire. Malnutrition contributes to one in five maternal deaths and nearly half of all deaths among children under five globally. It can also lead to complications such as preterm birth and low birth weight. In 2020 alone, one in every four newborns was born small and vulnerable. Poor maternal nutrition is also linked to impaired cognitive development, increased risk of chronic diseases later in life, and economic and social costs.

Malnutrition during pregnancy is a global issue. In Latin America, more than 17% of women of reproductive age are anaemic, and no country in the region is on course to meet the targets for low birth weight. Sub-Saharan Africa also faces disproportionate rates of malnutrition during pregnancy. In Ghana, more than 35% of women of reproductive age are anaemic, 14% of infants are born with low birth weight, and 17% of children under five are stunted. These numbers are even higher in Nigeria, where 38% of women of reproductive age are anaemic, and 32% of children under five are stunted.

An evidence-based solution

The good news is that this malnutrition crisis has a clear, evidence-based solution: multiple micronutrient supplements (MMS).

In low- and middle-income countries (LMICs), pregnant women and girls often receive iron and folic acid supplementation, if they receive anything at all. While helpful, these two nutrients are not enough to meet the full range of micronutrient needs during pregnancy. An MMS tablet, however, contains 15 essential vitamins and minerals, and when taken daily during pregnancy, it improves anaemia and is 13% more effective at reducing low birth weight than iron and folic acid alone. Among women who are anaemic, MMS reduces infant deaths by 29% and lowers the risk of babies being born too small by 19%.

MMS is also affordable. At less than US$0.02 per tablet, a full course during pregnancy costs approximately US$4 per woman. A US$1.1 billion investment roadmap produced by the Gates Foundation, Eleanor Crook Foundation, Kirk Humanitarian, and Children’s Investment Fund Foundation could: reach 260 million women by 2030, saving more than 500,000 lives; improve birth outcomes for over five million babies; or prevent anaemia in more than 15 million pregnant women.

For example, in Nigeria alone, it is estimated that investments in MMS could prevent more than two million cases of maternal anaemia and nearly 71,000 infant deaths.

For every US$1 invested in MMS, there is an estimated US$37 return in economic benefits. This is comparable to the economic benefits of vaccines, one of the most cost-effective global health interventions, which generate up to US$44 in economic benefits for every $1 invested.

Growing global consensus

More than 20 years of research has shown that MMS tablets are effective and affordable. The World Health Organization (WHO) now recommends them during pregnancy and has added MMS to its Model List of Essential Medicines, reflecting the growing global consensus on the importance of maternal nutrition. However, continued investments in strengthening health systems and improving the quality of antenatal care are necessary for scaling MMS implementation and use.

In countries like Ghana, where maternal anaemia and low birth weight remain persistent challenges, scaling MMS would require strengthening routine antenatal care systems, so supplements consistently reach women. This includes ensuring reliable supply chains, training health workers, integrating MMS into national guidelines, and supporting community outreach to improve uptake and adherence.

With the right investments and coordination from governments, donors, and partners, MMS tablets can be delivered through existing systems to reach the women who need them most and prevent thousands of avoidable maternal and newborn deaths.

Charting the path forward

The teenage girl who caught my eye in the clinic got her test results. What she may not get is the nutrition her pregnancy demands to thrive. We could change that, not just for her, but for millions of women facing the same challenges.

The evidence is clear: providing MMS improves maternal health, reduces the risk of low birth weight, and gives newborns a stronger start in life, all at a relatively low cost. All we need now is the commitment to deliver consistently.

By investing in MMS and strengthening the systems that connect women to care throughout pregnancy, we can ensure that a simple answer like “vitamins” is a standard part of care for every woman, everywhere.

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The opinions expressed are those of the author and do not necessarily reflect the position of Re:solve Global Health.

Katherine Mergen is a program specialist for policy and Latin America and Caribbean region at Project HOPE.