Ethiopia

Summary: Phase 3. Scale-up delivery at the national or sub-national level  

While the country has made commendable progress in reducing childhood stunting and wasting and in promoting exclusive breastfeeding practices, maternal undernutrition and anemia remain pressing concerns, According to the WHO, the Global Health Observatory, the national prevalence of anemia among pregnant women in Ethiopia was 26.2% (675,400) in 2023, with regional disparities reaching as high as 41.9% in some regions. Additionally, 21.3% of women were underweight in 2022. The compounded effects of anemia and poor living conditions during pregnancy extend beyond maternal health, significantly affecting neonatal outcomes. 

Despite national guidelines recommending daily iron and folic acid (IFA) supplementation for six months during pregnancy, in 2022, only 17% pregnant women received IFA for 90 or more days during pregnancy. This low coverage is likely linked to limited antenatal care (ANC) access, with only 53% of pregnant women who attended 4 or more ANC visits according to Ethiopia Demographic and Health Survey 2024–25 report.

Nutrition International’s policy brief laid out a compelling investment case for transitioning from IFA to Multiple Micronutrient Supplements (MMS). In Ethiopia, the transition from IFA to MMS is expected to avert 1,561,983 disability-adjusted life years (DALYs) over 10 years, prevent the deaths of an additional 19,677 children and yield benefits that are 177 times greater than the cost. Thus, MMS is not only safe and effective but also highly cost-efficient, aligning with WHO guidelines for cost-effectiveness and offering a high return on investment.

MMS was incorporated into the country’s updated Antenatal Care (ANC) guidelines in 2022, which now recommends its use “when feasible.” This language reflects a gradual policy shift from Iron and Folic Acid (IFA) supplementation toward MMS in antenatal services. To support this transition, a costed implementation roadmap has been developed. Concurrently, efforts are underway to register the United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP) formulation with the Food and Drug Authority and to include it in Ethiopia’s Essential Medicines List. The government has also initiated several foundational activities, including the establishment of an MMS Task Force and a Technical Advisory Group, both designed to guide and facilitate the transition from IFA to MMS.

(Source: HMHB Survey 2025, HMHB Survey 2021 – 2023, and 2nd Africa Maternal and MMS Meeting Report 2024, NutriDash)

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Summary: Phase 4. Sustained scale-up & integration

In Ethiopia, BEP is included in the health system and in the social protection programme, with support provided from visible/confirmed pregnancy until delivery. The BEP products provided include ready-to-use supplements (e.g., LNS-PLW) and fortified blended foods or fortified cereals (e.g., CSB Plus); for more details refer to the UNICEF Supply Catalogue. A national protocol for treatment of undernourishment during pregnancy exists and a national multi-sectoral nutrition coordination platform is in place.

Source: HMHB Survey 2025

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