Costs and benefits of replacing preventive antenatal iron and folic acid with multiple micronutrients in 25 low- and middle-income countries

Micronutrient deficiencies during pregnancy have serious consequences for both mother and child; thus, the longstanding standard of care in low- and low-middle income countries has been daily prenatal iron–folic acid (IFA) supplementation. While prenatal multiple micronutrient supplements (MMS) provide additional significant benefits in comparison to IFA supplements, the view that MMS is too expensive has hindered national MMS adoption. However, increased competition, volume procurement and the use of advanced purchase commitments have significantly reduced the cost of MMS.

Using new cost data, we estimate the benefits of replacing IFA with MMS in both health (averted low birth weights (LBWs), stillbirths and female neonatal mortality) and monetary (costs of averted LBW and death; total economic value; benefit–cost ratios) terms in 25 LMICs with the greatest burden of LBW. A number of scenarios describing different coverage and procurement cost scenarios are explored.