Multiple Micronutrient Supplements (MMS)

Multiple Micronutrient Supplements Program for Pregnant Women

A proper intake of energy, protein, vitamins and minerals is necessary to fulfill the increased needs of the mother and fetus during pregnancy. Deficiencies of micronutrients such as vitamin A, iron, iodine and folate are very common during pregnancy due to insufficient dietary intake of fruits, vegetables, meat, and dairy products. These deficiencies can negatively impact the health of a mother, her pregnancy, as well as the health and nutrition of the newborn baby. 

According to the National Micronutrient Survey in Bangladesh 2019-2020, 43% of the non-pregnant and non-lactating (NPNL) women had zinc deficiency, 30% iodine deficiency, 29% folate deficiency, and 14% iron deficiency. Alarmingly 70% of NPNL women lacked vitamin D, 20% vitamin B12 deficiency, and 29% had mild to severe anemia.

Evidence shows that the provision of Multiple Micronutrient Supplements (MMS) containing 15 essential vitamins and minerals as per United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP) has a highly impactful solution compared to Iron and Folic Acid (IFA) for pregnant women to reduce the Low Birth Weight (LBW) and Small for Gestational Age (SGA) rate. UNIMMAP formula has resulted in a 12% reduction in LBW and an 8% reduction in SGA in low and middle-income countries. Bangladesh has the highest prevalence of low birth weight children in the world at 28 % (UNICEF and WHO, 2019).

The Children Investment Fund Foundation (CIFF), a UK-based philanthropic organization, has assembled a consortium with Social Marketing Company(implementing partner), Global Alliance for Improve Nutrition (policy partner), Sight and Life (technical partner), icddr,b(evaluation partner) and Renata Ltd. (manufacturing partner)toimplement a project for reducing LBW in Bangladesh.The objective of the project is to develop a sustainable business model of MMS for pregnant women which will be affordable to all segments of the populationwith assured quality and accessible across the country.

SMC conducted a Knowledge, Attitude and Practice study to obtain insights from providers and consumersbefore launching the product in the market. The findings helped to understand the consumers’ willingness to pay and finalize the brand name, pack design, marketing plan and demand generation strategies.The brand name of MMS in Bangladesh is FullCare. Renata Limited has manufactured FullCarefor SMC following the Critical Good Manufacturing Practice guidelines of the pharmaceutical industry. The full course (180 tablets for 180 days) price of FullCare is Tk. 720.

SMC is implementing the MMS project in 62 Districts of 8 Divisions in Bangladesh (excluding 2 Districts -Bhola and Kurigram where UNICEF is piloting to test a Pro-Poor Model of MMS). SMC haslaunched FullCareon July 05, 2021. FullCarehas been made available to the outlets through its efficient sales forces based in 12 area offices located in strategic places across the country. At this stage, SMC is selling FullCare mostly through its Blue Star (private sector non-graduate medical health providers) and Green Star (private sector non-graduate public health product sellers) networks and gradually reaching other pharmacies throughout the country. SMC has its online-based electronic sales reporting system named ‘eSales’ which helps to analyze sales performances by staff, type of outlets, different locations etc. at any given point of time or any reference period. This technological platform helps to monitor and ensure smooth supply chain management of FullCare.

SMC is continuously building the capacity of its graduate and non-graduate Star network providers so that they can effectively counsel the pregnant mothers regarding MMS. Obstetrical and Gynecological Society of Bangladesh (OGSB) was engaged to provide training on FullCare to the Blue Star and Green Star Providers across the country.SMC is continuously organizing district level scientific seminars on FullCarewith Obstetricians and Gynecologists, relevant physicians and upazila-level health providerswho are offering services to pregnant women. In addition, field staff is organizing meetings with union-based Family Welfare Visitors and Sub-Assistant Community Medical Officersto orient them on FullCare. SMC is also supporting healthcare providers with the necessary information, education and communication materials.

SMC is creating awareness ofFullCare through its dispersed Star network providers throughout the country. Also, field staff are disseminating FullCare information among the potential users through the courtyard and interpersonal communicationsessions at the community in 104 upazilas.SMC is distributing different types of communication materials to promote and encourage pregnant women as apart of demand generation activities.Field staff are organizing courtyard sessions withpregnant women (called GorvobatiMa Shomabesh)in the community where importance of antenatal care, institutional delivery and necessity of taking FullCaretablets are discussed mostly by a graduate doctor. SMC organized several TV talk shows on pregnancy care and MMS on renowned National TV Channels. The discussants of the talk shows weremostly the relevant government officials, membersof OGSB and SMC. Talk shows were organizedas a part ofsensitization and creating a favorable policy environment to increase the use of MMS.

SMC also developed an interactive digital interface to follow up the FullCare users, send several pregnancy care messages and collect feedback from the users. This interface is operated by the SMC’s Tele-counseling unit. The graph shows quarterly sales of FullCare in blisters (10 tablets per blister) from July 2021 to September 2022. SMC sold nearly20 million blisters of FullCare from July 2021 – November 2022.

The introduction of FullCare is one of the important initiatives of SMC as a part of its nutritional life-cycle approach.FullCarewill contribute to reduce the nutritional deficiencies of pregnant women along with their fetuses. SMC is now in the phase of increasing nutritional products as a part of its strategies following life-cycle approach of nutrition to improve the nutritional status of different age groups.