Prenatal vitamins get a fundraising boost at Nutrition for Growth summit

Multiple micronutrient supplements, or MMS — more commonly known as prenatal vitamins — are about to have their moment. For years, researchers and advocates have been pressing for more uptake in MMS, a combination of up to 15 essential vitamins and minerals given to pregnant women in the form of powders or pills. MMS improves the health of mothers and reduces the risk that the baby will be stillborn, born early, or have a low birth weight — problems that affect millions of mothers and babies annually because women lack essential nutrients during pregnancy. Now those efforts are getting a financing boost at the Nutrition for Growth summit in Paris this week, where governments, philanthropies, and development banks are gathered to make political and financial pledges for various interventions to prevent and treat malnutrition. The event marks the culmination of a monthslong global MMS fundraising effort. On Thursday, the Children’s Investment Fund Foundation, the Eleanor Crook Foundation, the Gates Foundation, and Kirk Humanitarian will announce more than $250 million in contributions to MMS. Kirk Humanitarian, a U.S. philanthropy, announced its $125 million piece of that commitment last year. They’re calling on other donors to join them in raising $1 billion by the United Nations General Assembly in September. “As traditional donor commitments falter, philanthropy must step up,” William Moore, the CEO of Eleanor Crook, wrote Devex in an email. “This isn’t charity; it’s an investment in human potential with returns that will benefit generations to come.” Eleanor Crook, which focuses on malnutrition, helped draft the $1.1 billion MMS investment road map launched nearly a year ago with a goal to reach 260 million women in 45 countries with MMS by the end of 2030. It seeks to raise $720 million from public and private donors. The remaining funds will need to come from domestic governments. “At N4G, it’s a unique opportunity to really mobilize the international community,” Yashodhara Rana, the organization’s director for policy and research for maternal and child nutrition, told Devex, calling MMS a “small but mighty intervention.” A combination of actions has MMS on the ascent in low- and middle-income countries. More than a dozen now have policies to provide MMS, and at least half a dozen more are exploring implementation. Researchers have gathered decades of evidence demonstrating that MMS is more effective than supplements containing iron and folic acid supplementation, or IFAS, which are more commonly taken among women in low- and middle-income countries, where the prevalence of maternal malnutrition and risk of child mortality are high. Advocates have promoted wider production of MMS in order to reduce prices and increase availability. MMS now cost less than two cents a tablet. They are considered a “best buy” in global health, with a $37 return for every $1 spent. And the World Health Organization added MMS to its list of essential medicines for pregnant women in 2021. MMS is essentially the same as the prenatal vitamins that are routinely prescribed to women in the global north at the outset of their pregnancies. But women in the global south rarely have access to them. In 1999, a collection of United Nations agencies developed a standard formulation, known as UNIMMAP MMS, containing 15 vitamins and minerals that address the deficiencies women in the global south often face. This includes anemia, caused by iron deficiencies, which can lead to post-partum hemorrhaging or low birthweight in infants. Countries have traditionally turned to IFAS to address these problems, even though MMS actually offers a broader range of essential nutrients alongside iron and folic acid. These include vitamin A and zinc, both of which are crucial to fetal development. “We came from a situation where there are very few global manufacturers of MMS, very few financiers of MMS, very many barriers in terms of policies,” Martin Mwangi, the program lead of the Healthy Mother Healthy Babies Consortium, told Devex. Hosted by the Micronutrient Forum, HMHB attempts to accelerate interventions that improve maternal and child nutrition. Over the past decade or so, that all began to change. The research underscoring the benefits of MMS has been particularly critical to spurring that shift. Rijuta Pandav, an advocacy and communications associate for the Micronutrient Forum, said there has been evidence for more than two decades of the benefits of MMS. And ongoing analyses have consistently shown that giving pregnant women MMS produces better outcomes for babies than IFAS, including reducing the number of babies born at a low birth weight, reducing the number of babies born early, and reducing stillbirths. “We reached out to experts in the field of maternal and child health to see how we could have the most impact on the greatest number of lives,” Spencer Kirk, the founder and managing director of Kirk Humanitarian, explained to Devex in an email. The answer was consistently MMS, he said. That research has spurred a second crucial development: Changes in global policy recommendations that called for shifting away from IFAS and toward MMS. “As traditional donor commitments falter, philanthropy must step up.” --— William Moore, CEO, Eleanor Crook Foundation As early as 2013, a series on maternal and child nutrition from the medical journal, The Lancet, was recommending replacing IFAS with MMS in some instances. Then, in 2021, the WHO added MMS to its model essential medicines list, as an antenatal supplement for pregnant women. Across the global south, policymakers look to the WHO’s list when determining what interventions to prioritize and purchase. “What we have seen is after the WHO onboarded MMS in the essential medicines list, countries have been busy taking it up at national level now and updating their essential medicines lists,” Mwangi said. “Usually, that means that then MMS can be budgeted for a national level, and that starts to unlock domestic financing.” And that speaks to a third critical development, he said, which was the gradual improvement in the affordability and availability of MMS, which meant countries could actually buy it. This follows a sustained campaign by the global nutrition community to encourage broader manufacturing of MMS, including by producers in the global south. In 2023, Kirk Humanitarian partnered with the Indonesian company Dexa Medica to expand production of MMS. A year later, the Bangladeshi government approved local production of MMS. With the support of international NGOs, South Africa and Nigeria are also preparing for production. All of which, Mwangi said, has added up to a situation where “it’s very affordable now for a country to procure.” In fact, UNICEF prices MMS at less than two cents per tablet. The Copenhagen Consensus, which looks to prioritize global health solutions, declared MMS one of the 12 best investments for global development in 2023. And there is evidence that MMS is more cost-effective in many settings than IFAS. Even at those low prices, though, advocates believe that funding is the final piece that needs to fall into place in order to encourage more countries to either take up MMS or to replace their IFAS services with MMS. That’s where N4G comes in. With his foundation’s pledge, Kirk said he wanted “to build upon growing momentum of MMS adoption.” Some $50 million of the Gates contribution and $34.4 million of Kirk Humanitarian’s earlier contribution are earmarked for the UNICEF-led Child Nutrition Fund, which will match the investments of national governments. Rana and others understand that this is a difficult funding environment, given the uncertainty around ongoing U.S. commitments to global health and nutrition under the Trump administration. Still, she said, “This is exactly the time to be doing this.” One benefit of investing in MMS, she highlighted, is that it represents a pathway to improving antenatal health services more broadly. “The intention is not just to switch a commodity,” she said. “I see this as a strengthening of the antenatal care system for effective delivery of MMS.” Rana said that advocates of MMS are also careful to emphasize that the current call for donations is meant to create a pathway to sustainability, where domestic governments take over the funding for what is a very affordable intervention. “We’ve made a lot of mistakes in global health, not having these conversations early on, not establishing shared expectations on a roadmap for governments to ramp up funding as donor funding decreases,” she said. This time they are trying to approach that differently by helping to facilitate a period when donor funding will help get programs in place and then preparing countries to take over. “Right now we’re seeing the maximum momentum that we’ve seen since MMS really came into the picture,” Pandav said.