{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T18:50:37Z","timestamp":1789757437143,"version":"4.0.1"},"reference-count":73,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Gates Foundation","doi-asserted-by":"publisher","award":["INV-042338"],"award-info":[{"award-number":["INV-042338"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"award":["INV-042338"],"award-info":[{"award-number":["INV-042338"]}],"id":[{"id":"https:\/\/ror.org\/0456r8d26","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008627","name":"Global Affairs Canada","doi-asserted-by":"crossref","award":["P005253"],"award-info":[{"award-number":["P005253"]}],"id":[{"id":"10.13039\/501100008627","id-type":"DOI","asserted-by":"crossref"}]},{"award":["P005253"],"award-info":[{"award-number":["P005253"]}],"id":[{"id":"https:\/\/ror.org\/0427vvt16","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Globally, momentum is building around antenatal multiple micronutrient supplementation (MMS), with evidence that it is as effective as iron\u2013folic acid supplementation in preventing maternal anemia and more effective in improving birth outcomes. In line with the World Health Organization 2020 recommendation and as part of a broader implementation research project, this study examines MMS acceptability, pregnant women (PW)\u2019s adherence practices and experiences, and facilitators and barriers to acceptability, adherence, and provision of MMS within public ANC services in Pakistan and Nigeria. Methods: Following introduction of MMS by the Government of Pakistan in April 2022 (Swabi District) and the Government of Nigeria in December 2023 (Bauchi State), mixed-methods research was conducted using cross-sectional surveys (one in each country), focus group discussions (6 in Pakistan, 9 in Nigeria), and in-depth interviews (7 in Pakistan, 10 in Nigeria) with PW, family members, and facility- and community-based healthcare providers (HCPs). Results: Findings in both settings showed that MMS is widely accepted, and almost all women (&gt;97%) started consuming the MMS they received. Adherence levels, assessed using both pill-count and self-reported measures, exceeded 70%. In both countries, perceived benefits were identified as a key enabler to MMS acceptability and adherence among PW, whereas perceived negative effects acted as a barrier. Facilitators of MMS provision included trusting relationships between PW and HCPs, while delayed antenatal care (ANC) initiation, anemia screening, and limited agency of PW were identified as barriers. Conclusions: This study provides findings to inform MMS scale-up across public ANC platforms in two low- and middle-income countries and contributes to global evidence on context-specific considerations for MMS implementation.<\/jats:p>","DOI":"10.3390\/nu18071101","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T12:11:59Z","timestamp":1774872719000},"page":"1101","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Acceptability, Adherence, and Provision Through Antenatal Care: Evidence on Multiple Micronutrient Supplementation in Pakistan and Nigeria"],"prefix":"10.3390","volume":"18","author":[{"given":"Jennifer","family":"Busch-Hallen","sequence":"first","affiliation":[{"name":"Nutrition International, Ottawa, ON K2P 2K3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4866-5856","authenticated-orcid":false,"given":"Jennifer","family":"Ayoub","sequence":"additional","affiliation":[{"name":"Nutrition International, Ottawa, ON K2P 2K3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9608-1655","authenticated-orcid":false,"given":"Kimberly B.","family":"Harding","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shabina","family":"Raza","sequence":"additional","affiliation":[{"name":"Nutrition International, Islamabad 44000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9710-425X","authenticated-orcid":false,"given":"Osita","family":"Okonkwo","sequence":"additional","affiliation":[{"name":"Nutrition International, Abuja 900108, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babajide","family":"Adebisi","sequence":"additional","affiliation":[{"name":"Nutrition International, Abuja 900108, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3322-4479","authenticated-orcid":false,"given":"Loloah","family":"Chamoun","sequence":"additional","affiliation":[{"name":"Nutrition International, Ottawa, ON K2P 2K3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5574-9371","authenticated-orcid":false,"given":"Khawaja Masuood","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Nutrition Wing, Ministry of National Health Services, Regulations and Coordination, Government of Pakistan, Islamabad 45500, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fazal","family":"Majeed","sequence":"additional","affiliation":[{"name":"Directorate General Health Services and Integrated Health Program of Khyber Pakhutunkhwa, Peshawar 25000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul","family":"Latif","sequence":"additional","affiliation":[{"name":"District Health Office of Swabi, Swabi 23430, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ladidi","family":"Bako-Aiyegbusi","sequence":"additional","affiliation":[{"name":"Federal Ministry of Health and Social Welfare, Abuja 900242, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Uruakpa","sequence":"additional","affiliation":[{"name":"Federal Ministry of Health and Social Welfare, Abuja 900242, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Obasi","sequence":"additional","affiliation":[{"name":"National Primary Health Care Development Agency, Abuja 900103, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rilwanu","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Bauchi State Primary Health Care Development Board, Bauchi 740001, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asim Shahzad","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Nutrition International, Islamabad 44000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huma","family":"Habib","sequence":"additional","affiliation":[{"name":"Independent Researcher, Islamabad 25000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huma","family":"Chishti","sequence":"additional","affiliation":[{"name":"Nutrition International, Islamabad 44000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nkechinyere","family":"Adinoyi","sequence":"additional","affiliation":[{"name":"Nutrition International, Abuja 900108, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Ezeonu","sequence":"additional","affiliation":[{"name":"Nutrition International, Abuja 900108, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Anugwa","sequence":"additional","affiliation":[{"name":"Nutrition International, Abuja 900108, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3707-8218","authenticated-orcid":false,"given":"Lara","family":"Nasreddine","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El Solh, Beirut 11-0236, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Beckworth","sequence":"additional","affiliation":[{"name":"Red Kite Consulting, Saskatoon, SK S7L 0J8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Crossland","sequence":"additional","affiliation":[{"name":"Red Kite Consulting, Saskatoon, SK S7L 0J8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1925-9923","authenticated-orcid":false,"given":"Chowdhury","family":"Jalal","sequence":"additional","affiliation":[{"name":"Nutrition International, Ottawa, ON K2P 2K3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1497-5856","authenticated-orcid":false,"given":"Alison","family":"Greig","sequence":"additional","affiliation":[{"name":"Nutrition International, Ottawa, ON K2P 2K3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandana","family":"Arabi","sequence":"additional","affiliation":[{"name":"Nutrition International, Ottawa, ON K2P 2K3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah N.","family":"Rowe","sequence":"additional","affiliation":[{"name":"Nutrition International, Ottawa, ON K2P 2K3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1016\/S0140-6736(21)00394-9","article-title":"Revisiting maternal and child undernutrition in low-income and middle-income countries: Variable progress towards an unfinished agenda","volume":"397","author":"Victora","year":"2021","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1111\/nyas.14121","article-title":"Review of the evidence regarding the use of antenatal multiple micronutrient supplementation in low-and middle-income countries","volume":"1444","author":"Bourassa","year":"2019","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1038\/nrendo.2016.37","article-title":"Micronutrient deficiencies in pregnancy worldwide: Health effects and prevention","volume":"12","author":"Gernand","year":"2016","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_4","unstructured":"World Health Organization, Study Group on Iron Deficiency Anaemia, and World Health Organization (1959). Iron Deficiency Anaemia: Report of a Study Group, World Health Organization."},{"key":"ref_5","unstructured":"World Health Organization (2012). Guideline: Daily Iron and Folic Acid Supplementation in Pregnant Women, World Health Organization."},{"key":"ref_6","first-page":"166","article-title":"Expert Consensus on an Open-Access UNIMMAP MMS Product Specification: 2024 revision","volume":"1540","author":"Ajello","year":"2024","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e1090","DOI":"10.1016\/S2214-109X(17)30371-6","article-title":"Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality: A meta-analysis of individual patient data from 17 randomised trials in low-income and middle-income countries","volume":"5","author":"Smith","year":"2017","journal-title":"Lancet Glob. Health"},{"key":"ref_8","first-page":"CD004905","article-title":"Multiple-micronutrient supplementation for women during pregnancy","volume":"3","author":"Keats","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1111\/nyas.14132","article-title":"Replacing iron-folic acid with multiple micronutrient supplements among pregnant women in Bangladesh and Burkina Faso: Costs, impacts, and cost-effectiveness","volume":"1444","author":"Kumordzie","year":"2019","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1093\/jn\/nxz052","article-title":"Multiple micronutrient supplements are more cost-effective than iron and folic acid: Modeling results from 3 high-burden Asian countries","volume":"149","author":"Kashi","year":"2019","journal-title":"J. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1111\/nyas.14103","article-title":"The upper level: Examining the risk of excess micronutrient intake in pregnancy from antenatal supplements","volume":"1444","author":"Gernand","year":"2019","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/nyas.14088","article-title":"Benefits of supplementation with multiple micronutrients in pregnancy","volume":"1444","author":"Black","year":"2019","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e298","DOI":"10.1016\/S2214-109X(24)00449-2","article-title":"The effects of prenatal multiple micronutrient supplementation and small-quantity lipid-based nutrient supplementation on small vulnerable newborn types in low-income and middle-income countries: A meta-analysis of individual participant data","volume":"13","author":"Wang","year":"2025","journal-title":"Lancet Glob. Health"},{"key":"ref_14","unstructured":"World Health Organization (2020). WHO Antenatal Care Recommendations for a Positive Pregnancy Experience. Nutritional Interventions Update: Multiple Micronutrient Supplements During Pregnancy, World Health Organization."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1111\/nyas.14756","article-title":"Multiple micronutrient supplements versus iron-folic acid supplements and maternal anemia outcomes: An iron dose analysis","volume":"1512","author":"Gomes","year":"2022","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_16","unstructured":"Peters, D.H., Tran, N.T., and Adam, T. (2013). Implementation Research in Health: A Practical Guide, World Health Organization."},{"key":"ref_17","unstructured":"Tropical Disease Research (2025, February 03). Massive Open Online Course (MOOC) on Implementation Research: Infectious Diseases of Poverty. Available online: https:\/\/tdr.who.int\/home\/our-work\/strengthening-research-capacity\/massive-open-online-course-(mooc)-on-implementation-research."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e12532","DOI":"10.1111\/mcn.12532","article-title":"Barriers and enablers for iron folic acid (IFA) supplementation in pregnant women","volume":"14","author":"Siekmans","year":"2018","journal-title":"Matern. Child. Nutr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/S0140-6736(13)60937-X","article-title":"Maternal and child undernutrition and overweight in low-income and middle-income countries","volume":"382","author":"Black","year":"2013","journal-title":"Lancet"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1016\/S0140-6736(21)00568-7","article-title":"Mobilising evidence, data, and resources to achieve global maternal and child undernutrition targets and the Sustainable Development Goals: An agenda for action","volume":"397","author":"Heidkamp","year":"2021","journal-title":"Lancet"},{"key":"ref_21","unstructured":"National Institute of Population Studies (NIPS) [Pakistan], and ICF (2019). Pakistan Demographic and Health Survey 2017-18, ICF."},{"key":"ref_22","unstructured":"Ministry of National Health Services Regulations and Coordination, United Nations Children\u2019s Fund (UNICEF), and Aga Khan University (2018). Pakistan National Nutrition Survey 2018."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Fayehun, O., and Asa, S. (2020). Abnormal birth weight in urban Nigeria: An examination of related factors. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0242796"},{"key":"ref_24","unstructured":"National Population Commission (NPC), and ICF (2019). Nigeria Demographic and Health Survey 2018."},{"key":"ref_25","unstructured":"Federal Government of Nigeria (FGoN), and The International Institute of Tropical Agriculture (IITA) (2024). Nigeria National Food Consumption and Micronutrient Survey (NFCS-MN) 2021."},{"key":"ref_26","unstructured":"Ministry of National Health Services Regulations and Coordination, United Nations Children\u2019s Fund (UNICEF), and Nutrition International (2022). Iron Folic Acid (IFA) Bottleneck Analysis Report."},{"key":"ref_27","unstructured":"United Nations Global Marketplace (2025, November 27). Folic Acid Supply Chain Strengthening. Available online: https:\/\/www.ungm.org\/Public\/Notice\/80365?utm_source."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"100455","DOI":"10.1016\/j.advnut.2025.100455","article-title":"Contribution of maternal adherence to the effect of multiple micronutrient supplementation during pregnancy: A systematic review and individual participant data meta-analysis","volume":"16","author":"Smith","year":"2025","journal-title":"Adv. Nutr."},{"key":"ref_29","unstructured":"Ministry of National Health Services Regulations and Coordination, and United Nations Children\u2019s Fund (UNICEF) (2022). Pakistan Maternal Nutrition Strategy 2022\u20142027."},{"key":"ref_30","unstructured":"Nutrition International (2025, November 27). Multiple Micronutrient Supplementation Implementation Research in Nigeria: Optimizing Adherence to Maternal Multiple Micronutrient Supplementation. Available online: https:\/\/nutritionintl.org\/learning-resource\/mms-implementation-research-nigeria\/."},{"key":"ref_31","unstructured":"Federal Ministry of Health (2021). National Guidelines for the Prevention and Control of Micronutrient Deficiencies in Nigeria, Federal Ministry of Health."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Meh, C., Thind, A., Ryan, B., and Terry, A. (2019). Levels and determinants of maternal mortality in northern and southern Nigeria. BMC Pregnancy Childbirth, 19.","DOI":"10.1186\/s12884-019-2471-8"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1017\/S0001972014000795","article-title":"Articulations of belonging: The Politics of ethnic and religious pluralism in Bauchi and Gombe states, north-east Nigeria","volume":"85","author":"Higazi","year":"2015","journal-title":"Africa"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s12978-016-0140-1","article-title":"Health care seeking behaviours in pregnancy in rural Sindh, Pakistan: A qualitative study","volume":"13","author":"Qureshi","year":"2016","journal-title":"Reprod. Health"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Idris, I.B., Hamis, A.A., Bukhori, A.B.M., Hoong, D.C.C., Yusop, H., Shaharuddin, M.A.-A., Fauzi, N.A.F.A., and Kandayah, T. (2023). Women\u2019s autonomy in healthcare decision making: A systematic review. BMC Womens Health, 23.","DOI":"10.1186\/s12905-023-02792-4"},{"key":"ref_36","unstructured":"Pakistan Bureau of Statistics (2025, November 27). Khyber Pakhtunkhwa Insight: 7th Population and Housing Census, First Digital Census of Pakistan, Available online: https:\/\/www.pbs.gov.pk\/sites\/default\/files\/population\/2023\/material\/kp_insight.pdf."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Guest, G., and Namey, E. (2015). Mixed methods research. Public Health Research Methods, SAGE Publications.","DOI":"10.4135\/9781483398839"},{"key":"ref_38","unstructured":"Merriam, S., and Tisdell, E. (2015). Qualitative Research: A Guide to Design and Implementation, John Wiley & Sons. [4th ed.]."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1111\/j.1365-2648.2007.04559.x","article-title":"Combining individual interviews and focus groups to enhance data richness","volume":"62","author":"Lambert","year":"2008","journal-title":"J. Adv. Nurs."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1037\/qup0000196","article-title":"Conceptual and design thinking for thematic analysis","volume":"9","author":"Braun","year":"2022","journal-title":"Qual. Psychol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"100198","DOI":"10.1016\/j.glmedi.2025.100198","article-title":"Using thematic analysis in qualitative research","volume":"6","author":"Ahmed","year":"2025","journal-title":"J. Med. Surg. Public Health"},{"key":"ref_42","first-page":"e79495","article-title":"Compliance With Iron and Folic Acid Supplements Among Pregnant Women Attending Tertiary Care Hospital in the District of Peshawar","volume":"17","author":"Ummair","year":"2025","journal-title":"Cureus"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Fite, M.B., Roba, K.T., Oljira, L., Tura, A.K., and Yadeta, T.A. (2021). Compliance with Iron and Folic Acid Supplementation (IFAS) and associated factors among pregnant women in Sub-Saharan Africa: A systematic review and meta-analysis. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0249789"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Kissell, M.C., Pereira, C., Gomes, F., Woldesenbet, K., Tessema, M., Kelemu, H., Noor, R., Escubil, L., Panicker, A., and Mishra, A. (2025). Acceptability of Antenatal Multiple Micronutrient Supplementation (MMS) Compared to Iron and Folic Acid (IFA) Supplementation in Pregnant Individuals: A Narrative Review. Nutrients, 17.","DOI":"10.3390\/nu17182994"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e081359","DOI":"10.1136\/bmjopen-2023-081359","article-title":"Acceptance of multiple micronutrient supplementations (MMS) and iron and folic acid supplement utilisation among pregnant and lactating women in the rural part of Ethiopia, 2022: A cross-sectional study","volume":"15","author":"Abebe","year":"2025","journal-title":"BMJ Open"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Clermont, A., Kodish, S.R., Matar Seck, A., Salifou, A., Rosen, J., Grais, R.F., and Isanaka, S. (2018). Acceptability and utilization of three nutritional supplements during pregnancy: Findings from a longitudinal, mixed-methods study in Niger. Nutrients, 10.","DOI":"10.3390\/nu10081073"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1079\/PHN2005665","article-title":"Acceptability of multiple micronutrient supplements by pregnant and lactating women in Mali","volume":"8","author":"Aguayo","year":"2005","journal-title":"Public Health Nutr."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e13712","DOI":"10.1111\/mcn.13712","article-title":"Qualitative evaluation of a package of implementation strategies codesigned to support the introduction of multiple micronutrient supplementation (MMS) for pregnant women in Bamako, Mali","volume":"21","author":"Ba","year":"2025","journal-title":"Matern. Child Nutr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.ajcnut.2025.04.033","article-title":"Assessing the adherence and acceptability to iron and folic acid compared with multiple micronutrient supplements during pregnancy: A cluster-randomized noninferiority trial in Cambodia","volume":"122","author":"Sauer","year":"2025","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"103069","DOI":"10.1016\/j.cdnut.2024.103069","article-title":"Systems Trial of Antenatal Multiple Micronutrient Supplements (MMS) Versus Iron-Folic Acid in a UN Health Care System Serving Palestinian Camps in Jordan","volume":"8","author":"Horino","year":"2024","journal-title":"Curr. Dev. Nutr."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"17","DOI":"10.20473\/amnt.v8i1.2024.17-25","article-title":"A Comparison of Adherence Levels of Pregnant Women to Consuming Multiple Micronutrient Supplements and Iron Folic Acid at Mulyorejo Public Health Center, Surabaya","volume":"8","author":"Abidah","year":"2024","journal-title":"Amerta Nutr."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Khan, B.A.A., Mahmood, H., Ahmed, J.M., Anwar, B., Muhammad, A., and Jabeen, R. (2025). Exploring challenges in accessing primary healthcare for pregnant women in Pakistan: A qualitative descriptive study. BMC Health Serv. Res., 25.","DOI":"10.1186\/s12913-024-11637-1"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e076883","DOI":"10.1136\/bmjopen-2023-076883","article-title":"Systematic review and narrative synthesis of the key barriers and facilitators to the delivery and uptake of primary healthcare services to women in Pakistan","volume":"13","author":"Barlow","year":"2023","journal-title":"BMJ Open"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e12331","DOI":"10.1111\/mcn.12331","article-title":"Adherence partners are an acceptable behaviour change strategy to support calcium and iron-folic acid supplementation among pregnant women in Ethiopia and Kenya","volume":"13","author":"Martin","year":"2017","journal-title":"Matern. Child. Nutr."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Stawarz, K., Cox, A., and Blandford, A. (2016, January 24\u201325). Understanding the role of contextual cues in supporting the formation of medication-taking habits. Proceedings of the 2nd Behaviour Change Conference: Digital Health and Wellbeing, London, UK.","DOI":"10.1177\/2055207616678707"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Sauer, C., Sokchea, M., Sreang, S., Kroeun, H., Hun, V., Sen Gupta, A., Rattana, K., Chea, M., and Hoang, M.-A. (2026). Exploring Behavioral Interventions to Enhance Adherence to Multiple Micronutrient Supplementation Among Pregnant Women in Cambodia: A Mixed-Methods Study. Nutrients, 18.","DOI":"10.3390\/nu18040583"},{"key":"ref_57","first-page":"CD007754","article-title":"Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes","volume":"11","author":"Lassi","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_58","unstructured":"World Health Organization (2018). WHO Recommendations on Health Policy and System Support to Optimize Community Health Worker Programme, World Health Organization."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1016\/S0140-6736(13)60685-6","article-title":"Women\u2019s groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: A systematic review and meta-analysis","volume":"381","author":"Prost","year":"2013","journal-title":"Lancet"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"3556","DOI":"10.1038\/s41598-025-87957-x","article-title":"Effect of nutrition education and iron-folic acid supplementation on anemia among pregnant women in Ethiopia: A quasi-experimental study","volume":"15","author":"Anato","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e730","DOI":"10.1016\/S2214-109X(20)30104-2","article-title":"Effective coverage measurement in maternal, newborn, child, and adolescent health and nutrition: Progress, future prospects, and implications for quality health systems","volume":"8","author":"Marsh","year":"2020","journal-title":"Lancet Glob. Health"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e13809","DOI":"10.1111\/mcn.13809","article-title":"Piloting Multiple Micronutrient Supplementation Within the Routine Antenatal Care System in Ethiopia: Insights From Stakeholders","volume":"21","author":"Berhanu","year":"2025","journal-title":"Matern. Child Nutr."},{"key":"ref_63","unstructured":"UNICEF (2021). Interim Country-Level Decision-Making Guidance for Introducing Multiple Micronutrient Supplementation for Pregnant Women, UNICEF."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1186\/s13063-025-08906-7","article-title":"Multiple micronutrient supplementation for maternal anemia prevention (MMS-MAP): An individually randomized trial of higher-dose iron (60 mg, 45 mg) compared to low-dose iron (30 mg) in multiple micronutrient supplements in pregnancy","volume":"26","author":"Smith","year":"2025","journal-title":"Trials"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"e13745","DOI":"10.1111\/mcn.13745","article-title":"Exploring factors affecting adherence to multiple micronutrient supplementation during pregnancy in Cambodia: A qualitative analysis","volume":"21","author":"Hoang","year":"2025","journal-title":"Matern. Child Nutr."},{"key":"ref_66","first-page":"S79","article-title":"Implementing antenatal iron and folic acid supplementation programs: Barriers and enablers in 7 countries","volume":"7","author":"Siekmans","year":"2019","journal-title":"Glob. Health Sci. Pract."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Silubonde, T.M., Draper, C.E., Baumgartner, J., Ware, L.J., Smuts, C.M., and Norris, S.A. (2022). Barriers and facilitators of micronutrient supplementation among non-pregnant women of reproductive age in Johannesburg, South Africa. PLoS Glob. Public Health, 2.","DOI":"10.1371\/journal.pgph.0001310"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Nisar, Y.B., Alam, A., Aurangzeb, B., and Dibley, M.J. (2014). Perceptions of antenatal iron-folic acid supplements in urban and rural Pakistan: A qualitative study. BMC Pregnancy Childbirth, 14.","DOI":"10.1186\/1471-2393-14-344"},{"key":"ref_69","first-page":"105","article-title":"Socio-cultural factors of gender roles in women\u2019s healthcare utilization in Southwest Nigeria","volume":"3","author":"Azuh","year":"2015","journal-title":"Open J. Soc. Sci."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"319","DOI":"10.2147\/PPA.S498537","article-title":"Adherence definitions, measurement modalities, and psychometric properties in hiv, diabetes, and nutritional supplementation studies: A scoping review","volume":"19","author":"Burleson","year":"2025","journal-title":"Patient Prefer. Adherence"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1007\/s13142-015-0315-2","article-title":"Self-report measures of medication adherence behavior: Recommendations on optimal use","volume":"5","author":"Stirratt","year":"2015","journal-title":"Transl. Behav. Med."},{"key":"ref_72","unstructured":"BMGF, CIFF, ECF, and Kirk Humanitarian (2025, November 28). Healthier Pregnancies and Brighter Futures for Mothers and Babies. A Global Investment Roadmap for Multiple Micronutrient Supplementation. Available online: https:\/\/kirkhumanitarian.org\/wp-content\/uploads\/2024\/07\/MMS-Investment-Roadmap-Digital-B-1.pdf."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1017\/S1368980013000554","article-title":"Development and use of the generic WHO\/CDC logic model for vitamin and mineral interventions in public health programmes","volume":"17","year":"2014","journal-title":"Public Health Nutr."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/7\/1101\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T04:10:42Z","timestamp":1775103042000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/7\/1101"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,30]]},"references-count":73,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["nu18071101"],"URL":"https:\/\/doi.org\/10.3390\/nu18071101","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,30]]}}}