Need to Improve Access to Micronutrient Supplements for Pregnant Women in Nigeria

Rebecca Ejifoma writes on the need to enhance access to Multiple Micronutrient Supplements, MMS, to reduce iron and folic acid deficiencies, and improve pregnancy outcomes, as Vitamin Angels advocate the full implementation of government policy to upscale MMS and its inclusion in the national Micronutrient Deficiency Control Guidelines

Pregnancy remains a reality that leaves women vulnerable and somewhat susceptible to communicable diseases like anaemia, especially women in underserved and far-to-reach communities. According to health experts. Hence, they warned that pregnant women are at a higher risk of iron and folic acid deficiencies. This is why good nutrition like MMS commonly referred to as prenatal multivitamins, is essential to improve maternal health and pregnancy outcomes.

Micronutrients Are Critical for Mothers, Babies

According to research, This is because pregnancy increases a woman’s energy, protein, and micronutrient needs – an average increase of 300 calories per day due to the rapid growth and development that occurs. These pregnant women in low and middle-income countries (LMICs) are said to be at increased risk of being deficient in multiple, critically important, micronutrients including vitamins A, C, D, E, BT (thiamine), B2 (riboflavin), B3 (niacin), B6, B12, folic acid and also in minerals like iron, zinc, iodine, copper, and selenium.

Speaking at a media engagement and capacity-building workshop on Multiple Micronutrient Supplements (MMS) in pregnancy in Lagos, the Country Director of Vitamin Angels Nigeria, Dr Francis Ohanyido sees micronutrients as critical for both mother and child. He, however, noted that inadequate nutrition can lead to critical health risks to the infant such as low birth weight, preterm delivery, and being born small for gestational age. And poor nutrition can also lead to serious maternal health outcomes and even to the death of the mother or her baby. “That is why the first 1,000 days of life of a child – from conception to age two – whatever the mother takes has an impact on the child including brain development.”

Effects of Poor Maternal Nutrition for Women, Children 

According to Ohanyido, malnourished women with severe anaemia are twice as likely to die during or shortly after childbirth. Adding, he said micronutrient deficiencies can have lifelong impacts on a child’s physical, mental, and emotional development. And due to COVID-19, rates of malnutrition in mothers and young children are predicted to rise sharply over the next three years.

He further outlined the consequences of inadequate food, health and care across a woman’s life which include low pre-pregnancy BM, anaemia and other micronutrient deficiencies, obstructed/prolonged labour, fatigue and impaired well-being, eclampsia and preeclampsia, impaired productivity and school performance, maternal mortality.

According to Ohanyido, many women lack access to nutritious diets and lack quality health and nutrition services globally. 170 women — one in 10 — of reproductive age are underweight. 570 million women — one in three of reproductive age are anaemic. 

Only 38 per cent of women receive over 90 iron folic acid (IFA) tablets during their pregnancy. Only 59 per cent of pregnant women attend four antenatal care (ANC) visits. Since 2016, WHO recommends eight ANC contacts, which further increases the gap. Each year, 20 million babies suffer from low birthweight (LBW), an early marker of poor maternal and foetal nutrition. 

Sadly, experts warned that inadequate food, health, and care in children can lead to short stature, impaired cognitive development, anaemia and other micronutrient deficiencies, fatigue and impaired well-being, and impaired productivity and school performance.

Hence the urgent need for MMS. “MMS has significant benefits compared to iron-folic acid,” he hinted. “MMS contains 15 micronutrients including iron and folic acid (IFA). And multiple micronutrient supplementation contains 15 essential vitamins and minerals for pregnant and nursing women and meets micronutrient requirements that poor diets cannot meet. The essential vitamins and minerals include Vitamin A, Vitamin D, Vitamin E, Vitamin C, Thiamin, Riboflavin, Niacin, Vitamin B6, Folic Acid, Vitamin B12, Copper, Iodine, Iron, Selenium, and Zinc.”

It is for this reason that Vitamins Angels is advocating full implementation of government policy to upscale MMS and its inclusion in the national Micronutrient Deficiency Control Guidelines. The country director added, “We are at that point in the nation where nutrition comes to the front burner of national discussions and everything we do including implementation to make Nigeria better. It is also important that our leaders understand this issue before us”.

He, however, conceded that one of the things Nigeria does is trying to scale up the implementation. “This is a formulation of multivitamins for pregnant women as identified by the United Nations that should help women who are going through pregnancy to have a better value in terms of nutrition for both them and their babies. 

He harped on the recommendation. “One thing that is very evident from science is that the first 1,000 days of life of the child – from conception to age two of the child – whatever the mother takes has an impact on the child including brain development. It’s important also that this nutrition is there for this woman who is the carrier of this passenger so that her nutritional level should be good.”

While noting that Nigeria currently uses iron and folic acid as supplements, Ohanyido said the causes of anaemia – beyond iron and folic acid deficiency is more than that. “That is why the world, especially the UN has felt countries must move towards the direction of using multiple micronutrients which have 15 micronutrients comprising vitamins and minerals. If we have to get the Nigeria that we want people to have to be healthy, it starts from conception; it starts from pregnancy that the woman should go to pregnancy with a good experience and a healthy outcome for her,” he emphasised.

MMS to Reduce the High Rate of MMR

A significant part of mortality in Nigeria is around maternal mortality rate and then infant mortality. One of the things that MMS does – from research compared to iron and folic acid – reduces stillbirth and has other advantages for the child in terms of good health in the first 1,000 days of life. It helps reduce the issues around even infection because if the mother is doing very well, she also passes it on to the child in terms of quality outcomes for the child. 

MMS also helps to give that supplementation in terms of the nutrient level the mother has been through during pregnancy. A lot of women who are going through pregnancies in Nigeria, especially in underserved communities are not reached. A lot of them don’t have the kind of food that will give them the gateway to good health. So we must introduce MMS and roll it out in a way that is accessible in Nigeria.

It is now for us stakeholders and the government to begin to chart a common course in terms of making sure that MMS is available. MMS will gradually replace iron and folic acid but the speed will depend on how much the government is willing to invest and how much the partners are willing to put into that to make it acceptable to everyone in Nigeria.

According to Vitamin Angels, improving maternal malnutrition is possible when we invest in women and deliver a package of evidence-based maternal nutrition interventions.

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