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

INTRODUCTION: 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 (LMICs) has been daily prenatal iron-folic acid (IFA) supplementation. While prenatal multiple micronutrient supplements (MMSs) 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.

METHODS: 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.

RESULTS: Replacing preventive antenatal IFA with MMS would avert 3 514 594 LBW births, 186 369 stillbirths and 218 914 female neonatal deaths over 5 years in these countries. Providing MMS to all pregnant women receiving at least one antenatal care visit averts 7 272 320 LBW, 473 471 stillbirths and 541 591 female neonatal deaths. The total cost of replacing IFA with MMS ranges from US$201.8 million to US$1.326 billion, equivalent to between 0.5% and 3.0% of current spending on efforts to reduce undernutrition. Using the most conservative estimate, this would generate US$7.19 billion in economic returns and a benefit-cost ratio greater than 10. The cost of averting a stillbirth or neonatal death ranges from US$497 to US$1306.

CONCLUSION: Replacing prenatal IFA with MMS cost-effectively generates large health benefits.