This article was originally published in The News Pakistan on July 11, 2026.

Pakistan is pioneering a major shift in maternal nutrition that could transform the health of mothers and babies for generations. What is now needed is accelerated implementation and sustained momentum to ensure equitable access and support for all pregnant women.

The change? Moving from iron and folic acid supplementation (IFAS) to multiple micronutrient supplementation (MMS) through routine antenatal care. The transition is already underway in 33 districts under government leadership and backed by the Pakistan Maternal Nutrition Strategy (2022–2027), providing a clear pathway for national scale-up. Pakistan’s recent endorsement of the Ministerial Declaration on Scaling Up MMS for Maternal and Child Health further underscores this commitment.

This matters because women’s nutrition is one of Pakistan’s most urgent yet under-addressed public health challenges. Nearly half of women of reproductive age are anaemic, 80 per cent are deficient in vitamin D, and one in four lack vitamin A. These micronutrient deficiencies rarely exist in isolation. This silent crisis not only affects women’s health and wellbeing now, but its consequences will extend to the next generation. For women who enter pregnancy with these nutritional deficiencies, the risk of complications increases for both mother and newborn. Pakistan’s neonatal mortality rate stands at 36 per 1,000 live births; nearly one in four babies is born underweight and stunting remains widespread among children under five.

For decades, IFAS has been the standard antenatal intervention in Pakistan. While it has helped reduce iron deficiency anaemia, its overall impact has been constrained by low uptake and poor adherence among pregnant women. Evidence shows that MMS, which contains 15 essential vitamins and minerals, is as effective at preventing anaemia and significantly reduces the risks of low birthweight, preterm birth, and babies born too small for their gestational age. In simple terms, MMS protects both mothers and babies more comprehensively.

The economic case is just as compelling. Over a ten-year period, if MMS reaches one-third of pregnant women in Pakistan, it could avert more than 40,000 additional child deaths. The overall benefits of transitioning from IFAS to MMS are estimated to be more than 1,200 times the cost of replacing IFAS with MMS, according to Nutrition International’s MMS Cost-Benefit Tool. For Pakistan’s resource-constrained health system, this represents a clear investment in both human capital and long-term development outcomes.

In 2020, the WHO recommended that countries with high prevalence of nutrition deficiencies consider transitioning from IFAS to MMS in the context of rigorous research. It emphasised that such transitions should be deliberate, phased and embedded within existing health systems to ensure quality, continuity and long-term impact.

“The evidence showed that transitioning to MMS must not only be a commodity switch; it must be a shift in how antenatal care is delivered.

—Dr. Shabina Raza, Country Director, Pakistan

Pakistan does not need to look far for lessons. In fact, other countries can learn from us. In Swabi, Khyber Pakhtunkhwa, implementation research explored how to effectively deliver MMS through the existing health system. The evidence showed that transitioning to MMS must not only be a commodity switch; it must be a shift in how antenatal care is delivered. When MMS is integrated into routine antenatal care, supported by reliable supply, trained providers, and effective counselling, women are more likely to start and continue supplementation. Nearly all women who received MMS in Swabi, 97.4 per cent started taking it, while adherence levels exceeded 73 per cent, demonstrating strong acceptability and sustained use when MMS is delivered effectively through routine antenatal care.

The same evidence highlighted how common challenges, such as missed doses, perceived side effects, and social barriers, can be addressed through better program design, including more intentional follow-up and family engagement. As Pakistan gears up for MMS nationwide expansion, this evidence offers a critical opportunity to refine delivery strategies and strengthen implementation.

Efforts are now focused on strengthening readiness for scale.

A national roadmap is being developed to guide phased expansion and financing, alongside provincial costed implementation plans for operationalisation. Federal and provincial governments are leading this momentum with support from development partners. Nutrition International has been supporting this process across the continuum, from generating implementation evidence to early scale-up and policy alignment.

At this pivotal moment, the question is no longer whether Pakistan should make this shift, but how quickly it can ensure equitable and sustained access to MMS for every pregnant woman. This requires action on multiple fronts: stronger integration within antenatal care services; increased government ownership through domestic financing and adequate budget allocations for sustainability; and stronger health system readiness, including reliable supply chains, strengthened support for MMS adherence, and sustained community awareness.

Pakistan is already moving in the right direction through growing policy commitment and phased scale-up efforts. The focus must now be on accelerating and consolidating these gains so that current momentum translates into results. With sustained actions across these priorities, Pakistan is well positioned to move towards its maternal nutrition targets and deliver measurable improvements in maternal and child health.

Learn more about MMS and maternal nutrition. 

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