Globally, approximately two out of every three women of reproductive age have micronutrient deficiencies.[1] This is alarming because malnutrition during pregnancy has harmful consequences for the mother and her baby. Malnourished mothers are more likely to give birth to babies that are born too small or too soon. They are also more likely to have anemia, which increases the risk of preterm birth and postpartum hemorrhage, a leading cause of maternal death. In the eight Central America Integration System (SICA) members: Belize, Costa, Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama, and the Dominican Republic, an estimated 21% to 28% of pregnant women are anemic[2], 9% to 15% of babies are born with low weight,[3]and for every 1,000 babies born, 9 to 28 do not make it to their first birthday.[4]
Opportunities
For decades, countries around the world, including SICA members, have provided iron and folic acid (IFA) as the standard supplement to address malnutrition during pregnancy. However, more than 20 years of research has shown that the United Nations International Multiple Micronutrient Antenatal Preparation of multiple micronutrient supplements (UNIMMAP MMS), with 15 vitamins and minerals, is more effective than IFA in preventing babies from being born either too soon, too small, or stillborn.[5] Additionally, prevention of anemia during pregnancy with MMS is comparable to that of IFA.[6] Given this, many countries around the world are conducting implementation research to study the transition from IFA to MMS and are designing costed roadmaps for scale-up. Some SICA members are in the exploration phase of this transition.[7] The strong coordination among member states including the presence of the Council of Ministers of Health of Central America and the Dominican Republic (COMISCA) provides a unique opportunity to support this transition at the regional level.
MMS Landscape Analysis
In June 2025, The Eleanor Crook Foundation (ECF) signed a memorandum of understanding with the executive secretariat of COMISCA and the Instituto de Nutricion de Centro America y Panama (INCAP) to address maternal malnutrition through MMS in SICA countries. As part of this initiative, INCAP will begin by conducting an eight-country landscape analysis to understand IFA implementation (supply and delivery) and explore interest and opportunities to transition from IFA to MMS within national antenatal care platforms. The landscape analysis will cover all four pillars necessary for transition and scale-up: policy/regulatory, financing, quality product, and delivery channels.[8] Findings will be available in early 2026 and shared with COMISCA, ECF and other partners for further action.
For more information on MMS please visit: https://hmhb.micronutrientforum.org/
About the Partners
Eleanor Crook Foundation. A US-based private grant-making philanthropy incorporated in the state of Texas, has as its main objective the elimination of child deaths due to malnutrition. It achieves this through direct activities and by making grants to organizations to conduct advocacy, research, policy analysis, and scaling activities; as a registered charity under section 501(c)(3) of the US Tax Code, ECF neither conducts nor funds lobbying activities.Executive Secretariat of COMISCA. The permanent executive and technical body of the Council of Ministers of Health of Central America and the Dominican Republic (COMISCA), has as its main objective the implementation of the Council’s decisions, presidential mandates of the Central American Integration System (SICA), and other applicable technical and legal provisions. It also coordinates activities that promote the development of the regional integration process in the health sector, operationalizing regional efforts with the support of technical and operational entities, allowing for the formulation, discussion, collective validation, and consensus-building of technically sound proposals within its areas of competence.
INCAP. A non-profit and specialized regional institution in food and nutrition of the Central American Integration System (SICA), registered under the laws of the Central American and Dominican Republic Member States as established in its Basic Agreement committed to improving nutrition and health in Central America and the Dominican Republic. INCAP was established as a permanent technical entity with the purpose to contribute to the development of the nutrition science, and promote its practical application and to strengthen the technical capacity of the Central America and Dominican Republic Member States to solve the food and nutrition problems.
[1] Stevens et al. Micronutrient deficiencies among preschool-aged children and women of reproductive age worldwide: a pooled analysis of individual level data from population-representative surveys. Lancet Glob. Heal. 2022, 10 (11). https://pubmed.ncbi.nlm.nih.gov/36240826/
[2] WHO. “Anaemia in women of reproductive age (aged 15-49), prevalence (%), by pregnancy status.” Global Health Observatory data, https://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-anaemia-in-women-of-reproductive-age-(-). Accessed November 12, 2025.
[3] UNICEF. “Low Birthweight.” UNICEF Data, https://data.unicef.org/topic/nutrition/low-birthweight/. Accessed November 12, 2025.
[4] WHO. “Child deaths in infants, infant mortality rate (between birth and 11 months per 1000 live births).” Global Health Observatory data. https://www.who.int/data/gho/data/indicators/indicator-details/GHO/infant-mortality-rate-(probability-of-dying-between-birth-and-age-1-per-1000-live-births). Accessed November 12, 2025.
[5] Smith, E. R.et al. 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. Lancet Glob. Heal. 2017, 5 (11). https://pubmed.ncbi.nlm.nih.gov/29025632/
[6] Keats EC, Haider BA, Tam E, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2019 Mar 14;3(3):CD004905. doi: 10.1002/14651858.CD004905.pub6. PMID: 30873598; PMCID: PMC6418471.
[7] Healthy Mothers Healthy Babies. “World Map of Activities.” https://hmhb.micronutrientforum.org/world-map/. Accessed November 12, 2025.
[8] BMGF, CIFF, ECF, and Kirk Humanitarian. “Healthier Pregnancies and Brighter Futures for Mothers and Babies: A global investment roadmap for multiple micronutrient supplementation.” https://hmhb.micronutrientforum.org/knowledge-hub/mms-global-investment-roadmap/. Accessed November 12, 2025
