Market update: multiple micronutrient supplements (MMS)
Multiple micronutrient supplements (MMS) are a safe, cost-effective intervention to improve the health and nutrition of pregnant women and their babies.
Last updated 1 September 2026.
Background
Micronutrient deficiencies during pregnancy can lead to serious health consequences for both mother and child, including insufficient weight gain, impaired foetal growth, cognitive impairments, birth defects, still birth and maternal death.
In 1999, UNICEF, the United Nations University and WHO developed the United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP), a standardized prenatal supplement containing 15 essential vitamins and minerals designed to support healthier pregnancies and better birth outcomes. The formulation sets clear quality specifications for all 15 ingredients, including test requirements, manufacturing standards aligned with UNICEF guidelines and unified labelling.
Daily supplementation of MMS is recommended in pregnancy to support maternal health and well-being, as well as foetal growth and development. It has been shown to significantly improve pregnancy outcomes, particularly where the prevalence of undernourished women is high, and is cost effective when compared to other pregnancy micronutrient supplements.
Highlights
Global need
Up to 89 million bottles of MMS are needed annually in low- and lower-middle-income countries by 2030 to meet the nutritional needs of pregnant women.
Though projected need is high, funded demand remains limited and largely donor driven. Only 41 million bottles are expected to be procured annually by 2030, leaving a gap of 48 million bottles.
The MMS market is at an early stage. UNICEF's strategy prioritizes localization, supplier diversification and price competitiveness to build a sustainable, long-term market. To support these goals, UNICEF launched a competitive tender in May 2026 to secure affordable prices and reduce delivery lead times through local procurement.
Demand and forecasting
Current estimates indicate that 89 million 180-tablet bottles of MMS will be needed annually by 2030 to cover all pregnant women in low- and lower-middle-income countries. Of this population, 75 million pregnant women could potentially be reached through antenatal care services. However, based on expected procurement activity, realistic donor commitments and the pace of country-level adoption, only 41 million bottles are expected to be procured annually by 2030, leaving a gap of 48 million bottles relative to total need.
Despite substantial projected need, budget-backed demand for MMS is currently dependent on partner contributions, country programme funding and emergency response mechanisms. To support sustainable uptake and scale-up, UNICEF and partners are working with governments to strengthen the enabling environment and policy landscape for MMS, ensure its full integration into the antenatal care platform, co-deliver it alongside other maternal nutrition interventions and strengthen systems through health worker training, capacity building and the development of training manuals and tools.
UNICEF is also supporting demand generation for MMS through social and behavioural change communication targeted at pregnant women, spouses, caregivers and community members. In parallel, UNICEF is working to ensure sustainable funding for MMS by leveraging domestic financing and advocating for the inclusion of MMS and maternal nutrition budget lines in state and national budgets. The Child Nutrition Fund is also being used to catalyse domestic financing for maternal nutrition.
UNICEF Supply Division develops a realistic supply planning forecast by collecting MMS demand data from countries, drawing on programme plans, funding information, procurement pipelines, stock levels and delivery data. This consolidated forecast is shared with industry to support production planning, procurement decisions and supply continuity. Forecasting is made challenging by the fact that government demand is difficult to predict and WHO has yet to recommend MMS for routine use in antenatal care.
UNICEF monitoring and procurement
UNICEF Supply Division has developed the Nutrition Crisis Dashboard, which provides insights into the procurement and demand status of MMS from both UNICEF and Kirk Humanitarian (contribution-in- kind), starting from 2024. The purpose of the dashboard is to ensure harmonization of demand creation with availability of supply.
The dashboard displays information on MMS forecasts, suppliers and deliveries to UNICEF country offices, and it enables visibility to relevant partners. The dashboard also provides programmatic information on countries’ pathway to scaling MMS use by pregnant women. The dashboard is accessible through a digital platform managed by UNICEF Supply Division, with access granted to relevant partners as needed.
In 2024, UNICEF introduced the bottle of 180-tablets, representing a full course of MMS for one pregnant woman following the first dedicated tender and establishment of Long-Term Arrangements (LTAs). Procurement grew significantly in 2024 and 2025, largely due to CIK donations from Kirk Humanitarian, which accounted for approximately 90 per cent of the US$40 million worth of total MMS procured over this period.
Two MMS presentations are currently available: blister packs of 30-tablets and bottles of 180-tablets. A 90-tablet bottle will also be available soon. While donor-funded supply has met most government demand to date, governments are increasingly showing interest in allocating budget to maternal nutrition programmes from 2026 onward, incentivized by the Child Nutrition Fund (CNF) Match Window.
The Match Window is a transformative financing mechanism that empowers national governments to mobilize a 1:1 match of domestic resources dedicated to procuring essential nutrition supplies. As of November 2025, 63 countries in Africa, Asia, the Middle East and Latin America are eligible to receive CNF support.
As the MMS market is still nascent, forward-looking projections on procurement and funding are still being developed and are not yet included in this edition. However, as the market matures, there will be greater visibility on supply, and funding is expected to evolve as countries become familiar with MMS and maternal nutrition programmes are strengthened. Demand is projected to increase in 2027.
Supply
UNICEF has historically maintained LTAs with manufacturers in Bangladesh, India, Denmark, Germany and the United States of America. This limited geographic concentration poses supply resilience risks as programme advocacy expands MMS across multiple countries. To address this, UNICEF issued a tender in May 2026 prioritizing localized procurement to reduce delivery times from six months to three or less, improve supply predictability and accelerate programme delivery. By 2027, UNICEF aims to qualify at least three additional regional or local producers, with no single supplier accounting for more than 50 per cent of annual UNICEF MMS volumes. Key markets targeted for localization include Indonesia, Pakistan and Nigeria, where current demand is projected to grow.
Products available through UNICEF
UNICEF has procured MMS since 2002, with a key focus since 2024 on accelerating its introduction and scale-up across countries, in line with UNICEF's Global Nutrition Strategy 2020–2030. UNICEF aims to support more than 100 countries in delivering supplementation in pregnancy, and 44 countries are currently implementing MMS programmes in both development and humanitarian contexts.
In 2024, UNICEF and partners launched an Acceleration Plan to Prevent Anaemia and Malnutrition in Women, aiming to fast-track delivery of essential nutrition services, including MMS, to 16 priority countries.
UNICEF has several MMS presentations in its standard material database, informed by 13 years of historical demand. Bottles of 180 and 90-tablets are expected to progressively replace the blister packs of 60 and bottles of 100-tablets that historically represent the majority of UNICEF procurement. The MMS Acceleration Plan standardizes around the BOT-180 presentation to provide micronutrients in the critical period of pregnancy where need is high, as well as supporting the transition from iron and folic acid (IFA).
UNICEF selects Good Manufacturing Practices (GMP) approved manufacturers competitively through tenders, typically over a period of two to three years. Several additional international manufacturers in the United States, Indonesia, India, Pakistan, Nigeria and China are actively developing MMS formulations and are at varying stages of product development and scale-up.
Price
Large-volume forward purchase agreements with manufacturers have already brought donor-funded MMS supply close to price parity with iron-folic acid (IFA), demonstrating that a lower benchmark price per 180-tablet bottle is achievable at scale. Replicating this price point across UNICEF's wider supplier base is still in progress. In the 2026 tender, UNICEF is exploring supplier-financing instruments, including volume-based pricing and sliding discount structures linked to cumulative procurement volume. These instruments are designed to help manufacturers bridge the gap between their offered price and the target price. That gap reflects higher input costs linked to the complexity of the 15-ingredient UNIMMAP formulation, as well as the need for larger production volumes to bring down unit costs for all suppliers.
A tender outcome is expected by the end of 2026, and achieving competitive tender pricing will be critical to closing the remaining affordability gap. A 50 per cent reduction through CNF price matching provides a strong incentive for countries to allocate domestic funding. These efforts are complemented by localization strategies that support the gradual government ownership of MMS programmes.
Sustainability
UNICEF’s sustainable procurement approach integrates social, economic and environmental criteria into MMS sourcing. The revised organization-wide Procedure on Sustainable Procurement makes sustainability mandatory in tenders, and the MMS Request for Proposal (RFP) requires proposers to submit company environmental and social policies as part of the technical dossier, with alignment to the UN Supplier Code of Conduct.
Local production in countries with high demand is central to both the economic and environmental dimensions of sustainability. Producers are also encouraged to minimize secondary and tertiary packaging waste, while maintaining product stability under Zone IVb climatic conditions which are typically characterized by hot and humid environments that place greater demands on packaging and storage.
UNICEF and partners
UNICEF works closely with a range of global partners to introduce, advocate for and scale up the delivery of MMS as the standard of care for antenatal supplementation in low- and middle-income countries. Key partners include Kirk Humanitarian, Gates Foundation, and Child Nutrition Fund partners including Mohammed Bin Rashid Al-Maktoum Global Initiatives, Children’s Investment Fund Foundation (CIFF), Women's Tennis Foundation and Latter-Day Saints Church.
Issues and challenges
- Demand forecasting: Roughly half of UNICEF's forecast is not yet backed by secured financing due to unpredictable government demand, the coexistence of donation and procured supply pathways that require greater coordination in forecasting efforts, and the absence of a WHO recommendation for routine MMS use.
- Price competitiveness: The complexity of the 15-ingredient formulation makes price parity with traditional anti-anaemia products difficult to achieve without incentives.
- Supplier concentration: LTA holders are in Europe, North America and Bangladesh, leaving high-burden countries in Africa and Southeast Asia distant from manufacturing.
- Regulatory complexity: Country-specific registration requirements and pharmacopoeial standards create technical and quality barriers for manufacturers and procurers.
- Quality and regulatory classification: Dietary supplements represent the third-largest market segment for vitamins and minerals after animal feed and food. In many countries, dietary supplements are regulated as foods, which do not require the same level of evidence for quality, safety and efficacy as products regulated as medicines. MMS used in UNICEF programmes must meet pharmacopeial-grade ingredient requirements, with stricter limits for contaminants and more rigorous manufacturing controls. These higher quality expectations can create barriers for manufacturers seeking qualification and a lack of harmonization between regulators.
- Donor concentration: Kirk Humanitarian's in-kind donations and forward purchase agreements have been instrumental in establishing the MMS market and driving down prices, but continued market growth will also benefit from a broader base of funding over time.
- Limited WHO guidance: The absence of a broader policy classification continues to suppress demand signals and limits the commitments needed to drive market expansion.
Steps forward
- UNICEF has issued a new global RFP in 2026, establishing LTAs for 24+24+12 months, targeting supplier diversification.
- To support MMS policy adoption, UNICEF will advocate for its inclusion in national essential medicines lists, clinical guidelines and government financing mechanisms.
- Together with partners, UNICEF will continue implementation research and demand generation, working towards reaching 260 million pregnant women with MMS by 2030.
- Technical assistance will be provided to emerging manufacturers in high-burden regions to build a diversified supplier base.
- Advocacy efforts will continue for a WHO recommendation update to expand MMS into routine maternal health programmes globally.
For more information, please contact:
Gideon Chelule
Contracts Manager
UNICEF Supply Division
[email protected]
