Feasibility and Readiness for Scaling-Up Multiple Micronutrient Supplements in Nepal: A Qualitative Study Using the...

Micronutrient deficiencies in pregnancy remain a critical public health issue in Nepal, where iron-folic acid (IFA) supplementation alone has not fully addressed maternal and neonatal risks. Multiple micronutrient supplements (MMS) promise broader nutritional benefits; however, real-world guidance for their effective and equitable integration into routine maternal care is lacking. A qualitative study, guided by the ExpandNet scaling-up framework, was conducted from February to March 2025, including 28 focus group discussions with antenatal care (ANC) providers and female community health volunteers (FCHVs) and 40 key informant interviews with policymakers at different levels of the health system. Data was analyzed thematically to identify perceived facilitators and barriers to MMS adoption, institutionalization, and scale-up, and equitable implementation. Stakeholders viewed MMS as offering clear advantages over IFA, citing broader micronutrient coverage and fewer side effects that could improve adherence. However, they identified several system-level requirements for successful scale-up, including formal policy integration, sustainable financing, strengthened procurement and supply chains, and adequate storage capacity at facilities. FCHVs and ANC providers emphasized the need for clearer role definitions, improved training, and manageable counseling workloads. Persistent community-level barriers-such as concerns about tablet size, misconceptions about fetal growth, and low trust in free medicines-were seen as risks to equitable uptake. Respondents highlighted community engagement, culturally tailored counseling, and consistent support for FCHVs and ANC providers as essential to ensuring effective and equitable MMS adoption. Stakeholders in Nepal view MMS as a promising strategy to improve maternal and newborn nutrition, but its potential depends on strong policy commitment, adequate and sustainable financing, and community-centered implementation. Addressing product-related concerns, strengthening counseling and trust in public services, and ensuring uninterrupted supply chains are essential to MMS scale-up, including translating its introduction into equitable and meaningful gains in maternal and child nutrition.