Project: Maternal Nutrition in Bangladesh

Nutrition International (NI) implemented a maternal iron and folic acid supplementation project in Bangladesh to increase adherence to IFA supplements (IFAS) among pregnant women. Nearly half (45.7%) of pregnant women in Bangladesh are anaemic (WHO Global Health Observatory, 2016). The project comprised multiple intervention components, including the use of Behaviour Change Communication (BCC) materials and Interpersonal Counselling (IPC) to encourage IFAS adherence, consultative meetings with the government of Bangladesh, strengthening the supply chain, and improving the capacity of field health workers through training on IFA supplementation. NI contracted Limestone Analytics to conduct an independent analysis of the IFA supplementation project and evaluate its cost-effectiveness.

Outcomes of our study: Our study found that community-level investments in health worker training are a cost-effective way to address demand and supply side barriers to IFAS consumption and adherence in Bangladesh. Even after adjusting for improvements in IFAS consumption observed in the comparison districts, adherence and consumption nearly doubled. The purpose of increasing IFAS adherence and consumption was to reduce maternal and infant mortality and morbidity. We found that NI’s Supplementation Project could achieve this goal at the cost of $56.69 USD per disability-adjusted life year (DALY) averted.

The work completed for this project builds on earlier work we completed with NI. While our first project focused on comparing the cost-effectiveness of two alternative maternal supplements (IFAS and MMS), this project highlights the importance of addressing adherence irrespective of what supplement is used.

Clients / Partners




  • Conducted a literature review on the effect of iron and folic acid in LMICs and evidence of IPC
  • Started data analysis
  • Conducted difference-in-differences regression to evaluate the impact of the NI Supplementation project in Bangladesh


Data and Cost-Effectiveness Analysis
  • Completed data analysis
  • Developed first iteration of a cost-effectiveness model in excel to evaluate the incremental cost-effectiveness of NI’s supplementation project in Bangladesh


Final Report
  • Presentation of findings at NI


Knowledge Translation
  • Development of dissemination materials
  • Manuscript development