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Implementing calcium supplementation projects based on lessons learned from iron and folic acid supplementation

Pregnancy places tremendous demands on a mother’s body and complications during this time can have serious consequences and can sometimes be fatal. Every day around the world approximately 800 women die because of pregnancy and child birth related complications. One of the leading causes of such deaths are the hypertensive disorders pre-eclampsia and eclampsia. Currently there is only one strategy recommended by the World Health Organization (WHO) for prevention of pre-eclampsia: calcium supplementation.

The WHO recommends:
“In areas where dietary calcium intake is low, calcium supplementation during pregnancy (at doses of 1.5–2.0 g elemental calcium/day) is recommended for the prevention of pre-eclampsia in all women, but especially those at high risk of developing pre-eclampsia”.

Research has shown that, for women deficient in calcium, calcium supplements can reduce their risk of developing pre-eclampsia. For women at high risk of developing the disorder, the risk can be reduced by 78 percent. Read the WHO’s Guideline on Calcium supplementation in pregnant women for more information.

At this time, there is little information to help policy and program planners or health professionals determine how to put the WHO recommendations on calcium into practice in communities. Many of the challenges calcium supplementation programs face, such as poorly functioning supply chains, late contact with pregnant women, and low compliance, are similar to the challenges faced by iron and folic acid (IFA) supplementation programming. 

To address these challenges, the Micronutrient Initiative is undertaking an in-depth operations research project with Cornell University and implementing partners in Ethiopia and Kenya. The project is determining optimal prenatal calcium supplementation program details such as acceptability, dosages and frequency, appropriate delivery platforms and sources of social support, effective communication strategies, and training for service providers. The project takes lessons learned from previous IFA programming and incorporates calcium supplementation into strengthened IFA programs. The fact that Ethiopia and Kenya have very different methods of delivering prenatal care will provide evidence applicable to many other countries interested in adopting calcium supplementation recommendations and strengthening their IFA programs.

To learn more about these two vital interventions for women, read our FAQs on Lessons from IFA supplementation and their application to potential calcium supplementation initiatives and Calcium supplementation for prevention of pre-eclampsia in pregnancy.