Rationale for the Study

Calcium supplementation has the potential to reduce adverse gestational outcomes by decreasing the risk of developing hypertensive disorders during pregnancy, which are associated with a significant number of maternal deaths and considerable risk of preterm birth.

Currently, there is little information to help policy and program planners or health professionals determine how to put the World Health Organization (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 iron and folic acid (IFA) supplementation programming challenges.

Nutrition International is undertaking an in-depth operations research project to address these challenges. This includes addressing key programmatic issues, such as dose, duration, frequency, packaging, delivery platforms, procurement, public communication, and training of service providers.

Findings from this study will be applicable to many other countries interested in using the final calcium supplementation recommendations and for strengthening their IFA programs.

As a leader in global nutrition, Nutrition International is working to improve maternal and newborn health by improving access to antenatal, obstetric and postnatal services for pregnant women at the community level, and helping to ensure more women use these services.

Project Objective

Provide guidance for the operationalization of World Health Organization’s recommendation for calcium supplementation during pregnancy by determining the optimal calcium program details such as dose, duration, frequency, packaging, delivery platforms, procurement, public communication, and training for service providers.

Region: North Kakamega, Kenya and Oromia, Ethiopia

Participants: More than 1,000 pregnant women


Key Components

  • Understand pregnant women and health providers’ knowledge, attitudes and practices related to supplementation during pregnancy
  • Trial of Improve Practices (TIPs) to determine women’s preferences for dosing regimen and type of supplement
  • Using national dietary intake data from Ethiopia, develop and pilot a screening tool to be used by health providers to determine whether to recommend calcium supplements to individual pregnant women
  • Propose adaptation to existing IFA counselling and promotion materials in Kenya to include calcium
  • In one sub-county in Kenya, pilot the implementation of calcium supplementation program


  • Promotion of calcium supplementation in pregnancy (provided at health facility)
  • Promotion of IFA supplementation in pregnancy