Assessing Market Demand for Weekly Iron and Folic Acid Supplementation and Factors Affecting Scale Up

Weekly Iron and Folic Acid (WIFA) Supplementation is a World Health Organization (WHO) recommended program for adolescent girls and women of reproductive age, but very few national programs are delivering the WHO-recommended supplement at scale. R4D supported Nutrition International (NI) in assessing potential market demand and the factors affecting scale-up of these programs, to inform future activities by NI and their partners in this space.


The Challenge

Iron-deficiency anemia and neural tube defects are two common conditions that result from nutritional deficiencies and increase the risk of poor maternal and infant birth outcomes and impair healthy child development. Iron-deficiency anemia, a condition driven by malnutrition and acute or chronic infections, affects approximately 2 billion people worldwide1.  Left untreated, anemia can increase risks of premature delivery, maternal and child mortality and infectious diseases2.  Meanwhile, women with folic acid deficiencies are more likely to give birth to babies with neural tube defects, or birth defects of the brain, spine, or spinal cord. Neural tube defects are a major cause of neonatal morbidity and mortality3, with nearly 300,000 babies affected by defects worldwide born each year.

The Opportunity

Since 2011, the World Health Organization (WHO) has recommended weekly iron and folic acid (WIFA) supplement programs targeted at adolescent girls and women of reproductive age (WRA), with a formulation consisting of 60 mg of elemental iron and 2800 µg of folic acid. Despite the WHO recommendation, WIFA programs for adolescent girls and WRA have not yet scaled widely. Understanding the processes of procurement, regulation, and delivery of supplements as well as an understanding of country context can help program implementers and donors understand the feasibility and country readiness for WIFA. This understanding can also help program implementers and donors consider the costs and benefits of scaling up existing WIFA programs or implementing new WIFA programs.

Our Work

In 2018, R4D partnered with Nutrition International to assess the potential market demand for a WIFA supplement of the WHO-recommended 60 mg iron and 2800 µg folic acid. R4D’s assessment aimed to understand 1) factors affecting scale-up of WIFA programs for adolescents and WRA using existing iron and folic acid formulations, and 2) demand-side barriers to adoption of the WHO-recommended WIFA formulation. The analysis focused on nine Nutrition International focus countries: India, Indonesia, Bangladesh, Pakistan, Ethiopia, Tanzania, Senegal, Kenya and Nigeria. Through a combination of document review and key stakeholder interviews at the global and country levels, R4D analyzed potential demand-side barriers to WIFA program scale-up with respect to several key topics: funding; political will; regulation; procurement; delivery platforms; program acceptability; user experiences. R4D also estimated potential market size scenarios through 2030 if global and national stakeholders were to address those barriers to a greater or lesser extent. R4D shared findings with NI in Ottawa in April 2018, as an input into NI’s strategic deliberations on priority actions in this space.



1 WHO, “Micronutrient Deficiencies: Iron Deficiency Anaemia,” accessed March 6, 2018,

2 Nutritional Anaemias: Tools for Effective Prevention and Control (Geneva: WHO, 2017).

3 Mustafa A. Salih, Waleed R. Murshid, and Mohammed Z. Seidahmed, “Epidemiology, Prenatal Management, and Prevention of Neural Tube Defects,” Saudi Medical Journal 35, no. Suppl 1 (2014): S15–28.

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