Desk Review: A landscape analysis describing available antenatal services, the nutritional status of pregnant mothers, and maternal micronutrient supplementation (IFA/MMS) in Bauchi State, Nigeria was conducted by the Institute of Human Virology in Nigeria, on behalf of NI. It included a desk review of published and grey literature which gathered health and nutrition related information about pregnant women, pregnant adolescent girls and newborns’ health in Bauchi state.

Stakeholder Consultative Meetings: State and federal Technical Working Groups (TWGs) were established at project outset and will be convened quarterly and bi-annually (respectively) to guide all phases of the implementation research, MMD implementation, and translation of the results. These TWGs will also facilitate buy-in for this project and ensure findings are human-centered, aligned with current and emerging policies, research initiatives, best practices and relevant for institutionalization and scale-up in Nigeria.

Human-Centered Design Process: A woman-centered approach that uses human-centered design (HCD) with consideration of the importance of gender dynamics and diversity will be the cornerstone of this implementation research project’s approach. Putting women at the center to steer solutions, including mainstreaming gender, alongside improving service delivery, behavior change interventions, and building on existing public programming, are key components to making meaningful and sustainable improvements to adherence. From the outset, the design will be based on government priorities, resources, capacity, and scalability, and driven by the voices of women.

Gender Transformative Approach: Gender is a central part of this project. It will be mainstreamed across all its phases to measure and address gender-related barriers to MMS adherence and to better understand household dynamics and decision-making related to ANC and IFA.

Adaptive Implementation: MMS will be implemented in select LGAs in Bauchi state to serve as a testing ground for the implementation research on adherence. Ongoing monitoring and adaptive implementation will be an important component of this project. Regular meetings with pregnant women and their influencers will guide the roll-out of MMS and complement the findings from the routine monitoring and supportive supervision of healthcare providers.

Implementation Research: A cluster randomized control design will be used to evaluate the effectiveness of the adherence solutions (intervention arm) in terms of improving adherence compared against the MMS standard introduction package (control arm), while taking into consideration the current IFA supplementation provided through the government system (reference arm). It will also look at implementation research outcomes such as feasibility, scalability, equity and cost-effectiveness.