# Maternal perspectives on Multiple Micronutrient Supplementation (MMS) in Indonesia: a cross-sectional study of knowledge, attitudes, and acceptance

## TL;DR

This study explores how pregnant women in Indonesia understand and accept multiple micronutrient supplements, finding that better knowledge leads to more positive attitudes and acceptance.

## Contribution

The study provides new insights into maternal perspectives on MMS in Indonesia, identifying key factors influencing knowledge, attitudes, and acceptance.

## Key findings

- Most participants had a positive attitude (90.1%) toward MMS.
- Higher education and income were associated with better knowledge and acceptance of MMS.
- Early antenatal education is crucial for improving informed acceptance of MMS.

## Abstract

Multiple Micronutrient Supplementation (MMS) is recommended globally to improve maternal nutrition and pregnancy outcomes. As Indonesia transitions from iron-folic acid to MMS, understanding the perspectives of pregnant women is critical for effective implementation. However, evidence on pregnant women’s perceptions and acceptance of MMS remains limited. This study aims to assess the levels and determinants of knowledge, attitude, and acceptance (KAA) of MMS among pregnant women in Indonesia.

A nationwide cross-sectional study was conducted using a validated online survey. Participants were recruited via digital outreach and midwife networks. Descriptive statistics and multivariable logistic regression were used to assess KAA levels and predictors, reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Most participants had a positive attitude (90.1%), 62.7% had good knowledge, and 66.5% reported high acceptance. Poor knowledge was less likely among women aged 25–34 (aOR: 0.27; CI: 0.08–0.89), those with junior high (aOR: 0.46; CI: 0.25–0.85), senior high (aOR: 0.28; CI: 0.16–0.49), or higher education (aOR: 0.32; CI: 0.18–0.57), incomes of 1–3 million (aOR: CI: 0.64; 0.42–0.98), 3–5 million (aOR: 0.56; CI: 0.34–0.87), or > 5 million (aOR: 0.52; CI: 0.33–0.83), and those in the first (aOR: 0.22; CI: 0.14–0.35) or second trimester (aOR: 0.30; CI: 0.20–0.45). Negative attitude was less likely with income of 3–5 million (aOR: 0.46; CI: 0.46–0.89), first (aOR: 0.09; CI: 0.02–0.39) or second trimester (aOR: 0.04; CI: 0.01–0.30), and good knowledge (aOR: 0.52; CI: 0.33–0.82), but more likely among employed women (aOR: 1.60; CI: 1.02–2.49). Low acceptance was more likely in the second trimester (aOR: 2.13; CI: 1.34–3.37), but less likely with good knowledge (aOR: 0.25; CI: 0.18–0.34).

While attitudes toward MMS were largely positive, gaps in knowledge and acceptance persist. Improving knowledge was consistently associated with better attitude and higher acceptance. Strengthening early antenatal education is essential to improving informed acceptance and effective integration of MMS into maternal care in Indonesia.

The online version contains supplementary material available at 10.1186/s12889-025-24885-5.