When a pregnant woman in rural Ethiopia leaves a health center with a small packet of tablets in her hand, what she carries home can make the difference between a thriving baby and a missed opportunity. 

To ensure the former, human-centered design work led by the Johns Hopkins Center for Communication Programs and partners began with a simple question: How do we help women consistently take the daily dose of the prenatal micronutrient supplements they are given? 

Multiple micronutrient supplements, known as MMS, combine iron, folic acid and other essential vitamins and minerals into a single daily tablet. The combination helps fill nutrient gaps in pregnancy that single-nutrient tablets often miss. In low-resource settings, taking MMS during pregnancy can reduce the risk of anemia, support fetal growth, and improve birth outcomes. 

Through the Gates-funded Optimizing Adherence to Nutrition Supplements program in Ethiopia, CCP researchers studied how to help more pregnant women take the tablets consistently. The answers turned out to be surprisingly simple: A reflective “dangler” and a picture-heavy information sheet. 

Researchers began by sitting down with women, families and health workers to understand daily realities. Women described heavy workloads, long days of farm work and household chores, and a tendency to forget daily pills. Providers reported that counseling about supplements was inconsistent and that many women left health centers without fully understanding when or why to take the supplements. 

Those insights shaped two practical solutions. 

The first tool is the dangler. It is a reflective placard on a lanyard that hangs in the home where it can easily catch the eye. Part instruction sheet and part visual reminder, the dangler features an illustration of a healthy pregnant woman and simple guidance about taking her prenatal supplements. 

Women said the image helped them connect with the message. Inquiring neighbors and family members became an additional source of reminders. 

“When I first saw the dangler, I thought if I take the tablets consistently, my body will become strong and healthy like the woman on the dangler,” one participant said. 

Participants even suggested small design changes to make the image more relatable. One request was simply to add hair, so the woman looked more like them. 

The second tool is an illustrated information sheet designed for use both in health centers and at home. The sheet helps health providers give consistent counseling and provides women with a clear visual reference after they leave the health center. 

One health care provider told researchers that the tool made it easier to communicate with different clients about the benefits of nutrient supplements. “The visuals and text of the information sheet help us effectively communicate with both literate and illiterate clients,” she said. 

Another health worker said the sheet sparked conversations beyond the facility. Women shared it with husbands and family members, helping build support for taking the supplements every day. 

“Our human-centered approach shows that simple, low-cost tools like the reflective dangler and the pictorial information sheet are feasible and acceptable to communities and providers, and they are linked to meaningful increases in MMS adherence,” said Biruk Melaku, CCP’s senior director of design and innovation in Ethiopia. 

An evaluation conducted by CCP examined 24 health centers in two regions. Fourteen intervention health centers used the dangler and information sheet; another 14 facilities did not. They found that pregnant women who took the MMS supplements were significantly more likely to visit health centers using the tools than the centers that did not. 

Frontline staff and women noticed the difference. 

“I recommend the dangler and information sheet for other health facilities,” one health worker said. “It does not require much time or energy.” 

The tools work because they meet people where they are. Busy women who may have limited literacy do not need dense instructions. They need visual reminders that fit easily into daily life and can be understood by everyone in the household. 

The materials also help standardize counseling across health centers. Visual job aids give health workers clear prompts and guidance, particularly those with limited training. 

Stakeholders said the solutions could be scaled nationally with contextual adaptation. That includes translating materials into local languages, tailoring images to reflect regional culture, and integrating the tools into existing maternal health services. 

Researchers also identified operational improvements that could further strengthen adherence. These include changes to the image on the dangler to fit with various contexts. 

“This work is a reminder that innovation is not always digital or expensive,” said CCP’s Tewabech Tesfalign, who directs the project in Ethiopia. “Sometimes it is a simple visual that catches your eye at the right moment, or a takeaway that turns a clinic conversation into a household habit.”