There is a quiet assumption embedded in much of modern healthcare, that access follows need. But in pregnancy advice, that’s rarely the case.
We know that maternal nutrition plays a critical role in both immediate and long-term health outcomes. It is consistently identified as one of the most important non-genetic factors influencing foetal development, with deficiencies linked to anaemia, preterm birth, low birth weight and increased risk of chronic disease later in life.
And yet, despite this, access to something as foundational as a prenatal multivitamin remains uneven.
In Australia, around one in four pregnant women are not taking a prenatal supplement because of cost. That figure is often cited, but the background around it is murkier.
In building Land Lab, an Australian company focused on perinatal nutrition, alongside it, we established the Motherlines Foundation – a DGR-registered initiative that provides pregnant women who are experiencing financial hardship and hold a government issued concession card with ten months of our evidence-based prenatal multivitamin at no cost.
When we began working more closely with women accessing support through the Motherlines Foundation, with an initial pilot program of 30 women, nearly half of participants were not taking a prenatal before entering. Among those women, the overwhelming reason was cost. But cost rarely existed in isolation. Many of the women we supported were navigating overlapping pressures such as single incomes, regional access limitations, multiple children, or the cumulative financial demands of pregnancy and early parenthood. Almost half reported barriers to accessing fresh food, including transport limitations and availability.
The question was not simply whether women were choosing to take supplements but whether the systems around them made it realistically possible to do so.
What was striking in the pilot was how quickly behaviour shifted once the constraint of cost was removed. When women were given access to an evidence-based prenatal for free, uptake was immediate. One hundred per cent of participants commenced supplementation, and most did so early in pregnancy, with 63 per cent enrolling in the first trimester.
From a clinical perspective, that was important. Early pregnancy is a period of rapid development, where micronutrient sufficiency has a disproportionate impact. From a human perspective, what stood out was something else: relief. Women described not having to “budget” for supplements alongside scans, appointments and basic living costs. They spoke about the psychological shift of being able to take something they trusted, without questioning whether it was worth the trade-off elsewhere. There was also a consistent theme of dignity. Participants were acutely aware that they were receiving the same product sold commercially – not a reduced or “budget” version.
Australia’s supplement industry has expanded rapidly in recent years, but growth has not necessarily translated into accessibility. For many consumers, particularly in pregnancy, the category remains difficult to navigate – with wide variation in formulation, dosing and quality. At the same time, there is no national framework to ensure equitable access to prenatal supplementation, despite its inclusion in antenatal care recommendations. The result is a system where something widely understood to be beneficial is still, in practice, optional and contingent on individual means.
The Motherlines pilot proved that when financial barriers are removed and quality is maintained, women engage with supplementation early and consistently. So, why isn’t that the baseline?
The next phase of the program is focused on scaling that access – extending support to more women, particularly in regional and underserved communities, and strengthening partnerships with services already working at the frontline of maternal care.
But the broader implication sits beyond any single organisation. If maternal nutrition is as critical as we say it is, then access to it cannot remain a private variable.