Abstract
BACKGROUND: 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. METHODS: 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). RESULTS: 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). CONCLUSION: 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-24885-5.