Reaching mothers and young children with critical
health and nutrition interventions will require sustained
commitments and cooperation among the many international
partners who have a role in promoting development. It will
also require new financial commitments. The World Bank
estimates that the cost of scaling up essential nutrition
interventions, including expanding upon those identified
in The Lancet, is $11.8 billion annually.29 Of this amount,
it is expected that $1.5 billion would be covered through
household expenditures on improved food products (such
as iodized salt). The remainder, $10.3 billion, would need to
come from public sources.
Over the past decade, international development
assistance has more than doubled, but funding to address
malnutrition remains modest. Based on data reported by
major aid donors and excluding multilateral assistance
from the World Bank and others, spending on basic
nutrition activities totaled just $439 million over the four
years between 2002 and 2007. This was less than one
percent of all bilateral development assistance.30
In the United States, funding for international nutrition
programs is scattered across a number of agencies and
programs. Most nutrition programming occurs through the
maternal child health program within the Global Health
Bureau at the U.S. Agency for International Development
(USAID). Initiatives include micronutrient supplementation,
food fortification, and programs to treat infectious diseases
that contribute to malnutrition. The flagship nutrition
program, the Infant and Young Child Nutrition Project
(IYCN), provides technical and financial assistance for
programs designed to deliver essential nutrition messages,
such as the importance of exclusive breastfeeding, timely
introduction of complementary food to maintain the weight
gain of growing children, and appropriate care practices for
children who are ill.31
Some nutrition activities are supported through U.S. food
aid. The majority of food aid is used in emergencies, but
recent changes to food aid programs have sharpened the
focus on addressing malnutrition in non-disaster-affected
communities fighting chronic malnutrition. The Preventing
Malnutrition for Children Under 2 Approach (PM2A) for
food aid was recently tested in Haiti and is being implemented
in several other countries.32 Programs based on this model
seek to prevent malnutrition by providing food assistance to
all young children living in targeted communities.
The U.S. food aid budget in 2008 totaled approximately
$2.9 billion, the majority of which was distributed in
emergencies although not necessarily targeted for the
treatment of malnutrition.33 Non-emergency food aid
amounted to approximately $354 million (excluding the
6 Briefing Paper, October 2009
U.S. FOOD AID: An Asset for Improved Nutrition?
Over the past decade, the United States has provided about
half of all the food aid delivered to hungry and poor people
around the world.39 Much of this aid alleviates immediate
suffering, but it comes at a high cost. Current regulations
require U.S. food aid to be purchased in the United States
and shipped on U.S.-flagged ships. These requirements add
significant expense to food aid programs. For every dollar
allocated to food aid, up to 60 cents goes to pay for packing
and shipping costs.40
An additional concern about U.S. food aid is that current
food aid commodities do not meet the nutritional needs of
women and young children. In 2007, wheat and sorghum
accounted for more than half of all U.S. food aid donations.41
Unfortified and unprocessed, these and other basic grains do
not contain the nutrients, vitamins, and minerals needed by
mothers and young children.
Two other commonly provided commodities—Corn Soy
Blend and Wheat Soy Blend—are little better. These fortified
blended foods were developed in the 1960s, when much less
was known about the unique nutritional needs of expectant
and new mothers and their children.42 The World Food Program (WFP) recognizes that, as currently formulated, these
fortified blended foods are the least preferred option for use
in programs targeting young children.
As efforts are made to better target food aid programs
to address maternal and child malnutrition, it is critical to
ensure that much more of each food aid dollar reaches
intended beneficiaries and that food aid commodities meet
the unique nutritional needs of women and young children.43
Expanding the local and regional purchase (LRP) of food
aid presents new opportunities for using food aid in nutrition
programs while also stimulating agricultural production. The
current focus of LRP programs is on supporting local farmers,
fostering agriculture markets, and improving th