Open Letter to the U.S. Government About the Quality of Food Aid

White flag with red logo of Doctors Without Borders/Médecins Sans Frontières (MSF) against sunny blue sky

© Valérie Batselaere/MSF

An open letter from Sophie Delaunay, Executive Director of MSF-USA, urging the U.S. to stop supplying nutritionally substandard food to malnourished children in developing countries.

Secretary Hillary Clinton
U.S. Department of State
Administrator Rajiv Shah
U.S. Agency for International Development
Secretary Tom Vilsack
U.S. Department of Agriculture

On the eve of World Food Day 2010, I write on behalf of Médecins Sans Frontières/Doctors Without Borders (MSF) to urge the U.S. to stop supplying nutritionally substandard food to malnourished children in developing countries.

The U.S. is by far the world’s largest food assistance donor, accounting for more than half of global food aid in 2009. Its policies and practices are enormously influential in assuring that the right foods reach the right people at the right time. The main beneficiaries of food assistance are primarily young children and women. Yet the fortified foods in U.S. food assistance, including corn soya blend (CSB) and other fortified blended flours (FBF), are of an inappropriate nutritional composition for the primary target beneficiaries—particularly young children. MSF is reiterating a call to ensure that U.S. food aid meets the nutritional needs of young children.

MSF medical teams are frontline witnesses to the human devastation caused by malnutrition. An estimated 195 million children under five are malnourished; malnutrition contributes to one third of the 8 million deaths of children under five each year. In 2010, MSF is operating 120 nutrition programs in 36 countries. Already, our teams in Niger have treated more than 100,000 children for severe acute malnutrition this year. It is no accident that most of these acutely malnourished children are under 2 and fall within the critical window when quality diets make such a difference to health and development. As the U.S. government acknowledged during the launch of the “1000 Days” Campaign during the Millennium Development Goals Summit in September, the first two years of a child’s life provide a critical window of vulnerability and opportunity.

The U.S. government’s stated attention to malnutrition and maternal and child health directly conflicts with U.S. food aid policy. We understand that there is no one-size-fits-all solution to treating and preventing global childhood malnutrition, but making sure that food provided to children under the age of two meets nutritional needs is a minimum prerequisite.

After the first six months of breastfeeding, the types of complementary foods introduced into the diet are of paramount importance. The composition of U.S. sourced complementary foods provided through international food assistance—CSB—is contrary to overwhelming scientific evidence. It does not provide sufficient nutrients; it is high in anti-nutrients, inhibiting proper digestibility and absorption; and it contains no dairy products, important for growth.1 Diets that do not provide the right blend of high-quality protein, essential fats, carbohydrates, vitamins, and minerals can impair growth and development, increase the risk of death from common illnesses, or result in life-long health and developmental damage.

Nutritional experts under the auspices of the World Health Organization (WHO) reaffirmed in October 2008 the current formulations of FBF are not what young children need.2 The World Food Program (WFP) September 2009 nutritional implementation strategy now calls for food assistance received by the beneficiary population to meet their nutritional needs, and places a particular emphasis on children under the age of two. This should be indisputable. In a March 2010 letter to the EU, the nutrition directors of WHO, UNICEF and WFP reiterated the need for a change from FBF to meet the needs of young children.3 However, U.S. and EU policy have not changed. 

Countries that have successfully reduced malnutrition—including Mexico, Thailand, the U.S., and many European countries—have done so through programs that ensure young children from the poorest families have access to quality foods. The U.S. government recognizes this. The domestic nutrition program, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), provides vouchers to low-income mothers for the purchase of high-value foods like milk, fruit, and eggs. Thus, the U.S. sends inadequate food overseas to vulnerable children that it would not use in its domestic nutrition programs. 

U.S. international food assistance has not always been substandard. In the 1960s, when FBF was designed under the leadership of USAID, the U.S. Department of Agriculture (USDA), and the National Institutes of Heath (NIH), it contained milk powder, and was developed with a specification responding to then available nutritional science. But, when milk surpluses began to dry up in the 1980s and the price of milk escalated, the milk was removed, considerably weakening the nutrition composition of these foods. This practice has not changed.4

The U.S. has taken some steps recently towards moving food assistance to an appropriate nutritional standard, for instance with the USAID emergency responses in Pakistan and Haiti. The 2008 U.S. Farm Bill invites a reformulation of food aid to “meet nutrient needs of target populations.”  The food aid quality review being conducted by the School of Nutrition at Tufts University and an ongoing study of the U.S. Government Accountability Office (GAO) examining nutrition in U.S. food aid are expected to add further evidence of the need for reform. But why should children have to wait for a catastrophic disaster or the results of further confirmatory studies to receive food assistance tailored to their needs?

We urge you to implement reforms so that addressing the needs of malnourished children is what drives the U.S. government’s international food assistance policy.

We request a meeting on this issue and would be available at your convenience.  Thank you for your time in this important matter.


Sophie Delaunay, Executive Director
U.S Section of Médecins Sans Frontières/Doctors Without Borders (MSF)

  1. Shoham, Jeremy, et. al., “Proceedings of the World Health Organization: Consultation on the Management of Moderate Malnutrition in Children under 5 Years of Age.” Food and Nutrition Bulletin, 2009; 30(3): 464-474.  
  2. Proceedings published in Food and Nutrition Bulletin 2009; 30 supplement 3.  
  3. Joint position WFP/UNICEF/WHO with regard to the management of moderate malnutrition, using improved formulations of fortified blended flours sent to ECHO in March 2010.  
  4. Marchione. TJ, History of Food and Nutrition in Emergency Relief Foods Provided through U.S. Government Emergency Food Aid Programs: Policies and Customs Governing Their Formulation, Selection and Distribution. The Journal of Nutrition, (2002) 132: 2104S–2111S.