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

The US Standard and A Double Standard
The access to nutritious, enriching foods that the U.S. government provides to young American children is a stark contrast to the nutritionally devoid blend of fortified flour sent to malnourished children outside the country.

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The Starved for Attention campaign targeted other major food aid donors on World Food Day, urging them to do their part to improve the quality of food sent to malnourished children all over the world. Letters were sent to high-level administrators in the governments of the following 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.

12 Responses to “Open Letter to the U.S. Government About the Quality of Food Aid”

  1. Carol Sperry says:

    Please send better food to malnourished children.

  2. audrey goddard says:

    we must cherish all children, all, not just our own.

  3. Suresh Kumar says:

    Also malnourised children should have chance to have better food for their brain development like in the developed country. So please send them better food ……

  4. Bipin Kumar says:

    Without knowing the copyright issues, I have cross-posted some excerpts from this page on my personal blog.

    If you have any restrictions about this, please inform me so.

    The post can be found here:

  5. Anna pavlova says:

    Since in many food aid deliveries that have long in transit times or are dropped from planes fruit and eggs are not possible options logistically, it seems to me that such letter should provide a list of realsitically possible and logistically possible foods that would meet the appropriate criteria. I understand milkpowder is one. What else that can survive transit and meet volume requirements?

  6. The most basic ethical requirement is for us to become more humane. To become more humane means to respond not merely with the most minimal, substandard food aid. We are required to respond appropriately to the needs of all the mothers and young babies, to provide food that adequately nourishes their developing brains and bodies. We simply must succeed in changing our food aid policies to prevent children in the developing world from becoming ill and dying. These are not just someone else’s children ‘over there’, far away. The world’s boundaries are dissolving. These are, very simply, humanity’s children. They are yours and mine, and they are our future. We can not stand idly by.

  7. Lois Markiewicz says:

    U.S. food will be substandard as long as it is under the control of Monsanto and others who genetically modify foods. These foods make MANY people SICK and do not supply the nutrients of REAL food.
    I told my Congressmen I wanted them to NOT vote for any World Food aid that allowed for genetically modified foods to be pushed on unsuspecting third world countries. These foods have never been tested and are not safe or healthy. We have to put a stop to this.
    I cannot eat corn or wheat that has been genetically modified. How many other people are ill because of this?

  8. Why donate food that’s either sale by date or not for human consumption? We are an aid and development organization in Kenya but we always want well wishers and donors to donate what is really needed and in good quality and standard.


  9. John O Gilmore Jr says:

    Americans have dropped the ball in almost every important area of life. We simply no longer pay attention to what our government and the corporations are doing.

    This stuff we are sending, in our name, is little more than waste fodder that farmers wont even feed their livestock. Shame on us!

    Shame on YOU for allowing such a travesty to occur.

    If we continue our path of ignoring the important issues of life we will become in need of food aid ourselves. Many of our own citizens are already there right now.

    Love, Kindness, Forgiveness and Gratitude for the gift of LIFE is the only antidote for our ignorance (“to ignore”).

    Please upgrade the “food” in our Food Aid.

  10. Julie Zimber says:

    Please send VERY NUTIRTIOUS food only! It is simply gross to send sub-standard food to the populations that MOST NEED GOOD NUTRITION to even have a chance at establishing a better lives for themselves. Please stop this tragic form of “aid” immediately!

    MONSANTO and others who genetically alter food need to be STOPPED to assure safe food in this country.

    Please do what is right.

  11. Rabeah says:

    Please support better nutritional food for under privileged, poor, famine stricken and war inflicted children around the world. To progress into a better future for these region the children need to grow into healthy, able, and intellectual adults. Please support this campaign for a better world.

  12. John Luster, MD says:

    I agree, of course, with the principle of providing complete nutrition in our food aid, but the recommendation that this food must have milk products in it to be good nutrition is just not right. Not only isn’t milk necessary for good nutrition, most of what would be sent overseas would be produced in America from factory farms from hormone-treated cows. I think Doctors Without Borders needs to re-think this one.

    John B. Luster, MD, M.P.H.
    Orange, Ca., USA