Can Food Aid Contribute to Improved Nutrition?

By Patrick Webb

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Much is known about how to design effective nutrition interventions. We know, for example, that food is not the only—or always the optimal—resource required. The most effective use of food is in combination with relevant non-food resources. However, where malnutrition is linked to constrained food access, and where food of sufficient quality and quantity is required to meet identified needs, food is a critical element of a nutrition intervention.

 For many years, food aid has been used to directly supplement the diets of young children and pregnant women.  The World Food Programme of the United Nations (WFP) began supporting 'mother and infant' projects in the mid-1960s by delivering supplementary food through health clinics—an activity that accounted for 6 percent of WFP development expenditure during the decade. 

This approach was expanded considerably during the 1970s after the World Food Conference (1974) called on governments and donors to provide supplementary foods to vulnerable groups "on a scale large enough to cover on a continuing basis a substantial part of their need."  Today, programmes seeking to protect or enhance the nutritional status of mothers and infants represent roughly 20 percent of WFP's development portfolio. They also account for as much as half of the development resources channelled through USAID from Public Law 480 Title II.[1] 

Resources are no longer restricted to clinic-based supplementary feeding activities.  Presently, a wide range of interventions can be included under the umbrella of 'nutrition' programmes in both development and humanitarian relief settings.  For example, the distribution of 'a basket' of food commodities to crisis-affected populations represents general nutrition support. The immediate aim of general distribution is to meet food needs of people with constrained access to normal sources of food, and thus try to 'protect' their nutrition—that is, prevent sustained food shortfalls that would contribute to excess mortality via increased malnutrition. 

There are other targeted feeding interventions that provide 'special' foods, such as those that are micronutrient-fortified, sometimes tailored to child needs and aimed at reversing malnutrition and stabilizing such gains. Additionally, therapeutic feeding involves the treatment of severely malnourished children—and adults as necessary—with energy-dense foods combined with medical intervention protocols, and in cases where deficiencies in vitamins or minerals are a threat to nutritional well being, fortified foods are targeted to defined vulnerable populations. The latter has been seen recently where fortified cereal flour was distributed to Angolan refugees known to be at risk of pellagra (niacin deficiency). In Nepal, a micronutrient-fortified 'porridge' was made available to refugees from Bhutan, which brought a riboflavin-deficiency disease (angular stomatitis) under control and was also associated with improvements in birthweights.

Increased demand by donors for evidenced-based programming has led to an accumulation of empirical data documenting the positive nutritional impacts of these kinds of food-supported interventions. A review of maternal and child programs implemented by Private Voluntary Organizations (PVOs) using Title II resources found that a large majority "have been successful in improving the nutritional status (as measured by stunting and/or underweight) of children in their target populations."[2]  Most projects documented a reduction in the prevalence of stunting at an average of 2.4 percentage points per year. 

A recent study in Ethiopia showed that food aid had a significant impact on protecting child growth during droughts.[3]  Another study in Ethiopia showed that households receiving food aid through Food-for-Work as well as general food distribution to drought-affected populations had positive results in terms of child weight-for-height.[4] 

Studies of refugees in Algeria found that fortified food given to stunted children permitted rapid nutritional improvement.[5]  It was shown that treatment of micronutrient deficiencies and growth retardation can be achieved among seriously malnourished children even up to the age of five. 

In Mexico, a government-supported program called Progressa supplies food to children under 3-years old in poor households. This has had a significant impact on child growth rates, reduced stunting and anaemia.[6] "Nutrition supplements alone" are estimated to create an almost 3-percent increase in lifetime earnings for those children through improved growth and productivity.[7]

Another targeted food supplementation in Bangladesh found that low-income women receiving supplementation during pregnancy had birth-weight outcomes comparable with women from wealthy households who did not receive the supplements.[8]

These results confirm that food aid can certainly play an important part in nutrition programming.  That said, while the evidence suggests positive impacts on child growth, resolution of micronutrient deficiencies and effective reversal of severe malnutrition, this occurs only under certain conditions:

i)  interventions are carefully targeted to meet local needs after in-depth problem assessment.

ii)  malnutrition is widespread in the population and already contributing to morbidity and mortality.

iii)  supplementary food arrives in sufficient quantity and quality to be able to make an impact.

iv)  foods are consumed mostly by those most in need of them.

v)      appropriate non-food resources are available in combination with the food—including necessary medical treatments, vaccinations, clean water, deworming, iron folate supplements, and nutrition and health counseling.[9] 

When these key principles or conditions are met, "supplemental maternal and child feeding programs have been repeatedly shown to be a highly effective means of improving child nutrition."[10] 

Given the scale and persistence of malnutrition around the world, there needs to be a far greater share of development resources earmarked for nutrition interventions than is currently available. The aim in coming years should be not only to explore new avenues for action, but also to expand and enhance what is already done well.

Patrick Webb is Dean for Academic Affairs at the Friedman School of Nutrition Science and Policy, Tufts University, Boston. He was formerly Chief of Nutrition for the UN World Food Programme.

[1] Public Law 480 (P.L. 480), also known as the Food for Peace Program, is comprised of three titles. Title II provides for the donation of U.S. agricultural commodities by the U.S. government to meet humanitarian food needs in foreign countries.

[2] Swindale, A., M. Deitchler, B. Cogill and T. Marchione.  2004.

[3] Yamano, T. et. al. 2003.  Child Growth, Shocks and Food Aid in Rural Ethiopia.  World Bank Policy Research Working Paper Series No. 3096.

[4] Quisumbing, A. 2002.  Food Aid and Child Nutrition in Rural Ethiopia. World Development. 31 (7):1309-132.

[5] Lopriore, C. and F. Branca.  2001.  Strategies to fight anaemia and growth retardation in Saharawi refugee children.  Rome: Italian Nutrition Institute. 

[6] Rivera, J. et. al. 2004.  Impact of the Mexican Program for Education, Health and Nutrition (Progresa) on Rates of Growth and Anemia in Infants and Young Children.  Journal of the American Medical Association.  291 (2): 2563-70.

[7] Behrman and Hoddinott.  2001.  Evaluation of the Impact of PROGRESA on Preschool child height.  International Food Policy Research Institute.  Washington, D.C.

[8] Ortolano, S. et. al. 2003.  Effect of targeted food supplementation and services in the Bangladesh Intergrated Nutrition Project on women and their pregnancy outcomes.  Journal of Health Population and Nutrition.  21 (2): 83-9. 

[9] Lopriore, C. P. Webb and C. van Nieuwenhuyse.  2005.  The Uses of Food in Maternal and Child Nutrition Interventions: A Review of Recent Evidence and Lessons Learned.  Rome.  World Food Programme.

[10] Barrett, c and D. Maxwell.  2005.  Food Aid After Fifty Years.  London; Routledge. 

This piece was originally published in Bread for the World Institute's 2006 Hunger Report, Frontline Issues in Nutrition Assistance. Find out more about the publication or order your copy from our online store.