Let Them Eat Plumpy’Nut

The recent disastrous earthquake in Indonesia has prompted a quick humanitarian response from Western countries, raising some key questions: Who decides what kind of emergency food aid is delivered, and should it be healthier? This argument is not new — nutritionists and development workers have been debating it for years — but improved food options are causing it to heat up again.

This is no abstract discussion. A child dies of malnutrition every six seconds. The World Health Organization estimates that, at any given moment, 20 million children are suffering from the most severe form of food deprivation — frequently as a result of other crises, such as earthquakes, hurricanes, droughts, and civil unrest. Emergency food aid has to bring them back from the brink quickly and reliably. Unfortunately, serious questions have been raised about the healthful properties of the fortified, blended wheat, corn, or soy flours that are the mainstay of many emergency food programs. Is using these foods when better alternatives are available ethical?

A rising chorus is advocating that food-aid staples — which have the advantage of being affordable and widely available — be replaced with a highly nutritious, easily transportable paste, formulated in 1999 and now broadly distributed by Doctors Without Borders (MSF, for Médecins Sans Frontières). In 2006 and 2007, the organization treated more than 150,000 malnourished children in 22 countries with ready-to-use foods, including Plumpy’nut. Plumpy’nut, which is made from powdered milk, ground peanuts, oil, powdered sugar, vitamins, and minerals, comes in foil packets and doesn’t need refrigeration. Its value was celebrated last year on 60 Minutes.

Plumpy’nut tastes like peanut butter, and kids love to eat it. But it’s expensive, and critics say it’s better to reach as many people as possible with a more affordable choice. And the need remains great.

The latest reports from Indonesia are horrific: more than 700 dead from the 7.6-magnitude earthquake and aftershocks that hit the Indonesian island of Sumatra last week. In some regions, nearly 90 percent of houses have been destroyed, leaving people homeless and hungry. In American Samoa and Tonga, a quake and accompanying tsunami have also taken many lives.

Save the Children, CARE, Mercy Corps, the International Rescue Committee, Catholic Relief Services, and World Vision are coordinating food aid, though early reports are that some has piled up, undelivered, at the airport and aid offices. Some aid, consisting of rice noodles, nutritional supplements, and mineral water, was reportedly looted from the regent office in Padang Pariaman for that reason. Other food aid was dropped by helicopter, causing people to scramble to retrieve it.

The problem for many critics of food aid is not the delivery method, though, but the food itself, which critics say is failing to address childhood malnutrition. Last year, MSF convened a seminar at Columbia University to discuss the problem. As Susan Shepherd, nutrition advisor for MSF’s Access to Essential Medicines Campaign, put it, "It is unacceptable that current food aid is not providing adequate, nutrient-rich food for the most vulnerable children." MSF called for an expansion of malnutrition treatment with milk-based, fortified, and energy-dense therapeutic foods, including Plumpy’nut.

Action Against Hunger (AAH) has sometimes teamed with MSF to campaign for more nutritious food, including Plumpy’nut. "There is nothing inherently wrong with the standard corn-soy blend as long as it is enriched with micronutrients and vitamins, which isn’t always the case," AAH’s senior nutrition advisor, Marie-Sophie Whitney, says. "We shouldn’t be feeding kids anything we wouldn’t feed our own children."

There’s also the extremely sensitive issue of where the food for aid comes from — and what its effect may be on local trade. AAH charges that U.S. government food aid displaces local farmers by dumping cheap U.S. surplus grain. "Most countries have functioning markets and regional surpluses that go overlooked in the food aid equation," Whitney says.

This point is reinforced by Emi MacLean, U.S. manager of MSF’s access campaign. She said that many corn-soy and other blends do not contain animal-sourced foods, such as dairy products. According to MacLean, the dairy component was removed about 20 years ago when the U.S. milk surplus ran out. "Almost all of the emergency food aid that the U.S. currently sends internationally is not appropriate for young children under the age of 2," she says, adding that the corn-soy blend was formulated decades ago based on available U.S. surplus. "But high-quality protein, such as in dairy and eggs, and micronutrients, are of critical importance for children under 3 if they are to recover from malnutrition," she says.

The charge — that the U.S. dumps less nutritious surplus food — is vehemently denied by Steve Hansch, a veteran aid worker who is also a board member of Relief International.

"It’s just wrong to use words like ‘surplus’ and ‘dumping,’" Hansch says. "That was the case with food aid in the 1960s, but now it’s a market-driven operation. For example, an NGO in Tanzania will submit a proposal to the U.S. Department of Agriculture, which will then open bids and buy at the lowest price."

For Hansch, food aid is caught in a dilemma. "We spend most of our money sending basic grains, especially corn, because that reaches the largest numbers of people," he says. "If instead, we spent our money on ideal food formulations, our per-treatment record would go up, but the majority of kids in refugee camps would get no food at all."

Largely for the reason Hansch brings up — the financial aspect — movement among NGOs and governments to adopt a higher standard for nutrition in food aid has so far been limited.

Last year, following a World Health Organization experts meeting in Switzerland, a group of international nutrition experts proclaimed that food distributed to young children should be nutritionally tailored to them, which means including high-value, animal-sourced protein and adequate micronutrients. They also said that ready-to-use emergency foods should include dairy, eggs, and other animal-sourced foods instead of solely relying on fortified and blended flours as currently formulated. But an MSF representative also said that enforcing such a standard would cost 3.5 billion euros (more than $5 billion) annually.

However, current policy is costly, too. According to MacLean, $600 million could be saved annually if food aid were purchased locally instead of shipped as in-kind donations from the United States in U.S.-flagged ships.

The good news is that the Barack Obama administration is reviewing U.S. food aid policy. MacLean says she hopes a re-evaluation will "bring major modifications to the emergency food support provided to young children."

We do need to take a second look at our food policy. But with donor fatigue and a world economic crisis as obstacles, the fight to bring Plumpy’nut and other, healthier options to a broader population might be stalled for some time.