USAID: Nutrition Policy Paper

USAID Policy Paper: Nutrition

May 1982

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Executive Summary
I. Introduction
II. Objective of the Nutrition Policy and its Accomplishment
III. Elements of the Policy
Conclusions
Selected Bibliography
Wednesday, 11-Jul-2001 16:51:14 EDT

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Executive Summary
Estimates indicate that six hundred million people in less developed countries (LDCs) are in danger of not getting enough to eat. As a result, their productivity, health, and life expectancy are jeopardized. If the U.S. is to make progress toward helping LDCs improve agricultural production, economic performance, and human potential, nutrition must be included as a critical input as well as an essential output of development programs. Most of USAID's development assistance either affects health or food consumption or relies upon nutritional well-being to achieve development objectives. For this reason, it is of greatest importance to give increased attention to opportunities for improving the nutrition impact of sectoral policies, strategies, programs, and projects.
This policy paper reviews the justifications for U.S. investment in improving nutri-tion in LDCs and sets out some policy guidelines for USAID programs. The objective of the nutrition policy is to maximize the nutritional impact of USAID's economic assistance. The policy recommendations are as follows:

USAID places highest priority on alleviating undernutrition-inadequate food consumption and biological utilization of nutrients.

USAID's policy is to improve nutrition through sectoral programs in agriculture, health, food aid, population, and education as well as through direct-nutrition programs.

This policy will be implemented through incorporating nutrition and food consumption as factors in decision making in sectoral strategies, programs and projects.

This can be effected through:

identifying projects based upon analysis of nutrition and food consumption problems; this is especially appropriate in formulating country development strategies.

including nutrition as a factor in project design:

in agriculture, through maximizing consumption effects of crop and technology selection, research and extension, and appropriate national policies.

in health, through primary health care which emphasizes growth monitoring of children, providing pre-and post-natal nutrition, supporting environmental health measures, and promoting proper infant feeding practices.

in food aid, through targeting appropriate rations to at-risk groups complemented by growth monitoring, health care, and nutrition education.

in population by complementing voluntary family planning services with nutrition programs whenever feasible.

in education, through promotion of basic education for women, nutrition education in the schools, training community outreach workers in nutrition, and advanced training for professionals and policy makers in LDCs in nutrition.

targeting sectoral projects to individuals or housholds at-risk of developing nutrition problems;

monitoring and evaluating nutrition impacts of projects that are likely to affect nutrition, food consumption, or food production.

complementing sectoral programs with nutrition projects to enhance nutrition impacts;

utilizing the private sector, especially the food industry, in food programs whenever feasible;

encouraging appropriate national agriculture, health, and nutrition policies to address nutrition and food consumption problems;

coordinating with LDC governments and other donors to achieve nutrition goals.

In seeking opportunities to integrate nutrition concerns throughout USAID's development assistance program, USAID will focus on the factors that affect food consumption, nutritional needs, and health of nutritionally at-risk groups.
Preface

Since 1965, USAID has been a leader in international efforts to improve nutritional status in LDCs. For instance, through USAID's pioneering work in nutrition planning and surveillance¹, the multisectoral nature of the nutrition problem in LDCs has become increasingly clear. USAID's nutrition strategy of 1973² demonstrated keen foresight in emphasizing protein-calorie malnutrition³ rather than the then-popular "protein-gap." USAID's nutrition strategy of 1977⁴ introduced integrated preventive approaches to nutrition by focusing attention on household purchasing power for food. This approach was innovative not only in calling attention to the fact that all members of a household may be at nutritional risk (not just the women and children), but also in noting that nutrition problems involve more than aggregate food supply. USAID has also been a major proponent of nutrition planning in developing countries and has been a leader in increasing the nutrition planning capacity of developing country policy advisors, through workshops and training sessions at U.S. institutions.
In the last decade, significant strides in nutritional science have caused USAID to reexamine its nutrition policies and strategies. Major scientific and methodological findings have implications for nutrition programs.

Measurement of children's growth in less developed countries (LDCs) has shown that until they reach 5 years of age, children in nearly all populations (excluding pygmies) have the potential to grow as tall as U.S. children. This means that children in LDCs are short not because of genetics but rather because of poor nutrition.

A number of studies have shown that adequate dietary energy (calories) plays a central role in producing healthy, adequate birth weight babies. Supplementing marginally nourished pregnant women's energy intake improves pregnancy outcome significantly.

Nutritionists and psychologists have shown that poor nutrition impairs cognitive and neurological development which in tum reduce learning capacity, attention span, and school performance.

Studies on the effect of energy intake and iron status on energy expenditure have proved that undernutrition and anemia reduce work productivity. Improvement of nutritional status is matched by increased worker output.

Investigators from many institutions have shown that most staple grains provide sufficient amounts of protein for human needs. Only for preschool-aged children fed entirely on staple grain and in some populations for which roots and tubers comprise nearly all of the dietary calories, protein content of the diet may be insufficient. Medical studies have shown that poor nutritional status impairs the body's im-mune system resulting in more frequent and longer bouts of illness and higher susceptibility to life threatening disease.

Clinical nutrition studies have revealed previously unknown but essential components of the diet; for instance fiber, trace minerals and a balance of cholesterol and different fats have been found to be essential.

The absence of a truly equivalent manufactured substitute for breastmilk has highlighted the unique role of breastfeeding in infant nutrition, even in the United States. In developing countries breastfeeding is essential to infants in low income households because breastmilk substitutes are often unhygienic because they are improperly prepared using unclean utensils and unsafe water.

USAID's policies in food and agriculture, health, population and food assistance have also changed, necessitating restatement of USAID's major policy objectives in nutrition to provide overall guidance for improving programming to meet these objectives.

¹Nutrition surveillance involves collection and analysis of data on food consumption and nutritional status on a regular basis. The current work being carried out at Cornell University through the Office of Nutrition is a good example of pioneering efforts in tracking nutrition surveillance efforts and promoting the functional classification of malnutrition.
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²The USAID Nutrition Program Strategy, U.S. Agency for International Development, June, 1973.
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³Lack of protein and calories is sometimes called protein calorie malnutrition (PCM).
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⁴"USAID's Responsibilities in Nutrition," AIDTO Circular A-98, April 1977.
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Last Updated on: July 11, 2001