(introduction...)

1. Individuals have special food needs at critical periods in their lives - most notably expectant mothers and their unborn babies, children under five, and nursing mothers. Inadequate nutrition in the first years of life and before is likely to damage health, mental development and future labour productivity. The high demands of reproduction deplete a woman’s nutrient stores, increasing her vulnerability to disease and reducing her capacity to work and care for her children. The consequences of "early malnutrition" reach beyond the individuals and families involved: society as a whole suffers losses when children cannot learn, when poor health restricts productivity, and when malnourished women give birth to the next generation that will also be malnourished.

2. Today, approximately 30 percent of children under five (i.e., over 200 million, according to a recent WHO estimate) are more vulnerable to sickness and more likely to die because they are undernourished. Most of them live in South Asia and sub-Saharan Africa. It is estimated that 50 percent of disease-related mortality among infants could be avoided if infant malnutrition were eradicated.

3. WFP can help end the inheritance of hunger through supplementary feeding programmes which provide the energy and nutrients missing from the basic diet of those who have special nutritional requirements. At present, WFP reaches over four million expectant and nursing mothers and children under five through primary health care centres. This assistance, which addresses early malnutrition, has important long-term pay-offs that cannot be achieved with later interventions. At the same time, there are challenges: past supplementary feeding programmes have not been without difficulties, particularly in the poorest countries where often food is needed most but sufficient complementary resources and capacities are lacking.

4. This paper examines the conditions under which WFP can better contribute to protecting poor women and children against lasting damage from early malnutrition. It will make recommendations on WFP’s future policy and operational principles for supplementary feeding programmes, including measures required to increase these activities in the countries with the greatest needs. Recommendations will also be made for better meeting critical food needs during crisis and rehabilitation, bearing in mind the special circumstances involved.

WFP’s mission

5. Assistance to mothers and children "at risk" features prominently in the core policies and strategies that govern WFP activities. One of the strategic goals set by the WFP Mission Statement is to provide food aid "to improve the nutrition and quality of life of the most vulnerable people at critical times in their lives". The World Food Summit Plan of Action includes a similar commitment to "develop within available resources well targeted social welfare and nutrition safety nets to meet the needs of the food insecure, particularly needy people, children and the infirm" (Commitment Two, Objective 2.2c).

6. WFP has begun to elaborate this mandate and the strategic implications of increasing its focus on tackling early malnutrition:

• In 1996, WFP produced and circulated a paper - "Ending the Inheritance of Hunger" - that discusses the role of food aid in reversing the cycle of hunger passed from one generation to another.
• In 1997, WFP/WHO conducted a thematic evaluation of supplementary feeding programmes targeted to mothers and children under five.
• At the request of WFP, WHO conducted a literature review on the role of supplementary feeding as well as a desk review of recent WFP-assisted projects of this type.
• A technical consultation was held in early May with 24 participants, many of them recognized experts in the operational aspects of nutrition programmes in both development and relief.
• The "Ending the Inheritance of Hunger" seminar was held on 31 May 1997, organized by WFP in partnership with the United Nations University. It brought together representatives of WFP’s Executive Board and of other Member States, United Nations agencies, NGOs and eminent scholars.

WFP’s experience and lessons learned

7. WFP has acquired much experience and expertise in over 30 years of assistance to Mother and Child Health (MCH) and other projects that provide supplementary feeding. Major findings from the recent assessment of WFP’s programmes, including a portfolio review of ongoing supplementary feeding projects, are as follows:

• The level of WFP assistance is substantial. Food assistance targeted to mothers and children at critical times of their lives accounts for about 20 percent of WFP’s current development portfolio; the 27 ongoing supplementary feeding interventions carry a commitment value of over 300 million dollars. But supplementary food rations for mothers and children under five are also provided in many relief situations: up to 10 percent of WFP emergency resources are allocated to supplementary or therapeutic feeding.
• Interventions reach large numbers of beneficiaries. Most projects are designed to reach between 20,000 and 100,000 beneficiaries per annum; seven projects target more than 200,000 people each year.
• Considering the potential long-term benefits, food requirements are modest. The size of a food ration over a year most frequently amounts to about 60 kilograms of cereals, edible oil, pulses and/or blended foods, and at a cost of approximately 25 dollars per person.
• Projects in Africa are more expensive. Africa, Asia and Latin America receive about equal shares of WFP resources for supplementary feeding; average WFP costs per beneficiary are highest in Africa: 50 percent higher than in Latin America and about three times as high as in Asia.
• Too little is done in least developed countries (LDCs). LDCs receive only about one third of WFP’s assistance for mothers and children; in tonnage terms, fewer resources are committed for LDCs than for non-priority countries (i.e., neither LDC nor low-income, food-deficit (LIFDC).

8. Research findings show that malnutrition is the outcome of an array of inter-linked risk factors: poverty (unemployment, landlessness); lack of education (illiteracy, poor child spacing); poor health (lack of clean water, poor hygiene, parasitic infections); low social status (tribes, castes, minorities); unfavourable traditions (taboos, low status of women); and/or a harsh environment, all leading to insufficient access to food and/or micronutrients.

9. Not surprisingly, then, a key finding of the thematic evaluation of WFP assistance to address the food needs of women and children at critical times of their lives is that the effectiveness of a food aid intervention is maximized when the achievement of a direct dietary effect is combined with indirect effects such as a better utilization of health and education services; increased household food security and mothers’ caring capacity; and empowerment of women. The full text of the thematic evaluation is contained in document WFP EB.3/97/5/Add.5.

10. In WFP’s experience, food assistance to address early malnutrition will be most effective under conditions of widespread food insecurity. Supplementary feeding will usually be a less preferable option where malnutrition is primarily the result of factors such as inadequate weaning or caring practices and unfavourable social traditions, which can be better addressed through services such as nutrition education, training, growth monitoring and a build-up of referral systems.

11. To be fully effective, WFP assistance through supplementary feeding needs to be integrated with other components. This requires policy, planning and management resources, apart from the actual handling of the food itself. However, the ideal - integrated utilization of a substantial number of complementary activities - is frequently not attainable. There are situations in which WFP is faced with a very practical choice: supplementary feeding with very limited, but viable, complementary activities or no assistance at all.

12. The policy issues and operational challenges which emerged from WFP’s recent review of experiences are discussed in the following section. Action on these issues will be crucial if WFP is to increase the share of food assistance programmed to contribute to a better nutritional status of mothers and children at critical times in their lives.