The US is the largest donor to nutrition globally; funding is mainly provided through US global health and food security programs

The US is the single largest donor to global nutrition efforts, disbursing US$2.9 billion in 2014 for both nutrition-specific and nutrition-sensitive interventions (see box below) and US$2.5 billion in 2013, according to the 2016 Global Nutrition Report. US nutrition-specific interventions cover a wide range of purposes, including addressing malnutrition, providing mineral and nutrient supplements such as Vitamin A and iodine, and promoting breast feeding, among others. US nutrition-sensitive interventions address the underlying causes of malnutrition. These interventions include water and sanitation programs, agricultural activities, and programs focusing on women’s and girls’ education and equality.

Types of nutrition interventions:

Interventions that address immediate causes of undernutrition and have the improvement of nutrition (i.e., support for exclusive breastfeeding, supplementary feeding, etc.) as their primary objective.

Interventions that address underlying causes of malnutrition and that take into account cross-sector actions and impacts (i.e., improving access to diverse foods).

The US has been a strong advocate for nutrition interventions, particularly during the critical 1,000‑day period between the start of a woman’s pregnancy and her child’s second birthday. In line with this approach, US nutrition support has traditionally been part of the US’s work in maternal and child health. Under the Obama administration, nutrition efforts continued to be conducted through global health programming, as well as through a new enhanced and integrated approach to agriculture and food security. Major US programs, including the Feed the Future initiative and Food for Peace, as well as the Global Food Security Act of 2016, drive US efforts in food security, including nutrition.

Feed the Future was launched in May 2010 to support implementation of the US’s food security pledges made at the G8 Summit in 2009. It coordinates efforts across the US government, working with partner countries, private sector actors, and research entities. Its goal is to drive economic and agricultural development that will address poverty, global hunger, and food security, focusing especially on smallholder farmers, most of whom are women. It highlights several cross‑cutting issues: gender equity, environmental stewardship and protection, and climate change. Feed the Future efforts are funded through the State-Foreign Operations (SFOPs) appropriations bill (see Key question 4: How is the US’s ODA budget structured?). According to government data, the US mobilized over US$11 billion for Feed the Future between 2010 and 2014. US global nutrition efforts primarily focus on Feed the Future’s 19 focus countries (see Deep Dive: Agriculture).

Feed the Future’s operational strategy also applies to other programs working in food security and agriculture which derive funding from sources other than SFOPs. This includes the US’s food assistance programs such as Food for Peace, Food for Progress, and the McGovern-Dole International Food for Education and Child Nutrition program. These federal programs receive funding primarily from the agricultural appropriations bill, and are managed either solely or jointly by the United States Agency for International Development (USAID) and the Department of Agriculture. Food for Peace is the US’s largest food-assistance program, which is managed by the Office of Food and Peace in USAID (see Deep Dive: Agriculture).

Feed the Future leverages multilateralism and global partnership. The US government has made several commitments to international nutrition initiatives over the past years. First, the US was integral to the founding of the Global Agriculture and Food Security Program (GAFSP), housed at the World Bank, during the US’s G20 presidency in 2009. GAFSP is the multilateral mechanism designated to implement the 2009 G20 pledges. US funding to GAFSP runs through the Department of the Treasury from the SFOPs. According to GAFSP’s own records, the US has disbursed US$588 in total to GAFSP, as of August 2016. Second, the US signed the Nutrition for Growth (N4G) compact and pledged US$10 billion for 2012 to 2014, of which US$7.5 billion was disbursed, according to the Global Nutrition Report 2016. The US also committed US$2.2 billion, of which US$1.3 billion was disbursed – the largest amount of any donor - in support of the New Alliance for Food Security and Nutrition, from 2012 to 2014. The Alliance was an initiative resulting from the US’s push to consolidate more global support for food security during its G8 presidency in 2012. Feed the Future is the primary way the US contributes to this global effort on food security.

US funding to nutrition has increased significantly since 2010, largely due to elevated attention to nutrition through President Barack Obama’s food security agenda, especially through Feed the Future. Since 2009, the government has had a nutrition-specific budget line in the SFOPs, which provides funding to basic nutrition, channeled bilaterally. According to OECD data, the US provided US$274 million in basic nutrition support in 2015. This makes the US by far the largest donor country to basic nutrition, representing 32% of the total spent by all OECD donor countries in 2015. This includes funding from the nutrition-specific budget line as well as other lines within the SFOPs which invest in nutrition-specific interventions. Present Trump’s FY2018 budget request proposes decreasing funding for the nutrition-specific budget line by 37%, from US$125 million to US$79 million. However, the Senate and House of Representatives’ SFOPs maintain the US$125 million level. As the appropriations process is still ongoing, the outcome of nutrition funding is not yet clear for FY2018.

In line with Feed the Future’s operational approach, USAID leads the US’s nutrition efforts. There are several key documents that guide the US government’s work on nutrition:

  • The Joint Strategic Plan FY2014-2017 of the State Department and USAID: Nutrition is highlighted as a cross-cutting priority area under two strategic objectives: “Promote inclusive economic growth, reduce extreme poverty, and improve food security” (1.2) and “Strengthen America’s efforts to combat global health challenges” (2.5). This plan is currently under review for the FY2018-2021 time period.
  • USAID’s Multi-Sectoral Nutrition Strategy 2014-2025 :  This multi-sectoral approach sets goals across US nutritional initiatives. The strategy addresses direct and underlying causes of malnutrition, and highlights the importance of linking development and humanitarian assistance to increase the impact of US global nutrition efforts. Broadly, it identifies three priorities in line with the 2025 World Health Assembly Nutrition Targets: 1) decrease chronic malnutrition, measured by stunting, 2) maintain the Global Acute Malnutrition (GAM) below 15%, and 3) decrease malnutrition in women of reproductive age and children under five, with a focus on the 1,000-day window between the beginning of pregnancy and the child’s second birthday.
  • In 2016, the government released the US Government Global Nutrition Coordination Plan 2016-2021. It aims to strengthen the impact of the diverse US nutrition portfolio “through better communication, collaboration, and linking research to program implementation”.
  • The 2016-2025 Food Assistance and Food Security Strategy, from USAID’s Office of Food for Peace within the Bureau for Democracy, Conflict and Humanitarian Assistance, outlines two key strategic objectives for the program: 1) improving and sustaining food security and 2) embracing nutritional security.  The new strategy supports Feed the Future, the Global Food Security Act (see below) and other US-related strategies and objectives.

In 2016, the US government enacted the Global Food Security Act (GFSA) (see Deep Dive: Agriculture). This was the largest development-related authorizing legislation passed by Congress in a decade. The GFSA authorizes two years of funding for America’s food-security investments, primarily going to smallholder and women farmers through Feed the Future. It also codifies Feed the Future, laying the groundwork for improved coordination across the government by requiring different departments and agencies that implement global food-security programs to share information with each other and Congress. GFSA identifies improving the nutritional status of women and children as one of eight priority areas within US global food security efforts.

USAID leads nutrition efforts, coordinating a ‘whole-of-government’ approach

USAID leads the US’s nutrition efforts, which are largely integrated through the agency’s work in global health, food security and assistance, and agriculture. US global nutrition activities primarily occur within the framework of Feed the Future, and for food assistance, through Food for Peace. USAID coordinates Feed the Future through its administrator, currently Mark Green, who serves as the US Global Food Security Coordinator, supported by the Deputy Coordinator for Diplomacy and the Deputy Coordinator for Development (see Deep Dive: Agriculture). The latter heads the Bureau for Food Security, which was established to manage Feed the Future. In addition, USAID’s Bureaus for Global Health (which houses the Office of Maternal and Child Health and Nutrition) and for Democracy, Conflict and Humanitarian Assistance (which houses the Office of Food for Peace) also help implement nutrition and food security cooperation.

The Department of Agriculture funds Food for Peace, which USAID implements, as well as the McGovern-Dole International Food for Education and Child Nutrition program. The Department implements the latter through the Foreign Agricultural Service.

Other US development cooperation programs, such as the Millennium Challenge Corporation and the President’s Emergency Plan for AIDS Relief, also provide some nutrition support both in terms of financing and implementation.

Congress authorizes, oversees, and funds the US government’s nutrition-specific funding as well as for related programs within Feed the Future through its annual SFOPs. It does not specify an overall funding level for Feed the Future, but rather allocates funds separately for related activities and accounts. This includes: nutrition, global health programs (implemented by USAID), bilateral food security and agriculture activities (implemented by USAID, MCC, and other agencies), and related multilateral organizations. Funding for food assistance comes from the annual agricultural appropriations bill. Important congressional committees are: the House Foreign Affairs Committee and the Senate Foreign Relations Committee, and the Appropriations Committees of both chambers.