Forecast: The Impact of USAID Nutrition Cuts
by Anna Gordon & Lauren Gilbert
Picture a famine victim: thin arms and legs, brittle hair, a swollen belly, and a dull, tired look in their eyes. This is the look of severe acute malnutrition, the technical diagnosis for a child that is at risk of starving to death.
Globally, about 2.5% of children under 5 are severely malnourished. It is most common in South Asia, where 4.2% of children are severely malnourished. About 45% of child deaths worldwide are among severely malnourished children. That is, being severely malnourished makes a child about 10 times more likely to die.
SAM begins when a child’s weight-for-height drops below three standard deviations of the WHO’s growth standards. At that point, without nourishment, the body goes into triage, severely compromising the immune system. Usually, malnutrition doesn’t kill directly; starvation is rarely an official cause of death. Rather, a child with SAM will get an opportunistic infection, which they otherwise would have fought off easily. In their weakened state, it’s fatal.
Because malnourished children are severely immunocompromised, the treatment they require goes beyond mere renourishment. Cooking and serving food in unsanitary conditions — common in areas where SAM is prevalent — could exacerbate malnourishment, as a case of food poisoning could be fatal. Until the late 1990s, SAM was primarily managed in hospitals and involved careful preparation of milk-based products. Hospital-based treatment helped mitigate infection and ensure appropriate re-feeding regimens, but it is labor-intensive, which limits coverage and increases the cost of managing cases.
Ready-to-use therapeutic foods, first trialed in 1996 and widely adopted beginning in 2007, dramatically changed how SAM cases were managed. RUTFs are peanut butter-based pastes with added oils, vitamins, and nutrients. They do not need to be refrigerated or cooked, and can be eaten straight out of the package. Their introduction allowed SAM to be treated at home or in community health clinics, instead of in hospitals, for the first time. Best of all, RUTFs are relatively cheap; about $0.33 per dose. When provided a full course, a child’s risk of dying from severe acute malnutrition halves.
Until early 2025, USAID was one of the largest purchasers of RUTF in the world. As of May 2025, future funding for SAM management is highly uncertain. It appears that USAID’s nutrition spending will be cut between 40% and 100%. USAID spent $200M on child wasting1 in 2024, and thus spending in 2025 may be anywhere between $0 to $120M.
Given how imperative USAID’s RUTF treatments are for children with severe acute malnutrition, recent aid cuts beg the question–just how many children will die due to these funding cuts? In this article we attempt to estimate this number. All our calculations are in this sheet; we walk through them on a high-level below.
Our methods
In May 2024, USAID announced that it would spend $200M to address SAM. In general, about half of malnutrition spending is spent on staff and logistics, while about half is spent directly on RUTFs.
SAM management is standardized. Kids receive two to three sachets of RUTF a day, depending on their height and weight, for six to eight weeks. At two sachets a day for eight weeks, that is 112 total sachets; at three sachets a day for six weeks, that is 126 sachets. A sachet of RUTF costs about $0.33, so the total cost to treat a child with SAM is about $74-$84 (half of which is the RUTF, half of which is logistics). Therefore, the US would have paid for about 2.3-2.6 million courses of RUTF in 2025 with no aid cuts.
USAID’s own estimate of the number of courses provided falls within this range. In 2022, the agency estimated that a previous $200 million commitment would provide RUTF to 2.4 million children suffering from severe acute malnutrition.
In order to accurately estimate how many lives RUTF saves, we also need to know how many children with SAM would die without access to RUTF. This number is notoriously difficult to estimate; it is unethical not to provide food to a malnourished child at a clinic, making it difficult to estimate the counterfactual of what happens to children that receive no treatment.
For this estimate, we relied on studies conducted between the late 1990s and early 2000s, before RUTF became more widely available. Studies from this era show that mortality rates for children suffering from SAM varied widely across countries. In countries like Malawi and South Africa, where comorbidities such as HIV and tuberculosis were common, mortality rates were as high as 24% and 25%. In contrast, children with SAM in countries like Bangladesh had mortality rates as low as 9%.
We use the median case fatality point of 17% from this meta-analysis of inpatient children with SAM. We are looking exclusively at studies where children were treated before RUTF became widely available and treated according to WHO or UNICEF guidelines.
Next, we can look at the number of children who survive severe acute malnutrition once properly treated with RUTF. One large study conducted by the IRC of 27,000 children in Mali found that when treated with a simplified approach that included the provision of RUTF, 92% of children recovered within weeks.
Using this figure, if we assume that 92% of children treated with RUTF recover, we can conservatively assume that the other 8% will die. This means that approximately 8% of children with SAM treated with RUTF will die in comparison to 17% of children who go untreated. That implies that for every 100 children USAID provides with RUTF, approximately 9 children’s lives are saved that otherwise would have died.
Assuming that USAID would have provided between 2.3-2.6 million courses of treatment over the course of a year, and 9% of all children provided with treatment would die without it, this means that approximately between 214,000-241,000 children will die should USAID cease all RUTF distribution.
However, it is likely that some form of nutrition funding will survive. According to estimates from the Center for Global Development, 63% of nutrition funding is expected to continue —though the estimate ranges from 40% to 77%. If we assume funding for SAM programs will be cut at the same rate as nutrition broadly, this reduces coverage to 1.5-1.7 million courses of RUTF.
Preserving some nutrition funding means that fewer lives will be lost, but the toll is still high — the 37% cut currently forecast will result in 79,000 and 89,000 deaths.
For a five year estimate, we assume that other organizations or countries are able to pick up some of the funding that USAID provided. We extrapolate from our one year estimate and apply a 30% discount to subsequent years, which results in 300,000 to 338,000 deaths over five years.
Conclusion
Given our range of estimates, we think that USAID cuts to nutrition programming will result in between 79,000 and 89,000 deaths over the next year. Nevertheless, we do want to emphasize that this range will be imprecise because effects of nutrition interventions are notoriously difficult to estimate. How a child’s body absorbs and responds to calories and nutrients depends on many conditions: infections, access to water and sanitation, degree of malnourishment when the therapy begins, among other variables.
We can compare to other estimates of SAM deaths, though, and our estimates are in line with others.
Brooke Nichols estimates that if all funding to nutrition was cut, 167,000 children would die in the next year. A 37% cut would thus result in 105,000 deaths, slightly above the top end of our range.
Saskia Osendarp et al estimate that a $290M cut in nutrition aid would result in 369,000 extra child deaths. Extrapolating linearly, an $80M cut would result in 105,000 deaths.
Regardless of which estimate you choose, all of these estimates are catastrophic. $80 million is about $0.50 per US taxpayer - and 100,000 child deaths is equivalent to all the children in Seattle dying.
Nearly 100,000 families will never be the same; hundreds of thousands of parents, grandparents and siblings will spend the rest of their lives mourning a child, grandchild or sibling.
Some organizations are trying to pick up the pieces. Project Resource Optimization has put together a list of high impact, high priority projects that could proceed with philanthropic funding only. They’ve identified three malnutrition programs they think are the highest priority — one for internally displaced people fleeing conflict in Mali, one for internally displaced people fleeing conflict in Cameroon, and one providing basic care in Niger. These programs are the tip of the iceberg for USAID’s nutrition funding, but saving them would be a start.
Anna Gordon is the AI Journalism Lead at the Tarbell Center. She previously worked as a reporter for TIME Magazine, where she often wrote about global health and development.
Lauren Gilbert is the Horizon Scanning Study Group Programme Manager at Renaissance Philanthropy. She is also a fellow at the Energy for Growth Hub and Roots of Progress.
SAM is considered a form of “wasting,” which refers to low weight-for-height standards. Stunting, the result of chronic malnutrition, is when children fall two standard deviations below height-for-age standards.