Our study aimed to identify the formal and informal food resources available to, and used by, food insecure families living in an urban poor district of Lima, Peru. Our findings add to a body of evidence from other countries that food insecure households have high participation rates in FAPs compared to food secure households [4, 6,7,8]. However, we also found heavy use of FAPs among the food secure. This could be because all households under study were from a low-income neighborhood, thus even those households that were food secure were not wealthy and had easy accessibility to FAPs.
Similarly, our results showed increasing proportions of households using informal food resources at each increasing level of food insecurity. This differs from previous findings in Peru that showed informal food resource use or similar intangibles were associated with decreased food insecurity [21, 24, 25]. This may be because two of these studies focused on social networks, rather than specific coping mechanisms, [24, 25] and the third, which assessed gifting and receiving food, was conducted in the Amazon Region where practices around food sharing may be different [21]. Our findings are consistent with studies in other parts of the world that show that use of informal food resources, such as borrowing money, increases with increasing food insecurity [13,14,15]. Given the flexible nature of some FAPs in Peru, the use of informal food resources may be more telling of a household’s food insecurity, specifically purchasing food on credit and borrowing money to buy food, which steadily increased with increasing levels of food insecurity in our study.
Our qualitative findings of reasons for FAP use and non-use were consistent with the literature. Other qualitative and mixed-methods studies in Argentina, the US, Canada, and the UK support our findings that financial need is a principal reason for FAP use [13, 37,38,39]. Research in Argentina, Brazil, and the US supports our findings of ineligibility, lack of access, and other system hassles as primary barriers to FAP participation [13, 37, 40]. Additionally, research in Canada and of Latinos living in the US found that not having access to preferred foods limited participants’ abilities to use food banks as many participants desired foods of better nutritional quality [38, 41]. This is comparable to our findings that concerns about food preference and nutritional quality were primary reasons for not using FAPs.
By using mixed methods, our study explored relationships between food (in)security and food resource use that may not be captured in research relying on only quantitative or qualitative data. For example, financial need was a main reason for using both the Comedor Popular and Vaso de Leche, and we saw that use of these programs tended to increase with increasing severity of food insecurity. This may suggest that these two programs are reaching their target population of those with financial need. Alternatively, most people reported their children consumed food from Qali Warma because it was given to them in school, not necessarily because of financial need. This could explain why food secure households most frequently used Qali Warma. The different qualitative and quantitative results for these programs can be explained by their structures—Comedor Popular and Vaso de Leche require individuals to sign up, whereas Qali Warma is given out to all children in public schools where it is present, regardless of individuals’ needs.
This study shows some possible areas of intervention to make FAPs more effective in addressing food insecurity in urban areas of Peru. Issues related to food were prominent reasons for non-use across FAPs. It is important that FAPs provide food that is both nutritious and fitting of beneficiaries’ tastes and preferences. Research has found that some foods provided by FAPs in Peru are nutritionally insufficient [20, 42,43,44,45] and simultaneously high in carbohydrates, sugars, and saturated fat, [42, 43] but research on beneficiaries’ perceptions of these foods is more limited [45, 46]. Additionally, there were particular concerns with Vaso de Leche about respondents being considered ineligible or not allowed to sign up for other reasons. Though many respondents did not participate because they did not meet standard program eligibility criteria, there seemed to be inconsistent application of this criteria (for example, respondents cited different age cut-offs) or application of subjective criteria (e.g. owning a business or having a fully constructed house as evidence of socioeconomic status that precludes participation). Furthermore, many respondents were not given any reason for why they could not participate. This confusion around eligibility is likely due to the fact that, though the government sets forth criteria for first and second priority target populations, the final decision on enrollment is at the discretion of local mothers’ committees, so application of criteria is subjective. Previous studies have shown that actual users of various FAPs in Peru do not always meet government eligibility criteria [20, 44, 45, 47,48,49]. The flexibility around eligibility criteria in Peru is an important distinction from the more standardized practices in countries where the overwhelming majority of research on FAPs takes place, and thus needs to be considered in both scientific studies and policy proposals.
This research has a number of strengths. To our knowledge, it is the first study in Peru to assess FAP use by level of food (in)security, and one of the first to investigate this and the use of informal food resources among the urban poor in Peru. It used a stratified random sample; thus the data can be considered representative of the low-income district under study and possibly other similar districts within Lima. Finally, qualitative themes about FAP use/non-use were validated via expert-checking with local data collectors.
However, the study also needs to be seen in light of certain limitations. First, different timeframes were used to measure FAP and informal food resource use (past 6 months or past 4 weeks, and past 7 days respectively), which may complicate comparisons between the use of these resources. Different timeframes were assigned to FAP and informal resource use to replicate similar questions in previous studies in Peru [21, 35] and because of the assumption that it may be harder to recall informal food resource use beyond 7 days, whereas FAP use is usually continuous. A second limitation was that all qualitative data came from a small series of short-answer questions, nested within a 30-min household questionnaire where answers were typed by data collectors into a tablet. Compared to voice recordings, this form of data collection may have resulted in the loss of some level of detail or been susceptible to observer bias. Additionally, qualitative data from a survey format is naturally more limited than other qualitative methods, like in-depth interviews, which could more naturally capture narratives of how participants began using FAPs. Third, slightly different wording between open-ended questions for each FAP may have led to responses that are hard to compare across FAPs. For example, we asked, “What is the main reason you go to the Comedor Popular?” compared to, “What is the main reason the child eats Vaso de Leche?” The latter question focuses on consuming the Vaso de Leche ration and not the reason for household participation in order to allow for separate responses for each child in the household, not only eligible children. This was to capture household sharing of Vaso de Leche food rations with non-eligible family members, which we found in our study and has been cited in the literature [46,47,48]. Finally, the differences between FAP eligibility criteria for our questionnaire and data analysis, as well as from program standards (Table 1), may have created some discrepancies in analysis. The purpose for these distinctions was to capture as large a breadth of FAP users from the questionnaire, but then minimize the number of eligible respondents for analysis so as to not inflate non-use. Given the flexible and inconsistent application of program criteria, [47, 48] we felt that only surveying respondents who fit program criteria would result in excluding a considerable number of families who used the FAP despite not being eligible.
Future studies would benefit from creating a purposive sample of households that are eligible for or participate in Cuna Más, as the number of Cuna Más participants was negligible in our study. It would be valuable to capture the state of food (in)security among Cuna Más beneficiaries as well as collect qualitative data on why eligible families do or do not participate in the program. This would allow researchers and policymakers to understand if Cuna Más is reaching its target population and possible barriers or enablers to program use. Additionally, given the predominance of “food quality” as a theme for both FAP participation and non-participation, this study could be complemented by further research on beneficiaries’ perceptions of the quality of, and their preferences for, the food offered at FAPs in Peru. The food security construct includes not only quantity of food available, but also access to nutritious foods that meet food preferences [1]. Therefore, if FAPs aim to address issues of food insecurity, it is important that researchers and policymakers alike pay attention to what kind of food is available in these programs and what beneficiaries think of them.
Further, the ongoing COVID-19 pandemic and associated economic crisis has highlighted the urgency to identify alternative ways for governments to provide food to those in need. For large parts of 2020, FAPs in Peru were not able to operate in normal capacity due to shutdowns and social distancing measures. Reconsidering the distribution patterns of traditional food assistance is thus warranted. Moreover, in times of crises such as the current one, informal food resources may become significantly more important than FAPs at helping people deal with food access issues. Future studies should further investigate these types of communal assistance as important coping mechanisms for food insecure families living in urban poverty in times of crisis.