Following a threat of legal action against a Norwegian company that was exporting a similar product to Kenya, Nutriset was criticized by Médecins Sans Frontières, which stated in an open letter that "Nutriset has been asked repeatedly by us and others for simple, reasonable licensing terms... Instead it appears that has decided to adopt a policy of aggressive protection of patents that could be considered an abuse in relation to humanitarian products." A UNICEF study, commissioned at Duke University and the University of North Carolina, recommended a diversified supplier base of RUTF products to better serve global needs. In response to the criticism, Nutriset has allowed companies and NGOs in some African countries to make the paste and not pay license fees.