Maternal and Child Health (MCH)

President Trump reinstated and expanded the Mexico City Policy, often known as the Global Gag Rule, and renamed it the Protecting Life in Global Health Assistance (PLGHA) policy. When in place under previous administrations, the policy applied only to international family planning assistance, whereas Trump’s version of the policy "extend(s) the requirements... to global health assistance furnished by all departments or agencies." Research has documented the harms of this policy in previous administrations when the policy was in effect, and the expansion of this policy via this 2017 Presidential Memorandum demonstrated a disregard for evidence and international human rights norms. This policy spurred a chain of events that significantly reduced community and government engagement in HIV prevention, care, and treatment programs and prohibits beneficiaries from accessing key services in many countries that receive U.S. global health assistance. The expansion of the PLGHA policy was against evidence, need, and human rights principles and was not gender transformative; this policy was gender blind, as it did not discuss the role of gender norms on the promotion of SRHR through U.S. global health assistance programs.

The United States National Action Plan on Women, Peace, and Security described what the U.S. continues to do to empower women as equal partners in preventing conflict and building peace in countries threatened and affected by war, violence, and insecurity. The Plan moderately promoted SRHR by calling for better access to "clinical care and reproductive health services such as family planning, HIV testing, counseling and treatment, and maternal health" and aimed to “reduce maternal mortality by 30 percent…through... prenatal care and services, obstetric care, voluntary family planning, HIV testing and counseling, nutritional support, and safe water, sanitation and hygiene interventions.” Despite the Plan's focus on conflict and security, it did not go in-depth about the impact of conflict on maternal and child health. This Plan is moderately gender transformative, as it called for more gender equality and inclusivity in all initiatives, especially regarding “members of marginalized groups, including youth, ethnic, racial or religious minorities, persons with disabilities, displaced persons and indigenous peoples, lesbian, gay, bisexual, transgender, and intersex (LGBTI) individuals, and people from all socioeconomic strata.” It also discussed the distinct health needs of ex-combatants and former violent extremists who are female, specifically stating that these women have a difficult time adhering to traditional gender norms upon their return from combat. This National Action Plan supported the U.S. government's ability to promote SRHR with regard to maternal and child health programs and funding.

The Department of State Implementation Plan for the U.S. Adolescent Girls Strategy was launched in partnership with three other U.S. implementing agencies as part of the first U.S. Global Strategy to Empower Adolescent Girls in 2015. This Plan acknowledged the impact of forced marriage, especially early or childhood marriage, and the impact of FGC on the health of AGYW. Specifically, it stated that these practices lead to poor maternal health outcomes, including high morbidity and mortality rates from pregnancy and birth complications, trauma, and other diseases and infections. The Plan provided details on "preserv[ing] the rights of married and pregnant girls and adolescent mothers to attend school" and "remov[ing] barriers to sexual and reproductive health and comprehensive, accessible, youth-friendly health services" to prevent early pregnancy. Though the Plan was responsive to need and grounded in human rights principles, it did not incorporate significant evidence-based programming because it did not address how to meet the clinical needs or provide maternity care of pregnant AGYW. This Plan is gender transformative in that it promoted gender equality by decreasing early marriage and pregnancy through educational empowerment. This Strategy moderately promoted SRHR through the Department of State’s maternal and child health programs.

Acting on the Call is USAID's annual flagship report that covers USAID’s reproductive, maternal, newborn, and child health programs. The 2017 report provided data that was strongly grounded in evidence and human rights principles and was responsive to need. It discussed USAID’s focus on ending preventable maternal and child mortality and morbidity through the provision of health services including family planning, antenatal care (ANC), and immunizations. It also prioritized the strengthening of health systems at all levels to reduce health disparities and achieve equitable care. The report specifically mentioned the importance of integrating family planning and HIV and AIDS care into maternal and child health, and noted the intersection of these domains as vital to comprehensive SRHR programming. This report was gender transformative and addressed the need for gender-sensitive policies, the eradication of gender norms, and the promotion of women into decision-making roles.

Acting on the Call is USAID's annual flagship report for the Agency’s reproductive, maternal, newborn, and child health programs and services. The 2016 report was based on programmatic evidence and human rights principles and was responsive to need as it promoted respectful maternity care through facility interventions, dissemination of patient rights materials, and outlined priority actions that seek to address barriers to maternal health. It specifically addressed the importance of “dignified and respectful care during childbirth” and how it is crucial in decreasing maternal mortality rates. However, the report could have been more evidence-based by advocating for improved communication between patients and medical staff and advocated for the transformation of patient care at more than just the systems level (e.g. the provider-patient level). Additionally, this report was gender transformative because it called for increased gender-sensitive services and addressed the importance of male engagement in maternal and child health efforts.

The USAID Adolescent Girl Strategy Implementation Plan was launched in partnership with three other U.S. implementing agencies as part of the first U.S. Global Strategy to Empower Adolescent Girls in 2015. The Plan moderately promoted SRHR, noting the importance of utilizing USAID’s “whole-of-girl” approach to reduce gender disparities and GBV and increase capacity of women and girls through USAID’s programs. Though it did not explicitly describe USAID’s maternal and child health programs, this Plan provided a high-level overview of the programs, best practices, and indicators that would be used to measure USAID’s progress in implementing the Adolescent Girl Strategy across all USAID programs. The Plan was responsive to need and based in evidence, particularly related to the implementation of activities to end child marriage, meet the needs of married children, and provide services to children in adversity. The Plan also referenced USAID’s ongoing work on gender (e.g., implementing USAID’s 2012 Gender Equality and Female Empowerment Policy) and directly acknowledged the importance of incorporating activities that foster gender equity in all USAID programs. This Plan supported the ability of USAID to implement maternal and child health programs that moderately promoted SRHR.