This is an average of the three domain scores below.
The United States Agency for International Development (USAID) received a 74 (C) with transparency and a 76 (C) without transparency because the Agency issued some documents that positively impacted sexual and reproductive health and rights (SRHR) globally and other guidance, such as the Protecting Life in Global Health Assistance (PLGHA) Frequently Asked Questions (FAQs), that severely harmed SRHR. In the Family Planning domain, USAID’s grade decreased significantly due to issued documents that did not meaningfully discuss family planning or, in the case of the PLGHA FAQs, negatively impacted USAID’s ability to implement comprehensive family planning and SRHR programs that were evidence-informed, responsive to need, consistent with internationally-recognized human rights principles, and gender transformative. For both Family Planning and Maternal and Child Health, funding allocations that were not responsive to need led to a low score in both domains. In the Maternal and Child Health and HIV and AIDS domains, USAID’s grades decreased due to issued guidance that was not gender transformative or comprehensive. In all three domains, USAID’s funding data received a high transparency score and the issued guidance received a lower transparency score.
USAID received an 84 (B) with transparency and an 88 (B+) without transparency for HIV and AIDS based on four HIV and AIDS-related documents issued in 2018. These documents ranged from significantly hindering to moderately promoting sexual reproductive health and rights (SRHR) within the HIV and AIDS sector and all four documents neglected to discuss the role of gender norms in the implementation of relevant programming. USAID’s grade decreased in this domain since last year primarily due to the lack of HIV and AIDS-specific information in the 2018 Acting on the Call Report. USAID received a high budget score because disbursed funds were responsive to demonstrated HIV and AIDS programming needs. USAID’s commitment to HIV and AIDS programming was demonstrated in the disbursement of funds for HIV and AIDS programming according to country-level incidence.
USAID received a 70 (C-) with transparency and a 72 (C-) without transparency for Maternal and Child Health based on three documents issued in 2018 that were related to maternal and child health. Though the impact of this guidance on SRHR ranged from positive to negative, all of the guidance focused on child survival more than maternal wellbeing and lacked a gender transformative approach to programming. Maternal health programs should address issues beyond maternal survival — such as the impact of gender norms on pregnancy and the importance of respectful maternity care to address disrespect and abuse. These factors are vital in determining the health of the mother and, subsequently, the health of the child. USAID, as the agency that coordinates maternal and child health in-country through local civil society partnerships, has the potential to support gender transformative and person-centered policies and programming that reflect the realities of the infrastructure and gender norms. These documents were evidence that USAID did not fully step into this role in 2018. Furthermore, the PLGHA FAQs did not adequately address the unique impacts the PLGHA policy could have on maternal and child health programming. The USAID budget grade reflected the conclusion that maternal and child health programs were not responsive to need, as a significant portion of the funds disbursed for maternal and child health programming in FY 2019 were not disbursed in countries with the highest maternal mortality.
USAID received a 66 (D) with transparency and a 68 (D+) without transparency for Family Planning in 2018. USAID was graded based on three family planning-related guidance and procedures that were issued in 2018. These documents varied in their grades, but none of them were gender transformative or explicitly based in human rights norms. As the agency that coordinates family planning funds through bilateral programs and partners with local civil society, USAID has the potential to implement truly evidence-based and human rights-based programming. These documents were evidence that USAID did not fully step into this role in 2018. The USAID budget grade reflected these conclusions, as a significant portion of the funds disbursed for family planning programming in FY 2019 were not responsive to country-level unmet family planning need.