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TRANSPARENCY SCORE
The transparency grade represents the expectation that the federal government should make data about U.S. global health assistance available, accessible, and informative. To see the transparency grade, toggle below.

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TRANSPARENCY SCORE
The transparency grade represents the expectation that the federal government should make data about U.S. global health assistance available, accessible, and informative. To see the transparency grade, toggle below.

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D

This is an average of the three domain scores below.

YEAR 2018

Family Planning (FP)

The U.S. Government received a 63 (D) with transparency and a 66 (D) without transparency for Family Planning across all actors. This reflects the negative impact of the PLGHA FAQ and Six Month Review documents as well as insufficient funding for key family planning providers, including UNFPA.

F
F

White House

 

The White House received a 54 (F) with transparency and a 59 (F) without transparency in Family Planning in 2018. In the FY 2019 budget request, the White House did not request any funding for the United Nations Population Fund (UNFPA) and zeroed out all family planning funds for USAID. These budgetary determinations significantly hindered the ability of U.S. global health assistance to support comprehensive family planning programs. The White House did not issue any executive orders or presidential memoranda related to family planning nor did it sign any family planning policies into law in 2018. The transparency score for the White House is low for family planning due to the difficulty accessing budgetary and policy information.

The CHANGE data index grades government agencies on policies and funding impacting family planning, maternal and child health, and HIV & AIDS foreign assistance.

Selecting a document will download the file
2017_Presidential Memorandum of January 23, 2017_The Mexico City Policy (Expanded Global Gag Rule)
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.
2016_The United States National Action Plan on Women, Peace, and Security
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 sexual and reproductive health and rights by calling for better access to "clinical care and reproductive health services such as family planning, HIV testing, counseling, and treatment…" though HIV testing, counseling, and care was not discussed in further detail. The Plan did not explain the impact of access to HIV and AIDS prevention and treatment services on conflict prevention and country stability nor did it acknowledge the relationship between gender-based violence (GBV) in conflict and the prevalence of HIV and AIDS among women and girls. In fact, there was little discussion on any structural, cultural, and safety barriers that prevented women in conflict-ridden areas from accessing the HIV and AIDS care they wanted and needed. However, the Plan did discuss the intersections of HIV and AIDS with other sexual and reproductive health (SRH) issues, such as maternal mortality. Additionally, 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.” The Plan also discussed the distinct 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. However, it did not explicitly mention the disproportionate impact of HIV and AIDS on former combatant populations or other key populations such as female sex workers or people who inject drugs (PWID). This National Action Plan supported the U.S. government's ability to promote SRHR with regard to HIV and AIDS programs and funding.
C
C

Congress

 

Congress received a 74 (C) with transparency and a 74 (C) without transparency for Family Planning because the enacted FY 2019 Congressional budget appropriated inadequate funds for the United Nations Population Fund (UNFPA) and USAID in 2018. Congress did not pass any legislation related to family planning in 2018. Information on family planning legislation and funding was available, so the transparency score did not decrease Congress’ grade for this domain.

F
D-

Department of State

 

The Department of State received a 56 (F) with transparency and a 60 (D-) without transparency for Family Planning based on two documents related to the PLGHA expansion of the Global Gag Rule: the Six Month Review and the FAQs. Neither were gender aware nor based in evidence or human rights principles. However, both documents were responsive to need because they addressed concerns and questions from partners regarding the implementation of PLGHA. In the budget evaluation, the Department of State largely disbursed family planning funds in accordance with unmet contraceptive need. However, access to family planning and contraception was severely impacted by the Department of State once again defunding the United Nations Population Fund (UNFPA) due to an unsubstantiated Kemp-Kasten amendment violation in FY 2019.

The CHANGE data index grades government agencies on policies and funding impacting family planning, maternal and child health, and HIV & AIDS foreign assistance.

Selecting a document will download the file
2018_Protecting Life in Global Health Assistance FAQs_September 2018
The PLGHA FAQs provided detailed guidance on the implementation of Trump's expanded Global Gag Rule for implementing partners as of September 2018. The FAQs were responsive to need in that they clarified areas of the policy that partners had expressed were vague or unclear. The FAQs were neither based in human rights principles nor evidence. The FAQs were also not gender transformative and substantially hindered the Department of State's ability to implement comprehensive family planning programs in 2018.
2018_Protecting Life in Global Health Assistance Six Month Review
The PLGHA Six Month Review summarized the PLGHA policy and identified solutions to challenges that had arisen in the process of PLGHA implementation. The review was responsive to need in that it addressed concerns expressed by partners affected by the policy, but was not evidence-informed, based in human rights principles, or gender transformative. The document stated that it was too early to assess the impacts of Trump's expanded Global Gag Rule on family planning despite research and literature documenting the harm caused by the policy. The Six Month Review substantially hindered the Department of State's ability to implement comprehensive family planning programs in 2018.
2016_Department of State Implementation Plan for the U.S. Adolescent Girls Strategy
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 moderately promotes sexual and reproductive rights (SRHR) because it discussed the importance of incorporating HIV prevention in all adolescent girls' empowerment programs, especially those that address girls’ political, civic, and economic participation and programs that increase peace and security. This Plan specifically acknowledged the relationship between girls who have undergone female genital cutting (FGC) and their increased risk of acquiring HIV. The Plan also mentioned HIV as a barrier to girls’ education and provided examples of existing Department of State programs that are responsive to need and grounded in human rights, including the President’s Emergency Plan for Aids Relief (PEPFAR). However, this Plan did not disclose how to support the needs of adolescent girls and young women (AGYW) who are living with HIV. It only discussed preventing HIV transmission to AGYW. The Plan is gender accommodating, not gender transformative because it relied on existing gender norms and references unequal gender and age dynamics that put AGYW at a higher risk of HIV incidence.
D
D

US Agency for International Development

 

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.

The CHANGE data index grades government agencies on policies and funding impacting family planning, maternal and child health, and HIV & AIDS foreign assistance.

Selecting a document will download the file
2018_Acting on the Call
Acting on the Call is USAID's annual flagship report for reproductive, maternal, newborn, and child health services. The 2018 report cited country-level annual progress toward family planning targets and provided recommendations to advance family planning in each country context in a manner that was responsive to need. At the same time, the 2018 report, when compared to the 2017 version, included more language regarding USAID's "Journey to Self-Reliance" framework for program countries. This language is consistent with the Trump administration's efforts to reduce U.S. funds for global health as a means to increase the incentive for countries to increase domestic funding. This method of achieving self reliance is neither evidence-based nor sustainable and, given this context, the addition of self reliance language in the report was concerning. Though Acting on the Call reports on both family planning and maternal and child health data, the report did not provide substantial detailed analysis of USAID’s family planning programming. The evaluation of family planning efforts was not included within each country analysis. Additionally, the 2018 report did not mention gender norms or human rights principles as they apply to family planning.
2018_Acquisition and Assistance Strategy
As USAID’s first-ever Acquisition and Assistance (A&A) Strategy, this guidance document increased the accountability and transparency of USAID's procurement, partnering, and project management processes across the Agency. The goal of this Strategy was to streamline "approaches to design and procurement" and develop "new and innovative methods of collaboration" to advance USAID's Journey to Self-Reliance mandate. The Strategy was responsive to need and evidence-based because it cited the current make-up of USAID foreign assistance funding recipients and set specific goals to diversify this partner base. Many of the strategies and shifts put forward in the report incorporated feedback received from smaller and/or local partners. The Strategy also demonstrated a commitment to human rights norms, specifically to the right of self determination, by actively incorporating local partners in the design, procurement, and implementation of USAID's programming. Though the Strategy referenced the importance of "diverse" partners, it did not define who these partners were except for a specific mention of faith-based organizations. Women's rights and human rights groups should also be explicitly mentioned as underutilized partners because of their important role in advancing SRHR for all populations. This Strategy indicated a meaningful effort by USAID to ensure that local partners and recipient countries are included and supported throughout the Journey to Self-Reliance. However, this effort by USAID seems to be in direct conflict with the Trump Administration's strategy of decreasing appropriated funds as a means to motivate self reliance and haphazardly decrease U.S. involvement in foreign assistance. It is unclear in this Strategy how USAID aims to reconcile this conflict.
2018_Agency Priority Goal Action Plan_Maternal and Child Health
The Agency Priority Goals (APGs) for Maternal and Child Health provide quarterly updates on family planning commodity delivery and an overview of family planning programs implemented by USAID. The 2018 APGs were responsive to need and evidence-based in that they cited statistics regarding family planning that have informed the APGs. However, this report was lacking references to international human rights norms and did not include discussions surrounding gender norms in family planning programs. There was only one mention of family planning in each of the quarterly and annual indicators without any programmatic detail or guidance. These mentions of family planning were geared toward families and spacing of births, neither of which may apply to people who give birth outside of traditionally defined families or for people who seek contraceptives for purposes other than spacing births. The cited family planning indicator, "Absolute change in modern contraceptive prevalence rate," did not include any consideration for access to contraceptives for key populations, specifically, and did not account for the role of gender norms in shaping family planning and contraceptive access.
2018_Protecting Life in Global Health Assistance FAQs_September 2018
The PLGHA FAQs provided detailed guidance on the implementation of Trump's expanded Global Gag Rule for implementing partners as of September 2018. The FAQs were responsive to need in that they clarified areas of the policy that partners had expressed were vague or unclear. The FAQs were neither based in human rights principles nor evidence. The FAQs were also not gender transformative and substantially hindered 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.
2017_ADS Chapter 303maa_Standard Provisions for U.S. Nongovernmental Organizations
The Standard Provisions for U.S. Non-governmental organization (NGO) Recipients outlined the standard provisions for all global health activities conducted by U.S. NGOs that received global health assistance funds from USAID. This document is part of the Automated Directive System (ADS), which is the standard operating procedure for USAID. The Standard Provisions provided the first instructions for the implementation of the Protecting Life in Global Health Assistance (PLGHA) policy and explained the requirements of foreign NGOs that receive U.S. global health assistance funds. This partial revision of ADS Chapter 303maa was responsive to need and provided guidance for implementing PLGHA for USAID staff and implementing partners since the Trump Administration’s expansion of the Mexico City Policy. The Standard Provisions explained the limitations placed on U.S.-based NGOs: U.S.-based NGOs that receive U.S. global health assistance funding may not provide any health assistance to foreign NGOs who perform or promote abortion as a method of family planning and must ensure that their sub-grantees do not sub-grant to foreign NGOs that violate the PLGHA policy. While USAID did not have control over the policy language itself, USAID could control the guidance they released regarding the implementation of the policy. The Standard Provisions also stated that foreign NGOs that receive U.S. global health assistance funds cannot perform or actively promote abortions as a method of family planning or provide funding to other foreign NGOs that do so. If a foreign NGO is found to be in violation of the policy, the provisions stated that their funding will be terminated. Though this updated Standard Provision was responsive to need, this document did not include adequate guidance or definitions regarding terms such as “financial support” and “passive referral.”
2017_ADS Chapter 303mab_Standard Provisions for Non-U.S. Nongovernmental Organizations
The Standard Provisions for non-U.S. NGO Recipients outlined the standard provisions for all global health activities conducted by international NGOs that received global health assistance funds from USAID. This document is part of the ADS, which is the standard operating procedure for USAID. The Standard Provisions provided the first instructions for the implementation of the PLGHA policy and explained the requirements of foreign NGOs that receive U.S. global health assistance funds. This partial revision of ADS Chapter 303mab was responsive to need and provided guidance for implementing the PLGHA policy for USAID staff and implementing partners since the Trump Administration’s expansion of the Mexico City Policy. The Standard Provisions stated that foreign NGOs that receive U.S. global health assistance funds cannot perform or actively promote abortions as a method of family planning or provide funding to other foreign NGOs that do so. If a foreign NGO is found to be in violation of the policy, the provisions stated that their funding will be terminated. The Standard Provisions also explained the limitations placed on U.S.-based NGOs: U.S.-based NGOs that receive U.S. global health assistance funding may not provide any health assistance to foreign NGOs who perform or promote abortion as a method of family planning and must ensure that their sub-grantees do not sub-grant to foreign NGOs that violate the PLGHA policy. While USAID did not have control over the policy language itself, USAID could control the guidance they released regarding the implementation of the policy. Though this updated Standard Provision was responsive to need, this document did not include adequate guidance or definitions regarding terms such as “financial support” and “passive referral.”
2016_USAID Adolescent Girl Strategy Implementation Plan
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 using 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 family planning programs, this Plan provided a high-level overview of the programs, best practices, and indicators that were 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. The Implementation 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 family planning programs that moderately promoted SRHR.
NA
NA

Department of Health and Human Services

 

HHS does not receive a grade within the Family Planning domain because it does not work in international family planning.

NA
NA

Department of Defense

 

The DoD does not receive a grade within the Family Planning domain because it does not work in international family planning.