YEAR 2018

Maternal and Child Health (MCH)

The U.S. Government received a 70 (C-) with transparency and a 74 (C) without transparency for Maternal and Child Health across all actors due to the lower budget requests by the White House and Congress. This domain grade was further lowered due to the omittance of specific references to MCH programming in the PLGHA FAQ and Six Month Review documents, which indicates that the U.S. government is not considering the unique impact of the implementation of PLGHA on maternal and child health programs. Low transparency on policy and funding data related to maternal and child health also contributed to this score.

D+

White House

The White House received a 63 (D) with transparency and a 68 (D+) without transparency for Maternal and Child Health in 2018 because the President’s FY 2019 budget did not allocate funds for UNICEF or for UNIFEM (now UN Women). The White House also did not issue any maternal and child health-related executive actions or sign any maternal and child health-related legislation in 2018. Similar to other domains, the transparency score for the White House under the Maternal and Child Health domain was low due to difficulty accessing funding information and the inability to search White House policies by criteria that had been previously available. The low transparency score in this domain, in combination with the lack of funds requested for UNICEF and UNIFEM in the President’s FY 2019 budget request, led to this low score.

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

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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 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.

2015_U.S. Statement to UN Women Executive Board Recognizing Sexual Rights

2015_United States Global Strategy to Empower Adolescent Girls

2012_United States Strategy to Prevent and Respond to Gender-based Violence Globally

2012_Executive Order-Preventing and Responding to Violence Against Women and Girls Globally

2009_Statement by the President on Global Health Initiative

B+

A-

Congress

Congress received an 89 (B+) with transparency and a 90 (A-) without transparency for Maternal and Child Health because, although no new legislation was passed in this domain, the FY 2019 Congressional budget included an appropriation of funds for UNICEF and UNIFEM (now UN Women) — despite the absence of funding for both in the President’s budget request. Congress also appropriated more funding for USAID’s maternal and child health programs in FY 2019 than the amount appropriated in FY 2018. The transparency score was lowered due to a lack of clarity regarding UNIFEM funding.

The Fòs Feminista 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

2004_Medically Accurate Information on Condoms_Consolidated Appropriations Act, 2004 (H.R. 2673)

1961_The Foreign Assistance Act of 1961

Department of State

The Department of State received a 35 (F) with transparency and a 40 (F) without transparency for Maternal and Child Health in 2018 based on two documents related to the PLGHA expansion of the Global Gag Rule: the Six Month Review and the FAQs. Neither document was gender aware or 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. The omittance of specific references to maternal and child health programming in both documents indicated that the Department of State was not considering the unique impact of the implementation of PLGHA on maternal and child health programs. This shortsightedness has serious implications for the ability of the Department of State to implement comprehensive maternal and child health programming. With regards to budget allocation, the Department of State budget evaluation depicted that funds were being distributed according to countries with the highest maternal mortality.

The Fòs Feminista 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 not responsive to need, evidence-based, human rights-based, or gender transformative within this domain. The FAQs received a lower grade within this domain compared to Family Planning and HIV and AIDS because they did not mention maternal and child health programming specifically, despite the unique impacts this policy could have on maternal and child health services. The FAQs significantly hindered the Department of State's ability to support comprehensive maternal and child health programming 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-based, based in human rights principles, or gender transformative. The review received a lower grade within this domain compared to Family Planning and HIV and AIDS because the review did not mention maternal and child health programming specifically, despite the unique impacts this policy could have on maternal and child health services. The Six Month Review significantly hindered the Department of State's ability to support comprehensive maternal and child health programming 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 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.

2012_U.S. Department of State Policy Guidance: Promoting Gender Equality to Achieve our National Security and Foreign Policy Objectives

2012_United States Department of State Implementation Plan of the National Action Plan on Women, Peace, and Security

C-

US Agency for International Development

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.

The Fòs Feminista 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 offered thorough country-level analyses of data around maternal and child health outcomes that were evidence-based and responsive to need but were not gender transformative. The report did not discuss the importance of implementing programming and policies to champion respectful maternity care as a means to address disrespect and abuse. Instead, the report focused largely on USAID's "Journey to Self-Reliance" framework and provided detailed country-level updates including: population-level statistics, intervention coverage, child mortality, nutrition, and health systems strengthening. While the report aimed to improve maternal and child health through the strengthening of health systems, it did not address the importance of a patient-centered approach, which includes respectful maternity care, gender transformative programming, and the improvement of working conditions for health care workers.

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 seemed 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 a quarterly overview of MCH programs implemented by USAID. The goals in this report include intersecting issues such as family planning, nutrition, and malaria. The APGs are responsive to need and evidence-based, but are not gender transformative. The APGs are predominantly child health-focused with "All cause under 5 mortality" as a primary indicator of success in maternal and child health programming. Using this indicator as the primary indicator for maternal and child health actively disregards the health, human rights, wellbeing, and childbirth experience of the woman. The addition of the indicator "Absolute change in total percentage of births delivered in a health facility" in the FY2018 APGs will further strengthen this reporting mechanism. Efforts to promote respectful maternity care could be strengthened, though the APGs do include changing attitudes of health care workers as a maternal and child health strategy.

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 not responsive to need, evidence-based, human rights-based or gender transformative within this domain. The FAQs received a lower grade within this domain compared to Family Planning and HIV and AIDS because they did not mention maternal and child health programming specifically, despite the unique impacts this policy could have on maternal and child health programs. The FAQs significantly hindered USAID's ability to support comprehensive maternal and child health programming.

2017_Acting on the Call

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.

2016_Acting on the Call

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.

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 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.

2015_Acting on the Call

2015_Ending Preventable Maternal Mortality: USAID Maternal Health Vision for Action Evidence for Strategic Approaches

2014_Acquisition and Assistance Policy Directive (AAPD)

2013_Counter-trafficking in Persons Field Guide

2012_Ending Child Marriage and Meeting the Needs of Married Children: The USAID Vision for Action

2012_Gender Equality and Female Empowerment Policy: USAID Policy

2012_United States Strategy to Prevent and Respond to Gender-based Violence Globally

2012_USAID Implementation of the United States National Action Plan on Women, Peace, and Security

Department of Health and Human Services

HHS received a 66 (D) with transparency and a 75 (C) without transparency for Maternal and Child Health. HHS was graded on the Protecting Life in Global Health Assistance (PLGHA) FAQ that included the “HHS Specific Information” section on page 17. The disbursed funds for maternal and child health programs through HHS were not publicly available, which contributed to this actor’s low transparency grade in this domain.

The Fòs Feminista 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_August 2018

The Protecting Life in Global Health Assistance (PLGHA) FAQs provided detailed guidance on the implementation of the expanded Global Gag Rule for implementing partners as of September 2018. HHS was graded based on the "HHS Specific Information" section on page 17 that outlined how HHS administered grants according to the Code of Federal Regulations (CFR). The information offered in this section did not have an effect on the ability of HHS to implement HIV and AIDS programs that were evidence-based, responsive to need, consistent with internationally-recognized human rights principles, gender transformative.

Department of Defense

The DoD does not receive a grade within the Maternal and Child Health domain because it does not work in international maternal and child health.

TRANSPARENCY SCORE

TRANSPARENCY SCORE

Maternal and Child Health (MCH)

White House

Congress

Department of State

US Agency for International Development

Department of Health and Human Services

Department of Defense