This is an average of the three domain scores below.
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.
The State Department received a 35 (F) with transparency and a 40 (F) without transparency for Maternal and Child Health based on two documents related to the PLGHA expansion of the Global Gag Rule: the Six Month Review and the FAQ. Neither is gender aware nor based in evidence or human rights principles. However, both documents are responsive to need because they address concerns and questions from partners regarding the implementation of PLGHA. The omittance of specific references to MCH programming in both documents indicates that the State Department is 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 State Department to implement comprehensive MCH programming. With regards to budget allocation, the State Department budget evaluation depicts that funds are being distributed according to countries with the highest maternal mortality.
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 relate to MCH. Though the impact of this guidance on SRHR ranges 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 are 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 reflects the conclusion that MCH programs are not responsive to need, as a significant portion of the funds disbursed for MCH programming in FY 2019 was not disbursed in countries with the highest maternal mortality.
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 includes the “HHS Specific Information” section on page 17. The disbursed funds for MCH programs through HHS are not publicly available, which contributed to this actor’s low transparency grade in this domain.
DoD does not receive a grade within the maternal health domain because they do not work in international maternal and child health.
Congress received a 89 (B+) with transparency and a 90 (A-) without transparency for Maternal and Child Health because, although no new legislation was passed on MCH, the FY 2019 Congressional budget included an appropriation of funds for UNICEF and UNIFEM — 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 White House received a 63 (D) with transparency and 68 (D+) without transparency for Maternal and Child Health 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 health executive actions or sign any MCH-related legislation in 2018. Similar to other domains, the transparency score for the White House under MCH is low due to difficulty accessing funding information and the inability to search White House policies by criteria that have 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.