Actor Score Overview

The White House received a 65 (D) with transparency and a 69 (D+) without transparency in 2019. These grades were the result of the White House’s low proposed budget for Family Planning and for Maternal and Child Health, including the zeroing out of funding for the United Nations Population Fund (UNFPA), UNIFEM (now UN Women), and UNICEF. The policies issued or signed by the White House either did not impact sexual reproductive health and rights (SRHR), such as the Global Health Security Strategy, or harmed SRHR by omitting health altogether, as seen in the United States Strategy on Women, Peace and Security. Related policy information was difficult to find, which led to low transparency grades across all domains.

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2019_President’s-Budget-Request.pdf

Congress received an 85 (B) with transparency and an 85 (B) without transparency because it appropriated adequate funding for Family Planning and Maternal and Child Health as well as full funding for HIV and AIDS in 2019. Congress passed one policy in 2019 that did not significantly impact sexual reproductive health and rights (SRHR) within the Maternal and Child Health and Family Planning domains but did promote SRHR within the HIV and AIDS domain. Congress scored high on transparency due to available policy and budget information.

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2019_Congress Budget

The Department of State received a 61 (D-) with transparency and a 66 (D) without transparency in 2019. The Family Planning and Maternal and Child Health domain grades were lower due to the release of guidance for the implementation of the Protecting Life in Global Health Assistance (PLGHA) policy through the 2019 PLGHA FAQs as well as the neglect of both family planning and maternal and child health in issued guidance and reports such as the President’s Emergency Plan For AIDS Relief (PEPFAR) Annual Report to Congress. The Department of State’s HIV and AIDS grade was high due to activities that were evidence-based and highly responsive to need, as described in PEPFAR’s Monitoring, Evaluation, and Reporting (MER) Indicator Reference Guide and the 2019 Country Operational Plan (COP) Guidance. The Department of State’s actor-level grade was lowered by a lack of policy transparency within the Family Planning and Maternal and Child Health domains. The Department of State’s grade was raised by high budget scores, which indicated that family planning and maternal and child health funds were mostly responsive to need, and HIV funds were highly responsive to need.

The United States Agency for International Development (USAID) received a 77 (C+) with transparency and an 81 (B-) without transparency. In 2019, the Agency released a number of policy and guidance documents that negatively impacted SRHR, including an updated version of the Protecting Life in Global Health Assistance (PLGHA) FAQs. The majority of policy documents released by USAID in 2019 hindered the Agency’s ability to support global health programs that promote SRHR, including the expansion of the implementation of pre-existing statutory requirements regarding abortion activities through Automated Directive System (ADS) Chapter 308, which impacts programs in all domains. USAID’s grade also decreased across domains due to low transparency because the 2018 version of ADS Chapter 308 was not updated to the USAID website before additional revisions were released in 2019.

Additionally, family planning and maternal and child health funds were not spent according to need, which further reduced USAID’s grades in these domains. Following a consultation with USAID in 2020, we have made minor adjustments to the methodology for the budget calculation for USAID’s Family Planning and Maternal and Child Health domains to most accurately reflect the appropriation of these funds. This change is reflected in the 2019 grades.

The Department of Health and Human Services (HHS) received a 60 (D-) with transparency and a 68 (D+) without transparency. This grade was based on the release of the Center for Disease Control and Prevention (CDC) Global Health Strategy as well as four statements related to the U.S. government’s regressive stance on sexual and reproductive health and rights (SRHR) shared by Alex Azar, the U.S. Secretary of Health and Human Services, at various international fora in 2019. The transparency grades for HHS were low across domains because the information on the disbursement of HHS’s funding remains unavailable online.

The Department of Defense (DoD) received a 71 (C-) with transparency and an 81 (B-) without transparency due to the unavailability of policy and budget information related to sexual and reproductive health and rights (SRHR) and low transparency of funding data related to HIV and AIDS. The Maternal and Child Health and Family Planning domains do not factor into the DoD grade because the DoD does not work in international maternal and child health or family planning.