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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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C+

This is an average of the three domain scores below.

YEAR 2019

US Agency for International Development

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.

B
B+

HIV & AIDS

 

USAID received an 85 (B) with transparency and an 88 (B+) without transparency for the HIV and AIDS domain in 2019. USAID was graded based on a number of Agency-level guidance documents, Agency Priority Goals for HIV/AIDS, ADS Chapters, and two PLGHA FAQs. Though these documents were responsive to need, none of them included a gender transformative component and few were based on international human rights norms. The two PLGHA FAQs as well as the updated ADS Chapter 308 significantly reduced the Agency’s grade in this domain because they substantially hindered USAID’s ability to implement HIV and AIDS programming that promoted SRHR. USAID’s grade in this domain was again reduced due to the lack of HIV and AIDS-specific information in the 2019 Acting on the Call Report, which was noted in 2018 as well. Within this domain, USAID received a high budget score because USAID disbursed funds for HIV and AIDS programming according to country-level HIV incidence.

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
2019_Acting on the Call
Acting on the Call is USAID's annual flagship report for reproductive, maternal, newborn, and child health services. As in the 2018 report, the 2019 report mentioned child mortality caused by HIV and AIDS in the country-level analyses, but the inclusion of HIV and AIDS programming was not included in a standardized way across all countries. For example, the country-specific section for Tanzania mentioned the following: “Integrated voluntary family planning within existing HIV care in 5,600 facilities and care delivery points, which increased the availability of voluntary family planning by 300 percent.” This was a unique case where HIV and AIDS programming was mentioned at the country level, so more country-level data is needed to document the intersections between maternal and child health and HIV and AIDS programs across the board. There was no mention of HIV as a leading cause of maternal death, nor any emphasis on the integration of HIV testing and treatment into antenatal care (ANC) services. Prevention of mother-to-child transmission (PMTCT) services and programs for orphans and vulnerable children (OVC) were not discussed, both of which directly contribute to maternal and child health outcomes. Overall, this report was responsive to need, but was not based in evidence or human rights principles, nor was not gender transformative. It substantially hindered SRHR because it did not address HIV and AIDS as a primary cause of maternal mortality globally. The exclusion of HIV and AIDS within this report reinforced the fragmented and siloed nature of U.S. global health programs across program and budget areas.
2019_Additions to the Answers to FAQs Related to the Revised Standard Provision for Grants and Cooperative Agreements to Implement the PLGHA Policy_June 2019
These additional Frequently Asked Questions (FAQs) were released in June 2019 after the assurance by Secretary Pompeo in March 2019 that the language surrounding financial assistance in the guidance on the implementation of the Protecting Life in Global Health (PLGHA) would not change. This additional document asserted that the definition of financial assistance will remain unchanged and that organizations who sub-grant will be required to ensure their subgrantee’s compliance with the policy. Similar to the original FAQ document, there was no discussion of the impacts of this policy or its expansion on HIV and AIDS. This document was somewhat responsive to need as it included additional questions and answers based on confusion expressed by recipients of U.S. global health assistance. The document was not evidence-based, based in international human rights, or gender transformative as it was based on the PLGHA policy which has been shown to be harmful globally, particularly to women and girls. The PLGHA policy has also been shown to decrease access to HIV and AIDS services. Overall, this document provided a substantial hindrance to SRHR.
2019_ADS Chapter 212_Breastfeeding and Infant and Young Child Nutrition Promotion, Protection, and Support
This Automated Directive System (ADS) chapter was updated in its entirety for the first time since 2012 and addressed USAID’s priorities and positions related to breastfeeding and child nutrition. The update expanded the chapter’s guidance regarding infant and young child nutrition as well as incorporated new language on the donation of breastmilk in humanitarian crises. The chapter also included language regarding breastfeeding and HIV, and referenced the WHO guidance on this subject that was released in 2016. The update also included a shift away from the stigmatizing “HIV-infected” language and instead used the accepted language of “people living with HIV” (PLHIV). This document was responsive to need and based in human rights and evidence. However, the document was not gender transformative. Though it discussed the importance of policies on paid family leave or workplace breastfeeding, it did not take steps to ensure these policies were put in place (which could be achieved through the requirement for partners to report on the implementation of this guidance in their programs through mandatory performance reports). The guidance was gender blind because it ignored gender inequalities and stereotypes that could have influenced a person’s ability to adhere to this guidance, such as a pregnant person who is transgender. Overall, this chapter moderately promoted SRHR with regard to guidance for pregnant and breastfeeding women (PBFW) who are living with HIV.
2019_ADS Chapter 303_Grants and Cooperative Agreements to Non-Governmental Organizations and Standard Provisions
This chapter of the Automated Directive System (ADS) governs the grants and cooperative agreements between USAID and NGOs and included three reference documents that were updated in 2019: the ADS 303maa, 303mab, and 303mat. The ADS 303maa was the Standard Provisions that specified the expectations of U.S.-based NGOs that receive funding from USAID through grants and cooperative agreements. The ADS 303mab was the Standard Provisions for foreign NGOs, and the ADS 303mat was the Standard Provisions for fixed amount awards to NGOs. These provisions were updated in 2019 to incorporate the newly expanded Protecting Life in Global Health (PLGHA) policy, including additional guidance regarding the consequences of violation of the PLGHA policy and a new requirement for prime partners to ensure compliance with PLGHA among all sub-partners, regardless of donor. With regard to violations of the policy, the updated ADS allowed for USAID to determine “consistent with 2 CFR 200.338, that other corrective action is warranted” while the previous version only listed termination of the USAID award and repayment of funds as a consequence of a PLGHA violation. Given that USAID was required to implement the PLGHA policy, the agency was only graded for their implementation of the policy and not for the existence of the policy. All of the ADS 303 updates were responsive to need, as it was clear that USAID attempted to address some of the confusion surrounding the policy, particularly amongst grantees and sub-grantees. However, this chapter of the ADS was still not based in evidence nor human rights and was not gender transformative, so therefore may or may not have impacted USAID’s ability to implement HIV and AIDS programs that promoted SRHR.
2019_ADS Chapter 308_Agreements with Public International Organizations and Standard Provisions
This chapter of the Automated Directive System (ADS) governed the agreements between USAID and Public International Organizations (PIOs) (such as UNAIDS, UNICEF, WHO, etc.) and included one reference document that was updated in 2018 and 2019: the ADS 308mab. The ADS 308mab was the Standard Provisions for Cost-Type Agreements with Public International Organizations and specified the mandatory policies and guidelines that must be followed by PIOs who receive funding from USAID. The provisions were updated in August 2018 to require abortion-related restrictions to be included in all health awards. In previous iterations of the ADS 308mab, these restrictions were only required to be included in awards that funded family planning activities. As such, the 2018 update of the ADS 308mab constituted an expansion of the implementation of pre-existing statutory requirements regarding abortion and involuntary sterilization. This updated language expanded the PIO programs to which these pre-existing statutory requirements apply. The 2018 update also added a new requirement that the PIO that received U.S. funds “must insert this provision in all subsequent subawards and contracts” whereas this was not required in prior versions of the ADS 308mab. The 2018 updates to the ADS 308mab substantially hindered SRHR. The updates released in November 2019 were not related to SRHR. The references to voluntarism and the prohibition of involuntary sterilization in this chapter were based in evidence and human rights, however the expansion of the implementation of abortion restrictions and the expansion of these restrictions to all health awards was not based in evidence or human rights, was not responsive to need, nor was gender transformative. Note: The 308mab was updated in August 2018 but CHANGE has been unable to confirm that this version was ever uploaded onto USAID’s website as required by law. Instead, the 2014 version of the document was replaced in 2019 with the 2019 version of the document with the 2018 edits included but not highlighted as new. For this reason, USAID was significantly docked in the transparency grade, as this lack of transparency by USAID hindered the ability of grantees, sub-grantees, partners and civil society to access and respond to the ADS accordingly.
2019_Agency Financial Report_Fiscal Year 2019
This document was in response to congressionally mandated reporting on the spending of USAID. The report highlighted HIV and AIDS programming within the context of reducing child transmission and included a testimony of a woman living with HIV in Tanzania to demonstrate the importance of USAID’s programming. However, the report did not discuss HIV and AIDS in a meaningful way. This report was responsive to need, as expressed by Congress, and based in evidence however there was no mention of human rights principles or gender norms. Overall, this document neither harmed nor promoted SRHR.
2019_Protecting Life in Global Health Assistance Frequently Asked Questions and Answers_September 2019
The Protecting Life in Global Health Assistance (PLGHA) FAQ document was updated in September 2019 to provide clarity on the implementation of the May 2019 expansion of PLGHA as well as address questions and concerns from the 2018 Department of State’s Six Month Review. The text of this document was similar to the 2018 FAQ document, though also included additional questions and answers (see questions 33-37). The document did not meaningfully discuss the impacts of the May 2019 expansion on HIV and AIDS prevention and treatment. Similar to the 2018 FAQs, this document aimed to provide clarity on the policy but left many questions unanswered. This document was somewhat responsive to need as it included additional questions and answers based on confusion expressed by recipients of U.S. global health assistance, specifically regarding the definition of “financial assistance” and the applicability of the policy to technical assistance. The document was not evidence-based, was not grounded in international human rights, and was not gender transformative as it was based on the PLGHA policy which has been shown to be harmful globally, particularly to women and girls. The PLGHA policy has also been shown to decrease access to HIV and AIDS services. Overall, this document provided a substantial hindrance to SRHR.
2019_State and USAID Agency Priority Goal Action Plan_HIV/AIDS
The Agency Priority Goals (APGs) for HIV and AIDS were released by both the Department of State and USAID to hold the President's Emergency Plan For AIDS Relief (PEPFAR) accountable via quarterly reporting that included details around the goals, strategies, milestones, indicators, and progress made towards controlling the HIV epidemic in FY 2019. The 2019 APGs set goals to scale up antiretroviral therapy (ART) services, voluntary medical male circumcision (VMMC) services, and access to HIV and AIDS services for priority and key populations, including men who have sex with men (MSM), sex workers, transgender people, and adolescent girls and young women (AGYW). As a result, this plan was responsive to need and based in evidence and human rights. The APGs were not gender transformative as gender norms were not discussed. Overall, the APGs moderately promoted SRHR.
2019_State and USAID FY 2018 Annual Performance Report_FY 2020 Annual Performance Plan
This document shared the goals and timelines for FY 2020 as well as evaluated and summarized the progress of State and USAID in achieving various strategic goals in FY 2018. Goals included global health and gender programs across all three domains. The FY 2020 Performance Plan elements were included throughout the report along with reporting on standard indicators for each Performance Goal under the 4 Strategic Objectives. The report discussed the joint efforts by the Department of State and USAID to achieve HIV and AIDS epidemic control within the third goal. However, there is very little discussion of the data that was used to inform President's Emergency Plan For AIDS Relief (PEPFAR) programming or the human rights foundation for such programmatic decisions. The document did not provide a recommendation or detailed plan for the continuation of the success of HIV and AIDS prevention and treatment programming. This document was responsive to need but was not evidence based, based in human rights nor gender transformative. The Plan mentioned the disadvantages of a “gender-blind system” within Strategic Goal Two but perpetuated such a system by not including a gendered lens throughout the document.
2019_USAID Policy Framework: Ending the Need for Foreign Assistance
This document discussed USAID's new policy framework to achieve self-reliance through a three-step approach. The document was general and did not discuss any particular aspect of assistance, such as HIV and AIDS. There was one mention of HIV and AIDS as a foreign assistance success, but it was without a discussion of President's Emergency Plan For AIDS Relief (PEPFAR) as the main mechanism by which USAID has carried out these programs. This policy was responsive to need in that it reflected conversations about democratizing foreign assistance and creating more sustainable systems, however the framework did not mention the evidence or international human rights norms that should be the foundation of such programs. This policy framework was also not gender transformative, as it contained very little about the role of gender in a country's "Journey to Self-Reliance." USAID’s Policy Framework moderately hindered the ability of USAID to support HIV and AIDS programs that promote SRHR.
2018_Acting on the Call
Acting on the Call is USAID's annual flagship report for reproductive, maternal, newborn, and child health services. Within the 2018 report, HIV and AIDS was discussed strictly in the context of child mortality despite the fact that HIV is a leading contributor of maternal mortality worldwide. Evidence suggests that HIV and AIDS are key factors in maternal mortality and wellness and in child health through the prevention of maternal to child transmission (PMTCT). By leaving out HIV and AIDS data herein, the framework of this report reinforced the silos between maternal and child health, family planning, and HIV and AIDS programming that challenged USAID's ability to support integrated SRHR programs in 2018.
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_ADS Chapter 312sae_Condoms and Pharmaceuticals
The Automated Directives System (ADS) contains the operational policies that guide USAID's programs and operations. The Condoms and Pharmaceuticals ADS Help Document is an addendum to ADS Chapter 312 that was revised in 2018 to guide the procurement of condoms and pharmaceuticals by USAID’s Bureau for Global Health. The updated directive required that the procurement of all condoms (internal and external) be managed by the Office of HIV/AIDS. While this directive was detailed and informative and included the procurement of female (internal) condoms, it is unclear what prompted this update. As a result, it was challenging to gauge whether the guidance was responsive to need, evidence-based, human rights-based, or gender transformative. It was also unclear how the consolidation of procurement of all condoms under the Office of HIV/AIDS will impact USAID's HIV and AIDS programming and, therefore, SRHR overall, given that condoms are an important intervention in both family planning and maternal and child health.
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 HIV and AIDS programs that were evidence-informed, responsive to need, consistent with internationally-recognized human rights principles, and gender transformative.
2018_State and USAID Agency Priority Goal Action Plan_HIV/AIDS
The Agency Priority Goals (APGs) for HIV and AIDS hold the President’s Emergency Plan for Aids Relief (PEPFAR) accountable through quarterly reporting that includes details around the goals, strategies, milestones, indicators, and progress made towards controlling the HIV epidemic. Released by both the Department of State and USAID, these reports are useful for government transparency and are responsive to need and based in evidence and human rights. However, the APGs did not explain the role of USAID, specifically, in HIV and AIDS programming and only discussed PEPFAR-level successes and challenges. As a result, the APGs did not hinder or promote USAID's ability to support comprehensive HIV and AIDS programs, so the APGs did not increase or decrease USAID's score in this domain in 2018.
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 (which “encompasses the interconnected events that resonate across a girl’s life from birth to adulthood”) to reduce gender disparities and gender-based violence (GBV) and increase capacity of women and girls through USAID’s programs. Though it did not explicitly mention USAID’s HIV and AIDS programs through the President’s Emergency Plan for Aids Relief (PEPFAR), 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 programs, including HIV and AIDS. The Plan was responsive to need and based in evidence. The Plan 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 HIV and AIDS programs that moderately promoted SRHR.
D
D

Maternal and Child Health (MCH)

 

USAID received a 75 (C) with transparency and a 78 (C+) without transparency for the Maternal and Child Health domain in 2019. USAID was graded based on a number of Agency-level guidance documents, Agency Priority Goals for Maternal and Child Health, Automated Directive System (ADS) Chapters, and two Protecting Life in Global Health Assistance (PLGHA) FAQ documents. While these documents varied in their grades and most were responsive to need, they were not gender transformative and few were based in internationally recognized human rights norms. ADS Chapter 212, however, provided a much-needed update to USAID’s breastfeeding practices and was one of the few documents based in international human rights norms and guidance. The Agency Priority Goals for Maternal and Child Health and annual Acting on the Call report both lacked any explicit discussion of respectful maternity care, depicting a backslide from previous years where respectful maternity care was included in both documents.

USAID’s budget grade in this domain suggested that the Agency’s maternal and child health programs were not responsive to need, as a significant portion of maternal and child health funds disbursed in FY 2019 was not programmed in countries with the highest maternal mortality. Following a consultation with USAID in 2020, we have made minor adjustments to the methodology for the budget calculation for USAID’s Maternal and Child Health domain to most accurately reflect the appropriation of these funds. This change is reflected in the 2019 grades.

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
2019_Acting on the Call
Acting on the Call is USAID's annual flagship report for reproductive, maternal, newborn, and child health services. The 2019 report focused largely on maternal health more than other domains, but still did not meaningfully discuss respectful maternity care or maternity care for LGBTQI+ people, people living with disabilities, or people who have been impacted by genital cutting. The report discussed the importance of respect for all patients and providers but did not specifically discuss respectful maternity care and the disrespect and abuse faced by people receiving maternal and child health services. There was no explanation of how respect for all patients and providers was being integrated into country-level programming. The report was based on programmatic data collected by USAID and reports on indicators that were commonly accepted in the maternal and child health field. The report did not reference international human rights norms nor did it include gender transformative language. In contrast, the language reinforced the established gender binary and did not discuss or move to address the structural barriers to respectful maternal health care. With regard to maternal and child health, this report moderately promoted SRHR.
2019_Additions to the Answers to FAQs Related to the Revised Standard Provision for Grants and Cooperative Agreements to Implement the PLGHA Policy_June 2019
These additional Frequently Asked Questions (FAQs) were released in June 2019 after the assurance by Secretary Pompeo in March 2019 that the language surrounding financial assistance in the guidance on the implementation of Protecting Life in Global Health Assistance (PLGHA) would not change. This additional document asserted that the definition of financial assistance would remain unchanged and that organizations who sub-grant would be required to ensure their subgrantee’s compliance with the policy. Similar to the original FAQ document, there was no discussion of the impacts of this policy or its expansion on maternal and child health. This document was somewhat responsive to need as it includes additional questions and answers based on confusion expressed by recipients of U.S. global health assistance. The document was not evidence-based, based in international human rights, or gender transformative as it was based on the PLGHA policy which has been shown to be harmful globally, particularly to women and girls. The PLGHA policy has been shown to decrease access to maternal care while increasing rates of unsafe abortion. Overall, this document provided a substantial hindrance to SRHR.
2019_ADS Chapter 212_Breastfeeding and Infant and Young Child Nutrition Promotion, Protection, and Support
This Automated Directive System (ADS) chapter was updated in its entirety for the first time since 2012 and addressed USAID’s priorities and positions related to breastfeeding and child nutrition. The update expanded the chapter’s guidance regarding infant and young child nutrition and incorporated new language on the donation of breastmilk in humanitarian crises. The chapter referenced WHO guidelines and accepted normative guidance from agencies such as the Department of Health and Human Services (HHS) and implementers, such as PATH. This document was responsive to need and based in human rights and evidence. However, the document was not gender transformative. Though it discussed the importance of policies on paid family leave or workplace breastfeeding, it did not ensure these policies were put in place (which could have been achieved through the requirement for partners to report on the implementation of this guidance in their programs through mandatory performance reports). The guidance, including the description of Kangaroo Mother Care, included gendered language that was not inclusive. The guidance was gender blind because it ignored gender inequalities and stereotypes that might influence a person’s ability to adhere to this guidance, such as a pregnant person who is transgender. Overall, this chapter moderately promoted SRHR with regard to guidance for PBFW and USAID’s maternal and child health programs.
2019_ADS Chapter 303_Grants and Cooperative Agreements to Non-Governmental Organizations and Standard Provisions
This chapter of the Automated Directive System (ADS) governed the grants and cooperative agreements between USAID and NGOs and included three reference documents that were updated in 2019: the ADS 303maa, 303mab, and 303mat. The ADS 303maa is the Standard Provisions that specified the expectations of U.S.-based NGOs that receive funding from USAID through grants and cooperative agreements. The ADS 303mab is the Standard Provisions for foreign NGOs, and the ADS 303mat is the Standard Provisions for fixed amount awards to NGOs. These provisions were updated in 2019 to incorporate the newly expanded Protecting Life in Global Health Assistance (PLGHA) policy, including additional guidance regarding the consequences of violation of the PLGHA policy and a new requirement for prime partners to ensure compliance with PLGHA among all sub-partners, regardless of donor. With regard to violations of the policy, the updated ADS allowed for USAID to determine “consistent with 2 CFR 200.338, that other corrective action is warranted” while the previous version only listed termination of the USAID award and repayment of funds as a consequence of a PLGHA violation. Given that USAID was required to implement the PLGHA policy, the Agency was graded for their implementation of the policy and not for the existence of the policy. All of the ADS 303 updates were responsive to need, as it was clear that USAID attempted to address some of the confusion surrounding the policy, particularly amongst primes and sub-primes. However, this chapter of the ADS was still not based in evidence or human rights and was not gender transformative.
2019_ADS Chapter 308_Agreements with Public International Organizations and Standard Provisions
This chapter of the Automated Directive System (ADS) governed the agreements between USAID and Public International Organizations (PIOs) (such as UNAIDS, UNICEF, WHO, etc.) and included one reference document that was updated in 2018 and 2019: the ADS 308mab. The ADS 308mab was the Standard Provisions for Cost-Type Agreements with Public International Organizations and specified the mandatory policies and guidelines that must be followed by PIOs that receive funding from USAID. The provisions were updated in August 2018 to require abortion-related restrictions to be included in all health awards. In previous iterations of the ADS 308mab, these restrictions were only required to be included in awards that funded family planning activities. As such, the 2018 update of the ADS 308mab constituted an expansion of the implementation of pre-existing statutory requirements regarding abortion and involuntary sterilization. This updated language expanded the PIO programs to which these pre-existing statutory requirements apply. The 2018 update also added a new requirement that the PIO receiving U.S. funds “must insert this provision in all subsequent subawards and contracts” whereas this was not required in prior versions of the ADS 308mab. The 2018 updates to the ADS 308mab substantially hindered SRHR. The updates released in November 2019 were not related to SRHR. The references to voluntarism and the prohibition of involuntary sterilization in this chapter were based in evidence and human rights, however the expansion of the implementation of abortion restrictions and the expansion of these restrictions to all health awards was not based in evidence or human rights, was not responsive to need, nor was gender transformative. Note: The 308mab was updated in August 2018 but CHANGE has been unable to confirm that this version was ever uploaded onto USAID’s website as required by law. Instead, the 2014 version of the document was replaced in 2019 with the 2019 version of the document with the 2018 edits included but not highlighted as new. For this reason, USAID was significantly docked in transparency as this lack of transparency by USAID hindered the ability of grantees, sub-grantees, partners and civil society to access and respond to the ADS accordingly.
2019_Agency Financial Report_Fiscal Year 2019
This document was in response to congressionally mandated reporting on the spending of USAID. The report highlights some of USAID’s success and strategies moving forward and referenced maternal and child health as a crosscutting theme across malaria programs and other global health efforts. This document was responsive to need (as expressed by Congress) and based in evidence. However, there was no discussion of human rights principles or gender norms in this report. Overall, this document neither hindered nor promoted SRHR.
2019_Agency Priority Goal Action Plan_Maternal and Child Health
The Agency Priority Goals (APGs) for Maternal and Child Health provide a quarterly overview of maternal and child health programs implemented by USAID in FY 2019. The goals in this report included intersecting issues such as family planning, nutrition, and malaria. Similar to the 2018 plan, the 2019 APGs included many family planning and child health-focused indicators with only one indicator focused on the health of the person giving birth. As such, the APGs did not provide a holistic account of maternal health needs. This indicator (the number of births in healthcare settings) was also incomplete as it did not take into account the experience of the person giving birth nor did it monitor the prevalence of disrespect and abuse. Programs and activities to promote respectful maternity care should be included in USAID’s maternal and child health goals. This document was responsive to need and based in human rights and evidence, but was not gender transformative. The APGs acknowledged gender inequalities, as they referenced gendered challenges to promoting maternal health but did not make addressing them an APG. Overall, the APGs did not promote SRHR.
2019_Protecting Life in Global Health Assistance Frequently Asked Questions and Answers_September 2019
The Protecting Life in Global Health Assistance (PLGHA) FAQ document was updated in September 2019 to provide clarity on the implementation of the May 2019 expansion of PLGHA as well as address questions and confusion from the 2018 Department of State’s Six Month Review. The text of this document was similar to the 2018 FAQ document but also included additional questions and answers (see questions 33-37). The document did not meaningfully discuss the impacts of the May 2019 expansion on maternal and child health. Similar to the 2018 FAQs, this document aimed to provide clarity on the policy but left many questions unanswered. This document was somewhat responsive to need as it included additional questions and answers based on confusion expressed by recipients of U.S. global health assistance, specifically regarding the definition of “financial assistance” and the applicability of the policy to technical assistance. The document was not evidence-based, was not grounded in international human rights, and was not gender transformative as it was based on the PLGHA policy which has been shown to be harmful globally, particularly to women and girls. The PLGHA policy has also been shown to decrease access to maternal care while increasing rates of unsafe abortion. Overall, this document provided a substantial hindrance to SRHR.
2019_State and USAID FY 2018 Annual Performance Report_FY 2020 Annual Performance Plan
This document shared the goals and timelines for FY 2020 as well as evaluated and summarized the progress of State and USAID in achieving various strategic goals in FY 2018. These goals included global health and gender programs across all three domains. The FY 2020 Performance Plan elements were included throughout the report along with reporting on standard indicators for each Performance Goal under the 4 Strategic Objectives. The Report provided an overview of USAID’s efforts in this area, as USAID was the main implementer of maternal and child health programs globally. Within this domain, the Report was not based in evidence or human rights nor was it responsive to need, as maternal and child health was not included as a part of the Annual Performance Plan. The Plan was also not gender transformative, as it mentioned the disadvantages of a “gender-blind system” within Strategic Goal Two but perpetuated such a system by not including a gendered lens throughout the document. Overall, this document neither hindered nor promoted USAID’s ability to support maternal and child health programs that promote SRHR.
2019_USAID Policy Framework: Ending the Need for Foreign Assistance
This document discussed USAID's new policy framework to achieve self-reliance through a three-step approach. The framework was very general and did not discuss any particular aspect of assistance such as maternal and child health. Maternal and child health was briefly mentioned as a success of foreign assistance and within the context of USAID as “doing no harm” through its programs. This policy was responsive to need in that it reflected conversations about democratizing foreign assistance and creating more sustainable systems, however the framework did not mention the evidence or international human rights norms that should be the foundation of such programs. This policy framework was not gender transformative, as it contained very little about the role of gender in a country's "Journey to Self-Reliance." USAID’s Policy Framework moderately hindered the ability of USAID to support maternal and child health programs that promote SRHR.
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.
C
C

Family Planning (FP)

 

USAID received a 73 (C) with transparency and a 76 (C) without transparency for the Family Planning domain in 2019. USAID was graded based on a number of Agency-level guidance documents, Agency Priority Goals for Maternal and Child Health, Automated Directive System (ADS) Chapters, and two PLGHA FAQ documents. While these documents varied in their grades and most were responsive to need, they were not gender transformative and few were based in internationally recognized human rights norms. Many of these documents also lacked explicit mention of family planning programs, which further reinforced the siloed nature of USAID’s global health programming. This was particularly evident in the annual Acting on the Call report, which did not describe the extent to which—if at all—family planning and maternal and child health activities were integrated within USAID-funded programs.

Furthermore, USAID’s budget grade in this domain suggested that the Agency’s family planning programs were not responsive to need, as a significant portion of family planning funds disbursed in FY 2019 was not programmed in countries with the highest total fertility rate. Following a consultation with USAID in 2020, we have made minor adjustments to the methodology for the budget calculation for USAID’s Family Planning domain to most accurately reflect the appropriation of these funds. This change is reflected in the 2019 grades.

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
2019_Acting on the Call
Acting on the Call is USAID's annual flagship report for reproductive, maternal, newborn, and child health services. The 2019 report cited country-level annual progress toward family planning targets and provided recommendations to advance family planning in numerous country-specific snapshots in a way that was somewhat responsive to need. However, a commitment to family planning was not uniform across all countries. Though contraceptive prevalence rate was recorded throughout the report, there was no discussion or explanation as to why this was the only relevant family planning indicator included in the report. There was also a lack of discussion around the integration of maternity care and family planning care in all countries. The report was based on evidence collected by USAID, but did not reference international human rights norms and did not include gender transformative language. With regard to family planning, this report moderately hindered SRHR.
2019_Additions to the Answers to FAQs Related to the Revised Standard Provision for Grants and Cooperative Agreements to Implement the PLGHA Policy_June 2019
These additional Frequently Asked Questions (FAQs) were released in June 2019 after the assurance by Secretary Pompeo in March 2019 that the language surrounding financial assistance in the guidance on the implementation of Protecting Life in Global Health Assistance (PLGHA) would not change. This additional document asserted that the definition of financial assistance will remain unchanged and that organizations who sub-grant will be required to ensure their subgrantee’s compliance with the policy. Similar to the original FAQ document, there was no discussion of the impacts of this policy or its expansion on family planning. This document was somewhat responsive to need as it included additional questions and answers based on confusion expressed by recipients of U.S. global health assistance. The document was not evidence-based, grounded in international human rights or gender transformative as it was based on the PLGHA policy which has been shown to be harmful globally, particularly to women and girls. The PLGHA policy has been shown to actually increase the rate of abortion in country, many of which are unsafe. Overall, this document provided a substantial hindrance to SRHR.
2019_ADS Chapter 212_Breastfeeding and Infant and Young Child Nutrition Promotion, Protection, and Support
This Automated Directive System (ADS) chapter was updated in its entirety for the first time since 2012 and addressed USAID’s priorities and positions related to breastfeeding and child nutrition. The update expanded the chapter’s guidance regarding infant and young child nutrition as well as incorporated new language on the donation of breastmilk in humanitarian crises. The chapter included language regarding the Lactational Amenorrhea Method (LAM) as a method of postpartum contraception, however did not cite data that proved the referenced 98 percent rate of efficacy of this method. It did not adequately provide guidance about facilitating modern contraceptive use for pregnant and breastfeeding women. This document was responsive to need and based in human rights and evidence. However, the document was not gender transformative. Though it discussed the importance of policies on paid family leave or workplace breastfeeding, it did not take steps to ensure these policies were put in place (which could be achieved through the requirement for partners to report on the implementation of this guidance in their programs through mandatory performance reports). The guidance was gender blind because it ignored gender inequalities and stereotypes that might influence a person’s ability to adhere to this guidance, such as a pregnant person who is transgender. Overall, this chapter moderately promoted SRHR with regard to guidance for PBFW and USAID’s family planning programs.
2019_ADS Chapter 303_Grants and Cooperative Agreements to Non-Governmental Organizations and Standard Provisions
This chapter of the Automated Directive System (ADS) governed the grants and cooperative agreements between USAID and NGOs and included three reference documents that were updated in 2019: the ADS 303maa, 303mab, and 303mat. The ADS 303maa is the Standard Provisions that specified the expectations of U.S.-based NGOs that receive funding from USAID through grants and cooperative agreements. The ADS 303mab is the Standard Provisions for foreign NGOs, and the ADS 303mat is the Standard Provisions for fixed amount awards to NGOs. These provisions were updated in 2019 to incorporate the newly expanded Protecting Life in Global Health Assistance (PLGHA) policy, and included additional guidance regarding the consequences of violation of the PLGHA policy as well as a new requirement for prime partners to ensure compliance with PLGHA among all sub-partners, regardless of donor. With regard to violations of the policy, the updated ADS allowed for USAID to determine “consistent with 2 CFR 200.338, that other corrective action is warranted” while the previous version only listed termination of the USAID award and repayment of funds as a consequence of a PLGHA violation. Given that USAID was required to implement the PLGHA policy, the agency was graded for their implementation of the policy and not for the existence of the policy. All of the ADS 303 updates were responsive to need, as it was clear that USAID attempted to address some of the confusion surrounding the policy, particularly amongst grantees and sub-grantees. However, this chapter of the ADS was not based in evidence or human rights and was not gender transformative.
2019_ADS Chapter 308_Agreements with Public International Organizations and Standard Provisions
This chapter of the Automated Directive System (ADS) governed the agreements between USAID and Public International Organizations (PIOs) (such as UNAIDS, UNICEF, WHO, etc.) and included one reference document that was updated in 2018 and 2019: the ADS 308mab. The ADS 308mab is the Standard Provisions for Cost-Type Agreements with Public International Organizations and specifies the mandatory policies and guidelines that PIOs who receive funding from USAID must follow. The provisions were updated in August 2018 to require abortion-related restrictions to be included in all health awards. In previous iterations of the ADS 308mab, these restrictions were only required to be included in awards that funded family planning activities. As such, the 2018 update of the ADS 308mab constituted an expansion of the implementation of pre-existing statutory requirements regarding abortion and involuntary sterilization. This updated language expanded the PIO programs to which these pre-existing statutory requirements apply. The 2018 update also added a new requirement that the PIO receiving U.S. funds “must insert this provision in all subsequent subawards and contracts” whereas this was not required in prior versions of the ADS 308mab. The 2018 updates to the ADS 308mab substantially hindered SRHR. The updates released in November 2019 were not related to SRHR. The references to voluntarism and the prohibition of involuntary sterilization in this chapter were based in evidence and human rights, however, the expansion of the implementation of abortion restrictions and the expansion of these restrictions to all health awards was not based in evidence or human rights, was not responsive to need, nor was gender transformative. Note: The 308mab was updated in August 2018 but CHANGE has been unable to confirm that this version was ever uploaded onto USAID’s website as required by law. Instead, the 2014 version of the document was replaced in 2019 with the 2019 version of the document with the 2018 edits included but not highlighted as new. For this reason, USAID was significantly docked in transparency, as this lack of transparency by USAID hindered the ability of grantees, sub-grantees, partners and civil society to access and respond to the ADS accordingly.
2019_Agency Financial Report_Fiscal Year 2019
This document was in response to congressionally mandated reporting on the spending of USAID. The report highlighted some of USAID’s success and strategies moving forward but did not specifically discuss family planning except in the listing of expenses. This document was responsive to need (as expressed by Congress) and based in evidence, however there was no discussion of human rights principles or gender norms. Overall, this document neither hindered nor promoted SRHR.
2019_Agency Priority Goal Action Plan_Maternal and Child Health
The Agency Priority Goals (APGs) for Maternal and Child Health provide a quarterly overview of maternal and child health programs implemented by USAID in FY 2019. The goals in this report focused on intersecting issues such as family planning, nutrition, and malaria. The document discussed family planning within some of the indicators as a key intervention to decrease maternal deaths. It also mentioned a decreasing trend in modern contraceptive use in priority countries and an increase in teenage pregnancy, but did not provide the data to explain what has caused both of these challenges. There was no mention of the importance of method mix and comprehensive information about family planning by healthcare providers, which is particularly relevant in settings with a large presence of faith-based providers who have the ability to opt out of the provision of some modern contraceptive methods. This document was responsive to need and somewhat based in human rights and evidence. The document was not gender transformative but gender aware, as it referenced challenges to contraceptive uptake but did not take steps to address them. As such, it only moderately promoted SRHR through USAID’s family planning programming.
2019_Protecting Life in Global Health Assistance Frequently Asked Questions and Answers_September 2019
The Protecting Life in Global Health Assistance (PLGHA) FAQs document was updated in 2019 to provide clarity on the implementation of the May 2019 expansion of PLGHA as well as address questions and confusion from the 2018 Department of State’s Six Month Review. The text of this document was similar to the 2018 FAQ document though included additional questions and answers (see questions 33-37). The document did not meaningfully discuss the impacts of the May 2019 expansion on family planning. Similar to the 2018 FAQs, this document aimed to provide clarity on the policy but left many questions unanswered. This document was somewhat responsive to need as it included additional questions and answers based on confusion expressed by recipients of U.S. global health assistance, specifically regarding the definition of “financial assistance” and the applicability of the policy to technical assistance. The document was not evidence-based, was not grounded in international human rights, and was not gender transformative as it was based on the PLGHA policy which has been shown to be harmful globally, particularly to women and girls. The PLGHA policy has been shown to actually increase the rate of abortion in country, many of which are unsafe. Overall, this document provided a substantial hindrance to SRHR.
2019_State and USAID FY 2018 Annual Performance Report_FY 2020 Annual Performance Plan
This document shared the goals and timelines for FY 2020 as well as evaluated and summarized the progress of State and USAID in achieving various strategic goals in FY 2018. These goals included global health and gender programs across all three domains. The FY 2020 Performance Plan elements were included throughout the report along with reporting on standard indicators for each Performance Goal under the 4 Strategic Objectives. The Report did not discuss family planning, despite the fact that USAID is one of the largest funders of family planning programs globally. Within this domain, the Report was not based in evidence or human rights and was not responsive to need, as family planning was not included as a part of the FY 2020 Performance Plan. The Plan was not gender transformative, as it mentioned the disadvantages of a “gender-blind system” within Strategic Goal Two but perpetuated such a system by not including a gendered lens throughout the document. Overall, this report neither hindered nor promoted SRHR.
2019_USAID Policy Framework: Ending the Need for Foreign Assistance
This document discussed USAID's new policy framework to achieve self-reliance through a three-step approach. The Framework was general and did not discuss any particular aspect of global health assistance, though there was one mention of voluntary family planning within the context of USAID’s mandate of “doing no harm” through its programs. This Framework was responsive to need in that it reflected conversations about democratizing foreign assistance and creating more sustainable systems. However, the framework did not mention the evidence or international human rights norms that should be the foundation of such programs. This Framework was not gender transformative, as it contained very little detail about the role of gender in a country's "Journey to Self-Reliance." USAID’s Policy Framework moderately hindered the ability of USAID to support family planning programs that promote SRHR.
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.