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

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

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D

This is an average of the three domain scores below.

YEAR 2019

White House

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.

Selecting a document will download the file
2019_President’s-Budget-Request.pdf

B
B+

HIV & AIDS

 

The White House received an 84 (B) with transparency and an 87 (B+) without transparency for HIV and AIDS. The White House proposed adequate—but less than ideal—funding for the Global Fund and for the Department of State’s HIV and AIDS programs but zeroed out funding for USAID’s HIV and AIDS programs. This grade was harmed by the lack of inclusion of HIV and AIDS in a meaningful manner in the United States Strategy on Women, Peace, and Security and the Global Health Security Strategy. The transparency grade was low for HIV and AIDS due to the White House website no longer using filters or criteria to navigate the policies listed online. Similar to 2018, HIV and AIDS continued to be the White House’s highest scoring domain.

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_Global Health Innovation Act of 2017 (H.R.1660)
This law signed by the President instituted a new requirement for the Administrator of USAID to report to Congress about USAID’s investment in and development of novel global health technologies. The passage of this bill indicated White House and Congressional interest in global health technologies and implemented a mechanism to hold USAID accountable to continuous innovation of such technologies. HIV and AIDS technologies, unlike family planning technologies, were explicitly mentioned in the Act which provided an accountability mechanism for these specific technologies. The Act did not reference human rights principles or the need for more women and girl-centered technologies, such as multi-purpose prevention technologies that prevent both pregnancy and HIV acquisition. This law was responsive to need and evidence-based, as it emphasized the importance of global health technologies and innovation in achieving global health goals. Overall, this law promoted SRHR within the HIV and AIDS domain because it encouraged the development of technologies to support HIV and AIDS programming.
2019_United States Government Global Health Security Strategy
This document was a cross-agency Strategy to improve global health security both in the U.S. and globally. The Strategy discussed the importance of disease prevention and treatment and outlined the role of the U.S. and other funders invested in strengthening health systems in countries that may not currently have the capacity to respond to outbreaks. This Strategy was high-level and did not specifically discuss relevant global health issues, including HIV and AIDS. The annex of the Strategy mentioned the role of the President's Emergency Plan For AIDS Relief (PEPFAR) in ending the HIV and AIDS epidemic, however the discussion about HIV and AIDS should have been more consistent throughout the Strategy given the importance of this health issue to global health security. This Strategy was responsive to need and evidence-based, as it referenced global standards regarding global health security and data proving the need for strengthening of health systems throughout the Strategy. The Strategy was neither gender transformative nor based in international human rights norms, as it did not discuss the role of gender norms in global health security or specifically reference human rights principles that frame global health security efforts. Overall, this Strategy’s silence on HIV and AIDS did not harm SRHR but it also did not promote SRHR. Future strategies should provide specific details about relevant programs that contribute to global health security, including HIV and AIDS.
2019_United States Strategy on Women, Peace, and Security
The U.S. Strategy on Women, Peace, and Security is the operationalization of the Women, Peace, and Security Act of 2017 and is intended to "increase women’s meaningful leadership in political and civic life by helping to ensure they are empowered to lead and contribute, equipped with the necessary skills and support to succeed, and supported to participate through access to opportunities and resources." However, the Strategy dismissed the important role of health in the wellbeing and participation of women and girls in decision-making processes and institutions both during times of conflict and peace. Given that the Department of State and USAID were named as relevant actors in this Strategy, the lack of discussion of health—specifically of HIV and AIDS treatment and prevention—was an obvious gap in the Strategy. The absence of health was further glaring given the documented impact of the breakdown of health systems on people living with HIV (PLHIV) in conflict and humanitarian settings. The Strategy also did not address the risk of sexual transmission of HIV due to gender-based violence (GBV) in conflict and crisis settings. This Strategy was responsive to need as it addressed the lack of representation of women in conflict resolution and peacebuilding processes. However, the Strategy is not grounded in evidence as evidence shows the key role of health—particularly HIV and AIDS prevention, care, and treatment—in achieving country stability. The Strategy was not grounded in human rights, as the document cited "the United States Government’s interpretation of the laws of armed conflict and International Human Rights Law'' which may have implied that human rights principles were not being followed as written. Lastly, this Strategy was not gender transformative because it recognized but did not take steps to address the root causes of gender inequity within conflict and post-conflict settings, nor did it advocate strongly for the inclusion of all populations in these efforts. It is possible that this Strategy, once implemented, could create avenues for significant gender transformation but this Strategy is narrow in a way that ultimately harms women and girls.
2018_Asia Reassurance Initiative Act of 2018 (S. 2736)
The Asia Reassurance Initiative Act discussed U.S. efforts to improve relations with countries in Asia and promote democracy and human rights within the region. These efforts were responsive to need and based in human rights principles, particularly related to reducing poverty and violations of human rights that have occurred within the region. However, the law was not gender transformative or strongly evidence-based in HIV and AIDS prevention and treatment efforts. It mentions "reducing the HIV and AIDS infection rate” through the Lower Mekong Initiative (LMI), but provided no programmatic guidance on how to accomplish this. The LMI was launched in 2009 and is a multinational partnership among Cambodia, Laos, Myanmar, Thailand, Vietnam, and the U.S. to create integrated sub-regional cooperation among the five Lower Mekong countries. The LMI could serve as a promising platform for HIV and AIDS prevention and treatment efforts, but this could only be implemented if additional policy and technical guidance are released. The law also briefly mentioned supporting women’s equality, but did not discuss the importance of addressing gender-based violence (GBV) and sexual and reproductive health and rights (SRHR) in promoting democracy and human rights. Given the prevalence of GBV against ethnic and religious minorities in the region, this was a missed opportunity by the White House to address this issue. For these reasons, this law will likely only have minimal direct effect on the ability of U.S. global health assistance to support HIV and AIDS programs in the region.
2018_PEPFAR Extension Act of 2018 (H.R. 6651)
The PEPFAR Extension Act amended the PEPFAR Stewardship and Oversight Act of 2013 by extending the authorization of PEPFAR through FY 2023. The law allowed PEPFAR to continue its programming, which is largely evidence-based, responsive to need, and based in human rights norms. However, this law also maintained previous authorization language that is not gender transformative and continued clauses that cause harm to key populations, such as the Anti-Prostitution Loyalty Oath and the refusal clause. With the reauthorization, the White House had the opportunity to revise these harmful aspects of the authorization of PEPFAR and chose not to do so. As a result, this law moderately promoted the ability of U.S. global health assistance to support HIV and AIDS programs that are evidence-informed, responsive to need, consistent with human rights principles, and gender transformative.
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…" though HIV testing, counseling, and care was not discussed in further detail. The Plan did not explain the impact of access to HIV and AIDS prevention and treatment services on conflict prevention and country stability nor did it acknowledge the relationship between gender-based violence (GBV) in conflict and the prevalence of HIV and AIDS among women and girls. In fact, there was little discussion on any structural, cultural, and safety barriers that prevented women in conflict-ridden areas from accessing the HIV and AIDS care they wanted and needed. However, the Plan did discuss the intersections of HIV and AIDS with other sexual and reproductive health (SRH) issues, such as maternal mortality. Additionally, this plan is moderately gender transformative as it called for more gender equality and inclusivity in all initiatives, especially regarding “members of marginalized groups, including youth, ethnic, racial or religious minorities, persons with disabilities, displaced persons and indigenous peoples, lesbian, gay, bisexual, transgender, and intersex (LGBTI) individuals, and people from all socioeconomic strata.” The Plan also discussed the distinct needs of ex-combatants and former violent extremists who are female, specifically stating that these women have a difficult time adhering to traditional gender norms upon their return from combat. However, it did not explicitly mention the disproportionate impact of HIV and AIDS on former combatant populations or other key populations such as female sex workers or people who inject drugs (PWID). This National Action Plan supported the U.S. government's ability to promote SRHR with regard to HIV and AIDS programs and funding.
D-
D

Maternal and Child Health (MCH)

 

The White House received a 62 (D-) with transparency and a 65 (D) without transparency due to low funding proposed for Maternal and Child Health and for the defunding of UNICEF and UNIFEM (now UN Women) in 2019. This grade was further harmed by the exclusion of maternal and child health—and health more generally—in the United States Strategy on Women, Peace, and Security. The transparency grade was also low in this domain because the White House website no longer uses filters or criteria to navigate the policies listed online.

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_Global Health Innovation Act of 2017 (H.R.1660)
This law signed by the President instituted a new requirement for the Administrator of USAID to report to Congress about USAID’s investment in and development of global health technologies. The passage of this bill indicated White House and Congressional interest in global health technologies and implemented a mechanism to hold USAID accountable to continuous innovation of such technologies. While HIV and AIDS technologies were explicitly mentioned, this Act did not require USAID to report on other technologies that USAID may be developing, such as maternal and child health technologies or multi-purpose family planning and/or HIV and AIDS technologies. It is possible that without explicit mention of these technologies, they may be omitted from reporting. This law was responsive to need and evidence-based, as it emphasized the importance of global health technologies and innovation in achieving global health goals. The Act did not reference human rights principles or the need for more women and girl-centered technologies. Overall, this law neither promoted nor harmed SRHR with regard to maternal and child health.
2019_United States Government Global Health Security Strategy
This document was a cross-agency Strategy to improve global health security both in the U.S. and globally. The Strategy discussed the importance of disease prevention and treatment and outlined the role of the U.S. and other funders invested in strengthening health systems in countries that may not currently have the capacity to respond to outbreaks. This Strategy was high-level and did not specifically discuss any relevant global health program areas. Maternal and child health was mentioned once as evidence of the success of U.S. global health programs to date, but did not include a description of the role of U.S. global health assistance in these efforts. The Strategy also did not provide any context or discussion of the continuing gaps in maternal and child health programming with regard to global health security. This Strategy was responsive to need and evidence-based, as it referenced global standards regarding global health security and data showing the need to strengthen health systems throughout the Strategy. The document was neither gender transformative nor based in international human rights norms, as it did not discuss the role of gender norms in global health security or specifically reference human rights principles that frame global health security efforts. Overall, this Strategy’s silence on maternal and child health did not harm nor promote SRHR. Future policy documents outlining global health strategies should provide specific details about relevant programs that contribute to global health security.
2019_United States Strategy on Women, Peace, and Security
The U.S. Strategy on Women, Peace, and Security was the operationalization of the Women, Peace, and Security Act of 2017 and was intended to "increase women’s meaningful leadership in political and civic life by helping to ensure they are empowered to lead and contribute, equipped with the necessary skills and support to succeed, and supported to participate through access to opportunities and resources." However, the Strategy dismissed the important role of maternal and child health in the health, wellbeing, and participation of women and girls in decision-making processes and institutions both during times of conflict and peace. Even though the Department of State and USAID were named as relevant actors, the lack of discussion of health—specifically of maternal and child health—was an obvious gap, especially given the prevalence of gender-based violence (GBV) and lack of access to respectful maternity care in crisis settings. This Strategy was responsive to need as it addressed the lack of representation of women in conflict resolution and peacebuilding processes. However, the Strategy was not grounded in evidence as evidence shows the key role of women's health in country stability. The Strategy was not grounded in human rights, as the document cited "the United States Government’s interpretation of the laws of armed conflict and International Human Rights Law'' which may have implied that human rights principles were not being followed as written. Lastly, this Strategy was not gender transformative because it recognized but did not take steps to address the root causes of gender inequity within conflict and post-conflict settings, nor did it advocate strongly for the inclusion of all populations in these efforts. It is possible that this Strategy, once implemented, could create avenues for significant gender transformation but the current version of the Strategy is narrow in a way that ultimately harms women and girls.
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…" though HIV testing, counseling, and care was not discussed in further detail. The Plan did not explain the impact of access to HIV and AIDS prevention and treatment services on conflict prevention and country stability nor did it acknowledge the relationship between gender-based violence (GBV) in conflict and the prevalence of HIV and AIDS among women and girls. In fact, there was little discussion on any structural, cultural, and safety barriers that prevented women in conflict-ridden areas from accessing the HIV and AIDS care they wanted and needed. However, the Plan did discuss the intersections of HIV and AIDS with other sexual and reproductive health (SRH) issues, such as maternal mortality. Additionally, this Plan is moderately gender transformative as it called for more gender equality and inclusivity in all initiatives, especially regarding “members of marginalized groups, including youth, ethnic, racial or religious minorities, persons with disabilities, displaced persons and indigenous peoples, lesbian, gay, bisexual, transgender, and intersex (LGBTI) individuals, and people from all socioeconomic strata.” The Plan also discussed the distinct needs of ex-combatants and former violent extremists who are female, specifically stating that these women have a difficult time adhering to traditional gender norms upon their return from combat. However, it did not explicitly mention the disproportionate impact of HIV and AIDS on former combatant populations or other key populations such as female sex workers or people who inject drugs (PWID). This National Action Plan supported the U.S. government's ability to promote SRHR with regard to HIV and AIDS programs and funding.
F
F

Family Planning (FP)

 

The White House received a 48 (F) with transparency and a 52 (F) without transparency because of the defunding of UNFPA (due to an unsubstantiated Kemp-Kasten amendment violation in FY 2019) and low funding proposed for USAID’s family planning program in the President’s proposed budget. These budgetary determinations significantly hindered the ability of U.S. global health assistance to support comprehensive family planning programs. This grade was further influenced by the lack of any acknowledgment of family planning programming needs from the United States Strategy on Women, Peace, and Security. The transparency grade was also low in this domain because the White House website no longer uses filters or criteria to navigate the policies listed online.

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_Global Health Innovation Act of 2017 (H.R.1660)
This law was signed by the President and instituted a new requirement for the Administrator of USAID to report to Congress about USAID’s investment in and development of global health technologies. The passage of this bill indicated Congressional and White House interest in global health technologies and implements a mechanism to hold USAID accountable to continuous innovation of such technologies. While HIV and AIDS technologies were explicitly mentioned, this Act did not include an explicit request for information about family planning technologies that USAID may be developing, such as multi-purpose prevention technologies that prevent both pregnancy and HIV acquisition. It is possible that without explicit mention of these technologies, they may be omitted from reporting. This law was responsive to need and evidence-based, as it emphasized the importance of global health technologies and innovation in achieving global health goals. The Act did not reference human rights principles or the need for more women and girl-centered technologies, such as multi-purpose prevention. Overall, this law neither promoted nor harmed SRHR with regard to family planning.
2019_United States Government Global Health Security Strategy
This document was a cross-agency Strategy to improve global health security both in the U.S. and globally. The document discussed the importance of disease prevention and treatment and outlined the role of the U.S. and other funders invested in strengthening health systems in countries that may not currently have the capacity to respond to outbreaks. This Strategy was high-level and did not specifically discuss any aspects of global health, such as family planning. This Strategy was responsive to need and evidence-based, as it referenced global standards regarding global health security and data that prove the need for strengthening of health systems. The document was neither gender transformative nor based in international human rights norms, as it did not discuss the role of gender norms in global health security nor did it specifically reference human rights principles that frame global health security efforts. Overall, this Strategy’s silence on family planning did not harm nor promote SRHR. Future policy documents outlining global health strategies should provide specific details about relevant programs that contribute to global health security.
2019_United States Strategy on Women, Peace, and Security
The U.S. Strategy on Women, Peace, and Security was the operationalization of the Women, Peace, and Security Act of 2017 and was intended to "increase women’s meaningful leadership in political and civic life by helping to ensure they are empowered to lead and contribute, equipped with the necessary skills and support to succeed, and supported to participate through access to opportunities and resources." The Strategy, however, dismissed the important role of health in the wellbeing and participation of women and girls in decision-making processes and institutions both during times of conflict and peace. Given that the Department of State and USAID were named as relevant actors in this Strategy, the absence of health was an obvious gap, particularly given the unique health needs of women in conflict settings who experience gender-based violence (GBV) and could lose access to critical family planning and other reproductive health services. The Strategy also did not address the importance of providing post-abortion care (PAC) as a component of post-violence care. This Strategy was responsive to need as it addressed the lack of representation of women in conflict resolution and peacebuilding processes. However, the Strategy was not based in evidence as evidence shows the importance of family planning in promoting women's health and country stability. The Strategy was also not based in human rights, as the document cited "the United States Government’s interpretation of the laws of armed conflict and International Human Rights Law'' which may have implied that human rights principles may not be followed as written. Lastly, this Strategy was not gender transformative because it recognized but did not take steps to address the root causes of gender inequity within conflict and post-conflict settings. It also did not strongly advocate for the inclusion of all populations in these efforts. It is possible that this Strategy, once implemented, could create avenues for significant gender transformation, but this Strategy is narrow in a way that ultimately harms women and girls.
2017_Presidential Memorandum of January 23, 2017_The Mexico City Policy (Expanded Global Gag Rule)
President Trump reinstated and expanded the Mexico City Policy, often known as the Global Gag Rule, and renamed it the Protecting Life in Global Health Assistance (PLGHA) policy. When in place under previous administrations, the policy applied only to international family planning assistance, whereas Trump’s version of the policy "extend(s) the requirements... to global health assistance furnished by all departments or agencies." Research has documented the harms of this policy in previous administrations when the policy was in effect, and the expansion of this policy via this 2017 Presidential Memorandum demonstrated a disregard for evidence and international human rights norms. This policy spurred a chain of events that significantly reduced community and government engagement in HIV prevention, care, and treatment programs and prohibits beneficiaries from accessing key services in many countries that receive U.S. global health assistance. The expansion of the PLGHA policy was against evidence, need, and human rights principles and was not gender transformative; this policy was gender blind, as it did not discuss the role of gender norms on the promotion of SRHR through U.S. global health assistance programs.
2016_The United States National Action Plan on Women, Peace, and Security
The United States National Action Plan on Women, Peace, and Security described what the U.S. continues to do to empower women as equal partners in preventing conflict and building peace in countries threatened and affected by war, violence, and insecurity. The Plan moderately promoted sexual and reproductive health and rights by calling for better access to "clinical care and reproductive health services such as family planning, HIV testing, counseling, and treatment…" though HIV testing, counseling, and care was not discussed in further detail. The Plan did not explain the impact of access to HIV and AIDS prevention and treatment services on conflict prevention and country stability nor did it acknowledge the relationship between gender-based violence (GBV) in conflict and the prevalence of HIV and AIDS among women and girls. In fact, there was little discussion on any structural, cultural, and safety barriers that prevented women in conflict-ridden areas from accessing the HIV and AIDS care they wanted and needed. However, the Plan did discuss the intersections of HIV and AIDS with other sexual and reproductive health (SRH) issues, such as maternal mortality. Additionally, this Plan is moderately gender transformative as it called for more gender equality and inclusivity in all initiatives, especially regarding “members of marginalized groups, including youth, ethnic, racial or religious minorities, persons with disabilities, displaced persons and indigenous peoples, lesbian, gay, bisexual, transgender, and intersex (LGBTI) individuals, and people from all socioeconomic strata.” The Plan also discussed the distinct needs of ex-combatants and former violent extremists who are female, specifically stating that these women have a difficult time adhering to traditional gender norms upon their return from combat. However, it did not explicitly mention the disproportionate impact of HIV and AIDS on former combatant populations or other key populations such as female sex workers or people who inject drugs (PWID). This National Action Plan supported the U.S. government's ability to promote SRHR with regard to HIV and AIDS programs and funding.