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
Family Planning (FP)
The U.S. Government received a 61 (D-) with transparency and a 64 (D) without transparency for Family Planning across all actors in 2019. This grade reflected the continued harm to SRHR by the implementation of the PLGHA policy and the harm to SRHR caused by omitting family planning from key global health documents concerning women and girls by various actors. Similar to 2018, this grade was also harmed by insufficient family planning funding, the defunding of the United Nations Population Fund (UNFPA) due to an unsubstantiated Kemp-Kasten amendment violation in FY 2019, low transparency of policies by USAID, and family planning spending by USAID that was not responsive to need.
F
F
White House
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 SRHR by calling for better access to "clinical care and reproductive health services such as family planning…", although this is the extent to which it discussed family planning. It did not include safe abortion care or contraceptive use in its list of SRH services supported with U.S. funds under this commitment. However, it did discuss the structural, cultural, and safety barriers that prevent women in conflict-ridden areas from accessing the family planning care they want and need. The Plan is grounded in human rights and is responsive to need in that it acknowledged the impact of discrimination and poor accessibility on SRHR. Additionally, the Plan is moderately gender transformative as it called for increased gender equality and inclusivity in all initiatives, especially regarding “members of marginalized groups, including youth, ethnic, racial or religious minorities, persons with disabilities, displaced persons and indigenous peoples, lesbian, gay, bisexual, transgender, and intersex (LGBTI) individuals, and people from all socioeconomic strata.” It also discussed the distinct needs of ex-combatants and former violent extremists who are female, and specifically stated that these women have a difficult time adhering to traditional gender norms upon their return from combat. This National Action Plan supported the U.S. government's ability to promote SRHR with regard to family planning programs and funding.
C-
C-
Congress
Congress received a 71 (C-) with transparency and a 71 (C-) without transparency due to inadequate funding appropriated for Family Planning and high levels of transparency within policy and funding. These budgetary determinations hindered the ability of U.S. global health assistance to support comprehensive family planning programs that promoted SRHR. The Global Health Innovation Act neither hindered nor raised the grade within this 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 instituted a new requirement for the Administrator of USAID to issue a report to Congress about USAID’s investment in and development of global health technologies. The passage of this bill indicated 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 report on other technologies that USAID may have been 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 girls centered technologies, such as multi-purpose prevention. Overall, this law neither promoted nor harmed SRHR with regard to family planning.
F
D-
Department of State
The Department of State received a 55 (F) with transparency and 61 (D-) without transparency for Family Planning in 2019. This grade was lowered by the implementation of the PLGHA policy through the 2019 PLGHA FAQs and the omission of family planning in the PEPFAR Annual Report to Congress. The grade was raised by the 2019 PEPFAR COP Guidance and the PEPFAR MER Indicator Reference Guide, both of which emphasized the importance of family planning and HIV integration. The transparency grade for policies was lowered by the State and USAID Annual Performance Report and FY 2020 Annual Performance Plan, as this document did not clarify the role of the Department of State in global family planning programming. In the budget evaluation, the Department of State largely disbursed family planning funds in accordance with unmet contraceptive need at the country level. However, access to family planning and contraception was severely impacted by the Department of State once again defunding the United Nations Population Fund (UNFPA) due to an unsubstantiated Kemp-Kasten amendment violation in FY 2019.
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_PEPFAR 2019 Annual Report to Congress
The President's Emergency Plan For AIDS Relief (PEPFAR) Annual Report to Congress provided an overview of PEPFAR’s accomplishments to date and discussed the program’s future directions. This report largely summarized high-level known information about PEPFAR programs. Within this domain, the report was focused on family health and did not frame family planning as relevant to HIV and AIDS programs, or beneficial to non-traditional families or people who are not in a union/relationship. The report was responsive to need but not based in evidence, as it only referenced condoms in the context of HIV prevention programming and neglected to emphasize the importance of family planning for all people, including non-traditional families, the LGBTQIA+ community, sex workers, and people who are not in a union/relationship. The family-centered approach to this report further stigmatized the aforementioned populations from seeking family planning services and, in the process, decreased the entry points for them to receive HIV and AIDS prevention and treatment services. The report did not include a voluntary family planning component and was therefore not based in international human rights norms. The report was not gender transformative but demonstrated awareness of gender norms in the discussion of layered packages in DREAMS programming. This report hindered SRHR because it promoted a family health narrative and ignored the nuances of voluntary family planning programming.
2019_PEPFAR 2019 Country Operational Plan Guidance for all PEPFAR Countries
Released annually by the Office of the Global AIDS Coordinator, the Country Operational Plan (COP) Guidance outlines the plan for global HIV and AIDS activities funded by the President's Emergency Plan For AIDS Relief (PEPFAR) and provides the basis for the approval of annual bilateral HIV and AIDS funding for partner countries. The 2019 COP Guidance was based in evidence, human rights norms, and was responsive to need. The document continued its comprehensive guidance on the implementation of PEPFAR programs for all populations and, within this domain, emphasized the importance of integration of family planning and HIV and AIDS services. However, language about the integration of family planning and HIV services should be mandatory and should be inclusive of people living with HIV (PLHIV) and prevention purposes. Within the guidance, these integration efforts were undercut by PEPFAR’s refusal to procure any contraceptive commodities except for internal and external condoms. The procurement and provision of contraceptive commodities is key to emphasize the importance of integration and has been specifically requested by populations served by PEPFAR, particularly adolescent girls and young women. This integration also provided a point of entry for HIV and AIDS prevention and treatment which could assist PEPFAR in achieving the last mile. The guidance was not gender transformative but demonstrated gender awareness through the use of gender neutral language such as “clients” or “patients,” as well as through the discussion of the impact of gender norms on numerous program areas, including DREAMS, stigma reduction activities, and programs to reach undiagnosed men.
2019_PEPFAR Monitoring, Evaluation, and Reporting Indicator Reference Guide_MER 2.0 (Version 2.4)
The President's Emergency Plan For AIDS Relief (PEPFAR) Monitoring, Evaluation, and Reporting (MER) guidance listed the indicators used to monitor and evaluate PEPFAR. All PEPFAR programs were evaluated according to their performance within these indicators and metrics, and this guide helped country teams and PEPFAR sub-grantees understand the M&E process. In 2019, some of the MER indicators were updated, but it remains unclear what prompted these changes. The document focused largely on HIV-specific indicators, however, it referenced family planning within the KP_PREV, PP_PREV and FPINT_SITE indicators. These indicators were responsive to need and were evidence-based in that they provided a way to measure the integration of voluntary family planning services into PEPFAR programming (particularly the FPINT_SITE indicator which was consistent with international human rights norms by mandating the availability of a broad range of modern contraceptives at PEPFAR sites). The guide was not gender transformative but gender aware, as it included some consideration of environmental factors, such as family situation in HIV treatment and prevention, but did not address these barriers.
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 PLGHA 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 implementation of the policy but left many questions unanswered, such as when the Department of State will release the follow-up to the 2018 Six-Month Review. 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 increase the rate of abortions, many of which are unsafe. Overall, this document was 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 the Department 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 Annual 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 mentioned family planning within the USAID Agency Priority Goals but did not discuss the role of the Department of State in the funding of family planning policies or programs. It is possible that family planning and contraceptive access in humanitarian settings may be a component of the Department of State’s Safe from the Start initiative, but it was not made clear in this report. The Report provided an opportunity for the Department of State to clarify its role in both humanitarian and non-humanitarian family planning, but it failed to seize that opportunity. Within this domain, the Report was not based in evidence or human rights, but was responsive to need with regard to Congressional reporting requirements. The Plan was not gender transformative, as it mentioned the disadvantages of a “gender-blind system” within Strategic Goal Two but did not apply a gendered lens throughout the document. This Report neither promoted nor hindered SRHR with regard to the Department of State’s family planning programs.
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 the Department of State's ability to implement comprehensive family planning programs in 2018.
2018_Protecting Life in Global Health Assistance Six Month Review
The PLGHA Six Month Review summarized the PLGHA policy and identified solutions to challenges that had arisen in the process of PLGHA implementation. The review was responsive to need in that it addressed concerns expressed by partners affected by the policy, but was not evidence-informed, based in human rights principles, or gender transformative. The document stated that it was too early to assess the impacts of Trump's expanded Global Gag Rule on family planning despite research and literature documenting the harm caused by the policy. The Six Month Review substantially hindered the Department of State's ability to implement comprehensive family planning programs in 2018.
2016_Department of State Implementation Plan for the U.S. Adolescent Girls Strategy
The Department of State Implementation Plan for the U.S. Adolescent Girls Strategy was launched in partnership with three other U.S. implementing agencies as part of the first U.S. Global Strategy to Empower Adolescent Girls in 2015. The Plan was evidence-based and grounded in human rights with a strategic objective to expand girls’ access to education, health, and services, which included "preserv[ing] the rights of married and pregnant girls and adolescent mothers to attend school, institut[ing] comprehensive sexuality education in national curricula, and remov[ing] barriers to sexual and reproductive health and rights and comprehensive, accessible, youth-friendly health services." Additionally, this Plan outlined the joint responsibility that all governments have in prioritizing adolescent health and rights, promoting accountability of SRH programs, and addressing the lack of access to or availability of education and health services, which would include family planning. This Plan also repeatedly addressed the distinct health needs of adolescent girls that are displaced by insecurity, conflict, or natural disaster. However, it did not address the cultural or structural barriers (i.e., government policies that hinder access to SRHR, stigmatizing attitudes of healthcare providers, and prohibitively high cost of services) that prevent key underserved populations, such as sex workers and women living with disabilities, from accessing family planning services. Additionally, this Plan is gender accommodating because it acknowledged—but does not work to change—existing gender norms and inequities that prevent AGYW from accessing family planning services.
C
C
US Agency for International Development
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.
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Department of Health and Human Services
HHS does not receive a grade within the Family Planning domain because they do not work in international family planning.
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Department of Defense
The DoD does not receive a grade within the Family Planning domain because they do not work in international family planning.