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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

Maternal and Child Health (MCH)

The U.S. Government received a 68 (D+) with transparency and a 71 (C-) without transparency for Maternal and Child Health across all actors in 2019. This grade stemmed from a low budget request by the White House and gender-blind language across policy documents that reinforced the traditional gender binary with regard to maternal and child health programs. The U.S. government also omitted specific references to maternal and child health programming in the PLGHA policy documents and guidance, which indicates that the U.S. government did not consider the unique impact of the implementation of the PLGHA policy on maternal and child health programs. The grade was positively impacted by the continued issuance of USAID’s reports like Acting on the Call and USAID’s revision of ADS Chapter 212 that are based in evidence. Low transparency regarding USAID’s maternal and child health policies and maternal and child health funding by HHS also contributed to this grade.

D-
D

White House

 

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.
B
B

Congress

 

Congress received an 86 (B) with transparency and an 86 (B) without transparency because it appropriated adequate levels of funding for UNICEF and USAID’s maternal and child health programs but inadequate funding for UNIFEM (now UN Women). The Global Health Innovation Act neither hindered nor raised the grade within this domain. Congress scored high on transparency due to available policy and budget information.

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 report to Congress on 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 include a request for details about other technologies that USAID could have been 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.
F
F

Department of State

 

The Department of State received a 35 (F) with transparency and 40 (F) without transparency for Maternal and Child Health in 2019. This grade was lowered by the implementation of the PLGHA policy through the 2019 PLGHA FAQs, which was responsive to need but not based in evidence or international human rights norms. None of the documents graded in this domain included gender transformative language. The grade was raised by the PEPFAR COP Guidance and the PEPFAR MER Indicators, which both emphasized the importance of integrating maternal and child health and HIV and AIDS services, particularly for pregnant and breastfeeding women (PBFW) and prevention of mother-to-child transmission (PMTCT) activities. 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 maternal and child health programming. In the budget evaluation, the Department of State disbursed maternal and child health funds in accordance with country level maternal mortality.

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 the PEPFAR program’s accomplishments to date and discussed the program’s future directions. This report largely summarized high-level known information about PEPFAR programs. The report provided critical information about maternal and child health programming through PEPFAR, including viral load monitoring for PBFW, maternal retention in treatment, orphan and vulnerable children (OVC) programs, and prevention of mother-to-child transmission (PMTCT) programs. Within this domain, the report was responsive to need and based in evidence and human rights norms. Some HIV and AIDS services were included in antenatal care (ANC) programming such as opt-out HIV testing, and reported activities were based in evidence and international human rights norms. The document was not gender transformative as it did not discuss the impact of gender norms with PEPFAR’s maternal health programming. Overall, the Annual Report moderately promoted SRHR.
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 did not adequately emphasize the importance of integration of HIV and antenatal care (ANC) services. The guidance was not gender transformative but demonstrated gender awareness through the use of gender-neutral language such as “clients” or “patients” and the discussion of the impact of gender norms on HIV and AIDS prevention and treatment within DREAMS programming. However, the guidance was based in evidence and human rights norms as well as was responsive to need. The document continued to provide comprehensive guidance on the implementation of PEPFAR programs for all populations and, within this domain, emphasized the importance of point-of-care programs for PBFW and prevention of mother-to-child transmission (PMTCT) activities. Overall, the Guidance moderately promoted SRHR.
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 included 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 implementing partners understand the M&E process. In 2019, some of the MER indicators were updated, but it remains unclear what prompted these changes. The document included a few maternal health related indicators, and particularly focused on prevention of mother-to-child transmission (PMTCT) and antenatal care (ANC), as well as included pregnancy status as a disaggregate group across various treatment indicators. Within this domain, the guidance was evidence-based, based in human rights, and responsive to need. However, the guide was not gender transformative but gender aware, as it included some consideration of structural factors, such as family situation, on HIV prevention and treatment but did not move to 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) 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 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 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 the availability of maternal health services. 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 mentioned maternal and child health within the USAID Agency Priority Goals but did not discuss the role of the Department of State in the funding of maternal and child health policies or programs. The Report provided an opportunity for the Department of State to clarify its role in both humanitarian and non-humanitarian maternal and child health activities, but it failed to seize that opportunity. Within this domain, the Report was not based in evidence or human rights and was not responsive to need beyond standard Congressional reporting requirements. 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. This Report neither promoted nor hindered SRHR with regard to the Department of State’s maternal and child health 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 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 services. The FAQs significantly hindered the Department of State's ability to support comprehensive maternal and child health programming 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-based, based in human rights principles, or gender transformative. The review received a lower grade within this domain compared to Family Planning and HIV and AIDS because the review did not mention maternal and child health programming specifically, despite the unique impacts this policy could have on maternal and child health services. The Six Month Review significantly hindered the Department of State's ability to support comprehensive maternal and child health programming 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. This Plan acknowledged the impact of forced marriage, especially early or childhood marriage, and the impact of FGC on the health of AGYW. Specifically, it stated that these practices lead to poor maternal health outcomes, including high morbidity and mortality rates from pregnancy and birth complications, trauma, and other diseases and infections. The Plan provided details on "preserv[ing] the rights of married and pregnant girls and adolescent mothers to attend school" and "remov[ing] barriers to sexual and reproductive health and comprehensive, accessible, youth-friendly health services" to prevent early pregnancy. Though the Plan was responsive to need and grounded in human rights principles, it did not incorporate significant evidence-based programming because it did not address how to meet the clinical needs or provide maternity care of pregnant AGYW. This Plan is gender transformative in that it promoted gender equality by decreasing early marriage and pregnancy through educational empowerment. This Strategy moderately promoted SRHR through the Department of State’s maternal and child health programs.
D
D

US Agency for International Development

 

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.
F
D+

Department of Health and Human Services

 

HHS received a 59 (F) with transparency and a 68 (D+) without transparency for Maternal and Child Health in 2019. The four statements related to the U.S. government’s regressive stance on SRHR (including maternal and child health) shared by Alex Azar, U.S. Secretary of Health and Human Services, significantly decreased the HHS’s grade in this domain. The amount of disbursed funds for maternal and child health programs through HHS was not publicly available, which also contributed to the low transparency grade in 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.

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2019_CDC Global Health Strategy_2019-2021
This Strategy included a brief description of maternal and child health programs carried out by the CDC and presented programmatic and global evidence that highlighted the importance of these programs as a broad contributor to global health. The Strategy discussed the strengthening of health systems through the Saving Mothers, Giving Life Initiative, and the CDC’s role in developing new tools and techniques to address maternal and child health needs. The integration of maternal and child health efforts with HIV and AIDS or family planning was not discussed in the Strategy, which reinforced the siloed nature of these programs. The information moderately promoted SRHR with regard to CDC's maternal and child health programming, though it did not include a gender transformative approach to maternal and child health.
2019_Joint Statement on the Nairobi Summit on the ICPD25
This Statement by the U.S. Secretary of Health and Human Services Alex Azar only affirmed the specific elements of the International Conference on Population and Development (ICPD) Programme of Action that aligned with the Trump Administration’s ideology. It asserted that any outcomes of the Nairobi Summit—including any discussions or decisions related to SRHR—were not to be considered reflective of Member State consensus. Though this Statement might not immediately impact the implementation of global health programs related to SRHR, including those related to maternal and child health, it reflects the U.S. government’s stance on SRHR generally and amplifies and emboldens anti-SRHR ideals globally. This Statement operated within traditional gender norms and was based on ideology, not evidence or international human rights norms. Furthermore, the Statement conflicted with comprehensive sexuality education "that fails to adequately engage parents" and mentioned the importance of "giving young people the skills to avoid sexual risk" which suggested support for abstinence-only programs. The language did not promote autonomy and agency of all people to engage in sexual experiences free of shame, coercion, and violence, and substantially hindered SRHR.
2019_Joint Statement_Item 12.8: Global Strategy for Womens, Childrens, Adolescents Health (2016-2030)
This Statement denounced "ambiguous" terms such as "the right to sexual and reproductive health (and its derivatives)" at a World Health Assembly meeting to discuss the WHO Global Strategy for Women’s, Children’s, and Adolescents’ Health. This Statement highlighted the role of the family over the rights of the individual and did not include inclusive language regarding gender or the specific health needs of key populations. The Statement did not mention maternal and child health as a relevant health issue for women, adolescents, and children. This Statement was not based in evidence or international human rights norms and substantially hindered SRHR.
2019_U.S. Commitment Statement to the Nairobi Summit on ICPD25
This Commitment Statement undermined international human rights norms related to SRHR and their supporting processes, including the U.S. government’s own commitments under the International Conference on Population and Development Programme of Action. This Commitment Statement sought to excuse the U.S. government from its commitments to comprehensive SRHR included in the International Conference on Population and Development Programme of Action under the guise of protecting "the inherent value of every human life -- both born and unborn". and the role of "caring fathers" and faith-based orgniazations in supporting women and girls’ access to healthcare. This Statement included an account of some relevant U.S. global health or development initiatives that contributed to ICPD, including the statement that the U.S. government is the largest bilateral funder for family planning and "that hasn't changed." This language assumed that only couples were using family planning to “either achieve or prevent pregnancy", however is not the only situation in which someone would want to use family planning. This statement moderately hindered SRHR because it was not based in evidence or international human rights norms and was not gender transformative.
2019_U.S. Government Statement at the U.N. High Level Meeting on Universal Health Coverage
This Statement emphasized the U.S. government’s commitment to universal health coverage (UHC) but condemned the inclusion of SRHR language and sexual education that "diminishes the protective role of the family in improving health." This Statement also rejected that there is an international right to abortion. Though language included here may be more immediately related to domestic U.S. health policy, it directly translates to the ideology being used to shape U.S. global health assistance through the Protecting Life in Global Health Assistance (PLGHA) policy and other mechanisms. This Statement substantially hindered SRHR because it did not discuss maternal and child health as a vital health issue, was not based in evidence or international human rights norms, and was not gender transformative.
2018_Protecting Life in Global Health Assistance FAQs_August 2018
The PLGHA FAQs provided detailed guidance on the implementation of the expanded Global Gag Rule for implementing partners as of September 2018. HHS was graded based on the "HHS Specific Information" section on page 17 that outlined how HHS administered grants according to the Code of Federal Regulations (CFR). The information offered in this section did not have an effect on the ability of HHS to implement maternal and child health programs that were evidence-based, responsive to need, consistent with internationally-recognized human rights principles, and gender transformative.
NA
NA

Department of Defense

 

The DoD does not receive a grade within the Maternal and Child Health domain because they do not work in international maternal and child health.