This is an average of the three domain scores below.
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.
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.
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 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.
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.
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 DoD does not receive a grade within the Maternal and Child Health domain because they do not work in international maternal and child health.