YEAR 2021

Congress

Congress received an 87 (B+) with transparency and a 91 (A-) without transparency in 2021. Congress appropriated full funding for HIV and AIDS, adequate funding for maternal and child health (MCH), and inadequate funding for family planning (FP). Congress passed the American Rescue Plan Act (H.R.1319) which moderately promoted the ability of U.S. global health assistance to support efforts to address the impacts of COVID-19, which could include the impacts of the pandemic on sexual and reproductive health and rights (SRHR). Across domains, Congress demonstrated high policy transparency in the HIV and AIDS domain, low policy transparency in the MCH and FP domains, and high transparency for funding data across domains.

Fiscal Year 2022 Approved Budget
2021_Congress Budget H.R. 2471

A+

HIV & AIDS

Congress received a 97 (A+) with transparency and a 99 (A+) without transparency in the HIV and AIDS domain in 2021. Congress appropriated full funding for the President’s Emergency Plan for AIDS Relief (PEPFAR) and The Global Fund to Fight AIDS, Tuberculosis and Malaria. Passing the American Rescue Plan Act (H.R.1319) moderately increased Congress’ grade in this domain because it appropriated additional funds for the Department of State to support HIV and AIDS prevention, care, and treatment programs as well as mentioned the need to mitigate the impact of COVID-19 on such programs. Congress demonstrated high levels of policy and funding transparency related to HIV and AIDS globally in 2021.

The Fòs Feminista 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

2021_American Rescue Plan Act (H.R.1319)

The American Rescue Plan Act appropriated additional U.S. global health funding for specific implementing agencies to prevent, prepare for, and respond to the COVID-19 pandemic, as well as support public health surveillance to respond to other emerging infectious disease threats globally. It included contributions to support multilateral vaccine development partnerships and a contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The law appropriated additional funding for the Department of State to support HIV and AIDS prevention, care, and treatment programs as well as mentioned the need to mitigate the impact of COVID-19 on such programs. This action was responsive to need and based in evidence and human rights. This law was not gender transformative, as it should have included a call for data to be disaggregated by sex and/or gender to inform responses to COVID-19 given the disproportionate impacts of the pandemic on women, girls, and gender-diverse people. This action moderately promoted SRHR in the HIV and AIDS domain.

2020_Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (H.R. 6074)

The Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 became law on March 6, 2020, and appropriated an additional $435 million in Global Health Programs (GHP) funds for the Department of State and United States Agency for International Development (USAID) to “prevent, prepare for, and respond to” the COVID-19 pandemic through September 30, 2022. This action was highly responsive to need because it was passed early in the pandemic and provided much-needed funds to support the initial global health response to the pandemic. The appropriation of additional funds to support pandemic response efforts was also based in evidence and human rights. This action moderately promoted the ability of U.S. global health assistance to support HIV and AIDS programs that could address the impacts of COVID-19 related to SRHR.

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. HIV and AIDS technologies, unlike family planning technologies, were explicitly mentioned in the Act which provided an accountability mechanism for these specific technologies. 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 promoted SRHR within the HIV and AIDS domain because it encouraged the development of technologies to support HIV and AIDS programming.

2018_Asia Reassurance Initiative Act of 2018 (S. 2736)

The Asia Reassurance Initiative Act discussed U.S. efforts to improve relations with countries in Asia and promote democracy and human rights within the region. These efforts were responsive to need and based in human rights principles, particularly related to reducing poverty and violations of human rights that have occurred within the region. However, the legislation was not gender transformative or strongly evidence-based in HIV and AIDS prevention and treatment efforts. It mentioned "reducing the HIV and AIDS infection rate” through the Lower Mekong Initiative (LMI), but provided no programmatic guidance on how to accomplish this. The LMI was launched in 2009 and is a multinational partnership among Cambodia, Laos, Myanmar, Thailand, Vietnam, and the U.S. to create integrated sub-regional cooperation among the five Lower Mekong countries. The LMI could serve as a promising platform for HIV and AIDS prevention and treatment efforts, but this could only be implemented if additional policy and technical guidance are released. The legislation also briefly mentioned supporting women’s equality, but did not discuss the importance of addressing gender-based violence (GBV) and sexual and reproductive health and rights (SRHR) in promoting democracy and human rights. Given the prevalence of GBV against ethnic and religious minorities in the region, this was a missed opportunity by Congress to address this issue. For these reasons, this legislation will likely only have minimal direct effect on the ability of U.S. global health assistance to support comprehensive HIV and AIDS programs in the region.

2018_PEPFAR Extension Act of 2018 (H.R. 6651)

The PEPFAR Extension Act amended the PEPFAR Stewardship and Oversight Act of 2013 by extending the authorization of PEPFAR through FY 2023. The legislation allows PEPFAR to continue its programming, which is largely evidence-based, responsive to need, and based in human rights norms. However, it also maintained previous authorization language that is not gender transformative and continued clauses that cause harm to key populations, such as the Anti-Prostitution Loyalty Oath and the refusal clause. With the reauthorization, Congress had the opportunity to revise these harmful aspects of the authorization of PEPFAR and chose not to do so. As a result, this legislation moderately promoted the ability of U.S. global health assistance to support HIV and AIDS programs that are evidence-informed, responsive to need, consistent with human rights principles, and gender transformative.

2015_Justice for Victims of Trafficking Act of 2015 (S. 178)

2013_PEPFAR Stewardship and Oversight Act of 2013 (S. 1545)

2008_Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (H.R. 5501)

2004_Medically Accurate Information on Condoms_Consolidated Appropriations Act, 2004 (H.R. 2673)

2003_United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (H.R. 1298) (Anti-Prostitution Loyalty Oath and Abstinence-Only Education)

1961_The Foreign Assistance Act of 1961

B+

Maternal and Child Health (MCH)

Congress received an 89 (B+) with transparency and a 94 (A) without transparency in the Maternal and Child Health (MCH) domain in 2021. Congress appropriated adequate levels of funding for the United Nations Children’s Emergency Fund (UNICEF), UNIFEM (now UN Women), and global MCH programs implemented by the United States Agency for International Development (USAID). Though it was unclear if global MCH programs were included in the additional funds Congress appropriated for USAID’s global health programs, the American Rescue Plan Act moderately increased Congress’ grade in this domain because it appropriated additional global health assistance funds to respond to the impacts of COVID-19, which could include issues that are related to SRHR. Congress demonstrated a low level of transparency of policy data and high transparency of funding information related to MCH globally in 2021.

The Fòs Feminista 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

2021_American Rescue Plan Act (H.R.1319)

The American Rescue Plan Act appropriated additional U.S. global health funding for specific implementing agencies to prevent, prepare for, and respond to the COVID-19 pandemic, as well as support public health surveillance to respond to other emerging infectious disease threats globally. It included contributions to support multilateral vaccine development partnerships and a contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Though it was unclear if the additional funding for USAID’s global health programs appropriated by this Act included global MCH programming, these funds could support USAID’s response to the impacts of COVID-19 on issues related to SRHR. This action had low transparency in this domain. This action was responsive to need and based in evidence and human rights. This law was not gender transformative, as it should have included a call for data to be disaggregated by sex and/or gender to inform responses to COVID-19 given the disproportionate impacts of the pandemic on women, girls, and gender-diverse people. This action moderately promoted SRHR in the MCH domain.

2020_Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (H.R. 6074)

The Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 became law on March 6, 2020, and appropriated an additional $435 million in Global Health Programs (GHP) funds for the Department of State and United States Agency for International Development (USAID) to “prevent, prepare for, and respond to” the COVID-19 pandemic through September 30, 2022. This action was highly responsive to need because it was passed early in the pandemic and provided much-needed funds to support the initial global health response to the pandemic. The appropriation of additional funds to support pandemic response efforts was also based in evidence and human rights. This action moderately promoted the ability of U.S. global health assistance to support MCH programs that could address the impacts of COVID-19 related to SRHR.

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.

2004_Medically Accurate Information on Condoms_Consolidated Appropriations Act, 2004 (H.R. 2673)

1961_The Foreign Assistance Act of 1961

B-

Family Planning (FP)

Congress received a 75 (C) with transparency and a 80 (B-) without transparency in the Family Planning (FP) domain in 2021 because Congress appropriated inadequate funding for both the United Nations Population Fund (UNFPA) and USAID’s global FP programs. The low level of funding hindered the ability of U.S. global health assistance to fully support comprehensive FP programs that promoted SRHR. Though it was unclear if global FP programs were included in the additional funds appropriated by Congress for USAID’s global health programs, the American Rescue Plan Act moderately increased Congress’ grade in this domain because it appropriated additional global health assistance funds to respond to the impacts of COVID-19, which could include issues that are related to SRHR. Congress demonstrated a low level of transparency of policy data and high transparency of funding information related to FP globally in 2021.

The Fòs Feminista 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

2021_American Rescue Plan Act (H.R.1319)

The American Rescue Plan Act appropriated additional U.S. global health funding for specific implementing agencies to prevent, prepare for, and respond to the COVID-19 pandemic, as well as support public health surveillance to respond to other emerging infectious disease threats globally. It included contributions to support multilateral vaccine development partnerships and a contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Though it was unclear if the additional funding for USAID’s global health programs appropriated by this Act would include global FP programming, these funds could support USAID’s response to the impacts of COVID-19 on issues related to SRHR. This action had low transparency in this domain. This action was responsive to need and based in evidence and human rights. This law was not gender transformative, as it should have included a call for data to be disaggregated by sex and/or gender to inform responses to COVID-19 given the disproportionate impacts of the pandemic on women, girls, and gender-diverse people. This action moderately promoted SRHR in the FP domain.

2020_Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (H.R. 6074)

The Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 became law on March 6, 2020, and appropriated an additional $435 million in Global Health Programs (GHP) funds for the Department of State and United States Agency for International Development (USAID) to “prevent, prepare for, and respond to” the COVID-19 pandemic through September 30, 2022. This action was highly responsive to need because it was passed early in the pandemic and provided much-needed funds to support the initial global health response to the pandemic. The appropriation of additional funds to support pandemic response efforts was also based in evidence and human rights. This action moderately promoted the ability of U.S. global health assistance to support FP programs that could address the impacts of COVID-19 related to SRHR.

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.

2004_Contributions to United Nations Population Fund (UNFPA)_Consolidated Appropriations Act, 2004 (H.R. 2673)

2004_Medically Accurate Information on Condoms_Consolidated Appropriations Act, 2004 (H.R. 2673)

1998_Tiahrt Amendment

1994_Leahy Amendment

1986_Livingston-Obey Amendment

1985_Additional Provision on Involuntary Sterilization and Abortion

1985_DeConcini Amendment

1985_Kemp-Kasten Amendment

1981_Biden Amendment

1981_Siljander Amendment

1978_Prohibition of Use of Funds for Abortion and Involuntary Sterilizations

1973_Helms Amendment