Department of Health and Human Services 2021 | The Sexual and Reproductive Health and Rights Index

Department of Health and Human Services

The Department of Health and Human Services (HHS) received a 61 (D-) with transparency and a 70 (C-) without transparency in 2021. This grade was based on a whole-of-government global health security report and several actions specific to the Centers for Disease Control and Prevention (CDC), including CDC strategies and requirements that apply to certain CDC awards. The transparency scores for HHS were low across domains because it was unclear whether most of the graded actions were relevant to this actor’s global health programs. Similarly, there was no indication of what information had been changed from previous versions of some actions and prior versions were not available on the website for comparison. Funding data for the global HIV and AIDS and maternal and child health (MCH) programs within HHS were unavailable at the time of grading, which contributed to the low transparency grade in 2021.

D-

C-

HIV & AIDS

HHS received a 62 (D-) with transparency and a 71 (C-) without transparency in the HIV and AIDS domain in 2021. This domain grade was raised by the action: “CDC Virtual Training Prepares Mentors and Peer Educators to Respond to Disclosures of Violence” because it was based in evidence, consistent with human rights, and responsive to need. Several of the Additional Requirements (ARs) and the General Terms and Conditions for Research and Non-Research neither promoted nor hindered sexual and reproductive health and rights (SRHR) because it was unclear whether these actions were relevant to the HHS’ global HIV and AIDS programs. AR 35 noted that the PLGHA policy had been revoked, but did not provide additional guidance or directives for implementing partners to adapt their programs to align with the policy change, which moderately hindered SRHR. Funding data for global HIV and AIDS efforts implemented by HHS were not publicly available at the time of grading, which contributed to the low transparency grade in the HIV and AIDS domain 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.

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2021_CDC Additional Requirement – 1: Human Subjects Requirements

AR 1 outlined the regulations that institutions must follow if they engage in projects involving research with human subjects. AR 1 applied to all CDC projects that conducted human subjects research and provided guidance for institutions to obtain the necessary approvals as well as included hyperlinks to the specific Code of Federal Regulations (CFR) sections that protect human research subjects. AR 1 was consistent with human rights, based in evidence, and responsive to need. Requiring the protection of human subjects helped to ensure that the rights of people enrolled in global research projects related to HIV and AIDS were protected. Specific protections for human subjects across genders were not included in AR 1, nor did it include considerations for other protected classes or specific populations that may warrant extra protections as human subjects. This action moderately promoted SRHR in the HIV and AIDS domain.

2021_CDC Additional Requirement – 2: Requirements for Inclusion of Women and Racial and Ethnic Minorities in Research

AR 2 outlined the requirements for CDC-supported research projects that involved human subjects and the inclusion of "individuals of both sexes and the various racial and ethnic groups" whenever feasible and appropriate. AR 2 referred to the Federal Register to provide additional guidance on the application of this requirement. AR 2 was responsive to need and based in evidence because it promoted the ethical inclusion of women and racial and ethnic minorities in research. However, it was gender exploitative as it reinforced a sex and gender binary and did not acknowledge other identities that may be underrepresented in human subjects research. To more fully promote inclusivity, AR 2 should have been more inclusive of people of diverse sexual orientation, gender identity or expression or sex characteristics (SOGIESC) in human subjects research. Nevertheless, the inclusion of underrepresented groups across racial and ethnic minorities is important for research as it applies to global health programs, including HIV and AIDS programs funded by the President’s Emergency Plan for AIDS Relief (PEPFAR). AR 2 moderately promoted SRHR in the HIV and AIDS domain.

2021_CDC Additional Requirement – 4: HIV/AIDS Confidentiality Provisions

AR 4 outlined requirements for the protection of personal data collected through HIV and AIDS surveillance activities across all CDC projects. The requirements promoted the confidentiality and security provisions of HIV and AIDS surveillance data, which was based in evidence, consistent with human rights norms, and responsive to need. However, it was unclear if the requirements applied to domestic programs only or if they also applied to global health programs like PEPFAR, which did not promote transparency . This action neither hindered nor promoted SRHR in the HIV and AIDS domain.

2021_CDC Additional Requirement – 5: HIV Program Review Panel Requirements

AR 5 provided the requirements for creating and selecting members of a program review panel for HIV and AIDS research, projects, and other activities. AR 5 required that projects that included funding for a conference must receive approval for all conference materials from the panel. This action did not promote transparency as it was unclear what the intended purpose and responsibilities of the program review panel were nor was it clear if this requirement applied to global health programs, including global HIV and AIDS programs funded through PEPFAR. This action neither hindered nor promoted SRHR in the HIV and AIDS domain.

2021_CDC Additional Requirement – 6: Patient Care

AR 6 stated that all “STD or HIV infected patients” participating in CDC-funded projects were to be linked to a local care system to provide medical care, counseling, social services, and therapy. This guidance was based in evidence and human rights and was responsive to need. However, the use of outdated language such as “HIV infected patients” was stigmatizing and did not reflect current best practices. While AR 6 provided necessary guidance, it did not provide any external references for additional guidance or protocols to guide the implementation of relevant programs. Overall, AR 6 moderately promoted SRHR in the HIV and AIDS domain.

2021_CDC Additional Requirement – 25: Data Management and Access

AR 25 outlined the requirements for project recipients that conduct data collection with federal funds to develop, submit, and comply with a Data Management Plan (DMP) for the collection and generation of public health data. It provided detail on inclusion and exclusion criteria for the DMP and explained which projects were required to submit a DMP. AR 25 was based in evidence and responsive to need as the availability of public health data could promote innovation and advance global health priorities, including those related to HIV and AIDS. It promoted transparency by minimizing the possibility for data to be misrepresented. AR 25 moderately promoted SRHR in the HIV and AIDS domain.

2021_CDC Additional Requirement – 28: Inclusion of Persons Under the Age of 21 in Research

AR 28 provided clear guidelines and expectations for the inclusion of persons under 21 in all CDC-funded research, including global health research. AR 28 stated that if a project intentionally does not involve persons under 21, they must provide a particular reason or justification for this exclusion. AR 28 was based in evidence and best practices and was aligned with human rights norms because it emphasized the inclusion of young people in research, which would include research related to SRHR. AR 28 moderately promoted SRHR in the HIV and AIDS domain.

2021_CDC Additional Requirement – 35: Protecting Life in Global Health Assistance is waived, effective January 28, 2021

AR 35 announced the revocation of Protecting Life in Global Health Assistance (PLGHA), also known as the Global Gag Rule (GGR). Though announcing the removal of this policy was responsive to need, AR 35 did not provide additional guidance or directives for implementing partners that were impacted by the policy to adapt their programs to align with the policy change. Through AR 35, HHS and CDC could have released information that addressed questions from implementing partners and other stakeholders impacted by the policy as it applied to CDC grants, but this was not done. Additionally, it was unclear when AR 35 was updated to reflect the revocation of PLGHA, which did not promote transparency . AR 35 moderately hindered SRHR in the HIV and AIDS domain.

2021_CDC Additional Requirement – 36: Certificates of Confidentiality

AR 36 provided guidance on issuing Certificates of Confidentiality to participants engaged in biomedical, behavioral, clinical, or other research activities that contain identifiable information, as required by the Public Health Service Act. AR 36 defined which kinds of information collected through research were considered sensitive, the responsibilities of data collection teams to protect these types of data, and how to use the collected data responsibly. AR 36 was based in evidence and human rights norms and was responsive to need because it provided necessary protections for sensitive data collected through CDC research, including global health research. However, AR 36 did not explicitly mention SRHR, so the benefits for SRHR research may have only been indirect. AR 36 neither promoted nor hindered SRHR in the HIV and AIDS domain.

2021_CDC Additional Requirement – 37: Prohibition on certain telecommunications and video surveillance services or equipment for all awards issued on or after August 13, 2020

AR 37 provided information about the prohibition of the use of federal grant or cooperative agreement funds from HHS to procure or obtain telecommunication and video surveillance services or equipment from specific companies. This telecommunications prohibition mirrors that which can be found in the August 2021 version of the HHS General Terms and Conditions for Research and Non-Research Grants and Cooperative Agreements. AR 37 included relevant references to the CFR and provided recommendations for how recipients should implement AR 37 and maintain compliance with these restrictions throughout the course of their agreement. AR 37 included an exemption for PEPFAR funding until 2022, though it stated that “PEPFAR recipients are expected to work toward implementation” of this federal regulation. This exemption may provide greater flexibility for PEPFAR recipients but would likely have little effect on HHS’s ability to promote SRHR through its global HIV and AIDS efforts. This action neither promoted nor hindered SRHR in the HIV and AIDS domain.

2021_CDC Global Health Strategy 2019-2021

The Executive Summary of the CDC Global Health Strategy for 2019 through 2021 was updated in January 2021 to include the CDC’s response to the COVID-19 pandemic and emerging threats to global health. The rest of the Strategy was unchanged, so only the Executive Summary was graded in 2021. The updated Executive Summary mentioned that COVID-19 has had “far-reaching social and economic impacts, including disruption of essential healthcare services” and the upending of global health programs, including those that provided HIV and AIDS services. It also highlighted the importance of supporting diverse partnerships and collaboration across sectors. This updated content was based in evidence and responsive to need, though it was gender blind because there was no mention of the pandemic’s disproportionate impact on women, girls, gender-diverse people, or people living with HIV (PLHIV), specifically. The exclusion of SRHR and gender in the Executive Summary contributed to the silos that isolate SRHR from other global health issues, which was not based in human rights or evidence. Given the high-level nature of this action, however, it would likely have very little effect on the CDC’s ability to promote SRHR through its global health programs. This action neither promoted nor hindered SRHR in the HIV and AIDS domain.

2021_CDC Strategy for Global Response to COVID-19 2020-2023

This Strategy defined the CDC’s programmatic priorities and outlined the criteria for monitoring and evaluating the CDC’s health security efforts both domestically and internationally in the context of COVID-19. This action included high-level goals to guide the CDC’s immediate response to COVID-19 and prepare for future health threats. The principles and objectives outlined in the Strategy were generally based in evidence and responsive to need (e.g., the principle of leveraging existing global health programs and investments as a part of outbreak response). It mentioned the importance of coordinating pandemic response activities with the provision of essential health services, including HIV/tuberculosis (TB) programs, which was responsive to need, based in evidence, and aligned with human rights. However, it did not define the pandemic’s disproportionate impacts on specific populations beyond labeling them as “vulnerable,” so this action was not fully based in evidence and was gender blind. This action moderately promoted SRHR in the HIV and AIDS domain.

2021_CDC Virtual Training Prepares Mentors and Peer Educators to Respond to Disclosures of Violence

This CDC Success Story reported on a virtual training program to prevent and respond to gender-based violence (GBV) through PEPFAR’s DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) programs. The CDC adapted the Listen, Inquire, Validate, Enhance safety, and Support (LIVES) training created by the World Health Organization’s (WHO) into the CDC’s Listen, Ongoing connection, Validate, Encourage safety, and Support (LOVES) Virtual Training Program, which was based in evidence and consistent with human rights. The slight adjustments between the two trainings were made to acknowledge potential safety concerns of the mentors as well as the adolescent girls and young women (AGYW) as well as consider what was reasonably within a mentor’s control, which was responsive to need. The LOVES Virtual Training Program trained mentors to immediately respond with empathy to disclosures of violence among AGYW, which was responsive to need and based in evidence and human rights. The LOVES training package includes pre-recorded training materials and videos, as well as three live interactive virtual sessions, which was responsive to need because mentors could complete the training virtually during the COVID-19 pandemic. The action lacked detail on the level to which this training had been introduced across DREAMS sites and did not include the outcomes of the training. DREAMS includes gender transformative components and this training supported immediate responses to disclosures of GBV and challenged gender norms that enable violence. This action moderately promoted SRHR in the HIV and AIDS domain.

2021_CDC’s Center for Global Health Responds to Outbreaks

This action highlighted the ways in which the CDC’s Center for Global Health has leveraged existing capacities to address COVID-19 and described how programs have adapted to the pandemic to continue addressing ongoing global health threats. This action discussed the general importance of leveraging PEPFAR programs in outbreak response and outlined how the CDC has adapted global HIV and AIDS programs to continue to provide health services during COVID-19. The action listed innovations that the CDC had instituted during the COVID-19 pandemic, such as differentiated service delivery models, multi-month dispensing (MMD) of antiretroviral therapy (ART), and community-based service delivery options. These innovations were based in evidence, consistent with human rights, and responsive to need. However, this action did not mention the impact of the pandemic on key and priority populations such as men who have sex with men (MSM), sex workers, AGYW, or pregnant and breastfeeding persons, nor did it explore how these innovations would meet their needs related to HIV prevention, care, and treatment during the pandemic. Thus, it was gender blind and not fully responsive to need. This action moderately promoted SRHR in the HIV and AIDS domain.

2021_General Terms and Conditions for Non-Research Grant and Cooperative Agreements

The General Terms and Conditions list the federal regulations and policies, funding restrictions and limitations, and reporting requirements that apply to HHS non-research grants and cooperative agreements. The updated version from August 2021 included guidance for regular financial and performance reporting, requirements for a data management plan, audit requirements, key personnel guidelines, guidance for acknowledgement of federal funding, and CDC staff responsibilities for award management. The General Terms and Conditions did not include specific technical guidance related to evidence or human rights. However, this action was responsive to need because it provided guidance for how awards should be managed. Though this action was revised in August 2021, there was no indication of which information had been changed from the previous version, and prior versions were not available on the website for comparison, which did not promote transparency and was not responsive to need. This action neither promoted nor hindered the ability of HHS to support SRHR through non-research awards related to HIV and AIDS.

2021_General Terms and Conditions for Research Grant and Cooperative Agreements_Revised August 2021

The General Terms and Conditions list the federal regulations and policies, funding restrictions and limitations, and reporting requirements that apply to HHS research grants and cooperative agreements. The updated version from August 2021 included guidance for regular financial and performance reporting, requirements for a data management plan, audit requirements, key personnel guidelines, guidance for acknowledgement of federal funding, and CDC staff responsibilities for award management. The General Terms and Conditions provided technical guidance for research awards, including a definition of human subjects and confidentiality requirements, which were consistent with human rights norms and research ethics. This action was responsive to need because it provided guidance for how awards should be managed, but there was no indication of which information had been changed from the previous version, and prior versions were not available on the website for comparison, which did not promote transparency and was not responsive to need. This action neither hindered nor promoted SRHR in the HIV and AIDS domain.

2021_Strengthening Health Security Across the Globe_Progress and Impact of United States Government Investments in the Global Health Security Agenda

This Report detailed the progress and impact of the USG’s investments in global health security during fiscal year (FY) 2020, including efforts completed by HHS and CDC. The Report detailed the distribution of Congressional appropriations to advance global health security efforts in 19 partner countries to respond to disease outbreaks and prevent future outbreaks whenever possible. The Report mentioned HIV in the context of the CDC's Division of Global Health Protection Field Epidemiology Training Program (FETP) as one of the issues addressed by the FETP. However, the Report did not include details to indicate why HIV and AIDS efforts were included in this intervention or explain the outcomes of this programming. Though the Report focused on global health security, SRHR and other cross-cutting issues such as gender and GBV were not mentioned. This was not based in evidence as the inclusion of SRHR and gender equity promotes global health security. This exclusion was also not responsive to need as SRHR services are often the first set of “essential services” to be neglected in a health emergency, as notably evidenced by the initial global response to COVID-19. The action made one mention of gender in the context of OneHealth, and was therefore gender blind. This action moderately hindered SRHR in the HIV and AIDS domain.

2020_Contraception for Women at High Risk of HIV Technical Update

The purpose of this Technical Update was to explain the implications of the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial results on “reproductive health programming” funded through U.S. global health assistance, including the HHS’s HIV and AIDS programs funded through PEPFAR. The Technical Update summarized updated guidance from the World Health Organization (WHO) regarding the use of contraception by women at high risk of acquiring HIV, which had been revised because of the ECHO Trial findings. Though the WHO released its revised guidance in August 2019 shortly after the ECHO Trial results were published, PEPFAR implementing agencies, including HHS and the CDC, did not publish this Technical Update until December 2020. Because of this delay, the action was not fully responsive to need. The Technical Update was aligned with international human rights norms and evidence (e.g., quality of care, voluntarism, informed choice, differentiated service delivery models, patient-centered approaches free of stigma and discrimination) and included specific programmatic and policy guidance for working closely with diverse stakeholders to adapt global HIV and family planning (FP) programs accordingly. The Technical Update mentioned “male and female condoms” as the only contraceptive methods that can reduce the risk of sexually transmitted infection (STI) and HIV transmission, which was based in evidence but was not gender transformative because it used the outdated “male and female” terminology instead of the gender inclusive “internal and external” terminology. This Technical Update substantially promoted SRHR in the HIV and AIDS domain.

2020_General Terms and Conditions for Non-Research Grants and Cooperative Agreements

The General Terms and Conditions list the federal regulations and policies, funding restrictions and limitations, and reporting requirements that apply to HHS non-research grants and cooperative agreements. The version that was updated in December 2020 included information about regular financial and performance reporting, requirements for a data management plan, audit requirements, key personnel guidelines, acknowledgement of federal funding, and CDC staff responsibilities for award management. The General Terms and Conditions did not include specific technical guidance related to evidence or human rights. However, it was responsive to need because it provided guidance about how awards should be managed. This action included the same prohibition of the purchase of certain telecommunications and video surveillance services or equipment as was included in the United States Agency for International Development (USAID) Automated Directive System (ADS) Chapter 303. It also mentioned an exemption for PEPFAR funding until 2022, which was not included in ADS Chapter 303. This exemption likely had little effect on the ability of HHS to promote SRHR through its global HIV and AIDS efforts. Though this action was revised in December 2020, there was no indication of which information had been changed from the prior version, and prior versions are not available on the website for comparison, which contributed to very low transparency. This action neither hindered nor promoted SRHR in the HIV and AIDS domain.

2020_General Terms and Conditions for Research Grants and Cooperative Agreements

The General Terms and Conditions list the federal regulations and policies, funding restrictions and limitations, and reporting requirements that apply to HHS research grants and cooperative agreements. The version that was updated in December 2020 included information about regular financial and performance reporting, requirements for a data management plan, audit requirements, key personnel guidelines, acknowledgement of federal funding, and CDC staff responsibilities for award management. The General Terms and Conditions provided technical guidance for research awards, including a definition of human subjects and confidentiality requirements, which were consistent with human rights norms and research ethics. This action included the same prohibition of the purchase of certain telecommunications and video surveillance services or equipment as was included in USAID’s ADS Chapter 303. It also mentioned an exemption for PEPFAR funding until 2022, which was not included in ADS Chapter 303. This exemption likely had little effect on the ability of HHS to promote SRHR through its global HIV and AIDS efforts. Though this action was revised in December 2020, there was no indication of which information had been changed from the prior version, and prior versions are not available on the website for comparison, which contributed to very low transparency. This action neither hindered nor promoted the ability of HHS to support SRHR in the HIV and AIDS domain.

2020_Geneva Consensus Declaration on Promoting Women’s Health and Strengthening the Family

Along with 33 largely authoritarian governments, the United States signed the Geneva Consensus Declaration, a nonbinding declaration to advance the Trump administration’s anti-abortion agenda. Secretary of State Pompeo and Secretary of Health and Human Services Azar jointly participated in the signing ceremony on behalf of the Trump administration. The Declaration cited several international human rights documents to bolster its position that abortion was not to be included in any sexual and reproductive health (SRH) or universal health coverage programs. However, the Declaration did not recognize pregnant people’s right to bodily autonomy. It was also not aligned with evidence as evidence suggests that restricting access to safe abortion services results in increased rates of unsafe abortion. This action was not responsive to need and was not gender transformative because it reinforced a gender binary throughout the Declaration and ignored gender inequalities and other systemic issues that might impact people's ability to access SRHR services, including HIV and AIDS services. In fact, both the language used and the exclusion of SRHR were so deeply rooted in patriarchal structures that the Declaration was gender exploitative. The Declaration failed to acknowledge the human rights of those in the LGBTQI+ community, which threatened to roll back progress made on recognizing the health needs of pregnant people who may not identify as women and/or those who identify as LGBTQI+. The stance of the Administration as demonstrated by HHS signing onto this Declaration substantially hindered the ability of HHS to promote SRHR in the HIV and AIDS domain.

2020_President’s Interagency Task Force: Report on U.S. Government Efforts to Combat Trafficking in Persons

This report discussed the U.S. government's efforts to end trafficking in the United States and globally. This strategy prioritized the needs and perspectives of those who have been trafficked, called for innovations in data gathering, and promoted education and public awareness activities related to human trafficking. While the health impacts of trafficking were mentioned, the Report centered on domestic efforts to combat trafficking even though the actions described in this whole-of-government report would impact global health assistance programs and activities. The Report described its carceral approach to combating trafficking including prosecution, which relies heavily on law enforcement to prevent trafficking even though these systems do not consistently protect the rights of marginalized groups. This report did not define or provide the evidence base for the “victim-centered and trauma-informed approach” it purported to take in its approaches to combating human trafficking, which was significantly lacking. The Report did not integrate international human rights standards as it conflated commercial sex work and trafficking for the purposes of sex, which ultimately denies sex workers their rights and can impede efforts to prevent trafficking. The carceral approach outlined in this report posed additional risks and barriers for sex workers accessing health services due to the fear of prosecution or being targeted by law enforcement. While this report briefly mentioned gender, it was largely gender blind and made no mention of how trafficking impacts people in the LGBTQI+ community. The Report did not sufficiently explain which actions were undertaken with U.S. global health funds, which was a transparency issue. The Report moderately hindered SRHR in the HIV and AIDS domain.

2020_Strengthening Health Security Across the Globe: Progress and Impact of U.S. Government Investments in the Global Health Security Agenda, 2019 Annual Report

In 2020, the Department of State, in collaboration with other U.S. implementing agencies including HHS and CDC released the Strengthening Health Security Across the Globe annual report that identified the U.S. government’s contributions to global health security by country and U.S. government actor. Though several areas of global health were mentioned throughout the report, HIV and AIDS were noticeably absent. PEPFAR was only mentioned in relation to the adaptation of existing surveillance mechanisms, laboratory infrastructure, and infection prevention and control (IPC) programs to aid in the global response to COVID-19. It was unclear if HHS was engaged in this work given that the CDC supports laboratory infrastructure in PEPFAR countries, so this contributed to low transparency. HIV and AIDS was the subject of a case study covered in the report in which U.S. government officials identified and contained an HIV outbreak among children in Pakistan. While this inclusion was responsive to need and acknowledged the impact of HIV and AIDS on security in one district in one country, it minimized the value of the CDC’s HIV prevention and treatment efforts in promoting health security given the vast amount of clinical and laboratory infrastructure worldwide that are supported through U.S. global health assistance funds managed by HHS. Further, there was no mention of other areas of SRHR that impact health security such as FP, maternal and child health (MCH), and gender-based violence (GBV). SRHR is a critical aspect of health security. Neglecting SRH in security discussions can contribute to negative health impacts and human rights violations for women, girls, gender-diverse people, and other marginalized groups. The exclusion of SRHR throughout the Report contributed to the increased development of siloes that exclude SRHR from other areas of global health, such as disease outbreaks. The Report was largely gender blind, as it ignored the fact that health security is unattainable without gender equity and countering harmful norms that affect women, girls, and gender diverse people. This report moderately hindered SRHR through the HIV and AIDS domain.

2020_Violence Against Children and Youth Survey Country Process

The Violence Against Children and Youth Survey (VACS) Country Process action laid out the strategy for engaging countries in this process. The guidance included considerations for programmatic response, ethical standards, process sustainability, survey support, partner support, and in-country capacity. There were very few mentions of SRHR-related topics, and no consideration of the HIV and AIDS service needs of participants or detail regarding how survey participants would be referred to relevant health services if they reported experiencing violence while being surveyed. However, this guidance was evidence-based and consistent with human rights because it cited the recommendations from the World Health Organization (WHO) on ethics and safety regarding patients' rights as guiding principles in developing these surveys. This action also noted the importance of connecting findings from the VACS with evidence-based and evidence-informed policies and programs to prevent and respond to violence to form the basis for a National Action Plan, which is a distinct opportunity to decrease violence and promote SRHR at the country level. This action stated that participants in these surveys should be offered services that included free programs, services, and amenities based on their country's response plan, which was responsive to need and grounded in human rights. The guidance was not gender transformative as it instructed interviewers to only engage with participants of the same sex, which overlooked the experiences of participants who experienced violence from people of the same sex. There were also no discussions of gender norms or other policies that might impact people's experiences of violence, which was gender blind. This Country Process action moderately promoted SRHR in the HIV and AIDS domain.

2019_CDC Global Health Strategy_2019-2021

The CDC Global Health Strategy, 2019-2021 presented data to document the CDC’s progress to date with regard to HIV and AIDS activities. It provided evidence to support continued investment in CDC’s programs across the spectrum of HIV and AIDS prevention, care, and treatment through the President’s Emergency Plan for AIDS Relief (PEPFAR). This Strategy was based on programmatic and global evidence but did not include an international human rights component. The Strategy also did not include a gender transformative approach to the CDC’s HIV and AIDS programs. In fact, the word "gender" was not mentioned in the entire document, despite gender being a vital factor in HIV and AIDS programming. However, the Strategy advocated for the continued support of evidence-based HIV and AIDS programs carried out by the CDC and therefore moderately promoted SRHR.

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 HIV and AIDS efforts, 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 conflicts 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 omitted inclusive language regarding gender or the specific health needs of key populations. This Statement did not mention HIV and AIDS as a health issue that is relevant 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 ICPD 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 organizations (FBOs) 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 HIV and AIDS programming administered by PEPFAR. 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 was possibly 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 HIV and AIDS as a vital health issue, was not based in evidence or international human rights norms, and was not gender transformative.

2018_HHS Strategic Plan_Strategic Goal 2: Protect the Health of Americans Where They Live, Learn, Work, and Play

The HHS Strategic Plan provides an overview of the Agency's domestic and global strategy that is based on evidence and human rights norms. Strategic Objective 2.2 within the Strategic Plan states that the Centers for Disease Control and Prevention (CDC) will implement HIV programs "including prevention, testing, treatment, and retention interventions, provide technical assistance, and conduct research in support of PEPFAR." The Strategic Plan did not include any other specific information, so was determined to have little effect on the ability of HHS to implement HIV and AIDS programs that are evidence-based, responsive to need, consistent with internationally-recognized human rights principles, and gender transformative .

2018_Protecting Life in Global Health Assistance FAQs_August 2018

The Protecting Life in Global Health Assistance (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 HIV and AIDS programs that were evidence-based, responsive to need, consistent with internationally-recognized human rights principles, and gender transformative .

D+

Maternal and Child Health (MCH)

HHS received a 59 (F) with transparency and a 68 (D+) without transparency in the Maternal and Child Health (MCH) domain in 2021. This domain grade was raised by the action: “CDC Virtual Training Prepares Mentors and Peer Educators to Respond to Disclosures of Violence” because it was based in evidence, consistent with human rights, and responsive to need. However, several ARs and the General Terms and Conditions for Research and Non-Research neither promoted nor hindered SRHR because it was unclear whether these actions were relevant to the global MCH programs within HHS. AR 35 noted that the PLGHA policy had been revoked, but did not provide additional guidance or directives for implementing partners to adapt their programs to align with the policy change, which moderately hindered SRHR. The CDC Global Immunization Strategic Framework did not mention the connection between vaccine-preventable diseases (VPDs) and MCH outcomes or SRHR generally, which was not based in evidence or responsive to need. Funding data for global MCH efforts implemented by HHS were not publicly available at the time of grading, which contributed to the low transparency grade in the MCH domain 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.

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2021_CDC Additional Requirement – 1: Human Subjects Requirements

AR 1 outlined the regulations that institutions must follow if they engage in projects involving research with human subjects. AR 1 applied to all CDC projects that conducted human subjects research and provided guidance for institutions to obtain the necessary approvals as well as included hyperlinks to the specific CFR sections that protect human research subjects. AR 1 applied to all CDC projects and was consistent with human rights, based in evidence, and responsive to need. Requiring the protection of human subjects helped to ensure that the rights of people enrolled in global research projects related to MCH were protected. Specific protections for human subjects across genders were not included in AR 1, nor did it include considerations for other protected classes or specific populations that may warrant extra protections as human subjects. This action moderately promoted SRHR in the MCH domain.

2021_CDC Additional Requirement – 2: Requirements for Inclusion of Women and Racial and Ethnic Minorities in Research

AR 2 outlined the requirements for CDC-supported research projects that involved human subjects and the inclusion of "individuals of both sexes and the various racial and ethnic groups" whenever feasible and appropriate. AR 2 referred to the Federal Register to provide additional guidance on the application of this requirement. AR 2 was responsive to need and based in evidence because it promoted the ethical inclusion of women and racial and ethnic minorities in research. However, it was gender exploitative as it reinforced a sex and gender binary and did not acknowledge other identities that may be underrepresented in human subjects research. To more fully promote inclusivity, AR 2 should have been more inclusive of people of diverse SOGIESC in human subjects research. Nevertheless, the inclusion of underrepresented groups across racial and ethnic minorities is important for research as it applies to global health programs, including global MCH programs. AR 2 moderately promoted SRHR in the MCH domain.

2021_CDC Additional Requirement – 4: HIV/AIDS Confidentiality Provisions

AR 4 outlined requirements for the protection of personal data collected through HIV and AIDS surveillance activities across all CDC projects. The requirements promoted the confidentiality and security provisions of HIV and AIDS surveillance data, which was based in evidence, consistent with human rights norms, and responsive to need. However, it was unclear if the requirements applied to domestic programs only or if they also applied to global HIV and AIDS programs, which did not promote transparency given that PEPFAR programs often include prevention of mother-to-child transmission (PMTCT) activities and other efforts related to MCH. This action neither hindered nor promoted SRHR in the MCH domain.

2021_CDC Additional Requirement – 5: HIV Program Review Panel Requirements

AR 5 provided the requirements for creating and selecting members of a program review panel for HIV and AIDS research, projects, and other activities. AR 5 required that projects that included funding for a conference must receive approval for all conference materials from the panel. This action did not promote transparency as it was unclear what the intended purpose and responsibilities of the program review panel were nor was it clear if this requirement applied to global health programs, including MCH activities that may be included in PEPFAR programs. This action neither hindered nor promoted SRHR in the MCH domain.

2021_CDC Additional Requirement – 6: Patient Care

2021_CDC Additional Requirement – 25: Data Management and Access

AR 25 outlined the requirements for project recipients that conduct data collection with federal funds to develop, submit, and comply with a DMP for the collection and generation of public health data. It provided detail on inclusion and exclusion criteria for the DMP and explained which projects were required to submit a DMP. AR 25 was based in evidence and was responsive to need as the availability of public health data could promote innovation and advance global health priorities, including those related to MCH. It also promoted transparency by minimizing the possibility for data to be misrepresented. AR 25 moderately promoted SRHR in the MCH domain.

2021_CDC Additional Requirement – 28: Inclusion of Persons Under the Age of 21 in Research

2021_CDC Additional Requirement – 35: Protecting Life in Global Health Assistance is waived, effective January 28, 2021

AR 35 announced the revocation of PLGHA, also known as the GGR. Though announcing the removal of this policy was responsive to need, AR 35 did not provide additional guidance or directives for implementing partners that were impacted by the policy to adapt their programs to align with the policy change. Through AR 35, HHS and CDC could have released information that addressed questions from implementing partners and other stakeholders impacted by the policy as it applied to CDC grants, but this was not done. Additionally, it was unclear when AR 35 was updated to reflect the revocation of PLGHA, which did not promote transparency . Therefore, AR 35 moderately hindered SRHR in the MCH domain.

2021_CDC Additional Requirement – 36: Certificates of Confidentiality

2021_CDC Additional Requirement – 37: Prohibition on certain telecommunications and video surveillance services or equipment for all awards issued on or after August 13, 2020

AR 37 provided information about the prohibition of the use of federal grant or cooperative agreement funds from HHS to procure or obtain telecommunication and video surveillance services or equipment from specific companies. This telecommunications prohibition mirrors that which can be found in the August 2021 version of the HHS General Terms and Conditions for Research and Non-Research Grants and Cooperative Agreements. AR 37 included relevant references to the CFR and provided recommendations for how recipients should implement AR 37 and maintain compliance with these restrictions throughout the course of their agreement. It was unclear how this guidance would affect the ability of HHS programs to promote SRHR through its global MCH efforts. This action neither promoted nor hindered SRHR in the MCH domain.

2021_CDC Global Health Strategy 2019-2021

2021_CDC Global Immunization Strategic Framework 2021_2030

This action guided the CDC’s investments in strengthening global immunization program capacity and scientific expertise to support the control, elimination, and eradication of vaccine-preventable diseases (VPDs) through 2030. This action linked the importance of immunization to primary care for children and adolescents, which would include health care visits for services related to SRHR such as human papillomavirus (HPV) vaccination for adolescents but lacked explicit mention of the connection between these issues. It only mentioned “pregnant women” in the context of expanding existing immunization approaches and did not provide additional information about the importance of immunizations during pregnancy, which was not responsive to need or based in evidence. It provided details on vaccine research for vector-borne diseases including malaria and Zika, which was related to MCH because such diseases could be transmitted sexually and could impact the health of pregnant and breastfeeding persons. Zika, malaria, and chikungunya could also be transmitted from the pregnant person to the fetus and contribute to poor birth outcomes. However, the action did not mention the connection between these diseases and MCH outcomes or SRHR generally, so it was not based in evidence or responsive to need. This action was gender blind as there was no meaningful mention of gender and the language used reinforced a gender binary. This action neither promoted nor hindered SRHR in the MCH domain.

2021_CDC Strategy for Global Response to COVID-19 2020-2023

This Strategy defined the CDC’s programmatic priorities and outlined the criteria for monitoring and evaluating the CDC’s health security efforts both domestically and internationally in the context of COVID-19. This action included high-level goals to guide the CDC’s immediate response to COVID-19 and prepare for future health threats. The principles and objectives outlined in the Strategy were generally based in evidence and responsive to need (e.g., the principle of leveraging existing global health programs and investments as a part of outbreak response). It mentioned the importance of coordinating pandemic response activities with the provision of essential health services, including MCH programs, which was responsive to need, based in evidence, and aligned with human rights. However, it did not define the pandemic’s disproportionate impacts on specific populations beyond labeling them as “vulnerable,” so it was not fully based in evidence and was gender blind. This action moderately promoted SRHR in the MCH domain.

2021_CDC Virtual Training Prepares Mentors and Peer Educators to Respond to Disclosures of Violence

This CDC Success Story reported on a virtual training program to prevent and respond to GBV through the PEPFAR DREAMS programs. The CDC adapted the LIVES training created by the WHO into the LOVES Virtual Training Program, which was based in evidence and consistent with human rights. The slight adjustments between the two trainings were made to acknowledge potential safety concerns of the mentors as well as the AGYW as well as consider what was reasonably within a mentor’s control, which was responsive to need. The LOVES Virtual Training Program trained mentors to immediately respond with empathy to disclosures of violence among AGYW, which was responsive to need and based in evidence and human rights. The LOVES training package included pre-recorded training materials and videos, as well as three live interactive virtual sessions, which was responsive to need because mentors could complete the training virtually during the COVID-19 pandemic. The action lacked detail on the level to which this training had been introduced across DREAMS sites and did not include the outcomes of the training. DREAMS includes gender transformative components and this training supported immediate responses to disclosures of GBV and challenged gender norms that enable violence. This action moderately promoted SRHR in the MCH domain.

2021_CDC’s Center for Global Health Responds to Outbreaks

This action highlighted the ways in which the CDC’s Center for Global Health has leveraged existing capacities to address COVID-19 and described how programs have adapted to the pandemic in order to continue addressing ongoing global health threats. This action discussed the general importance of leveraging PEPFAR programs in outbreak response and outlined how the CDC has adapted global HIV and AIDS programs to continue to provide health services during COVID-19. The action listed innovations that the CDC has instituted during the COVID-19 pandemic, such as differentiated service delivery models, MMD of ART, and community-based service delivery options. While these innovations were based in evidence, consistent with human rights, and responsive to need in a general sense, this action did not include details about any innovations related to the prevention of mother-to-child transmission (PMTCT) of HIV or adaptations to global MCH programs in response to the pandemic. This action did not mention the impact of the pandemic on key and priority populations, including pregnant and breastfeeding persons, so it was gender blind and not fully responsive to need. Due to the lack of inclusion of information about MCH innovations and the impact of the pandemic on MCH services, this action moderately hindered SRHR in the MCH domain.

2021_General Terms and Conditions for Non-Research Grant and Cooperative Agreements

2021_General Terms and Conditions for Research Grant and Cooperative Agreements_Revised August 2021

2021_Strengthening Health Security Across the Globe_Progress and Impact of United States Government Investments in the Global Health Security Agenda

This Report detailed the progress and impact of the USG’s investments in global health security during FY 2020, including efforts completed by HHS and CDC. The Report detailed the distribution of Congressional appropriations to advance global health security efforts in 19 partner countries to respond to disease outbreaks and prevent future outbreaks whenever possible. The Report mentioned the impact of COVID-19 on MCH outcomes, but it did not meaningfully discuss HHS or CDC investments in MCH programs to promote global health security. Though the Report focused on global health security, SRHR and other cross-cutting issues such as GBV were not mentioned. This was not based in evidence as the inclusion of SRHR and gender equity promotes global health security. This exclusion was not responsive to need as SRHR services are often the first set of “essential services” to be neglected in a health emergency, as notably evidenced by the initial global response to COVID-19. The Report made one mention of gender in the context of OneHealth, and was therefore gender blind. This action moderately hindered SRHR in the MCH domain.

2020_Contraception for Women at High Risk of HIV Technical Update

The purpose of this Technical Update was to explain the implications of the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial results on “reproductive health programming” funded through U.S. global health assistance, including the HHS’s global MCH programs. The Technical Update summarized updated guidance from the World Health Organization (WHO) regarding the use of contraception by women at high risk of acquiring HIV, which had been revised based on the ECHO Trial findings. Though the WHO released its revised guidance in August 2019 shortly after the ECHO Trial results were published, PEPFAR implementing agencies, including HHS and the Centers for Disease Control and Prevention (CDC), did not publish this Technical Update until December 2020. Because of this delay, the action was not fully responsive to need. The Technical Update was aligned with international human rights norms and evidence (e.g., quality of care, voluntarism, informed choice, differentiated service delivery models, patient-centered approaches free of stigma and discrimination) and included specific programmatic and policy guidance for working closely with diverse stakeholders to adapt global HIV and family planning (FP) programs accordingly. While the Technical Update stated that women who receive FP counseling should receive information about HIV prevention, it did not include guidance about counseling people who had just given birth about their contraceptive options. This was not fully consistent with MCH evidence or responsive to need in this domain because people who have given birth should be counseled on contraceptive options immediately after giving birth. This Technical Update did not include guidance for incorporating this update into HHS’s global MCH portfolio, which was an oversight that further siloed MCH efforts from related global health programs. This Technical Update was consistent with human rights norms, but not all available evidence and the language was gender blind so it moderately promoted SRHR in this domain.

2020_General Terms and Conditions for Non-Research Grants and Cooperative Agreements

The General Terms and Conditions list the federal regulations and policies, funding restrictions and limitations, and reporting requirements that apply to HHS non-research grants and cooperative agreements. The version that was updated in December 2020 included information about regular financial and performance reporting, requirements for a data management plan, audit requirements, key personnel guidelines, guidance for acknowledgement of federal funding, and CDC staff responsibilities for award management. The General Terms and Conditions did not include specific technical guidance related to evidence or human rights. However, it was responsive to need because it provided guidance about how awards should be managed. This action also included the same prohibition on the purchase of certain telecommunications and video surveillance services or equipment as was included in the United States Agency for International Development (USAID) Automated Directive System (ADS) Chapter 303. It also mentioned an exemption for PEPFAR funding until 2022, which was not included in ADS Chapter 303. This exemption likely had little effect on HHS’s ability to promote SRHR through its global MCH efforts. Though this action was revised in December 2020, there was no indication of which information had been changed from the prior version and prior versions are not available on the website for comparison, which contributed to low transparency. This action neither hindered nor promoted SRHR in the MCH domain.

2020_General Terms and Conditions for Research Grants and Cooperative Agreements

The General Terms and Conditions list the federal regulations and policies, funding restrictions and limitations, and reporting requirements that apply to HHS research grants and cooperative agreements. The version that was updated in December 2020 included information about regular financial and performance reporting, requirements for a data management plan, audit requirements, key personnel guidelines, acknowledgement of federal funding, and CDC staff responsibilities for award management. The General Terms and Conditions provided technical guidance for research awards, including a definition of human subjects and confidentiality requirements, which were consistent with human rights norms and research ethics. This action included the same prohibition of the purchase of certain telecommunications and video surveillance services or equipment as was included in USAID’s ADS Chapter 303. It also mentioned an exemption for PEPFAR funding until 2022, which was not included in ADS Chapter 303. This exemption likely had little effect on the ability of HHS to promote SRHR through its global MCH efforts. Though this action was revised in December 2020, there was no indication of which information had been changed from the prior version, and prior versions are not available on the website for comparison, which contributed to very low transparency. This action neither hindered nor promoted the ability of HHS to support SRHR in the MCH domain.

2020_Geneva Consensus Declaration on Promoting Women’s Health and Strengthening the Family

Along with 33 largely authoritarian governments, the United States signed the Geneva Consensus Declaration, a nonbinding declaration to advance the Trump administration’s anti-abortion agenda. Secretary of State Pompeo and Secretary of Health and Human Services Azar jointly participated in the signing ceremony on behalf of the Trump administration. The Declaration cited several international human rights documents to bolster its position that abortion was not to be included in any sexual and reproductive health (SRH) or universal health coverage programs. However, the Declaration did not recognize pregnant people’s right to bodily autonomy. It was also not aligned with evidence as evidence suggests that restricting access to safe abortion services results in increased rates of unsafe abortion, which can contribute to maternal morbidity and mortality. This action was not responsive to need and was not gender transformative because it reinforced a gender binary throughout the Declaration and ignored gender inequalities and other systemic issues that might impact people's ability to access SRHR services, including MCH services. In fact, both the language used and the exclusion of SRHR were so deeply rooted in patriarchal structures that the Declaration was gender exploitative. The Declaration also failed to acknowledge the human rights of those in the LGBTQI+ community, which threatened to roll back progress made on recognizing the health needs of pregnant people who may not identify as women and/or those who identify as LGBTQI+. The stance of the Administration as demonstrated by HHS signing onto this Declaration substantially hindered the ability of HHS to promote SRHR in the MCH domain.

2020_President’s Interagency Task Force: Report on U.S. Government Efforts to Combat Trafficking in Persons

2020_Strengthening Health Security Across the Globe: Progress and Impact of U.S. Government Investments in the Global Health Security Agenda, 2019 Annual Report

2020_Violence Against Children and Youth Survey Country Process

The Violence Against Children and Youth Survey (VACS) Country Process action laid out the strategy for engaging countries in this process. The guidance included considerations for programmatic response, ethical standards, process sustainability, survey support, partner support, and in-country capacity. There were very few mentions of SRHR-related topics, and no consideration of the MCH service needs of participants, or how survey participants would be referred to relevant health services if they reported experiencing violence while being surveyed. However, this guidance was evidence-based and consistent with human rights because it cited the recommendations from the World Health Organization (WHO) on ethics and safety regarding patients' rights as guiding principles in developing these surveys. This action also noted the importance of connecting findings from the VACS with evidence-based and evidence-informed policies and programs to prevent and respond to violence to form the basis for a National Action Plan, which is a distinct opportunity to decrease violence and promote SRHR at the country level. This action stated that participants in these surveys should be offered services that included free programs, services, and amenities based on their country's response plan, which was responsive to need and grounded in human rights. The guidance was not gender transformative as it instructed interviewers to only engage with participants of the same sex, which overlooked the experiences of participants who experienced violence from people of the same sex. There were no discussions of gender norms or other policies that might impact people's experiences of violence, which was gender blind. This Country Process action moderately promoted SRHR in the MCH domain.

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.

TRANSPARENCY SCORE

TRANSPARENCY SCORE

Department of Health and Human Services

HIV & AIDS

Maternal and Child Health (MCH)

Family Planning (FP)