Domain Score Overview

The U.S. Government received an 88 (B+) with transparency and a 92 (A-) without transparency in the HIV and AIDS domain across all actors in 2021. This grade reflected the continued commitment of the U.S. government (USG) to support the President’s Emergency Plan for AIDS Relief (PEPFAR) to implement programs that were based in evidence, consistent with international human rights norms, and responsive to need. However, the majority of PEPFAR actions graded across actors in 2020 were gender accommodating and not gender transformative. Global HIV and AIDS efforts were largely excluded from the Strengthening Health Security Across the Globe Report, which was graded across all actors except the U.S. Congress. All actors except the U.S. Congress had low transparency for most actions graded in the HIV and AIDS domain. Budget scores were relatively high across actors where budget data were available, and transparency of funding information was high for all actors except the Department of Health and Human Services (HHS) and the Department of Defense (DoD). Consistent with previous years, the domain grade for HIV and AIDS was higher than the Maternal and Child Health and Family Planning domains across actors in 2021.

The U.S. Government received a 76 (C) with transparency and an 81 (B-) without transparency for the Maternal and Child Health (MCH) domain across all actors in 2021. Though global MCH efforts were meaningfully included in the National Strategy on Gender Equity and Equality, MCH was omitted from some whole-of-government actions as well as key agency-level actions from both the Department of State and the United States Agency for International Development (USAID). In many cases, agency-level actions reinforced a gender binary and did not use inclusive language such as “pregnant and breastfeeding persons,” which excluded the experiences of all people who can become pregnant and was therefore gender accommodating. The lack of data on global MCH programs or activities in agency-level and whole-of-government actions in 2021 reinforced the siloed nature of global health programs and did not support the implementation of integrated programming based in evidence and human rights. Low transparency of actions graded in this domain across actors as well as lack of funding information for the Department of Health and Human Services (HHS) global MCH efforts also negatively affected the overall MCH domain grade in 2021.

The U.S. Government received a 71 (C-) with transparency and a 75 (C) without transparency for the Family Planning (FP) domain across all actors in 2021. Global FP efforts were not meaningfully included in most whole-of-government actions as well as key agency-level actions for both the Department of State and USAID in 2021. Most agency-level actions were gender accommodating as they reinforced a gender binary and did not use inclusive language such as “internal and external condoms.” The lack of data about global FP programs or activities in agency-level and whole-of-government actions reinforced the siloed nature of global health programs and did not support the implementation of integrated sexual and reproductive health (SRH) programming based in evidence and human rights. An inadequate funding request from the White House, a low level of appropriated funding by the U.S. Congress for global FP programs, and the disbursement of FP funds by USAID that was not responsive to need contributed to the low grade in this domain. Low transparency of actions graded in this domain across actors also lowered the overall FP domain grade in 2021.