This is an average of the three domain scores below.
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 White House received an 80 (B-) with transparency and an 85 (B) without transparency in the Maternal and Child Health (MCH) domain in 2021. The White House requested adequate funding for USAID’s global MCH programs, UNIFEM (now UN Women), and the United Nations Children’s Emergency Fund (UNICEF). Generally, actions graded in this domain meaningfully referenced global MCH programs, which supported the ability of U.S. global health assistance to promote SRHR through the MCH domain. The National Strategy on Gender Equity and Equality meaningfully included issues across MCH, including global investments in the SDGs, client-centered services, integrating obstetric care with other SRH services, and the impact of climate change on pregnant people. The White House demonstrated a moderate level of transparency of MCH policies but a low level of transparency for the availability of funding information in this domain in 2021.
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 Department of State received a 44 (F) with transparency and a 50 (F) without transparency in the Maternal and Child Health (MCH) domain in 2021. This domain grade was raised by the meaningful inclusion of MCH activities in the PEPFAR Core Program and Policy Priorities and the updated March 2021 DREAMS Guidance, which were both responsive to need, based in evidence, aligned with human rights norms, and gender transformative. The February 2021 COP/ROP Guidance and other COP/ROP-related materials did not promote SRHR in the MCH domain because they did not include adequate information for partners to understand the revocation of PLGHA and adapt their programs accordingly. This domain grade was low overall because the actions did not include data about MCH programs or activities across the board, which reinforced the siloed nature of global health programs, negatively affected transparency, and hindered SRHR. In the budget evaluation, the Department of State allocated MCH funds in a manner that was somewhat in accordance with country-level maternal mortality, which moderately promoted SRHR in the MCH domain in 2021.
USAID received a 73 (C) with transparency and a 76 (C) without transparency in the Maternal and Child Health domain in 2021. This domain grade was raised by USAID’s Implementation Plan for the U.S. COVID-19 Global Response and Recovery Framework, which documented the impacts of the pandemic on MCH outcomes as well as outlined responses to protect global MCH programs that were based in evidence and responsive to need. This actor’s domain grade was decreased by the removal of the PLGHA section in ADS Chapter 303 without providing additional information or guidance for partners to adapt their programs accordingly, which significantly hindered SRHR. Overall, transparency was low for many actions graded in this domain because USAID did not indicate which content had been updated in 2021 from previous versions. USAID had a high level of transparency for funding data but did not disburse MCH funding in a manner that was responsive to need, which decreased this actor’s grade in this domain.
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.