YEAR 2022

Maternal and Child Health (MCH)

The U.S. Government received a 79 (C+) with transparency and an 83 (B) without transparency for the Maternal and Child Health (MCH) domain across all actors in 2022. 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). This omission reinforced the siloed nature of global health programs and did not support the implementation of integrated programming based in evidence and human rights. In most instances, agency-level actions were gender accommodating as they 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. All actors received low to moderate transparency scores for actions graded in the MCH domain. The continued lack of funding information for the Department of Health and Human Services (HHS) global MCH efforts and low scores for appropriate use of funds by USAID and the Department of State also negatively affected the overall MCH domain grade in 2022.

B+

White House

The White House received an 87 (B+) with transparency and an 88 (B+) without transparency in the Maternal and Child Health (MCH) domain in 2022. The White House requested adequate funding for global MCH programs within USAID, 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 global health assistance to promote SRHR in the MCH domain. The White House demonstrated a moderate level of transparency within MCH policies and a moderate level of transparency for the availability of funding information in the MCH domain.

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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2022_White House Action Plan on Global Water Security

Recognizing that global water security is essential to U.S. national security, this Plan outlined an innovative, whole-of-government approach to address this challenge. The Plan was responsive to need and aligned with human rights principles. It included a discussion of gender and recognized the disproportionate impact of water scarcity on women and girls, though was rooted in a gender binary. The Plan was gender blind, as it did not acknowledge the gendered norms that govern access to water and sanitation infrastructure or the links between water scarcity and SGBV against women. The Plan did not consider evidence on the links between water scarcity, climate-related disruptions, and the curtailing of SRHR services and access. The Plan neither promoted nor hindered SRHR in the MCH domain.

2022_Consolidated Appropriations Act (H.R.2617)

This Act provided appropriations to federal agencies for the remainder of FY2023, and included supplemental appropriations for disaster relief and support to Ukraine. The action was responsive to need. It was difficult to assess if it was aligned with human rights principles or based in evidence, as it outlined allocations without clarifying the rationales for those allocations. Most of the MCH-related efforts were domestically focused, but cross-cutting efforts such as specific funding for gender equality and countering GBV were also included. The Act neither promoted nor hindered SRHR in the MCH domain.

2022_Executive Order on Advancing Equality for Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Individuals

The Order was issued to combat unlawful discrimination against LGBTQIA+ individuals, eliminate the inequalities that harm LGBTQIA+ individuals and their families, and defend their rights and safety. It advanced human rights and discouraged discrimination. While the bulk of the action was focused on domestic measures, the Order committed foreign assistance to develop an action plan to promote an end to use of “so called conversion therapy” around the world. It clearly mandated the end of a practice that is detrimental to the health and safety of LGBTQIA+ individuals. Based on the activities detailed, the Order was responsive to need and based in evidence. While the Order did not directly advance MCH outcomes globally, it reaffirmed the need to protect the rights and safety of the LGBTQIA+ community globally. The action moderately promoted SRHR in the MCH domain.

2022_Executive Order on Protecting Access to Reproductive Healthcare Services

The Order responded to the overturn of Roe v. Wade, and aimed to protect healthcare service delivery and promote access to critical reproductive healthcare services, including abortion. It was gender accomodating, as the use of gendered language such as "pregnant women" did not acknowledge that diversity of people that use and need reproductive healthcare services. It was based in evidence, responsive to need, and aligned with international human rights principles. The Order committed to enhancing access to a “full range of reproductive health services” including care for “pregnancy loss, miscarriages and ectopic pregnancies”, and abortion services. It also highlighted the need for new ways to increase outreach and education about access to reproductive healthcare services. The Order moderately promoted SRHR in the MCH domain.

2022_Fact Sheet_ The Biden Administration’s Commitment to Global Health

The action summarized the global health achievements of the Biden-Harris Administration in 2021 and outlined commitments for 2022. The action aligned with international human rights principles, was based in evidence, and responsive to need. For instance, it highlighted the impact of the COVID-19 pandemic on childhood immunization, nutrition, and polio eradication. The action underscored the revocation of the expanded Mexico City Policy and the resumed funding to UNFPA, and aimed to position the U.S. as a champion of SRHR. However, commitments as a champion were not clearly articulated and only included weak language around international collaboration. Nonetheless, the commitments around vaccine justice and supply chain improvements globally will have positive externalities on MCH (e.g., HPV vaccination and screening). The action moderately promoted SRHR in the MCH domain.

2022_Global Malnutrition Prevention and Treatment Act of 2021 (H.R.4693)

The Act directed USAID to conduct activities to prevent and treat malnutrition globally. Specific information was provided about available resources to address malnutrition through the Global Nutrition Coordination Plan. Instructions were provided to inform effective targeting of those resources based on country-wise indicators. The Act was responsive to need and based in evidence. The Act used gendered language (e.g., “pregnant and lactating women” rather than people), but outlined support for MCH activities through specific resource allocations for prenatal nutrient supplements and breastfeeding support. The emphasis on stronger community health systems will have cascading impacts on MCH outcomes. The Act moderately promoted SRHR in the MCH domain.

2022_Memorandum on Addressing the Long-Term Effects of COVID-19

The action acknowledged the domestic and global impacts of COVID-19 and addressed the long-term effects of COVID-19 on individuals and on society. The action was based in evidence and responsive to need. Although the bulk of the activities mentioned were domestic in focus, the implications of the emergent data and guidance to agencies applied to international health outcomes. For instance, the action included a mandate to collect evidence on the impact of long COVID-19 on pregnant people amongst other marginalized groups such as people living with disabilities, and different race and ethnicity groups. The action included gender-neutral language (e.g., “pregnant people”). The action moderately promoted SRHR in the MCH domain.

2022_Memorandum on the Establishment of the White House Task Force to Address Online Harassment and Abuse

The action attempted to bolster efforts to prevent and address online harassment and abuse. The action was aligned with human rights principles, responsive to need, and based in evidence. It considered global and national data on the prevalence of violence, as well as the links between online harassment and physical violence. While the engagement with law enforcement personnel was not aligned with approaches that encourage a decarceral approach, it expanded GBV strategy into virtual spaces. The action moderately promoted SRHR in the MCH domain.

2022_Memorandum on Presidential Determination with Respect to the Efforts of Foreign Governments Regarding Trafficking in Persons

This action reviewed which forms of U.S. foreign assistance could be received by other countries based on their compliance with the minimum standards for the elimination of trafficking in persons, which was defined in the TVPA. The action stated that USG will not provide "nonhumanitarian, nontrade-related assistance"—which includes global health assistance—to specific countries that do not meet these minimum standards, with some exceptions to allow for global health funding, as well as "development assistance that directly addresses basic human needs" on a country-by-country basis. Like the previous year, this year’s action was not based in evidence or responsive to need. Cutting off global health assistance for these countries could pose a barrier for survivors of trafficking to receiving sexual and reproductive healthcare, including MCH services. Its emphasis on compliance rather than entitlements, and its focus on carceral approaches was not aligned with international human rights principles. The action was gender blind, as it did not acknowledge the gendered prevalence of trafficking or the impact of these funding cuts on survivors. By leveraging global health assistance as a tool to coerce compliance with TVPA, this action moderately hindered SRHR in the MCH domain.

2022_National Security Memorandum on Countering Biological Threats, Enhancing Pandemic Preparedness, and Achieving Global Health Security

The action focused on countering biological threats, advancing pandemic preparedness, and achieving global health security. Much of the action focused on national-level preparedness policies and strategies and did not specifically mention health and foreign policy beyond the need to align it with the Global Health Systems strategy. It was based in evidence and responsive to need. It was not explicitly aligned with human rights principles and was mostly gender blind. For instance, it did acknowledge the gendered impacts of the kinds of threats mentioned in it. This action neither promoted nor hindered SRHR in the MCH domain.

2022_Presidential Memorandum to Promote Accountability for Conflict-Related Sexual Violence

The action outlined USG efforts to combat CRSV and promoted legal, policy, diplomatic, and financial solutions to deter future violence. These details indicated efforts to identify interventions beyond carceral solutions. The action was aligned with human rights principles and responsive to need. It was gender accomodating rather than transformative as it acknowledged the impact of violence on women and children, but did not discuss the burden of violence faced by gender-diverse and sexually diverse people in conflict. Nonetheless, it demonstrated commitment to addressing GBV. The action moderately promoted SRHR in the MCH domain.

2022_Strengthening Health Security Across the Globe: Progress and Impact of U.S. Government Investments in the Global Health Security Agenda

The action documented USG strategy for global health security with an emphasis on the following four areas: (1) marshaling political will, (2) developing global norms around quality of care and technical standards, (3) enhancing sustainable multilateral financing, and (4) strengthening capacities in partner countries. While the action was not explicitly based in human rights principles, it aligned to International Health Regulations, the Biological and Toxins Weapon Convention, UN Security Council Resolution 1540, and other international health conventions that are rights-based. It was responsive to need and based in evidence. The action was gender blind as it focused on supply-side interventions and did not mention gender. Despite acknowledging the impact of COVID-19 on maternal health outcomes in some geographies, there was no substantive discussion of future commitments. The action neither promoted nor hindered SRHR in the MCH domain.

2022_U.S. Government Global Food Security Strategy FY22-26

This action updated the Global Food Security Strategy and charted a course towards reducing global poverty, hunger, and malnutrition in the face of COVID-19, climate change, growing conflict, and rising inequality. The strategy's overarching goal was to sustainably reduce global poverty, hunger, and malnutrition via the Feed the Future (the USG global hunger and food-security initiative) three objectives: (1) inclusive and sustainable agriculture-led economic growth, (2) strengthened resilience among people, communities, countries, and systems; and (3) a well-nourished population, especially among women and children. The action was aligned with human rights principles, responsive to need, and based in evidence. It demonstrated a commitment to inclusion as a cross cutting strategy, and recognised groups that need targeted intervention including, but not limited to “women and girls; persons with disabilities; LGBTQIA+ people; displaced persons; migrants; Indigenous peoples and communities; youth; older persons; religious minorities; ethnic and racial groups; people in lower castes; and people of diverse economic classes and political opinions.” The updated strategy acknowledged links between improved nutrition and better overall health outcomes, and included updated indicators to reinforce this point. Despite the stated commitment to inclusion, the action was gender accomodating at best, as it retained the focus on “pregnant women” in objectives related to maternal nutrition. The action promoted “adequate diets for women and appropriate infant and young child feeding practices” and outlined income-supplementing strategies to encourage women’s empowerment. The action moderately promoted SRHR in the MCH domain.

2022_U.S. Government Global Water Strategy 2022-2027

This action expanded on the White House Action Plan to ensure health, prosperity, stability, and resilience through sustainable and equitable water resources management, access to safe drinking water, sanitation services, and hygiene practices. The action was responsive to need and based in evidence. It acknowledged the links between water security and positive health outcomes. Sexual and reproductive health—including menstrual hygiene management—was not discussed. The action explored the gendered impact of water scarcity and its connections to GBV. It demonstrated a commitment to inclusion, as evidenced by its prioritization of access to “basic services for those who experience intersecting vulnerabilities arising from age, sex, gender identity and expression, sexual orientation, sex characteristics, religion, race, ethnicity, disability, geography, or other specific barriers.” The action moderately promoted SRHR in the MCH domain.

2022_United States Government Women, Peace, and Security (WPS) Congressional Report

The WPS Report provided Congress with an overview of progress made in implementing the WPS Agenda since the Biden-Harris administration’s interventions in 2021. The Report evaluated progress in advancing the WPS Strategy's four lines of effort across the Department of State, DoD, DHS, and USAID: participation, protection, internal capabilities, and partnerships. Improved health outcomes were included as a positive impact of implementing the WPS Agenda. The Report was responsive to need, as it included GBV prevention and programming as a cross-cutting measure of progress towards achieving the WPS Agenda. It also emphasized the importance of evidence-based implementation and decision-making, and included specific and actionable milestones to measure progress, which was responsive to need. The Report moderately promoted SRHR in the MCH domain.

2022_United States Strategy to Combat Gender Based Violence Globally

The action updated earlier efforts “to advance equity and inclusivity and address the factors that increase the risks of gender-based violence and undermine access to services and safety, particularly for the most marginalized groups.” It was aligned with international human rights principles responsive to need, and recognised the most recent evidence about addressing GBV. For instance, it acknowledged other at-risk, marginalized communities such LGBTQI+ persons, and boys and men as survivors of violence. It explored the rise of digital platforms and social media as drivers of violence, analyzed the impact of the COVID-19 pandemic, and examined links between climate change and violence. The action was gender transformative, as it not only offered a critical examination of gender norms and dynamics, but also committed to creating systems that reinforced this critique and broke cycles of violence. The action significantly promoted SRHR in the MCH domain.

2022_United States Strategy to Prevent Conflict and Promote Stability

The action affirmed U.S. intent to “strengthen fragile states where state weakness or failure would magnify threats to the American homeland” and “empower reform-minded governments, people, and civil society” in these states. The action was responsive to need and based in evidence, but was not aligned with human rights principles. It acknowledged the “gaps between men and women in conflict-affected areas” but did not substantively address any of the domains or cross-cutting themes like GBV. The action neither promoted nor hindered SRHR in the MCH domain.

Congress

Congress received a 94 (A) with transparency and a 96 (A+) without transparency in the Maternal and Child Health (MCH) domain in 2022. 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). Congress demonstrated a moderate level of transparency with regard to actions and high transparency of funding information related to MCH globally in 2022.

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

2022_Consolidated Appropriations Act (H.R.2617)

This Act provided appropriations to federal agencies for the remainder of FY2023, and included supplemental appropriations for disaster relief and support to Ukraine. The action was responsive to need. It is difficult to assess If it was aligned with human rights principles or based in evidence, as it outlined allocations without clarifying the rationales for those allocations. Most of the MCH-related efforts were domestically focused, but cross-cutting efforts such as specific funding for gender equality and countering GBV were also included. The Act neither promoted nor hindered SRHR in the MCH domain.

2022_Global Malnutrition Prevention and Treatment Act of 2021 (H.R.4693)

The Act directed USAID to conduct activities to prevent and treat malnutrition globally. Specific information was provided about available resources to address malnutrition through the Global Nutrition Coordination Plan. Instructions were provided to inform effective targeting of those resources based on country-wide indicators. The Act was responsive to need and based in evidence. The Act used gendered language (e.g., ‘pregnant and lactating women’ rather than people), but outlined support for MCH activities through specific resource allocations for prenatal nutrient supplements and breastfeeding support. The emphasis on stronger community health systems will have cascading impacts on MCH outcomes broadly. The Act moderately promoted SRHR in the MCH domain.

Department of State

The Department of State received a 36 (F) with transparency and a 43 (F) without transparency in the MCH domain in 2022. This domain grade was raised by the PEPFAR Five Year Plan, as well as the updated PrEP Ring FAQs, which were both responsive to need, based in evidence, and aligned with human rights principles. However, subsequent edits to the Five Year Plan did not promote SRHR, and were not based in evidence or responsive to need, and thus negatively impacted the MCH score. This domain grade was low because the actions did not include data or information about activities within MCH programs, 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 somewhat in accordance with country-level maternal mortality, which moderately promoted SRHR. Transparency was relatively low across actions but moderately high with regard to budget data in the MCH domain.

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

2022_Agency Priority Goal_State_Action Plan_Quarterly Updates_Equity Across Foreign Affairs Work

To report on the progress of the Department of State, the APGs on ensuring equity across foreign affairs work were released bi-annually. They aimed to “advance equity and support for underserved communities in the development and conduct of foreign policy, by developing assessment tools and establishing country-specific baselines, measurements, and reporting mechanisms for the Department.” The intent was to enable programs led and overseen by the Department of State to engage underserved communities and ensure sustainability and effectiveness in the long-term. Given the increased need to center communities and equity in U.S. foreign policy work, the APGs were aligned with human rights principles, responsive to need, and based in evidence. There was a cross-cutting focus on inclusion throughout them, specifically referencing “vulnerable and marginalized groups, including racial, ethnic, and religious groups, persons with disabilities, indigenous persons, LGBTQI+ persons, and women and girls in all their diversity.” The APGs neither promoted nor hindered SRHR in the MCH domain.

2022_Agency Priority Goal_USAID-State_Action Plan_Quarterly Updates_HIV-AIDS

To report on joint progress toward PEPFAR program goals, strategies, milestones, and indicators in FY 2020, the APGs for HIV and AIDS were released quarterly by both the Department of State and USAID. They expanded person-centered services such as multi-month drug dispensing and self-testing modalities; focused on prevention for AGYW, young men, and orphans and vulnerable children (OVC); and increased access to VMMC. The action was responsive to need and strongly based in evidence. The APGs did not provide any gender-disaggregated insights, and limited all discussions of gender to a binary which made it gender accomodating. They used improper terminology such as “transgendered people,” and did not reference any human rights principles or frameworks. Despite a clear articulation on goals and indicators for success in the HIV domain, they did not discuss links to allied health outcomes in other sectors, including maternal health. The APGs neither promoted nor hindered SRHR in the MCH domain.

2022_USAID-State_FY2023_Annual Performance Plan

The joint USAID-State FY 2023 Annual Performance Plan summarized progress toward the five goals outlined in the FY 2022-2026 Joint Strategic Plan Framework. Relevant performance goals included those related to preventing maternal and child mortality, achieving the 95-95-95 goal for HIV and AIDS, and integrating voluntary FP with other health programs. Efforts to combat GBV and promote inclusion were integrated into the strategic objectives. This Plan was responsive to need, based in evidence, and aligned with human rights principles. It contained gender sensitive elements such as efforts to promote gender equality globally and build gender-responsive systems. This Plan moderately supported SRHR in the MCH domain.

2022_PEPFAR 2022 Annual Report to Congress

The Report to Congress detailed the achievements of PEPFAR, recapped efforts conducted to recover from COVID-19 and outlined the support to countries to achieve their 95:95:95 goals. The Report was aligned with human rights principles and highly responsive to need. Inclusion was a cross-cutting focus within the action, with KPs defined to include “the LGBTQI+ community, people who use drugs, sex workers, racial and ethnic minorities, and women and girls and others…” However, the Report also included gendered language (e.g., “breast-feeding women'' rather than people, “mother to child transmission” rather than vertical transmission). Aside from the graphs, it was unclear how much of the Report had been updated since last year, which negatively impacted the transparency score. It was based in evidence, as it recognised (a) the need to build health system capacities to respond to comorbidities such as cervical cancer and tuberculosis rather than addressing HIV in a silo, (b) the linkage of PEPFAR performance with evaluations of multi-layer interventions such as DREAMS, and (c) the inclusion of the latest PHIA survey results and gender-disaggregated analyses. The Report moderately promoted SRHR in the MCH domain.

2022_PEPFAR 2022 Annual Treatment Report to Congress

The Annual Treatment Report from PEPFAR provided information to Congress on PEPFAR-supported treatment programs as required by Section 7611 (g) of Title 22 of the U.S. Code. The Report focused on the shift to the fourth phase of PEPFAR in the Five Year Plan to end the HIV and AIDS pandemic by 2030. Highlights included reaching 95-95-95 goals for all ages, genders, and populations groups; closing equity gaps for priority populations; sustaining success; and strengthening general health systems. The Report was responsive to need and based on evidence. Inclusion and data-driven decision-making based on expanded PHIA survey data were cross-cutting themes in the Report. While the Report focused on norms that keep men from accessing treatment as well as the DREAMS partnership there was no mention of pregnant people and KPs in the context of programming. The action moderately hindered SRHR in the MCH domain.

2022_U.S. Department of State and U.S. Agency for International Development FY 2023 Budget Request

The action detailed the Department of State budget request for FY 2023. It included funding for the war in Ukraine, and addressed the climate crisis (with the goal of delivering co-benefits for global health and WASH, food security, and the development of digital ecosystems. The request was responsive to need, based in evidence, and aligned with human rights principles. There were broad investments in the global health workforce and systems to enhance countries’ abilities to provide core health services and improve health systems resiliency, but the actual “transformative investments” were unclear. Despite specific commitments to the Global Fund and the GEEA Fund, there was limited mention of how the funding would concretely advance the USG “Leadership in Global Health.” The request neither promoted nor hindered SRHR in the MCH domain.

2022_PEPFAR 2022 Country and Regional Operational Plan (COP:ROP) Guidance for all PEPFAR Countries

A revised version of the PEPFAR COP/ROP was released in 2022, and detailed themes within the PEPFAR Strategy for 2021-2025. The COP/ROP was intended to push PEPFAR countries towards sustained epidemic control of HIV by supporting equitable health services and solutions, building enduring national health systems and capabilities, and establishing lasting collaborations. While the action included a page at the beginning of the text that listed the updates to the 2022 version, the changes were not highlighted in the body text which negatively affected the transparency score. The new implementation themes included a shift to person-centered care from client-centered care, the inclusion of KPs, and updated treatment guidelines, all of which were responsive to need and based in evidence. The action moderately promoted SRHR in the MCH domain.

2022_PEPFAR 2023 Country and Regional Operational Plan (COP:ROP) Guidance for all PEPFAR Countries

This version of the COP/ROP was significantly updated to reflect the PEPFAR Five Year Plan, which promised to end the HIV/AIDS pandemic as a public health threat by 2030, while also sustainably strengthening public health systems. Based on partner feedback, the action was redesigned as a shorter, “more relevant” resource to support country teams, which was responsive to need and based in evidence. The action demonstrated a commitment to health equity with a focus on three priority populations: infants and children, AGYW, and KPs. It included a strong stance against stigma and discrimination and noted structural barriers that result in GBV, with particular impacts on AGYW and KPs. It included new issues such as mental health for AGYW and integrated SRHR and HIV care. The action was gender transformative, as it acknowledged the need for gendered considerations related to program implementation. The action increased accountability and improved holistic care for children, pregnancy, and breastfeeding women, focused on reducing MTCT, and acknowledged the need for targeted interventions for pregnant/breastfeeding/parenting AGYW to increase antenatal care (ANC) retention rates and treatment adherence. This action also outlined a transition from annual planning to two-year operational planning. The action moderately promoted SRHR in the MCH domain.

2022_Diversity Equity Inclusion and Accessibility Strategic Plan

The action advanced DEIA goals for the federal workforce by ensuring that the USG was in "the strongest possible position to deliver for the U.S. people in an increasingly diverse, complex, and interconnected world." It responded to a 2021 Executive Order from the White House on enhancing DEIA in the federal workforce and intended to “transform the Department into a more just, equitable, and accessible institution internally to ensure a more equitable and inclusive world.” The action was aligned with human rights principles on inclusion, responsive to need, and based in evidence. The action moderately promoted SRHR in the MCH domain.

2022_PEPFAR Guidance_PrEP Ring FAQ

This action detailed PEPFAR guidance to implementing programs that were funded by the Department of State about the use and distribution of the PrEP ring. The action was aligned with human rights principles and responsive to need, as it committed to “women having informed choices.” However, it also used gendered language (e.g., “women having…” rather than “people”) ,which excluded other KPs. The action clarified that despite constraints on use and distribution, implementation science studies could proceed, which demonstrated commitment to evidence. The action moderately promoted SRHR in the MCH domain.

2022_PEPFAR Monitoring, Evaluation, and Reporting Indicator Reference Guide_MER 2.0 (Version 2.6.1)

The Monitoring, Evaluation, and Reporting (MER) Indicator Reference Guide is reviewed and updated annually to streamline and prioritize the standard indicators used across PEPFAR programs. The September 2022 update to the action introduced greater disaggregation by age (the 50+ age category was divided into smaller bands) across both testing and treatment. This update was responsive to need, as it allowed for greater oversight and evidence-based decisions about PEPFAR programs. The updated action was neither gender-transformative nor inclusive, as it maintained the disaggregation methodology for counting KPs which directed implementing partners to report an individual in the KP category “with which he or she is most identified” which was not intersectional in approach. The update also included a sex-based indicator (male/female) instead of a gender-based indicator which was not based in evidence. The update neither promoted nor hindered SRHR in the MCH domain.

2022_PEPFAR Technical Guidance in Context of COVID-19 Pandemic_2022.01.19

This Guidance updated earlier versions of this Technical Guidance that supported PEPFAR programming throughout the COVID-19 pandemic and ensured that programs remained consistent with recommendations from the WHO and CDC. The Guidance was responsive to need and aligned with human rights principles. It was based in evidence, as it included guidelines about universal masking for healthcare professionals. However, the sections on HIV care, maternal health, and FP, and their links to COVID-19 were not updated. The Guidance neither promoted nor hindered SRHR in the MCH domain.

2022_Reimagining PEPFAR’s Strategic Direction_September 2022

PEPFAR reimagined its global strategy through a series of stakeholder consultations in 2021 and 2022 to produce the revised Five Year Plan, which promised to end the HIV and AIDS pandemic as a public health threat by 2030. It was aligned with human rights principles, as it referenced the SDGs as well as international commitments set by UNAIDS and the Global Fund. The action was responsive to need and based in evidence. Activities listed as part of goal one and two demonstrated a commitment to inclusion and equity in both substance and execution, with plans for working with KPs, and a clear localisation strategy for addressing health inequity. The action was gender transformative, as it focused on social and structural barriers to effective care, especially for women, girls, and the LGBTQI community, and explored the integration of GBV programming into HIV programming. The action acknowledged the need to close gaps in preventing mother-to-child transmission (MTCT), provide precision medicine for children living with HIV, and support young mothers and families in need. It prioritized community-led capacity building which was a significant sustainability goal, and demonstrated potential for effective care, even in the absence of the PEPFAR program. The action moderately promoted SRHR in the MCH domain.

2022_Reimagining PEPFAR’s Strategic Direction_July 26 2023_Footnote Update

PEPFAR reimagined its global strategy through a series of stakeholder consultations in 2021 and 2022 to produce the revised Five Year Plan, which promised to end the HIV/AIDS pandemic as a public health threat by 2030. The document was updated to include a footnote that defined the scope of SRHR programming within PEPFAR. The update was not aligned with human rights principles, responsive to need, or based in evidence. The SRHR Index team found that the update occurred on July 26, 2023 however the document kept a 2022 publication date and is therefore scored for 2022. It would be unclear to a reader when this update was added, which negatively affected the transparency score. The action significantly hindered SRHR in the MCH domain.

2022_Reimagining PEPFAR’s Strategic Direction_July 27 2023_Footnote Update

PEPFAR reimagined its global strategy through a series of stakeholder consultations in 2021 and 2022 to produce the revised Five Year Plan, which promised to end the HIV/AIDS pandemic as a public health threat by 2030. The document was updated a second time to include a footnote that defined the scope of SRHR programming within PEPFAR. While the update improved the previously included footnote, it still was not aligned with human rights principles, responsive to need, or based in evidence.The SRHR Index team found that the update occurred on July 27, 2023 however the document kept a 2022 publication date and is therefore scored for 2022. It would be unclear to a reader when this update was added, which negatively affected the transparency score. The action moderately hindered SRHR in the MCH domain.

2022_Strengthening Health Security Across the Globe: Progress and Impact of U.S. Government Investments in the Global Health Security Agenda

The action documented USG strategy for global health security with an emphasis on the following four areas: (1) marshaling political will, (2) developing global norms around quality of care and technical standards, (3) enhancing sustainable multilateral financing, and (4) strengthening capacities in partner countries. While the action was not explicitly based in human rights principles, it aligned to International Health Regulations, the Biological and Toxins Weapon Convention, UN Security Council Resolution 1540, and other international health conventions that are rights-based. It was responsive to need and based in evidence. The action was gender blind , as it focused on supply-side interventions and did not mention gender. Despite acknowledging the work of PEPFAR globally, there was no substantive discussion of their work in discussions on health security. The action neither promoted nor hindered SRHR in the MCH domain.

2022_FY2020_Bureau of Population, Refugees, and Migration_Summary of Major Activities

The action outlined the funded activities for the Bureau of Population, Refugees, and Migration, including supporting migrants and populations in crisis. Funding stemmed from four core sources, one of which was considered “the resource pot” for Global Health Programs within the Department of State. The allocations included the Emergency Response Fund, the Gap Priorities Fund, funding to address COVID-19, and funding for programs that addressed GBV, all of which were implemented at the regional level. It also included funding for cross-cutting efforts such as for evaluations, research, and inclusion. The action was aligned with human rights principles, responsive to need, and based in evidence. The action did not list how these funds were programmed, which affected its transparency score. The action neither promoted nor hindered SRHR in the MCH domain.

2022_U.S. Government Global Food Security Strategy FY22-26

This action updated the Global Food Security Strategy and charted a course towards reducing global poverty, hunger, and malnutrition in the face of COVID-19, climate change, growing conflict, and rising inequality. The strategy's overarching goal was to sustainably reduce global poverty, hunger, and malnutrition via the Feed the Future (the USG global hunger and food-security initiative) three objectives: (1) inclusive and sustainable agriculture-led economic growth, (2) strengthened resilience among people, communities, countries, and systems; and (3) a well-nourished population, especially among women and children. The action was aligned with human rights principles, responsive to need, and based in evidence. It demonstrated a commitment to inclusion as a cross cutting strategy, and recognised groups that need targeted intervention including, but not limited to “women and girls; persons with disabilities; LGBTQI+ people; displaced persons; migrants; Indigenous peoples and communities; youth; older persons; religious minorities; ethnic and racial groups; people in lower castes; and people of diverse economic classes and political opinions.” The updated strategy acknowledged links between improved nutrition and better overall health outcomes and included updated indicators to reinforce this point. However, it was not clear if the Department of State had a role besides acting as coordinator between agencies. The action neither promoted nor hindered SRHR in the MCH domain.

2022_U.S. Government Global Water Strategy 2022-2027

This action outlined planned contributions from the Department of State to the Global Water Strategy, and its role in ensuring health, prosperity, stability, and resilience through sustainable and equitable water resources management and access to safe drinking water, sanitation services, and hygiene practices. The action was responsive to need and based in evidence, as it acknowledged the links between water security and positive health outcomes broadly. The action was not aligned with human rights principles, as it framed water security solely as an issue of national security and a pathway to engage “international partners on fundamental issues of power and politics.” Sexual and reproductive health—including menstrual hygiene management—was not discussed. GBV was discussed, but not in the sections related to the Department of State. The action moderately hindered SRHR in the MCH domain.

2022_United States Strategy to Prevent Conflict and Promote Stability

The action affirmed U.S. intent to “strengthen fragile states “where state weakness or failure would magnify threats to the American homeland” and “empower reform-minded governments, people, and civil society” in these states. The action was responsive to need and based in evidence, but was not aligned with human rights principles. It acknowledged the “gaps between men and women in conflict-affected areas” but did not substantively address any of the domains or cross-cutting themes like GBV. The action neither promoted nor hindered SRHR in the MCH domain.

2022_United States Strategy to Combat Gender Based Violence Globally

The action updated earlier efforts “to advance equity and inclusivity and address the factors that increase the risks of gender-based violence and undermine access to services and safety, particularly for the most marginalized groups.” It was aligned with international human rights principles, responsive to need, and recognised the most recent evidence about addressing GBV. For instance, it acknowledged other at-risk, marginalized communities such as LGBTQIA+ persons, and boys and men as survivors of violence. It explored the rise of digital platforms and social media as drivers of violence, analyzed the impact of the COVID-19 pandemic, and examined links between climate change and violence. The action was gender transformative, as it not only offered a critical examination of gender norms and dynamics, but also committed to creating systems that reinforced this critique and broke cycles of violence. The action significantly promoted SRHR in the MCH domain.

2022_United States Government Women, Peace, and Security (WPS) Congressional Report

The WPS Report provided Congress with an overview of the progress made in implementing the WPS Agenda since the Biden-Harris administration interventions in 2021. The Report evaluated progress in advancing the WPS Strategy's four lines of effort across the Department of State, Department of Defence (DoD), Department of Homeland Security (DHS), and USAID: participation, protection, internal capabilities, and partnerships. While improved health outcomes were mentioned as a positive impact of implementing the WPS Agenda on sexual exploitation and GBV, they were not included as a core focus area. It was gender accomodating, as it focused only on ‘women’s empowerment and representation’ and did not include LGBTQIA+ communities. The report did not include a discussion of how impact is measured or evaluated. The action moderately hindered SRHR in the MCH domain.

C+

US Agency for International Development

USAID received a 75 (C) with transparency and a 79 (C+) without transparency in the MCH domain in 2022. This domain grade was raised by efforts such as the Maternal and Child Health and Nutrition Technical Roadmap 2030, which outlined a sustainable, cross-sectoral strategy to promote global MCH that was based in evidence and responsive to need. The domain grade was decreased slightly because of the omission of MCH in the USAID Climate Strategy 2022-2030, which moderately hindered SRHR. Overall, transparency was low for many actions graded in this domain because USAID did not indicate which content was updated in 2022. USAID had a high level of transparency for funding data but did not disburse MCH funding that was responsive to need, which decreased this actor’s grade in this domain.

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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2022_ADS Chapter 201_2022.09.28

ADS Chapter 201 described the process for creating development policy, as well as the development policy universe that affected all of the Agency programs and actions. This chapter was edited in September 2022 and added two Internal Mandatory references sections on energy assistance guidance and a carbon-intensive assistance exemptions template. Neither were publicly available, which negatively affected transparency. This ADS chapter used gendered language like “female empowerment” and did not address efforts to empower people of diverse SOGIESC. This action neither promoted nor hindered SRHR in the MCH domain.

2022_ADS Chapter 303_Update

ADS Chapter 303 outlined internal guidance, policy directives, procedures, and standards for grants and cooperative agreements with nongovernmental organizations (NGOs), including those that were established with U.S. global health assistance funds. The following sections were updated in July 2022: notice of funding opportunity format, reviewing applications, and award administration. None of these updates were publicly available, which negatively affected transparency. The chapter was updated again in December 2022 where several sections were updated with minor edits for clarity of language. It was unclear how these updates would impact the implementation of global HIV and AIDS programs. This action neither promoted nor hindered SRHR in the MCH domain.

2022_ADS Chapter 303maa_2022.12.29

ADS Chapter 303maa was a mandatory reference for ADS Chapter 303 and was updated in December 2022 to add or revise 18 sections. Most updates pertained to operational aspects such as mandatory disclosures, regulations governing employees, negotiated indirect cost rates, exchange visitor visa requirements, whistleblower protections, reporting host government taxes, and investment promotion. A new section—M32. USAID Disability Policy – Assistance—added language about USAID commitment to programming, advocacy, awareness-raising, and host-country engagement to advance opportunities for people living with disabilities. This action required that recipients not discriminate against people living with disabilities in USAID-funded program implementation with a holistic approach for “men, women, and children with disabilities.” The addition of this section could help to ensure that USAID funds programs that are inclusive to people with all abilities. This action was responsive to need and aligned with international human rights principles. The added language was gender accomodating, as it acknowledged the need for “comprehensive and consistent approach” for all populations but used gendered language that reinforced a gender binary. The updates to ADS Chapter 303maa moderately promoted SRHR in the MCH domain.

2022_ADS Chapter 303mab_12.29.2022

ADS Chapter 303mab was a mandatory reference for ADS Chapter 303 and was updated in December 2022 to add or revise 14 sections. Most updates pertained to operational aspects such as disputes and appeals, mandatory disclosures, regulations governing employees, exchange visitor visa requirements, whistleblower protections, reporting host government taxes, and investment promotion. It was unclear how these updates would impact the implementation of global MCH programs. This action neither promoted nor hindered SRHR in the MCH domain

2022_ADS Chapter 303mat_12.29.2022

ADS Chapter 303mat was a mandatory reference for ADS Chapter 303 and was updated in December 2022 to add or revise 11 sections. Most updates pertained to operational aspects such as mandatory disclosures, whistleblower protections, reporting subawards and executive compensation, reporting host government taxes, and investment promotion. It was unclear how these updates would impact the implementation of global MCH programs. This action neither promoted nor hindered SRHR in the MCH domain.

2022_ADS Chapter 308mab_2022.7.26

ADS Chapter 308mab was a mandatory reference for ADS Chapter 308 and titled “Standard Provisions for Cost-Type Agreements with Public International Organizations (PIOs).” It was revised in July 2022. Provision RAA.15 Special Provision for UNOPS was added to outline the financial management required of the grant recipient for indirect costs. It was unclear how these updates would impact the implementation of global MCH programs. This action neither promoted nor hindered SRHR in the MCH domain.

2022_Agency Priority Goal_USAID-State_Action Plan_Quarterly Updates_HIV-AIDS

To report on joint progress toward PEPFAR program goals, strategies, milestones, and indicators in FY 2020, the APGs for HIV and AIDS were released quarterly by both the Department of State and USAID. They expanded person-centered services such as multi-month drug dispensing and self-testing modalities; focused on prevention for adolescent girls and young women (AGYW), young men, and orphans and vulnerable children (OVC); and increased access to VMMC. The action was responsive to need and strongly based in evidence. The APGs did not provide any gender-disaggregated insights and limited all discussions of gender to a binary making them gender accomodating. They used improper terminology such as “transgendered people,” and did not reference any human rights principles or frameworks. Despite a clear articulation on goals and indicators for success in the HIV domain, they did not discuss links to allied health outcomes in other sectors, including maternal health. The APGs neither promoted nor hindered SRHR in the MCH domain.

2022_Agency Priority Goal_USAID_Action Plan_Quarterly Updates_Preventing Child and Maternal Deaths

USAID published quarterly action plans to report on its progress toward its APG for preventing child and maternal deaths in FY 2021. The APGs were gender accomodative as language focused on “pregnant women” and did not provide indicators of maternal health and well-being beyond contraceptive use. They did not reference any human rights principles or frameworks. This action included the promotion of high-impact interventions for causes of maternal mortality, nutrition counseling for pregnant and lactating women, and behavior change communication efforts to promote voluntary FP. Programmatic efforts and indicators were based in evidence and responsive to need. These APGs reflected USAID commitment to ensuring that data were collected thoroughly and accurately, while also maintaining accountability to targets. These APGs moderately promoted SRHR in the MCH domain.

2022_Agency Priority Goal_USAID_Action Plan_Quarterly Updates_Resilience and Food Security

USAID published quarterly action plans to report on its progress toward its APG for resilience and food security in FY 2021. This action included efforts to strengthen inclusive agricultural systems, expand availability of nutritious food, increase representation of marginalized populations, and promote sustainable, environmentally conscious strategies. Programmatic efforts and indicators were based in evidence and responsive to need. The APGs reflected USAID commitment to ensuring that data were collected thoroughly and accurately, while also maintaining accountability to targets. Despite the clear link between food insecurity and MCH, there was only a singular mention of maternal health in relation to COVID-19 impacts. This action neither promoted nor hindered SRHR in the MCH domain.

2022_USAID-State_FY2023_Annual Performance Plan

2022_USAID Approach to HIV and Optimized Programming Report (AHOP)

The Report outlined efforts to shift to a patient-centered model of care that integrated HIV programs with existing primary healthcare systems. This Report committed USAID to applying an intersectional, multi-disease systems approach that weaved HIV prevention and response into efforts to address malaria, TB, reproductive health and FP, MCH, and global health security. The Report was responsive to need and based in evidence. Explicit mentions of human rights grounded the strategy and informed innovative policy efforts to “challenging and changing laws that criminalize HIV transmission or same-sex relationships, laws and policies that limit access to health services for adolescents and youth, and laws that contribute to human rights abuses that limit full access to health services.” MCH-related language provided more of a commitment than a solid plan for reducing vertical transmission. The Report was relatively gender transformative, as it mentioned the need to address “gender-related barriers” and efforts to overturn laws that criminalize homosexuality. This Report moderately promoted SRHR in the MCH domain.

2022_Climate Change Impacts on Human Health and the Health Sector

This Report outlined USAID understanding of and approach to addressing climate risks at a health systems level. It provided a broad overview of the negative health impacts of climate change, particularly for vulnerable populations and low- and middle-income countries. The Report promoted efforts to increase health system resilience through adaptation and mitigation strategies, which was responsive to need and based in evidence. While this action articulated links between climate change and health, it did not explicitly mention sexual and reproductive health or climate exacerbated GBV. The report was gender accomodating, as it acknowledged the gendered impacts of climate change but used gendered language that reinforced a gender binary. Climate impacts on maternal and neonatal health were mentioned, including heat stress, extreme weather events, and air pollution. This Report moderately promoted SRHR in the MCH domain.

2022_USAID_Climate Strategy_2022-2030

This action outlined a strategic framework for a whole-of-Agency approach “to advance equitable and ambitious actions to confront the climate crisis” via targeted direct action and systems change. Given the worsened climate crisis, this action was responsive to need and based in evidence. The action emphasized the increased vulnerability of marginalized populations, including women and girls, people with disabilities, and LGBTQI+ people. The action included some gender transformative efforts to examine gendered power dynamics and avoid exacerbating gender inequality. Despite the severe impact of climate change on maternal health, sexual and reproductive health was only mentioned as an outcome of education for young women and girls. The action did not address any existing evidence on the links between climate change and maternal health outcomes. This action moderately hindered SRHR in the MCH domain.

2022_USAID_Evidence Act Annual Report 2021

This Report provided an update about fulfillment of requirements related to the Evidence Act. It outlined the compliance by the Chief Data Officer to 14 functional requirements, and ensured the continuous collection, evaluation, and use of USAID data, which was based In evidence and responsive to need. It was not clear if progress was made from the last version of the Report, which negatively affected transparency. This report neither promoted nor hindered SRHR in the MCH domain.

2022_USAID_Evidence Act Annual Report 2022

This Report provided an update about USAID fulfillment of requirements related to the Evidence Act. It outlined the compliance by the Chief Data Officer to 14 functional requirements, and ensured the continuous collection, evaluation, and use of USAID data, which was based in evidence and responsive to need. It was not clear if progress was made from the last version of the Report, which negatively affected transparency. This Report neither promoted nor hindered SRHR in the MCH domain.

2022_USAID_Getting to 2030_Maternal and Child Health and Nutritional Technical Report

This Roadmap articulated USAID approach “"to save lives, decrease morbidity and disability, and increase the potential of women, newborns, children, families, and communities to thrive." WASH was positioned as a key aspect of MCH and nutrition programming. The Roadmap promoted equitable access to healthcare, resource mobilization, behavior change communication, community ownership, cross-sectoral collaboration, and targeted monitoring, evaluation, research and learning activities. These commitments were based in evidence, aligned with human rights principles, and responsive to need. While most of the language enforced a gender binary, there was one mention of advancing gender transformative models. The Roadmap emphasized the need for integration of FP and reproductive health services with MCH programming. This Roadmap significantly promoted SRHR in the MCH domain.

2022_USAID_U.S. Global Food Security Strategy Implementation Report FY2021

This GFSS FY 2021 Implementation Report described USG efforts to "support developing countries in seeking to reduce their food insecurity, malnutrition, and poverty while building resilience to recurrent crises." It explored how malnutrition among women and children continued to be a burden for LMICs and how gender inequalities in the food system were exacerbated by the COVID-19 pandemic. It was responsive to need, as it reported on increased investment in gender equity and women's empowerment through initiatives like the Gender Climate and Nutrition Initiative and the Inclusive Development Initiative. The Report provided examples of evidence-based decision making and efforts to conduct further research. It included little documentation about efforts to promote MCH or ways to leverage PEPFAR infrastructure for nutrition programming. The Report was gender accomodative, as it only focused on GBV. This Report neither promoted nor hindered SRHR in the MCH domain.

2022_U.S. Government Global Food Security Strategy FY22-26

This action updated the GFSS and charted a course towards reducing global poverty, hunger, and malnutrition in the face of COVID-19, climate change, growing conflict, and rising inequality. The strategy's overarching goal was to sustainably reduce global poverty, hunger, and malnutrition via the Feed the Future (the USG global hunger and food-security initiative) three objectives: (1) inclusive and sustainable agriculture-led economic growth, (2) strengthened resilience among people, communities, countries, and systems; and (3) a well-nourished population, especially among women and children. The action was aligned with human rights principles, responsive to need, and based in evidence. It demonstrated a commitment to inclusion as a cross cutting strategy, and recognized groups that need targeted intervention including, but not limited to “women and girls; persons with disabilities; LGBTQI+ people; displaced persons; migrants; Indigenous peoples and communities; youth; older persons; religious minorities; ethnic and racial groups; people in lower castes; and people of diverse economic classes and political opinions.” As the lead of Feed the Future, USAID supported the implementation of the GFSS across the three objectives and coordinated the monitoring, evaluation, and learning efforts, all of which were based in evidence. The updated strategy acknowledged links and indicators between improved nutrition and better overall health outcomes. The action promoted “adequate diets for women and appropriate infant and young child feeding practices” and income-supplementing strategies to encourage women’s empowerment. The action moderately promoted SRHR in the MCH domain.

2022_Global Health eLearning Course_Female Genital Mutilation and Cutting

This eLearning Course provided information about the prevalence and impacts of FGM/C. It described different types of FGM/C, the geographic distribution of affected populations, the rationale behind the practice, resulting short-term and long-term complications, and socio-demographic factors related to the practice. The Course highlighted key aspects from the USAID FGM/C implementation roadmap such as cross-sectoral integration of prevention efforts in girls’ education; investing in gender-transformative programming, supporting rights-based policies to eliminate FGM/C; monitoring and evaluation; advancing gender-equal social norms; and availability of FGM/C-specific sexual, reproductive, and maternal health services. These recommendations were aligned with human rights, responsive to need, and based in evidence. The Course also discussed promising interventions such as partnerships between training providers and religious leaders. This action was somewhat gender transformative, as it advocated for the implementation of programs that engage men and boys and challenge existing gender norms, but used language that reinforced a sex and gender binary. Obstetric complications from FGM/C were highlighted via a case study of the Gambia. This Course significantly promoted SRHR in the MCH domain.

2022_Global Health eLearning Course_Good Governance in the Management of Medicines

This eLearning Course focused on good governance in the management of medicines, especially for vulnerable populations. The Course covered the basics on pharmaceutical management, corruption, and regulatory policy. It included several relevant case studies about quality, overpriced condoms, and counterfeit antiretroviral medicines. Key recommendations were based in evidence and responsive to need, and included an emphasis on monitoring and evaluation, establishment of governing bodies with effective oversight capacity, and mechanisms for involving civil society in accountability efforts. However, there was no mention of the importance of medicine management to maternal health. This Course neither promoted nor hindered SRHR in the MCH domain.

2022_Global Health eLearning Course_HIV AIDS Legal and Policy Requirements

This eLearning Course provided guidance about the legal and policy requirements that applied to global HIV programs that were supported by U.S. global health assistance funds. The Course provided information about a wide variety of topics including condoms, sex work, working with local partners such as faith-based organisations or law enforcement, voluntary medical male circumcision, FP/HIV integrated services, restrictions related to abortion and involuntary sterilisation, and compliance with USG requirements. The Course was responsive to need, as it provided useful information to support implementation of these policies. However, it mostly focused on restrictions instead of what was allowed under U.S. policy at the time. The Course was updated to remove all mentions of the PLGHA policy in 2021. The 2022 version still lacked information about its revocation and guidance for partners about implementing programming in its absence. This was not based in evidence, responsive to need, or aligned with human rights principles. The Course highlighted opportunities to support programming such as FP/HIV integration across PEPFAR programs and provided information about which commodities could be purchased with PEPFAR funding, which was responsive to need, based in evidence, and aligned with human rights principles. While the Course included some gender transformative elements such as the implementation of DREAMS programming, it was gender accommodating as it used gendered language and did not include guidance for addressing gender norms in FP/HIV integrated programming. The Course did not highlight what was updated in 2022, which negatively affected transparency. The Course neither promoted nor hindered SRHR in the MCH domain.

2022_Global Health eLearning Center_Pharmaceutical Systems Strengthening 101

This eLearning Course outlined the importance of access to medical products and related services to attain UHC and solve current global health challenges including HIV, tuberculosis, MCH, and FP. It covered the basics of pharmaceutical system strengthening with modules on governance, financing, regulations, supply chain management, capacity building, and quality assurance. The Course included a specific module on maternal and neonatal health to illustrate the need for a strong pharmaceutical health system. It also emphasized the need for data to inform decision-making, which was based in evidence and responsive to need. This Course neither promoted nor hindered SRHR in the MCH domain.

2022_Global Health eLearning Course_Standard Days Method

This eLearning Course focused on the Standard Days Method, a form of modern birth control that relies on tracking menstrual cycles to avoid intercourse during the fertile window. The course detailed the method, misconceptions, challenges for implementation, and detailed steps for implementing the method into FP programs. The Course was based in evidence and responsive to need. It was gender accomodating as it reinforced a gender binary, used gendered language, and did not address harmful social and gender norms that impact the ability for menstruating people to regulate frequency of sexual activity. The Course did not highlight what was updated or changed in 2022, which negatively affected transparency. This Course neither promoted nor hindered SRHR in the MCH domain.

2022_Global Health eLearning Course_U.S. Family Planning and Abortion Requirements

The Course provided an overview of the FP and abortion legislative and policy requirements that applied to U.S. foreign assistance funding and programs. The course primarily focused on the principles of voluntarism and informed consent through the Tiahrt amendment, which was based in evidence and aligned with human rights principles. The Course was responsive to need, as it emphasized that it was the responsibility of USAID staff to discuss legislative abortion restrictions with implementing partners throughout the life of the award to ensure awareness of the restrictions. However, it did not clearly state which information was changed for 2022, which negatively affected transparency. It did not mention the Biden administration policy to support SRHR globally. It also did not include vaginal rings as a method of contraception, and therefore was not reflective of the full range of available contraceptive methods. As in 2021, the Course mentioned the revocation of the PLGHA policy, but did not provide detail or guidance for partners to understand how to implement this policy change. As a result, this Course was not fully responsive to need, based in evidence, or aligned with human rights principles. The Course encouraged staff to "be aware of perceptions among program managers, clients, and providers that may suggest potential vulnerabilities," which could lead to unnecessary oversight of personal or professional beliefs that would not be relevant to their implementation of abortion restrictions. The Course was gender blind as it did not include a meaningful or inclusive discussion of gender. This Course neither promoted nor hindered SRHR in the MCH domain.

2022_National Strategy for Combatting Multi-drug Resistant Tuberculosis

This Document reported efforts to combat TB since the launch of the USG Five Year National Strategy for Combating Multidrug Resistant Tuberculosis. The Document emphasized the impact of the COVID-19 pandemic on recent progress toward elimination and framed the rationale for addressing TB from a global health security lens rather than a human rights lens. The Document was based in evidence and committed to funding new research efforts and developing new evidence on potential interventions. While the Document mentioned several activities involving PLHIV, there was no mention of integration of HIV and TB services, and no mention of PEPFAR. The Document was gender blind, as it did not mention gender disaggregated data on prevalence, identification, and treatment or the need for gender-sensitive interventions. This Document moderately hindered SRHR in the MCH domain.

2022_USAID_Nutrition Report to Congress_FY22

This Report to Congress provided information about commitments to tackle deficiencies in essential vitamins and minerals, and summary statistics on nutrition-specific treatment and prevention interventions on a country-by-country basis. It also discussed national level data on progress toward 2025 WHA global targets on stunting, wasting, anemia, and breastfeeding, children receiving vitamin A, and treatment for severe acute malnutrition in children. The Report was based in evidence and responding to need but focused on “pregnant women” which reinforced a gender binary. This report neither promoted nor hindered SRHR in the MCH domain.

2022_USAID_Report to Congress on the Empowerment of Women through Sanitation and Hygiene Program

This Report provided an update to Congress about WASH programs and their efforts to increase access to adequate sanitation facilities and integrate feminine hygiene products in design and implementation. USAID supported the release of the first global MHH monitoring data to identify gaps and partnered with Emory University to test and validate indicators for menstruation-related outcomes, which was responsive to need and based in evidence. Other existing initiatives helped to increase access to sanitary products and safe hygienic spaces for female frontline health workers and people that were affected by natural disasters and complex emergencies. The Report launched the first USAID Standard Definition of MHH and developed tools for missions to report planned menstruation-related activities, which demonstrated the institutionalization of menstrual health as a key USAID priority. The Report was gender accomodating as it reinforced a gender binary by only referring to “women.” This Report moderately promoted SRHR in the MCH domain.

2022_USAID_Report to Congress on Health System Strengthening for FY2021

This Report summarized cross-cutting investments for HSS. Funding diagrams underscored the relevance of HSS to FP and MCH. The Report emphasized the need for locally derived solutions led by local organizations, increased capacity of healthcare workers and facilities, and the leveraging of data for planning and implementation, all of which were based in evidence and responsive to need. The Report was gender blind as it did not include a meaningful or inclusive discussion of gender. While HSS had cascading impacts across all three SRHR domains, the report lacked new language or relevant commitments. The Report neither promoted not hindered SRHR in the MCH domain.

2022_USAID_Report to Congress on Youth Policy

This Report described USAID efforts to “increase the meaningful participation of youth” through skill building, leadership opportunities, and mentorship. The Report emphasized economic and educational opportunities for youth as well as efforts to elevate youth in global health programming. The activities were based in evidence and responsive to need. However, SRHR-related mentions were limited to DREAMS funding. This Report neither promoted nor hindered SRHR in the MCH domain.

2022_United States Strategy to Combat Gender Based Violence Globally

The action updated earlier efforts “to advance equity and inclusivity and address the factors that increase the risks of gender-based violence and undermine access to services and safety, particularly for the most marginalized groups.” It was aligned with international human rights principles, responsive to need, and recognized the most recent evidence about addressing GBV. For instance, it acknowledged other at-risk, marginalized communities such as LGBTQIA+ persons, and boys and men as survivors of violence. It explored the rise of digital platforms and social media as drivers of violence, analyzed the impact of the COVID-19 pandemic, and examined links between climate change and violence. The action was gender transformative, as it not only offered a critical examination of gender norms and dynamics, but also committed to creating systems that reinforced this critique and broke cycles of violence. The USAID plan specifically mentioned the role of a Senior LGBTQIA+ Coordinator to “support the inclusion of LGPTQIA+ persons in gender-based violence programs.” The action significantly promoted SRHR in the MCH domain.

2022_United States Government Women, Peace, and Security (WPS) Congressional Report

The WPS Report provided Congress with an overview of progress made in implementing the WPS Agenda globally since the Biden-Harris administration interventions in 2021. The Report evaluated progress in advancing the WPS Strategy's four lines of effort across the Department of State, DoD, DHS, and USAID: participation, protection, internal capabilities, and partnerships. While improved global health outcomes were included as a positive impact of implementing the WPS Agenda, USAID global FP, contraception, and sexual health programs were not mentioned. The Report was responsive to need, as it included GBV prevention and programming as a cross-cutting measure of progress towards achieving the WPS Agenda. The Report also highlighted USAID efforts to integrate WPS activities with other actions related to countering violent extremism and implementing gender-sensitive interventions during the COVID-19 pandemic. It highlighted USAID efforts to prevent CEFM and provide gender training for USAID personnel. The Report included several gender transformative elements such as enhancing gender-sensitive data analytics, recognizing “the intersectionalities inhabited by women,” and supporting initiatives to address and overhaul harmful gender norms, though was ultimately gender aware as it predominantly focused on women. The Report included specific and actionable milestones to measure USAID progress, which was responsive to need and could support evidence-based decision making in the future. The Report moderately promoted SRHR in the MCH domain.

D-

D+

Department of Health and Human Services

HHS received a 60 (D-) with transparency and a 69 (D+) without transparency in the Maternal and Child Health (MCH) domain in 2022. The Global Health Equity Strategy and the CDC Core Health Equity Science and Intervention Strategy moderately supported SRHR. The newly released HHS strategic plan for FY 2022-2026 and the General Terms and Conditions for Research and Non-Research neither promoted nor hindered SRHR in this domain because it was unclear as written whether these actions were relevant to the global MCH programs. The National Strategy for Combating Multi-Drug Resistant Tuberculosis moderately hindered SRHR as it did not mention the sex disaggregation of data despite the fact that gender is a key aspect that informs tuberculosis intervention strategies. 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.

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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2022_CDC Center for Global Health 2022 Annual Report_Making an impact through global partnerships

This Document summarized the work of the CDC to advance health security globally over the last 75 years. The action was not completely responsive to need. Despite the stated commitment to health security, the Document never mentioned SRHR, which is a core component of achieving health security. The Document did not explicitly align with the human rights framework, and instead argued for improving core public health capabilities and health systems globally as a means to ensuring health security nationally. The proposed programs were based in evidence and emphasized community ownership and data-led decision making. However, there was a lack of a gender analysis of programs within the Document which invisibilized the gendered norms and barriers that impede the achievement of health security. A key component of CGH work declares that better vaccination capacities and stronger global health infrastructure would improve MCH health outcomes, but this was not discussed in the Document. The Document neither promoted nor hindered SRHR in the MCH domain. 

2022_CDC Core Health Equity Science and Intervention Strategy

This action was an agency-wide strategy aimed to integrate health equity across HHS. It was aligned to human rights principles, responsive to need and based in evidence. It noted socio-economic and structural barriers to health equity, and acknowledged various populations that are often marginalized in the discussion on health. Specifically, it stated that the “CDC is transforming its public health research, surveillance, and implementation science efforts to shift from simply listing the markers of health inequities to identifying and addressing the drivers of these disparities.” Because of the strength of this detail, this action moderately promoted SRHR in the MCH domain.

2022_General Terms and Conditions Non-Research Grant and Cooperative Agreements_revised November 2022

The General Terms and Conditions listed the federal regulations and policies, funding restrictions and limitations, and reporting requirements that applied to HHS non-research grants and cooperative agreements. The action provided guidance 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.  Though this action was revised in November 2022, there was no mention of changes from the previous version. 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 SRHR in the MCH domain.

2022_General Terms and Conditions Research Grant and Cooperative Agreements_Revised November 2022

The action listed the federal regulations and policies, funding restrictions and limitations, and reporting requirements that applied to HHS research grants and cooperative agreements. It provided guidance 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 action defined human subjects and confidentiality requirements in alignment with human rights norms and research ethics. This action was responsive to need because it provided guidance about how awards should be managed, though there was no indication of which information had been changed from the previous version. Prior versions were not available on the website for comparison, which did not promote transparency. This action neither hindered nor promoted SRHR in the MCH domain.

2022_CDC Global Health Equity Strategy

The action documented CDC commitments to health equity science and an intervention-based strategy to holistically reimagine how the CDC approaches health equity. It was grounded in human-rights principles and responsive to need. It clearly articulated cross-cutting principles of community engagement, inclusion strategies for the most at-risk, and a process for evidence-led decision-making. The action did not mention SRHR as a core goal and did not discuss MCH interventions to drive intermediate or end outcomes of improved health equity. This action moderately promoted SRHR in the MCH domain.

2022_National Strategy for Combatting Multi-drug Resistant Tuberculosis

2022_HHS Strategic Plan 2022-2026

This action updated the HHS Strategic Plan, and provided priorities, accomplishments, and next steps to track HHS work. The action was responsive to need, but it did not include SRHR and gender in its Objectives and Goals, which contributes to the perceived separation of SRHR from other global health issues. As a result, it was not based in human rights or evidence. Additionally, it was not entirely responsive to the latest global data. For instance, in the discussion on climate change in Strategic Goal 2, Objective 2.4 could have included its impacts on SRHR. Additionally, maternal health, pregnant people, and gender are not substantially discussed across the objectives. However, some sections of the strategy committed to evidence generation through locally-led, participatory approaches. Activities to foster collaborations between the USG and international community based organizations (CBOs) to advance public health outcomes were included. This action neither promoted nor hindered SRHR in the domain of MCH.

2022_Strengthening Health Security Across the Globe: Progress and Impact of U.S. Government Investments in the Global Health Security Agenda

The action documented USG strategy for global health security with an emphasis on the following four areas: (1) marshaling political will, (2) developing global norms around quality of care and technical standards, (3) enhancing sustainable multilateral financing, and (4) strengthening capacities in partner countries. While the action was not explicitly based in human rights principles, it aligned to International Health Regulations, the Biological and Toxins Weapon Convention, UN Security Council Resolution 1540, and other international health conventions that are rights based. It was responsive to need and based in evidence. The action was gender blind as it focused on supply-side interventions and did not mention gender. Despite acknowledging the impact of COVID-19 on maternal health outcomes in some geographies, there was no substantive discussion about future MCH commitments. The action neither advanced nor hindered SRHR in the MCH domain.

TRANSPARENCY SCORE

TRANSPARENCY SCORE

Maternal and Child Health (MCH)

White House

Congress

Department of State

US Agency for International Development

Department of Health and Human Services

Department of Defense