Actor Score Overview

 

This is an average of the three domain scores below

White House

The White House received a 65 (D) with transparency and a 69 (D+) without transparency in 2019. These grades were the result of the White House’s low proposed budget for Family Planning and for Maternal and Child Health, including the zeroing out of funding for the United Nations Population Fund (UNFPA), UNIFEM (now UN Women), and UNICEF. The policies issued or signed by the White House either did not impact sexual reproductive health and rights (SRHR), such as the Global Health Security Strategy, or harmed SRHR by omitting health altogether, as seen in the United States Strategy on Women, Peace and Security. Related policy information was difficult to find, which led to low transparency grades across all domains.

HIV & AIDS

The White House received an 84 (B) with transparency and an 87 (B+) without transparency for HIV and AIDS. The White House proposed adequate—but less than ideal—funding for the Global Fund and for the Department of State’s HIV and AIDS programs but zeroed out funding for USAID’s HIV and AIDS programs. This grade was harmed by the lack of inclusion of HIV and AIDS in a meaningful manner in the United States Strategy on Women, Peace, and Security and the Global Health Security Strategy. The transparency grade was low for HIV and AIDS due to the White House website no longer using filters or criteria to navigate the policies listed online. Similar to 2018, HIV and AIDS continued to be the White House’s highest scoring domain.

Maternal and Child Health (MCH)

The White House received a 62 (D-) with transparency and a 65 (D) without transparency due to low funding proposed for Maternal and Child Health and for the defunding of UNICEF and UNIFEM (now UN Women) in 2019. This grade was further harmed by the exclusion of maternal and child health—and health more generally—in the United States Strategy on Women, Peace, and Security. The transparency grade was also low in this domain because the White House website no longer uses filters or criteria to navigate the policies listed online.

Family Planning (FP)

The White House received a 48 (F) with transparency and a 52 (F) without transparency because of the defunding of UNFPA (due to an unsubstantiated Kemp-Kasten amendment violation in FY 2019) and low funding proposed for USAID’s family planning program in the President’s proposed budget. These budgetary determinations significantly hindered the ability of U.S. global health assistance to support comprehensive family planning programs. This grade was further influenced by the lack of any acknowledgment of family planning programming needs from the United States Strategy on Women, Peace, and Security. The transparency grade was also low in this domain because the White House website no longer uses filters or criteria to navigate the policies listed online.

 

This is an average of the three domain scores below

Congress

Congress received an 85 (B) with transparency and an 85 (B) without transparency because it appropriated adequate funding for Family Planning and Maternal and Child Health as well as full funding for HIV and AIDS in 2019. Congress passed one policy in 2019 that did not significantly impact sexual reproductive health and rights (SRHR) within the Maternal and Child Health and Family Planning domains but did promote SRHR within the HIV and AIDS domain. Congress scored high on transparency due to available policy and budget information.

HIV & AIDS

Congress received a 97 (A+) with transparency and a 97 (A+) without transparency due to Congress appropriating high levels of funding for the Global Fund and President’s Emergency Plan for AIDS Relief (PEPFAR) and high levels of transparency within policy and funding. This grade was further raised by the passage of the Global Health Innovation Act which instituted a Congressional reporting requirement regarding HIV and AIDS-related global health technologies by USAID.

Maternal and Child Health (MCH)

Congress received an 86 (B) with transparency and an 86 (B) without transparency because it appropriated adequate levels of funding for UNICEF and USAID’s maternal and child health programs but inadequate funding for UNIFEM (now UN Women). The Global Health Innovation Act neither hindered nor raised the grade within this domain. Congress scored high on transparency due to available policy and budget information.

Family Planning (FP)

Congress received a 71 (C-) with transparency and a 71 (C-) without transparency due to inadequate funding appropriated for Family Planning and high levels of transparency within policy and funding. These budgetary determinations hindered the ability of U.S. global health assistance to support comprehensive family planning programs that promoted SRHR. The Global Health Innovation Act neither hindered nor raised the grade within this domain.

 

This is an average of the three domain scores below

Department of State

The Department of State received a 61 (D-) with transparency and a 66 (D) without transparency in 2019. The Family Planning and Maternal and Child Health domain grades were lower due to the release of guidance for the implementation of the Protecting Life in Global Health Assistance (PLGHA) policy through the 2019 PLGHA FAQs as well as the neglect of both family planning and maternal and child health in issued guidance and reports such as the President’s Emergency Plan For AIDS Relief (PEPFAR) Annual Report to Congress. The Department of State’s HIV and AIDS grade was high due to activities that were evidence-based and highly responsive to need, as described in PEPFAR’s Monitoring, Evaluation, and Reporting (MER) Indicator Reference Guide and the 2019 Country Operational Plan (COP) Guidance. The Department of State’s actor-level grade was lowered by a lack of policy transparency within the Family Planning and Maternal and Child Health domains. The Department of State’s grade was raised by high budget scores, which indicated that family planning and maternal and child health funds were mostly responsive to need, and HIV funds were highly responsive to need.

HIV & AIDS

The Department of State received a 94 (A) with transparency and 98 (A+) without transparency for HIV and AIDS in 2019. The grade within this domain was raised by the Department of State and USAID Agency Priority Goals for HIV and AIDS, 2019 PEPFAR COP Guidance, and the updated version of the PEPFAR MER Indicator Reference Guide. Overall, these documents were based in evidence and responsive to need but did not include gender transformative language and were not grounded in international human rights norms. In particular, the PEPFAR COP Guidance included index testing guidance and targets that ignored evidence, international human rights norms, and input from civil society that advised against these targets. This grade was lowered by the implementation of the PLGHA policy through the 2019 PLGHA FAQs, which was responsive to need but not based in evidence or international human rights norms. In the budget evaluation, the Department of State largely disbursed HIV and AIDS funds in accordance with country-level HIV incidence.

Maternal and Child Health (MCH)

The Department of State received a 35 (F) with transparency and 40 (F) without transparency for Maternal and Child Health in 2019. This grade was lowered by the implementation of the PLGHA policy through the 2019 PLGHA FAQs, which was responsive to need but not based in evidence or international human rights norms. None of the documents graded in this domain included gender transformative language. The grade was raised by the PEPFAR COP Guidance and the PEPFAR MER Indicators, which both emphasized the importance of integrating maternal and child health and HIV and AIDS services, particularly for pregnant and breastfeeding women (PBFW) and prevention of mother-to-child transmission (PMTCT) activities. The transparency grade for policies was lowered by the State and USAID Annual Performance Report and FY 2020 Annual Performance Plan, as this document did not clarify the role of the Department of State in maternal and child health programming. In the budget evaluation, the Department of State disbursed maternal and child health funds in accordance with country level maternal mortality.

Family Planning (FP)

The Department of State received a 55 (F) with transparency and 61 (D-) without transparency for Family Planning in 2019. This grade was lowered by the implementation of the PLGHA policy through the 2019 PLGHA FAQs and the omission of family planning in the PEPFAR Annual Report to Congress. The grade was raised by the 2019 PEPFAR COP Guidance and the PEPFAR MER Indicator Reference Guide, both of which emphasized the importance of family planning and HIV integration. The transparency grade for policies was lowered by the State and USAID Annual Performance Report and FY 2020 Annual Performance Plan, as this document did not clarify the role of the Department of State in global family planning programming. In the budget evaluation, the Department of State largely disbursed family planning funds in accordance with unmet contraceptive need at the country level. However, access to family planning and contraception was severely impacted by the Department of State once again defunding the United Nations Population Fund (UNFPA) due to an unsubstantiated Kemp-Kasten amendment violation in FY 2019.

 

This is an average of the three domain scores below

US Agency for International Development

The United States Agency for International Development (USAID) received a 77 (C+) with transparency and an 81 (B-) without transparency. In 2019, the Agency released a number of policy and guidance documents that negatively impacted SRHR, including an updated version of the Protecting Life in Global Health Assistance (PLGHA) FAQs. The majority of policy documents released by USAID in 2019 hindered the Agency’s ability to support global health programs that promote SRHR, including the expansion of the implementation of pre-existing statutory requirements regarding abortion activities through Automated Directive System (ADS) Chapter 308, which impacts programs in all domains. USAID’s grade also decreased across domains due to low transparency because the 2018 version of ADS Chapter 308 was not updated to the USAID website before additional revisions were released in 2019.

Additionally, family planning and maternal and child health funds were not spent according to need, which further reduced USAID’s grades in these domains. Following a consultation with USAID in 2020, we have made minor adjustments to the methodology for the budget calculation for USAID’s Family Planning and Maternal and Child Health domains to most accurately reflect the appropriation of these funds. This change is reflected in the 2019 grades.

HIV & AIDS

USAID received an 85 (B) with transparency and an 88 (B+) without transparency for the HIV and AIDS domain in 2019. USAID was graded based on a number of Agency-level guidance documents, Agency Priority Goals for HIV/AIDS, ADS Chapters, and two PLGHA FAQs. Though these documents were responsive to need, none of them included a gender transformative component and few were based on international human rights norms. The two PLGHA FAQs as well as the updated ADS Chapter 308 significantly reduced the Agency’s grade in this domain because they substantially hindered USAID’s ability to implement HIV and AIDS programming that promoted SRHR. USAID’s grade in this domain was again reduced due to the lack of HIV and AIDS-specific information in the 2019 Acting on the Call Report, which was noted in 2018 as well. Within this domain, USAID received a high budget score because USAID disbursed funds for HIV and AIDS programming according to country-level HIV incidence.

Maternal and Child Health (MCH)

USAID received a 75 (C) with transparency and a 78 (C+) without transparency for the Maternal and Child Health domain in 2019. USAID was graded based on a number of Agency-level guidance documents, Agency Priority Goals for Maternal and Child Health, Automated Directive System (ADS) Chapters, and two Protecting Life in Global Health Assistance (PLGHA) FAQ documents. While these documents varied in their grades and most were responsive to need, they were not gender transformative and few were based in internationally recognized human rights norms. ADS Chapter 212, however, provided a much-needed update to USAID’s breastfeeding practices and was one of the few documents based in international human rights norms and guidance. The Agency Priority Goals for Maternal and Child Health and annual Acting on the Call report both lacked any explicit discussion of respectful maternity care, depicting a backslide from previous years where respectful maternity care was included in both documents.

USAID’s budget grade in this domain suggested that the Agency’s maternal and child health programs were not responsive to need, as a significant portion of maternal and child health funds disbursed in FY 2019 was not programmed in countries with the highest maternal mortality. Following a consultation with USAID in 2020, we have made minor adjustments to the methodology for the budget calculation for USAID’s Maternal and Child Health domain to most accurately reflect the appropriation of these funds. This change is reflected in the 2019 grades.

Family Planning (FP)

USAID received a 73 (C) with transparency and a 76 (C) without transparency for the Family Planning domain in 2019. USAID was graded based on a number of Agency-level guidance documents, Agency Priority Goals for Maternal and Child Health, Automated Directive System (ADS) Chapters, and two PLGHA FAQ documents. While these documents varied in their grades and most were responsive to need, they were not gender transformative and few were based in internationally recognized human rights norms. Many of these documents also lacked explicit mention of family planning programs, which further reinforced the siloed nature of USAID’s global health programming. This was particularly evident in the annual Acting on the Call report, which did not describe the extent to which—if at all—family planning and maternal and child health activities were integrated within USAID-funded programs.

Furthermore, USAID’s budget grade in this domain suggested that the Agency’s family planning programs were not responsive to need, as a significant portion of family planning funds disbursed in FY 2019 was not programmed in countries with the highest total fertility rate. Following a consultation with USAID in 2020, we have made minor adjustments to the methodology for the budget calculation for USAID’s Family Planning domain to most accurately reflect the appropriation of these funds. This change is reflected in the 2019 grades.

 

This is an average of the three domain scores below

Department of Health and Human Services

The Department of Health and Human Services (HHS) received a 60 (D-) with transparency and a 68 (D+) without transparency. This grade was based on the release of the Center for Disease Control and Prevention (CDC) Global Health Strategy as well as four statements related to the U.S. government’s regressive stance on sexual and reproductive health and rights (SRHR) shared by Alex Azar, the U.S. Secretary of Health and Human Services, at various international fora in 2019. The transparency grades for HHS were low across domains because the information on the disbursement of HHS’s funding remains unavailable online.

HIV & AIDS

HHS received a 60 (D-) with transparency and a 68 (D+) without transparency for HIV and AIDS in 2019. The four statements related to the U.S. government’s regressive stance on SRHR (including HIV and AIDS) shared by Alex Azar, the U.S. Secretary of Health and Human Services, significantly decreased the HHS’s grade in this domain. The amount of disbursed funds for HIV and AIDS programs through HHS was not publicly available which also contributed to the low transparency grade in this domain.

Maternal and Child Health (MCH)

HHS received a 59 (F) with transparency and a 68 (D+) without transparency for Maternal and Child Health in 2019. The four statements related to the U.S. government’s regressive stance on SRHR (including maternal and child health) shared by Alex Azar, U.S. Secretary of Health and Human Services, significantly decreased the HHS’s grade in this domain. The amount of disbursed funds for maternal and child health programs through HHS was not publicly available, which also contributed to the low transparency grade in this domain.

Family Planning (FP)

HHS does not receive a grade within the Family Planning domain because they do not work in international family planning.

 

This is an average of the three domain scores below

Department of Defense

The Department of Defense (DoD) received a 71 (C-) with transparency and an 81 (B-) without transparency due to the unavailability of policy and budget information related to sexual and reproductive health and rights (SRHR) and low transparency of funding data related to HIV and AIDS. The Maternal and Child Health and Family Planning domains do not factor into the DoD grade because the DoD does not work in international maternal and child health or family planning.

HIV & AIDS

The DoD received a 71 (C-) with transparency and an 81 (B-) without transparency due to the unavailability of budget information and low transparency in 2019. The DoD also did not release any policy or technical guidance related to HIV and AIDS in 2019.

Maternal and Child Health (MCH)

The DoD does not receive a grade within the Maternal and Child Health domain because they do not work in international maternal and child health.

Family Planning (FP)

The DoD does not receive a grade within the Family Planning domain because they do not work in international family planning.