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TRANSPARENCY SCORE
The transparency grade represents the expectation that the federal government should make data about U.S. global health assistance available, accessible, and informative. To see the transparency grade, toggle below.

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TRANSPARENCY SCORE
The transparency grade represents the expectation that the federal government should make data about U.S. global health assistance available, accessible, and informative. To see the transparency grade, toggle below.

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C-

This is an average of the three domain scores below.

YEAR 2018

Maternal and Child Health (MCH)

The U.S. Government received a 70 (C-) with transparency and a 74 (C) without transparency for Maternal and Child Health across all actors due to the lower budget requests by the White House and Congress. This domain grade was further lowered due to the omittance of specific references to MCH programming in the PLGHA FAQ and Six Month Review documents, which indicates that the U.S. government is not considering the unique impact of the implementation of PLGHA on maternal and child health programs. Low transparency on policy and funding data related to maternal and child health also contributed to this score.

F
F

Department of State

 

The State Department received a 35 (F) with transparency and a 40 (F) without transparency for Maternal and Child Health based on two documents related to the PLGHA expansion of the Global Gag Rule: the Six Month Review and the FAQ. Neither is gender aware nor based in evidence or human rights principles. However, both documents are responsive to need because they address concerns and questions from partners regarding the implementation of PLGHA. The omittance of specific references to MCH programming in both documents indicates that the State Department is not considering the unique impact of the implementation of PLGHA on maternal and child health programs. This shortsightedness has serious implications for the ability of the State Department to implement comprehensive MCH programming. With regards to budget allocation, the State Department budget evaluation depicts that funds are being distributed according to countries with the highest maternal mortality.

The CHANGE 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
2018_Protecting Life in Global Health Assistance Six Month Review
The Protecting Life in Global Health Assistance (PLGHA) Six Month Review summarizes the PLGHA policy and identifies solutions to challenges that have arisen in the process of PLGHA implementation. The review is responsive to need in that it addresses concerns expressed by partners affected by the policy, but is not evidence-based, based in human rights principles or gender transformative. The review received a lower grade within this domain compared to FP and HIV and AIDS because the review does not mention MCH programming specifically, despite the unique impacts this policy could have on maternal and child health services. The Six Month Review significantly hinders the Department of State's ability to support comprehensive maternal and child health programming.
2018_Protecting Life in Global Health Assistance FAQs
The Protecting Life in Global Health Assistance (PLGHA) FAQs provide detailed guidance on the implementation of Trump's expanded Global Gag Rule for implementing partners. The FAQs are not responsive to need, evidence-based, human rights-based or gender transformative within this domain. The FAQs received a lower grade within this domain compared to FP and HIV and AIDS because it does not mention MCH programming specifically, despite the unique impacts this policy could have on maternal and child health services. The FAQs significantly hinder the Department of State's ability to support comprehensive maternal and child health programming.
C-
C-

US Agency for International Development

 

USAID received a 70 (C-) with transparency and a 72 (C-) without transparency for Maternal and Child Health based on three documents issued in 2018 that relate to MCH. Though the impact of this guidance on SRHR ranges from positive to negative, all of the guidance focused on child survival more than maternal wellbeing and lacked a gender transformative approach to programming. Maternal health programs should address issues beyond maternal survival — such as the impact of gender norms on pregnancy and the importance of respectful maternity care to address disrespect and abuse. These factors are vital in determining the health of the mother and, subsequently, the health of the child. USAID, as the agency that coordinates maternal and child health in-country through local civil society partnerships, has the potential to support gender transformative and person-centered policies and programming that reflect the realities of the infrastructure and gender norms. These documents are evidence that USAID did not fully step into this role in 2018. Furthermore, the PLGHA FAQs did not adequately address the unique impacts the PLGHA policy could have on maternal and child health programming. The USAID budget grade reflects the conclusion that MCH programs are not responsive to need, as a significant portion of the funds disbursed for MCH programming in FY 2019 was not disbursed in countries with the highest maternal mortality.

The CHANGE 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
2018_Acting on the Call Report
Acting on the Call is USAID's annual flagship report for reproductive, maternal, newborn, and child health services. This year's report offers thorough country-level analyses of data around maternal and child health outcomes that are evidence-based and responsive to need but are not gender transformative. The report does not discuss the importance of programming and policies to champion respectful maternity care as a means to address disrespect and abuse. Instead, the report focuses largely on USAID's "Journey to Self-Reliance" framework and provides detailed country-level updates including: population-level statistics, intervention coverage, child mortality, nutrition, and health systems strengthening. While the report aims to improve maternal and child health through the strengthening of health systems, it does not address the importance of a patient-centered approach, which includes respectful maternity care, gender transformative programming, and the improvement of working conditions for health care workers.
2018_Maternal and Child Health Agency Priority Goals
The Agency Priority Goals (APGs) for Maternal and Child Health provide a quarterly overview of MCH programs implemented by USAID. The goals in this report include intersecting issues such as family planning, nutrition, and malaria. The APGs are responsive to need and evidence-based, but are not gender transformative. The APGs are predominantly child health-focused with "All cause under 5 mortality" as a primary indicator of success in MCH programming. Using this indicator as the primary indicator for MCH actively disregards the health, human rights, wellbeing, and childbirth experience of the woman. The addition of the indicator "Absolute change in total percentage of births delivered in a health facility" in the FY2018 APGs will further strengthen this reporting mechanism. Efforts to promote respectful maternity care could be strengthened, though the APGs do include changing attitudes of health care workers as an MCH strategy.
2018_Protecting Life in Global Health Assistance FAQs
The Protecting Life in Global Health Assistance (PLGHA) FAQs provide detailed guidance on the implementation of Trump's expanded Global Gag Rule for implementing partners. The FAQs are not responsive to need, evidence-based, human rights-based or gender transformative within this domain. The FAQs received a lower grade within this domain compared to FP and HIV and AIDS because it does not mention MCH programming specifically, despite the unique impacts this policy could have on maternal and child health programs. The FAQs significantly hinder USAID's ability to support comprehensive maternal and child health programming.
2018_Acquisition and Assistance Strategy
As USAID’s first-ever Acquisition and Assistance (A&A) Strategy, this guidance document increases the accountability and transparency of USAID's procurement, partnering, and project management processes across the Agency. The goal of this Strategy is to streamline "approaches to design and procurement" and develop "new and innovative methods of collaboration" to advance USAID's Journey to Self-Reliance mandate. The Strategy is responsive to need and evidence-based because it cites the current make-up of USAID foreign assistance funding recipients and sets specific goals to diversify this partner base. Many of the strategies and shifts put forward in the report incorporate feedback received from smaller and/or local partners. The Strategy also demonstrates a commitment to human rights norms, specifically to the rights of self determination, by actively incorporating local partners in the design, procurement, and implementation of USAID's programming. Though the Strategy references the importance of "diverse" partners, it does not define who these partners are except for a specific mention of faith-based organizations. Women's rights and human rights groups should also be explicitly mentioned as underutilized partners because of their important role in advancing SRHR for all populations. This Strategy indicates a meaningful effort by USAID to ensure that local partners and recipient countries are included and supported throughout the Journey to Self-Reliance. However, this effort by USAID seems to be in direct conflict with the Trump Administration's strategy of decreasing appropriated funds as a means to motivate self reliance and haphazardly decrease U.S. involvement in foreign assistance. It is unclear in this strategy how USAID aims to reconcile this conflict.
D
C

Department of Health and Human Services

 

HHS received a 66 (D) with transparency and a 75 (C) without transparency for Maternal and Child Health. HHS was graded on the Protecting Life in Global Health Assistance (PLGHA) FAQ that includes the “HHS Specific Information” section on page 17. The disbursed funds for MCH programs through HHS are not publicly available, which contributed to this actor’s low transparency grade in this domain.

The CHANGE 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
2018_Protecting Life in Global Health Assistance FAQs (HHS)
The Protecting Life in Global Health Assistance (PLGHA) FAQ provides detailed guidance on the implementation of the expanded Global Gag Rule for implementing partners. HHS was graded based on the "HHS Specific Information" section on page 17 that outlines how HHS awarding agencies administer grants according to the Code of Federal Regulations (CFR). The information offered in this section does not have an effect on the ability of HHS to implement MCH programs that are evidence-based, responsive to need, consistent with internationally-recognized human rights principles, and gender transformative.
NA
NA

Department of Defense

 

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

B+
A-

Congress

 

Congress received a 89 (B+) with transparency and a 90 (A-) without transparency for Maternal and Child Health because, although no new legislation was passed on MCH, the FY 2019 Congressional budget included an appropriation of funds for UNICEF and UNIFEM — despite the absence of funding for both in the President’s budget request. Congress also appropriated more funding for USAID’s Maternal and Child Health programs in FY 2019 than the amount appropriated in FY 2018. The transparency score was lowered due to a lack of clarity regarding UNIFEM funding.

The CHANGE 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
D
D+

White House

 

The White House received a 63 (D) with transparency and 68 (D+) without transparency for Maternal and Child Health because the President’s FY 2019 budget did not allocate funds for UNICEF or for UNIFEM (now UN Women). The White House also did not issue any maternal health executive actions or sign any MCH-related legislation in 2018. Similar to other domains, the transparency score for the White House under MCH is low due to difficulty accessing funding information and the inability to search White House policies by criteria that have been previously available. The low transparency score in this domain, in combination with the lack of funds requested for UNICEF and UNIFEM in the President’s FY 2019 budget request, led to this low score.