Like other global initiatives, the United Nations Millennium Development Goals (MDGs) have had mixed results. One reason global efforts fall short is they ignore decentralization. This paper examines the challenges of implementing global initiatives, using Family Planning 2020 (FP2020) as a case study. FP2020's goal is enabling 120 million more women and girls to use modern contraceptives by 2020. Thirty-six developing countries have made FP2020 commitments, but these countries have thousands of governing entities that will determine the priority family planning programs receive. Advance Family Planning (AFP) works with local partners to influence family planning decisions. We examine AFP's experience in Indonesia, Kenya and Senegal to describe and analyze the incongruity between FP2020's objectives and those of subnational decision makers and what must happen for local goals to reflect global goals.