A review for an advertisement is received, the advertisement to be provided to recipients over a distribution network with content provided by content publishers. An aggregated approval score for the advertisement is generated based on the received review and other reviews for the advertisement. The aggregated approval score is provide to a content publisher. An indication to accept or reject the advertisement for presentation with content provided to recipients by the content publisher is received from the content publisher. The indication is received after providing the aggregated approval score to the content publisher.