[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4848 Introduced in House (IH)]






108th CONGRESS
  2d Session
                                H. R. 4848

    To amend the Foreign Assistance Act of 1961 to provide for the 
  establishment of centers for the treatment of obstetric fistula in 
                         developing countries.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 15, 2004

Mr. Smith of New Jersey (for himself, Ms. Ros-Lehtinen, Mr. Pitts, Mr. 
Payne, and Mr. Pence) introduced the following bill; which was referred 
              to the Committee on International Relations

_______________________________________________________________________

                                 A BILL


 
    To amend the Foreign Assistance Act of 1961 to provide for the 
  establishment of centers for the treatment of obstetric fistula in 
                         developing countries.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Obstetric Fistula Surgical Repair, 
Assistance, and Prevention Act of 2004''.

SEC. 2. FINDINGS AND PURPOSE.

    (a) Findings.--Congress finds the following:
            (1) Obstetric fistula is a devastating condition that 
        occurs during childbirth when prolonged pressure of the baby's 
        head against the mother's pelvis can lead to the child's death 
        as well as cut off the blood supply of the tissues surrounding 
        the woman's vagina, bladder, or rectum, causing those tissues 
        to deteriorate, and thus leaving an open hole, or fistula.
            (2) Obstetric fistula can be excruciatingly painful and 
        often causes a woman to lose control of her bowel movements.
            (3) To date, an estimated 2,000,000 cases of obstetric 
        fistula have been reported worldwide--mostly in Africa among 
        women who are very young, delivering their first child, lacking 
        proper nutrition and maternity care, and living in rural areas.
            (4) The actual number of women who have obstetric fistula 
        may actually be much higher due to a lack of adequate 
        reporting. For example, an additional estimate contends that in 
        Nigeria alone, approximately 1,000,000 women suffer from 
        obstetric fistula.
            (5) It is estimated that 50,000 to 100,000 new cases of 
        obstetric fistula occur each year, mostly involving women under 
        the age of 20.
            (6) Women who suffer from obstetric fistula may also suffer 
        from social isolation because they are often abandoned by their 
        husbands, families, and employers.
            (7) Women who suffer from obstetric fistula may also suffer 
        severe emotional stress from their condition and social 
        isolation that is often magnified by the death of their child 
        during labor.
            (8) Obstetric fistula can be prevented through increased 
        access by women to emergency obstetrical care, a postponement 
        of sexual activity and childbearing past the teenage years, and 
        increased training for birth attendants in local communities.
            (9) Obstetric fistula can also be treated through a 
        relatively minor surgical procedure that is 90 percent 
        effective and which can cost as little as $150.
            (10) A large percentage of women who suffer from obstetric 
        fistula are unaware that treatment exists and may spend their 
        entire lives suffering from this condition needlessly.
            (11) Unfortunately, there are few treatment centers or 
        hospitals with the capacity to treat obstetric fistula in 
        developing countries, particularly countries in Africa, and 
        demand for services and surgery far exceed the supply.
            (12) Currently the United States Agency for International 
        Development provides assistance for programs that target 
        prevention of obstetric fistula but not programs that target 
        treatment of obstetric fistula.
            (13) Tens of thousands of women in developing countries 
        suffering from obstetric fistula could be successfully treated 
        if adequate resources were devoted to this objective.
    (b) Purpose.--The purpose of this Act is to ensure that, in 
addition to the prevention of obstetric fistula, treatment of obstetric 
fistula is an important priority of United States bilateral foreign 
assistance programs, including through--
            (1) the establishment and expansion of the capacity to 
        treat obstetric fistula in developing countries, including 
        through the provision of surgery and post-surgery care; and
            (2) the reduction of the incidence of obstetric fistula in 
        developing countries, including through the conduct of 
        appropriate seminars and the dissemination of appropriate 
        educational materials, such as brochures, pamphlets, and 
        posters.

SEC. 3. DEFINITION.

    In this Act, the term ``obstetric fistula'' means a rupture or hole 
in tissues surround a woman's vagina, bladder, or rectum that occurs 
when the woman is in obstructed childbirth for a prolonged period of 
time without adequate medical attention.

SEC. 4. AMENDMENTS TO THE FOREIGN ASSISTANCE ACT OF 1961.

    Section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C. 
2151b(c)) is amended--
            (1) by redesignating paragraph (4) as paragraph (5); and
            (2) by inserting after paragraph (3) the following new 
        paragraph:
    ``(4)(A) In carrying out the purposes of this subsection, the 
President is authorized to furnish assistance, on such terms and 
conditions as the President may determine, for the establishment and 
operation of not less than twelve centers for the treatment of 
obstetric fistula at appropriate sites in developing countries.
    ``(B) In selecting sites for the establishment of centers pursuant 
to subparagraph (A), the President should seek the consultation and 
advice of United States embassy officials, appropriate nongovernmental 
organizations, and local government officials in developing countries 
with high rates of obstetric fistula, with particular emphasis on 
countries in Africa.
    ``(C) Each center established pursuant to subparagraph (A) shall, 
to the maximum extent practicable, carry out the following activities:
            ``(i) The provision of surgery to repair obstetric fistula 
        in women who do not otherwise have the resources to pay for 
        such surgery and the provision of necessary post-surgery care 
        and support for such women.
            ``(ii) Assistance related to surgery and post-surgery care 
        and support described in clause (i), including the provision of 
        transportation to and from the center for women in need of such 
        transportation and the provision of necessary temporary shelter 
        and food assistance to women in need of such shelter and food 
        assistance.
            ``(iii) Activities to reduce the incidence of obstetric 
        fistula, including the conduct of appropriate seminars and the 
        dissemination of appropriate educational materials, such as 
        brochures, pamphlets, and posters.
    ``(D) Not later than January 31 of each year, the President shall 
prepare and transmit to Congress a report on the implementation of this 
paragraph for the prior fiscal year.
    ``(E) In addition to amounts otherwise available for such purpose, 
there are authorized to be appropriated to the President $35,000,000 
for each of the fiscal years 2005 and 2006 to carry out this paragraph. 
Amounts appropriated under this clause are authorized to remain 
available until expended.
    ``(F) In this paragraph, the term `obstetric fistula' means a 
rupture or hole in tissues surrounding a woman's vagina, bladder, or 
rectum that occurs when the woman is in obstructed childbirth for a 
prolonged period of time without adequate medical attention.''.
                                 <all>