[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2114 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 2114

To provide a United States voluntary contribution to the United Nations 
   Population Fund only for the prevention, treatment, and repair of 
                           obstetric fistula.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 2, 2007

Mrs. Maloney of New York (for herself, Mr. Shays, Ms. Lee, Mr. Crowley, 
  Mr. Honda, Ms. McCollum of Minnesota, Mr. Castle, Mr. Michaud, Mr. 
Jackson of Illinois, Mr. Meeks of New York, Mr. Lantos, Mr. Allen, Mr. 
 Grijalva, Mr. McNulty, Ms. Woolsey, Mr. Carnahan, Ms. Schakowsky, and 
 Ms. Watson) introduced the following bill; which was referred to the 
                      Committee on Foreign Affairs

_______________________________________________________________________

                                 A BILL


 
To provide a United States voluntary contribution to the United Nations 
   Population Fund only for the prevention, treatment, and repair of 
                           obstetric fistula.

    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 ``Repairing Young Women's Lives Around 
the World Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Every minute, one woman dies from pregnancy-related 
        complications. Ninety-five percent of these women live in 
        Africa and Asia.
            (2) For every woman who dies from pregnancy-related 
        complications, 20 women survive but experience long or short 
        term illnesses or disabilities. One of the most devastating is 
        obstetric fistula which is caused when a woman who needs 
        trained medical assistance for a safe delivery, including 
        Caesarian section, cannot get it. The consequences are life-
        shattering. The baby usually dies, and the woman is left with 
        chronic incontinence.
            (3) Obstetric fistula is a hole that is formed between the 
        bladder and the vagina, or the rectum and the vagina, after a 
        woman suffers from prolonged obstructed labor. In the struggle 
        to pass through the birth canal, the fetus puts constant 
        pressure, sometimes for several days, on the bladder and 
        vaginal or rectal wall, destroying the tissue and leaving a 
        wound.
            (4) Country specific obstetric fistula prevention and 
        treatment needs assessments undertaken by the United Nations 
        Population Fund (UNFPA) across Africa and Asia found services 
        for fistula treatment to be largely unavailable in most 
        countries where fistula occurs. For example, Kenya estimates 
        that 3,000 cases occur per year, but only 7.5 percent of those 
        women receive treatment. In Burkina Faso, women reported 
        waiting as long as five years before they were able to receive 
        treatment.
            (5) According to the Department of State 2006 Human Rights 
        Report for Ethiopia: ``The combination of pregnancy at an early 
        age, chronic maternal malnutrition, and a lack of skilled care 
        at delivery often led to obstetric fistulae and permanent 
        incontinence. Approximately 8,700 women developed obstetric 
        fistulae annually, and 27,000 women with untreated fistulae 
        were estimated to be living in rural areas. Treatment for 
        fistulae was available at only one hospital, the Addis Ababa 
        Fistula Hospital, which annually performed over 1,000 fistula 
        operations. It estimated that for every successful operation 
        performed, 10 other young women needed the treatment but did 
        not receive it. The maternal mortality rate was extremely high, 
        partly due to food taboos for pregnant women, poverty, early 
        marriage, and birth complications related to FGM [Female 
        Genital Mutilation], particularly infibulation.''
            (6) Obstetric fistula affects women who survive obstructed 
        labor. In nearly every case of obstetric fistula, the baby will 
        be stillborn and the mother will have physical pain as well as 
        social and emotional trauma from the loss of her child.
            (7) The physical symptoms of obstetric fistula include 
        incontinence or constant uncontrollable leaking of urine or 
        feces, frequent bladder infections, infertility, and foul odor. 
        The social consequences may be even more severe. The smell 
        often drives husbands and loving family members away. In many 
        communities, women with fistula are considered ``unclean'' and 
        stigmatized. Women may also isolate themselves due to the shame 
        they feel about their condition.
            (8) Fistula is a relatively hidden problem, largely because 
        it affects the most marginalized members of society: young, 
        poor, illiterate women in remote areas. Many of these women 
        never seek treatment. Because they often suffer alone, their 
        injuries may be ignored or misunderstood.
            (9) Adolescents are at greater risk of complications during 
        childbirth that can lead to fistula because they have less 
        access to health care and are subject to other significant risk 
        factors. Young girls suddenly find themselves marginalized, 
        alone, and are often blamed for their condition.
            (10) Although data on obstetric fistula are scarce, it is 
        generally accepted that there are more than 2,000,000 women 
        living with fistula and 50,000 to 100,000 new cases each year. 
        These figures are based on the number of women who seek medical 
        care. Many more suffer in silence, unaware that treatment is 
        available.
            (11) Obstetric fistula was once common throughout the 
        world, but over the last century has been eliminated in Europe, 
        North America, and other developed regions through improved 
        medical care.
            (12) Obstetric fistula is fully preventable by having a 
        trained medical attendant present during labor and childbirth, 
        access to emergency obstetric care in the event of 
        complications, delaying early marriage and childbirth, and 
        gaining access to education and family planning.
            (13) Obstetric fistula can also be surgically repaired. 
        Surgery requires a specially trained surgeon and support staff, 
        access to an operating theater and to attentive post-operative 
        care. Success rates for surgical repair of fistula can be as 
        high as 90 percent and cost an average of $300.
            (14) In 2003, UNFPA launched the first-ever global Campaign 
        to End Fistula. It is working with partners all over the world 
        to support interventions to prevent fistula from occurring, 
        treat women who are affected, and support women after surgery.
            (15) The Campaign to End Fistula currently supports 
        projects in over 40 countries in sub-Saharan Africa, South 
        Asia, and the Middle East. In each country the Campaign 
        identifies the extent of the problem and the resources 
        available to treat fistula, develops a national strategy and 
        builds partnerships to address the problem, and implements 
        activities to prevent and treat fistula, including efforts to 
        reintegrate women into their communities once they are healed.
            (16) The United States Government provided a voluntary 
        contribution of $21,500,000 to UNFPA for fiscal year 2001 and 
        the Administration's budget request for fiscal year 2008 
        allocates $25,000,000 for UNFPA.
            (17) UNFPA is working in more than 140 countries to reduce 
        maternal death and disability, such as obstetric fistula, and 
        to save women's lives.
            (18) In the winter of 2001, the Secretary of State 
        submitted written testimony to the Committee on Foreign 
        Relations of the Senate expressing support for the invaluable 
        work of UNFPA and for securing funding for the organization.
            (19) The United States Government, as part of its efforts 
        to improve the dire health conditions of Afghan women, pledged 
        in October 2001 an additional $600,000 to UNFPA to address the 
        reproductive health care needs of Afghan refugees in 
        surrounding nations and of internally displaced persons within 
        Afghanistan.
            (20) Congress demonstrated its strong bipartisan support 
        for a voluntary United States contribution to UNFPA of up to 
        $34,000,000 in the Foreign Operations, Export Financing, and 
        Related Programs Appropriations Act, 2002, which was passed by 
        the House of Representatives on a vote of 357 to 66 and by the 
        Senate by unanimous consent and signed into law (Public Law 
        107-115) by the President on January 10, 2002. However, the 
        President decided not to obligate the funds.
            (21) In May 2002, the President sent a three-person 
        delegation to investigate UNFPA programs in China and 
        allegations that the agency was involved in coercive abortion 
        practices.
            (22) This independent delegation concluded that such 
        allegations were untrue.
            (23) On May 29, 2002, the delegation sent a letter to the 
        Secretary of State stating the following: ``First Finding: We 
        find no evidence that UNFPA has knowingly supported or 
        participated in the management of a program of coercive 
        abortion or involuntary sterilization in the PRC. First 
        Recommendation: We therefore recommend that not more than 
        $34,000,000 which has already been appropriated be released to 
        UNFPA.''.
            (24) Regrettably, the Administration overruled the 
        recommendation of its own delegation and invoked an overly 
        broad interpretation of the law in order to eliminate funding 
        for UNFPA.

SEC. 3. UNITED STATES VOLUNTARY CONTRIBUTION TO THE UNITED NATIONS 
              POPULATION FUND.

    Notwithstanding any other provision of law, in addition to amounts 
otherwise available to carry out the purposes of chapter 3 of part 1 of 
the Foreign Assistance Act of 1961, there are authorized to be 
appropriated $34,000,000 for fiscal year 2008 and each subsequent 
fiscal year to be available only for United States voluntary 
contributions to the United Nations Population Fund (UNFPA) only for 
prevention, treatment, and repair of obstetric fistula.
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