[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1410 Introduced in House (IH)]
111th CONGRESS
1st Session
H. R. 1410
To provide assistance to improve the health of newborns, children, and
mothers in developing countries, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 10, 2009
Ms. McCollum (for herself, Mr. Reichert, Mrs. Capps, Mr. Payne, Mr.
Blumenauer, Mr. Schiff, Mr. Moore of Kansas, Mr. Grijalva, Ms. Moore of
Wisconsin, Ms. Jackson-Lee of Texas, Mrs. Tauscher, Mr. McDermott, Mr.
McGovern, Mr. Walz, Mr. Moran of Virginia, Ms. Watson, Ms. Woolsey, Ms.
DeLauro, Mr. Hinchey, Mr. Carson of Indiana, Mr. Young of Alaska, Ms.
Lee of California, Mr. Oberstar, Mr. Murphy of Connecticut, Mrs.
Christensen, Ms. Eddie Bernice Johnson of Texas, Ms. Hirono, Mr.
Serrano, Ms. Slaughter, Mr. Filner, Ms. DeGette, Mr. Crowley, Mr.
Honda, Mr. Olver, Mr. Snyder, Mr. Shimkus, Mr. Jackson of Illinois, and
Mrs. Maloney) introduced the following bill; which was referred to the
Committee on Foreign Affairs
_______________________________________________________________________
A BILL
To provide assistance to improve the health of newborns, children, and
mothers in developing countries, and for other purposes.
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 ``Newborn, Child, and Mother Survival
Act of 2009''.
SEC. 2. FINDINGS AND PURPOSES.
(a) Findings.--Congress finds the following:
(1) At least 9,200,000 children under the age of 5 die each
year, more than 25,000 children per day, mostly from
preventable and treatable causes according to the United
Nations Children's Fund (UNICEF).
(2) In poor countries, an estimated 3,700,000 newborns die
in the first 4 weeks of life according to the World Health
Organization (WHO).
(3) Approximately 536,000 women die every year in
developing countries from causes related to pregnancy and
childbirth, the equivalent of 1 woman per minute, according to
WHO.
(4) For every maternal death some 20 women--or 10 million
women per year--suffer complications with severe consequences,
including pregnancy-related injuries, infections, diseases, and
disabilities.
(5) Worldwide, 68 countries account for 97 percent of all
maternal and under-5 child deaths.
(6) Nearly 1 of every 5 children die before the age of 5,
more than 2,000,000 child deaths per year, in the ten countries
with the highest child mortality rates in the world: Sierra
Leone, Afghanistan, Chad, Equatorial Guinea, Guinea-Bissau,
Mali, Burkina Faso, Nigeria, Rwanda, and Burundi.
(7) Nine out of 10 women in sub-Saharan Africa will lose a
child during their lifetimes.
(8) In sub-Saharan Africa, a woman's lifetime risk of
maternal death is a staggering 1 in 22, compared with 1 in
8,000 in industrialized countries, according to UNICEF.
(9) Pneumonia, diarrhea, low birth weight, sepsis, birth
trauma, and malaria, all preventable and treatable, are the top
contributors of deaths of children under the age of 5.
(10) Poor nutrition is a major factor in 20 percent of
maternal deaths, up to one-third of under-5 child deaths, and
60 to 80 percent of newborn deaths.
(11) Risk factors for maternal death in developing
countries include pregnancy and childbirth at an early age,
closely-spaced births, infectious diseases, malnutrition, and
complications during childbirth.
(12) In Mozambique, the ratio of nongovernmental
organizations engaged in HIV/AIDS prevention efforts compared
to nongovernmental organizations engaged in maternal and child
health efforts is 100 to 1, according to Mozambique's Minister
of Health, yet in that country 168 out of every 1,000 children
die before the age of 5 and one in every 45 mothers are at risk
of death.
(13) Antenatal care coverage for pregnant mothers in
developing countries is often low. For example, in sub-Saharan
Africa antenatal care coverage is 69 percent yet programs for
prevention of maternal to child transmission of HIV reach an
average of only 11 percent of those who need them, according to
UNICEF.
(14) In many poor countries, a lack of access, including
transportation to quality health care facilities, results in
deaths for newborns, children, and mothers.
(15) No skilled birth attendant is present at 34 percent of
deliveries worldwide which means 45,000,000 births each year
are occurring at home without skilled health personnel,
according to WHO.
(16) Due to an estimated 50 percent shortfall in skilled
birth attendants, 700,000 skilled and trained birth attendants
are needed worldwide to ensure universal coverage to maternity
care, while an additional 47,000 doctors with emergency
obstetric skills are required, particularly in rural areas,
according to WHO.
(17) Expansion of clinical care for newborns and mothers,
such as clean delivery by skilled birth attendants, emergency
obstetric care, and neonatal resuscitation can save the lives
of mothers, and can also avert 50 percent of newborn deaths.
(18) Maternal, newborn, and child health services should
include interventions along the continuum of care from before
pre-pregnancy to early childhood period and should be provided
at home, community, and clinics.
(19) An effective household to hospital continuum of care
is especially important for maternal survival, since timely
linkage to referral-level obstetric care is necessary to reduce
maternal mortality.
(20) A package of 32 affordable interventions, including
skilled care at birth, emergency obstetric care, breastfeeding,
vaccinations, antibiotics, and micro-nutrients, could save
6,000,000 children per year at a cost of only $25 per child or
$1.62 per person in 60 priority countries.
(21) Millions of children's lives can be saved by high-
impact, low-cost, feasible interventions like oral rehydration
therapy (ORT) for diarrhea ($0.07 per treatment), antibiotics
to treat respiratory infections ($0.25 per treatment), and
anti-malaria tablets ($0.29 per treatment).
(22) Exclusive breastfeeding--giving only breast milk for
the first 6 months of life--could help prevent an estimated
1,400,000 newborn and infant deaths each year, primarily by
protecting again diarrhea and pneumonia.
(23) Three million children die each year due to lack of
access to low-cost antibiotics and anti-malarial drugs.
(24) Two million children die from diarrheal diseases
unnecessarily due to lack of access to ORT prepared with clean
water.
(25) Between 1999 and 2004, distribution of low-cost
vitamin A supplements saved an estimated 2,300,000 lives, yet
the unmet need for vitamin A supplements results in an
estimated 250,000 to 500,000 children becoming blind each year,
with 70 percent of such children dying within 12 months of
losing their sight.
(26) Studies suggest that high coverage and quality of
proven health interventions could avert about 67 percent of
neonatal and child deaths in 60 priority countries worldwide.
(27) Maternal and child mortality rates are an important
indicator of a government's commitment to women and children,
as well as a barometer of a country's healthcare system and
overall development performance.
(28) It is estimated that an additional $850,000,000
invested in newborn and child health could save the lives of
nearly 1,000,000 children every year.
(29) Investments in child survival have contributed to a
major decline in the rate of child mortality, even in poor
countries such as Indonesia, Nepal, Laos, Bangladesh, and
Bolivia, which have all reduced their under-5 child mortality
by more than one-half since 1990.
(30) Under-five child mortality has decreased by 20 to 50
percent in 15 United States Agency for International
Development-assisted countries over the past ten years.
(31) In 2000, the United States joined 188 other countries
in supporting eight United Nations Millennium Development Goals
to reduce the mortality rate of children under the age of 5 by
two-thirds (goal 4) and to reduce maternal deaths by three-
quarters (goal 5).
(32) In 2008, of the 68 priority countries representing 97
percent of newborn and child mortality, only 16 of these
countries are on track to achieve Millennium Development Goal
(MDG) 4 of reducing child mortality by two-thirds.
(b) Purposes.--The purposes of this Act are to--
(1) authorize assistance to reduce mortality and improve
the health of newborns, children, and mothers in developing
countries, including strengthening the capacity of health
systems and health workers;
(2) develop and implement a strategy based on a continuum
of care to reduce mortality and improve the health of newborns,
children, and mothers in developing countries; and
(3) assess, monitor, and evaluate the progress and
contributions of relevant departments and agencies of the
Government of the United States in achieving reductions of
newborn, child, and maternal mortality in developing counties
as well as contributions in achieving the United Nations
Millennium Development Goals through the establishment of an
interagency task force.
SEC. 3. ASSISTANCE TO REDUCE MORTALITY AND IMPROVE THE HEALTH OF
NEWBORNS, CHILDREN, AND MOTHERS IN DEVELOPING COUNTRIES.
(a) In General.--Chapter 1 of part I of the Foreign Assistance Act
of 1961 (22 U.S.C. 2151 et seq.) is amended--
(1) in section 101(a)(1), by inserting at the end before
the semicolon the following: ``, with particular focus on
children and mothers'';
(2) in section 102(b)(4)(B), by striking ``reduction of
infant mortality'' and inserting ``reduction of newborn, child,
and maternal mortality'';
(3) in section 104(c)--
(A) by striking paragraphs (2) and (3); and
(B) by redesignating paragraph (4) as paragraph
(2);
(4) by redesignating sections 104A, 104B, and 104C as
sections 104B, 104C, and 104D, respectively; and
(5) by inserting after section 104 the following new
section:
``SEC. 104A. ASSISTANCE TO REDUCE MORTALITY AND IMPROVE THE HEALTH OF
NEWBORNS, CHILDREN, AND MOTHERS.
``(a) Authorization.--Consistent with section 104(c), the President
is authorized to furnish assistance, on such terms and conditions as
the President may determine, to reduce mortality and improve the health
of newborns, children, and mothers in developing countries.
``(b) Activities To Prevent Mortality and Improve Newborn and Child
Health.--Assistance provided under subsection (a) shall, to the maximum
extent practicable, be used to--
``(1) improve newborn care and treatment, including
educating families about proper antenatal and skilled delivery
care, drying and warming with the mother, immediate and
exclusive breastfeeding, handwashing, clean cord care, prompt
recognition and care seeking for danger signs, and treatment of
neonatal infections; and
``(2) increase access to and utilization of appropriate
interventions to treat life-threatening childhood illnesses,
including--
``(A) to prevent and mitigate the severity of and
treat diarrhea, including point of use water treatment,
improvements in hygienic behavior, oral rehydration
therapy (ORT), zinc, exclusive breastfeeding in the
first six months of life, and adequate and young child
feeding during the first 6 to 24 month period;
``(B) to prevent deaths due to pneumonia with a
focus on community-based treatments using antibiotics
and effective recognition of severe illness with
appropriate referral;
``(C) to achieve the delivery of full immunization
services, including efforts to eliminate polio and
introduce new vaccines as available; and
``(D) to prevent and treat malaria through
increased use of insecticide-treated nets, indoor
residual spraying, and timely and appropriate treatment
of malaria.
``(c) Activities To Prevent Mortality and Improve Maternal
Health.--Assistance provided under subsection (a) shall, to the maximum
extent practicable, be used to--
``(1) improve birth preparedness, including quality
antenatal care throughout pregnancy; and
``(2) expand access and improve quality of maternity
services, including--
``(A) skilled birth attendants;
``(B) recognition and treatment of obstetric
complications and disabilities, such as post-partum
hemorrhage;
``(C) quality emergency obstetric care;
``(D) activities to treat and repair injuries
resulting from pregnancy and childbirth; and
``(E) activities to lower or remove financial
barriers to maternal healthcare services.
``(d) Activities To Promote Healthy Newborns, Children, and
Mothers.--Assistance provided under subsection (a) shall, to the
maximum extent practicable, be used to--
``(1) improve child and maternal nutrition, including the
delivery of iron, folic acid, zinc, vitamin A, iodine, and
other key micronutrients;
``(2) promote breastfeeding, appropriate complementary
feeding, and the management of acute severe malnutrition,
including the use of ready to use therapeutic food;
``(3) improve access to clean water and improved sanitation
through community-based hygiene education programs, the use of
personal water purification tools and devices, and latrine
construction;
``(4) reduce exposure to environmental toxins and indoor
smoke from cooking fires;
``(5) address antimicrobial resistance in children and
mothers;
``(6) ensure access to transportation for newborns,
children, and mothers in need of emergency clinical care;
``(7) ensure access to comprehensive post-natal newborn and
maternal care, including services during the immediate post-
partum period; and
``(8) increase access to low- or no-cost deworming
products.
``(e) Activities To Strengthen Communities and Health Systems.--
Assistance provided under subsection (a) shall, to the maximum extent
practicable, be used to--
``(1) improve capacity for health governance, finance and
workforce, including support for the training and supervision
of clinicians, nurses, midwives, skilled birth attendants,
nutritionists, technicians, sanitation and public health
workers, community-based health workers, peer educators,
volunteers, and private sector enterprises;
``(2) recruit, train, and supervise providers of
comprehensive emergency obstetric and newborn care services;
``(3) establish and support management information systems
in host country institutions and the development and use of
tools and models to collect, analyze, and disseminate
information relating to newborn, child, and maternal health,
including registration of all births and deaths, along with
cause of death, at district and country levels;
``(4) develop and conduct needs assessments, baseline
studies, targeted evaluations, and other information-gathering
efforts for the design, monitoring, and evaluation of newborn,
child, and maternal health programs; and
``(5) implement tailored programs in priority countries in
political transition or post conflict settings to extend
newborn, child, and maternal services as quickly as possible to
assist in rebuilding of fragile health systems.
``(f) Activities To Promote Integration, Coordination, and Maximum
Utilization of Health and Development Resource Assistance.--Assistance
provided under subsection (a) shall, to the maximum extent practicable,
be used to--
``(1) carry out activities in host countries, including--
``(A) the prevention of the transmission of HIV
from mother-to-child and other HIV/AIDS counseling,
care, and treatment;
``(B) the prevention of malaria and other malaria
counseling, care, and treatment;
``(C) the prevention of tuberculosis and other
tuberculosis counseling, care, and treatment;
``(D) child spacing;
``(E) nutrition;
``(F) education and microfinance activities that
facilitate increasing access to and use of critical
health services or practices; and
``(G) water and sanitation activities; and
``(2) carry out activities linked to United States
Government programs to reduce poverty and improve health and
development, including--
``(A) title II of the Agricultural Trade
Development and Assistance Act of 1954 (7 U.S.C. 1721
et seq.);
``(B) the United States Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C.
7601 et seq.) and the amendments made by that Act
(commonly known as the `President's Emergency Plan for
HIV/AIDS Relief' or `PEPFAR');
``(C) the Presidential Malaria Initiative (PMI);
``(D) global health programs administered by the
United States Agency for International Development
(USAID);
``(E) programs administered by USAID's Office of
U.S. Foreign Disaster Assistance programs (OFDA); and
``(F) global health programs administered by the
Department of Health and Human Services.
``(g) Guidelines.--To the maximum extent practicable, programs,
projects, and activities carried out using assistance provided under
this section shall be--
``(1) carried out through private and voluntary
organizations, including faith-based organizations, and
relevant international and multilateral organizations,
including the GAVI Alliance (formerly known as the Global
Alliance for Vaccines and Immunization) and the United Nations
Children's Fund (UNICEF), the World Health Organization (WHO),
the World Food Programme (WFP), and the Global Fund to Fight
AIDS, Tuberculosis and Malaria, giving priority to
organizations that demonstrate effectiveness and commitment to
preventing mortality and improving the health of newborns,
children, and mothers;
``(2) carried out with input by host countries, including
civil society and local communities, as well as other donors
and multilateral organizations;
``(3) carried out with input by beneficiaries and other
directly-affected populations, especially women and
marginalized communities; and
``(4) designed to build the capacity of host country
governments and civil society organizations.
``(h) Annual Report.--Not later than February 1 of each year, the
President shall transmit to Congress a report on the implementation of
this section for the prior fiscal year.
``(i) Definitions.--In this section:
``(1) AIDS.--The term `AIDS' has the meaning given the term
in section 104B(g)(1) of this Act.
``(2) HIV.--The term `HIV' has the meaning given the term
in section 104B(g)(2) of this Act.
``(3) HIV/AIDS.--The term `HIV/AIDS' has the meaning given
the term in section 104B(g)(3) of this Act.''.
(b) Conforming Amendments.--The Foreign Assistance Act of 1961 (22
U.S.C. 2151 et seq.) is amended--
(1) in section 104(c)(2) (as redesignated by subsection
(a)(2)(B) of this section), by striking ``and 104C'' and
inserting ``104C, and 104D'';
(2) in section 104B (as redesignated by subsection (a)(3)
of this section)--
(A) in subsection (c)(1), by inserting ``and
section 104A'' after ``section 104(c)'';
(B) in subsection (f)(2)(A), by striking ``section
104B, and section 104C'' and inserting ``section 104C,
and section 104D''; and
(C) in subsection (g), by striking ``section
104(c), this section, section 104B, and section 104C''
and inserting ``section 104(c), section 104A, this
section, section 104C, and section 104D'';
(3) in subsection (c) of section 104C (as redesignated by
subsection (a)(3) of this section), by inserting ``and section
104A'' after ``section 104(c)'';
(4) in subsection (c) of section 104D (as redesignated by
subsection (a)(3) of this section), by inserting ``and section
104A'' after ``section 104(c)'';
(5) in the first sentence of section 119(c), by striking
``section 104(c)(2), relating to Child Survival Fund'' and
inserting ``section 104A''; and
(6) in section 135(b)--
(A) in paragraph (1), by striking ``section
104A(g)(1)'' and inserting ``section 104B(g)(1)''; and
(B) in paragraph (3), by striking ``section
104A(g)(3)'' and inserting ``section 104B(g)(3)''.
SEC. 4. STRATEGY TO REDUCE MORTALITY AND IMPROVE THE HEALTH OF
NEWBORNS, CHILDREN, AND MOTHERS IN DEVELOPING COUNTRIES.
(a) Strategy Required.--The President shall develop and implement a
comprehensive United States Government strategy to reduce mortality and
improve the health of newborns, children, and mothers in developing
countries.
(b) Components.--The comprehensive United States Government
strategy developed pursuant to subsection (a) shall include the
following:
(1) An identification of not less than 60 countries with
priority needs for the 5-year period beginning on the date of
the enactment of this Act based on--
(A) the number and rate of neonatal deaths;
(B) the number and rate of child deaths;
(C) the number and ratio of maternal deaths;
(D) the number and rate of malnourished women of
reproductive age; and
(E) the number and rate of malnourished infants and
children under the age of 5.
(2) For each country identified in paragraph (1)--
(A) an assessment of the most common causes of
newborn, child, and maternal mortality;
(B) a description of the host country's overall
health strategy and expenditures, including an
assessment of components to specifically reduce
newborn, child, and maternal mortality rates;
(C) a description of the programmatic areas and
interventions providing maximum health benefits to
populations at risk as well as maximum reduction in
newborn, child, and maternal mortality;
(D) an assessment of the investments needed in
identified programs and interventions to achieve the
greatest results;
(E) a description of how United States assistance
complements and leverages efforts by other donors, as
well as builds capacity and self-sufficiency among
recipient countries;
(F) a description of goals and objectives for
improving newborn, child, and maternal health,
including, to the extent feasible, objective and
quantifiable indicators; and
(G) a description of the host government's
commitment to working with partners and civil society
to achieve accelerated reductions in newborn, child and
maternal mortality.
(3) With respect to the 30 countries identified in
paragraph (1) that have the highest newborn, child, and
maternal mortality rates, a plan to--
(A) reduce the mortality rate among newborns,
children, and mothers in each of those countries by 25
percent by 2013;
(B) address the human resources crisis in each of
those countries by increasing by at least 100,000 the
number of functional (trained, equipped, and
supervised) community health workers and volunteers
serving at primary care and community levels in those
countries by 2013; and
(C) achieve an average reduction in child and
maternal malnutrition in at least 10 of those countries
by 15 percent by 2013.
(4) With respect to the countries identified in paragraph
(1) without a United States Agency for International
Development (USAID) mission or in conflict, post-conflict, or
in a condition of political transition and at risk of increased
newborn, child, and maternal mortality, a plan to prevent
newborn, child, and maternal deaths in each of those countries
through coordination with and support from multilateral
organizations.
(5) An expansion of the Child Survival and Health Grants
Program of USAID, at a minimum proportionate to any increase in
newborn, child, and maternal health assistance, to provide
additional support programs and interventions determined to be
efficacious and cost-effective in improving health and reducing
mortality.
(6) A description of the measured or estimated impact on
newborn, child, and maternal morbidity and mortality of each
project or program carried out.
(c) Report.--Not later than 180 days after the date of the
enactment of this Act, the President shall transmit to Congress a
report that contains the strategy described in this section.
SEC. 5. INTERAGENCY TASK FORCE ON NEWBORN, CHILD, AND MATERNAL HEALTH
IN DEVELOPING COUNTRIES.
(a) Establishment.--There is established a task force to be known
as the Interagency Task Force on Newborn, Child, and Maternal Health in
Developing Countries (in this section referred to as the ``Task
Force'').
(b) Duties.--
(1) In general.--The Task Force shall assess, monitor, and
evaluate the progress and contributions of relevant departments
and agencies of the Government of the United States in
achieving the United Nations Millennium Development Goals by
2015 for reducing the mortality of children under the age of 5
by two-thirds (Millennium Development Goal 4) and reducing
maternal mortality by three-quarters (Millennium Development
Goal 5) in developing countries, including by--
(A) identifying and evaluating programs and
interventions that directly or indirectly contribute to
the reduction of newborn, child, and maternal mortality
rates;
(B) assessing effectiveness of programs,
interventions, and strategies toward achieving the
maximum reduction of newborn, child, and maternal
mortality rates;
(C) assessing the level of coordination among
relevant departments and agencies of the Government of
the United States, the international community,
international organizations, faith-based organizations,
academic institutions, and the private sector;
(D) assessing the level of coordination of United
States bilateral programs and the host country
government in implementing the host country's health
strategy to reduce newborn, child, and maternal
mortality rates;
(E) assessing the contributions made by United
States-funded programs toward achieving the Millennium
Development Goals 4 and 5;
(F) identifying the bilateral efforts of other
nations and multilateral efforts toward achieving the
Millennium Development Goals 4 and 5; and
(G) preparing the annual report required by
subsection (f).
(2) Consultation.--To the maximum extent practicable, the
Task Force shall consult with individuals with expertise in the
matters to be considered by the Task Force who are not officers
or employees of the Government of the United States, including
representatives of United States-based nongovernmental
organizations (including faith-based organizations and private
foundations), academic institutions, private corporations, the
United Nations Children's Fund (UNICEF), and the World Bank.
(c) Membership.--
(1) Number and appointment.--The Task Force shall be
composed of the following members:
(A) The Administrator of the United States Agency
for International Development.
(B) The Assistant Secretary of State for
Population, Refugees and Migration.
(C) The Coordinator of United States Government
Activities to Combat HIV/AIDS Globally (commonly known
as the ``U.S. Global AIDS Coordinator'').
(D) The Coordinator of the United States Government
Presidential Malaria Initiative (PMI).
(E) The Director of the Office of Global Health
Affairs of the Department of Health and Human Services.
(F) The Under Secretary for Food, Nutrition and
Consumer Services of the Department of Agriculture.
(G) The Chief Executive Officer of the Millennium
Challenge Corporation.
(H) The Director of the Peace Corps.
(I) Other officials of relevant departments and
agencies of the Federal Government who shall be
appointed by the President.
(J) Two ex-officio members appointed by the Speaker
of the House of Representatives in consultation with
the minority leader of the House of Representatives.
(K) Two ex-officio members appointed by the
majority leader of the Senate in consultation with the
minority leader of the Senate.
(2) Chairperson.--The Administrator of the United States
Agency for International Development shall serve as chairperson
of the Task Force.
(d) Meetings.--The Task Force shall meet on a regular basis, not
less often than quarterly, on a schedule to be agreed upon by the
members of the Task Force, and starting not later than 90 days after
the date of the enactment of this Act.
(e) Definition.--In this section, the term ``Millennium Development
Goals'' means the key development objectives described in the United
Nations Millennium Declaration, as contained in United Nations General
Assembly Resolution 55/2 (September 2000).
(f) Report.--Not later than 120 days after the date of the
enactment of this Act, and not later than April 30 of each year
thereafter, the Task Force shall submit to Congress and the President a
report on the implementation of this section.
SEC. 6. AUTHORIZATION OF APPROPRIATIONS.
(a) In General.--There are authorized to be appropriated to carry
out this Act, and the amendments made by this Act, such sums as may be
necessary for each of the fiscal years 2010 through 2014.
(b) Availability of Funds.--Amounts appropriated pursuant to the
authorization of appropriations under subsection (a) are authorized to
remain available until expended.
<all>