1.This Act may be cited as the
Newborn, Child, and Mother Survival
Act of 2009
.
2.
(a)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)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.
3.Assistance to
reduce mortality and improve the health of newborns, children, and mothers in
developing countries
(a)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:
104A.Assistance to
reduce mortality and improve the health of newborns, children, and
mothers
(a)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 healthAssistance
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 healthAssistance 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 mothersAssistance
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 systemsAssistance 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 assistanceAssistance 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)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)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)In
this section:
(1)The
term AIDS has the meaning given the term in section 104B(g)(1) of
this Act.
(2)The
term HIV has the meaning given the term in section 104B(g)(2) of
this Act.
(3)The
term HIV/AIDS has the meaning given the term in section 104B(g)(3)
of this
Act.
.
(b)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)
.
4.Strategy to
reduce mortality and improve the health of newborns, children, and mothers in
developing countries
(a)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)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)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.
5.Interagency task
force on newborn, child, and maternal health in developing countries
(a)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)
(1)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)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)
(1)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)The
Administrator of the United States Agency for International Development shall
serve as chairperson of the Task Force.
(d)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)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)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.
6.Authorization of
appropriations
(a)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)Amounts appropriated pursuant to the authorization of
appropriations under subsection (a) are authorized to remain available until
expended.