[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5121 Introduced in House (IH)]

111th CONGRESS
  2d Session
                                H. R. 5121

   To promote the sexual and reproductive health of individuals and 
        couples in developing countries, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 22, 2010

 Ms. Clarke (for herself, Ms. Woolsey, Mr. Ellison, Mrs. Maloney, Mr. 
Stark, Ms. Chu, Mrs. Davis of California, Ms. Watson, Mr. Grijalva, Ms. 
 Kilpatrick of Michigan, Ms. Baldwin, Mrs. Capps, Mr. Moore of Kansas, 
Ms. Schakowsky, Mr. Cohen, Mr. Meek of Florida, Ms. Lee of California, 
and Ms. Slaughter) introduced the following bill; which was referred to 
                    the Committee on Foreign Affairs

_______________________________________________________________________

                                 A BILL


 
   To promote the sexual and reproductive health of individuals and 
        couples 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 ``Global Sexual and Reproductive 
Health Act of 2010''.

SEC. 2. FINDINGS AND PURPOSES.

    (a) Findings.--Congress makes the following findings:
            (1) The advancement of sexual and reproductive health is 
        necessary to meeting most of the eight United Nations 
        Millennium Development Goals (MDGs), the current international 
        development framework developed by 189 countries in 2000, 
        including the United States. Target 5B, which is found under 
        MDG 5 on improving maternal health and which requires achieving 
        universal access to reproductive health by the year 2015, is an 
        essential element in attaining MDGs related to eradicating 
        poverty (MDG 1), achieving universal education (MDG 2), 
        promoting gender equality (MDG 3), reducing child mortality 
        (MDG 4), improving maternal health (MDG 5), combating HIV/AIDS 
        (MDG 6), and ensuring environmental sustainability (MDG 7).
            (2) The report of the United Nations Secretary-General to 
        the 2009 Commission on Population and Development ``. . . 
        reaffirms that population, reproductive health and gender 
        issues are central to development and to the achievement of the 
        Millennium Development Goals.''.
            (3) Throughout much of the world, the lack of access of 
        women, particularly poor women, to basic reproductive health 
        services and information contributes to death and suffering 
        among women and their families, undermines women's struggle for 
        self-determination, and vitiates the efforts of families to 
        lift themselves out of the poverty in which over a billion of 
        the world's people live. By allowing individuals and couples to 
        choose the number and timing of their children, reproductive 
        health care gives families and individuals greater control over 
        their economic resources.
            (4) Aspects of sexual and reproductive health, including 
        maternal mortality and morbidity, reproductive cancers, and 
        sexually transmitted infections (STIs), including HIV, account 
        for nearly 20 percent of the global burden of ill-health for 
        women and some 14 percent for men, according to the World 
        Health Organization (WHO).
            (5) Poor sexual and reproductive health is the leading 
        cause of death and disability among women of child-bearing age.
            (6) School-based education and family planning play an 
        interrelated role in lifting the status of women. Delaying 
        sexual debut, along with contraceptive use among young women 
        already sexually active, lowers the likelihood that young women 
        will leave their schooling due to pregnancy, and education 
        increases the chances that young women will delay the age at 
        which they marry and give birth.
            (7) Sexual and reproductive health programs can empower 
        women to make informed decisions and better control their 
        lives, and by engaging men and boys in taking responsibility 
        for the sexual and reproductive health of their partners, can 
        contribute to greater gender equality.
            (8) Access to sexual and reproductive health services, 
        including family planning, has a direct and important impact on 
        infant and child mortality. By allowing women to choose the 
        timing, number, and spacing of their pregnancies, high-risk 
        births are averted, and the children that are born have a 
        greater chance of surviving to adulthood. Four million newborns 
        die in the first four weeks of life, which accounts for 43 
        percent of all deaths of children under the age of 5. By 
        providing women family planning services to space their births 
        3 years apart, rates for infant and under-5 mortality would 
        drop by 24 percent and 35 percent, respectively.
            (9) Increasing access to sexual and reproductive health 
        could significantly decrease pregnancy-related mortality and 
        morbidity by reducing the number of pregnancies that place 
        women at increased risk of experiencing such complications.
            (10) An estimated 215,000,000 women in developing countries 
        have an unmet need for effective, modern contraceptives and 
        would like to postpone childbearing, space births, or want no 
        more children but are not using a modern method of 
        contraception. Providing modern contraceptives to fill this 
        unmet need would avert an estimated 53,000,000 unintended 
        pregnancies each year, thereby preventing 150,000 women from 
        dying of pregnancy-related complications, 600,000 children from 
        losing their mothers, and 25,000,000 induced abortions.
            (11) Complications due to pregnancy and childbirth are the 
        leading cause of death among women ages 15 to 19. Each year, an 
        estimated 550,000 women worldwide die from complications 
        related to pregnancy, childbirth, or unsafe abortion. Another 
        50,000,000 women annually suffer long-term illness or permanent 
        physical impairment from such causes.
            (12) Unsafe abortion accounts for 13 percent of maternal 
        deaths worldwide. More than half of abortions (55 percent) in 
        the developing world are unsafe. Of the 19,000,000 unsafe 
        abortions that take place each year, most occur in the 
        developing world. Around 70,000 women die and millions more 
        suffer serious injuries from the complications of unsafely 
        performed abortions. Abortion rates are similar in countries 
        whether abortion is illegal or legal. However, death and injury 
        from unsafe abortion is greatly reduced where abortion is legal 
        for a broad range of indications and where safe abortion is 
        accessible.
            (13) Meeting the need for family planning services and 
        pregnancy-related care, by doubling the current global 
        investment for both, would reduce maternal mortality by 70 
        percent and deaths to newborns by 44 percent. These goals can 
        be achieved for $1,500,000,000 less than the cost of achieving 
        maternal and newborn health alone. Every dollar invested in 
        family planning saves $1.40 in maternal and newborn health care 
        services.
            (14) Worldwide, women of childbearing age account for more 
        than half of people living with HIV/AIDS. Integrating 
        reproductive health services, including family planning, with 
        HIV prevention programs, such as those for voluntary counseling 
        and testing and prevention of mother-to-child transmission, is 
        essential to effectively combating HIV/AIDS and other STIs.
            (15) The world is witnessing the largest generation of 
        young people in history--almost half of the world's population, 
        some 3,000,000,000 people, is under the age of 25. Unmet need 
        for sexual and reproductive health services is highest among 
        this age cohort. Fewer than 5 percent of the poorest sexually 
        active youth use modern contraception.
            (16) The WHO has identified unsafe sex as the second most 
        important risk factor for disability and death among young 
        people in the world's poorest communities. Forty-five percent 
        of all new HIV infections occur among young people.
            (17) Sixty percent of unsafe abortions in Africa, 42 
        percent in Latin America and the Caribbean, and 30 percent in 
        Asia are performed on women under the age of 25.
            (18) The WHO has identified a 4-pronged approach to 
        preventing HIV infection in infants, which includes prevention 
        of unintended pregnancy among HIV-infected women as a key 
        strategy to prevent mother-to-child transmission of HIV.
            (19) According to the United States Agency for 
        International Development, enabling HIV-positive women who want 
        to avoid a pregnancy with contraceptive services can prevent an 
        additional 55,000 child deaths and avert more than 150,000 
        unintended pregnancies in high HIV prevalence countries.
            (20) Demographic factors exacerbate problems related to 
        environmental sustainability. The past century of population 
        growth has put increasing pressure on natural resources as the 
        scale of human needs and activities expands. At the same time, 
        actual family size in most developing countries remains greater 
        than the desired family size. Access to family planning 
        services helps couples to determine their own family size, 
        hence mitigating the depletion of natural resources like clean 
        water, air, and land.
            (21) Practices like early marriage, female genital 
        mutilation, and early sexual debut adversely impact the sexual 
        and reproductive health of young people in many developing 
        countries, and strong barriers exist to providing the 
        information, services, and other forms of support that young 
        people need to lead healthy sexual and reproductive lives.
            (22) Comprehensive sexuality education seeks to help young 
        people develop the interpersonal skills necessary for the 
        formation of caring, supportive, and non-coercive relationships 
        and the ability to exercise responsibility regarding sexual 
        relationships by addressing such issues as abstinence and the 
        use of condoms, contraceptives, and other protective sexual 
        health measures.
            (23) The United Nations has estimated that the minimum 
        financial requirements for sexual and reproductive health, 
        including family planning and maternal health, are roughly 
        $23,500,000,000 in 2009 and increase to approximately 
        $33,000,000,000 in 2015. The minimum financial requirement for 
        HIV/AIDS is estimated at $24,000,000,000 in 2009, and increases 
        to $36,200,000,000 in 2015. As agreed in the International 
        Conference on Population and Development's Programme of Action, 
        which the United States committed to, developed-country donors 
        are responsible for one-third of the total cost needed per 
        year. Developing countries are responsible for the remaining 
        two-thirds.
            (24) The United States has had a history of supporting and 
        recognizing the fundamental health and human rights of all 
        people through the signing or ratifying of various 
        international agreements. Those agreements include the 
        Universal Declaration of Human Rights (1948), the International 
        Covenant on Civil and Political Rights (1966), the 
        International Covenant on Economic, Social, and Cultural Rights 
        (1966), the Convention on the Elimination of All Forms of 
        Discrimination Against Women (1979), the Convention on the 
        Rights of the Child (1989), the International Conference on 
        Population and Development Programme of Action (1994), and the 
        United Nations Millennium Development Goals (2000).
            (25) The United States has been the largest donor to 
        international family planning and reproductive health efforts 
        over the last 40 years and has been an unparalleled source of 
        leadership and innovation in the field. Nonetheless, it has not 
        met its fair share of financial assistance to global sexual and 
        reproductive health programs. Now is the time to shore up the 
        United States political and financial commitment in order to 
        satisfy the large unmet need for these services, thereby 
        helping to improve women's sexual and reproductive health 
        worldwide.
    (b) Purposes.--The purposes of this Act are to--
            (1) authorize assistance to improve the sexual and 
        reproductive health of individuals and couples in developing 
        countries; and
            (2) implement comprehensive sexual and reproductive health 
        programs offering a continuum of care that are responsive to 
        the sexual and reproductive health needs of young people and 
        adults.

SEC. 3. STATEMENT OF POLICY.

    The following shall be the policy of the United States Government:
            (1) All individuals and couples shall have the basic 
        reproductive right to decide freely and responsibly the number, 
        spacing, and timing of their children and shall have the 
        information and means to do so, and the right to attain the 
        highest standard of sexual and reproductive health.
            (2) All individuals and couples also shall have the right 
        to make decisions concerning reproduction free of 
        discrimination, coercion, and violence, as expressed in human 
        rights documents.
            (3) The promotion of the responsible exercise of these 
        reproductive rights for all people shall be the fundamental 
        basis for sexual and reproductive health programs supported by 
        United States Government assistance.
            (4) The principle of free and informed consent must 
        underlie all sexual and reproductive health programs and 
        services. This principle applies to individuals whether they 
        choose to continue or terminate their pregnancies--thus, forced 
        pregnancies as well as forced abortions or sterilizations are 
        prohibited. Decisions relating to contraceptive use should be 
        made on an informed and voluntary basis after adequate 
        information, counseling, and services are provided on a range 
        of methods.
            (5) Incentives and disincentives should not be used in 
        family planning programs in order to meet numerical population 
        targets or quotas for fertility goals. Instead, governments 
        should use other indicators, such as unmet needs, to define 
        family planning goals.
            (6) In sexual and reproductive health programs funded by 
        the United States Government, special attention should be paid 
        to serving the needs of young people.

SEC. 4. ASSISTANCE TO SUPPORT THE ACHIEVEMENT OF UNIVERSAL ACCESS TO 
              SEXUAL AND REPRODUCTIVE HEALTH.

    (a) Assistance Authorized.--The President is authorized to provide 
assistance in order to support the achievement of universal access to 
sexual and reproductive health in developing countries and to ensure 
individuals and couples in developing countries can freely and 
responsibly determine the number, timing, and spacing of their children 
and have the means to do so.
    (b) Activities Supported.--Assistance provided under subsection (a) 
may be used to--
            (1) expand access to and use of voluntary family planning 
        information and services, to enable individuals and couples to 
        avoid unintended pregnancies and other risks to sexual and 
        reproductive health, including those associated with pregnancy, 
        reproductive tract infections, and sexually transmitted 
        infections (STIs), including HIV;
            (2) improve public knowledge of contraceptives, including 
        where methods may be obtained, and risk-reduction strategies, 
        and to promote the benefits of family planning and other sexual 
        and reproductive health care to individuals, families, and 
        communities, including through the use of education and 
        awareness programs, mass media, and community mobilization and 
        outreach;
            (3) increase the responsiveness of sexual and reproductive 
        health programs to the needs of the intended beneficiaries 
        during the entirety of their sexual and reproductive lives, 
        including young people and older adults;
            (4) reduce the incidence of unsafe abortion, including 
        research on the health consequences of unsafe abortion, and 
        provide for the equipment and training necessary for medical 
        treatment of the consequences of unsafe abortions;
            (5) notwithstanding any other provision of law, provide 
        safe abortion, to the extent permitted by the laws of the 
        recipient country;
            (6) promote the integration of family planning services in 
        HIV and other STI prevention, treatment, care, and support;
            (7) integrate family planning services with maternal and 
        newborn health care, especially in antenatal, post-partum, and 
        post-abortion care settings;
            (8) ensure the consistent availability and affordability of 
        high quality sexual and reproductive health supplies and 
        services, including male and female condoms, for the prevention 
        of HIV and other STIs;
            (9) encourage the abandonment of female genital mutilation, 
        early marriage, early childbearing, and other harmful 
        traditional practices that have negative reproductive health 
        consequences;
            (10) prevent and repair obstetric fistula;
            (11) promote the constructive engagement of men and boys, 
        the empowerment of women and girls, and more equitable gender 
        norms in order to improve health outcomes and support the 
        adoption of healthy reproductive behaviors;
            (12) prevent and mitigate gender-based violence;
            (13) provide comprehensive sexuality education for young 
        people;
            (14) prevent, diagnose, and treat, where appropriate, 
        infertility and cancers of the reproductive system and refer as 
        appropriate;
            (15) develop improved methods of safe and effective 
        contraception and related disease control through investments 
        in biomedical research, with particular emphasis on methods 
        which--
                    (A) are likely to be safer, easier to use, more 
                efficient to make available in developing country 
                settings, and less expensive than current methods;
                    (B) are controlled by women, including barrier 
                methods and microbicides;
                    (C) are likely to prevent the spread of STIs; and
                    (D) encourage and enable men to take greater 
                responsibility for their own fertility and the 
                protection of their partner;
            (16) support an enabling environment for women to access 
        sexual and reproductive health care services by working with 
        communities to identify and lower or remove barriers to access, 
        including financial, gender, socio-cultural, and transportation 
        barriers;
            (17) train health care professionals on educating 
        individuals, including young people, about their sexual and 
        reproductive health care options, including family planning 
        options; and
            (18) foster conditions to create favorable policy 
        environments, improve quality, strengthen systems, and 
        contribute to the sustainability of family planning and other 
        reproductive health programs.

SEC. 5. ASSISTANCE TO REDUCE THE INCIDENCE OF UNSAFE ABORTION AND ITS 
              CONSEQUENCES.

    (a) Assistance Authorized.--The President is authorized to provide 
assistance to reduce the incidence of unsafe abortion in developing 
countries and provide care for women experiencing injury or illness 
from complications of unsafe abortion in developing countries.
    (b) Activities Supported.--Assistance provided under subsection (a) 
shall be used to--
            (1) ensure access to family planning services to prevent 
        unintended pregnancies;
            (2) ensure that women who experience an unintended 
        pregnancy have access to reliable information and compassionate 
        counseling on all of their options, including access to 
        antenatal care and safe abortion when permitted by the laws of 
        the recipient country;
            (3) where local laws permit abortion, support safe abortion 
        services, including referrals, and support the training of 
        abortion providers and the necessary equipment and commodities 
        for surgical and medical abortion; and
            (4) support emergency treatment for complications of 
        induced or spontaneous abortion, including provision of 
        services and training and equipping of providers.
    (c) Eligibility for Assistance.--Notwithstanding any other 
provision of law, regulation, or policy, in determining eligibility for 
assistance authorized under this section, sections 104, 104A, 104B, and 
104C of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b, 2151b-2, 
2151b-3, and 2151b-4), foreign nongovernmental organizations--
            (1) shall not be ineligible for such assistance solely on 
        the basis of health or medical services, including counseling 
        and referral services, provided by such organizations with non-
        United States Government funds if such services are permitted 
        in the country in which they are being provided and would not 
        violate United States Federal law if provided in the United 
        States; and
            (2) shall not be subject to requirements relating to the 
        use of non-United States Government funds for advocacy and 
        lobbying activities other than those that apply to United 
        States nongovernmental organizations receiving assistance under 
        part I of the Foreign Assistance Act of 1961.

SEC. 6. ASSISTANCE TO PROVIDE SEXUAL AND REPRODUCTIVE HEALTH SERVICES 
              DURING EMERGENCY SITUATIONS.

    (a) Assistance Authorized.--The President is authorized to provide 
assistance, including through international organizations, national 
governments, and international and local nongovernmental organizations, 
to ensure that sexual and reproductive health services are provided in 
developing countries at every phase of a humanitarian emergency, 
including early recovery.
    (b) Priority.--In providing assistance authorized under subsection 
(a), the President shall give priority to--
            (1) those reproductive health services that are essential 
        in emergencies, whether they are conflict or natural disaster 
        settings, to save lives and help survivors fulfill their 
        potential even under the most difficult circumstances; and
            (2) building local capacity and improving national systems 
        whenever possible during displacement and early recovery.
    (c) Activities Supported.--Assistance provided under subsection (a) 
shall be used to--
            (1) direct the Secretary of State and the Administrator of 
        the United States Agency for International Development to 
        implement the Minimum Initial Services Package (MISP), a set of 
        life-saving priority activities that must be put in place in 
        the earliest days of an emergency and that is set out in the 
        Sphere Project's Humanitarian Charter and Minimum Standards in 
        Disaster Response;
            (2) among other activities, establish critical reproductive 
        health coordination mechanisms, prevent sexual violence and 
        assist survivors by providing essential medical care including 
        psychosocial services, prevent transmission of HIV and other 
        sexually transmitted infections (STIs), ensure access to 
        emergency obstetric and newborn care, to contraceptive methods, 
        and to treatment of STIs, continue antiretroviral treatment, 
        and lay the groundwork for comprehensive reproductive health 
        care; and
            (3) as soon as conditions permit, ensure that comprehensive 
        reproductive health care programs, including comprehensive 
        family planning, are put in place for the duration of 
        displacement and are maintained as the relief phase ends and 
        communities transition to early recovery.
    (d) Coordination.--Assistance authorized under subsection (a) shall 
be coordinated in terms of policy, practice, and funding across and 
within relevant United States Government departments and agencies 
involved in emergency situations.

SEC. 7. ASSISTANCE TO PROMOTE SEXUAL AND REPRODUCTIVE HEALTH CARE FOR 
              YOUNG PEOPLE.

    (a) Assistance Authorized.--The President is authorized to provide 
assistance to ensure access to sexual and reproductive health care for 
young people in developing countries.
    (b) Priority.--In providing assistance authorized under subsection 
(a), the President shall prioritize a plan to increase comprehensive 
knowledge about sexuality among young people and improve sexual and 
reproductive health outcomes among young people, while improving 
coordination and implementation of host country and United States 
Government activities focused on adolescent and youth sexual and 
reproductive health.
    (c) Activities Supported.--Assistance provided under subsection (a) 
shall be used, among other things, to--
            (1) provide universal and affordable access to--
                    (A) evidence-based comprehensive sexuality 
                education and reproductive health education, in 
                consultation with local communities, in and outside 
                schools to ensure young people can delay sexual debut 
                and make informed decisions about their sexual and 
                reproductive health; and
                    (B) youth-friendly comprehensive sexual and 
                reproductive health care, including activities 
                described in section 4(b), as appropriate;
            (2) coordinate the achievement of the goals of sexual and 
        reproductive health programming for young people in United 
        States Government-funded programs;
            (3) educate implementers on best practices in adolescent 
        and youth programming and delivery and for effective 
        dissemination of policy guidelines regarding adolescent and 
        youth programming; and
            (4) incorporate the recommendations of young people in 
        program design and service delivery oriented for young people.

SEC. 8. STRATEGY TO INTEGRATE AND LINK SEXUAL AND REPRODUCTIVE HEALTH 
              SERVICES.

    (a) Strategy Required.--
            (1) In general.--The President shall develop and implement 
        a strategy to improve and create linkages among the various 
        components of sexual and reproductive health with each other 
        and with other global health care services, delivery, and 
        policies in order to meet the goal described in paragraph (2).
            (2) Goal described.--The goal of better linkages and 
        integration referred to in paragraph (1) is to ensure that 
        individual men and women are provided with a continuum of 
        sexual and reproductive health services that meet their needs. 
        Integration does not require that all of these services should 
        be provided by the same clinician or even in the same setting; 
        rather, there should be a mechanism in place, so that every 
        person has access to the sexual and reproductive health 
        services he or she needs, either directly or by referral.
    (b) Elements.--The strategy required by subsection (a) shall 
include the following:
            (1) In general, at the program level, supporting health 
        systems to link the various components of sexual and 
        reproductive health services both in terms of health system 
        management, such as integrating commodity and supply systems, 
        training, supervision, data collection and analysis, and 
        service provision, to ensure that people have access to a full 
        range of services in their community.
            (2) In general, such services should include prevention of 
        ill-health, provision of information and counseling, screening, 
        diagnosis and curative care and referral for a full range of 
        sexual and reproductive health and other health and social 
        services.
            (3) With respect to linkages and program integration of 
        sexual and reproductive health services, such services shall 
        include activities described in section 4(b).
            (4) With respect to linkages of sexual and reproductive 
        health services with other global health services, such 
        services shall include--
                    (A) counseling about and referrals to other related 
                health services such as addressing newborn, infant, and 
                child health (including educating families about proper 
                antenatal and delivery care, breastfeeding, hygiene, 
                and interventions for neonatal infections and life-
                threatening childhood illnesses), malaria, 
                tuberculosis, neglected tropical diseases, and proper 
                nutrition for all ages; and
                    (B) referrals to nearby, quality services that 
                cannot be provided by the primary provider and other 
                social services.

SEC. 9. COORDINATION; RESEARCH, MONITORING, AND EVALUATION.

    (a) Coordination.--Assistance authorized under this Act shall 
promote coordination between and among donors, the private sector, 
nongovernmental and civil society organizations, and governments in 
order to support comprehensive and responsive sexual and reproductive 
health programs in developing countries.
    (b) Research, Monitoring, and Evaluation.--
            (1) In general.--Assistance authorized under this Act shall 
        be used for the conduct of formative research and to monitor 
        and evaluate the effectiveness and efficiency of programs.
            (2) Requirements.--In carrying out paragraph (1), the 
        President shall ensure that there is--
                    (A) support for formative research on the 
                determinants of accessing sexual and reproductive 
                health products and services, and adopting healthy 
                behaviors related to sexuality and reproduction, to 
                inform program design;
                    (B) support for the ongoing, regular, and 
                systematic collection of information to serve as the 
                basis for monitoring change in population-based 
                outcomes;
                    (C) support for evaluations of programmatic 
                effectiveness by measuring the extent to which change 
                in population-based outcomes can be attributed to 
                program interventions or environmental factors;
                    (D) support for operations research that uses 
                appropriate scientific methods to compare different 
                interventions with the objective of increasing the 
                efficiency, effectiveness, and quality of programs;
                    (E) support for field research on the 
                characteristics of programs most likely to result in 
                sustained use of effective family planning in meeting 
                each individual's lifetime reproductive goals, with 
                particular emphasis on the perspectives of family 
                planning users, including support for relevant social 
                and behavioral research focusing on such factors as the 
                use, nonuse, and unsafe or ineffective use of various 
                contraceptive and related-disease control methods; and
                    (F) support for the development of new evaluation 
                techniques and performance criteria for sexual and 
                reproductive health programs, emphasizing the user's 
                perspective and reproductive goals.

SEC. 10. DEFINITIONS.

    In this Act:
            (1) Adolescent.--The term ``adolescent'' means an 
        individual who has attained the age of 10 years but not 20 
        years.
            (2) Comprehensive sexuality education.--The term 
        ``comprehensive sexuality education'' means helping young 
        people develop the interpersonal skills necessary for the 
        formation of caring, supportive, and non-coercive relationships 
        and the ability to exercise responsibility regarding sexual 
        relationships by addressing such issues as sexual diversity, 
        abstinence, and the use of condoms, contraceptives, and other 
        protective sexual health measures.
            (3) Integration.--The term ``integration'' means joining 
        together different kinds of services or operational programs, 
        either directly or by referral, to ensure more comprehensive 
        services, promote a continuum of care, and to maximize health 
        outcomes.
            (4) Linkages.--The term ``linkages'' means--
                    (A) the bi-directional synergies in policy, 
                programs, services, and advocacy related to sexual and 
                reproductive health, including HIV/AIDS; and
                    (B) refers to a broader human rights based 
                approach, of which service integration is a subset.
            (5) Reproductive health.--The term ``reproductive 
        health''--
                    (A) means a state of complete physical, mental, and 
                social well-being and not merely the absence of disease 
                or infirmity, in all matters relating to the 
                reproductive system and to its functions and processes; 
                and
                    (B) implies that an individual is able to have a 
                satisfying and safe sex life and that such individual 
                has the capability to reproduce and the freedom to 
                decide if, when, and how often to do so, including the 
                right of men and women to be informed and to have 
                access to safe, effective, affordable, and acceptable 
                methods of family planning of their choice, as well as 
                other methods of their choice for regulation of 
                fertility which are not against the law, and the right 
                of access to appropriate health-care services that will 
                enable women to go safely through pregnancy and 
                childbirth and provide couples with the best chance of 
                having a healthy infant.
            (6) Reproductive rights.--The term ``reproductive 
        rights''--
                    (A) means those rights that embrace certain human 
                rights that are already recognized in national laws, 
                international human rights documents, and other 
                consensus documents;
                    (B) includes the recognition of the basic right of 
                all couples and individuals to decide freely and 
                responsibly the number, spacing, and timing of their 
                children and to have the information and means to do 
                so, and the right to attain the highest standard of 
                sexual and reproductive health; and
                    (C) further includes the right of all couples and 
                individuals to make decisions concerning reproduction 
                free of discrimination, coercion, and violence, as 
                expressed in human rights documents.
            (7) Sexual health.--The term ``sexual health''--
                    (A) means a state of physical, emotional, mental, 
                and social well-being in relation to sexuality and not 
                merely the absence of disease, dysfunction, or 
                infirmity;
                    (B) includes a positive and respectful approach to 
                sexuality and sexual relationships, as well as the 
                possibility of having pleasurable and safe sexual 
                experiences, free of coercion, discrimination, and 
                violence; and
                    (C) further includes the sexual rights of all 
                persons to be respected, protected, and fulfilled.
            (8) Unmet need.--The term ``unmet need'' refers to nonuse 
        of a modern contraceptive method by an individual who is 
        married or unmarried and sexually active, is able to become 
        pregnant, and wants to stop childbearing or to wait at least 2 
        years before having a child.
            (9) Young people.--The term ``young people'' means those 
        individuals who have attained the age of 10 years but not 25 
        years.
            (10) Youth.--The term ``youth'' means an individual who has 
        attained the age of 15 years but not 25 years.
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