1.This Act may be cited as the
Global Sexual and Reproductive Health
Act of 2010
.
2.
(a)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)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.
3.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.
4.Assistance to
support the achievement of universal access to sexual and reproductive
health
(a)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)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.
5.Assistance to
reduce the incidence of unsafe abortion and its consequences
(a)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)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
assistanceNotwithstanding 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.
6.Assistance to
provide sexual and reproductive health services during emergency
situations
(a)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)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)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)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.
7.Assistance to
promote sexual and reproductive health care for young people
(a)The President is authorized to provide assistance to
ensure access to sexual and reproductive health care for young people in
developing countries.
(b)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)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.
8.Strategy to
integrate and link sexual and reproductive health services
(a)
(1)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)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)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.
9.Coordination;
research, monitoring, and evaluation
(a)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)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)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.
10.In this Act:
(1)The
term adolescent means an individual who has attained the age of 10
years but not 20 years.
(2)Comprehensive
sexuality educationThe 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)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)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)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)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)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)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)The term young people means those individuals
who have attained the age of 10 years but not 25 years.
(10)The
term youth means an individual who has attained the age of 15
years but not 25 years.