[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5268 Introduced in House (IH)]

111th CONGRESS
  2d Session
                                H. R. 5268

    To provide assistance to improve maternal and newborn health in 
             developing countries, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 11, 2010

 Mrs. Capps (for herself, Ms. McCollum, Mrs. Christensen, Ms. Woolsey, 
Mrs. Maloney, Ms. Moore of Wisconsin, Ms. DeLauro, Ms. Clarke, Ms. Lee 
 of California, Ms. Wasserman Schultz, Mr. Loebsack, Mr. Grijalva, Ms. 
Schakowsky, Ms. Shea-Porter, Ms. Norton, Mrs. Davis of California, Mr. 
   Conyers, and Ms. Matsui) introduced the following bill; which was 
              referred to the Committee on Foreign Affairs

_______________________________________________________________________

                                 A BILL


 
    To provide assistance to improve maternal and newborn health 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 ``Improvements in Global Maternal and 
newborn health Outcomes while Maximizing Successes Act'' or 
``Improvements in Global MOMS Act''.

SEC. 2. FINDINGS AND PURPOSES.

    (a) Findings.--Congress makes the following findings:
            (1) In 2000, the United States joined 188 other countries 
        in supporting 8 United Nations Millennium Development Goals 
        (MDGs), including MDG 5, to reduce the maternal mortality ratio 
        by three-quarters by 2015. In 2005, universal access to 
        reproductive health was added as a target for MDG 5.
            (2) On January 15, 2009, United States Permanent 
        Representative to the United Nations Susan Rice stated before 
        the Committee on Foreign Relations of the Senate that President 
        Barack Obama is committed to ``making the Millennium 
        Development Goals America's goals.''.
            (3) With thousands of avoidable maternal deaths still 
        occurring, the United States will need to immediately scale up 
        its funding and delivery of proven low-cost, lifesaving 
        interventions in order to fulfill its commitment to help ensure 
        that MDG 5 is met.
            (4) Substantial progress in maternal health has been made 
        in some countries and regions: Egypt, Honduras, Malaysia, Sri 
        Lanka, and parts of Bangladesh have all halved their maternal 
        mortality ratios over the past few decades.
            (5) However, MDG 5 has made the least progress of all the 
        MDGs. At the current pace, MDG 5 will not be met in Asia until 
        2076 and much later in Africa.
            (6) An estimated 8,800,000 children under the age of 5 die 
        each year. Over 40 percent of these die in the first month of 
        life. And mortality rates are increasing for those born to 
        young mothers or where pregnancies are less than a year apart.
            (7) Hundreds of thousands of women die each year from 
        causes related to pregnancy and childbirth. Ninety-nine percent 
        of these deaths occur in the developing world and the vast 
        majority are preventable.
            (8) In sub-Saharan Africa, a woman's lifetime risk of 
        maternal death is a staggering 1 in 22, compared with 1 in 
        4,800 in the United States, according to the United Nations 
        Children's Fund (UNICEF).
            (9) Nine out of 10 women in sub-Saharan Africa will lose a 
        child during their lifetimes.
            (10) For every maternal death, approximately 20 women--or 
        10,000,000 women per year--suffer complications with severe 
        consequences, including pregnancy-related injuries such as 
        fistula, uterine prolapse, infections, diseases, and 
        disabilities.
            (11) The number one cause of maternal deaths is hemorrhage. 
        Other primary causes of maternal death include sepsis, unsafe 
        abortion, hypertensive disorder, and prolonged or obstructed 
        labor.
            (12) Violent acts against pregnant women can lead to poor 
        health outcomes, including preterm labor, preterm delivery, 
        miscarriage, and stillbirths, and even maternal deaths, and the 
        risk for maternal mortality is 3 times as high for abused 
        mothers.
            (13) The spacing of births has a powerful impact on a 
        child's chances of survival. Children born less than 2 years 
        after the previous birth are about 2.5 times more likely to die 
        before age 5 than children born 3 to 5 years after the previous 
        birth.
            (14) Pregnancy is the leading cause of death for young 
        women aged 15 to 19 worldwide. Compared to girls in their 
        twenties, girls aged 15 to 19 are twice as likely, and girls 
        under 15 five times as likely, to die in childbirth, and 
        mortality and morbidity rates are also higher among infants 
        born to young mothers.
            (15) Globally, 215,000,000 women would like to delay or end 
        childbearing, but do not have access to modern contraceptives. 
        Fully addressing this need would prevent an additional 
        53,000,000 unintended pregnancies each year and reduce maternal 
        deaths due to unsafe abortion by 82 percent.
            (16) If family planning and maternal and newborn services 
        were provided simultaneously, the costs of these services would 
        decline by $1,500,000,000 compared with investing in maternal 
        and newborn care alone--this dual investment would result in a 
        70 percent decline in maternal deaths and 44 percent decline in 
        newborn deaths.
            (17) Maternal death rates are inextricably tied to neonatal 
        survival, with the risk of death doubling for newborns in some 
        countries in the developing world following maternal death.
            (18) In many developing countries, including fragile states 
        and countries affected by conflict, lack of access to quality 
        health care facilities, health services, and trained providers 
        results in deaths for mothers, newborns, and children--the 
        majority of births in Africa take place without a skilled 
        attendant present, increasing the risk of death or disability 
        for both mother and newborn.
            (19) The experiences of United States Government-supported 
        and nongovernmental organization maternal and child health 
        programs in countries such as Nepal, Ethiopia, and Senegal have 
        demonstrated that community-based approaches, linked to primary 
        and referral care when possible, can deliver high-impact 
        interventions to prevent or treat many of the life-threatening 
        conditions affecting mothers, newborns, and children under the 
        age of 5.
            (20) More than half of all children and pregnant women in 
        developing countries suffer from anemia, which is exacerbated 
        by malaria, neglected tropical diseases, and nutritional 
        deficits, causing adverse pregnancy outcomes and even death.
            (21) According to WHO, women that have undergone female 
        genital mutilation are significantly more likely than those who 
        have not undergone female genital mutilation to experience 
        serious postpartum health problems, and children born to 
        mothers who have undergone female genital mutilation face 
        higher death rates immediately after birth.
            (22) According to the Director of National Intelligence's 
        2009 Annual Threat Assessment, widespread poor maternal and 
        child health and malnutrition has the potential to weaken 
        central governments and empower non-state actors, including 
        terrorist and paramilitary groups.
            (23) The United States Agency for International Development 
        has estimated the economic impact of maternal and newborn 
        mortality to be a global loss of over $15,000,000,000 due to 
        diminished productivity.
    (b) Purposes.--The purposes of this Act are--
            (1) to authorize assistance to improve maternal and newborn 
        health in developing countries; and
            (2) to develop a strategy to reduce mortality and improve 
        maternal and newborn health in developing countries.

SEC. 3. ASSISTANCE TO IMPROVE MATERNAL AND NEWBORN HEALTH IN DEVELOPING 
              COUNTRIES.

    (a) In General.--Chapter 1 of part I of the Foreign Assistance Act 
of 1961 (22 U.S.C. 2151 et seq.) is amended--
            (1) in section 102(b)(4)(B), by striking ``reduction of 
        infant mortality'' and inserting ``reduction of maternal and 
        newborn mortality''; and
            (2) by inserting after section 104C the following new 
        section:

``SEC. 104D. ASSISTANCE TO REDUCE MORTALITY AND IMPROVE MATERNAL AND 
              NEWBORN HEALTH.

    ``(a) Authorization.--Consistent with section 104(c), the President 
is authorized to furnish assistance, on such terms and conditions as 
the President may determine, to reduce mortality and improve maternal 
health and the health of newborns in developing countries.
    ``(b) Activities Supported.--Assistance provided under subsection 
(a) shall, to the maximum extent practicable, include--
            ``(1) activities to expand access and improve quality of 
        maternal health services, including--
                    ``(A) comprehensive voluntary family planning 
                services, integrated into antenatal and postnatal care 
                and in child health services, to support women and men 
                in making informed decisions and having timely, 
                intended, well-spaced pregnancies and to help women 
                with preexisting conditions avoid high-risk, unintended 
                pregnancies;
                    ``(B) birth preparedness through the provision of 
                quality antenatal care, including--
                            ``(i) educating women and families about 
                        danger signs to look for, potential 
                        complications during pregnancy and childbirth, 
                        and where to access care;
                            ``(ii) providing counseling about hygiene, 
                        nutrition, and the care and feeding of babies;
                            ``(iii) helping women and families develop 
                        a birth plan that includes skilled delivery 
                        care and a transport plan in case of 
                        emergencies;
                            ``(iv) screening for complications 
                        including blood pressure screenings;
                            ``(v) diagnosis and treatment of existing 
                        conditions, such as HIV/AIDS, syphilis, 
                        malaria, and tuberculosis, and ensuring that 
                        women are provided with, or referred to, 
                        appropriate care and treatment for those 
                        conditions;
                            ``(vi) ensuring that women infected with 
                        HIV are provided mother-to-child transmission 
                        prevention services, including access to 
                        voluntary family planning, medications to 
                        prevent such transmission, and counseling on 
                        infant feeding; and
                            ``(vii) making vaccines, micronutrients, 
                        and treatment for infections and parasites 
                        available and accessible;
                    ``(C) skilled delivery care, including--
                            ``(i) the presence of an accredited health 
                        professional, such as midwife, doctor, or 
                        nurse, who has been educated and trained to 
                        proficiency in the skills needed to manage 
                        normal or uncomplicated pregnancies, 
                        childbirth, and the immediate postnatal period, 
                        and in the identification, management, or 
                        referral of complications in women and 
                        newborns, including active management of the 
                        third stage of labor; and
                            ``(ii) an enabling environment that 
                        includes access to a referral system, 
                        communication and transport, drugs and 
                        supplies, and equipment appropriate for a 
                        normal delivery;
                    ``(D) quality emergency obstetric care, including--
                            ``(i) increasing the technical competence 
                        of health care providers;
                            ``(ii) increasing the essential supplies 
                        and equipment including fluids, blood products, 
                        and drugs to treat complications such as 
                        infection, bleeding, and hypertension;
                            ``(iii) providing the information and 
                        counseling for the client, including quality of 
                        client-provider interaction;
                            ``(iv) ensuring continuity of 
                        comprehensive, acceptable care, referrals and 
                        followup; and
                            ``(v) access to cesarean section when 
                        necessary;
                    ``(E) postpartum care and support, including--
                            ``(i) activities to promote immediate 
                        exclusive breastfeeding;
                            ``(ii) activities to promote essential care 
                        of newborns;
                            ``(iii) activities to treat, repair, and 
                        provide followup services for injuries 
                        resulting from pregnancy and childbirth, 
                        including fistula; and
                            ``(iv) family planning counseling and 
                        service provision; and
                    ``(F) postabortion care, including--
                            ``(i) emergency treatment of complications 
                        of unsafe abortion;
                            ``(ii) family planning counseling and 
                        services; and
                            ``(iii) linkages to other reproductive 
                        health services;
            ``(2) working with communities and health care providers to 
        identify and remove barriers to maternal health care services, 
        including barriers such as financial, sociocultural, 
        transportation, gender discrimination, and stigma based on 
        preexisting health concerns, and ensure that those services are 
        based in individual human rights, as recognized by 
        international agreements and instruments;
            ``(3) comprehensive sexuality education programs and 
        services for youth that provide adolescents with information, 
        skills, and materials necessary to postpone childbearing;
            ``(4) promotion of activities that focus on empowering 
        women and girls and engaging men and boys at the individual, 
        household, and community levels to improve the health outcomes 
        of women, newborns, and children including education and 
        awareness programs about gender-based violence, the health 
        risks of female genital mutilation, and shared responsibility 
        for and benefits of family planning;
            ``(5) activities to improve essential newborn care and 
        treatment, including educating families and communities about 
        proper antenatal and skilled delivery care, tetanus toxoid 
        immunization during pregnancy, immediate and exclusive 
        breastfeeding, keeping the newborn warm, such as by providing 
        skin-to-skin care, keeping the cord clean, resuscitation of 
        newborns who are not breathing properly, and treatment of 
        infections;
            ``(6) activities to prevent and treat childhood illness, 
        including early infant diagnosis of HIV infection and 
        increasing access to appropriate prevention and treatment for 
        diarrhea, pneumonia, malaria, HIV/AIDS, and other life-
        threatening childhood illnesses;
            ``(7) activities to improve child and maternal nutrition, 
        including the delivery of iron, zinc, vitamin A, iodine, and 
        other key micronutrients, the promotion of breastfeeding and 
        appropriate complementary feeding, and the utilization of Ready 
        to Use Therapeutic Foods (RUTF) that, to the extent 
        practicable, are developed, purchased, or produced in the 
        country or region that they are utilized;
            ``(8) activities to strengthen the delivery of immunization 
        services, including efforts to strengthen routine immunization, 
        introduce new vaccines for diseases such as rotavirus and 
        pneuomcoccal disease, and eliminate polio;
            ``(9) activities to improve household-level behavior 
        related to safe water, hygiene, safe and hygienic food 
        preparation and storage, exposure to indoor smoke, and 
        environmental toxins such as lead;
            ``(10) activities to improve capacity for health 
        governance, health finance, and the health workforce, including 
        in the private sector, and support for training clinicians, 
        nurses, technicians, sanitation and public health workers, 
        community-based health workers, midwives, birth attendants, 
        peer educators, volunteers, and private sector enterprises to 
        provide integrated health services and referrals that meet the 
        needs of patients across a continuum of care;
            ``(11) activities to address antimicrobial resistance in 
        treating maternal health infections;
            ``(12) activities to establish and support management of 
        host country institutions' information systems and the 
        development and use of tools and models to collect, analyze, 
        and disseminate information related to maternal and newborn 
        health;
            ``(13) activities to develop and conduct needs assessments, 
        baseline studies, targeted evaluations, or other information-
        gathering efforts for the design, monitoring, and evaluation of 
        maternal and newborn health efforts, including--
                    ``(A) studying the availability and effects of 
                critical medicines, particularly those of importance in 
                the developing world, on pregnant women and newborns;
                    ``(B) collection, evaluation, and use of data on 
                the medical and socioeconomic factors that led to a 
                maternal or newborn death or `near miss' at the 
                community and health facility levels; and
                    ``(C) sociocultural barriers, influencers, and 
                enhancers of health and nutrition behaviors;
            ``(14) activities to integrate and coordinate assistance 
        provided under this section with existing health programs for--
                    ``(A) the prevention of the transmission of HIV 
                from mother to child and other HIV/AIDS prevention, 
                care, treatment, and counseling activities;
                    ``(B) malaria;
                    ``(C) tuberculosis;
                    ``(D) family planning and reproductive health;
                    ``(E) counseling for survivors of sexual- and 
                gender-based violence;
                    ``(F) neglected tropical diseases; and
                    ``(G) nutrition;
            ``(15) activities to improve orphan care services and to 
        support innovative orphan and vulnerable children programs;
            ``(16) activities to end harmful traditional practices 
        including female genital mutilation and child marriage;
            ``(17) activities to train health care providers to 
        prevent, identify, and manage cases of gender-based violence as 
        part of family planning and maternal and newborn health 
        services;
            ``(18) activities to support mental health care and provide 
        psychosocial support;
            ``(19) activities to improve access to clean water and 
        improved sanitation through community-based hygiene education 
        programs, access to household- and community-level water 
        purification tools and devices, and latrine construction; and
            ``(20) activities to prevent, control, and in some cases 
        eliminate neglected tropical diseases for both newborns and 
        mothers.
    ``(c) Guidelines.--To the maximum extent practicable, programs, 
projects, and activities carried out using assistance provided under 
this section shall be--
            ``(1) carried out through private and voluntary 
        organizations, including community and faith-based 
        organizations, and relevant international and multilateral 
        organizations, including the United Nations Population Fund, 
        the United Nations Children's Fund, and the Global Alliance for 
        Vaccines and Immunizations, that demonstrate effectiveness and 
        commitment to improving the health and rights of mothers, 
        newborns, and children;
            ``(2) carried out in the context of country-driven plans in 
        whose development the United States Government participates 
        along with other donors and multilateral organizations, 
        nongovernmental organizations, and civil society;
            ``(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.
    ``(d) Annual Report.--Not later than January 31, 2011, and annually 
thereafter for 4 years, the President shall transmit to Congress a 
report on the implementation of this section for the prior fiscal year.
    ``(e) Definitions.--In this section:
            ``(1) AIDS.--The term `AIDS' has the meaning given the term 
        in section 104A(g)(1) of this Act.
            ``(2) HIV.--The term `HIV' has the meaning given the term 
        in section 104A(g)(2) of this Act.
            ``(3) HIV/AIDS.--The term `HIV/AIDS' has the meaning given 
        the term in section 104A(g)(3) of this Act.''.

SEC. 4. DEVELOPMENT OF STRATEGY TO REDUCE MORTALITY AND IMPROVE 
              MATERNAL AND NEWBORN HEALTH IN DEVELOPING COUNTRIES.

    (a) Development of Strategy.--The President shall develop and 
implement a comprehensive strategy as part of the Global Health 
Initiative to reduce mortality and improve the health of mothers and 
newborns in developing countries.
    (b) Components.--The comprehensive United States Government 
strategy developed pursuant to subsection (a) shall include the 
following:
            (1) An identification of not less than 30 countries, 
        including fragile states and countries affected by conflict, 
        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 maternal deaths;
                    (C) the number and rate of malnourished women of 
                reproductive age; and
                    (D) the number of individuals with an unmet need 
                for family planning.
            (2) For each country identified in paragraph (1)--
                    (A) an assessment of the most common causes of 
                maternal and newborn mortality and morbidity;
                    (B) a description of the programmatic areas and 
                interventions providing maximum health benefits to 
                populations at risk and maximum reduction in mortality 
                and morbidity;
                    (C) an assessment of the investments needed in 
                identified programs and interventions to achieve the 
                greatest results;
                    (D) a description of how United States assistance 
                complements and leverages efforts by other donors and 
                builds capacity and self-sufficiency among recipient 
                countries; and
                    (E) a description of goals and objectives for 
                improving maternal and newborn health, including, to 
                the extent feasible, objective and quantifiable 
                indicators.
            (3) Enhanced coordination among relevant departments and 
        agencies of the United States Government engaged in activities 
        to improve the health and well-being of mothers and newborns in 
        developing countries.
            (4) A description of the measured or estimated impact on 
        maternal and newborn morbidity and mortality of each project or 
        program.
    (c) Report.--Not later than 180 days after the date of the 
enactment of this Act, the President shall transmit to Congress a 
report that contains the strategy described in this section.

SEC. 5. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--There are authorized to be appropriated to carry 
out this Act, and the amendments made by this Act, such sums as may be 
necessary for each of fiscal years 2011 through 2015.
    (b) Availability of Funds.--Amounts appropriated pursuant to the 
authorization of appropriations under subsection (a) are authorized to 
remain available until expended.
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