1.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
.
2.
(a)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)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.
3.Assistance to
Improve Maternal and Newborn Health in Developing Countries
(a)Chapter 1 of part I of the Foreign Assistance Act of 1961
(22 U.S.C. 2151 et seq.) is amended—
(1)in section
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:
104D.Assistance to
Reduce Mortality and Improve Maternal and Newborn Health
(a)Consistent
with section 104(c), the President is authorized to furnish assistance, on such
terms and conditions as the President may determine, to reduce mortality and
improve maternal health and the health of newborns in developing
countries.
(b)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)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)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)In
this section:
(1)The
term AIDS has the meaning given the term in section 104A(g)(1) of
this Act.
(2)The
term HIV has the meaning given the term in section 104A(g)(2) of
this Act.
(3)The
term HIV/AIDS has the meaning given the term in section 104A(g)(3)
of this
Act.
.
4.Development of
Strategy to Reduce Mortality and Improve Maternal and Newborn Health in
Developing Countries
(a)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)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)Not
later than 180 days after the date of the enactment of this Act, the President
shall transmit to Congress a report that contains the strategy described in
this section.
5.Authorization of
appropriations
(a)There are authorized to be appropriated to carry out this
Act, and the amendments made by this Act, such sums as may be necessary for
each of fiscal years 2011 through 2015.
(b)Amounts appropriated pursuant to the authorization of
appropriations under subsection (a) are authorized to remain available until
expended.