[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5441 Introduced in House (IH)]

111th CONGRESS
  2d Session
                                H. R. 5441

   To authorize assistance to aid in the prevention and treatment of 
    obstetric fistula in foreign countries, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 27, 2010

 Mrs. Maloney (for herself, Mr. Castle, and Mrs. Capps) introduced the 
 following bill; which was referred to the Committee on Foreign Affairs

_______________________________________________________________________

                                 A BILL


 
   To authorize assistance to aid in the prevention and treatment of 
    obstetric fistula in foreign 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 ``Obstetric Fistula Prevention, 
Treatment, Hope, and Dignity Restoration Act of 2010''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Every minute, one woman dies from pregnancy-related 
        complications. Of these deaths, 99 percent occur in the 
        developing world and 95 percent occur in Africa and Asia.
            (2) For every woman who dies from pregnancy-related 
        complications, an estimated 20 women survive but experience 
        pregnancy-related disabilities. One of the most severe is 
        obstetric fistula, which occurs when a woman who needs trained 
        medical assistance for a safe delivery, usually a cesarean 
        section, cannot get it.
            (3) Obstetric fistula is a hole that is formed between the 
        bladder and the vagina, or the rectum and the vagina (or both), 
        after a woman suffers from prolonged obstructed labor. In the 
        struggle to pass through the birth canal, the fetus puts 
        constant pressure, sometimes for several days, on the bladder 
        and vaginal or rectal walls, destroying the tissue that then 
        sloughs off, resulting in the abnormal opening.
            (4) In the majority of obstetric fistula cases, the baby 
        will be stillborn and the mother will experience physical pain 
        as well as social and emotional trauma from living with 
        incontinence as well as the loss of her child.
            (5) The physical symptoms of obstetric fistula include 
        incontinence or constant uncontrollable leaking of urine or 
        feces, frequent bladder infections, infertility, and foul odor.
            (6) Although data on obstetric fistula are scarce, the 
        World Health Organization (WHO) estimates there are more than 
        2,000,000 women living with fistula and 50,000 to 100,000 new 
        cases each year.
            (7) According to the United States State Department, ``The 
        combination of pregnancy at an early age, chronic maternal 
        malnutrition, and a lack of skilled care at delivery can all 
        contribute to the development of obstetric fistula and 
        permanent incontinence.''.
            (8) Obstetric fistula was once common throughout the world, 
        but over the last century was eliminated in Europe, North 
        America, and other developed regions through improved access to 
        medical interventions, particularly emergency obstetric care 
        for those women who need it.
            (9) The social consequences for women living with obstetric 
        fistula include isolation, divorce or abandonment, ridicule and 
        shame, inability to start a family, illness, risk of violence, 
        and lack of opportunity.
            (10) Obstetric fistula is preventable through medical 
        interventions such as skilled attendance present during labor 
        and childbirth, providing access to family planning, and 
        emergency obstetric care for women who develop childbirth 
        complications as well as social interventions such as delaying 
        early marriage and educating and empowering young women.
            (11) Obstetric fistula can also be surgically treated. 
        Surgery requires a specially trained surgeon and support staff, 
        and access to an operating theater and to attentive 
        postoperative care. When performed by a skilled surgeon, 
        success rates can be as high as 90 percent and cost an 
        estimated $300.
            (12) According to the Department of State, ``Because of 
        their roles in child rearing, providing and seeking care, and 
        managing water and nutrition, the ability of women to access 
        health-related knowledge and services is fundamental to the 
        health of their babies, older children and other family 
        members. Over the long-term, the health of women enhances their 
        productivity and social and economic participation and also 
        acts as a positive multiplier, benefitting social and economic 
        development through the health of future generations.''.
            (13) In 2002, the United Nations Population Fund (UNFPA) 
        and EngenderHealth embarked on the first ever assessments in 
        nine African countries to determine the need for and access to 
        services to address obstetric fistula. In 2003, UNFPA and 
        partners launched a global campaign to identify and address 
        obstetric fistula in an effort to develop a means to treat 
        those women who are suffering and provide the necessary health 
        services to prevent further cases. The campaign is currently 
        active in more than 45 countries in Africa, Asia, and the Arab 
        States region through support for fistula surgery, training of 
        doctors and nurses, equipping hospitals, and undertaking 
        community outreach to prevent further cases, and supporting 
        provision of rehabilitative care for women after treatment so 
        they can return to full and productive lives.
            (14) The global Campaign to End Fistula works with national 
        counterparts, including ministries of health, other pertinent 
        ministries, United Nations agencies, international and national 
        nongovernmental organizations, civil society organizations, and 
        fistula providers, in support of national processes and fistula 
        programmatic efforts. A key focus is national fistula capacity 
        strengthening.
            (15) In 2004, USAID provided funding through the ACQUIRE 
        Project managed by EngenderHealth to support services in two 
        countries, Bangladesh and Uganda. In 2007, USAID provided a 
        five-year cooperative agreement to EngenderHealth for the 
        Fistula Care project. USAID currently supports fistula 
        treatment services in 34 sites in 11 countries and addresses 
        prevention in those sites and 25 more. The ceiling for the 
        Fistula Care project is $70,000,000.
            (16) One of the key global health principles of the United 
        States Global Health Initiative is to strengthen and leverage 
        key multilateral organizations, global health partnerships, and 
        private sector engagement. The United States has committed to 
        join multilateral efforts involving the United Nations and 
        others to make progress toward achieving Millennium Development 
        Goals 4, 5, and 6.
            (17) By 2014, the United States through its Global Health 
        Initiative has committed to several targets that will reduce 
        the incidence of fistula, including through efforts to reduce 
        maternal mortality by 30 percent; prevent 54,000,000 unintended 
        pregnancies by reaching a modern contraceptive prevalence rate 
        of 35 percent; and reducing to 20 percent the number of first 
        births by women under 18 across assisted countries.

SEC. 3. PREVENTION AND TREATMENT OF OBSTETRIC FISTULA.

    (a) Authorization.--The President is authorized, in accordance with 
this section and section 4, to provide assistance, including through 
international organizations, national governments, and international 
and local nongovernmental organizations, to--
            (1) address the social and health issues that lead to 
        obstetric fistula; and
            (2) support treatment of obstetric fistula.
    (b) Activities.--Assistance provided pursuant to subsection (a) 
shall focus on--
            (1) increasing prevention through access to sexual and 
        reproductive health services, including skilled attendance at 
        birth, comprehensive emergency obstetric care, prenatal and 
        antenatal care, and contraception (family planning);
            (2) building local capacity and improving national health 
        systems to prevent and treat obstetric fistula within the 
        context of navigating pregnancy in good health overall;
            (3) supporting tools to enable countries to address 
        fistula, including supporting qualitative research, development 
        of sustainable financing mechanisms, training of skilled birth 
        attendants, promoting ``south-to-south'' training, and 
        provision of basic obstetric care at the community level;
            (4) addressing underlying social and economic inequities, 
        including empowering women and girls, reducing incidence of 
        child marriage, delaying childbirth, and increasing access to 
        formal and non-formal education; and
            (5) supporting reintegration and training programs to help 
        women who have undergone treatment return to full and 
        productive lives.

SEC. 4. COORDINATION, REPORTING, RESEARCH, MONITORING, AND EVALUATION.

    (a) In General.--Assistance authorized under this Act shall--
            (1) promote the coordination facilitated by the 
        International Obstetric Fistula Working Group, which 
        coordinates between and among donors, multilateral 
        institutions, the private sector, nongovernmental and civil 
        society organizations, and governments in order to support 
        comprehensive prevention and treatment of obstetric fistula; 
        and
            (2) be used for the development and implementation of 
        evidence-based programs, including monitoring, evaluation, and 
        research to measure the effectiveness and efficiency of such 
        programs throughout their planning and implementation phases.
    (b) Reporting.--Not later than December 31, 2011, and annually 
thereafter, the President shall transmit to Congress a report on 
activities undertaken pursuant to this Act during the preceding fiscal 
year to reduce the incidence of and increase treatment for obstetric 
fistula, and how such activities fit into existing national action 
plans to prevent and treat obstetric fistula.
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