1.This Act may be cited as the
Global Child Survival Act of
2009
.
2.
(a)Congress makes the following
findings:
(1)In 2000, the United States joined 188
countries in committing to achieve 8 Millennium Development Goals (MDGs) by
2015, including MDG 4 (Reduce child mortality)
, which aims to
reduce the mortality rate of children under the age of 5 by
2/3.
(2)The significant commitment of the United
States to reducing child mortality in the developing world contributed to a 25
percent reduction in the mortality rate of children under the age of 5 between
1990 and 2006, and over the past 20 years, the United States has invested over
$6,000,000,000 in child survival programs run by the United States Agency for
International Development (USAID). In 15 countries in Africa, Asia, and Latin
America that received assistance from USAID, under-5 mortality declined by an
average of 33 percent between 1996 and 2006 alone, with some countries
achieving a reduction as high as 50 percent.
(3)According to one of the world's leading
medical journals, the Lancet, despite United States and global efforts to
achieve MDG 4, of the 60 countries that account for 94 percent of under-5 child
deaths, only seven countries are on track to meet MDG 4, thirty-nine
countries are making some progress, although they need to accelerate the speed,
and fourteen countries are cause for serious concern
.
(4)8,800,000 children under the age of 5 die
annually, more than 24,000 children per day, mostly from preventable and
treatable causes, including 4,000,000 newborns who die in the first 4 weeks of
life, according to UNICEF.
(5)Pneumonia, diarrhea, low birth weight,
sepsis, birth trauma, and malaria, all of which are preventable and treatable
diseases, are the top contributors of deaths of children under the age of
5.
(6)More than 3,000,000 children die each year
due to lack of access to low-cost antibiotics, oral rehydration therapy, and
antimalarial drugs, and 2,500,000 die from diseases for which vaccines are
readily available.
(7)Nearly 1 of every 5 children die before the
age of 5, more than 2,000,000 deaths per year, in the 10 countries with the
highest child mortality rates in the world: Sierra Leone, Afghanistan, Chad,
Equatorial Guinea, Guinea-Bissau, Mali, Burkina Faso, Nigeria, Rwanda, and
Burundi.
(8)Approximately 536,000 women die every year,
99 percent of them in the developing world, from causes related to pregnancy
and childbirth.
(9)Maternal death rates are inextricably tied
to neonatal survival, with death rates for newborns increasing by 100 percent
in some countries in the developing world following maternal death.
(10)Risk factors for maternal death in
developing countries include pregnancy and childbirth at an early age, closely
spaced births, infectious diseases, malnutrition, and complications during
childbirth.
(11)According to the Lancet, nearly
2/3 of annual child and newborn deaths, or nearly
6,000,000 children under age 5, can be avoided in accordance with MDG 4 if a
package of high-impact, low-cost interventions were made available, including
oral rehydration therapy for diarrhea ($0.54 per course of treatment) and
antibiotics to treat respiratory infections ($0.71 per course of
treatment).
(12)2,000,000 lives could be saved annually by
providing oral rehydration therapy prepared with clean water.
(13)According to the World Health Organization
(WHO), Ready to Use Therapeutic Foods (RUTF) have proven to be safe,
cost-effective and highly effective in treating children with severe
malnutrition and in facilitating home-based, locally produced, care regimens.
Furthermore, according to the Journal of the American Medical Association
(JAMA), utilization of RUTF has shown promise in preventing at-risk children
from becoming malnourished.
(14)Exclusive breast feeding—giving only breast
milk for the first 6 months of life—could prevent an estimated 1,400,000
newborn and infant deaths each year, primarily by protecting against diarrhea
and pneumonia.
(15)Expansion of clinical care for newborns and
mothers, such as clean delivery by skilled attendants, emergency obstetric
care, and essential newborn care (neonatal resuscitation, infection management,
and special care for low weight newborns) can avert 50 percent of newborn
deaths and reduce maternal mortality.
(16)Controlling intestinal worms will help
prevent 16,000,000 cases of mental retardation and 200,000,000 years of lost
primary schooling among children in developing countries.
(17)The United Nations Children’s Fund
(UNICEF), with support from the World Health Organization, the World Bank, and
the African Union, has successfully demonstrated the accelerated child survival
and development program in Senegal, Mali, Benin, and Ghana, reducing mortality
of children under the age of 5 by 20 percent in targeted areas using low-cost,
high-impact interventions.
(18)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.
(19)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 (MDGs) America’s
goals.
.
(20)Nearing the halfway point of attaining the
MDGs by 2015 with thousands of avoidable newborn and child deaths still
occurring, the United States will need to immediately scale up its funding and
delivery of proven low-cost, life-saving interventions in order to fulfill its
commitment to help ensure that MDG 4 is met.
(21)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. According to the United States Agency for
International Development, hemorrhage, hypertensive disorders, anemia, and
sepsis account for 60 percent of all maternal deaths in the developing
world.
(22)According to the World Bank, the number of
orphaned children is expected to rise to 35,000,000 by 2010 due to the legacy
of AIDS and other diseases, war, and high rates of death in pregnancy and
childbirth.
(23)According to the World Health Organization,
women that have undergone female genital cutting (FGC) are significantly more
likely than those without FGC to experience serious postpartum health problems,
and children born to mothers who have undergone FGC face higher death rates
immediately after birth. According to the United Nations Interagency Statement
on Eliminating Female Genital Mutilation, programs that include education,
community involvement, public pledges and organized diffusion have been shown
to bring about the necessary consensus and coordination for the abandonment of
female genital cutting at the community level.
(24)According to the Director of National
Intelligence’s (DNI) 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.
(25)On March 27, 2009, Secretary of State
Hillary Clinton stated, Countries with higher infant mortality rates are
more vulnerable to political upheaval.
.
(26)According to UNICEF, relatively inexpensive
healthcare interventions, such as immunization programs, distribution of
insecticide-treated bed nets, and the utilization of micronutrient supplements,
have contributed to the lowest under-5 mortality rate since records began in
1960.
(b)The purposes of this Act are—
(1)to develop a strategy to reduce mortality
and improve the health of newborns, children, and mothers, and authorize
assistance for its implementation; and
(2)to establish a task force to assess,
monitor, and evaluate the progress and contributions of relevant departments
and agencies of the United States Government in achieving MDG 4.
3.Assistance to improve the health of
newborns, children, and mothers 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
newborn and child mortality
;
(2)in section 104(c)—
(A)by striking paragraphs (2) and (3);
and
(B)by redesignating paragraph (4) as paragraph
(2); and
(3)by inserting after section 104C the
following new section:
104D.Assistance to reduce mortality and improve
the health of newborns, children, and mothers
(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 the health of
newborns, children, and mothers in developing countries and to support efforts
to strengthen systems needed to build a continuum of maternal, newborn, and
child health services and link the formal health system with
communities.
(b)Assistance provided under subsection (a)
shall, to the maximum extent practicable, include—
(1)activities to improve essential newborn
care and treatment, including tetanus toxoid immunization, breastfeeding,
skin-to-skin care, birth asphyxia management, and treatment of
infections;
(2)activities to prevent and treat childhood
illness, including increasing access to appropriate treatment for diarrhea,
pneumonia, malaria, and other life-threatening childhood illnesses;
(3)activities to improve child and maternal
nutrition, including the delivery of iron, zinc, vitamin A, iodine, and other
key micronutrients, the promotion of breast feeding and appropriate
complementary feeding, and the utilization of Ready to Use Therapeutic Foods
(RUTF) to treat and prevent severe childhood malnutrition that, to the extent
practicable, are developed, purchased or produced in the country or region that
they are utilized;
(4)activities to strengthen the delivery of
immunization services, including efforts to strengthen routine immunization,
introduce new vaccines, and eliminate polio;
(5)activities to improve birth preparedness,
maternity services, and recognition and treatment of obstetric complications
and disabilities, including both near-term approaches such as household and
facility-based prevention and treatment of post-partum hemorrhage as well as
longer term investments in human and health system capabilities to deliver
emergency and comprehensive obstetric care;
(6)activities to improve household-level
behavior related to safe water, hygiene, exposure to indoor smoke, and
environmental toxins such as lead;
(7)activities to improve capacity for health
governance, health finance, and the health workforce, including 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;
(8)activities to address antimicrobial
resistance in treating child and maternal health infections;
(9)activities to establish and support the
management information systems of host country institutions and the development
and use of tools and models to collect, analyze, and disseminate information
related to newborn, child, and maternal health;
(10)activities to develop and conduct needs
assessments, baseline studies, targeted evaluations, or other
information-gathering efforts for the design, monitoring, and evaluation of
newborn, child, and maternal health efforts including—
(A)studying the effects of critical medicines,
particularly those of importance in the developing world, on pregnant women;
and
(B)studying the state of orphan care
services;
(11)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 counseling, care, and treatment
activities;
(B)malaria;
(C)tuberculosis;
(D)child spacing;
(E)counseling for new mothers and victims of
sexual violence; and
(F)neglected tropical diseases;
(12)activities to support scholarships to
educate girls through secondary education;
(13)activities to improve orphan care services
and to support innovative orphan and vulnerable children programs;
(14)activities to end female genital cutting
through proven programs that combine empowering human-rights based education,
organized diffusion, and public pledges for FGC abandonment;
(15)activities to improve access to clean water
and improved sanitation through community-based hygiene education programs, the
use of personal water purification tools and devices, and latrine construction;
and
(16)activities to prevent, control, and in some
cases eliminate neglected tropical diseases for both children 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 faith-based organizations, and relevant international
and multilateral organizations, including the GAVI Alliance and UNICEF, that
demonstrate effectiveness and commitment to improving the health of newborns,
children, and mothers;
(2)in all cases possible, carried out in the
context of country-led plans in whose development the United States Government
participates along with other donors and multilateral organizations,
non-government 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, 2010, 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. The
report shall include the most recent report submitted to the President by the
Interagency Task Force on Child Survival in Developing Countries under section
5(f) of the Global Child Survival Act of
2009.
(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.
.
(b)The Foreign Assistance Act of 1961 (22
U.S.C. 2151 et seq.) is amended—
(1)in section 104(c)(2) (as redesignated by
subsection (a)(1)(B) of this section), by striking and 104C
and
inserting 104C, and 104D
;
(2)in section 104A—
(A)in subsection (c)(1), by inserting
and section 104D
after section 104(c)
; and
(B)in subsection (f), by striking
section 104(c), this section, section 104B, and section 104C
and
inserting section 104(c), this section, section 104B, section 104C, and
section 104D
;
(3)in subsection (c) of section 104B, by
inserting and section 104D
after section
104(c)
;
(4)in subsection (c) of section 104C, by
inserting and section 104D
after section 104(c)
;
and
(5)in the first sentence of section 119(c), by
striking section 104(c)(2), relating to Child Survival Fund
and
inserting section 104D
.
4.Development of strategy to reduce mortality
and improve the health of newborns, children, and mothers in developing
countries
(a)The President shall develop and implement a
comprehensive strategy to reduce mortality and improve the health of newborns,
children, and mothers in developing countries.
(b)The comprehensive United States Government
strategy developed pursuant to subsection (a) shall include the
following:
(1)Using data compiled by the United Nations,
the World Bank, and other international organizations, an identification of not
less than 40 countries with priority needs for the 5-year period beginning on
the date of the enactment of this Act, to include—
(A)the number and rate of neonatal
deaths;
(B)the number and rate of child deaths;
and
(C)the number and ratio of maternal
deaths.
(2)For each country identified in paragraph
(1)—
(A)an assessment of the most common causes of
newborn, child, and maternal mortality;
(B)a description of the programmatic areas and
interventions providing maximum health benefits to populations at risk and
maximum reduction in mortality;
(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 newborn, child, and maternal health, including, to the extent
feasible, objective and quantifiable indicators.
(3)An expansion of the Child Survival and
Health Grants Program of the United States Agency for International
Development, at least proportionate to any increase in child and maternal
health assistance, to provide additional support programs and interventions
determined to be efficacious and cost-effective.
(4)Enhanced coordination among relevant
departments and agencies of the United States Government engaged in activities
to improve the health and well-being of newborns, children, and mothers in
developing countries.
(5)A description of the measured or estimated
impact on child and maternal 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.Interagency Task Force on Child Survival in
Developing Countries
(a)There is established a task force to be
known as the Interagency Task Force on Child Survival in Developing Countries
(in this section referred to as the Task Force
).
(b)
(1)The Task Force shall assess, monitor, and
evaluate the progress and contributions of relevant departments and agencies of
the United States Government in achieving MDG 4 in developing countries,
including by—
(A)identifying and evaluating programs and
interventions that directly or indirectly contribute to the reduction of
newborn, child, and maternal mortality rates;
(B)assessing effectiveness of programs,
interventions, and strategies toward achieving the maximum reduction of
newborn, child, and maternal mortality rates;
(C)assessing the level of coordination among
relevant departments and agencies of the United States Government, the
international community, international organizations, faith-based
organizations, academic institutions, the private sector, and host country for
input and coordination;
(D)assessing the contributions made by United
States-funded programs toward achieving MDG 4;
(E)identifying the bilateral efforts of other
nations and multilateral efforts toward achieving MDG 4; and
(F)preparing the annual report required by
subsection (f).
(2)To the maximum extent practicable, the Task
Force shall consult with individuals with expertise in the matters to be
considered by the Task Force who are not officers or employees of the United
States Government, including representatives of United States-based
nongovernmental organizations, the United Nations Children's Fund (UNICEF), the
World Bank, relevant agencies of foreign governments, academic institutions,
and private corporations.
(c)
(1)The Task Force shall be composed of the
following members:
(A)The Administrator of the United States
Agency for International Development.
(B)The Assistant Secretary of State for
Population, Refugees and Migration.
(C)The Coordinator of United States Government
Activities to Combat HIV/AIDS Globally.
(D)The Director of the Office of Global Health
Affairs of the Department of Health and Human Services.
(E)The Administrator of the Foreign
Agricultural Service of the Department of Agriculture.
(F)The Chief Executive Officer of the
Millennium Challenge Corporation.
(G)Other officials of relevant departments and
agencies of the Federal Government who shall be appointed by the
President.
(H)Two ex officio members appointed by the
Speaker of the House of Representatives in consultation with the minority
leader of the House of Representatives who may be members of the private sector
or nongovernmental organization community.
(I)Two ex officio members appointed by the
majority leader of the Senate in consultation with the minority leader of the
Senate who may be members of the private sector or nongovernmental organization
community.
(J)The Ambassador-at-Large for Global Women's
Issues.
(2)The Administrator of the United States
Agency for International Development shall serve as chairperson of the Task
Force.
(d)Members of the Task Force or their
designees shall meet on a regular basis, not less often than quarterly, on a
schedule to be agreed upon by the members of the Task Force, and starting not
later than 90 days after the date of the enactment of this Act.
(e)In this subsection, the term
Millennium Development Goals
means the key development
objectives described in the United Nations Millennium Declaration, as contained
in United Nations General Assembly Resolution 55/2 (September 2000).
(f)Not later than 180 days after the date of
the enactment of this Act and annually thereafter for 4 years, the Task Force
shall submit to the President a report on the implementation of this
section.
6.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 2010 through 2014, including such sums as
may be necessary under the development assistance (DA) account pursuant to
section 104D(b)(14) of the Foreign Assistance Act of 1961, as added by section
3(a)(2).
(b)Amounts appropriated pursuant to the
authorization of appropriations under subsection (a) are authorized to remain
available until expended.