[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2888 Introduced in House (IH)]

113th CONGRESS
  1st Session
                                H. R. 2888

   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

                             July 31, 2013

  Mrs. Carolyn B. Maloney of New York (for herself, Mr. Conyers, Mr. 
 Crowley, Mr. Farr, Mr. Grijalva, Mr. Johnson of Georgia, Ms. Lofgren, 
  Ms. McCollum, Mr. McDermott, Ms. Moore, Mr. Moran, and Ms. Speier) 
 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 2013''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Every minute, one woman dies from pregnancy-related 
        complications. Of these deaths, 99 percent occur in developing 
        countries. Over half of these deaths are in sub-Saharan Africa 
        and one third are in South 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 Department of State, ``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. The first fistula hospital in the 
        world stood where the Waldorf-Astoria Hotel is now located in 
        New York City.
            (9) The social consequences for women living with obstetric 
        fistula include isolation, divorce or abandonment, ridicule and 
        shame, loss of social belonging and association, illness and 
        malnutrition, risk of violence, and lack of economic 
        opportunities. Girls with obstetric fistula are also often 
        unable to continue schooling. Victims suffer psychological 
        consequences, such as feelings of hopelessness, self-hatred, 
        sadness, depression, and suicide, because of stigma and lack of 
        awareness that their condition is treatable. Fistula victims 
        need regular medical attention and an extra supply of soap to 
        keep clean, placing a huge financial burden on already poor 
        families. They also lose property when they are divorced or 
        abandoned by their husbands and family. Some lose jobs or are 
        denied work, while others quit their jobs out of shame, leading 
        to deepened poverty and vulnerability to repeat fistulas.
            (10) Obstetric fistula is preventable through medical 
        interventions, such as skilled attendance, including midwives, 
        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, the United States Agency for International 
        Development (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, contraception (family planning), and supporting 
        comprehensive sexuality education;
            (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 
        obstetric fistula, including supporting qualitative research 
        and data collection on the incidence and prevalence of 
        obstetric fistula, development of sustainable financing 
        mechanisms to encourage facility deliveries and provide fistula 
        survivors access to free or affordable treatment, training of 
        midwives and 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;
            (5) supporting reintegration and training programs to help 
        women who have undergone treatment return to full and 
        productive lives; and
            (6) promoting public awareness to increase understanding of 
        obstetric fistula, and thereby improve prevention and treatment 
        efforts, to help reduce stigma and violence against women and 
        girls with obstetric fistula.

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 one year after the date of the 
enactment of this Act 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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