[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3206 Introduced in House (IH)]
113th CONGRESS
1st Session
H. R. 3206
To promote the sexual and reproductive health of individuals and
couples in developing countries, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 27, 2013
Ms. Clarke (for herself, Ms. Bass, Ms. Brown of Florida, Mr. Clay, Mr.
Conyers, Mrs. Davis of California, Mr. Ellison, Mr. Enyart, Mr.
Grijalva, Ms. Norton, Mr. Honda, Mr. Huffman, Ms. Jackson Lee, Mr.
Jeffries, Ms. Lee of California, Mrs. Carolyn B. Maloney of New York,
Mr. McGovern, Ms. Moore, Mr. Moran, Mr. Quigley, Mr. Rangel, Mr. Rush,
Ms. Schakowsky, Ms. Slaughter, Ms. Wasserman Schultz, Ms. Waters, and
Mr. Bera of California) introduced the following bill; which was
referred to the Committee on Foreign Affairs
_______________________________________________________________________
A BILL
To promote the sexual and reproductive health of individuals and
couples 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 ``Global Sexual and Reproductive
Health Act of 2013''.
SEC. 2. FINDINGS AND PURPOSES.
(a) Findings.--Congress makes the following findings:
(1) The advancement of sexual and reproductive health is
central to the global development agenda and necessary to
meeting most of the eight United Nations Millennium Development
Goals (MDGs), the current international development framework
developed by 189 countries, including the United States. Target
5B, which is found under MDG 5 on improving maternal health and
which requires achieving universal access to reproductive
health, is an essential element in attaining MDGs related to
eradicating poverty (MDG 1), achieving universal education (MDG
2), promoting gender equality (MDG 3), reducing child mortality
(MDG 4), improving maternal health (MDG 5), combating HIV/AIDS
(MDG 6), and ensuring environmental sustainability (MDG 7).
Furthermore, advancement of sexual and reproductive health and
rights will be critical in building on the achievements of the
MDGs when they expire in 2015 and realizing the core goals of
poverty reduction and sustainable development in the post-2015
development agenda.
(2) The resolution of the 2013 United Nations Commission on
Population and Development ``recognize[es] that . . . sexual
and reproductive health and reproductive rights . . . as well
as . . . population and development, education and gender
equality, are integrally linked to global efforts to eradicate
poverty and achieve sustainable development . . . .''.
(3) Throughout much of the world, the lack of access of
women, particularly poor women, to basic reproductive health
services and information contributes to death and suffering
among women and their families, undermines women's struggle for
self-determination, and vitiates the efforts of families to
lift themselves out of the poverty in which over a billion of
the world's people live. By allowing individuals and couples to
choose the number and timing of their children, reproductive
health care gives families and individuals greater control over
their economic resources.
(4) Aspects of sexual and reproductive health, including
maternal mortality and morbidity, reproductive cancers, and
sexually transmitted infections (STIs), including HIV, account
for nearly 20 percent of the global burden of ill-health for
women and some 14 percent for men, according to the World
Health Organization (WHO).
(5) According to the Joint United Nations Programme on HIV/
AIDS (UNAIDS), HIV/AIDS is the leading cause of death among
women of childbearing age.
(6) School-based education and family planning play an
interrelated role in lifting the status of women. Delaying
sexual debut, along with contraceptive use among young women
already sexually active, lowers the likelihood that young women
will leave their schooling due to pregnancy, and education
increases the chances that young women will delay the age at
which they marry and give birth.
(7) Sexual and reproductive health programs can empower
women to make informed decisions and better control their
lives, and by engaging men and boys in taking responsibility
for the sexual and reproductive health of their partners, can
contribute to greater gender equality.
(8) Access to sexual and reproductive health services,
including family planning, has a direct and important impact on
infant and child mortality. By allowing women to choose the
timing, number, and spacing of their pregnancies, high-risk
births are averted, and the children that are born have a
greater chance of surviving to adulthood. Over 3,000,000
newborns die in the first 4 weeks of life, which accounts for
nearly 40 percent of all deaths of children under the age of 5.
By providing women family planning services to space their
births 3 years apart, rates for under-5 mortality would drop by
25 percent, averting 1,800,000 children's deaths each year.
(9) Increasing access to sexual and reproductive health
could significantly decrease pregnancy-related mortality and
morbidity by reducing the number of pregnancies that place
women at increased risk of experiencing such complications.
(10) An estimated 222,000,000 women in developing countries
have an unmet need for effective, modern contraceptives and
would like to postpone childbearing, space births, or want no
more children but are not using a modern method of
contraception. Providing modern contraceptives to fill this
unmet need would avert an estimated additional 54,000,000
unintended pregnancies each year, including 21,000,000
unplanned births and 26,000,000 abortions, 16,000,000 of which
would be unsafe. In turn, this would prevent 79,000 maternal
deaths and 1,100,000 infant deaths.
(11) Complications due to pregnancy and childbirth are a
leading cause of death among adolescent females ages 15 to 19
in low- and middle-income countries. Each year, an estimated
287,000 women worldwide die from complications related to
pregnancy, childbirth, or unsafe abortion.
(12) Unsafe abortion accounts for 13 percent of maternal
deaths worldwide. More than half of abortions (56 percent) in
the developing world are unsafe. Of the 22,000,000 unsafe
abortions that take place each year, nearly all occur in the
developing world. Around 47,000 women die and millions more
suffer serious injuries from the complications of unsafely
performed abortions. Abortion rates are similar in countries
whether abortion is illegal or legal, with evidence suggesting
abortion rates may in fact be higher in countries where it is
illegal. Regardless, death and injury from unsafe abortion is
greatly reduced where abortion is legal for a broad range of
indications and where safe abortion is accessible.
(13) Meeting the need for family planning services and
pregnancy-related care, by doubling the current global
investment for both, would prevent millions of needless cases
of maternal and newborn deaths and disabilities.
(14) Worldwide, women of childbearing age account for more
than half of people living with HIV/AIDS. Integrating
reproductive health services, including family planning, with
HIV prevention programs, such as those for voluntary counseling
and testing and prevention of mother-to-child transmission, is
essential to effectively combating HIV/AIDS and other STIs.
(15) The world is witnessing the largest generation of
young people in history--almost half of the world's population,
approximately 3,000,000,000 people, are under the age of 25.
Unmet need for sexual and reproductive health services is
highest among this age cohort. Fewer than 5 percent of the
poorest sexually active youth use modern contraception.
(16) The WHO has identified unsafe sex as the second most
important risk factor for disability and death among young
people in the world's poorest communities. Forty percent of all
new adult HIV infections occur among young people ages 15-24.
(17) Sixty percent of unsafe abortions in Africa, 42
percent in Latin America and the Caribbean, and 30 percent in
Asia are undergone by women under the age of 25.
(18) The WHO has identified a 4-pronged approach to
preventing HIV infection in infants, which includes prevention
of unintended pregnancy among HIV-infected women as a key
strategy to prevent mother-to-child transmission of HIV.
(19) According to the World Health Organization, enabling
HIV-positive women who want to avoid a pregnancy access to
contraceptive services can prevent as many as 160,000
additional HIV-positive births each year in high HIV prevalence
countries.
(20) Demographic factors exacerbate problems related to
environmental sustainability. The past century of population
growth has put increasing pressure on natural resources as the
scale of human needs and activities expands. At the same time,
actual family size in most developing countries remains greater
than the desired family size. Access to family planning
services helps couples to determine their own family size,
hence mitigating the depletion of natural resources like clean
water, air, and land.
(21) Practices like early and forced marriage, female
genital mutilation/cutting, and early sexual debut adversely
impact the sexual and reproductive health of young people in
many developing countries, and strong barriers exist to
providing the information, services, and other forms of support
that young people need to lead healthy sexual and reproductive
lives.
(22) Comprehensive sexuality education seeks to help young
people develop the interpersonal skills necessary for the
formation of caring, supportive, and noncoercive relationships
and the ability to exercise responsibility regarding sexual
relationships by addressing such issues as abstinence and the
use of condoms, contraceptives, and other protective sexual
health measures.
(23) The United Nations has estimated that the minimum
financial requirements for sexual and reproductive health,
including family planning and maternal health, are roughly
$32,700,000,000 in 2013 and increase to approximately
$33,000,000,000 in 2015. The minimum financial requirement for
HIV/AIDS is estimated at $34,700,000,000 in 2013, and increases
to $36,200,000,000 in 2015. As agreed in the International
Conference on Population and Development's Programme of Action,
which the United States committed to, developed-country donors
are responsible for one-third of the total cost needed per
year. Developing countries are responsible for the remaining
two-thirds, on average, with low income countries requiring a
larger share of external funding.
(24) The United States has had a history of supporting and
recognizing the fundamental health and human rights of all
people through the signing or ratifying of various
international agreements. Those agreements include the
Universal Declaration of Human Rights (1948), the International
Covenant on Civil and Political Rights (1966), the
International Covenant on Economic, Social, and Cultural Rights
(1966), the Convention on the Elimination of All Forms of
Discrimination Against Women (1979), the Convention on the
Rights of the Child (1989), the International Conference on
Population and Development Programme of Action (1994), the
United Nations Millennium Development Goals (2000), and the
Convention on the Rights of Persons with Disabilities (2009).
(25) The United States has been the largest donor to
international family planning and reproductive health efforts
over the last 40 years and has been an unparalleled source of
leadership and innovation in the field. Nonetheless, it has not
met its fair share of financial assistance to global sexual and
reproductive health programs. Now is the time to shore up the
United States political and financial commitment in order to
satisfy the large unmet need for these services, thereby
helping to improve women's and young people's sexual and
reproductive health worldwide.
(b) Purposes.--The purposes of this Act are to--
(1) authorize assistance to improve the sexual and
reproductive health of individuals and couples in developing
countries; and
(2) implement comprehensive sexual and reproductive health
programs offering a continuum of care that are responsive to
the sexual and reproductive health needs of young people and
adults.
SEC. 3. STATEMENT OF POLICY.
The following shall be the policy of the United States Government:
(1) All individuals and couples shall have the basic
reproductive right to decide freely and responsibly the number,
spacing, and timing of their children and shall have the
information and means to do so, and the right to attain the
highest standard of sexual and reproductive health.
(2) All individuals and couples also shall have the right
to make decisions concerning reproduction free of
discrimination, coercion, and violence, as expressed in human
rights documents.
(3) The promotion of the responsible exercise of these
reproductive rights for all people shall be the fundamental
basis for sexual and reproductive health programs supported by
United States Government assistance.
(4) The principle of free and informed consent must
underlie all sexual and reproductive health programs and
services. This principle applies to individuals whether they
choose to continue or terminate their pregnancies--thus, forced
pregnancies as well as forced abortions or sterilizations are
prohibited. Decisions relating to contraceptive use should be
made on an informed and voluntary basis after adequate
information, counseling, and services are provided on a range
of methods.
(5) Incentives and disincentives should not be used in
family planning programs in order to meet numerical population
targets or quotas for fertility goals. Instead, governments
should use other indicators, such as unmet needs, to define
family planning goals.
(6) In sexual and reproductive health programs funded by
the United States Government, special attention should be paid
to serving the needs of young people.
SEC. 4. ASSISTANCE TO SUPPORT THE ACHIEVEMENT OF UNIVERSAL ACCESS TO
SEXUAL AND REPRODUCTIVE HEALTH.
(a) Assistance Authorized.--The President is authorized to provide
assistance in order to support the achievement of universal access to
sexual and reproductive health in developing countries and to ensure
individuals and couples in developing countries can freely and
responsibly determine the number, timing, and spacing of their children
and have the means to do so.
(b) Activities Supported.--Assistance provided under subsection (a)
may be used to--
(1) expand access to and use of voluntary family planning
information and services, to enable individuals and couples to
avoid unintended pregnancies and other risks to sexual and
reproductive health, including those associated with pregnancy,
reproductive tract infections, and sexually transmitted
infections (STIs), including HIV;
(2) improve public knowledge of contraceptives, including
where methods may be obtained, and risk-reduction strategies,
and to promote the benefits of family planning and other sexual
and reproductive health care to individuals, families, and
communities, including through the use of education and
awareness programs, mass media, and community mobilization and
outreach;
(3) increase the responsiveness of sexual and reproductive
health programs to the needs of the intended beneficiaries
during the entirety of their sexual and reproductive lives,
including young people and older adults;
(4) reduce the incidence of unsafe abortion, including
research on the health consequences of unsafe abortion, and
provide for the equipment and training necessary for medical
treatment of the consequences of unsafe abortions;
(5) notwithstanding any other provision of law, provide
safe abortion, to the extent permitted by the laws of the
recipient country;
(6) promote the integration of family planning services in
HIV and other STI prevention, treatment, care, and support;
(7) integrate family planning services with maternal and
newborn health care, especially in antenatal, post-partum, and
post-abortion care settings;
(8) ensure the consistent availability and affordability of
high-quality sexual and reproductive health supplies and
services, including male and female condoms, for the prevention
of HIV and other STIs;
(9) encourage the abandonment of female genital mutilation,
early marriage, early childbearing, and other harmful
traditional practices that have negative reproductive health
consequences;
(10) prevent and repair obstetric fistula;
(11) promote the constructive engagement of men and boys,
the empowerment of women and girls, and more equitable gender
norms in order to improve health outcomes and support the
adoption of healthy reproductive behaviors;
(12) prevent and mitigate gender-based violence;
(13) provide comprehensive sexuality education for young
people;
(14) prevent, diagnose, and treat, where appropriate,
infertility and cancers of the reproductive system and refer as
appropriate;
(15) develop improved methods of safe and effective
contraception and related disease control through investments
in biomedical research, with particular emphasis on methods
which--
(A) are likely to be safer, easier to use, more
efficient to make available in developing country
settings, and less expensive than current methods;
(B) are controlled by women, including barrier
methods and microbicides;
(C) are likely to prevent the spread of STIs; and
(D) encourage and enable men to take greater
responsibility for their own fertility and the
protection of their partner;
(16) support an enabling environment for women to access
sexual and reproductive health care services by working with
communities to identify and lower or remove barriers to access,
including financial, gender, sociocultural, and transportation
barriers;
(17) train health care professionals on educating
individuals, including young people, about their sexual and
reproductive health care options, including family planning
options; and
(18) foster conditions to create favorable policy
environments, improve quality, strengthen systems, and
contribute to the sustainability of family planning and other
reproductive health programs.
SEC. 5. ASSISTANCE TO REDUCE THE INCIDENCE OF UNSAFE ABORTION AND ITS
CONSEQUENCES.
(a) Assistance Authorized.--The President is authorized to provide
assistance to reduce the incidence of unsafe abortion in developing
countries and provide care for women experiencing injury or illness
from complications of unsafe abortion in developing countries.
(b) Activities Supported.--Assistance provided under subsection (a)
shall be used to--
(1) ensure access to family planning services to prevent
unintended pregnancies;
(2) ensure that women who experience an unintended
pregnancy have access to reliable information and compassionate
counseling on all of their options, including access to
antenatal care and safe abortion when permitted by the laws of
the recipient country;
(3) where local laws permit abortion, support safe abortion
services, including referrals, and support the training of
abortion providers and the necessary equipment and commodities
for surgical and medical abortion; and
(4) support emergency treatment for complications of
induced or spontaneous abortion, including provision of
services and training and equipping of providers.
(c) Eligibility for Assistance.--Notwithstanding any other
provision of law, regulation, or policy, in determining eligibility for
assistance authorized under this section, sections 104, 104A, 104B, and
104C of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b, 2151b-2,
2151b-3, and 2151b-4), foreign nongovernmental organizations--
(1) shall not be ineligible for such assistance solely on
the basis of health or medical services, including counseling
and referral services, provided by such organizations with non-
United States Government funds if such services are permitted
in the country in which they are being provided and would not
violate United States Federal law if provided in the United
States; and
(2) shall not be subject to requirements relating to the
use of non-United States Government funds for advocacy and
lobbying activities other than those that apply to United
States nongovernmental organizations receiving assistance under
part I of the Foreign Assistance Act of 1961.
SEC. 6. ASSISTANCE TO PROVIDE SEXUAL AND REPRODUCTIVE HEALTH SERVICES
DURING EMERGENCY SITUATIONS.
(a) Assistance Authorized.--The President is authorized to provide
assistance, including through international organizations, national
governments, and international and local nongovernmental organizations,
to ensure that sexual and reproductive health services are provided in
developing countries at every phase of a humanitarian emergency,
including early recovery.
(b) Priority.--In providing assistance authorized under subsection
(a), the President shall give priority to--
(1) those reproductive health services that are essential
in emergencies, whether they are conflict or natural disaster
settings, to save lives and help survivors fulfill their
potential even under the most difficult circumstances; and
(2) building local capacity and improving national systems
whenever possible during displacement and early recovery.
(c) Activities Supported.--Assistance provided under subsection (a)
shall be used to--
(1) direct the Secretary of State and the Administrator of
the United States Agency for International Development to
implement the Minimum Initial Services Package (MISP), a set of
life-saving priority activities that must be put in place in
the earliest days of an emergency and that is set out in the
Sphere Project's Humanitarian Charter and Minimum Standards in
Disaster Response;
(2) among other activities, establish critical reproductive
health coordination mechanisms, prevent sexual violence and
assist survivors by providing essential medical care including
psychosocial services, prevent transmission of HIV and other
sexually transmitted infections (STIs), ensure access to
emergency obstetric and newborn care, to contraceptive methods,
and to treatment of STIs, continue antiretroviral treatment,
and lay the groundwork for comprehensive reproductive health
care; and
(3) as soon as conditions permit, ensure that comprehensive
reproductive health care programs, including comprehensive
family planning, are put in place for the duration of
displacement and are maintained as the relief phase ends and
communities transition to early recovery.
(d) Coordination.--Assistance authorized under subsection (a) shall
be coordinated in terms of policy, practice, and funding across and
within relevant United States Government departments and agencies
involved in emergency situations.
SEC. 7. ASSISTANCE TO PROMOTE SEXUAL AND REPRODUCTIVE HEALTH CARE FOR
YOUNG PEOPLE.
(a) Assistance Authorized.--The President is authorized to provide
assistance to ensure access to sexual and reproductive health care for
young people in developing countries.
(b) Priority.--In providing assistance authorized under subsection
(a), the President shall prioritize a plan to increase comprehensive
knowledge about sexuality among young people and improve sexual and
reproductive health outcomes among young people, while improving
coordination and implementation of host country and United States
Government activities focused on adolescent and youth sexual and
reproductive health.
(c) Activities Supported.--Assistance provided under subsection (a)
shall be used, among other things, to--
(1) provide universal and affordable access to--
(A) evidence-based comprehensive sexuality
education and reproductive health education, in
consultation with local communities, in and outside
schools to ensure young people can delay sexual debut
and make informed decisions about their sexual and
reproductive health; and
(B) youth-friendly comprehensive sexual and
reproductive health care, including activities
described in section 4(b), as appropriate;
(2) coordinate the achievement of the goals of sexual and
reproductive health programming for young people in United
States Government-funded programs;
(3) educate implementers on best practices in adolescent
and youth programming and delivery and for effective
dissemination of policy guidelines regarding adolescent and
youth programming; and
(4) incorporate the recommendations of young people in
program design and service delivery oriented for young people.
SEC. 8. STRATEGY TO INTEGRATE AND LINK SEXUAL AND REPRODUCTIVE HEALTH
SERVICES.
(a) Strategy Required.--
(1) In general.--The President shall develop and implement
a strategy to improve and create linkages among the various
components of sexual and reproductive health with each other
and with other global health care services, delivery, and
policies in order to meet the goal described in paragraph (2).
(2) Goal described.--The goal of better linkages and
integration referred to in paragraph (1) is to ensure that
individual men and women are provided with a continuum of
sexual and reproductive health services that meet their needs.
Integration does not require that all of these services should
be provided by the same clinician or even in the same setting;
rather, there should be a mechanism in place, so that every
person has access to the sexual and reproductive health
services he or she needs, either directly or by referral.
(b) Elements.--The strategy required by subsection (a) shall
include the following:
(1) In general, at the program level, supporting health
systems to link the various components of sexual and
reproductive health services both in terms of health system
management, such as integrating commodity and supply systems,
training, supervision, data collection and analysis, and
service provision, to ensure that people have access to a full
range of services in their community.
(2) In general, such services should include prevention of
ill-health, provision of information and counseling, screening,
diagnosis and curative care and referral for a full range of
sexual and reproductive health and other health and social
services.
(3) With respect to linkages and program integration of
sexual and reproductive health services, such services shall
include activities described in section 4(b).
(4) With respect to linkages of sexual and reproductive
health services with other global health services, such
services shall include--
(A) counseling about and referrals to other related
health services such as addressing newborn, infant, and
child health (including educating families about proper
antenatal and delivery care, breastfeeding, hygiene,
and interventions for neonatal infections and life-
threatening childhood illnesses), malaria,
tuberculosis, neglected tropical diseases, and proper
nutrition for all ages; and
(B) referrals to nearby quality services that
cannot be provided by the primary provider and other
social services.
SEC. 9. COORDINATION; RESEARCH, MONITORING, AND EVALUATION.
(a) Coordination.--Assistance authorized under this Act shall
promote coordination between and among donors, the private sector,
nongovernmental and civil society organizations, and governments in
order to support comprehensive and responsive sexual and reproductive
health programs in developing countries.
(b) Research, Monitoring, and Evaluation.--
(1) In general.--Assistance authorized under this Act shall
be used for the conduct of formative research and to monitor
and evaluate the effectiveness and efficiency of programs.
(2) Requirements.--In carrying out paragraph (1), the
President shall ensure that there is--
(A) support for formative research on the
determinants of accessing sexual and reproductive
health products and services, and adopting healthy
behaviors related to sexuality and reproduction, to
inform program design;
(B) support for the ongoing, regular, and
systematic collection of information to serve as the
basis for monitoring change in population-based
outcomes;
(C) support for evaluations of programmatic
effectiveness by measuring the extent to which change
in population-based outcomes can be attributed to
program interventions or environmental factors;
(D) support for operations research that uses
appropriate scientific methods to compare different
interventions with the objective of increasing the
efficiency, effectiveness, and quality of programs;
(E) support for field research on the
characteristics of programs most likely to result in
sustained use of effective family planning in meeting
each individual's lifetime reproductive goals, with
particular emphasis on the perspectives of family
planning users, including support for relevant social
and behavioral research focusing on such factors as the
use, nonuse, and unsafe or ineffective use of various
contraceptive and related-disease control methods; and
(F) support for the development of new evaluation
techniques and performance criteria for sexual and
reproductive health programs, emphasizing the user's
perspective and reproductive goals.
SEC. 10. DEFINITIONS.
In this Act:
(1) Adolescent.--The term ``adolescent'' means an
individual who has attained the age of 10 years but not 20
years.
(2) Comprehensive sexuality education.--The term
``comprehensive sexuality education'' means helping young
people develop the interpersonal skills necessary for the
formation of caring, supportive, and non-coercive relationships
and the ability to exercise responsibility regarding sexual
relationships by addressing such issues as sexual diversity,
abstinence, and the use of condoms, contraceptives, and other
protective sexual health measures.
(3) Integration.--The term ``integration'' means joining
together different kinds of services or operational programs,
either directly or by referral, to ensure more comprehensive
services, promote a continuum of care, and to maximize health
outcomes.
(4) Linkages.--The term ``linkages'' means--
(A) the bi-directional synergies in policy,
programs, services, and advocacy related to sexual and
reproductive health, including HIV/AIDS; and
(B) refers to a broader human rights based
approach, of which service integration is a subset.
(5) Reproductive health.--The term ``reproductive
health''--
(A) means a state of complete physical, mental, and
social well-being and not merely the absence of disease
or infirmity, in all matters relating to the
reproductive system and to its functions and processes;
and
(B) implies that an individual is able to have a
satisfying and safe sex life and that such individual
has the capability to reproduce and the freedom to
decide if, when, and how often to do so, including the
right of men and women to be informed and to have
access to safe, effective, affordable, and acceptable
methods of family planning of their choice, as well as
other methods of their choice for regulation of
fertility which are not against the law, and the right
of access to appropriate health care services that will
enable women to go safely through pregnancy and
childbirth and provide couples with the best chance of
having a healthy infant.
(6) Reproductive rights.--The term ``reproductive
rights''--
(A) means those rights that embrace certain human
rights that are already recognized in national laws,
international human rights documents, and other
consensus documents;
(B) includes the recognition of the basic right of
all couples and individuals to decide freely and
responsibly the number, spacing, and timing of their
children and to have the information and means to do
so, and the right to attain the highest standard of
sexual and reproductive health; and
(C) further includes the right of all couples and
individuals to make decisions concerning reproduction
free of discrimination, coercion, and violence, as
expressed in human rights documents.
(7) Sexual health.--The term ``sexual health''--
(A) means a state of physical, emotional, mental,
and social well-being in relation to sexuality and not
merely the absence of disease, dysfunction, or
infirmity;
(B) includes a positive and respectful approach to
sexuality and sexual relationships, as well as the
possibility of having pleasurable and safe sexual
experiences, free of coercion, discrimination, and
violence; and
(C) further includes the sexual rights of all
persons to be respected, protected, and fulfilled.
(8) Unmet need.--The term ``unmet need'' refers to nonuse
of a modern contraceptive method by an individual who is
married or unmarried and sexually active, is able to become
pregnant, and wants to stop childbearing or to wait at least 2
years before having a child.
(9) Young people.--The term ``young people'' means those
individuals who have attained the age of 10 years but not 25
years.
(10) Youth.--The term ``youth'' means an individual who has
attained the age of 15 years but not 25 years.
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