[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4148 Introduced in House (IH)]

<DOC>






114th CONGRESS
  1st Session
                                H. R. 4148

   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

                            December 1, 2015

  Mrs. Carolyn B. Maloney of New York (for herself, Mr. Grijalva, Mr. 
    Johnson of Georgia, Ms. Moore, and Mr. Conyers) 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 2015''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Every two minutes, 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. Most of these 
        deaths are preventable, which represents both a tragedy and an 
        opportunity.
            (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 is 
        experiencing prolonged, obstructed labor and 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 without 
        timely, adequate medical intervention. 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 or hole.
            (4) In the majority of obstetric fistula cases, the baby 
        will be stillborn and the mother will experience physical pain 
        and disability, as well as social and emotional trauma from 
        living with incontinence and from the loss of her child.
            (5) In addition to incontinence or constant uncontrollable 
        leaking of urine, feces, or both, the physical consequences of 
        obstetric fistula may include frequent bladder infections, 
        infertility, foul odor, and nerve damage.
            (6) Mental, emotional, and social side effects of obstetric 
        fistula may include depression, social isolation and 
        discrimination, suicidal thoughts or actions, and lack of 
        adequate economic opportunities, resulting in deepening poverty 
        and vulnerability. Girls with obstetric fistula are also often 
        unable to continue schooling. Women and girls with fistula 
        suffer psychological consequences, such as feelings of 
        hopelessness because of stigma and lack of awareness that their 
        condition is treatable. Fistula survivors need regular medical 
        attention and support, but too often adequate services are 
        unavailable or the women and their families cannot afford them. 
        Women may lose property if they are divorced or abandoned by 
        their husbands and family. Some lose jobs or are denied work, 
        while others may quit their jobs out of shame, leading to 
        deepened poverty and vulnerability to repeat fistulas.
            (7) 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.
            (8) The primary cause of obstetric fistula is a lack of 
        timely, adequate emergency obstetric care, such as a cesarean 
        section. Poverty, malnutrition, poor health services, early 
        childbearing, and gender discrimination are interlinked root 
        causes of obstetric fistula.
            (9) 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. As highlighted by the United Nations Secretary 
        General in his 2015 statement on the occasion of the 
        International Day to End Obstetric Fistula (May 23rd), in which 
        he called upon world leaders to commit to ending the scourge of 
        obstetric fistula in our lifetime, ``The fact that fistula 
        persists primarily among the poorest and most marginalized 
        women and girls in the world is an egregious outcome of social, 
        economic and gender inequalities, the denial of human rights 
        and inadequate access to quality reproductive health services, 
        including maternal and newborn care.''.
            (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) The majority of obstetric fistula can be surgically 
        treated. Surgery requires a specially trained, qualified 
        surgeon and support staff, and access to an operating theater 
        and to attentive postoperative care. When performed by a 
        skilled, competent surgeon, success rates can be as high as 90 
        percent and cost an estimated $400.
            (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 not 
        only their own health and well-being, but also that of their 
        babies, older children and other family members. Over the long-
        term, the health and well-being of women, in addition to being 
        essential in its own right, 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 and 
        support those women who are suffering and provide the necessary 
        health services to prevent further cases. The UNFPA-led 
        Campaign to End Fistula is now present in more than 50 
        countries across Africa, Asia, and the Arab region and is 
        comprised of over 90 partners at the global level and many more 
        at the regional and national levels. The Campaign has three 
        main focuses: the prevention of fistula cases, treatment of 
        existing cases of fistula, and social reintegration and follow 
        up for fistula survivors. The Campaign supports fistula 
        surgery, training of doctors, nurses, and other health workers, 
        community outreach to prevent further cases, identification of 
        women suffering fistula who need care, and supporting provision 
        of rehabilitative care for women after treatment in order to 
        break the cycle of poverty and marginalization that rendered 
        them vulnerable to fistula in the first place and to enable 
        them to reclaim their dignity and hope and return to full and 
        productive lives. Since 2003, UNFPA has directly supported more 
        than 57,000 fistula repairs, and additional repairs have been 
        supported by Campaign partners.
            (14) The 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, 
        academic institutions, and health providers (and professional 
        associations), in support of national processes and fistula 
        eradication efforts, including strategies to eradicate end-
        stage prolonged or obstructed labor that causes not only 
        fistula, but a host of newborn and maternal reproductive, 
        mental, neurologic and orthopedic conditions, that have 
        detrimental consequences for women's lives. A key focus is 
        national capacity strengthening to reach the regional backlogs 
        of women living with fistula in remote regions, suffering 
        needlessly, sometimes for decades.
            (15) In 2004, the United States Agency for International 
        Development (USAID) provided funding through the ACQUIRE 
        Project managed by EngenderHealth to support services in 
        Bangladesh and Uganda. From 2007 to 2013, USAID funded the 
        Fistula Care project, and in 2013, USAID awarded a new 5-year 
        cooperative agreement to EngenderHealth for the Fistula Care 
        Plus project to support national fistula programs in Africa and 
        Asia, expand access to care, assess the backlog of cases, test 
        new approaches to improve the efficiency and quality of care, 
        and improve health outcomes. USAID currently supports fistula 
        treatment services in 137 sites in six countries and addresses 
        prevention in those sites and 36 more. The ceiling for the 
        Fistula Care Plus project is $74,490,000. Since 2004, more than 
        39,000 women have received fistula repairs with USAID support.
            (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, and thereafter the Sustainable Development 
        Goals, through the United Nations Secretary General's Every 
        Woman Every Child initiative.
            (17) The United States, through its commitment to Ending 
        Preventable Maternal and Child Deaths, has set several targets 
        that will reduce the incidence of fistula, including through 
        efforts to reduce maternal mortality to 50 maternal deaths per 
        100,000 live births by 2035, and support voluntary family 
        planning and reproductive health programs to reach 120,000,000 
        additional women and girls with family planning information, 
        commodities and services by 2020. The USAID Maternal Health 
        Vision for Action calls for an increased focus on averting and 
        addressing maternal morbidity and disability.

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 nonformal 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.
                                 <all>