[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5068 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 5068

   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

                           February 16, 2018

  Mrs. Carolyn B. Maloney of New York 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 2018''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Every two minutes, one woman dies from pregnancy-
        related complications. This means approximately 830 women die 
        from pregnancy- or childbirth-related complications around the 
        world every day. 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) Obstetric fistula is one of the most severe and tragic 
        pregnancy-related injuries, which occurs when a woman 
        experiences prolonged, obstructed labor in the absence of 
        trained medical assistance, which is most commonly a Caesarean 
        section, necessary for a safe delivery.
            (3) Obstetric fistula is a hole that is formed between the 
        bladder and the vagina, or the rectum and the vagina (or both). 
        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 
        dies and sloughs off, resulting in the abnormal opening or 
        hole.
            (4) In approximately 90 percent of obstetric fistula cases, 
        the baby will be stillborn. A mother will experience physical 
        pain and multiple physical disabilities, as well as social and 
        emotional trauma from living with incontinence and from the 
        loss of her child.
            (5) In addition to constant uncontrollable leaking of 
        urine, feces, or both, the physical consequences of obstetric 
        fistula may include frequent bladder infections, painful sores, 
        kidney failure, infertility, foul odor, orthopedic injury, 
        nerve damage that makes normal walking impossible and internal 
        genital scarring that destroys normal sexual function.
            (6) Women and girls with obstetric fistula are commonly 
        ostracized by their families and communities, leading to 
        depression, anxiety, post-traumatic stress disorder, social 
        isolation and discrimination, suicidal thoughts or actions, and 
        lack of adequate economic opportunities, resulting in deepening 
        poverty, isolation, and vulnerability.
            (7) Although data on obstetric fistula are scarce, the 
        World Health Organization (WHO) estimates there are more than 
        2,000,000 women and girls living with fistula, and 50,000 to 
        100,000 new cases each year.
            (8) Obstetric fistula was once common throughout the world, 
        but over the last century has been virtually eliminated in 
        Europe, North America, and other developed regions through 
        improved access to high-quality, timely medical interventions, 
        particularly emergency obstetric care including Caesarean 
        section.
            (9) Obstetric fistula is preventable through timely medical 
        interventions and providing access to family planning for all 
        women who need it. Social interventions such as alleviating 
        poverty, delaying early marriage and early childbearing, 
        educating and empowering young women, remedying gender and 
        socioeconomic inequalities, and addressing malnutrition can 
        also help prevent this complication.
            (10) The majority of obstetric fistula can be surgically 
        treated. When performed by a skilled, competent surgeon, the 
        procedure is relatively inexpensive with high rates of success.
            (11) In 2003, the United Nations Population Fund (UNFPA), 
        EngenderHealth, and other partners launched a global Campaign 
        to End Fistula (the 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. Operating in more than 50 
        countries across Africa, Asia, and the Arab region, the 
        Campaign has four main goals: the prevention of fistula cases, 
        treatment of existing fistula cases, social reintegration and 
        follow up for fistula survivors, and advocacy for ending 
        fistula.
            (12) In order to meet these goals, The Campaign supports 
        and participates in the emerging ``safe surgery'' community of 
        practice that strengthens surgical ecosystems in low- and 
        middle-income countries (LMIC) towards better access to 
        essential and life-saving surgeries, which includes improved 
        training, equipment, supplies, infrastructure and health worker 
        density for timely access to Caesarean section and for 
        environments that optimize outcomes of fistula surgery.
            (13) Since 2003, UNFPA has directly supported more than 
        85,000 fistula repairs, with additional repairs supported by 
        Campaign partners.
            (14) USAID, in accordance with the United States 
        Government's commitment to ending preventable maternal and 
        newborn deaths and disabilities, currently supports fistula 
        treatment services in 137 sites in six countries. USAID 
        addresses prevention in those sites and thirty-six more. Since 
        2004, more than 39,000 women have received fistula repairs with 
        USAID support.
            (15) The United States has committed to joining 
        multilateral efforts involving the United Nations and others to 
        make progress toward achieving the Sustainable Development 
        Goals (SDGs), including through the Global Strategy for 
        Women's, Children's and Adolescents' Health (2016-2030). 
        Eliminating obstetric fistula is key to achieving the SDGs' 
        vision of ``leaving no one behind.''.
            (16) In his 2016 statement on the International Day to End 
        Obstetric Fistula, United Nations Secretary General Ban Ki-Moon 
        boldly laid forth a new global vision and goal of ending 
        obstetric fistula within a generation, saying that, ``The 
        persistence of fistula in some countries and regions is an 
        indicator of very poor access to quality maternal health 
        services. To end it, we must strengthen health systems and 
        address broader development and human rights issues affecting 
        women and girls: poverty, gender inequality, early marriage, 
        early childbearing, and lack of education. Let us use the 
        momentum of the Sustainable Development Goals together with 
        strong political leadership, accelerated investment and action, 
        and passionate and committed champions, to achieve this 
        historic and transformative goal.''.

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, structural, health, and human 
        rights issues that lead to obstetric fistula;
            (2) support treatment of obstetric fistula that includes 
        strengthening the safe surgery and safe anesthesia environment 
        in every country where fistula persists and where obstetric 
        services do not meet an acceptable standard of care; and
            (3) address and acknowledge the urgency of ensuring that 
        all women who need a Caesarean section are able to have access 
        to such life-saving surgery in a timely, safe, and high-quality 
        care environment, and address the growing threat of iatrogenic 
        fistula that most often results from Caesarean delivery done 
        poorly and under conditions with inadequate staff, supplies, or 
        equipment.
    (b) Activities.--Assistance provided pursuant to this section and 
section 4 shall focus on the following:
            (1) Increasing prevention of obstetric fistula through 
        access to sexual and reproductive health services, including 
        skilled attendance at birth, comprehensive emergency obstetric 
        and newborn care, timely, safe, high-quality Caesarean section 
        when necessary, prenatal and antenatal care, contraception and 
        family planning, and comprehensive reproductive health 
        education.
            (2) Building local capacity and improving national health 
        systems to ensure that all women in need have access to safe 
        surgery, including timely, and high-quality life-saving 
        obstetric and newborn care services to prevent and treat 
        obstetric fistula.
            (3) Supporting tools to enable countries to address 
        obstetric fistula, including the following:
                    (A) Supporting research to better identify the key 
                factors causing persistence of obstetric fistula in 
                certain regions.
                    (B) Quantitative data collection on the incidence 
                and prevalence of obstetric fistula, and development of 
                sustainable universal health care financing mechanisms 
                to enable all women to have access to skilled and life-
                saving health care during pregnancy, delivery, and the 
                postpartum period.
                    (C) Providing fistula survivors access to free or 
                affordable treatment.
                    (D) Training of midwives and skilled birth 
                attendants.
                    (E) Provision of basic obstetric care at the 
                community level.
            (4) Ensuring that countries address surgery, anesthesia, 
        and obstetrics ecosystem deficits in standardized healthcare 
        worker education, credentialing, and retention, WASH and power 
        in facilities, equipment and materials, transport, and 
        healthcare financing.
            (5) Addressing social and economic inequities that are 
        correlated with higher incidence of obstetric fistula by 
        empowering women and girls, alleviating poverty, reducing 
        incidence of child marriage, promoting delay and spacing of 
        childbirth, and increasing access to formal and nonformal 
        education.
            (6) Supporting reintegration and education to help women 
        who have undergone treatment or are awaiting treatment to 
        obtain medical and mental health services, legal counseling, 
        basic education, and income generating skills as needed, to 
        return to full and productive lives.
            (7) Promoting public awareness in communities to increase 
        understanding of obstetric fistula, and thereby improve 
        prevention and treatment efforts, and to help reduce stigma, 
        exclusion, and violence against women and girls with obstetric 
        fistula.

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

    Assistance authorized under this Act shall--
            (1) promote the UNFPA-led global Campaign to End Fistula 
        and the International Obstetric Fistula Working Group; 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.

SEC. 5. 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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