[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8529 Introduced in House (IH)]

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118th CONGRESS
  2d Session
                                H. R. 8529

To authorize assistance to train and retain obstetrician-gynecologists 
and sub-specialists in urogynecology and to help improve the quality of 
    care to meet the health care needs of women in least developed 
                   countries, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 23, 2024

 Ms. DeLauro introduced the following bill; which was referred to the 
                      Committee on Foreign Affairs

_______________________________________________________________________

                                 A BILL


 
To authorize assistance to train and retain obstetrician-gynecologists 
and sub-specialists in urogynecology and to help improve the quality of 
    care to meet the health care needs of women in least developed 
                   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 ``Physician Education for Fistula 
Treatment Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Obstetric fistula, an abnormal opening between a 
        woman's genital tract and her urinary tract or rectum, is a 
        devastating childbirth injury caused by prolonged, obstructed 
        labor in the absence of timely and quality medical care.
            (2) Worldwide, an estimated 500,000 women and girls live 
        with obstetric fistula with thousands more occurring annually. 
        It occurs disproportionately among impoverished, vulnerable, 
        and marginalized girls and women.
            (3) Women who experience an obstetric fistula suffer life-
        shattering consequences including chronic incontinence, shame, 
        social isolation, poverty, and physical, mental, and emotional 
        health problems.
            (4) Obstetric fistula is a violation of human rights and an 
        indicator of the failure of health systems to deliver 
        universally accessible, timely, and quality health care to 
        women and girls who need it.
            (5) Obstetric fistula is preventable. Universal health 
        coverage and universal access to quality care are essential in 
        ending preventable maternal and newborn deaths and 
        disabilities, including fistula. Skilled health personnel at 
        birth, emergency obstetric and newborn care, and universal 
        access to modern contraception are the most effective 
        interventions to prevent maternal mortality and fistula.
            (6) Safeguarding the rights and dignity of women and girls 
        and addressing underlying gender and socioeconomic inequalities 
        and discrimination which drive obstetric fistula are equally 
        important to end the condition.
            (7) In 2018 and 2020, the United Nations General Assembly 
        resolutions on fistula were adopted, calling for ``Ending 
        fistula within a decade''. This represents a turning point in 
        the global fight to eliminate fistula, as it brings the global 
        objective and timeline for ending fistula into alignment with 
        achieving the Sustainable Development Goals (SDGs)/Agenda 2030. 
        The resolutions also call for an increased focus on social 
        determinants to tackle the root causes of fistula.
            (8) Obstetric fistula can be surgically treated. The impact 
        of an obstetric fistula-repair surgery is immediate and women 
        can be reintegrated into society. There is however a high unmet 
        need for treatment and social reintegration of fistula 
        survivors.
            (9) The Covid-19 pandemic caused overloaded health systems 
        and reallocation of human and financial resources with 
        disruptions to services resulting in an undermining of the 
        sexual and reproductive health and rights of women and girls. 
        In 2020, fistula repairs were widely halted or slowed down due 
        to Covid-19, as they were deemed non-urgent and unsafe during 
        the pandemic. This may result in an increased backlog of 
        fistula cases.
            (10) The United Nations Population Fund (UNFPA)-led global 
        Campaign to End Fistula, is a key contributor to promoting the 
        rights, dignity, and well-being of women and girls. The 
        Campaign focuses on prevention, treatment, social 
        reintegration, and advocacy. Aimed at ``leaving no one behind'' 
        and ``reaching the furthest behind'', it contributes to 
        achieving the SDGs and has also helped restore overall health, 
        dignity, hope, and a sense of self-worth and agency to some of 
        the poorest, most marginalized women and girls worldwide 
        through its holistic, gender-sensitive, and rights-based 
        approach to policies and programs for the elimination of 
        obstetric fistula and several other maternal morbidities.
            (11) UNFPA has supported over 1140,000 surgical repairs 
        over the last two decades. The Campaign to End Fistula and its 
        partners has made remarkable progress, but the needs remain 
        great.
            (12) With 8 years to reach the global goal of ending 
        fistula by 2030, significantly intensified investment, efforts, 
        and partnerships at the international and national levels are 
        required.
            (13) The International Day to End Obstetric Fistula which 
        takes place on May 23, 2024, will be commemorated this year 
        with the theme: ``Breaking the Cycle: Preventing Fistula 
        Worldwide'', calling for investments to improve the quality of 
        care and emphasizing the key role of communities in addressing 
        social, cultural, political, and economic determinants that 
        impact maternal health and sexual reproductive health, and 
        reproductive rights.

SEC. 3. INTERNATIONAL OB/GYN AND UROGYNECOLOGY PROMOTION PROGRAM.

    (a) Purpose.--The purpose of assistance under this section is to 
train and retain obstetrician-gynecologists (OB-GYNs) and sub-
specialists in urogynecology and to help improve the quality of care to 
meet the health care needs of women in least developed countries.
    (b) Authorization.--
            (1) In general.--To carry out the purpose of subsection 
        (a), the President, acting through the Director of the John E. 
        Fogarty International Center for Advanced Study in the Health 
        Sciences, is authorized to provide assistance for least 
        developed countries to support the activities described in 
        subsection (c).
            (2) Reference.--Assistance authorized under this section 
        may be referred to as the ``International OB/GYN and 
        Urogynecology Promotion Program''.
    (c) Activities Supported.--Activities that may be supported by 
assistance under subsection (b) include the following:
            (1) Fellowship and residency programs.--Establishment of 
        fellowship and residency programs to be carried out in 
        coordination with institutions of higher education (as such 
        term is defined in section 101 of the Higher Education Act of 
        1965 (20 U.S.C. 1001)), institutions of higher learning, 
        midwifery programs, and existing clinical centers in least 
        developed countries--
                    (A) to support existing academic curricula for 
                education training for midwifery students;
                    (B) to develop and help sustain existing 
                specialized curriculum training for medical students 
                and residents to become knowledgeable and proficient in 
                women's health care; and
                    (C) to allow medical students, residents, and 
                midwifery students to practice and develop expertise in 
                geographical areas in which childbirth-related injuries 
                are most prevalent.
            (2) Training centers.--Establishment of training centers--
                    (A) to address the shortage of OB-GYNs and sub-
                specialists in the urogynecology profession; and
                    (B) to carry out specialized programs that are 
                located at health care institutions that provide 
                exceptionally high concentrations of expertise and 
                related resources related to these medical professions 
                and are delivered in a comprehensive and 
                interdisciplinary fashion.

SEC. 4. COMPREHENSIVE 10-YEAR STRATEGY TO ADDRESS THE SHORTAGE OF 
              PHYSICIANS IN LEAST DEVELOPED COUNTRIES.

    (a) In General.--The President, acting through the Director of the 
John E. Fogarty International Center for Advanced Study in the Health 
Sciences, shall establish a comprehensive, integrated, 10-year strategy 
to address the shortage of physicians in least developed countries.
    (b) Elements.--Such strategy shall maintain sufficient flexibility 
and remain responsive to the needs of women afflicted with childbirth-
related injuries and shall include the following:
            (1) A plan for implementation and coordination of programs 
        and activities under this Act, including grants and contracts 
        for prevention, treatment, and monitoring of childbirth-related 
        injuries.
            (2) Specific objectives, multi-sector approaches, and 
        specific strategies to treat women who suffer from childbirth-
        related injuries and to prevent further occurrences of 
        childbirth-related injuries.
            (3) Assignment of priorities for relevant executive branch 
        agencies.
            (4) Public health and health care delivery system research 
        on the prevention, repair, and rehabilitation of childbirth-
        related injuries.
            (5) Social science research in fields such as anthropology, 
        sociology, and related fields to monitor and evaluate the 
        underlying social and economic factors that contribute to 
        childbirth-related injuries.
            (6) Development, implementation, and evaluation of 
        evidence-based systems of care connecting maternity care 
        facilities with local care delivery and community education 
        programs. Such systems of care should promote rapid and long-
        term prevention of childbirth-related injuries, including--
                    (A) culturally appropriate childbirth education, 
                preparation, and planning; and
                    (B) access to obstetrician-gynecologists (OB-GYNs), 
                urogynecology care, or midwifery care.
            (7) Expansion of training centers and partnerships with 
        institutions of higher learning for medical students and 
        residents.
            (8) Priorities for the distribution of resources based on 
        factors such as the size and demographics of the population 
        suffering from childbirth-related injuries, the needs of that 
        population, and the existing infrastructure or funding levels 
        that may exist to treat and prevent childbirth-related 
        injuries, including obstetric fistula.
            (9) A plan for institutional capacity-building of 
        partnerships to strengthen universities, research centers, 
        health-profession training programs, and government institutes 
        to build the in-country capacity needed to eradicate 
        childbirth-related injuries in least developed countries.
    (c) Report.--Not later than 2 years after the date of the enactment 
of this Act, the President shall submit to Congress a report that 
contains the strategy required under this section.

SEC. 5. REPORT.

    (a) In General.--The President, acting through the Director of the 
John E. Fogarty International Center for Advanced Study in the Health 
Sciences, shall submit to Congress, on an annual basis, a report on the 
implementation of this Act for the preceding year.
    (b) Matters To Be Included.--The report required under subsection 
(a) shall include an evaluation of the effectiveness and performance of 
the International OB/GYN and Urogynecology Promotion Program 
established under section 3 and all related community outreach and 
medical programs.

SEC. 6. DEFINITIONS.

    In this Act:
            (1) Childbirth-related injuries.--The term ``childbirth-
        related injuries'' means injuries associated with obstructed 
        labor, including--
                    (A) pelvic organ prolapse;
                    (B) a displacement of pelvic organs such as the 
                uterus, bladder, or bowel; and
                    (C) obstetric fistula.
            (2) Low-income country.--The term ``low-income country'' 
        means a country with a per capita gross national income of 
        $1,035 or less.
            (3) Least developed country.--The term ``least developed 
        country'' means a country that--
                    (A) is a low-income country; and
                    (B) according to the United Nations Economic 
                Analysis and Policy Division, is confronting severe 
                structural impediments to sustainable development.
            (4) Relevant executive branch agencies.--The term 
        ``relevant executive branch agencies'' means the Department of 
        State, the United States Agency for International Development, 
        and any other department or agency of the United States that 
        participates in international health and humanitarian 
        activities pursuant to the authorities of such department or 
        agency or the Foreign Assistance Act of 1961.
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