[Congressional Record Volume 141, Number 113 (Thursday, July 13, 1995)]
[Senate]
[Pages S9905-S9913]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mrs. KASSEBAUM (for herself, Mr. Kennedy, Mr. Frist, Mr. Dodd, 
        Mr. Jeffords, Ms. Mikulski, Mr. Gregg, Mr. Wellstone, Mr. 
        Gorton, Mr. Pell, Mr. Hatch, Mr. Simon, Mr. Chafee and Mr. 
        Lieberman):
  S. 1028. A bill to provide increased access to health care benefits, 
to provide increased portability of health care benefits, to provide 
increased security of health care benefits, to increase the purchasing 
power of individuals and small employers, and for other purposes; to 
the Committee on Labor and Human Resources.


                THE HEALTH INSURANCE REFORM ACT OF 1995

  Mrs. KASSEBAUM. Mr. President, I rise today to introduce on behalf of 
myself, Senators Kennedy, Frist, Gregg, Jeffords, Gorton, Hatch, 
Chafee, Pell, Dodd, Simon, Mikulski, Wellstone, and Lieberman, the 
Health Insurance Reform Act of 1995.
  This legislation will make it easier for individuals and employers to 
buy and keep health insurance--even when a family member or employee 
becomes ill. And it will allow people to change jobs without fear of 
losing their health coverage.
  Despite past State and Federal reform efforts, the lack of poor 
portability of health insurance remains a serious concern for many 
Americans, particularly those with preexisting health conditions. The 
General Accounting Office estimates that as many as 25 million 
Americans could benefit from this legislation.
  The Health Insurance Reform Act builds upon and strengthens the 
current private insurance market by, one, guaranteeing that private 
health insurance coverage will be available, renewable and portable; 
two, limiting preexisting condition exclusions; and, three, increasing 
the purchasing clout of individuals and small employers by creating 
incentives to form private, voluntary coalitions to negotiate with the 
providers and health plans.
  Mr. President, I believe that the American people want us to work 
together to fix what is broken in the current system without relying on 
big Government solutions.
  The legislation we are introducing today does not impose new, 
expensive regulatory requirements on individuals, employers or States. 
It does not create new Federal bureaucracies. It does not create any 
new taxes, spending or price controls nor does it require employers to 
pay for health insurance coverage.
  While this insurance reform legislation alone will not cure all the 
ills of the Nation's health care system, it will in some small and 
important ways, I believe, promote greater access and security for 
health coverage for all Americans by requiring private insurance 
carriers to compete based on quality, price, and service instead of by 
refusing to provide coverage to those who are in poor health and who 
need it the most.
  Mr. President, I want to thank all of my cosponsors. Senators Gregg, 
Frist, Jeffords, Hatch and Gorton have all contributed a great deal to 
this effort. Senator Jeffords has worked particularly hard on the group 
purchasing provisions of the legislation. But I want to especially 
recognize the contributions of the ranking member of the Labor and 
Human Resources Committee, Senator Kennedy. He has worked, along with 
his staff, for many hours, in many ways, to help make this legislation 
a bipartisan effort. Senator Kennedy has spent many years on the health 
care agenda working tirelessly to improve the health care delivery 
system. And I am particularly pleased that this is such a strong 
bipartisan bill that we are introducing today. It is not a major piece 
of legislation. As I said, it is not going to be the answer to all the 
ills in our health care system. But I think it is a very important step 
forward.
  I am confident that with the support of the other original cosponsors 
and others, the Labor Committee we will be able to report this 
legislation favorably in the near future and we can begin to move 
forward, on a bipartisan basis, to make private health insurance more 
readily available, more secure and more affordable for all Americans. 
Mr. President, I intend to work with all of my colleagues to ensure 
that these reforms are enacted during the 104th Congress.
  Mr. KENNEDY. Mr. President, first of all, I welcome the opportunity 
to join Senator Kassebaum in the introduction of the Health Insurance 
Reform Act of 1995. I would like to pay tribute to her leadership in 
this area which is of enormous concern to the American people--
addressing the issue of access to health insurance in a way that is 
going to be reasonable for working families in this country.
  Making health insurance available to working Americans means they 
will be able to receive the kind of high-quality health care that is 
possible in this country--and that care will be available in the inner 
cities and rural communities of this country. Improving access to 
health care is one more way of stressing the obvious importance of 
prevention and demonstrating our commitment to the American people, 
particularly our seniors, to provide them with the security of health 
benefits in this diverse and complex Nation.
  Building on the current health care system is incredibly, incredibly 
difficult and complex. Many of us have been addressing this issue over 
a considerable period of time. I think comprehensive reform of the 
system is still a very, very worthy objective.
  But what we have today is something which, I think, is extremely 
important. There will be those who say, ``Well, have we lost our goal 
of trying to deal in a comprehensive way? Should we just come back and 
try to reform the entire system? Let's just wait for the opportunity to 
do so.''
  Senator Kassebaum has said, ``Let us try to find common ground and 
let us try to make progress in areas where progress can be made. And, 
at a time where we do have diversity on a great many issues that are of 
very great importance and where there is a difference in viewpoint by 
the American people, expressed by their representatives--let us put 
that aside and say that it is more important for families in this 
country to have access to health care; it is more important to make 
meaningful progress to try to address their central needs.'' I think 
she deserves great credit for these initiatives and for working in a 
very strong, bipartisan way to try to find common ground on an issue 
which is going to make a very important and significant difference in 
the lives of millions of Americans who have preexisting conditions. 
This bill will help respond to the real needs and anxieties of millions 
of people.
  Often we debate and discuss the bottom line issues in terms of cost, 
and that is certainly important. But for those who have a disability, 
we forget that these people live with a sense of fear and anxiety about 
what their future holds and whether they will have coverage for their 
health needs, or whether they will be locked into a particular work 
situation. The reforms in this bill let people know that Congress 
believes our working Americans deserve opportunities for moving ahead 
in terms of their career and progress for their families--which have 
been limited. It also encourages small businesses to work together to 
try to leverage the system in a positive and constructive way by using 
their purchasing power in the economy to negotiate a more reasonable 
cost for health care.
  So, even though some might consider this a modest step, I think it is 
an extremely important one. And it is one in which I welcome the 
opportunity to work with Senator Kassebaum and to work with Senator 
Jeffords, who, as Senator Kassebaum has mentioned, spends a great deal 
of time on this issue. Many others on our committee 

[[Page S 9906]]
do also. Senator Kassebaum has mentioned our Republican colleagues. I 
would like to mention our Democratic colleagues as well. Senator 
Wellstone has taken a particular interest and has made important 
contributions. And generally speaking, all of the members spend time 
and are interested in improving this Nation's health care system.
  Having been honored with chairing the Labor and Human Resources 
Committee last year, I was enormously impressed with the commitment of 
the members on the committee when we did move towards a markup on 
health care. The markup lasted for a period of some 10 days, long days 
from 8 or 9 in the morning until 10 at night. We had virtually complete 
attendance of our committee, Republicans and Democrats, all really 
participating in that process, all who went through an extraordinary 
learning experience. And, as a result of that, there were broad areas 
of bipartisan agreement and there were important areas of difference.
  For a number of reasons, we were unable to reach final legislation in 
the U.S. Senate. But nonetheless, I think all of us, as legislators, 
try and learn from past experiences.
  One that certainly continues to ring in my mind is the real desire in 
this body by Republicans and Democrats alike to see progress in this 
area. It is enormously obvious the reason why, and that is because this 
is a matter of ongoing central concern to families in this country. We 
all have seen the results of various polls about the budget, about 
deficits, about taxes, about priorities, about Medicare and Medicaid 
cuts. A variety of opinions are illustrated in newspapers and on radio 
and television across the country.
  But one element that shows up in all kinds of studies and reviews is 
the real desire of the American people for Congress to try and find 
common ground; to try and make progress; to try and move this process 
forward. We have a very, very important responsibility to try and do 
so.
  There are naysayers. There are those who will find reasons to 
criticize this approach. There will be those who say it goes too far in 
some areas--and there will be those who say it does not go far enough. 
I want to be one of those to say--I think this is an enormously 
important and constructive effort and I am very hopeful that we can 
build broad support in the Senate with the introduction of this bill as 
we move through the hearing process and through the markup.
  I invite all of the Members on this side, as Senator Kassebaum has 
done on her side, to join with us to make suggestions and 
recommendations. The issue of health care is a constantly changing 
landscape. It is dramatically different from where it was 2 or 4 years 
ago. But despite this, there continue to be issues of great concern for 
which we all agree something must be done--and those include the issues 
of access, affordability and coverage.
  What we have tried to do in this bill is to respond in a way, under 
the leadership of Senator Kassebaum, that we could find the areas of 
common stream. We have tried to review what we debated last year and 
take what was central to the different approaches that were put forward 
in the Senate by Republicans as well as Democrats. Then we have tried 
to take those recommendations and shape them in ways which would be 
more adaptive to the kind of conditions that we find today--advancing 
those ideas in a way that really can make an important difference.
  Mr. President, I welcome the chance of joining today with my 
colleagues in introducing the Health Insurance Reform Act of 1995. To 
review, I will now summarize and highlight the specifics of the bill.
   Mr. President, it is a pleasure to join Senator Kassebaum in 
introducing the Health Insurance Reform Act of 1995. This bipartisan 
proposal was developed in close cooperation between our two offices, 
and I commend her for her leadership.
  The private health insurance market in the United States is deeply 
flawed, and with each passing year, the flaws become more serious. This 
legislation is designed to remedy some of the worst abuses of the 
current system, and provides protection to large number of families 
victimized by such abuses.
  Today, insurers often impose exclusion for preexisting conditions. As 
a result, insurance is often denied for the very illnesses most likely 
to require medical care.
  The valid purpose of such exclusions is to prevent people from gaming 
the system by purchasing coverage only when they get sick. But too 
often today, the exclusions go too far. No matter how faithfully people 
pay their premiums, they may have to start again with a new exclusion 
period if they change jobs or lose their coverage.
  Eighty-one million Americans have conditions that could subject them 
to such exclusions if they lose their current coverage. Sometimes, the 
exclusions make them completely uninsurable.
  Many employers do not provide health insurance to their workers at 
all, but too often, even those who want to do the right thing can't 
find an insurer to write the coverage. Sometimes entire categories of 
businesses, with millions of employees, are redlined out of coverage. 
Even if a firm is in an acceptable category, coverage may be denied if 
someone in the firm--or a member of their family--is in poor health. 
People who have paid insurance premiums for years can be canceled 
because they have the misfortune to get sick, just when they need 
coverage the most.
  One consequence of the current system is job lock. Workers who want 
to change jobs to improve their careers or provide more efficiently for 
their families must give up the opportunity because it means losing 
their health insurance. A quarter of all American workers say they have 
been forced to stay in a job they otherwise would have left, because 
they were afraid of losing their health insurance.
  This legislation addresses these problems. Exclusions for preexisting 
condition will be limited. They cannot be reimposed on those with 
current coverage who change jobs or whose employer changes insurance 
companies. Cancellation of policies will be prohibited for those who 
continue to pay their premiums. No employers who want to buy a policy 
can be turned down because of the health of their employees. No 
employees can be excluded from an employer's policy because they have 
higher than average health costs. Any employee losing group coverage 
because they leave their job or for any other reason would be 
guaranteed the right to buy an individual policy.
  Small businesses and individuals are particularly victimized under 
the current system, because they lack the bargaining power of larger 
corporations. The legislation addresses this problem by encouraging the 
development of purchasing cooperatives that will have the same kind of 
clout enjoyed by large corporations.
  Because of concerns about the impact on overall premiums, this 
legislation does not provide for guaranteed availability of coverage 
for those who have not been part of an employment group. The bill 
requires the Secretary of HHS to conduct a study of current State 
practices in this area, to consult with the National Association of 
Insurance Commissioners and other appropriate sources of expertise, and 
to provide recommendations for solving this serious problem.
  I continue to support the goal of comprehensive health reform. I am 
confident we will find a way to provide health security for all 
citizens, stop the ominous rise in the number of uninsured, and the 
ridiculous soaring cost of health care. This bill is not a 
comprehensive reform, but it will eliminate some of the worst abuses of 
the private insurance market and provide greater protection for 
millions of our fellow citizens.
  Mr. FRIST. Mr. President, I rise today to join the distinguished 
chair of the Committee on Labor and Human Resources, Mrs. Kassebaum, in 
introducing the bipartisan ``Health Insurance Reform Act of 1995''.
  This bill provides long awaited reforms for this country's health 
insurance market. I say long awaited because the Senate passed similar 
insurance reforms a few years ago, but regrettably they failed to 
become law. This legislation, with its bipartisan support, reflects 
essential market-based reforms.
  One of the important things I have witnessed, from my perspective as 
a 

[[Page S 9907]]
physician and now as a member of the Senate Committee on Labor and 
Human Resources, is the absolutely critical role that both employers 
and employees play in the current health care system, and the critical 
role they must play as we struggle to reform the system to deliver 
higher quality health care at lower costs.
  Over the years, employers have directed much of the change in the 
health care system. Many employers have been a creative force in 
containing health care costs. In fact, as a result of innovative and 
aggressive management of health care costs, employers actually saw 
their health care costs for 1994 decline 1.1 percent for the first time 
in a decade.
  However, this success does not mean that the current system is free 
from problems. It is not.
  It is the large employers which have the greatest influence in the 
market. Small employers lack the same bargaining power. For example, 
the large employers reported health care cost decreases averaging 1.9 
percent, while small employers experienced an average cost increase of 
6.5 percent. Moreover, uninsured rates continue to climb in many States 
and many families are finding it more difficult to obtain health 
coverage.
  The system needs to be reformed so that health care is available to 
all Americans.
  Last year, many of these same insurance reforms became entangled with 
President Clinton's heavy-handed approach to health care reform. As a 
result, Congress again failed to pass these provisions which are 
necessary to increase access to insurance. Even so, many States moved 
forward with their own reforms. Forty-four States, including my State 
of Tennessee, have passed some type of small group insurance market 
reform. In addition, 27 States have set up high-risk insurance pools to 
increase access to insurance for individuals.
  There should be no bar to insurance based on preexisting conditions, 
and no one should have to face the fear that they will lose their 
health insurance when they lose their job, change jobs, divorce, or 
become sick. Mr. President, this is the focus of this legislation.
  As a transplant surgeon, I have personally witnessed the obstacles my 
patients face after they have received a new heart and are ready to 
return to the work force and productive lives. These reforms go to the 
heart of the problem for families that feel locked into their jobs 
because an illness makes it difficult to obtain health insurance. If I 
give someone a new heart today, they cannot hope to look for a new job 
tomorrow. Rather, they desperately hope to keep their current job to 
maintain their health insurance coverage. They are trapped. The costs 
of their care prohibit the freedom of movement. Therefore, Mr. 
President, this bill ensures portability from one group health plan to 
another.
  When insurers are allowed to discriminate based on a preexisting 
condition, a heart transplant recipient becomes a liability to the rest 
of a company's employees. It can even result in an insurer dropping the 
entire employer group altogether. Mr. President, this legislation 
prohibits insurance carriers from refusing to issue a policy or 
refusing to renew an existing policy. It is my hope that this bill will 
help return my patients to work and back to their pretransplant lives.
  This bill reflects a desire to build a partnership between business 
and Government, not an adversarial relationship. Instead of mandating 
and controlling the health care market, Government should ensure that 
the market operates efficiently to deliver value to all consumers 
regardless of their health status.
  Mr. JEFFORDS. Mr. President, I rise today in support of the Health 
Insurance Reform Act of 1995, which is being introduced today by 
Senators Kassebaum, Kennedy, Frist, Dodd, Gorton, Mikulski, Gregg, 
Pell, Simon, Wellstone, Chafee, Hatch, Lieberman, and myself. I applaud 
Senator Kassebaum and Senator Kennedy for their commitment in 
developing, what I believe to be the first truly bipartisan insurance 
reform bill introduced this Congress. As I have stated many times in 
the past few years, health care reform cannot be successful unless 
Republicans and Democrats work together.
  I am proud to be an original cosponsor of a piece of legislation that 
has been developed in one of the most inclusive processes that I have 
been privileged to be a part. This legislation makes great strides in 
laying a foundation for a well functioning private market, which is 
critical if we are to be successful in creating a solid health care 
system for all Americans.
  This bill puts into place minimum national insurance reform 
standards, which transforms the current exclusionary insurance system 
into one which moves closer to accepting all comers, yet the bill 
allows States a great amount of flexibility to move ahead at a faster 
pace if they choose.
  This bill, assures that if any individual has insurance today even if 
they get sick, or change or lose their job, they will be able to 
purchase insurance tomorrow.
  This bill encourages a variety of health plans to compete in the 
marketplace. Individuals will have choices between managed care plans 
which focus on preventative care, as well as, catastrophic plans with 
medical savings accounts.
  This bill fixes certain glitches in COBRA so that individuals with 
disabilities will no longer have to experience a gap in health 
insurance between the transition from employer to Medicare coverage.
  Mr. President, I am most grateful for the inclusion of the health 
plan purchasing coalition section of this legislation. I will be 
introducing legislation next week called the Employer Group Purchasing 
Reform Act of 1995, in which health plan purchasing coalitions are the 
center piece. I believe very strongly that voluntary private market 
group purchasing arrangements, for employers and individuals, is the 
key to making health insurance not only more accessible but also more 
affordable for all Americans.
  My legislation will also address the fraud and abuse in employer 
group purchasing arrangements called multiple employer welfare 
arrangements [MEWA's] under the Employee Retirement Income Security Act 
of 1974 [ERISA]. Senators Nunn and Cohen have both held hearings over 
the past few years which have uncovered ponzi schemes that have left 
millions of small business owners and their employees sick and without 
insurance. The legislation will give clear authority to the States to 
shut down group purchasing arrangements that are fraudulent and clear 
authority to certify health plan purchasing coalitions. In addition, 
the legislation also begins to level the playing field between insured 
and self-funded health plans in the market by amending ERISA. I look 
forward to the same bipartisan support of this bill as has been 
achieved by Senators Kassebaum and Kennedy.
  Mr. President, I am very eager to work with Senator Kassebaum, 
chairman of the Labor and Human Resources Committee, in the next couple 
of months, to report a market reform bill out of committee that can be 
brought to the Senate floor this session. We must begin to address 
Americans concern about portability and affordability of health 
insurance this year and I believe that the Health Insurance Reform Act 
of 1995 is an excellent place to start.
  Mr. HATCH. Mr. President, I am delighted to join with the 
distinguished chairman and ranking minority member of the Committee on 
Labor and Human Resources in cosponsoring today S. 1028, the Health 
Insurance Reform Act of 1995.
  This important piece of legislation is designed not only to increase 
access to health care benefits, but also to provide portability of 
those benefits and to increase the purchasing power of individuals and 
small employers who wish to seek insurance.
  As my colleagues know, the issue of health care coverage for millions 
of Americans remains a critical concern for this Congress and for the 
American people.
  The bill which we introduce today represents a reasonable and 
significant step in extending health insurance to a larger segment of 
the American population.
  As my colleagues are aware, for 18 years, I had the privilege of 
serving on the Labor and Human Resources Committee, including 6 years 
as chairman and 6 years as ranking minority member.

[[Page S 9908]]

  We have spent innumerable hours pondering how to improve our Nation's 
health care delivery system. There were times when we thought we had 
the answer, but we could never manage to develop exactly the right 
bill.
  More recently, last year in the Labor Committee we spent innumerable 
hours considering President Clinton's Health Security Act. Although my 
esteemed colleague and close friend, Senator Kennedy, fought long and 
hard for the President's proposal, that legislation was ultimately 
rejected by the American people and by the Congress.
  If we learned any lesson from that experience, it was that Americans 
do not want the Federal Government to have a larger role in shaping 
America's health care system.
  However, that does not lessen the need for some health care reform, 
and it is clear that insurance market reform is one area in which we 
have had, and continue to have, a good deal of consensus. We should not 
let the need for other reforms hold up passage of this much needed 
measure.
  Chairman Kassebaum and her staff are to be congratulated for 
developing the Health Insurance Reform Act based on the lessons we 
learned last year. It is a narrowly tailored bill which addresses very 
real problems in the marketplace.
  This bill will achieve many of the objectives we sought in the areas 
of insurance portability as well as correcting problems with respect to 
those individuals with preexisting health conditions.
  I am particularly pleased that the measure is receiving wide 
bipartisan support among the members of the Labor Committee. This is a 
very good signal that shows we have a viable bill which represents a 
consensus approach to a difficult and complicated problem.
  I strongly believe this bill represents the first meaningful and 
generally acceptable bipartisan insurance reform proposal in either 
house of Congress and I hope it will be enacted swiftly.
  Mr. WELLSTONE. Mr. President, I am pleased to join Senators Kennedy 
and Kassebaum, as well as many of my colleagues on the Labor and Human 
Resources Committee, in introducing the Health Insurance Reform Act of 
1995. The reforms included in this legislation would make it illegal 
for insurers to drop people when they become sick and to discriminate 
against individuals with preexisting conditions. While I wish that we 
were doing much more in Congress to ensure that all Americans have 
access to affordable, comprehensive health insurance coverage, I view 
the insurance reforms contained in this legislation as a serious step 
in the right direction. There is no excuse for not doing what we can to 
make coverage more accessible--especially for people with preexisting 
conditions and disabilities. It is a disgrace that our private 
insurance system continues to discriminate against precisely the 
individuals who most need coverage.
  All working Americans face a growing threat from the uncertainties 
created by the health insurance system. Even people with good health 
insurance coverage cannot count on protection if they lose or change 
jobs, especially if someone in their family has a preexisting 
condition. Our current health care system allows insurers to collect 
premiums for years and then suddenly refuse to renew coverage if 
individuals or employees get sick. It also allows insurers to routinely 
deny coverage to different types of businesses from auto dealers to 
restaurants.
  The GAO has estimated that as many as 25 million Americans could 
potentially benefit from the insurance reforms included in this 
bipartisan bill. Most of the people who would be helped by this 
legislation are people who change jobs and currently face preexisting 
conditions or waiting periods with their new health coverage.
  Many States, including Minnesota, have already enacted standards for 
insurance carriers, but because ERISA preemption prevents States from 
regulating self-funded health plans, only Federal standards can apply 
to all health plans. More and more employers in Minnesota have been 
choosing to offer self-funded plans to employees. Such plans now enroll 
about 1.5 million people, up from 890,000 in 1992, and about 50 percent 
of all privately insured residents. Current estimates also show that 
more than 400,000 Minnesotans--including 91,000 children--are 
uninsured.
  I am under no delusions that these insurance reforms will fix our 
broken health care system. They will not result in universal coverage--
or anywhere near it--and they will not solve the problem of rising 
costs. After all, only comprehensive reform will make health care 
affordable for many of the uninsured who simply cannot afford the high 
cost of coverage.
  While I am committed to fighting for comprehensive reforms that would 
include everyone and enable working families to afford health care 
coverage as good as Members of Congress have, I recognize that this may 
not happen this year. At the very least, however, we should act on 
reforms that would address some of the most egregious inequities in our 
current system, as well as those that would allow States to expand 
access and contain costs.
                                 ______

      By Mr. SIMPSON (for himself and Mr. Bingaman):
  S. 1029. A bill to amend the Foreign Assistance Act of 1961 to 
establish and strengthen policies and programs for the early 
stabilization of world population through the global expansion of 
reproductive choice, and for other purposes; to the Committee on 
Foreign Relations.


 THE INTERNATIONAL POPULATION STABILIZATION AND REPRODUCTIVE HEALTH ACT

  Mr. SIMPSON. Mr. President I rise to join my good friend and able 
colleague from New Mexico, Senator Jeff Bingaman. The two of us are 
reintroducing the very important legislation called the International 
Population Stabilization and Reproductive Health Act.
  During the last congressional session, Senator Bingaman and I 
introduced this bill to call attention to some very vital issues in 
this country and in the world. Our former colleague, Tim Wirth, 
championed these issues while he was in the Senate and, together, he 
and I laid the foundation upon which this bill is built, and then came 
my colleague from New Mexico, Jeff Bingaman--Senator Bingaman, who I 
thoroughly enjoy, and enjoy working with, his word is his bond. We work 
well together. He shares the same concerns and commitment to this 
crucial global issue as I do.
  I am pleased to be working in a bipartisan fashion with him so we can 
move forward with an effective public policy on an issue that affects 
everyone in some way, worldwide.
  The legislation we introduce today builds upon the Programme of 
Action Document adopted by acclamation by 180 nation states in 
September of 1994 at the International Conference on Population and 
Development in Cairo.
  At the conference, the United States was seen, as always, as the 
world's leader on population and development assistance. I was a 
congressional delegate at the conference. There were not a lot of 
colleagues seeking to go. Senator John Kerry was there and represented 
our country well.
  I came away much impressed with the leadership and direction 
displayed by our Vice President, Al Gore. Then, of course, assistance 
given to him by the now Under Secretary of State, former Senator Wirth, 
in guiding the conference and its delegates in developing a consensus 
document of a broad range of short- and long-range recommendations 
concerning maternal and child health care, strengthening family 
planning programs, the promotion of educational opportunities for girls 
and women, and improving the status and rights of women across the 
world.
  We surely do not want to lose our moral leadership role and 
relinquish any momentum by abandoning or severely weakening our 
financial commitment to population and development assistance. The 
United States needs to continue its global efforts to achieve 
responsible and sustainable population levels, and to back up that 
leadership with specific commitments to population planning activities.
  In my mind, of all the challenges facing this country--and there are 
plenty of them--and around the world--and there are plenty of them--
none compares to that of the increasing of the population growth of the 
world. All of our efforts to protect the environment, I have heard all 
of that in the last few days--protecting the environment, protecting 
this, protecting the aged, protecting the young--all the things to 
protect the environment and promote 

[[Page S 9909]]
economic development around the world are compromised and severely 
injured by the staggering growth in the world's population.
  I hope my colleagues realize, of course, that there are currently 5.7 
billion people on the Earth. In 1950, when I was a freshman at the 
University of Wyoming, not that long ago, there were 2.5 billion people 
on the face of the Earth. Mr. President, 2.5 billion in 1950, 5.7 
billion today.
  If current birth and death rates continue, the world's population 
will double again in just 40 years. Despite some progress in reducing 
fertility rates, birth rates in developing countries are declining too 
slowly to prevent a cataclysmic near tripling of the human race before 
stabilization can occur.
  The bill as Senator Bingaman and I propose focuses on a coordinated 
strategy that will help to achieve world population stabilization, 
encourage global economic development and self-determination, and 
improve the health and well-being of women and their children.
  Fundamental to this legislation is a recognition of the fact that 
worldwide efforts to alleviate poverty, stabilize populations, and 
secure the environment have been undermined by a total lack of 
attention to women's reproductive health and the role of women in the 
economic development of their families, their communities, and their 
countries.
  Under the legislation, global and U.S. expenditure targets will be 
set for overall population assistance, with specific programs to help 
achieve universal access to culturally competent family planning 
services and reproductive health care; expand programs for treatment 
and prevention of HIV and AIDS and other sexually transmitted diseases; 
close the gender gap in literacy and primary and secondary education; 
and increase economic opportunities for women so they can realize their 
full productivity potential.
  Other initiatives authorized under this legislation will help to 
reduce global maternal and infant mortality rates, and improve the 
overall health status of women and their children by addressing 
problems such as unsafe abortion. This is not about abortion. I have 
been here a long time. Every time we bring up something that has to do 
with stabilization of the Earth's population, somebody throws in the 
issue of abortion. That is not what this is about.
  It is also about harmful practices such as female genital mutilation, 
along with malnutrition, low immunization rates, and the spread of 
contagious diseases.
  There is a real need throughout much of the developing world for 
access to family planning services, especially as to safe abortion. 
Women in these countries are desperately seeking ways to take control 
of their reproductive lives and cannot do so because there is a severe 
lack of access to such services.
  Worldwide, estimates are that 350 million couples want to space or 
prevent another pregnancy but lack the access to a full range of modern 
family planning.
  In addition, any comprehensive family planning initiative must 
include access to primary health care with an emphasis on child 
survival to reduce infant mortality. In many developing countries, 
parents have a perception that many of their children will not survive 
beyond their first birthdays. If these parent's fears are allayed, they 
will not feel much pressure to have more children than they actually 
desire in order to insure against the possible loss of one or more of 
their children before adulthood.
  This is why for all of these pressing reasons, I join today with my 
friend and colleague from New Mexico, Senator Bingaman in introducing 
this legislation. It is our aim to call attention to global population 
stabilization, to give it focus, and to make it a vital part of U.S. 
foreign aid and development assistance programs. We need to begin to 
make much-needed policy changes in international population 
stabilization, and the United States needs to take this lead to ensure 
that these new policy developments are recognized worldwide. This one 
is long overdue.
  Mr. President, I ask unanimous consent to have printed in the Record 
a summary of the bill.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

  Summary: International Population Sta- bilization and Reproductive 
                               Health Act

       The International Population Stabilization and Reproductive 
     Health Act lays the foundation for a coordinated U.S. foreign 
     aid strategy, consistent with the Programme of Action 
     endorsed at the 1994 International Conference on Population 
     and Development. This strategy will: help achieve world 
     population stabilization; encourage global economic 
     development and self-determination; and improve the health 
     and well-being of women and their children.
       The Act recognizes that worldwide efforts to alleviate 
     poverty, stabilize population, and secure the environment 
     have been significantly undermined by the lack of attention 
     to women's reproductive health and the role of women in the 
     economic development of their families, their communities, 
     and their countries.


                         1. policy and purpose

       A. Key Objectives: To help stabilize the world's 
     population, improve the health and well-being of families, 
     provide greater self-determination for women and ensure the 
     role of women in the development process, and protect the 
     environment, key objectives of U.S. foreign policy will be 
     to:
       Assist in the worldwide effort to achieve universal access 
     to safe, effective, and voluntary family planning services;
       Promote access to quality reproductive health care for 
     women and primary health care for their children; and
       Support the global expansion of basic literacy, education, 
     and economic development opportunities for women.
       B. Expenditure Targets: To promote the objectives, 
     expenditure targets for population assistance are:
       Global Target: $17 billion by 2000 (total domestic and 
     international)
       U.S. Target: $1.85 billion by 2000.


                 2. u.s. population assistance programs

       U.S. population assistance will be available to 
     international governments; multilateral organizations, 
     including the United Nations and the UN Population Fund; and 
     nongovernmental organizations.
       A. Authorized Activities include:
       Affordable, culturally-competent, and voluntary family 
     planning and reproductive health services and educational 
     outreach efforts particularly those designed, monitored, and 
     evaluated by women and men from the local community;
       Research on safer, easier to use, and lower-cost fertility 
     regulation options and related disease control for women and 
     men that: are controlled by women; are effective in 
     preventing the spread of sexually transmitted diseases 
     (STDs); and encourage men to take greater responsibility for 
     their own fertility;
       Efforts to prevent and manage complications of unsafe 
     abortions, including research and public information 
     dissemination;
       Adolescent programs to prevent teen pregnancy, prevent the 
     spread of STDs, and promote responsible parenting; and
       Prenatal and postnatal programs that include breastfeeding 
     as a child survival strategy and means for enhancing birth 
     spacing.
       B. Conditions on Eligibility for Support:
       Largest share of U.S. population assistance will be made 
     available through nongovernmental organizations;
       Assistance priority to countries that account for a 
     significant portion of the world's population growth; have 
     significant unmet needs in the delivery of family planning 
     services; or are committed to population stabilization 
     through the expansion of reproductive choice;
       Programs receiving support must maintain privacy and 
     confidentiality standards; must support HIV-AIDS prevention; 
     promote responsible sexual behavior; and may not deny 
     services based on ability to pay;
       No U.S. funds may be used to coerce any person to accept 
     any method of fertility regulation or undergo contraceptive 
     sterilization or involuntary abortion.
       3. Economic and Social Development Assistance: U.S. 
     development assistance will be available to help improve 
     educational and economic opportunities for girls and women 
     and improve the health status of women and their children.
       Education: Priority assistance to countries that have 
     adopted strategies to help ensure achievement of the goal of 
     universal primary education of girls and boys before 2015.
       Economic Productivity: Priority assistance to governments 
     and nongovernmental organizations for programs that help 
     women increase their productivity through vocational training 
     and access to new technologies, extension services, credit 
     programs, child care, and through equal participation of 
     women and men in all areas of family and household 
     responsibilities.
       Women's Health: Priority assistance to governmental and 
     nongovernmental programs that increase the access of girls 
     and women to comprehensive reproductive health care services, 
     including HIV-AIDS prevention and the prevention of other 
     STDs.
       Children's Health: Priority assistance to governmental and 
     nongovernmental programs that are aimed at reducing 
     malnutrition; increasing immunization rates; reducing the 
     number of childhood deaths resulting from diarrheal diseases 
     and respiratory infections; and increasing life expectancy at 
     birth to greater than 70 years of age by 2005.
       Violence Prevention: Priority assistance to governmental 
     and nongovernmental programs which are aimed at eliminating 
     all 

[[Page S 9910]]
     forms of exploitation, abuse, and violence against women and children.
       4. Safe Motherhood Initiative: The Act authorizes the 
     ``Safe Motherhood Initiative,'' which helps girls and women 
     world-wide gain access to comprehensive reproductive health 
     care, including:
       fertility regulation services;
       prenatal care and high-risk screening;
       supplemental food programs for pregnant and nursing women;
       child survival and other programs that promote 
     breastfeeding;
       prevention and treatment of STDs, including HIV-AIDS;
       programs aimed at eliminating traditional practices 
     injurious to women's health, including female genital 
     mutilation; and
       programs promoting midwifery and traditional birth 
     attendants.
       5. Reports:
       A. Annual Report: To assess progress toward the Act's 
     objectives and expenditure targets, the President will submit 
     an annual report to the Congress which:
       estimates international population assistance by 
     government, donor agencies, and private sector entities;
       analyzes population trends by country and region; and
       assesses by country availability and use of fertility 
     regulation and abortion.
       B. Expenditure Target Report: To determine expenditure 
     targets for economic and social development activities, the 
     President will prepare a report which:
       estimates the resources needed, in total and by entity, to 
     achieve the education, productivity, and health initiatives 
     in the Act;
       identifies legal, social, and economic barriers to women's 
     self-determination and to improvements in the economic 
     productivity of women;
       describes existing initiatives aimed at increasing the 
     women's access to education, credit, and child care and new 
     technologies for development; and
       describes causes of mortality and morbidity among women of 
     childbearing age around the world and identifies actions and 
     resources needed to address them.
       C. Report on Discrimination: Each annual country human 
     rights report will include information on patterns within a 
     country of discrimination against women in inheritance laws, 
     property rights, family law, and access to credit, 
     technology, employment, education, and vocational training.
       6. Authorization of Appropriations:
       A. Section 104(g)(1): $635 million is authorized for Fiscal 
     Year 1996, $695 million for FY95, for section 104(g)(1) of 
     the Foreign Assistance Act of 1961.
       B. Development and Economic Assistance Activities: 
     Authorized levels are:
       $165 million in FY96 and $200 million in FY97 to increase 
     primary and secondary school enrollment and equalize levels 
     of male and female enrollment;
       $330 million for FY96 and $380 million for FY97 through the 
     Child Survival Fund for child survival activities, including 
     immunization and vaccines initiatives;
       $100 million for FY96 and FY97 for the Safe Motherhood 
     Initiative.
       C. AIDS Prevention and Control Fund: $125 million is 
     authorized for FY96, $145 million for FY97, for research, 
     treatment, and prevention of HIV-AIDS.

  Mr. SIMPSON. Mr. President, we are going to hold hearings on this. 
Those hearings will be held in my Subcommittee on Social Security and 
Family Policy. We are going to take this one very seriously. There is 
no need to talk about what is going to happen to the environment 
because of methane gas in cows, and how much propellant is in the 
bottom of the shaving cream can, when the population of the Earth will 
double in the next 40 years, and how many footprints will the Earth 
hold. It is very simple.
  Mr. BINGAMAN. Mr. President, I want to compliment my colleague who is 
the prime sponsor of this bill in this Congress, and I am pleased to 
cosponsor the bill with him. I want to compliment him for his 
leadership on this very important issue. He has been a leader in trying 
to deal with the problem of how to stabilize population growth in the 
world for a very long period of time.
  Today, we are reintroducing the International Population 
Stabilization and Reproductive Health Act. I also believe that this is 
a very important piece of legislation and has the potential of 
providing substantial benefits to this country over the coming decades.
  I think we have already benefited greatly from the very modest 
investment we have made in sustainable development and in population 
efforts.
  From my perspective, just as the Senator from Wyoming was saying, the 
attention to global population issues and support for worldwide 
development is critical to our future success here in this country.
  We have joined, Senator Simpson and I, with Congressman Beilenson and 
Congresswoman Morella, to introduce an earlier version of this in the 
last Congress, the 103d Congress.
  The bill we are introducing today, like the previous bill, will focus 
U.S. foreign policy on a coordinated strategy to accomplish three 
things. No. 1, to achieve world population stabilization; No. 2, to 
encourage global economic development and self-determination for all 
women; No. 3, to improve the health and well-being of women and their 
children.
  These three objectives are inseparable. To be successful, U.S. 
foreign policy needs to integrate population strategies and programs 
into our broader economic and development agenda. The way I see it, the 
U.S. efforts to help develop economies around the world, to promote 
democracy around the world, all of those efforts will be futile if we 
do not first address this issue of the staggering rate of global 
population growth.
  How can we expect underdeveloped countries to pull themselves up when 
the world's population is growing at a rate of over 10,000 people per 
hour? When the women and men who make up a nation's work force pool do 
not even have the right to plan their families? And when millions of 
women around the world do not have access to basic and lifesaving 
reproductive health care or educational opportunities?
  The 1994 U.N. International Conference on Population Development, 
which Senator Simpson attended and Senator Kerry attended, from this 
body, focused the world's attention on these issues and began a new era 
in population and development. At that Cairo conference, Senator 
Simpson indicated there was a program of action that was adopted as a 
consensus document. That program of action is the foundation for the 
legislation that we are introducing today. It clearly puts human beings 
at the center of development activities and encourages the 
international community to address global problems by meeting 
individual needs. It calls for gender equity and equality, for women to 
have and exercise choices in their economic and public and family 
lives, and for making reproductive health care available throughout the 
world.
  The program of action which was adopted in Cairo recognizes that some 
significant worldwide progress has already been made in the last few 
decades, including lower birth and death rates in most parts of the 
world, reduced infant mortality, increased life expectancy, a slight 
rise in educational attainment, and a slight narrowing in the gap 
between the educational levels of men and women.
  However, the Cairo Programme of Action, along with the State of 
Population Report, which was released just 2 days ago by the U.N. 
Population Fund, also recognized that a tremendous additional amount 
needs to be done. At the core of both the International Programme of 
Action and the United Nations report are two fundamental concepts. They 
are, first of all, that population, poverty, patterns of production and 
consumption, and the environment are so closely interconnected that 
none can be considered in isolation. And, second, that sustained 
economic growth, sustainable development in population, are 
fundamentally dependent upon investing in people; more specifically, on 
making advances in education and in economic status and in the 
empowerment of women.
  This legislation, which I am very proud to cosponsor with Senator 
Simpson in this Congress, represents a significant step forward. I 
sincerely hope our colleagues in the Senate will give it a careful 
look. I commend him for scheduling a hearing this next week, at which 
we can explore the issues in more depth, and I look forward to working 
with him throughout the rest of this Congress in trying to see this 
legislation enacted into law.
  Mr. SIMPSON. Mr. President, I certainly concur. I look forward to 
working with my friend from New Mexico. Hearings will start next week, 
and we will be about our business. That is something that is very 
clear.
                                 ______

      By Mr. REID (for himself, Mr. Simpson, Mr. Wellstone, and Ms. 
        Moseley-Braun):
  S. 1030. A bill entitled the ``Federal Prohibition of Female Genital 
Mutilation Act of 1995''; to the Committee on the Judiciary.

[[Page S 9911]]



    THE FEDERAL PROHIBITION OF FEMALE GENITAL MUTILATION ACT OF 1995

 Mr. REID. Mr. President, last September I introduced a sense-
of-the-Senate resolution condemning the practice of female genital 
mutilation [FGM]. I was compelled to react after I read an article in 
the newspaper reporting the arrest of two men in Egypt who arranged for 
the filming of this appalling ritual procedure being performed on a 10-
year-old girl for the Cable News Network [CNN]. Last October, Senators 
Wellstone, Moseley-Braun, and myself introduced legislation that would 
ban this practice and today, along with Senator Simpson, we again 
introduce such legislation.
  I realize the significance of the ritual in the culture and social 
system of the communities in Africa, Asia, and the Middle East. 
However, I cannot ignore the cruel and torturous nature of this 
procedure which is generally performed on very young girls who do not 
have a choice in what is about to happen to them. The immediate effects 
of the procedure are bleeding, shock, infections, emotional trauma, and 
even death because of hemorrhage and unhygienic conditions. As adults, 
complications during pregnancy and labor can occur.
  Although FGM is most prevalent in Africa, Asia, and the Middle East, 
it is not confined to these areas. It is estimated that over 80 million 
young girls and women have been mutilated in this ritual. Excision and 
infibulation are the most common practices. Infibulation, which is 
practiced in many countries, entails the excision of all of the female 
genitalia. The remaining tissue is stitched together leaving only a 
small opening for urine and menstrual flow. FGM has no medical 
justification for being performed on healthy young girls and women. In 
Egypt, mothers perpetuate the tradition to shield their girls from lust 
and to make sure they will be accepted in marriage. They believe an 
uncircumcised women cannot control her sexual appetite, or if married, 
likely to commit adultery.
  Although I believe this practice is a torturous act when performed on 
any woman, I am most concerned about it being performed on children and 
young girls under the age 18--in other words, below the age at which a 
child can give consent. A child does not have the ability to consent or 
understand the significance and the consequence this ritual will have 
on her life, on her health, or on her dignity. Young girls are tied and 
held down, they scream in pain and are not only physically scarred, but 
they are emotionally scarred for life.
  Many nations have made efforts to deter the practice of FGM with 
legislation against its execution as well as creating educational 
programs for women. The United Kingdom outlawed FGM in 1985 after a BBC 
documentary revealed that British doctors were performing the procedure 
on children whose families had immigrated. Unfortunately, despite these 
initiatives, the societal pressures are too much to overcome. Sudan is 
a prime example of the failure of honest efforts to deter the practice. 
Sudan has the longest record of efforts to combat the practice of FGM 
and has legislated against the procedure. Yet, according to the 1992 
Minority Rights Group report, 80 percent of Sudanese women continue to 
be infibulated. Nevertheless, as stated in my sense-of-the-Senate 
resolution, it is important that any effort by a nation to curb FGM be 
recognized and commended.
  The most successful endeavors to prevent FGM has been at the 
grassroots level led by women, many of whom have undergone this 
excruciating operation, with support from the
 World Health Organization, UNICEF, and other international human 
rights groups. African and Arab women have begun to speak out and we 
must do all we can to support their efforts. They are working under 
difficult circumstances and often in hostile social environments for 
the preservation of a woman's health, dignity, and human rights. We 
must work to support and encourage their efforts to end this violent 
degradation of female children throughout the world.

  Primarily, we must join other countries in legally banning FGM. As 
immigrants from Africa and the Middle East travel to other nations, the 
practice of FGM travels with them. The United Kingdom, Sweden, and 
Switzerland have all passed legislation prohibiting FGM in their 
countries. France and Canada maintain that FGM violates already 
established statutes prohibiting bodily mutilation and have taken 
action against its practice. The United States is also faced with the 
responsibility of abolishing this specific practice within its borders. 
Traditional child abuse interventions do not sufficiently address the 
problem.
  FGM is difficult to talk about, but ignoring this issue because of 
the discomfort it causes us does nothing but perpetuate the silent 
acquiescence to its practice. The women of Africa and the Middle East 
are standing up against tremendous pressure and defiance to fight for 
the health and dignity of their sisters, friends, mothers, and 
daughters. The least we can do is support and encourage their struggle 
and to continue to talk about FGM and to condemn its practice. 
Education will be our most important and effective tool against FGM, 
and I intend to do my part to educate my colleagues, my constituents, 
and my friends to the horrors of this ritual practice.
  In hopes to educate the public, our legislation provides for research 
on the prevalence of FGM in the United States. Furthermore, our bill 
provides that medical studies be aware of the ritual and be trained in 
how to treat effected women, and it will make illegal the denial of 
medical services to any woman who has undergone FGM procedures in the 
past.
  Seble Dawit and Salem Mekuria, two African women who are working to 
end FGM, described the challenges to abolishing FGM. ``We do not 
believe that force changes traditional habits and practices. Genital 
mutilation does not exist in a vacuum but as part of the social fabric, 
stemming from the power imbalance in relations between the sexes, from 
levels of education and the low economic and social status of most 
women. All eradication efforts must begin and proceed from these basic 
premises.'' 
 Mr. WELLSTONE. Mr. President, the issue of female genital 
mutilation [FGM] was first brought before the Senate last September 
when Senator Reid introduced a sense-of-the-Senate resolution 
condemning this cruel ritual practice and commending the Government of 
Egypt for taking quick action against two men who performed this deed 
on a 10-year-old girl in front of CNN television cameras. Last October, 
Senators Reid and Moseley-Braun and I introduced a bill entitled 
Federal Prohibition of Female Genital Mutilation Act of 1994. At that 
time we committed ourselves to working on this issue until legislation 
passes that bans the practice of female genital mutilation in the 
United States.
  The bill we are introducing today would accomplish this goal by 
making it illegal to perform the procedures of FGM on girls younger 
than 18. In addition, this legislation proscribes the following 
measures as necessary to the eradication of this procedure: compiling 
data on the number of females in the U.S. who have been subjected to 
FGM, identifying communities in the United States in which it is 
practiced, designing and implementing outreach activities to inform 
people of its physical and psychological effects, and developing 
recommendations for educating students in medical schools on treating 
women and girls who have undergone mutilations. I am proud to be a 
cosponsor of an act that addresses an issue so crucial to the mental 
and physical health of women and girls.
  The ritual practice of female genital mutilation currently affects an 
estimated 80 million women in over 30 countries. Although FGM is most 
widespread in parts of Africa, the Middle East, and the Far East, 
immigrants from practicing groups have brought the custom to wherever 
they have settled, including the American cities of New York, Seattle, 
Portland, San Francisco, and Washington, DC. This tradition is 
sometimes euphemistically referred to as ``female circumcision,'' a 
dangerously misleading label which encourages us to think of the 
procedure as nothing more significant than the culturally required 
removal of a piece of skin.
  A closer examination of the issue makes it clear that female genital 
mutilation is in fact the ritual torture of 

[[Page S 9912]]
young girls. In her Washington Post article, Judy Mann describes female 
genital mutilation as ``the ritualized removal of the clitoris and 
labia in girls--from newborns to late adolescents. In its most extreme 
form, a girl's external sexual organs are scraped away entirely and the 
vulva is sewn together with catgut, leaving a hole the size of a pencil 
for urine and menses to pass through. Her legs are bound together for 
several weeks while a permanent scar forms.''
  In the countries and cultures of its origin, FGM is most commonly 
performed with crude instruments such as dull razor blades, glass, and 
kitchen knives while the girl is tied or held down by other women. In 
most cases, anesthesia is not used. Afterwards, herb mixtures, cow 
dung, or ashes are often rubbed on the wound to stop the bleeding.
  Aside from the obvious emotional and physical trauma which are caused 
by this procedure, it has been estimated that 15 percent of all 
circumcised females die as a result of the ritual. The long term 
effects dealt with by American doctors who treat mutilated women and 
girls are listed by the New England Journal of Medicine as including 
chronic pelvic infections, infertility, chronic urinary tract 
infections, dermoid cysts (which may grow to the size of a grapefruit), 
and chronic anxiety or depression.
  Although female genital mutilation has sometimes been viewed as a 
purely cultural phenomena, it is clear that no ethical justification 
can be made for this inhumane practice in any country.
  The unacceptable nature of FGM by international human rights 
standards was underscored by the World Health Organization on May 12, 
1993, when it adopted a resolution which highlighted the importance of 
eliminating harmful traditional practices affecting the health of 
women, children and adolescents. This resolution explicitly cited 
female genital mutilation as a practice which restricts ``the 
attainment of the goals of health, development, and human rights for 
all members of society.'' In 1993, the Vienna Declaration of the World 
Conference on Human Rights also held that FGM is an international human 
rights violation.
  Additionally, FGM has already been banned in many Western nations. In 
1982, Sweden passed a law making all forms of female circumcision 
illegal, and the United Kingdom passed a similar law in 1985. France, 
the Netherlands, Canada, and Belgium have each set a precedent for the 
illegality of female circumcision by holding that it violates laws 
prohibiting bodily mutilation and child abuse. Action has been taken to 
enforce the statutes banning this practice in all the countries I've 
just mentioned.
  However, due to complex cultural factors, dealing with this issue in 
the United States require more than making the ritual practice of FGM 
illegal. Immigrant parents in the United States who import a 
circumciser from their home country or find an American doctor willing 
to perform the procedure claim to do so out of a desire to do the best 
thing for their daughters. In the societies and cultures that practice 
it, FGM is said to be an integral part of the socialization of girls 
into acceptable womanhood. Often, the mutilations are perceived by a 
girl's parents as her passport to social acceptance or the required 
physical marking of her marriageability. In spite of its obvious 
cruelty therefore, FGM is a part of cultural identity. Clearly, female 
genital mutilation must be dealt with in a manner which takes into 
account its complex causes and meanings.
  Because of the complexity of this issue and the lack of available 
information regarding FGM in the United States, this bill includes a 
provision ensuring that research be carried out to determine the number 
of females in the U.S. who have undergone mutilations. This research 
would also document the types of physical and psychological damage 
dealth with by American medical professionals who treat mutilated 
women.
  The bill also requires that we investigate approaches such
   as the one used in Great Britain where child protection networks are 
used to identify at risk girls and trained professionals are assigned 
to work with their families.

  Finally, the legislation would ensure that medical students are 
educated in how to treat women and girls who have undergone FGM. In 
1994, the New England Journal of Medicine reported that pregnant women 
who have undergone infibulation--in which the labia majora are stitched 
to cover the urethra and entrance to the vagina--are at serious risk, 
as are their unborn babies, if treated by physicians who have not been 
trained in dealing with infibulated women. In fact, untreated 
infibulated women have double the risk of maternal death and several 
times increased risk of stillbirth when compared with women who have 
not undergone mutilation.
  The education of medical students regarding FGM is especially 
essential as under this bill it would be considered illegal to 
discriminate or deny medical services to any woman who has undergone 
FGM procedures.
  Passage of a bill banning FGM would have helped Lydia Oluloro who 
fought her deportation and that of her two daughters on the grounds 
that her sister had threatened to kidnap the girls and have the 
mutilations performed on them if they were forced to return to their 
native Nigeria.
  Passage of this bill would also send a clear message to American 
medical professionals, some of whom reportedly have been offered as 
much as $3,000 to perform mutilations on young girls. It would see to 
it that the names of Western doctors who mutilate girls would no longer 
be passed around in immigrant communities. It would help in prosecuting 
cases resembling the one faced by the Atlanta district attorney in 1986 
in which an African-born nurse was charged with child abuse after 
botching a clitoridectomy on her 3-year-old niece, and it would ensure 
that immigrants are educated as they enter the country regarding the 
operations's illegality and its dangers.
  Female genital mutilation is the world's most widespread form of 
torture, yet no other mass dilation of humanity has received so 
comparatively little journalistic or governmental attention. We in the 
United States should make it clear that it is a serious crime if it 
occurs here. I urge my colleagues to support this legislation as an 
essential tool in the struggle against the perpetuation of this heinous 
practice.
 Ms. MOSELEY-BRAUN. Mr. President, I am very pleased to join 
Senator Reid, Senator Wellstone and Senator Simpson as an original 
cosponsor to the Federal Prohibition of Female Genital Mutilation Act 
of 1995.
  Male circumcision is a procedure with a long history. It is a common, 
accepted practice in the United States for male babies to be 
circumcised. In the Jewish religion, tradition dictates that a baby boy 
be circumcised when he is 8 days old in a special ceremony to symbolize 
the covenant between God and the children of Israel. It is quick, 
relatively painless, and without long-term consequences--for men.
  For women, however, circumcision is another matter altogether. The 
procedure known as female circumcision is not at all benign. It is 
mutilation.
  Eighty million women worldwide have been mutilated by female 
circumcision. The procedure is most widely seen in eastern and western 
Africa, and a number of Middle Eastern countries. And as communities 
from African countries immigrate to the United States, we are 
tragically seeing more and more cases of genital mutilation in this 
country. That is why this legislation is so important.
  I am concerned that in this country there are misperceptions that 
this procedure is part of African and Islamic culture and tradition, 
and that the Government should not interfere. Nowhere in Muslim 
scripture is female circumcision required. It is not practiced in Saudi 
Arabia, the cradle of Islam. Historically, the procedure dates back 
before the rise of the Moslem religion to the times of the Pharaoh in 
Egypt.
  In countries where the practice is not universal, female genital 
mutilation is more common among poor, uneducated women, and it is 
inextricably tied to the status of women in the community. In these 
societies, women who have not been circumcised are considered unclean, 
and unmarriageable. In communities where the only role for a women is 
to be married and have children, the fear of being labeled 
unmarriageable is enormous and real.

[[Page S 9913]]

  Ironically, that is why women are the strongest supporters of this 
practice. It is the older women who know best about how an 
uncircumcised woman in a traditional village will be treated. Girls are 
taught that with circumcision, they enter womanhood. Mothers encourage 
the mutilation because they want their daughters to marry--because 
marriage is the only access to a meal ticket. And men support the 
custom because a woman who is circumcised is considered chaste. In 
short, circumcision is a passport into the only role that some 
societies give women.
  As a woman and a mother, I can't imagine leading a child to this kind 
of torture.
  I want to raise awareness of this practice. This is mutilation of 
otherwise healthy women, pure and simple. We must work together to stop 
teaching girls that undergoing this kind of butchery is essential to 
their future.
  Mr. President, there are very serious health risks associated with 
the practice of female genital mutilation that do not exist with male 
circumcision. This practice is most often performed by midwives or 
other women elders with little or no medical training. It is performed 
without anesthetic or sanitary tools. Often, the cut is made with a 
razor blade or a piece of glass.
  The New England Journal of Medicine has examined female genital 
mutilation as a public health issue. They report that women often 
hemorrhage after the cutting. Prolonged bleeding may lead to severe 
anemia. Urinary tract infections and pelvic infections are common. 
Sometimes, cysts form in the scar tissue. The mutilation can also lead 
to infertility.
  At childbirth, circumcised women have double the risk of maternal 
death, and the risk of a stillbirth increases several fold. And because 
the cutting is performed without sanitary
 tools, female genital mutilation has become a means of spreading the 
HIV virus. There are no records of how many girls die as a result of 
this practice.

  Mr. President, Sweden, Britain, The Netherlands, and Belgium have 
outlawed this practice. In France, it is considered child abuse. The 
United States has an important role to play as well. Two years ago, the 
world health organization adopted a resolution on maternal child health 
and family planning for health sponsored by Guinea, Kenya, Nigeria, 
Togo, Zambia and Lebanon that highlights the importance of eliminating 
harmful traditional practices, includings female genital mutilation, 
affecting the health of women, children and adolescents.
  Banning this practice in the United States is just the first step 
toward eradicating it. Girls must be taught that they will have 
opportunities, both in marriage and outside the home, if they are not 
mutilated. Mothers must believe that their daughters will have a place 
in the community if they are not circumcised. And men must be taught 
that the terrible health risks involved with the procedure far outweigh 
their belief that a circumcised woman is a more suitable bride.
  I want to commend the Inter-African Committee on Traditional 
Practices Affecting the Health of Women and Children, for their work in 
Africa over the last 10 years to educate women so that this practice 
can be abolished. It will take much more than Government statements 
against the procedure to eradicate the tradition.
  Mr. President, no woman, anywhere, should have to undergo this kind 
of mutilation, not to get a husband, not to put food on the table, not 
for any reason. Female circumcision is, in the final analysis, about 
treating women as something less than people. It must be stopped. It 
has no place in today's world.
  By Mr. THOMAS (for himself, Mr. Simpson, Mr. Burns, Mr. Craig, Mr. 
Stevens, Mr. Kempthorne and Mr. Helms):
  S. 1031. A bill to transfer the lands administered by the Bureau of 
Land Management to the State in which the lands are located; to the 
Committee on Energy and Natural Resources.

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