Improvements in Global Maternal and Newborn Health Outcomes while Maximizing Successes Act or Improvements in Global MOMS Act - Amends the Foreign Assistance Act of 1961 to authorize the President to furnish assistance to reduce mortality and improve maternal health and the health of newborns in developing countries, including HIV/AIDS prevention programs.
Directs the President to implement a comprehensive strategy as part of the Global Health Initiative to reduce mortality and improve the health of mothers and newborns in developing countries.
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5268 Introduced in House (IH)]
111th CONGRESS
2d Session
H. R. 5268
To provide assistance to improve maternal and newborn health in
developing countries, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 11, 2010
Mrs. Capps (for herself, Ms. McCollum, Mrs. Christensen, Ms. Woolsey,
Mrs. Maloney, Ms. Moore of Wisconsin, Ms. DeLauro, Ms. Clarke, Ms. Lee
of California, Ms. Wasserman Schultz, Mr. Loebsack, Mr. Grijalva, Ms.
Schakowsky, Ms. Shea-Porter, Ms. Norton, Mrs. Davis of California, Mr.
Conyers, and Ms. Matsui) introduced the following bill; which was
referred to the Committee on Foreign Affairs
_______________________________________________________________________
A BILL
To provide assistance to improve maternal and newborn health in
developing countries, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Improvements in Global Maternal and
newborn health Outcomes while Maximizing Successes Act'' or
``Improvements in Global MOMS Act''.
SEC. 2. FINDINGS AND PURPOSES.
(a) Findings.--Congress makes the following findings:
(1) In 2000, the United States joined 188 other countries
in supporting 8 United Nations Millennium Development Goals
(MDGs), including MDG 5, to reduce the maternal mortality ratio
by three-quarters by 2015. In 2005, universal access to
reproductive health was added as a target for MDG 5.
(2) On January 15, 2009, United States Permanent
Representative to the United Nations Susan Rice stated before
the Committee on Foreign Relations of the Senate that President
Barack Obama is committed to ``making the Millennium
Development Goals America's goals.''.
(3) With thousands of avoidable maternal deaths still
occurring, the United States will need to immediately scale up
its funding and delivery of proven low-cost, lifesaving
interventions in order to fulfill its commitment to help ensure
that MDG 5 is met.
(4) Substantial progress in maternal health has been made
in some countries and regions: Egypt, Honduras, Malaysia, Sri
Lanka, and parts of Bangladesh have all halved their maternal
mortality ratios over the past few decades.
(5) However, MDG 5 has made the least progress of all the
MDGs. At the current pace, MDG 5 will not be met in Asia until
2076 and much later in Africa.
(6) An estimated 8,800,000 children under the age of 5 die
each year. Over 40 percent of these die in the first month of
life. And mortality rates are increasing for those born to
young mothers or where pregnancies are less than a year apart.
(7) Hundreds of thousands of women die each year from
causes related to pregnancy and childbirth. Ninety-nine percent
of these deaths occur in the developing world and the vast
majority are preventable.
(8) In sub-Saharan Africa, a woman's lifetime risk of
maternal death is a staggering 1 in 22, compared with 1 in
4,800 in the United States, according to the United Nations
Children's Fund (UNICEF).
(9) Nine out of 10 women in sub-Saharan Africa will lose a
child during their lifetimes.
(10) For every maternal death, approximately 20 women--or
10,000,000 women per year--suffer complications with severe
consequences, including pregnancy-related injuries such as
fistula, uterine prolapse, infections, diseases, and
disabilities.
(11) The number one cause of maternal deaths is hemorrhage.
Other primary causes of maternal death include sepsis, unsafe
abortion, hypertensive disorder, and prolonged or obstructed
labor.
(12) Violent acts against pregnant women can lead to poor
health outcomes, including preterm labor, preterm delivery,
miscarriage, and stillbirths, and even maternal deaths, and the
risk for maternal mortality is 3 times as high for abused
mothers.
(13) The spacing of births has a powerful impact on a
child's chances of survival. Children born less than 2 years
after the previous birth are about 2.5 times more likely to die
before age 5 than children born 3 to 5 years after the previous
birth.
(14) Pregnancy is the leading cause of death for young
women aged 15 to 19 worldwide. Compared to girls in their
twenties, girls aged 15 to 19 are twice as likely, and girls
under 15 five times as likely, to die in childbirth, and
mortality and morbidity rates are also higher among infants
born to young mothers.
(15) Globally, 215,000,000 women would like to delay or end
childbearing, but do not have access to modern contraceptives.
Fully addressing this need would prevent an additional
53,000,000 unintended pregnancies each year and reduce maternal
deaths due to unsafe abortion by 82 percent.
(16) If family planning and maternal and newborn services
were provided simultaneously, the costs of these services would
decline by $1,500,000,000 compared with investing in maternal
and newborn care alone--this dual investment would result in a
70 percent decline in maternal deaths and 44 percent decline in
newborn deaths.
(17) Maternal death rates are inextricably tied to neonatal
survival, with the risk of death doubling for newborns in some
countries in the developing world following maternal death.
(18) In many developing countries, including fragile states
and countries affected by conflict, lack of access to quality
health care facilities, health services, and trained providers
results in deaths for mothers, newborns, and children--the
majority of births in Africa take place without a skilled
attendant present, increasing the risk of death or disability
for both mother and newborn.
(19) The experiences of United States Government-supported
and nongovernmental organization maternal and child health
programs in countries such as Nepal, Ethiopia, and Senegal have
demonstrated that community-based approaches, linked to primary
and referral care when possible, can deliver high-impact
interventions to prevent or treat many of the life-threatening
conditions affecting mothers, newborns, and children under the
age of 5.
(20) More than half of all children and pregnant women in
developing countries suffer from anemia, which is exacerbated
by malaria, neglected tropical diseases, and nutritional
deficits, causing adverse pregnancy outcomes and even death.
(21) According to WHO, women that have undergone female
genital mutilation are significantly more likely than those who
have not undergone female genital mutilation to experience
serious postpartum health problems, and children born to
mothers who have undergone female genital mutilation face
higher death rates immediately after birth.
(22) According to the Director of National Intelligence's
2009 Annual Threat Assessment, widespread poor maternal and
child health and malnutrition has the potential to weaken
central governments and empower non-state actors, including
terrorist and paramilitary groups.
(23) The United States Agency for International Development
has estimated the economic impact of maternal and newborn
mortality to be a global loss of over $15,000,000,000 due to
diminished productivity.
(b) Purposes.--The purposes of this Act are--
(1) to authorize assistance to improve maternal and newborn
health in developing countries; and
(2) to develop a strategy to reduce mortality and improve
maternal and newborn health in developing countries.
SEC. 3. ASSISTANCE TO IMPROVE MATERNAL AND NEWBORN HEALTH IN DEVELOPING
COUNTRIES.
(a) In General.--Chapter 1 of part I of the Foreign Assistance Act
of 1961 (22 U.S.C. 2151 et seq.) is amended--
(1) in section 102(b)(4)(B), by striking ``reduction of
infant mortality'' and inserting ``reduction of maternal and
newborn mortality''; and
(2) by inserting after section 104C the following new
section:
``SEC. 104D. ASSISTANCE TO REDUCE MORTALITY AND IMPROVE MATERNAL AND
NEWBORN HEALTH.
``(a) Authorization.--Consistent with section 104(c), the President
is authorized to furnish assistance, on such terms and conditions as
the President may determine, to reduce mortality and improve maternal
health and the health of newborns in developing countries.
``(b) Activities Supported.--Assistance provided under subsection
(a) shall, to the maximum extent practicable, include--
``(1) activities to expand access and improve quality of
maternal health services, including--
``(A) comprehensive voluntary family planning
services, integrated into antenatal and postnatal care
and in child health services, to support women and men
in making informed decisions and having timely,
intended, well-spaced pregnancies and to help women
with preexisting conditions avoid high-risk, unintended
pregnancies;
``(B) birth preparedness through the provision of
quality antenatal care, including--
``(i) educating women and families about
danger signs to look for, potential
complications during pregnancy and childbirth,
and where to access care;
``(ii) providing counseling about hygiene,
nutrition, and the care and feeding of babies;
``(iii) helping women and families develop
a birth plan that includes skilled delivery
care and a transport plan in case of
emergencies;
``(iv) screening for complications
including blood pressure screenings;
``(v) diagnosis and treatment of existing
conditions, such as HIV/AIDS, syphilis,
malaria, and tuberculosis, and ensuring that
women are provided with, or referred to,
appropriate care and treatment for those
conditions;
``(vi) ensuring that women infected with
HIV are provided mother-to-child transmission
prevention services, including access to
voluntary family planning, medications to
prevent such transmission, and counseling on
infant feeding; and
``(vii) making vaccines, micronutrients,
and treatment for infections and parasites
available and accessible;
``(C) skilled delivery care, including--
``(i) the presence of an accredited health
professional, such as midwife, doctor, or
nurse, who has been educated and trained to
proficiency in the skills needed to manage
normal or uncomplicated pregnancies,
childbirth, and the immediate postnatal period,
and in the identification, management, or
referral of complications in women and
newborns, including active management of the
third stage of labor; and
``(ii) an enabling environment that
includes access to a referral system,
communication and transport, drugs and
supplies, and equipment appropriate for a
normal delivery;
``(D) quality emergency obstetric care, including--
``(i) increasing the technical competence
of health care providers;
``(ii) increasing the essential supplies
and equipment including fluids, blood products,
and drugs to treat complications such as
infection, bleeding, and hypertension;
``(iii) providing the information and
counseling for the client, including quality of
client-provider interaction;
``(iv) ensuring continuity of
comprehensive, acceptable care, referrals and
followup; and
``(v) access to cesarean section when
necessary;
``(E) postpartum care and support, including--
``(i) activities to promote immediate
exclusive breastfeeding;
``(ii) activities to promote essential care
of newborns;
``(iii) activities to treat, repair, and
provide followup services for injuries
resulting from pregnancy and childbirth,
including fistula; and
``(iv) family planning counseling and
service provision; and
``(F) postabortion care, including--
``(i) emergency treatment of complications
of unsafe abortion;
``(ii) family planning counseling and
services; and
``(iii) linkages to other reproductive
health services;
``(2) working with communities and health care providers to
identify and remove barriers to maternal health care services,
including barriers such as financial, sociocultural,
transportation, gender discrimination, and stigma based on
preexisting health concerns, and ensure that those services are
based in individual human rights, as recognized by
international agreements and instruments;
``(3) comprehensive sexuality education programs and
services for youth that provide adolescents with information,
skills, and materials necessary to postpone childbearing;
``(4) promotion of activities that focus on empowering
women and girls and engaging men and boys at the individual,
household, and community levels to improve the health outcomes
of women, newborns, and children including education and
awareness programs about gender-based violence, the health
risks of female genital mutilation, and shared responsibility
for and benefits of family planning;
``(5) activities to improve essential newborn care and
treatment, including educating families and communities about
proper antenatal and skilled delivery care, tetanus toxoid
immunization during pregnancy, immediate and exclusive
breastfeeding, keeping the newborn warm, such as by providing
skin-to-skin care, keeping the cord clean, resuscitation of
newborns who are not breathing properly, and treatment of
infections;
``(6) activities to prevent and treat childhood illness,
including early infant diagnosis of HIV infection and
increasing access to appropriate prevention and treatment for
diarrhea, pneumonia, malaria, HIV/AIDS, and other life-
threatening childhood illnesses;
``(7) activities to improve child and maternal nutrition,
including the delivery of iron, zinc, vitamin A, iodine, and
other key micronutrients, the promotion of breastfeeding and
appropriate complementary feeding, and the utilization of Ready
to Use Therapeutic Foods (RUTF) that, to the extent
practicable, are developed, purchased, or produced in the
country or region that they are utilized;
``(8) activities to strengthen the delivery of immunization
services, including efforts to strengthen routine immunization,
introduce new vaccines for diseases such as rotavirus and
pneuomcoccal disease, and eliminate polio;
``(9) activities to improve household-level behavior
related to safe water, hygiene, safe and hygienic food
preparation and storage, exposure to indoor smoke, and
environmental toxins such as lead;
``(10) activities to improve capacity for health
governance, health finance, and the health workforce, including
in the private sector, and support for training clinicians,
nurses, technicians, sanitation and public health workers,
community-based health workers, midwives, birth attendants,
peer educators, volunteers, and private sector enterprises to
provide integrated health services and referrals that meet the
needs of patients across a continuum of care;
``(11) activities to address antimicrobial resistance in
treating maternal health infections;
``(12) activities to establish and support management of
host country institutions' information systems and the
development and use of tools and models to collect, analyze,
and disseminate information related to maternal and newborn
health;
``(13) activities to develop and conduct needs assessments,
baseline studies, targeted evaluations, or other information-
gathering efforts for the design, monitoring, and evaluation of
maternal and newborn health efforts, including--
``(A) studying the availability and effects of
critical medicines, particularly those of importance in
the developing world, on pregnant women and newborns;
``(B) collection, evaluation, and use of data on
the medical and socioeconomic factors that led to a
maternal or newborn death or `near miss' at the
community and health facility levels; and
``(C) sociocultural barriers, influencers, and
enhancers of health and nutrition behaviors;
``(14) activities to integrate and coordinate assistance
provided under this section with existing health programs for--
``(A) the prevention of the transmission of HIV
from mother to child and other HIV/AIDS prevention,
care, treatment, and counseling activities;
``(B) malaria;
``(C) tuberculosis;
``(D) family planning and reproductive health;
``(E) counseling for survivors of sexual- and
gender-based violence;
``(F) neglected tropical diseases; and
``(G) nutrition;
``(15) activities to improve orphan care services and to
support innovative orphan and vulnerable children programs;
``(16) activities to end harmful traditional practices
including female genital mutilation and child marriage;
``(17) activities to train health care providers to
prevent, identify, and manage cases of gender-based violence as
part of family planning and maternal and newborn health
services;
``(18) activities to support mental health care and provide
psychosocial support;
``(19) activities to improve access to clean water and
improved sanitation through community-based hygiene education
programs, access to household- and community-level water
purification tools and devices, and latrine construction; and
``(20) activities to prevent, control, and in some cases
eliminate neglected tropical diseases for both newborns and
mothers.
``(c) Guidelines.--To the maximum extent practicable, programs,
projects, and activities carried out using assistance provided under
this section shall be--
``(1) carried out through private and voluntary
organizations, including community and faith-based
organizations, and relevant international and multilateral
organizations, including the United Nations Population Fund,
the United Nations Children's Fund, and the Global Alliance for
Vaccines and Immunizations, that demonstrate effectiveness and
commitment to improving the health and rights of mothers,
newborns, and children;
``(2) carried out in the context of country-driven plans in
whose development the United States Government participates
along with other donors and multilateral organizations,
nongovernmental organizations, and civil society;
``(3) carried out with input by beneficiaries and other
directly affected populations, especially women and
marginalized communities; and
``(4) designed to build the capacity of host country
governments and civil society organizations.
``(d) Annual Report.--Not later than January 31, 2011, and annually
thereafter for 4 years, the President shall transmit to Congress a
report on the implementation of this section for the prior fiscal year.
``(e) Definitions.--In this section:
``(1) AIDS.--The term `AIDS' has the meaning given the term
in section 104A(g)(1) of this Act.
``(2) HIV.--The term `HIV' has the meaning given the term
in section 104A(g)(2) of this Act.
``(3) HIV/AIDS.--The term `HIV/AIDS' has the meaning given
the term in section 104A(g)(3) of this Act.''.
SEC. 4. DEVELOPMENT OF STRATEGY TO REDUCE MORTALITY AND IMPROVE
MATERNAL AND NEWBORN HEALTH IN DEVELOPING COUNTRIES.
(a) Development of Strategy.--The President shall develop and
implement a comprehensive strategy as part of the Global Health
Initiative to reduce mortality and improve the health of mothers and
newborns in developing countries.
(b) Components.--The comprehensive United States Government
strategy developed pursuant to subsection (a) shall include the
following:
(1) An identification of not less than 30 countries,
including fragile states and countries affected by conflict,
with priority needs for the 5-year period beginning on the date
of the enactment of this Act based on--
(A) the number and rate of neonatal deaths;
(B) the number and rate of maternal deaths;
(C) the number and rate of malnourished women of
reproductive age; and
(D) the number of individuals with an unmet need
for family planning.
(2) For each country identified in paragraph (1)--
(A) an assessment of the most common causes of
maternal and newborn mortality and morbidity;
(B) a description of the programmatic areas and
interventions providing maximum health benefits to
populations at risk and maximum reduction in mortality
and morbidity;
(C) an assessment of the investments needed in
identified programs and interventions to achieve the
greatest results;
(D) a description of how United States assistance
complements and leverages efforts by other donors and
builds capacity and self-sufficiency among recipient
countries; and
(E) a description of goals and objectives for
improving maternal and newborn health, including, to
the extent feasible, objective and quantifiable
indicators.
(3) Enhanced coordination among relevant departments and
agencies of the United States Government engaged in activities
to improve the health and well-being of mothers and newborns in
developing countries.
(4) A description of the measured or estimated impact on
maternal and newborn morbidity and mortality of each project or
program.
(c) Report.--Not later than 180 days after the date of the
enactment of this Act, the President shall transmit to Congress a
report that contains the strategy described in this section.
SEC. 5. AUTHORIZATION OF APPROPRIATIONS.
(a) In General.--There are authorized to be appropriated to carry
out this Act, and the amendments made by this Act, such sums as may be
necessary for each of fiscal years 2011 through 2015.
(b) Availability of Funds.--Amounts appropriated pursuant to the
authorization of appropriations under subsection (a) are authorized to
remain available until expended.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Foreign Affairs.
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