Obstetric Fistula Prevention, Treatment, Hope, and Dignity Restoration Act of 2013 - Authorizes the President to provide assistance, including through international organizations, national governments, and international and local nongovernmental organizations, to address the social and health issues that lead to obstetric fistula and support treatment of obstetric fistula.
Requires such assistance to promote the coordination facilitated by the International Obstetric Fistula Working Group.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2888 Introduced in House (IH)]
113th CONGRESS
1st Session
H. R. 2888
To authorize assistance to aid in the prevention and treatment of
obstetric fistula in foreign countries, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 31, 2013
Mrs. Carolyn B. Maloney of New York (for herself, Mr. Conyers, Mr.
Crowley, Mr. Farr, Mr. Grijalva, Mr. Johnson of Georgia, Ms. Lofgren,
Ms. McCollum, Mr. McDermott, Ms. Moore, Mr. Moran, and Ms. Speier)
introduced the following bill; which was referred to the Committee on
Foreign Affairs
_______________________________________________________________________
A BILL
To authorize assistance to aid in the prevention and treatment of
obstetric fistula in foreign countries, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Obstetric Fistula Prevention,
Treatment, Hope, and Dignity Restoration Act of 2013''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Every minute, one woman dies from pregnancy-related
complications. Of these deaths, 99 percent occur in developing
countries. Over half of these deaths are in sub-Saharan Africa
and one third are in South Asia.
(2) For every woman who dies from pregnancy-related
complications, an estimated 20 women survive but experience
pregnancy-related disabilities. One of the most severe is
obstetric fistula, which occurs when a woman who needs trained
medical assistance for a safe delivery, usually a cesarean
section, cannot get it.
(3) Obstetric fistula is a hole that is formed between the
bladder and the vagina, or the rectum and the vagina (or both),
after a woman suffers from prolonged obstructed labor. In the
struggle to pass through the birth canal, the fetus puts
constant pressure, sometimes for several days, on the bladder
and vaginal or rectal walls, destroying the tissue that then
sloughs off, resulting in the abnormal opening.
(4) In the majority of obstetric fistula cases, the baby
will be stillborn and the mother will experience physical pain
as well as social and emotional trauma from living with
incontinence, as well as the loss of her child.
(5) The physical symptoms of obstetric fistula include
incontinence or constant uncontrollable leaking of urine or
feces, frequent bladder infections, infertility, and foul odor.
(6) Although data on obstetric fistula are scarce, the
World Health Organization (WHO) estimates there are more than
2,000,000 women living with fistula, and 50,000 to 100,000 new
cases each year.
(7) According to the Department of State, ``The combination
of pregnancy at an early age, chronic maternal malnutrition,
and a lack of skilled care at delivery can all contribute to
the development of obstetric fistula and permanent
incontinence.''.
(8) Obstetric fistula was once common throughout the world,
but over the last century was eliminated in Europe, North
America, and other developed regions through improved access to
medical interventions, particularly emergency obstetric care
for those women who need it. The first fistula hospital in the
world stood where the Waldorf-Astoria Hotel is now located in
New York City.
(9) The social consequences for women living with obstetric
fistula include isolation, divorce or abandonment, ridicule and
shame, loss of social belonging and association, illness and
malnutrition, risk of violence, and lack of economic
opportunities. Girls with obstetric fistula are also often
unable to continue schooling. Victims suffer psychological
consequences, such as feelings of hopelessness, self-hatred,
sadness, depression, and suicide, because of stigma and lack of
awareness that their condition is treatable. Fistula victims
need regular medical attention and an extra supply of soap to
keep clean, placing a huge financial burden on already poor
families. They also lose property when they are divorced or
abandoned by their husbands and family. Some lose jobs or are
denied work, while others quit their jobs out of shame, leading
to deepened poverty and vulnerability to repeat fistulas.
(10) Obstetric fistula is preventable through medical
interventions, such as skilled attendance, including midwives,
present during labor and childbirth, providing access to family
planning, and emergency obstetric care for women who develop
childbirth complications, as well as social interventions such
as delaying early marriage and educating and empowering young
women.
(11) Obstetric fistula can also be surgically treated.
Surgery requires a specially trained surgeon and support staff,
and access to an operating theater and to attentive
postoperative care. When performed by a skilled surgeon,
success rates can be as high as 90 percent and cost an
estimated $300.
(12) According to the Department of State, ``Because of
their roles in child rearing, providing and seeking care, and
managing water and nutrition, the ability of women to access
health-related knowledge and services is fundamental to the
health of their babies, older children and other family
members. Over the long-term, the health of women enhances their
productivity and social and economic participation and also
acts as a positive multiplier, benefitting social and economic
development through the health of future generations.''.
(13) In 2002, the United Nations Population Fund (UNFPA)
and EngenderHealth embarked on the first ever assessments in
nine African countries to determine the need for and access to
services to address obstetric fistula. In 2003, UNFPA and
partners launched a global campaign to identify and address
obstetric fistula in an effort to develop a means to treat
those women who are suffering and provide the necessary health
services to prevent further cases. The campaign is currently
active in more than 45 countries in Africa, Asia, and the Arab
states region through support for fistula surgery, training of
doctors and nurses, equipping hospitals, and undertaking
community outreach to prevent further cases, and supporting
provision of rehabilitative care for women after treatment so
they can return to full and productive lives.
(14) The Global Campaign to End Fistula works with national
counterparts, including ministries of health, other pertinent
ministries, United Nations agencies, international and national
nongovernmental organizations, civil society organizations, and
fistula providers, in support of national processes and fistula
programmatic efforts. A key focus is national fistula capacity
strengthening.
(15) In 2004, the United States Agency for International
Development (USAID) provided funding through the ACQUIRE
Project managed by EngenderHealth to support services in two
countries: Bangladesh and Uganda. In 2007, USAID provided a
five-year cooperative agreement to EngenderHealth for the
Fistula Care project. USAID currently supports fistula
treatment services in 34 sites in 11 countries and addresses
prevention in those sites and 25 more. The ceiling for the
Fistula Care project is $70,000,000.
(16) One of the key global health principles of the United
States Global Health Initiative is to strengthen and leverage
key multilateral organizations, global health partnerships, and
private sector engagement. The United States has committed to
join multilateral efforts involving the United Nations and
others to make progress toward achieving Millennium Development
Goals 4, 5, and 6.
(17) By 2014, the United States, through its Global Health
Initiative, has committed to several targets that will reduce
the incidence of fistula, including through efforts to reduce
maternal mortality by 30 percent, prevent 54,000,000 unintended
pregnancies by reaching a modern contraceptive prevalence rate
of 35 percent, and reducing to 20 percent the number of first
births by women under 18 across assisted countries.
SEC. 3. PREVENTION AND TREATMENT OF OBSTETRIC FISTULA.
(a) Authorization.--The President is authorized, in accordance with
this section and section 4, to provide assistance, including through
international organizations, national governments, and international
and local nongovernmental organizations, to--
(1) address the social and health issues that lead to
obstetric fistula; and
(2) support treatment of obstetric fistula.
(b) Activities.--Assistance provided pursuant to subsection (a)
shall focus on--
(1) increasing prevention through access to sexual and
reproductive health services, including skilled attendance at
birth, comprehensive emergency obstetric care, prenatal and
antenatal care, contraception (family planning), and supporting
comprehensive sexuality education;
(2) building local capacity and improving national health
systems to prevent and treat obstetric fistula within the
context of navigating pregnancy in good health overall;
(3) supporting tools to enable countries to address
obstetric fistula, including supporting qualitative research
and data collection on the incidence and prevalence of
obstetric fistula, development of sustainable financing
mechanisms to encourage facility deliveries and provide fistula
survivors access to free or affordable treatment, training of
midwives and skilled birth attendants, promoting ``south-to-
south'' training, and provision of basic obstetric care at the
community level;
(4) addressing underlying social and economic inequities,
including empowering women and girls, reducing incidence of
child marriage, delaying childbirth, and increasing access to
formal and non-formal education;
(5) supporting reintegration and training programs to help
women who have undergone treatment return to full and
productive lives; and
(6) promoting public awareness to increase understanding of
obstetric fistula, and thereby improve prevention and treatment
efforts, to help reduce stigma and violence against women and
girls with obstetric fistula.
SEC. 4. COORDINATION, REPORTING, RESEARCH, MONITORING, AND EVALUATION.
(a) In General.--Assistance authorized under this Act shall--
(1) promote the coordination facilitated by the
International Obstetric Fistula Working Group, which
coordinates between and among donors, multilateral
institutions, the private sector, nongovernmental and civil
society organizations, and governments in order to support
comprehensive prevention and treatment of obstetric fistula;
and
(2) be used for the development and implementation of
evidence-based programs, including monitoring, evaluation, and
research to measure the effectiveness and efficiency of such
programs throughout their planning and implementation phases.
(b) Reporting.--Not later than one year after the date of the
enactment of this Act and annually thereafter, the President shall
transmit to Congress a report on activities undertaken pursuant to this
Act during the preceding fiscal year to reduce the incidence of and
increase treatment for obstetric fistula, and how such activities fit
into existing national action plans to prevent and treat obstetric
fistula.
<all>
Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR E1175)
Referred to the House Committee on Foreign Affairs.
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