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 newborn 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 to reduce mortality and improve the health of mothers and newborns in developing countries that integrates U.S. government efforts on improving maternal and newborn health, including strategies with respect to HIV/AIDS, gender, child survival.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5862 Introduced in House (IH)]
113th CONGRESS
2d Session
H. R. 5862
To provide assistance to improve maternal and newborn health in
developing countries, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 11, 2014
Mrs. Capps 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 finds the following:
(1) In 2000, the United States joined 188 other countries
in supporting the 8 United Nations Millennium Development Goals
(MDGs), including MDG 4, which aims to reduce child mortality
by two-thirds and MDG 5, which aims 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) Substantial progress in maternal health has been made.
The total number of maternal deaths decreased by over 50
percent from 529,000 maternal deaths in 2000 to 287,000
maternal deaths in 2010. Egypt, Honduras, Malaysia, Sri Lanka,
and parts of Bangladesh have all halved their maternal
mortality ratios over the past few decades.
(3) While significant progress has been made in reducing
maternal mortality, the United Nations reports that current
maternal mortality levels are ``far removed from the 2015
target''.
(4) Women in developing countries are nearly 100 times more
likely to die of complications during pregnancy or childbirth
than in developed countries, with higher rates for women living
in rural areas and among poorer communities.
(5) The United States Agency for International Development
(USAID) estimates the global economic impact of maternal and
newborn mortality at $15 billion in lost productivity every
year.
(6) Annually, 287,000 women die from complications during
pregnancy or childbirth, with 99 percent of these deaths
occurring in developing countries. Six countries--Afghanistan,
the Democratic Republic of Congo, Ethiopia, India, Nigeria, and
Pakistan--account for almost one-half of all maternal deaths
worldwide.
(7) It is estimated that up to 90 percent of these maternal
deaths are preventable. With access to medicines and skilled
health care providers, most women across the world can expect a
successful delivery and a healthy newborn.
(8) The leading cause of maternal deaths is hemorrhage.
Other primary causes of maternal death include sepsis,
hypertensive disorder (pre-eclampsia/eclampsia), unsafe
abortion, and prolonged or obstructed labor.
(9) An essential part of ensuring a woman survives
pregnancy and childbirth includes access to maternal health
medicines and other supplies. Uterotonics prevent and treat
postpartum hemorrhage by causing contractions of the uterus
during and after childbirth, effectively controlling excessive
bleeding. If uterotonic medicines, such as oxytocin and
misoprostol, were available to all women giving birth over a
10-year period, approximately 41 million postpartum hemorrhage
cases could be prevented and 1.4 million women's lives saved.
(10) Pregnancy is the leading killer of adolescent girls
ages 15 to 19 in the developing world. Nearly 70,000 adolescent
girls die every year because their bodies are not ready for
childbirth. Compared to women in their twenties, adolescent
girls aged 15 to 19 are twice as likely to die in childbirth,
and girls under 15 are five times as likely to die, and
mortality and morbidity rates are also higher among infants
born to young mothers.
(11) For every maternal death, approximately 20 women and
girls experience serious or long-term negative health
consequences. Severe pregnancy-related injuries include
fistula, uterine prolapse, infections, diseases, and
disabilities. Maternal morbidities accrue an estimated global
cost of $6.8 billion.
(12) Healthy timing and spacing of pregnancy has a powerful
impact on the chances of survival for women, newborns, infants,
and children. Access to voluntary family planning plays an
essential role in improving maternal health.
(13) Delaying a first pregnancy until at least 18 years
old, waiting at least 24 months to become pregnant after a live
birth, and waiting at least 6 months after a miscarriage or
induced abortion, can reduce all maternal mortality by 30
percent and prevent 70,000 deaths per year of women who die
from unsafe abortion.
(14) Healthy timing and spacing of birth can also reduce
newborn and child death by more than 50 percent. Children born
less than two years after the previous birth are approximately
2.5 times more likely to die before the age of five than
children born three to five years after the previous birth.
(15) If all women who wanted to delay or avoid pregnancy
had access to modern contraception, 26 million abortions would
be averted.
(16) More than 220 million women in developing countries
who would prefer to delay or avoid childbearing lack access to
safe and effective family planning methods. Less than one-half
of married women of reproductive age in South Asia and less
than 25 percent of women in sub-Saharan Africa use modern
contraceptives. In 2012, an estimated 80 million women in
developing countries had an unintended pregnancy.
(17) It is estimated that if 120 million more women had
access to family planning information, services and supplies,
without coercion or discrimination by 2020, 200,000 fewer girls
and women would die during pregnancy and childbirth, there
would be 100 million fewer unintended pregnancies, there would
be 50 million fewer abortions, and 3 million fewer infants
would die in their first year of life.
(18) Violent acts against pregnant women can also lead to
poor health outcomes for women and their babies, including
miscarriage, pre-term birth, low birthweight, stillbirths, and
maternal deaths. The risk for maternal mortality is 3 times as
high for abused mothers. In emergency settings, gender-based
violence rates continue to increase.
(19) According to the World Health Organization (WHO),
women that have undergone female genital mutilation/cutting are
significantly more likely to experience serious postpartum
health problems than those who have not undergone female
genital mutilation, and children born to mothers who have
undergone female genital mutilation face higher death rates
immediately after birth.
(20) Maternal health is inextricably tied to newborn health
and survival. In some countries in the developing world the
risk of newborn death doubles following maternal death. The
conditions in utero, during labor, delivery, and shortly after
birth have a direct relationship on newborn outcomes.
(21) In 2012, 2.9 million newborns or 44 percent of total
under-five mortality did not survive the first month of life.
One million of these deaths occurred during the first day of
life.
(22) The leading causes of newborn mortality include
prematurity, intrapartum complications (including birth
asphyxia), and neonatal infections. Over two-thirds of these
deaths could be prevented through low-cost medicines, products,
and interventions that would not require intensive care.
(23) In addition to newborn mortality there are an
additional 2.65 million stillbirths each year that are not
included in newborn or under-five mortality statistics.
(24) Women in Africa are 24 times more likely to have a
stillbirth than women in high-income countries.
(25) In developing countries, nearly one-third of
stillbirth babies were alive when labor began. If 99 percent of
women in developing countries had comprehensive emergency
obstetric care, nearly 700,000 stillbirths could be prevented
each year.
(26) In many developing countries, 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 or the necessary medicines and
medical supplies, increasing the risk of death or disability
for both mother and newborn.
(27) If family planning and maternal and newborn services
were provided simultaneously, the costs of these services would
decline by $1.5 billion and would result in a 70 percent
decline in maternal deaths and a 44 percent decline in newborn
deaths.
(28) More than one-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.
(29) Maternal deaths worldwide could be reduced by 60,000
per year if women received appropriate HIV diagnosis and
treatment.
(30) With proper interventions, the transmission of HIV
between women and their infants during pregnancy and
breastfeeding can be reduced to 5 percent in the developing
world. The WHO recommends early diagnosis and immediate
treatment for children identified as HIV positive because,
without treatment, half of these children will die before the
age of two.
(31) Nine out of ten women in sub-Saharan Africa will lose
a child during their lifetimes, and only 30 percent of women in
sub-Saharan Africa have contact with a health worker after
giving birth.
(32) 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.
(33) 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 and newborns.
(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 morbidity
and improve maternal and newborn health in developing
countries.
SEC. 3. ASSISTANCE TO REDUCE MORTALITY AND 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, morbidity, and stillbirths''; 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 maternal and newborn mortality
and morbidity 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 to and improve quality of
maternal health services, including--
``(A) birth preparedness through the provision of
quality pre-pregnancy and antenatal care with a skilled
provider (midwife, nurse, or doctor), which should
consist of, at minimum--
``(i) iron and folic acid supplementation;
``(ii) tetanus vaccine;
``(iii) smoking cessation;
``(iv) prevention and management of
sexually transmitted infections and HIV,
including access to Preventing Mother-to-Child
Transmission;
``(v) screening, diagnosis, and treatment
of existing conditions, such as syphilis, HIV/
AIDS, malaria, and tuberculosis, and ensuring
that women are provided with, or referred to,
appropriate care and treatment and prophylaxis
for those conditions, including access to
antiretrovirals (ARVs);
``(vi) magnesium sulfate and low-dose
aspirin to prevent pre-eclampsia and calcium
supplementation to prevent hypertension;
``(vii) screening for complications,
including blood pressure screenings;
``(viii) magnesium sulfate for eclampsia;
antihypertensive medication;
``(ix) corticosteroids to prevent
respiratory distress syndrome;
``(x) induction of labor at term to manage
pre-labor rupture of membranes;
``(xi) nutrition treatment of malnourished
pregnant women; and
``(xii) antibiotics for pre-term labor;
``(B) expanding access to skilled childbirth and
postnatal care, particularly in areas with low
utilization of skilled delivery, including--
``(i) the presence of a skilled health
professional (nurse, midwife, or doctor) who
has been educated and trained to proficiency in
the skills needed to manage normal or
uncomplicated pregnancies or referral of
complications in women and newborns,
``(ii) clean delivery;
``(iii) uterotonics and active management
of third stage of labor to prevent postpartum
hemorrhage;
``(iv) social support during childbirth;
``(v) screening for HIV, linkages to HIV
care and treatment services, and follow up
tracking;
``(vi) induction of labor for prolonged
pregnancy;
``(vii) nutrition counseling;
``(viii) management of postpartum
hemorrhage;
``(ix) caesarean section for maternal/fetal
indication with prophylactic antibiotics;
``(x) treating maternal anemia; and
``(xi) postpartum family planning methods;
``(C) comprehensive voluntary family planning
services, integrated into antenatal and postnatal care,
to support women and men in making informed decisions
and having timely, intended, well-spaced pregnancies,
and to help women with pre-existing conditions avoid
high-risk, unintended pregnancies, including--
``(i) provision of family planning/birth
spacing counseling and services; and
``(ii) emergency treatment of complications
of unsafe abortions and linkages to other
reproductive health services;
``(2) activities to expand access to and improve quality of
services that reduce newborn and infant mortality, including--
``(A) immediate thermal care;
``(B) initiation of early, exclusive, and continued
breastfeeding;
``(C) hygienic cord and skin care;
``(D) kangaroo mother care;
``(E) extra support for feeding small and preterm
infants;
``(F) antibiotic therapy for newborns at risk of
bacterial infection;
``(G) use of surfactant in pre-term infants;
``(H) initiate prophylactic antiretroviral therapy
for infants exposed to HIV;
``(I) neonatal resuscitation with a bag and mask
for infants suffering from birth asphyxia;
``(J) continuous positive airway pressure to manage
respiratory distress syndrome;
``(K) case management of neonatal sepsis, neonatal
meningitis, and pneumonia;
``(L) case management of meningitis, malaria,
diarrhea, pneumonia, and severe acute malnutrition; and
``(M) comprehensive care of HIV, including ARVs,
cotrimoxazole, nutrition support, and psychosocial
support;
``(3) activities to support communities and health care
providers in identifying and removing barriers to maternal
health care services, including--
``(A) financial and sociocultural barriers;
``(B) child marriage;
``(C) transportation;
``(D) gender discrimination and gender-based
violence;
``(E) stigma based on pre-existing health concerns;
and
``(F) female genital mutilation/cutting;
``(4) 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 the supply of critical maternal
and newborn health commodities, including lifesaving medicines
and supplies, such as activities designed to strengthen
regulatory systems to ensure the quality of commodities in
circulation and those related to strengthening supply chain
systems so that these commodities reach the women and children
who need them;
``(6) activities supporting country-led efforts 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 and nutrition services
and referrals that meet the needs of patients across a
continuum of care;
``(7) activities that support country-led plans to reduce
maternal and newborn mortality and morbidity and stillbirths,
including--
``(A) 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; and
``(B) 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--
``(i) the study of the availability and
effects of critical medicines and devices,
particularly those of importance in developing
countries, on pregnant women and newborns;
``(ii) the collection, evaluation, and use
of data on the medical and socioeconomic
factors that led to a maternal or newborn death
or stillbirths at the community and health
facility levels; and
``(iii) the improvement of vital registries
to capture live births, neonatal deaths, and
the number of stillbirths; and
``(8) activities to integrate and coordinate assistance
provided under this section with existing health programs for
the prevention of the transmission of HIV from mother to child
and other HIV/AIDS prevention, care, treatment, and counseling
activities, including better integration with programs
addressing--
``(A) malaria;
``(B) tuberculosis;
``(C) family planning and reproductive health;
``(D) counseling for survivors of sexual- and
gender-based violence;
``(E) neglected tropical diseases;
``(F) nutrition; and
``(G) child survival.
``(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, local organizations, and relevant international
and multilateral organizations that demonstrate effectiveness,
including the United Nations Population Fund, the United
Nations Children's Fund, and the Global Alliance for Vaccines
and Immunizations, and that demonstrate commitment to improving
the health and rights of mothers and newborns and reducing the
number of stillbirths;
``(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, 2016, 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 MORBIDITY AND
IMPROVE MATERNAL AND NEWBORN HEALTH IN DEVELOPING
COUNTRIES.
(a) Development of Strategy.--The President shall develop and
implement a comprehensive strategy to reduce mortality and morbidity
and improve the health of mothers and newborns in developing countries
that integrates all current United States Government efforts on
improving maternal and newborn health, including strategies with
respect to HIV/AIDS, gender, child survival.
(b) Components.--The comprehensive United States Government
strategy developed pursuant to subsection (a) shall include the
following:
(1) An identification of not less than 24 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 near-miss morbidity for
women and newborns;
(C) the number and rate of maternal deaths;
(D) the number and rate of caesarean sections;
(E) the number and rate of malnourished women of
reproductive age; and
(F) 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 receiving assistance under section 104D of the Foreign
Assistance Act of 1961 (as added by section 3 of this Act).
(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 2016 through 2020.
(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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