Obstetric Fistula Prevention, Treatment, Hope, and Dignity Restoration Act of 2022
This bill authorizes the President to provide assistance to support the treatment of obstetric fistula and address the social, structural, health, and human rights issues that lead to obstetric fistula.
Such assistance shall promote the Campaign to End Fistula and the International Obstetric Fistula Working Group led by the United Nations Population Fund.
[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7869 Introduced in House (IH)]
<DOC>
117th CONGRESS
2d Session
H. R. 7869
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
May 24, 2022
Mrs. Carolyn B. Maloney of New York (for herself, Mr. Johnson of
Georgia, Ms. Moore of Wisconsin, and Mr. Grijalva) 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 2022''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Every two minutes, one woman dies from pregnancy-
related complications. This means approximately 830 women die
from pregnancy- or childbirth-related complications around the
world every day. 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) Obstetric fistula is one of the most severe and tragic
pregnancy-related injuries, which occurs when a woman
experiences prolonged, obstructed labor in the absence of
trained medical assistance, which is most commonly a Caesarean
section, necessary for a safe delivery.
(3) Obstetric fistula is a hole that is formed between the
bladder and the vagina, or the rectum and the vagina (or both).
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
dies and sloughs off, resulting in the abnormal opening or
hole.
(4) In approximately 90 percent of obstetric fistula cases,
the baby will be stillborn. A mother will experience physical
pain and multiple physical disabilities, as well as social and
emotional trauma from living with incontinence and from the
loss of her child.
(5) In addition to constant uncontrollable leaking of
urine, feces, or both, the physical consequences of obstetric
fistula may include frequent bladder infections, painful sores,
kidney failure, infertility, foul odor, orthopedic injury, and
nerve damage that makes normal walking impossible and internal
genital scarring that destroys normal sexual function.
(6) Women and girls with obstetric fistula are commonly
ostracized by their families and communities, leading to
depression, anxiety, post-traumatic stress disorder, social
isolation and discrimination, suicidal thoughts or actions, and
lack of adequate economic opportunities, resulting in deepening
poverty, isolation, and vulnerability.
(7) Although data on obstetric fistula is scarce, the
United Nations Population Fund (UNFPA) and Johns Hopkins
University estimates that an estimated 500,000 women and girls
live with obstetric fistula with thousands more occurring
annually.
(8) Obstetric fistula was once common throughout the world,
but over the last century has been virtually eliminated in
Europe, North America, and other developed regions through
improved access to high-quality, timely medical interventions,
particularly emergency obstetric care including Caesarean
sections.
(9) Obstetric fistula is preventable through timely medical
interventions and providing access to family planning for all
women who need it. Social interventions such as alleviating
poverty, delaying early marriage and early childbearing,
educating and empowering young women, remedying gender and
socioeconomic inequalities, and addressing malnutrition can
also help prevent this complication.
(10) The majority of obstetric fistula cases can be
surgically treated. When performed by a skilled, competent
surgeon, the procedure is relatively inexpensive with high
rates of success.
(11) In 2003, the UNFPA, EngenderHealth, and other partners
launched a global Campaign to End Fistula (the Campaign) to
identify and address obstetric fistula in an effort to develop
a means to treat and support those women who are suffering and
provide the necessary health services to prevent further cases.
Operating in more than 55 countries across Africa, Asia, and
the Arab region, the Campaign has four main goals: the
prevention of fistula cases, treatment of existing fistula
cases, social reintegration and follow up for fistula
survivors, and advocacy for ending fistula.
(12) In order to meet these goals, The Campaign supports
and participates in the emerging ``safe surgery'' community of
practice that strengthens surgical ecosystems in low- and
middle-income countries (LMIC) towards better access to
essential and life-saving surgeries, which includes improved
training, equipment, supplies, infrastructure and health worker
density for timely access to Caesarean sections and for
environments that optimize outcomes of fistula surgery.
(13) Since 2003, UNFPA has directly supported more than
85,000 fistula repairs, with additional repairs supported by
Campaign partners.
(14) The COVID-19 pandemic caused overloaded health systems
and reallocation of human and financial resources with
disruptions to services resulting in an undermining of the
sexual and reproductive health and rights of women and girls.
Beginning in 2020, Fistula repairs were widely halted or slowed
down due to COVID-19, as they were deemed nonurgent and unsafe
during the pandemic. This may result in an increased backlog of
fistula cases.
(15) The United States Agency for International Development
(USAID), in accordance with the United States Government's
commitment to ending preventable maternal and newborn deaths
and disabilities, currently supports fistula treatment services
in seven countries. As part of a comprehensive approach, USAID
addresses fistula prevention as well as reintegration support
to women as they re-enter their community and family life after
surgery. Cumulatively, USAID fistula support has trained
thousands of medical personnel and volunteers, including 350
fistula surgeons. Since 2004, more than 56,200 women have
received fistula repairs with USAID support.
(16) The United States has committed to joining
multilateral efforts involving the United Nations and others to
make progress toward achieving the Sustainable Development
Goals (SDGs), including through the Global Strategy for
Women's, Children's and Adolescents' Health (2016-2030).
Eliminating obstetric fistula is key to achieving the SDGs'
vision of ``leaving no one behind.''.
(17) In his July 2020 report prepared for the General
Assembly called Intensifying efforts to end obstetric fistula
within a decade, United Nations Secretary General Antonio
Guterres underscored the urgency around action to end fistula
in the wake of the COVID-19 pandemic, noting that ``the
pandemic caused by COVID-19 has disrupted health services and
exacerbated gender-based, socioeconomic and intersectional
inequalities. The health of women and girls, in particular
those in fragile contexts, is adversely affected by the
reallocation of resources and priorities. Essential health
services including contraception and emergency obstetric care
remain critical to prevent maternal mortality and fistula.
Since fistula surgery is considered to be elective care and,
therefore, suspended during the pandemic to protect the safety
of patients, new strategies will be required in the post-COVID-
19 recovery period to address the expected backlog of cases.''.
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, structural, health, and human
rights issues that lead to obstetric fistula;
(2) support treatment of obstetric fistula that includes
strengthening the safe surgery and safe anesthesia environment
in every country where fistula persists and where obstetric
services do not meet an acceptable standard of care; and
(3) address and acknowledge the urgency of ensuring that
all women who need a Caesarean section are able to have access
to such life-saving surgery in a timely, safe, and high-quality
care environment, and address the growing threat of iatrogenic
fistula that most often results from Caesarean delivery done
poorly and under conditions with inadequate staff, supplies, or
equipment.
(b) Activities.--Assistance provided pursuant to this section and
section 4 shall focus on the following:
(1) Increasing prevention of obstetric fistula through
access to sexual and reproductive health services, including
skilled attendance at birth, comprehensive emergency obstetric
and newborn care, timely, safe, high-quality Caesarean sections
when necessary, prenatal and antenatal care, contraception and
family planning, and comprehensive reproductive health
education.
(2) Building local capacity and improving national health
systems to ensure that all women in need have access to safe
surgery, including timely, and high-quality life-saving
obstetric and newborn care services to prevent and treat
obstetric fistula.
(3) Supporting tools to enable countries to address
obstetric fistula, including the following:
(A) Supporting research to better identify the key
factors causing persistence of obstetric fistula in
certain regions.
(B) Quantitative data collection on the incidence
and prevalence of obstetric fistula, and development of
sustainable universal health care financing mechanisms
to enable all women to have access to skilled and life-
saving health care during pregnancy, delivery, and the
postpartum period.
(C) Providing fistula survivors access to free or
affordable treatment.
(D) Training of midwives and skilled birth
attendants.
(E) Provision of basic obstetric care at the
community level.
(4) Ensuring that countries address surgery, anesthesia,
and obstetrics ecosystem deficits in standardized healthcare
worker education, credentialing, and retention, WASH and power
in facilities, equipment and materials, transport, and
healthcare financing.
(5) Addressing social and economic inequities that are
correlated with higher incidence of obstetric fistula by
empowering women and girls, alleviating poverty, reducing
incidence of child marriage, promoting delay and spacing of
childbirth, and increasing access to formal and nonformal
education.
(6) Supporting reintegration and education to help women
who have undergone treatment or are awaiting treatment to
obtain medical and mental health services, legal counseling,
basic education, and income generating skills as needed, to
return to full and productive lives.
(7) Promoting public awareness in communities to increase
understanding of obstetric fistula, and thereby improve
prevention and treatment efforts, and to help reduce stigma,
exclusion, and violence against women and girls with obstetric
fistula.
SEC. 4. COORDINATION, REPORTING, RESEARCH, MONITORING, AND EVALUATION.
Assistance authorized under this Act shall--
(1) promote the UNFPA-led global Campaign to End Fistula
and the International Obstetric Fistula Working Group; 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.
SEC. 5. 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
Referred to the House Committee on Foreign Affairs.
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