Obstetric Fistula Prevention, Treatment, Hope, and Dignity Restoration Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 8971 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 DECEMBER 15, 2020 Mrs. CAROLYN B. MALONEY of New York introduced the following bill; which was referred to the Committee on Foreign Affairs A BILL To authorize assistance to aid in the prevention and treat- ment of obstetric fistula in foreign countries, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Obstetric Fistula Pre- 4 vention, Treatment, Hope, and Dignity Restoration Act 5 of 2020’’. 6 SEC. 2. FINDINGS. 7 Congress finds the following: 8 (1) Every two minutes, one woman dies from 9 pregnancy-related complications. This means ap- 10 VerDate Sep 11 2014 21:30 Dec 29, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H8971.IH H8971 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 8971 IH proximately 830 women die from pregnancy- or 1 childbirth-related complications around the world 2 every day. Of these deaths, 99 percent occur in de- 3 veloping countries. Over half of these deaths are in 4 sub-Saharan Africa and one-third are in South Asia. 5 (2) Obstetric fistula is one of the most severe 6 and tragic pregnancy-related injuries, which occurs 7 when a woman experiences prolonged, obstructed 8 labor in the absence of trained medical assistance, 9 which is most commonly a Caesarean section, nec- 10 essary for a safe delivery. 11 (3) Obstetric fistula is a hole that is formed be- 12 tween the bladder and the vagina, or the rectum and 13 the vagina (or both). In the struggle to pass through 14 the birth canal, the fetus puts constant pressure, 15 sometimes for several days, on the bladder and vag- 16 inal or rectal walls, destroying the tissue that then 17 dies and sloughs off, resulting in the abnormal open- 18 ing or hole. 19 (4) In approximately 90 percent of obstetric fis- 20 tula cases, the baby will be stillborn. A mother will 21 experience physical pain and multiple physical dis- 22 abilities, as well as social and emotional trauma 23 from living with incontinence and from the loss of 24 her child. 25 VerDate Sep 11 2014 21:30 Dec 29, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H8971.IH H8971 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 8971 IH (5) In addition to constant uncontrollable leak- 1 ing of urine, feces, or both, the physical conse- 2 quences of obstetric fistula may include frequent 3 bladder infections, painful sores, kidney failure, in- 4 fertility, foul odor, orthopedic injury, nerve damage 5 that makes normal walking impossible and internal 6 genital scarring that destroys normal sexual func- 7 tion. 8 (6) Women and girls with obstetric fistula are 9 commonly ostracized by their families and commu- 10 nities, leading to depression, anxiety, post-traumatic 11 stress disorder, social isolation and discrimination, 12 suicidal thoughts or actions, and lack of adequate 13 economic opportunities, resulting in deepening pov- 14 erty, isolation, and vulnerability. 15 (7) Although data on obstetric fistula are 16 scarce, the World Health Organization (WHO) esti- 17 mates there are more than 2,000,000 women and 18 girls living with fistula, and 50,000 to 100,000 new 19 cases each year. 20 (8) Obstetric fistula was once common through- 21 out the world, but over the last century has been vir- 22 tually eliminated in Europe, North America, and 23 other developed regions through improved access to 24 high-quality, timely medical interventions, particu- 25 VerDate Sep 11 2014 21:30 Dec 29, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H8971.IH H8971 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 8971 IH larly emergency obstetric care including Caesarean 1 section. 2 (9) Obstetric fistula is preventable through 3 timely medical interventions and providing access to 4 family planning for all women who need it. Social 5 interventions such as alleviating poverty, delaying 6 early marriage and early childbearing, educating and 7 empowering young women, remedying gender and 8 socioeconomic inequalities, and addressing malnutri- 9 tion can also help prevent this complication. 10 (10) The majority of obstetric fistula can be 11 surgically treated. When performed by a skilled, 12 competent surgeon, the procedure is relatively inex- 13 pensive with high rates of success. 14 (11) In 2003, the United Nations Population 15 Fund (UNFPA), EngenderHealth, and other part- 16 ners launched a global Campaign to End Fistula 17 (the Campaign) to identify and address obstetric fis- 18 tula in an effort to develop a means to treat and 19 support those women who are suffering and provide 20 the necessary health services to prevent further 21 cases. Operating in more than 50 countries across 22 Africa, Asia, and the Arab region, the Campaign has 23 four main goals: the prevention of fistula cases, 24 treatment of existing fistula cases, social reintegra- 25 VerDate Sep 11 2014 21:30 Dec 29, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H8971.IH H8971 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 8971 IH tion and follow up for fistula survivors, and advocacy 1 for ending fistula. 2 (12) In order to meet these goals, The Cam- 3 paign supports and participates in the emerging 4 ‘‘safe surgery’’ community of practice that strength- 5 ens surgical ecosystems in low- and middle-income 6 countries (LMIC) towards better access to essential 7 and life-saving surgeries, which includes improved 8 training, equipment, supplies, infrastructure and 9 health worker density for timely access to Caesarean 10 section and for environments that optimize outcomes 11 of fistula surgery. 12 (13) Since 2003, UNFPA has directly sup- 13 ported more than 85,000 fistula repairs, with addi- 14 tional repairs supported by Campaign partners. 15 (14) USAID, in accordance with the United 16 States Government’s commitment to ending prevent- 17 able maternal and newborn deaths and disabilities, 18 currently supports fistula treatment services in 137 19 sites in six countries. USAID addresses prevention 20 in those sites and thirty-six more. Since 2004, more 21 than 39,000 women have received fistula repairs 22 with USAID support. 23 (15) The United States has committed to join- 24 ing multilateral efforts involving the United Nations 25 VerDate Sep 11 2014 21:30 Dec 29, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H8971.IH H8971 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 8971 IH and others to make progress toward achieving the 1 Sustainable Development Goals (SDGs), including 2 through the Global Strategy for Women’s, Children’s 3 and Adolescents’ Health (2016–2030). Eliminating 4 obstetric fistula is key to achieving the SDGs’ vision 5 of ‘‘leaving no one behind.’’. 6 (16) In his 2016 statement on the International 7 Day to End Obstetric Fistula, United Nations Sec- 8 retary General Ban Ki-Moon boldly laid forth a new 9 global vision and goal of ending obstetric fistula 10 within a generation, saying that, ‘‘The persistence of 11 fistula in some countries and regions is an indicator 12 of very poor access to quality maternal health serv- 13 ices. To end it, we must strengthen health systems 14 and address broader development and human rights 15 issues affecting women and girls: poverty, gender in- 16 equality, early marriage, early childbearing, and lack 17 of education. Let us use the momentum of the Sus- 18 tainable Development Goals together with strong po- 19 litical leadership, accelerated investment and action, 20 and passionate and committed champions, to achieve 21 this historic and transformative goal.’’. 22 VerDate Sep 11 2014 21:30 Dec 29, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H8971.IH H8971 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 8971 IH SEC. 3. PREVENTION AND TREATMENT OF OBSTETRIC FIS- 1 TULA. 2 (a) AUTHORIZATION.—The President is authorized, 3 in accordance with this section and section 4, to provide 4 assistance, including through international organizations, 5 national governments, and international and local non- 6 governmental organizations, to— 7 (1) address the social, structural, health, and 8 human rights issues that lead to obstetric fistula; 9 (2) support treatment of obstetric fistula that 10 includes strengthening the safe surgery and safe an- 11 esthesia environment in every country where fistula 12 persists and where obstetric services do not meet an 13 acceptable standard of care; and 14 (3) address and acknowledge the urgency of en- 15 suring that all women who need a Caesarean section 16 are able to have access to such life-saving surgery in 17 a timely, safe, and high-quality care environment, 18 and address the growing threat of iatrogenic fistula 19 that most often results from Caesarean delivery done 20 poorly and under conditions with inadequate staff, 21 supplies, or equipment. 22 (b) ACTIVITIES.—Assistance provided pursuant to 23 this section and section 4 shall focus on the following: 24 (1) Increasing prevention of obstetric fistula 25 through access to sexual and reproductive health 26 VerDate Sep 11 2014 21:30 Dec 29, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H8971.IH H8971 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 8971 IH services, including skilled attendance at birth, com- 1 prehensive emergency obstetric and newborn care, 2 timely, safe, high-quality Caesarean section when 3 necessary, prenatal and antenatal care, contracep- 4 tion and family planning, and comprehensive repro- 5 ductive health education. 6 (2) Building local capacity and improving na- 7 tional health systems to ensure that all women in 8 need have access to safe surgery, including timely, 9 and high-quality life-saving obstetric and newborn 10 care services to prevent and treat obstetric fistula. 11 (3) Supporting tools to enable countries to ad- 12 dress obstetric fistula, including the following: 13 (A) Supporting research to better identify 14 the key factors causing persistence of obstetric 15 fistula in certain regions. 16 (B) Quantitative data collection on the in- 17 cidence and prevalence of obstetric fistula, and 18 development of sustainable universal health care 19 financing mechanisms to enable all women to 20 have access to skilled and life-saving health care 21 during pregnancy, delivery, and the postpartum 22 period. 23 (C) Providing fistula survivors access to 24 free or affordable treatment. 25 VerDate Sep 11 2014 21:30 Dec 29, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H8971.IH H8971 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 8971 IH (D) Training of midwives and skilled birth 1 attendants. 2 (E) Provision of basic obstetric care at the 3 community level. 4 (4) Ensuring that countries address surgery, 5 anesthesia, and obstetrics ecosystem deficits in stan- 6 dardized healthcare worker education, credentialing, 7 and retention, WASH and power in facilities, equip- 8 ment and materials, transport, and healthcare fi- 9 nancing. 10 (5) Addressing social and economic inequities 11 that are correlated with higher incidence of obstetric 12 fistula by empowering women and girls, alleviating 13 poverty, reducing incidence of child marriage, pro- 14 moting delay and spacing of childbirth, and increas- 15 ing access to formal and nonformal education. 16 (6) Supporting reintegration and education to 17 help women who have undergone treatment or are 18 awaiting treatment to obtain medical and mental 19 health services, legal counseling, basic education, 20 and income generating skills as needed, to return to 21 full and productive lives. 22 (7) Promoting public awareness in communities 23 to increase understanding of obstetric fistula, and 24 thereby improve prevention and treatment efforts, 25 VerDate Sep 11 2014 21:30 Dec 29, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H8971.IH H8971 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 8971 IH and to help reduce stigma, exclusion, and violence 1 against women and girls with obstetric fistula. 2 SEC. 4. COORDINATION, REPORTING, RESEARCH, MONI- 3 TORING, AND EVALUATION. 4 Assistance authorized under this Act shall— 5 (1) promote the UNFPA-led global Campaign 6 to End Fistula and the International Obstetric Fis- 7 tula Working Group; and 8 (2) be used for the development and implemen- 9 tation of evidence-based programs, including moni- 10 toring, evaluation, and research to measure the ef- 11 fectiveness and efficiency of such programs through- 12 out their planning and implementation phases. 13 SEC. 5. REPORTING. 14 Not later than one year after the date of the enact- 15 ment of this Act and annually thereafter, the President 16 shall transmit to Congress a report on activities under- 17 taken pursuant to this Act during the preceding fiscal year 18 to reduce the incidence of and increase treatment for ob- 19 stetric fistula, and how such activities fit into existing na- 20 tional action plans to prevent and treat obstetric fistula. 21 Æ VerDate Sep 11 2014 21:30 Dec 29, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\H8971.IH H8971 pamtmann on DSKBC07HB2PROD with BILLS