,i #aacth ,,congress #ast ,session ,h4 ,r4 #bhhh ,,in ,,the ,,house ,,of ,,representatives ,july #ca1 #bjac ,mrs4 ,carolyn ,b4 ,maloney of ,new ,york 7for herself1 ,mr4 ,conyers1 ,mr4 ,crowley1 ,mr4 ,farr1 ,mr4 ,grijalva1 ,mr4 ,johnson of ,georgia1 ,ms4 ,lofgren1 ,ms4 ,mc,collum1 ,mr4 ,mc,dermott1 ,ms4 ,moore1 ,mr4 ,moran1 and ,ms4 ,speier7 introduced the following bill2 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 countries1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,obstetric ,fistula ,prevention1 ,treatment1 ,hope1 and ,dignity ,restoration ,act of #bjac4 #b4 ,findings ,congress finds the following3 7#a7 ,every minute1 one woman dies from pregnancy-related complications4 ,of these deaths1 #ii percent occur in developing countries4 ,over half of these deaths are in sub-,saharan ,africa and one third are in ,south ,asia4 7#b7 ,for every woman who dies from pregnancy-related complications1 an estimated #bj women survive but experience pregnancy-related disabilities4 ,one of the most severe is obstetric fistula1 which occurs when a woman who needs trained medical assistance for a safe delivery1 usually a cesarean section1 cannot get it4 7#c7 ,obstetric fistula is a hole that is formed between the bladder and the vagina1 or the rectum and the vagina 7or both71 after a woman suffers from prolonged obstructed labor4 ,in the struggle to pass through the birth canal1 the fetus puts constant pressure1 sometimes for several days1 on the bladder and vaginal or rectal walls1 destroying the tissue that then sloughs off1 resulting in the abnormal opening4 7#d7 ,in the majority of obstetric fistula cases1 the baby will be stillborn and the mother will experience physical pain as well as social and emotional trauma from living with incontinence1 as well as the loss of her child4 7#e7 ,the physical symptoms of obstetric fistula include incontinence or constant uncontrollable leaking of urine or feces1 frequent bladder infections1 infertility1 and foul odor4 7#f7 ,although data on obstetric fistula are scarce1 the ,world ,health ,organization 7,,who7 estimates there are more than #b1jjj1jjj women living with fistula1 and #ej1jjj to #ajj1jjj new cases each year4 7#g7 ,according to the ,department of ,state1 ,the combination of pregnancy at an early age1 chronic maternal malnutrition1 and a lack of skilled care at delivery can all contribute to the development of obstetric fistula and permanent incontinence44 7#h7 ,obstetric fistula was once common throughout the world1 but over the last century was eliminated in ,europe1 ,north ,america1 and other developed regions through improved access to medical interventions1 particularly emergency obstetric care for those women who need it4 ,the first fistula hospital in the world stood where the ,waldorf-,astoria ,hotel is now located in ,new ,york ,city4 7#i7 ,the social consequences for women living with obstetric fistula include isolation1 divorce or abandonment1 ridicule and shame1 loss of social belonging and association1 illness and malnutrition1 risk of violence1 and lack of economic opportunities4 ,girls with obstetric fistula are also often unable to continue schooling4 ,victims suffer psychological consequences1 such as feelings of hopelessness1 self-hatred1 sadness1 depression1 and suicide1 because of stigma and lack of awareness that their condition is treatable4 ,fistula victims need regular medical attention and an extra supply of soap to keep clean1 placing a huge financial burden on already poor families4 ,they also lose property when they are divorced or abandoned by their husbands and family4 ,some lose jobs or are denied work1 while others quit their jobs out of shame1 leading to deepened poverty and vulnerability to repeat fistulas4 7#aj7 ,obstetric fistula is preventable through medical interventions1 such as skilled attendance1 including midwives1 present during labor and childbirth1 providing access to family planning1 and emergency obstetric care for women who develop childbirth complications1 as well as social interventions such as delaying early marriage and educating and empowering young women4 7#aa7 ,obstetric fistula can also be surgically treated4 ,surgery requires a specially trained surgeon and support staff1 and access to an operating theater and to attentive postoperative care4 ,when performed by a skilled surgeon1 success rates can be as high as #ij percent and cost an estimated #cjj4 7#ab7 ,according to the ,department of ,state1 ,because of their roles in child rearing1 providing and seeking care1 and managing water and nutrition1 the ability of women to access health-related knowledge and services is fundamental to the health of their babies1 older children and other family members4 ,over the long-term1 the health of women enhances their productivity and social and economic participation and also acts as a positive multiplier1 benefitting social and economic development through the health of future generations44 7#ac7 ,in #bjjb1 the ,united ,nations ,population ,fund 7,,unfpa7 and ,engender,health embarked on the first ever assessments in nine ,african countries to determine the need for and access to services to address obstetric fistula4 ,in #bjjc1 ,,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 cases4 ,the campaign is currently active in more than #de countries in ,africa1 ,asia1 and the ,arab states region through support for fistula surgery1 training of doctors and nurses1 equipping hospitals1 and undertaking community outreach to prevent further cases1 and supporting provision of rehabilitative care for women after treatment so they can return to full and productive lives4 7#ad7 ,the ,global ,campaign to ,end ,fistula works with national counterparts1 including ministries of health1 other pertinent ministries1 ,united ,nations agencies1 international and national nongovernmental organizations1 civil society organizations1 and fistula providers1 in support of national processes and fistula programmatic efforts4 ,a key focus is national fistula capacity strengthening4 7#ae7 ,in #bjjd1 the ,united ,states ,agency for ,international ,development 7,,usaid7 provided funding through the ,,acquire ,project managed by ,engender,health to support services in two countries3 ,bangladesh and ,uganda4 ,in #bjjg1 ,,usaid provided a five-year cooperative agreement to ,engender,health for the ,fistula ,care project4 ,,usaid currently supports fistula treatment services in #cd sites in #aa countries and addresses prevention in those sites and #be more4 ,the ceiling for the ,fistula ,care project is #gj1jjj1jjj4 7#af7 ,one of the key global health principles of the ,united ,states ,global ,health ,initiative is to strengthen and leverage key multilateral organizations1 global health partnerships1 and private sector engagement4 ,the ,united ,states has committed to join multilateral efforts involving the ,united ,nations and others to make progress toward achieving ,millennium ,development ,goals #d1 #e1 and #f4 7#ag7 ,by #bjad1 the ,united ,states1 through its ,global ,health ,initiative1 has committed to several targets that will reduce the incidence of fistula1 including through efforts to reduce maternal mortality by #cj percent1 prevent #ed1jjj1jjj unintended pregnancies by reaching a modern contraceptive prevalence rate of #ce percent1 and reducing to #bj percent the number of first births by women under #ah across assisted countries4 #c4 ,prevention and treatment of obstetric fistula 7a7 ,authorization ,the ,president is authorized1 in accordance with this section and section #d1 to provide assistance1 including through international organizations1 national governments1 and international and local nongovernmental organizations1 to-- 7#a7 address the social and health issues that lead to obstetric fistula2 and 7#b7 support treatment of obstetric fistula4 7b7 ,activities ,assistance provided pursuant to subsection 7a7 shall focus on-- 7#a7 increasing prevention through access to sexual and reproductive health services1 including skilled attendance at birth1 comprehensive emergency obstetric care1 prenatal and antenatal care1 contraception 7family planning71 and supporting comprehensive sexuality education2 7#b7 building local capacity and improving national health systems to prevent and treat obstetric fistula within the context of navigating pregnancy in good health overall2 7#c7 supporting tools to enable countries to address obstetric fistula1 including supporting qualitative research and data collection on the incidence and prevalence of obstetric fistula1 development of sustainable financing mechanisms to encourage facility deliveries and provide fistula survivors access to free or affordable treatment1 training of midwives and skilled birth attendants1 promoting south-to-south training1 and provision of basic obstetric care at the community level2 7#d7 addressing underlying social and economic inequities1 including empowering women and girls1 reducing incidence of child marriage1 delaying childbirth1 and increasing access to formal and non-formal education2 7#e7 supporting reintegration and training programs to help women who have undergone treatment return to full and productive lives2 and 7#f7 promoting public awareness to increase understanding of obstetric fistula1 and thereby improve prevention and treatment efforts1 to help reduce stigma and violence against women and girls with obstetric fistula4 #d4 ,coordination1 reporting1 research1 monitoring1 and evaluation 7a7 ,in general ,assistance authorized under this ,act shall-- 7#a7 promote the coordination facilitated by the ,international ,obstetric ,fistula ,working ,group1 which coordinates between and among donors1 multilateral institutions1 the private sector1 nongovernmental and civil society organizations1 and governments in order to support comprehensive prevention and treatment of obstetric fistula2 and 7#b7 be used for the development and implementation of evidence-based programs1 including monitoring1 evaluation1 and research to measure the effectiveness and efficiency of such programs throughout their planning and implementation phases4 7b7 ,reporting ,not later than one year after the date of the enactment of this ,act and annually thereafter1 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 fistula1 and how such activities fit into existing national action plans to prevent and treat obstetric fistula4