,i  #aac? ,,congress  #a/ ,session  ,h4 
,r4 #bhhh  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #ca1 #bjac ,mrs4
 ,c>olyn ,b4 ,maloney ( ,new ,york 7=   
h]self1 ,mr4 ,cony]s1 ,mr4 ,cr[ley1 ,mr4
 ,f>r1 ,mr4 ,grijalva1 ,mr4 ,johnson (  
,georgia1 ,ms4 ,l(gr51 ,ms4 ,mc,collum1 
,mr4 ,mc,dermott1 ,ms4 ,moore1 ,mr4     
,moran1 & ,ms4 ,spei]7 introduc$ !      
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,=eign ,affairs  ,a ,,bill
  ,to au?orize assi/ance to aid 9 !     
prev5tion & treatm5t ( ob/etric fi/ula 9
 =eign c\ntries1 & = o!r purposes4  #a4 
,%ort title ,?is ,act may be cit$ z !   
,ob/etric ,fi/ula ,prev5tion1 ,treatm5t1
 ,hope1 & ,dignity ,re/oration ,act (   
#bjac4  #b4 ,f9d+s ,congress f9ds !     
foll[+3  7#a7 ,e m9ute1 "o woman dies f 
pregnancy-relat$ complications4 ,( ^!   
dea?s1 #ii p]c5t occur 9 develop+       
c\ntries4 ,ov] half ( ^! dea?s are 9    
sub-,sah>an ,africa & "o ?ird are 9 ,s\?
 ,asia4  7#b7 ,= e woman :o dies f      
pregnancy-relat$ complications1 an      

e/imat$ #bj wom5 survive b exp]i5ce     
pregnancy-relat$ disabilities4 ,"o ( !  
mo/ sev]e is ob/etric fi/ula1 :i* occurs
 :5 a woman :o ne$s tra9$ m$ical        
assi/ance = a safe deliv]y1 usually a   
ces>ean section1 _c get x4  7#c7        
,ob/etric fi/ula is a hole t is =m$     
betwe5 ! bladd] & ! vag9a1 or ! rectum &
 ! vag9a 7or bo?71 aft] a woman suff]s f
 prolong$ ob/ruct$ labor4 ,9 ! /ruggle  
to pass ?r\gh ! bir? canal1 ! fetus puts
 con/ant pressure1 sometimes = sev]al   
days1 on ! bladd] & vag9al or rectal    
walls1 de/roy+ ! tissue t !n sl\ghs (f1 
result+ 9 ! abnormal op5+4  7#d7 ,9 !   
majority ( ob/etric fi/ula cases1 ! baby
 w be /illborn & ! "m w exp]i5ce        
physical pa9 z well z social & emotional
 trauma f liv+ ) incont95ce1 z well z ! 
loss ( h] *ild4  7#e7 ,! physical       
symptoms ( ob/etric fi/ula include      
incont95ce or con/ant uncontrollable    
leak+ ( ur9e or feces1 frequ5t bladd]   
infections1 inf]tility1 & f\l odor4     
7#f7 ,al?\gh data on ob/etric fi/ula are

 sc>ce1 ! ,_w ,heal? ,organization      
7,,:o7 e/imates !re are m ?an #b1jjj1jjj
 wom5 liv+ ) fi/ula1 & #ej1jjj to       
#ajj1jjj new cases ea* ye>4  7#g7       
,accord+ to ! ,dep>tm5t ( ,/ate1 ,!     
comb9ation ( pregnancy at an e>ly age1  
*ronic mat]nal malnutrition1 & a lack ( 
skill$ c>e at deliv]y c all contribute  
to ! developm5t ( ob/etric fi/ula &     
p]man5t incont95ce44  7#h7 ,ob/etric    
fi/ula 0 once common ?r\gh\t ! _w1 b ov]
 ! la/ c5tury 0 elim9at$ 9 ,europe1     
,nor? ,am]ica1 & o!r develop$ regions   
?r\gh improv$ access to m$ical          
int]v5tions1 p>ticul>ly em]g5cy ob/etric
 c>e = ^? wom5 :o ne$ x4 ,! fir/ fi/ula 
hospital 9 ! _w /ood :]e !              
,waldorf-,a/oria ,hotel is n[ locat$ 9  
,new ,york ,city4  7#i7 ,! social       
consequ5ces = wom5 liv+ ) ob/etric      
fi/ula include isolation1 divorce or    
ab&onm5t1 ridicule & %ame1 loss ( social
 belong+ & association1 illness &       
malnutrition1 risk ( viol5ce1 & lack (  
economic opportunities4 ,girls )        

ob/etric fi/ula are also (t5 unable to  
cont9ue s*ool+4 ,victims suff]          
psy*ological consequ5ces1 su* z feel+s (
 hopelessness1 self-hatr$1 sadness1     
depression1 & suicide1 because ( /igma &
 lack ( aw>5ess t _! condition is       
treatable4 ,fi/ula victims ne$ regul>   
m$ical att5tion & an extra supply ( soap
 to keep clean1 plac+ a huge f9ancial   
burd5 on already poor families4 ,!y also
 lose prop]ty :5 !y are divorc$ or      
ab&on$ by _! husb&s & family4 ,"s lose  
jobs or are d5i$ "w1 :ile o!rs quit _!  
jobs out ( %ame1 lead+ to deep5$ pov]ty 
& vuln]ability to repeat fi/ulas4  7#aj7
 ,ob/etric fi/ula is prev5table ?r\gh   
m$ical int]v5tions1 su* z skill$        
att5dance1 includ+ midwives1 pres5t dur+
 labor & *ildbir?1 provid+ access to    
family plann+1 & em]g5cy ob/etric c>e = 
wom5 :o develop *ildbir? complications1 
z well z social int]v5tions su* z delay+
 e>ly m>riage & educat+ & emp[]+ "y     
wom54  7#aa7 ,ob/etric fi/ula c also be 
surgically treat$4 ,surg]y requires a   

specially tra9$ surgeon & support /aff1 
& access to an op]at+ !at] & to att5tive
 po/op]ative c>e4 ,:5 p]=m$ by a skill$ 
surgeon1 success rates c be z high z #ij
 p]c5t & co/ an e/imat$ #cjj4  7#ab7    
,accord+ to ! ,dep>tm5t ( ,/ate1        
,because ( _! roles 9 *ild re>+1 provid+
 & seek+ c>e1 & manag+ wat] & nutrition1
 ! ability ( wom5 to access heal?-relat$
 k & s]vices is fundam5tal to ! heal? ( 
_! babies1 old] *ildr5 & o!r family     
memb]s4 ,ov] ! long-t]m1 ! heal? ( wom5 
enhances _! productivity & social &     
economic p>ticipation & also acts z a   
positive multipli]1 b5efitt+ social &   
economic developm5t ?r\gh ! heal? (     
future g5]ations44  7#ac7 ,9 #bjjb1 !   
,unit$ ,nations ,population ,fund       
7,,unfpa7 & ,engender,health emb>k$ on !
 fir/ ev] assessm5ts 9 n9e ,african     
c\ntries to det]m9e ! ne$ = & access to 
s]vices to address ob/etric fi/ula4 ,9  
#bjjc1 ,,unfpa & p>tn]s laun*$ a global 
campaign to id5tify & address ob/etric  
fi/ula 9 an ef=t to develop a means to  

treat ^? wom5 :o are suff]+ & provide ! 
necess>y heal? s]vices to prev5t fur!r  
cases4 ,! campaign is curr5tly active 9 
m ?an #de c\ntries 9 ,africa1 ,asia1 & !
 ,arab /ates region ?r\gh support =     
fi/ula surg]y1 tra9+ ( doctors & nurses1
 equipp+ hospitals1 & und]tak+ community
 outrea* to prev5t fur!r cases1 &       
support+ provision ( rehabilitative c>e 
= wom5 aft] treatm5t s !y c return to   
full & productive lives4  7#ad7 ,!      
,global ,campaign to ,end ,fi/ula works 
) national c\nt]p>ts1 includ+ m9i/ries (
 heal?1 o!r p]t95t m9i/ries1 ,unit$     
,nations ag5cies1 int]national &        
national nongov]nm5tal organizations1   
civil society organizations1 & fi/ula   
provid]s1 9 support ( national processes
 & fi/ula programmatic ef=ts4 ,a key    
focus is national fi/ula capacity       
/r5g!n+4  7#ae7 ,9 #bjjd1 ! ,unit$      
,/ates ,ag5cy = ,int]national           
,developm5t 7,,usaid7 provid$ fund+     
?r\gh ! ,,acquire ,project manag$ by    
,engender,health to support s]vices 9   

two c\ntries3 ,banglade% & ,ug&a4 ,9    
#bjjg1 ,,usaid provid$ a five-ye>       
coop]ative agreem5t to ,engender,health 
= ! ,fi/ula ,c>e project4 ,,usaid       
curr5tly supports fi/ula treatm5t       
s]vices 9 #cd sites 9 #aa c\ntries &    
addresses prev5tion 9 ^? sites & #be m4 
,! ceil+ = ! ,fi/ula ,c>e project is    
#gj1jjj1jjj4  7#af7 ,"o ( ! key global  
heal? pr9ciples ( ! ,unit$ ,/ates       
,global ,heal? ,initiative is to /r5g!n 
& lev]age key multilat]al organizations1
 global heal? p>tn]%ips1 & private      
sector engagem5t4 ,! ,unit$ ,/ates has  
committ$ to jo9 multilat]al ef=ts       
involv+ ! ,unit$ ,nations & o!rs to make
 progress t[>d a*iev+ ,mill5nium        
,developm5t ,goals #d1 #e1 & #f4  7#ag7 
,by #bjad1 ! ,unit$ ,/ates1 ?r\gh its   
,global ,heal? ,initiative1 has committ$
 to sev]al t>gets t w r$uce ! incid5ce (
 fi/ula1 includ+ ?r\gh ef=ts to r$uce   
mat]nal mortality by #cj p]c5t1 prev5t  
#ed1jjj1jjj un9t5d$ pregnancies by rea*+
 a mod]n contraceptive preval5ce rate ( 

#ce p]c5t1 & r$uc+ to #bj p]c5t ! numb] 
( fir/ bir?s by wom5 "u #ah across      
assi/$ c\ntries4  #c4 ,prev5tion &      
treatm5t ( ob/etric fi/ula  7a7         
,au?orization ,! ,presid5t is au?oriz$1 
9 accordance ) ?is section & section #d1
 to provide assi/ance1 includ+ ?r\gh    
int]national organizations1 national    
gov]nm5ts1 & int]national & local       
nongov]nm5tal organizations1 to--  7#a7 
address ! social & heal? issues t lead  
to ob/etric fi/ula2 &  7#b7 support     
treatm5t ( ob/etric fi/ula4  7b7        
,activities ,assi/ance provid$ pursuant 
to subsection 7a7 %all focus on--  7#a7 
increas+ prev5tion ?r\gh access to      
sexual & reproductive heal? s]vices1    
includ+ skill$ att5dance at bir?1       
compreh5sive em]g5cy ob/etric c>e1      
pr5atal & ant5atal c>e1 contraception   
7family plann+71 & support+ compreh5sive
 sexuality education2  7#b7 build+ local
 capacity & improv+ national heal?      
sy/ems to prev5t & treat ob/etric fi/ula
 )9 ! context ( navigat+ pregnancy 9    

good heal? ov]all2  7#c7 support+ tools 
to enable c\ntries to address ob/etric  
fi/ula1 includ+ support+ qualitative    
rese>* & data collection on ! incid5ce &
 preval5ce ( ob/etric fi/ula1 developm5t
 ( su/a9able f9anc+ me*anisms to        
enc\rage facility deliv]ies & provide   
fi/ula survivors access to free or      
af=dable treatm5t1 tra9+ ( midwives &   
skill$ bir? att5dants1 promot+          
s\?-to-s\? tra9+1 & provision ( basic   
ob/etric c>e at ! community level2  7#d7
 address+ und]ly+ social & economic     
inequities1 includ+ emp[]+ wom5 & girls1
 r$uc+ incid5ce ( *ild m>riage1 delay+  
*ildbir?1 & increas+ access to =mal &   
non-=mal education2  7#e7 support+      
re9tegration & tra9+ programs to help   
wom5 :o h und]gone treatm5t return to   
full & productive lives2 &  7#f7 promot+
 public aw>5ess to increase und]/&+ (   
ob/etric fi/ula1 & !reby improve        
prev5tion & treatm5t ef=ts1 to help     
r$uce /igma & viol5ce aga9/ wom5 & girls
 ) ob/etric fi/ula4  #d4 ,coord9ation1  

report+1 rese>*1 monitor+1 & evaluation 
7a7 ,9 g5]al ,assi/ance au?oriz$ "u ?is 
,act %all--  7#a7 promote ! coord9ation 
facilitat$ by ! ,int]national ,ob/etric 
,fi/ula ,work+ ,gr\p1 :i* coord9ates    
betwe5 & among donors1 multilat]al      
in/itutions1 ! private sector1          
nongov]nm5tal & civil society           
organizations1 & gov]nm5ts 9 ord] to    
support compreh5sive prev5tion &        
treatm5t ( ob/etric fi/ula2 &  7#b7 be  
us$ = ! developm5t & implem5tation (    
evid5ce-bas$ programs1 includ+ monitor+1
 evaluation1 & rese>* to measure !      
effectiv5ess & effici5cy ( su* programs 
?r\gh\t _! plann+ & implem5tation       
phases4  7b7 ,report+ ,n lat] ?an "o ye>
 aft] ! date ( ! enactm5t ( ?is ,act &  
annually !reaft]1 ! ,presid5t %all      
transmit to ,congress a report on       
activities und]tak5 pursuant to ?is ,act
 dur+ ! prec$+ fiscal ye> to r$uce !    
incid5ce ( & increase treatm5t =        
ob/etric fi/ula1 & h[ su* activities fit
 into exi/+ national action plans to    

prev5t & treat ob/etric fi/ula4