,i #aacth ,,congress #b;d ,session ,h4 ,r4 #ehfb ,,in ,,the ,,house ,,of ,,representatives ,december #aa1 #bjad ,mrs4 ,capps introduced the following bill2 which was referred to the ,committee on ,foreign ,affairs ,a ,,bill ,to provide assistance to improve maternal and newborn health in developing countries1 and for other purposes4 #a4 ,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 ,act4 #b4 ,findings and purposes 7a7 ,findings ,congress finds the following3 7#a7 ,in #bjjj1 the ,united ,states joined #ahh other countries in supporting the #h ,united ,nations ,millennium ,development ,goals 7,m,d,gs71 including ,,mdg #d1 which aims to reduce child mortality by two-thirds and ,,mdg #e1 which aims to reduce the maternal mortality ratio by three-quarters by #bjae4 ,in #bjje1 universal access to reproductive health was added as a target for ,,mdg #e4 7#b7 ,substantial progress in maternal health has been made4 ,the total number of maternal deaths decreased by over #ej percent from #ebi1jjj maternal deaths in #bjjj to #bhg1jjj maternal deaths in #bjaj4 ,egypt1 ,honduras1 ,malaysia1 ,sri ,lanka1 and parts of ,bangladesh have all halved their maternal mortality ratios over the past few decades4 7#c7 ,while significant progress has been made in reducing maternal mortality1 the ,united ,nations reports that current maternal mortality levels are far removed from the #bjae target4 7#d7 ,women in developing countries are nearly #ajj times more likely to die of complications during pregnancy or childbirth than in developed countries1 with higher rates for women living in rural areas and among poorer communities4 7#e7 ,the ,united ,states ,agency for ,international ,development 7,,usaid7 estimates the global economic impact of maternal and newborn mortality at #ae billion in lost productivity every year4 7#f7 ,annually1 #bhg1jjj women die from complications during pregnancy or childbirth1 with #ii percent of these deaths occurring in developing countries4 ,six countries--,afghanistan1 the ,democratic ,republic of ,congo1 ,ethiopia1 ,india1 ,nigeria1 and ,pakistan--account for almost one-half of all maternal deaths worldwide4 7#g7 ,it is estimated that up to #ij percent of these maternal deaths are preventable4 ,with access to medicines and skilled health care providers1 most women across the world can expect a successful delivery and a healthy newborn4 7#h7 ,the leading cause of maternal deaths is hemorrhage4 ,other primary causes of maternal death include sepsis1 hypertensive disorder 7pre-eclampsia_/eclampsia71 unsafe abortion1 and prolonged or obstructed labor4 7#i7 ,an essential part of ensuring a woman survives pregnancy and childbirth includes access to maternal health medicines and other supplies4 ,uterotonics prevent and treat postpartum hemorrhage by causing contractions of the uterus during and after childbirth1 effectively controlling excessive bleeding4 ,if uterotonic medicines1 such as oxytocin and misoprostol1 were available to all women giving birth over a #aj-year period1 approximately #da million postpartum hemorrhage cases could be prevented and #a4d million women's lives saved4 7#aj7 ,pregnancy is the leading killer of adolescent girls ages #ae to #ai in the developing world4 ,nearly #gj1jjj adolescent girls die every year because their bodies are not ready for childbirth4 ,compared to women in their twenties1 adolescent girls aged #ae to #ai are twice as likely to die in childbirth1 and girls under #ae are five times as likely to die1 and mortality and morbidity rates are also higher among infants born to young mothers4 7#aa7 ,for every maternal death1 approximately #bj women and girls experience serious or long-term negative health consequences4 ,severe pregnancy-related injuries include fistula1 uterine prolapse1 infections1 diseases1 and disabilities4 ,maternal morbidities accrue an estimated global cost of #f4h billion4 7#ab7 ,healthy timing and spacing of pregnancy has a powerful impact on the chances of survival for women1 newborns1 infants1 and children4 ,access to voluntary family planning plays an essential role in improving maternal health4 7#ac7 ,delaying a first pregnancy until at least #ah years old1 waiting at least #bd months to become pregnant after a live birth1 and waiting at least #f months after a miscarriage or induced abortion1 can reduce all maternal mortality by #cj percent and prevent #gj1jjj deaths per year of women who die from unsafe abortion4 7#ad7 ,healthy timing and spacing of birth can also reduce newborn and child death by more than #ej percent4 ,children born less than two years after the previous birth are approximately #b4e times more likely to die before the age of five than children born three to five years after the previous birth4 7#ae7 ,if all women who wanted to delay or avoid pregnancy had access to modern contraception1 #bf million abortions would be averted4 7#af7 ,more than #bbj million women in developing countries who would prefer to delay or avoid childbearing lack access to safe and effective family planning methods4 ,less than one-half of married women of reproductive age in ,south ,asia and less than #be percent of women in sub-,saharan ,africa use modern contraceptives4 ,in #bjab1 an estimated #hj million women in developing countries had an unintended pregnancy4 7#ag7 ,it is estimated that if #abj million more women had access to family planning information1 services and supplies1 without coercion or discrimination by #bjbj1 #bjj1jjj fewer girls and women would die during pregnancy and childbirth1 there would be #ajj million fewer unintended pregnancies1 there would be #ej million fewer abortions1 and #c million fewer infants would die in their first year of life4 7#ah7 ,violent acts against pregnant women can also lead to poor health outcomes for women and their babies1 including miscarriage1 pre-term birth1 low birthweight1 stillbirths1 and maternal deaths4 ,the risk for maternal mortality is #c times as high for abused mothers4 ,in emergency settings1 gender-based violence rates continue to increase4 7#ai7 ,according to the ,world ,health ,organization 7,,who71 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 mutilation1 and children born to mothers who have undergone female genital mutilation face higher death rates immediately after birth4 7#bj7 ,maternal health is inextricably tied to newborn health and survival4 ,in some countries in the developing world the risk of newborn death doubles following maternal death4 ,the conditions in utero1 during labor1 delivery1 and shortly after birth have a direct relationship on newborn outcomes4 7#ba7 ,in #bjab1 #b4i million newborns or #dd percent of total under-five mortality did not survive the first month of life4 ,one million of these deaths occurred during the first day of life4 7#bb7 ,the leading causes of newborn mortality include prematurity1 intrapartum complications 7including birth asphyxia71 and neonatal infections4 ,over two-thirds of these deaths could be prevented through low-cost medicines1 products1 and interventions that would not require intensive care4 7#bc7 ,in addition to newborn mortality there are an additional #b4fe million stillbirths each year that are not included in newborn or under-five mortality statistics4 7#bd7 ,women in ,africa are #bd times more likely to have a stillbirth than women in high-income countries4 7#be7 ,in developing countries1 nearly one-third of stillbirth babies were alive when labor began4 ,if #ii percent of women in developing countries had comprehensive emergency obstetric care1 nearly #gjj1jjj stillbirths could be prevented each year4 7#bf7 ,in many developing countries1 lack of access to quality health care facilities1 health services1 and trained providers results in deaths for mothers1 newborns1 and children--the majority of births in ,africa take place without a skilled attendant present or the necessary medicines and medical supplies1 increasing the risk of death or disability for both mother and newborn4 7#bg7 ,if family planning and maternal and newborn services were provided simultaneously1 the costs of these services would decline by #a4e billion and would result in a #gj percent decline in maternal deaths and a #dd percent decline in newborn deaths4 7#bh7 ,more than one-half of all children and pregnant women in developing countries suffer from anemia1 which is exacerbated by malaria1 neglected tropical diseases1 and nutritional deficits1 causing adverse pregnancy outcomes and even death4 7#bi7 ,maternal deaths worldwide could be reduced by #fj1jjj per year if women received appropriate ,,hiv diagnosis and treatment4 7#cj7 ,with proper interventions1 the transmission of ,,hiv between women and their infants during pregnancy and breastfeeding can be reduced to #e percent in the developing world4 ,the ,,who recommends early diagnosis and immediate treatment for children identified as ,,hiv positive because1 without treatment1 half of these children will die before the age of two4 7#ca7 ,nine out of ten women in sub-,saharan ,africa will lose a child during their lifetimes1 and only #cj percent of women in sub-,saharan ,africa have contact with a health worker after giving birth4 7#cb7 ,according to the ,director of ,national ,intelligence's #bjji ,annual ,threat ,assessment1 widespread poor maternal and child health and malnutrition has the potential to weaken central governments and empower non-state actors1 including terrorist and paramilitary groups4 7#cc7 ,the experiences of ,united ,states ,government-supported and nongovernmental organization maternal and child health programs in countries such as ,nepal1 ,ethiopia1 and ,senegal have demonstrated that community-based approaches1 linked to primary and referral care when possible1 can deliver high-impact interventions to prevent or treat many of the life-threatening conditions affecting mothers and newborns4 7b7 ,purposes ,the purposes of this ,act are-- 7#a7 to authorize assistance to improve maternal and newborn health in developing countries2 and 7#b7 to develop a strategy to reduce mortality and morbidity and improve maternal and newborn health in developing countries4 #c4 ,assistance to ,reduce ,mortality and ,improve ,maternal and ,newborn ,health in developing countries 7a7 ,in general ,chapter #a of part ,i of the ,foreign ,assistance ,act of #aifa 7#bb ,u4,s4,c4 #baea et seq47 is amended-- 7#a7 in section #ajb7;b77#d77;,b71 by striking reduction of infant mortality and inserting reduction of maternal and newborn mortality1 morbidity1 and stillbirths2 and 7#b7 by inserting after section #ajd;,c the following new section3 #ajd;,d4 ,assistance to ,reduce ,mortality and ,improve ,maternal and ,newborn ,health 7a7 ,authorization ,consistent with section #ajd7;c71 the ,president is authorized to furnish assistance1 on such terms and conditions as the ,president may determine1 to reduce maternal and newborn mortality and morbidity and improve maternal health and the health of newborns in developing countries4 7b7 ,activities supported ,assistance provided under subsection 7a7 shall1 to the maximum extent practicable1 include-- 7#a7 activities to expand access to and improve quality of maternal health services1 including-- 7,a7 birth preparedness through the provision of quality pre-pregnancy and antenatal care with a skilled provider 7midwife1 nurse1 or doctor71 which should consist of1 at minimum-- 7i7 iron and folic acid supplementation2 7ii7 tetanus vaccine2 7iii7 smoking cessation2 7iv7 prevention and management of sexually transmitted infections and ,,hiv1 including access to ,preventing ,mother-to-,child ,transmission2 7v7 screening1 diagnosis1 and treatment of existing conditions1 such as syphilis1 ,,hiv_/,,aids1 malaria1 and tuberculosis1 and ensuring that women are provided with1 or referred to1 appropriate care and treatment and prophylaxis for those conditions1 including access to antiretrovirals 7,a,r,vs72 7vi7 magnesium sulfate and low-dose aspirin to prevent pre-eclampsia and calcium supplementation to prevent hypertension2 7vii7 screening for complications1 including blood pressure screenings2 7viii7 magnesium sulfate for eclampsia2 antihypertensive medication2 7ix7 corticosteroids to prevent respiratory distress syndrome2 7x7 induction of labor at term to manage pre-labor rupture of membranes2 7xi7 nutrition treatment of malnourished pregnant women2 and 7xii7 antibiotics for pre-term labor2 7,b7 expanding access to skilled childbirth and postnatal care1 particularly in areas with low utilization of skilled delivery1 including-- 7i7 the presence of a skilled health professional 7nurse1 midwife1 or doctor7 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 newborns1 7ii7 clean delivery2 7iii7 uterotonics and active management of third stage of labor to prevent postpartum hemorrhage2 7iv7 social support during childbirth2 7v7 screening for ,,hiv1 linkages to ,,hiv care and treatment services1 and follow up tracking2 7vi7 induction of labor for prolonged pregnancy2 7vii7 nutrition counseling2 7viii7 management of postpartum hemorrhage2 7ix7 caesarean section for maternal_/fetal indication with prophylactic antibiotics2 7x7 treating maternal anemia2 and 7xi7 postpartum family planning methods2 7,c7 comprehensive voluntary family planning services1 integrated into antenatal and postnatal care1 to support women and men in making informed decisions and having timely1 intended1 well-spaced pregnancies1 and to help women with pre-existing conditions avoid high-risk1 unintended pregnancies1 including-- 7i7 provision of family planning_/birth spacing counseling and services2 and 7ii7 emergency treatment of complications of unsafe abortions and linkages to other reproductive health services2 7#b7 activities to expand access to and improve quality of services that reduce newborn and infant mortality1 including-- 7,a7 immediate thermal care2 7,b7 initiation of early1 exclusive1 and continued breastfeeding2 7,c7 hygienic cord and skin care2 7,d7 kangaroo mother care2 7,e7 extra support for feeding small and preterm infants2 7,f7 antibiotic therapy for newborns at risk of bacterial infection2 7,g7 use of surfactant in pre-term infants2 7,h7 initiate prophylactic antiretroviral therapy for infants exposed to ,,hiv2 7,i7 neonatal resuscitation with a bag and mask for infants suffering from birth asphyxia2 7,j7 continuous positive airway pressure to manage respiratory distress syndrome2 7,k7 case management of neonatal sepsis1 neonatal meningitis1 and pneumonia2 7,l7 case management of meningitis1 malaria1 diarrhea1 pneumonia1 and severe acute malnutrition2 and 7,m7 comprehensive care of ,,hiv1 including ,a,r,vs1 cotrimoxazole1 nutrition support1 and psychosocial support2 7#c7 activities to support communities and health care providers in identifying and removing barriers to maternal health care services1 including-- 7,a7 financial and sociocultural barriers2 7,b7 child marriage2 7,c7 transportation2 7,d7 gender discrimination and gender-based violence2 7,e7 stigma based on pre-existing health concerns2 and 7,f7 female genital mutilation_/cutting2 7#d7 activities that focus on empowering women and girls and engaging men and boys at the individual1 household1 and community levels to improve the health outcomes of women1 newborns1 and children1 including education and awareness programs about gender-based violence1 the health risks of female genital mutilation1 and shared responsibility for1 and benefits of1 family planning2 7#e7 activities to improve the supply of critical maternal and newborn health commodities1 including lifesaving medicines and supplies1 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 them2 7#f7 activities supporting country-led efforts to improve capacity for health governance1 health finance1 and the health workforce1 including in the private sector1 and support for training clinicians1 nurses1 technicians1 sanitation and public health workers1 community-based health workers1 midwives1 birth attendants1 peer educators1 volunteers1 and private sector enterprises to provide integrated health and nutrition services and referrals that meet the needs of patients across a continuum of care2 7#g7 activities that support country-led plans to reduce maternal and newborn mortality and morbidity and stillbirths1 including-- 7,a7 management of host country institutions' information systems and the development and use of tools and models to collect1 analyze1 and disseminate information related to maternal and newborn health2 and 7,b7 activities to develop and conduct needs assessments1 baseline studies1 targeted evaluations1 or other information-gathering efforts for the design1 monitoring1 and evaluation of maternal and newborn health efforts1 including-- 7i7 the study of the availability and effects of critical medicines and devices1 particularly those of importance in developing countries1 on pregnant women and newborns2 7ii7 the collection1 evaluation1 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 levels2 and 7iii7 the improvement of vital registries to capture live births1 neonatal deaths1 and the number of stillbirths2 and 7#h7 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 prevention1 care1 treatment1 and counseling activities1 including better integration with programs addressing-- 7,a7 malaria2 7,b7 tuberculosis2 7,c7 family planning and reproductive health2 7,d7 counseling for survivors of sexual- and gender-based violence2 7,e7 neglected tropical diseases2 7,f7 nutrition2 and 7,g7 child survival4 7c7 ,guidelines ,to the maximum extent practicable1 programs1 projects1 and activities carried out using assistance provided under this section shall be-- 7#a7 carried out through private and voluntary organizations1 including community and faith-based organizations1 local organizations1 and relevant international and multilateral organizations that demonstrate effectiveness1 including the ,united ,nations ,population ,fund1 the ,united ,nations ,children's ,fund1 and the ,global ,alliance for ,vaccines and ,immunizations1 and that demonstrate commitment to improving the health and rights of mothers and newborns and reducing the number of stillbirths2 7#b7 carried out in the context of country-driven plans in whose development the ,united ,states ,government participates along with other donors and multilateral organizations1 nongovernmental organizations1 and civil society2 7#c7 carried out with input by beneficiaries and other directly affected populations1 especially women and marginalized communities2 and 7#d7 designed to build the capacity of host country governments and civil society organizations4 7d7 ,annual report ,not later than ,january #ca1 #bjaf1 and annually thereafter for #d years1 the ,president shall transmit to ,congress a report on the implementation of this section for the prior fiscal year4 7e7 ,definitions ,in this section3 7#a7 ,,aids ,the term ,,aids has the meaning given the term in section #ajd;,a7g77#a7 of this ,act4 7#b7 ,,hiv ,the term ,,hiv has the meaning given the term in section #ajd;,a7g77#b7 of this ,act4 7#c7 ,,hiv_/,,aids ,the term ,,hiv_/,,aids has the meaning given the term in section #ajd;,a7g77#c7 of this ,act4 4 #d4 ,development of strategy to reduce mortality and morbidity and improve maternal and newborn health in developing countries 7a7 ,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 health1 including strategies with respect to ,,hiv_/,,aids1 gender1 child survival4 7b7 ,components ,the comprehensive ,united ,states ,government strategy developed pursuant to subsection 7a7 shall include the following3 7#a7 ,an identification of not less than #bd countries1 including fragile states and countries affected by conflict1 with priority needs for the #e-year period beginning on the date of the enactment of this ,act based on-- 7,a7 the number and rate of neonatal deaths2 7,b7 the number and rate of near-miss morbidity for women and newborns2 7,c7 the number and rate of maternal deaths2 7,d7 the number and rate of caesarean sections2 7,e7 the number and rate of malnourished women of reproductive age2 and 7,f7 the number of individuals with an unmet need for family planning4 7#b7 ,for each country identified in paragraph 7#a7-- 7,a7 an assessment of the most common causes of maternal and newborn mortality and morbidity2 7,b7 a description of the programmatic areas and interventions providing maximum health benefits to populations at risk and maximum reduction in mortality and morbidity2 7,c7 an assessment of the investments needed in identified programs and interventions to achieve the greatest results2 7,d7 a description of how ,united ,states assistance complements and leverages efforts by other donors and builds capacity and self-sufficiency among recipient countries2 and 7,e7 a description of goals and objectives for improving maternal and newborn health1 including1 to the extent feasible1 objective and quantifiable indicators4 7#c7 ,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 countries4 7#d7 ,a description of the measured or estimated impact on maternal and newborn morbidity and mortality of each project or program receiving assistance under section #ajd;,d of the ,foreign ,assistance ,act of #aifa 7as added by section #c of this ,act74 7c7 ,report ,not later than #ahj days after the date of the enactment of this ,act1 the ,president shall transmit to ,congress a report that contains the strategy described in this section4 #e4 ,authorization of appropriations 7a7 ,in general ,there are authorized to be appropriated to carry out this ,act1 and the amendments made by this ,act1 such sums as may be necessary for each of fiscal years #bjaf through #bjbj4 7b7 ,availability of funds ,amounts appropriated pursuant to the authorization of appropriations under subsection 7a7 are authorized to remain available until expended4