,i #aadth ,,congress #ast ,session ,h4 ,r4 #dadh ,,in ,,the ,,house ,,of ,,representatives ,december #a1 #bjae ,mrs4 ,carolyn ,b4 ,maloney of ,new ,york 7for herself1 ,mr4 ,grijalva1 ,mr4 ,johnson of ,georgia1 ,ms4 ,moore1 and ,mr4 ,conyers7 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 #bjae4 #b4 ,findings ,congress finds the following3 7#a7 ,every two minutes1 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 ,most of these deaths are preventable1 which represents both a tragedy and an opportunity4 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 is experiencing prolonged1 obstructed labor and 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 prolonged1 obstructed labor without timely1 adequate medical intervention4 ,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 opening or hole4 7#d7 ,in the majority of obstetric fistula cases1 the baby will be stillborn and the mother will experience physical pain and disability1 as well as social and emotional trauma from living with incontinence and from the loss of her child4 7#e7 ,in addition to incontinence or constant uncontrollable leaking of urine1 feces1 or both1 the physical consequences of obstetric fistula may include frequent bladder infections1 infertility1 foul odor1 and nerve damage4 7#f7 ,mental1 emotional1 and social side effects of obstetric fistula may include depression1 social isolation and discrimination1 suicidal thoughts or actions1 and lack of adequate economic opportunities1 resulting in deepening poverty and vulnerability4 ,girls with obstetric fistula are also often unable to continue schooling4 ,women and girls with fistula suffer psychological consequences1 such as feelings of hopelessness because of stigma and lack of awareness that their condition is treatable4 ,fistula survivors need regular medical attention and support1 but too often adequate services are unavailable or the women and their families cannot afford them4 ,women may lose property if they are divorced or abandoned by their husbands and family4 ,some lose jobs or are denied work1 while others may quit their jobs out of shame1 leading to deepened poverty and vulnerability to repeat fistulas4 7#g7 ,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#h7 ,the primary cause of obstetric fistula is a lack of timely1 adequate emergency obstetric care1 such as a cesarean section4 ,poverty1 malnutrition1 poor health services1 early childbearing1 and gender discrimination are interlinked root causes of obstetric fistula4 7#i7 ,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 ,as highlighted by the ,united ,nations ,secretary ,general in his #bjae statement on the occasion of the ,international ,day to ,end ,obstetric ,fistula 7,may #bcrd71 in which he called upon world leaders to commit to ending the scourge of obstetric fistula in our lifetime1 ,the fact that fistula persists primarily among the poorest and most marginalized women and girls in the world is an egregious outcome of social1 economic and gender inequalities1 the denial of human rights and inadequate access to quality reproductive health services1 including maternal and newborn care44 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 ,the majority of obstetric fistula can be surgically treated4 ,surgery requires a specially trained1 qualified surgeon and support staff1 and access to an operating theater and to attentive postoperative care4 ,when performed by a skilled1 competent surgeon1 success rates can be as high as #ij percent and cost an estimated #djj4 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 not only their own health and well-being1 but also that of their babies1 older children and other family members4 ,over the long-term1 the health and well-being of women1 in addition to being essential in its own right1 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 and support those women who are suffering and provide the necessary health services to prevent further cases4 ,the ,,unfpa-led ,campaign to ,end ,fistula is now present in more than #ej countries across ,africa1 ,asia1 and the ,arab region and is comprised of over #ij partners at the global level and many more at the regional and national levels4 ,the ,campaign has three main focuses3 the prevention of fistula cases1 treatment of existing cases of fistula1 and social reintegration and follow up for fistula survivors4 ,the ,campaign supports fistula surgery1 training of doctors1 nurses1 and other health workers1 community outreach to prevent further cases1 identification of women suffering fistula who need care1 and supporting provision of rehabilitative care for women after treatment in order to break the cycle of poverty and marginalization that rendered them vulnerable to fistula in the first place and to enable them to reclaim their dignity and hope and return to full and productive lives4 ,since #bjjc1 ,,unfpa has directly supported more than #eg1jjj fistula repairs1 and additional repairs have been supported by ,campaign partners4 7#ad7 ,the ,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 academic institutions1 and health providers 7and professional associations71 in support of national processes and fistula eradication efforts1 including strategies to eradicate end-stage prolonged or obstructed labor that causes not only fistula1 but a host of newborn and maternal reproductive1 mental1 neurologic and orthopedic conditions1 that have detrimental consequences for women's lives4 ,a key focus is national capacity strengthening to reach the regional backlogs of women living with fistula in remote regions1 suffering needlessly1 sometimes for decades4 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 ,bangladesh and ,uganda4 ,from #bjjg to #bjac1 ,,usaid funded the ,fistula ,care project1 and in #bjac1 ,,usaid awarded a new #e-year cooperative agreement to ,engender,health for the ,fistula ,care ,plus project to support national fistula programs in ,africa and ,asia1 expand access to care1 assess the backlog of cases1 test new approaches to improve the efficiency and quality of care1 and improve health outcomes4 ,,usaid currently supports fistula treatment services in #acg sites in six countries and addresses prevention in those sites and #cf more4 ,the ceiling for the ,fistula ,care ,plus project is #gd1dij1jjj4 ,since #bjjd1 more than #ci1jjj women have received fistula repairs with ,,usaid support4 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 #f1 and thereafter the ,sustainable ,development ,goals1 through the ,united ,nations ,secretary ,general's ,every ,woman ,every ,child initiative4 7#ag7 ,the ,united ,states1 through its commitment to ,ending ,preventable ,maternal and ,child ,deaths1 has set several targets that will reduce the incidence of fistula1 including through efforts to reduce maternal mortality to #ej maternal deaths per #ajj1jjj live births by #bjce1 and support voluntary family planning and reproductive health programs to reach #abj1jjj1jjj additional women and girls with family planning information1 commodities and services by #bjbj4 ,the ,,usaid ,maternal ,health ,vision for ,action calls for an increased focus on averting and addressing maternal morbidity and disability4 #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 nonformal 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