,i  #aad? ,,congress  #a/ ,session  ,h4 
,r4 #dadh  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #a1 #bjae    
,mrs4 ,c>olyn ,b4 ,maloney ( ,new ,york 
7= h]self1 ,mr4 ,grijalva1 ,mr4 ,johnson
 ( ,georgia1 ,ms4 ,moore1 & ,mr4        
,cony]s7 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 (   
#bjae4  #b4 ,f9d+s ,congress f9ds !     
foll[+3  7#a7 ,e two m9utes1 "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 ,mo/ ( ^! dea?s are prev5table1 
:i* repres5ts bo? a trag$y & an         
opportunity4  7#b7 ,= e woman :o dies f 
pregnancy-relat$ 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 is exp]i5c+ prolong$1    
ob/ruct$ labor & 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$1 ob/ruct$ labor )\t timely1   
adequate m$ical int]v5tion4 ,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+ or 
hole4  7#d7 ,9 ! majority ( ob/etric    
fi/ula cases1 ! baby w be /illborn & !  
"m w exp]i5ce physical pa9 & disability1
 z well z social & emotional trauma f   
liv+ ) incont95ce & f ! loss ( h] *ild4 
7#e7 ,9 addition to incont95ce or       
con/ant uncontrollable leak+ ( ur9e1    
feces1 or bo?1 ! physical consequ5ces ( 

ob/etric fi/ula may include frequ5t     
bladd] infections1 inf]tility1 f\l odor1
 & n]ve damage4  7#f7 ,m5tal1 emotional1
 & social side effects ( ob/etric fi/ula
 may include depression1 social         
isolation & discrim9ation1 suicidal     
?\ghts or actions1 & lack ( adequate    
economic opportunities1 result+ 9 deep5+
 pov]ty & vuln]ability4 ,girls )        
ob/etric fi/ula are also (t5 unable to  
cont9ue s*ool+4 ,wom5 & girls ) fi/ula  
suff] psy*ological consequ5ces1 su* z   
feel+s ( hopelessness because ( /igma & 
lack ( aw>5ess t _! condition is        
treatable4 ,fi/ula survivors ne$ regul> 
m$ical att5tion & support1 b too (t5    
adequate s]vices are unavailable or !   
wom5 & _! families _c af=d !m4 ,wom5 may
 lose prop]ty if !y are divorc$ or      
ab&on$ by _! husb&s & family4 ,"s lose  
jobs or are d5i$ "w1 :ile o!rs may quit 
_! jobs out ( %ame1 lead+ to deep5$     
pov]ty & vuln]ability to repeat fi/ulas4
  7#g7 ,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#h7 ,!    
prim>y cause ( ob/etric fi/ula is a lack
 ( timely1 adequate em]g5cy ob/etric    
c>e1 su* z a ces>ean section4 ,pov]ty1  
malnutrition1 poor heal? s]vices1 e>ly  
*ildbe>+1 & g5d] discrim9ation are      
int]l9k$ root causes ( ob/etric fi/ula4 
7#i7 ,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 ,z highlight$ by !  
,unit$ ,nations ,secret>y ,g5]al 9 8    
#bjae /atem5t on ! occasion ( !         
,int]national ,day to ,end ,ob/etric    
,fi/ula 7,may #bcrd71 9 :i* he call$ ^u 
_w lead]s to commit to end+ ! sc\rge (  
ob/etric fi/ula 9 our lifetime1 ,! fact 
t fi/ula p]si/s prim>ily among ! poore/ 

& mo/ m>g9aliz$ wom5 & girls 9 ! _w is  
an egregi\s outcome ( social1 economic &
 g5d] inequalities1 ! d5ial ( human     
rights & inadequate access to quality   
reproductive heal? s]vices1 includ+     
mat]nal & newborn c>e44  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 ,! majority ( ob/etric fi/ula c be
 surgically treat$4 ,surg]y requires a  
specially tra9$1 qualifi$ surgeon &     
support /aff1 & access to an op]at+ !at]
 & to att5tive po/op]ative c>e4 ,:5     
p]=m$ by a skill$1 compet5t surgeon1    
success rates c be z high z #ij p]c5t & 
co/ an e/imat$ #djj4  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 n only _! own heal? &  
well-be+1 b also t ( _! babies1 old]    
*ildr5 & o!r family memb]s4 ,ov] !      
long-t]m1 ! heal? & well-be+ ( wom51 9  
addition to be+ ess5tial 9 its own "r1  
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 & support ^? wom5 :o are suff]+ & 
provide ! necess>y heal? s]vices to     
prev5t fur!r cases4 ,! ,,unfpa-l$       
,campaign to ,end ,fi/ula is n[ pres5t 9
 m ?an #ej c\ntries across ,africa1     
,asia1 & ! ,arab region & is compris$ ( 

ov] #ij p>tn]s at ! global level & _m m 
at ! regional & national levels4 ,!     
,campaign has ?ree ma9 focuses3 !       
prev5tion ( fi/ula cases1 treatm5t (    
exi/+ cases ( fi/ula1 & social          
re9tegration & foll[ up = fi/ula        
survivors4 ,! ,campaign supports fi/ula 
surg]y1 tra9+ ( doctors1 nurses1 & o!r  
heal? work]s1 community outrea* to      
prev5t fur!r cases1 id5tification ( wom5
 suff]+ fi/ula :o ne$ c>e1 & support+   
provision ( rehabilitative c>e = wom5   
aft] treatm5t 9 ord] to break ! cycle ( 
pov]ty & m>g9alization t r5d]$ !m       
vuln]able to fi/ula 9 ! fir/ place & to 
enable !m to reclaim _! dignity & hope &
 return to full & productive lives4     
,s9ce #bjjc1 ,,unfpa has directly       
support$ m ?an #eg1jjj fi/ula repairs1 &
 additional repairs h be5 support$ by   
,campaign p>tn]s4  7#ad7 ,! ,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 academic         
in/itutions1 & heal? provid]s 7&        
pr(essional associations71 9 support (  
national processes & fi/ula eradication 
ef=ts1 includ+ /rategies to eradicate   
end-/age prolong$ or ob/ruct$ labor t   
causes n only fi/ula1 b a ho/ ( newborn 
& mat]nal reproductive1 m5tal1          
neurologic & or?op$ic conditions1 t h   
detrim5tal consequ5ces = wom5's lives4  
,a key focus is national capacity       
/r5g!n+ to rea* ! regional backlogs (   
wom5 liv+ ) fi/ula 9 remote regions1    
suff]+ ne$lessly1 sometimes = decades4  
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 ,banglade% & ,ug&a4 ,f #bjjg  
to #bjac1 ,,usaid fund$ ! ,fi/ula ,c>e  
project1 & 9 #bjac1 ,,usaid aw>d$ a new 
#e-ye> coop]ative agreem5t to           
,engender,health = ! ,fi/ula ,c>e ,plus 
project to support national fi/ula      

programs 9 ,africa & ,asia1 exp& access 
to c>e1 assess ! backlog ( cases1 te/   
new approa*es to improve ! effici5cy &  
quality ( c>e1 & improve heal? outcomes4
 ,,usaid curr5tly supports fi/ula       
treatm5t s]vices 9 #acg sites 9 six     
c\ntries & addresses prev5tion 9 ^?     
sites & #cf m4 ,! ceil+ = ! ,fi/ula ,c>e
 ,plus project is #gd1dij1jjj4 ,s9ce    
#bjjd1 m ?an #ci1jjj wom5 h receiv$     
fi/ula repairs ) ,,usaid support4  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 & #f1 &      
!reaft] ! ,su/a9able ,developm5t ,goals1
 ?r\gh ! ,unit$ ,nations ,secret>y      
,g5]al's ,e ,woman ,e ,*ild initiative4 
7#ag7 ,! ,unit$ ,/ates1 ?r\gh its       
commitm5t to ,end+ ,prev5table ,mat]nal 

& ,*ild ,dea?s1 has set sev]al t>gets t 
w r$uce ! incid5ce ( fi/ula1 includ+    
?r\gh ef=ts to r$uce mat]nal mortality  
to #ej mat]nal dea?s p] #ajj1jjj live   
bir?s by #bjce1 & support volunt>y      
family plann+ & reproductive heal?      
programs to rea* #abj1jjj1jjj additional
 wom5 & girls ) family plann+ in=mation1
 commodities & s]vices by #bjbj4 ,!     
,,usaid ,mat]nal ,heal? ,vision =       
,action calls = an increas$ focus on    
av]t+ & address+ mat]nal morbidity &    
disability4  #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