,i #aaeth ,,congress #b;d ,session ,h4 ,r4 #gcja ,,in ,,the ,,house ,,of ,,representatives ,december #ac1 #bjah,ms4 ,de,lauro 7for herself1 ,ms4 ,norton1 ,mr4 ,grijalva1 ,ms4 ,jackson ,lee1 ,mr4 ,mc,govern1 ,ms4 ,mc,collum1 and ,ms4 ,lofgren7 introduced the following bill2 which was referred to the ,committee on ,foreign ,affairs ,a ,,bill ,to authorize assistance to train and retain obstetrician-gynecologists and sub-specialists in urogynecology and to help improve the quality of care to meet the health care needs of women in least developed countries1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,physician ,education for ,fistula ,treatment ,act4 #b4 ,findings ,congress finds the following3 7#a7 ,historically1 obstetric fistulas affected women in the ,united ,states and around the world4 ,advances in obstetric care and access to improved surgical techniques resulted in a drastic reduction in obstetric fistula by the early #bjth century in the ,united ,states4 7#b7 ,each year between #ej1jjj to #ajj1jjj women worldwide are affected by obstetric fistulas1 an abnormal opening between a woman's genital tract and her urinary tract or rectum4 7#c7 ,women who experience an obstetric fistula suffer constant incontinence1 shame1 and social segregation and health problems4 ,it is estimated that #b to #c million women live with untreated obstetric fistulas1 a scourge of epidemic proportions4 7#d7 ,a lack of available resources and training programs to develop expertise in comprehensive advanced pelvic reconstructive surgery continues to pose a challenge for the health care workforce in least developed countries4 7#e7 ,retention rates of ,,ob-,g,y,ns and sub-specialists in urogynecology have seen improvement with fellowships1 residencies1 and programs that provide resources and training4 7#f7 ,today1 obstetric fistula primarily affects the poorest women in the poorest parts of the world4 ,obstetric fistulas typically occur because women do not have timely access to emergency obstetric care during obstructed labor1 and continue to have fistulas due to lack of access to adequate surgical services once they sustain the injury4 7#g7 ,left untreated1 an obstetric fistula afflicts a woman with devastating physical conditions3 incontinence1 painful ulcers1 and constant and uncontrollable emission of offensive odors4 ,these symptoms leave a woman indelibly and perpetually stigmatized by her condition4 7#h7 ,because obstetric fistulas are not themselves fatal1 millions of women live with this horrific condition and have been overlooked by the international medical community4 ,at present1 humanitarian aid and nongovernmental programs treat fistula cases on a small scale and are not equipped to systematically prevent1 treat1 and eradicate obstetric fistula4 7#i7 ,obstetric fistula can be prevented when women and their families are educated about the birthing process and are provided timely access to emergency obstetric care4 ,basic interventions to identify and repair obstetric fistula have achieved meaningful and cost-effective results4 ,the impact of an obstetric fistula-repair surgery is immediate and women can be reintegrated into society4 ,however1 access to prevention1 effective midwifery services1 and ,,ob-,,gyn care can significantly decrease childbirth-related injuries4 #c4 ,international ,,ob_/,,gyn and ,urogynecology ,promotion ,program 7a7 ,purpose ,the purpose of assistance under this section is to train and retain obstetrician-gynecologists 7,,ob-,g,y,ns7 and sub-specialists in urogynecology and to help improve the quality of care to meet the health care needs of women in least developed countries4 7b7 ,authorization 7#a7 ,in general ,to carry out the purpose of subsection 7a71 the ,president1 acting through the ,director of the ,john ,e4 ,fogarty ,international ,center for ,advanced ,study in the ,health ,sciences1 is authorized to provide assistance for least developed countries to support the activities described in subsection 7c74 7#b7 ,reference ,assistance authorized under this section may be referred to as the ,international ,,ob_/,,gyn and ,urogynecology ,promotion ,program4 7c7 ,activities supported ,activities that may be supported by assistance under subsection 7b7 include the following3 7#a7 ,fellowship and residency programs ,establishment of fellowship and residency programs to be carried out in coordination with institutions of higher education 7as such term is defined in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja771 institutions of higher learning1 midwifery programs1 and existing clinical centers in least developed countries-- 7,a7 to support existing academic curricula for education training for midwifery students2 7,b7 to develop and help sustain existing specialized curriculum training for medical students and residents to become knowledgeable and proficient in women's health care2 and 7,c7 to allow medical students1 residents1 and midwifery students to practice and develop expertise in geographical areas in which childbirth-related injuries are most prevalent4 7#b7 ,training centers ,establishment of training centers-- 7,a7 to address the shortage of ,,ob-,g,y,ns and sub-specialists in the urogynecology profession2 and 7,b7 to carry out specialized programs that are located at health care institutions that provide exceptionally high concentrations of expertise and related resources related to these medical professions and are delivered in a comprehensive and interdisciplinary fashion4 #d4 ,comprehensive #aj-year strategy to address the shortage of physicians in least developed countries 7a7 ,in general ,the ,president1 acting through the ,director of the ,john ,e4 ,fogarty ,international ,center for ,advanced ,study in the ,health ,sciences1 shall establish a comprehensive1 integrated1 #aj-year strategy to address the shortage of physicians in least developed countries4 7b7 ,elements ,such strategy shall maintain sufficient flexibility and remain responsive to the needs of women afflicted with childbirth-related injuries and shall include the following3 7#a7 ,a plan for implementation and coordination of programs and activities under this ,act1 including grants and contracts for prevention1 treatment1 and monitoring of childbirth-related injuries4 7#b7 ,specific objectives1 multi-sector approaches1 and specific strategies to treat women who suffer from childbirth-related injuries and to prevent further occurrences of childbirth-related injuries4 7#c7 ,assignment of priorities for relevant executive branch agencies4 7#d7 ,public health and health care delivery system research on the prevention1 repair1 and rehabilitation of childbirth-related injuries4 7#e7 ,social science research in fields such as anthropology1 sociology1 and related fields to monitor and evaluate the underlying social and economic factors that contribute to childbirth-related injuries4 7#f7 ,development1 implementation1 and evaluation of evidence-based systems of care connecting maternity care facilities with local care delivery and community education programs4 ,such systems of care should promote rapid and long-term prevention of childbirth-related injuries1 including-- 7,a7 culturally appropriate childbirth education1 preparation1 and planning2 and 7,b7 access to obstetrician-gynecologists 7,,ob-,g,y,ns71 urogynecology care1 or midwifery care4 7#g7 ,expansion of training centers and partnerships with institutions of higher learning for medical students and residents4 7#h7 ,priorities for the distribution of resources based on factors such as the size and demographics of the population suffering from childbirth-related injuries1 the needs of that population1 and the existing infrastructure or funding levels that may exist to treat and prevent childbirth-related injuries1 including obstetric fistula4 7#i7 ,a plan for institutional capacity-building of partnerships to strengthen universities1 research centers1 health-profession training programs1 and government institutes to build the in-country capacity needed to eradicate childbirth-related injuries in least developed countries4 7c7 ,report ,not later than #b years after the date of the enactment of this ,act1 the ,president shall submit to ,congress a report that contains the strategy required under this section4 #e4 ,report 7a7 ,in general ,the ,president1 acting through the ,director of the ,john ,e4 ,fogarty ,international ,center for ,advanced ,study in the ,health ,sciences1 shall submit to ,congress1 on an annual basis1 a report on the implementation of this ,act for the preceding year4 7b7 ,matters ,to be included ,the report required under subsection 7a7 shall include an evaluation of the effectiveness and performance of the ,international ,,ob_/,,gyn and ,urogynecology ,promotion ,program established under section #c and all related community outreach and medical programs4 #f4 ,definitions ,in this ,act3 7#a7 ,childbirth-related injuries ,the term childbirth-related injuries means injuries associated with obstructed labor1 including-- 7,a7 pelvic organ prolapse2 7,b7 a displacement of pelvic organs such as the uterus1 bladder1 or bowel2 and 7,c7 obstetric fistula4 7#b7 ,low-income country ,the term low-income country means a country with a per capita gross national income of #a1jce or less4 7#c7 ,least developed country ,the term least developed country means a country that-- 7,a7 is a low-income country2 and 7,b7 according to the ,united ,nations ,economic ,analysis and ,policy ,division1 is confronting severe structural impediments to sustainable development4 7#d7 ,relevant executive branch agencies ,the term relevant executive branch agencies means the ,department of ,state1 the ,united ,states ,agency for ,international ,development1 and any other department or agency of the ,united ,states that participates in international health and humanitarian activities pursuant to the authorities of such department or agency or the ,foreign ,assistance ,act of #aifa4