,i  #aae? ,,congress  #b;d ,session  ,h4
 ,r4 #gcja  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,decemb] #ac1         
#bjah,ms4 ,de,lauro 7= h]self1 ,ms4     
,norton1 ,mr4 ,grijalva1 ,ms4 ,jackson  
,lee1 ,mr4 ,mc,govern1 ,ms4 ,mc,collum1 
& ,ms4 ,l(gr57 introduc$ ! foll[+ bill2 
:i* 0 ref]r$ to ! ,committee on ,=eign  
,affairs  ,a ,,bill  ,to au?orize       
assi/ance to tra9 & reta9               
ob/etrician-gynecologi/s &              
sub-speciali/s 9 urogynecology & to help
 improve ! quality ( c>e to meet ! heal?
 c>e ne$s ( wom5 9 lea/ develop$        
c\ntries1 & = o!r purposes4  #a4 ,%ort  
title ,?is ,act may be cit$ z !         
,physician ,education = ,fi/ula         
,treatm5t ,act4  #b4 ,f9d+s ,congress   
f9ds ! foll[+3  7#a7 ,hi/orically1      
ob/etric fi/ulas affect$ wom5 9 ! ,unit$
 ,/ates & ar\nd ! _w4 ,advances 9       
ob/etric c>e & access to improv$        
surgical te*niques result$ 9 a dra/ic   
r$uction 9 ob/etric fi/ula by ! e>ly    
#bj? c5tury 9 ! ,unit$ ,/ates4  7#b7    

,ea* ye> betwe5 #ej1jjj to #ajj1jjj wom5
 worldwide are affect$ by ob/etric      
fi/ulas1 an abnormal op5+ betwe5 a      
woman's g5ital tract & h] ur9>y tract or
 rectum4  7#c7 ,wom5 :o exp]i5ce an     
ob/etric fi/ula suff] con/ant           
incont95ce1 %ame1 & social segregation &
 heal? problems4 ,x is e/imat$ t #b to  
#c million wom5 live ) untreat$ ob/etric
 fi/ulas1 a sc\rge ( epidemic           
proportions4  7#d7 ,a lack ( available  
res\rces & tra9+ programs to develop    
exp]tise 9 compreh5sive advanc$ pelvic  
recon/ructive surg]y cont9ues to pose a 
*all5ge = ! heal? c>e work=ce 9 lea/    
develop$ c\ntries4  7#e7 ,ret5tion rates
 ( ,,ob-,g,y,ns & sub-speciali/s 9      
urogynecology h se5 improvem5t )        
fell[%ips1 resid5cies1 & programs t     
provide res\rces & tra9+4  7#f7 ,today1 
ob/etric fi/ula prim>ily affects !      
poore/ wom5 9 ! poore/ p>ts ( ! _w4     
,ob/etric fi/ulas typically occur       
because wom5 d n h timely access to     
em]g5cy ob/etric c>e dur+ ob/ruct$      

labor1 & cont9ue to h fi/ulas due to    
lack ( access to adequate surgical      
s]vices once !y su/a9 ! injury4  7#g7   
,left untreat$1 an ob/etric fi/ula      
afflicts a woman ) deva/at+ physical    
conditions3 incont95ce1 pa9ful ulc]s1 & 
con/ant & uncontrollable emission (     
(f5sive odors4 ,^! symptoms leave a     
woman indelibly & p]petually /igmatiz$  
by h] condition4  7#h7 ,because ob/etric
 fi/ulas are n !mselves fatal1 millions 
( wom5 live ) ?is horrific condition & h
 be5 ov]look$ by ! int]national m$ical  
community4 ,at pres5t1 humanit>ian aid &
 nongov]nm5tal programs treat fi/ula    
cases on a small scale & are n equipp$  
to sy/ematically prev5t1 treat1 &       
eradicate ob/etric fi/ula4  7#i7        
,ob/etric fi/ula c be prev5t$ :5 wom5 & 
_! families are educat$ ab\t ! bir?+    
process & are provid$ timely access to  
em]g5cy ob/etric c>e4 ,basic int]v5tions
 to id5tify & repair ob/etric fi/ula h  
a*iev$ mean+ful & co/-effective results4
 ,! impact ( an ob/etric fi/ula-repair  

surg]y is imm$iate & wom5 c be          
re9tegrat$ into society4 ,h[ev]1 access 
to prev5tion1 effective midwif]y        
s]vices1 & ,,ob-,,gyn c>e c             
significantly decrease *ildbir?-relat$  
injuries4  #c4 ,int]national ,,ob_/,,gyn
 & ,urogynecology ,promotion ,program   
7a7 ,purpose ,! purpose ( assi/ance "u  
?is section is to tra9 & reta9          
ob/etrician-gynecologi/s 7,,ob-,g,y,ns7 
& sub-speciali/s 9 urogynecology & to   
help improve ! quality ( c>e to meet !  
heal? c>e ne$s ( wom5 9 lea/ develop$   
c\ntries4  7b7 ,au?orization  7#a7 ,9   
g5]al ,to c>ry out ! purpose (          
subsection 7a71 ! ,presid5t1 act+ ?r\gh 
! ,director ( ! ,john ,e4 ,fog>ty       
,int]national ,c5t] = ,advanc$ ,/udy 9 !
 ,heal? ,sci5ces1 is au?oriz$ to provide
 assi/ance = lea/ develop$ c\ntries to  
support ! activities describ$ 9         
subsection 7c74  7#b7 ,ref]5ce          
,assi/ance au?oriz$ "u ?is section may  
be ref]r$ to z ! ,int]national          
,,ob_/,,gyn & ,urogynecology ,promotion 

,program4  7c7 ,activities support$     
,activities t may be support$ by        
assi/ance "u subsection 7b7 include !   
foll[+3  7#a7 ,fell[%ip & resid5cy      
programs ,e/abli%m5t ( fell[%ip &       
resid5cy programs to be c>ri$ out 9     
coord9ation ) in/itutions ( high]       
education 7z su* t]m is def9$ 9 section 
#aja ( ! ,high] ,education ,act ( #aife 
7#bj ,u4,s4,c4 #ajja771 in/itutions (   
high] le>n+1 midwif]y programs1 & exi/+ 
cl9ical c5t]s 9 lea/ develop$ c\ntries--
  7,a7 to support exi/+ academic        
curricula = education tra9+ = midwif]y  
/ud5ts2  7,b7 to develop & help su/a9   
exi/+ specializ$ curriculum tra9+ =     
m$ical /ud5ts & resid5ts to become      
kn[l$geable & pr(ici5t 9 wom5's heal?   
c>e2 &  7,c7 to all[ m$ical /ud5ts1     
resid5ts1 & midwif]y /ud5ts to practice 
& develop exp]tise 9 geographical areas 
9 :i* *ildbir?-relat$ injuries are mo/  
preval5t4  7#b7 ,tra9+ c5t]s ,e/abli%m5t
 ( tra9+ c5t]s-- 7,a7 to address !      
%ortage ( ,,ob-,g,y,ns & sub-speciali/s 

9 ! urogynecology pr(ession2 &  7,b7 to 
c>ry out specializ$ programs t are      
locat$ at heal? c>e in/itutions t       
provide exceptionally high conc5trations
 ( exp]tise & relat$ res\rces relat$ to 
^! m$ical pr(essions & are deliv]$ 9 a  
compreh5sive & int]discipl9>y fa%ion4   
#d4 ,compreh5sive #aj-ye> /rategy to    
address ! %ortage ( physicians 9 lea/   
develop$ c\ntries  7a7 ,9 g5]al ,!      
,presid5t1 act+ ?r\gh ! ,director ( !   
,john ,e4 ,fog>ty ,int]national ,c5t] = 
,advanc$ ,/udy 9 ! ,heal? ,sci5ces1 %all
 e/abli% a compreh5sive1 integrat$1     
#aj-ye> /rategy to address ! %ortage (  
physicians 9 lea/ develop$ c\ntries4    
7b7 ,elem5ts ,su* /rategy %all ma9ta9   
suffici5t flexibility & rema9 responsive
 to ! ne$s ( wom5 afflict$ )            
*ildbir?-relat$ injuries & %all include 
! foll[+3  7#a7 ,a plan = implem5tation 
& coord9ation ( programs & activities "u
 ?is ,act1 includ+ grants & contracts = 
prev5tion1 treatm5t1 & monitor+ (       
*ildbir?-relat$ injuries4  7#b7         

,specific objectives1 multi-sector      
approa*es1 & specific /rategies to treat
 wom5 :o suff] f *ildbir?-relat$        
injuries & to prev5t fur!r occurr5ces ( 
*ildbir?-relat$ injuries4  7#c7         
,assignm5t ( priorities = relevant      
executive bran* ag5cies4  7#d7 ,public  
heal? & heal? c>e deliv]y sy/em rese>*  
on ! prev5tion1 repair1 & rehabilitation
 ( *ildbir?-relat$ injuries4  7#e7      
,social sci5ce rese>* 9 fields su* z    
an?ropology1 sociology1 & relat$ fields 
to monitor & evaluate ! und]ly+ social &
 economic factors t contribute to       
*ildbir?-relat$ injuries4  7#f7         
,developm5t1 implem5tation1 & evaluation
 ( evid5ce-bas$ sy/ems ( c>e connect+   
mat]nity c>e facilities ) local c>e     
deliv]y & community education programs4 
,su* sy/ems ( c>e %\ld promote rapid &  
long-t]m prev5tion ( *ildbir?-relat$    
injuries1 includ+--  7,a7 culturally    
appropriate *ildbir? education1         
prep>ation1 & plann+2 &  7,b7 access to 
ob/etrician-gynecologi/s 7,,ob-,g,y,ns71

 urogynecology c>e1 or midwif]y c>e4    
7#g7 ,expansion ( tra9+ c5t]s &         
p>tn]%ips ) in/itutions ( high] le>n+ = 
m$ical /ud5ts & resid5ts4  7#h7         
,priorities = ! di/ribution ( res\rces  
bas$ on factors su* z ! size &          
demographics ( ! population suff]+ f    
*ildbir?-relat$ injuries1 ! ne$s ( t    
population1 & ! exi/+ infra/ructure or  
fund+ levels t may exi/ to treat &      
prev5t *ildbir?-relat$ injuries1 includ+
 ob/etric fi/ula4  7#i7 ,a plan =       
in/itutional capacity-build+ ( p>tn]%ips
 to /r5g!n univ]sities1 rese>* c5t]s1   
heal?-pr(ession tra9+ programs1 &       
gov]nm5t in/itutes to build ! 9-c\ntry  
capacity ne$$ to eradicate              
*ildbir?-relat$ injuries 9 lea/ develop$
 c\ntries4  7c7 ,report ,n lat] ?an #b  
ye>s aft] ! date ( ! enactm5t ( ?is     
,act1 ! ,presid5t %all submit to        
,congress a report t conta9s ! /rategy  
requir$ "u ?is section4  #e4 ,report    
7a7 ,9 g5]al ,! ,presid5t1 act+ ?r\gh ! 
,director ( ! ,john ,e4 ,fog>ty         

,int]national ,c5t] = ,advanc$ ,/udy 9 !
 ,heal? ,sci5ces1 %all submit to        
,congress1 on an annual basis1 a report 
on ! implem5tation ( ?is ,act = ! prec$+
 ye>4  7b7 ,matt]s ,to be includ$ ,!    
report requir$ "u subsection 7a7 %all   
include an evaluation ( ! effectiv5ess &
 p]=mance ( ! ,int]national ,,ob_/,,gyn 
& ,urogynecology ,promotion ,program    
e/abli%$ "u section #c & all relat$     
community outrea* & m$ical programs4    
#f4 ,def9itions ,9 ?is ,act3 7#a7       
,*ildbir?-relat$ injuries ,! t]m        
*ildbir?-relat$ injuries means injuries 
associat$ ) ob/ruct$ labor1 includ+--   
7,a7 pelvic organ prolapse2  7,b7 a     
displacem5t ( pelvic organs su* z !     
ut]us1 bladd]1 or b[el2 &  7,c7 ob/etric
 fi/ula4  7#b7 ,l[-income c\ntry ,! t]m 
l[-income c\ntry means a c\ntry ) a p]  
capita gross national income ( #a1jce or
 less4  7#c7 ,lea/ develop$ c\ntry ,!   
t]m lea/ develop$ c\ntry means a c\ntry 
t-- 7,a7 is a l[-income c\ntry2 &  7,b7 
accord+ to ! ,unit$ ,nations ,economic  

,analysis & ,policy ,division1 is       
confront+ sev]e /ructural imp$im5ts to  
su/a9able developm5t4  7#d7 ,relevant   
executive bran* ag5cies ,! t]m relevant 
executive bran* ag5cies means !         
,dep>tm5t ( ,/ate1 ! ,unit$ ,/ates      
,ag5cy = ,int]national ,developm5t1 &   
any o!r dep>tm5t or ag5cy ( ! ,unit$    
,/ates t p>ticipates 9 int]national     
heal? & humanit>ian activities pursuant 
to ! au?orities ( su* dep>tm5t or ag5cy 
or ! ,=eign ,assi/ance ,act ( #aifa4