,i #aafth ,,congress #b;d ,session ,h4 ,r4 #higa ,,in ,,the ,,house ,,of ,,representatives ,december #ae1 #bjbj,mrs4 ,carolyn ,b4 ,maloney of ,new ,york 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 #bjbj4 #b4 ,findings ,congress finds the following3 7#a7 ,every two minutes1 one woman dies from pregnancy-related complications4 ,this means approximately #hcj women die from pregnancy- or childbirth-related complications around the world every day4 ,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 7#b7 ,obstetric fistula is one of the most severe and tragic pregnancy-related injuries1 which occurs when a woman experiences prolonged1 obstructed labor in the absence of trained medical assistance1 which is most commonly a ,caesarean section1 necessary for a safe delivery4 7#c7 ,obstetric fistula is a hole that is formed between the bladder and the vagina1 or the rectum and the vagina 7or both74 ,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 dies and sloughs off1 resulting in the abnormal opening or hole4 7#d7 ,in approximately #ij percent of obstetric fistula cases1 the baby will be stillborn4 ,a mother will experience physical pain and multiple physical disabilities1 as well as social and emotional trauma from living with incontinence and from the loss of her child4 7#e7 ,in addition to constant uncontrollable leaking of urine1 feces1 or both1 the physical consequences of obstetric fistula may include frequent bladder infections1 painful sores1 kidney failure1 infertility1 foul odor1 orthopedic injury1 nerve damage that makes normal walking impossible and internal genital scarring that destroys normal sexual function4 7#f7 ,women and girls with obstetric fistula are commonly ostracized by their families and communities1 leading to depression1 anxiety1 post-traumatic stress disorder1 social isolation and discrimination1 suicidal thoughts or actions1 and lack of adequate economic opportunities1 resulting in deepening poverty1 isolation1 and vulnerability4 7#g7 ,although data on obstetric fistula are scarce1 the ,world ,health ,organization 7,,who7 estimates there are more than #b1jjj1jjj women and girls living with fistula1 and #ej1jjj to #ajj1jjj new cases each year4 7#h7 ,obstetric fistula was once common throughout the world1 but over the last century has been virtually eliminated in ,europe1 ,north ,america1 and other developed regions through improved access to high-quality1 timely medical interventions1 particularly emergency obstetric care including ,caesarean section4 7#i7 ,obstetric fistula is preventable through timely medical interventions and providing access to family planning for all women who need it4 ,social interventions such as alleviating poverty1 delaying early marriage and early childbearing1 educating and empowering young women1 remedying gender and socioeconomic inequalities1 and addressing malnutrition can also help prevent this complication4 7#aj7 ,the majority of obstetric fistula can be surgically treated4 ,when performed by a skilled1 competent surgeon1 the procedure is relatively inexpensive with high rates of success4 7#aa7 ,in #bjjc1 the ,united ,nations ,population ,fund 7,,unfpa71 ,engender,health1 and other partners launched a global ,campaign to ,end ,fistula 7the ,campaign7 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 ,operating in more than #ej countries across ,africa1 ,asia1 and the ,arab region1 the ,campaign has four main goals3 the prevention of fistula cases1 treatment of existing fistula cases1 social reintegration and follow up for fistula survivors1 and advocacy for ending fistula4 7#ab7 ,in order to meet these goals1 ,the ,campaign supports and participates in the emerging safe surgery community of practice that strengthens surgical ecosystems in low- and middle-income countries 7,,lmic7 towards better access to essential and life-saving surgeries1 which includes improved training1 equipment1 supplies1 infrastructure and health worker density for timely access to ,caesarean section and for environments that optimize outcomes of fistula surgery4 7#ac7 ,since #bjjc1 ,,unfpa has directly supported more than #he1jjj fistula repairs1 with additional repairs supported by ,campaign partners4 7#ad7 ,,usaid1 in accordance with the ,united ,states ,government's commitment to ending preventable maternal and newborn deaths and disabilities1 currently supports fistula treatment services in #acg sites in six countries4 ,,usaid addresses prevention in those sites and thirty-six more4 ,since #bjjd1 more than #ci1jjj women have received fistula repairs with ,,usaid support4 7#ae7 ,the ,united ,states has committed to joining multilateral efforts involving the ,united ,nations and others to make progress toward achieving the ,sustainable ,development ,goals 7,s,d,gs71 including through the ,global ,strategy for ,women's1 ,children's and ,adolescents' ,health 7#bjaf-bjcj74 ,eliminating obstetric fistula is key to achieving the ,s,d,gs' vision of leaving no one behind44 7#af7 ,in his #bjaf statement on the ,international ,day to ,end ,obstetric ,fistula1 ,united ,nations ,secretary ,general ,ban ,ki-,moon boldly laid forth a new global vision and goal of ending obstetric fistula within a generation1 saying that1 ,the persistence of fistula in some countries and regions is an indicator of very poor access to quality maternal health services4 ,to end it1 we must strengthen health systems and address broader development and human rights issues affecting women and girls3 poverty1 gender inequality1 early marriage1 early childbearing1 and lack of education4 ,let us use the momentum of the ,sustainable ,development ,goals together with strong political leadership1 accelerated investment and action1 and passionate and committed champions1 to achieve this historic and transformative goal44 #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 social1 structural1 health1 and human rights issues that lead to obstetric fistula2 7#b7 support treatment of obstetric fistula that includes strengthening the safe surgery and safe anesthesia environment in every country where fistula persists and where obstetric services do not meet an acceptable standard of care2 and 7#c7 address and acknowledge the urgency of ensuring that all women who need a ,caesarean section are able to have access to such life-saving surgery in a timely1 safe1 and high-quality care environment1 and address the growing threat of iatrogenic fistula that most often results from ,caesarean delivery done poorly and under conditions with inadequate staff1 supplies1 or equipment4 7b7 ,activities ,assistance provided pursuant to this section and section #d shall focus on the following3 7#a7 ,increasing prevention of obstetric fistula through access to sexual and reproductive health services1 including skilled attendance at birth1 comprehensive emergency obstetric and newborn care1 timely1 safe1 high-quality ,caesarean section when necessary1 prenatal and antenatal care1 contraception and family planning1 and comprehensive reproductive health education4 7#b7 ,building local capacity and improving national health systems to ensure that all women in need have access to safe surgery1 including timely1 and high-quality life-saving obstetric and newborn care services to prevent and treat obstetric fistula4 7#c7 ,supporting tools to enable countries to address obstetric fistula1 including the following3 7,a7 ,supporting research to better identify the key factors causing persistence of obstetric fistula in certain regions4 7,b7 ,quantitative data collection on the incidence and prevalence of obstetric fistula1 and development of sustainable universal health care financing mechanisms to enable all women to have access to skilled and life-saving health care during pregnancy1 delivery1 and the postpartum period4 7,c7 ,providing fistula survivors access to free or affordable treatment4 7,d7 ,training of midwives and skilled birth attendants4 7,e7 ,provision of basic obstetric care at the community level4 7#d7 ,ensuring that countries address surgery1 anesthesia1 and obstetrics ecosystem deficits in standardized healthcare worker education1 credentialing1 and retention1 ,,wash and power in facilities1 equipment and materials1 transport1 and healthcare financing4 7#e7 ,addressing social and economic inequities that are correlated with higher incidence of obstetric fistula by empowering women and girls1 alleviating poverty1 reducing incidence of child marriage1 promoting delay and spacing of childbirth1 and increasing access to formal and nonformal education4 7#f7 ,supporting reintegration and education to help women who have undergone treatment or are awaiting treatment to obtain medical and mental health services1 legal counseling1 basic education1 and income generating skills as needed1 to return to full and productive lives4 7#g7 ,promoting public awareness in communities to increase understanding of obstetric fistula1 and thereby improve prevention and treatment efforts1 and to help reduce stigma1 exclusion1 and violence against women and girls with obstetric fistula4 #d4 ,coordination1 reporting1 research1 monitoring1 and evaluation ,assistance authorized under this ,act shall-- 7#a7 promote the ,,unfpa-led global ,campaign to ,end ,fistula and the ,international ,obstetric ,fistula ,working ,group2 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 #e4 ,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