,i #aaith ,,congress #b;d ,session ,h4 ,r4 #ijae ,,in ,,the ,,house ,,of ,,representatives ,may #bb1 #bjbf,ms4 ,de,lauro 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 ,obstetric fistula1 an abnormal opening between a woman's genital tract and her urinary tract or rectum1 is a devastating childbirth injury caused by prolonged1 obstructed labor in the absence of timely and quality medical care4 7#b7 ,worldwide1 an estimated #ejj1jjj women and girls live with obstetric fistula with thousands more occurring annually4 ,it occurs disproportionately among impoverished1 vulnerable1 and marginalized girls and women4 7#c7 ,women who experience an obstetric fistula suffer life-shattering consequences including chronic incontinence1 shame1 social isolation1 poverty1 and physical1 mental1 and emotional health problems4 7#d7 ,obstetric fistula is a violation of human rights and an indicator of the failure of health systems to deliver universally accessible1 timely1 and quality health care to women and girls who need it4 7#e7 ,obstetric fistula is preventable4 ,universal health coverage and universal access to quality care are essential in ending preventable maternal and newborn deaths and disabilities1 including fistula4 ,skilled health personnel at birth1 emergency obstetric and newborn care1 and universal access to modern contraception are the most effective interventions to prevent maternal mortality and fistula4 7#f7 ,safeguarding the rights and dignity of women and girls and addressing underlying gender and socioeconomic inequalities and discrimination which drive obstetric fistula are equally important to end the condition4 7#g7 ,in #bjah and #bjbj1 the ,united ,nations ,general ,assembly resolutions on fistula were adopted1 calling for ,ending fistula within a decade4 ,this represents a turning point in the global fight to eliminate fistula1 as it brings the global objective and timeline for ending fistula into alignment with achieving the ,sustainable ,development ,goals 7,s,d,gs7_/,agenda #bjcj4 ,the resolutions also call for an increased focus on social determinants to tackle the root causes of fistula4 7#h7 ,obstetric fistula can be surgically treated4 ,the impact of an obstetric fistula-repair surgery is immediate and women can be reintegrated into society4 ,there is however a high unmet need for treatment and social reintegration of fistula survivors4 7#i7 ,in #ij percent of cases where women develop fistula and timely medical care is not available1 a stillborn baby is tragically delivered4 7#aj7 ,the ,united ,nations ,population ,fund 7,,unfpa7-led global ,campaign to ,end ,fistula1 is a key contributor to promoting the rights1 dignity1 and well-being of women and girls4 ,the ,campaign focuses on prevention1 treatment1 social reintegration1 and advocacy4 ,aimed at leaving no one behind and reaching the furthest behind1 it contributes to achieving the ,s,d,gs and has also helped restore overall health1 dignity1 hope1 and a sense of self-worth and agency to some of the poorest1 most marginalized women and girls worldwide through its holistic1 gender-sensitive1 and rights-based approach to policies and programs for the elimination of obstetric fistula and several other maternal morbidities4 7#aa7 ,,unfpa has supported over #aej1jjj surgical repairs over the last two decades4 ,the ,campaign to ,end ,fistula and its partners have made remarkable progress1 but the needs remain great4 7#ab7 ,with #d years to reach the global goal of ending fistula by #bjcj1 significantly intensified investment1 efforts1 and partnerships at the international and national levels are required4 7#ac7 ,the ,international ,day to ,end ,obstetric ,fistula which takes place on ,may #bc1 #bjbd1 will be commemorated this year with the theme3 ,her health1 her right3 ,shaping a future without fistula1 emphasizing that every girl and woman has the fundamental right to health1 including reproductive and sexual health1 and that the continued existence of obstetric fistula is a clear violation of this right4 #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