[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8529 Introduced in House (IH)]
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118th CONGRESS
2d Session
H. R. 8529
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
countries, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 23, 2024
Ms. DeLauro introduced the following bill; 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
countries, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Physician Education for Fistula
Treatment Act''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Obstetric fistula, an abnormal opening between a
woman's genital tract and her urinary tract or rectum, is a
devastating childbirth injury caused by prolonged, obstructed
labor in the absence of timely and quality medical care.
(2) Worldwide, an estimated 500,000 women and girls live
with obstetric fistula with thousands more occurring annually.
It occurs disproportionately among impoverished, vulnerable,
and marginalized girls and women.
(3) Women who experience an obstetric fistula suffer life-
shattering consequences including chronic incontinence, shame,
social isolation, poverty, and physical, mental, and emotional
health problems.
(4) Obstetric fistula is a violation of human rights and an
indicator of the failure of health systems to deliver
universally accessible, timely, and quality health care to
women and girls who need it.
(5) Obstetric fistula is preventable. Universal health
coverage and universal access to quality care are essential in
ending preventable maternal and newborn deaths and
disabilities, including fistula. Skilled health personnel at
birth, emergency obstetric and newborn care, and universal
access to modern contraception are the most effective
interventions to prevent maternal mortality and fistula.
(6) 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 condition.
(7) In 2018 and 2020, the United Nations General Assembly
resolutions on fistula were adopted, calling for ``Ending
fistula within a decade''. This represents a turning point in
the global fight to eliminate fistula, as it brings the global
objective and timeline for ending fistula into alignment with
achieving the Sustainable Development Goals (SDGs)/Agenda 2030.
The resolutions also call for an increased focus on social
determinants to tackle the root causes of fistula.
(8) Obstetric fistula can be surgically treated. The impact
of an obstetric fistula-repair surgery is immediate and women
can be reintegrated into society. There is however a high unmet
need for treatment and social reintegration of fistula
survivors.
(9) The Covid-19 pandemic caused overloaded health systems
and reallocation of human and financial resources with
disruptions to services resulting in an undermining of the
sexual and reproductive health and rights of women and girls.
In 2020, fistula repairs were widely halted or slowed down due
to Covid-19, as they were deemed non-urgent and unsafe during
the pandemic. This may result in an increased backlog of
fistula cases.
(10) The United Nations Population Fund (UNFPA)-led global
Campaign to End Fistula, is a key contributor to promoting the
rights, dignity, and well-being of women and girls. The
Campaign focuses on prevention, treatment, social
reintegration, and advocacy. Aimed at ``leaving no one behind''
and ``reaching the furthest behind'', it contributes to
achieving the SDGs and has also helped restore overall health,
dignity, hope, and a sense of self-worth and agency to some of
the poorest, most marginalized women and girls worldwide
through its holistic, gender-sensitive, and rights-based
approach to policies and programs for the elimination of
obstetric fistula and several other maternal morbidities.
(11) UNFPA has supported over 1140,000 surgical repairs
over the last two decades. The Campaign to End Fistula and its
partners has made remarkable progress, but the needs remain
great.
(12) With 8 years to reach the global goal of ending
fistula by 2030, significantly intensified investment, efforts,
and partnerships at the international and national levels are
required.
(13) The International Day to End Obstetric Fistula which
takes place on May 23, 2024, will be commemorated this year
with the theme: ``Breaking the Cycle: Preventing Fistula
Worldwide'', calling for investments to improve the quality of
care and emphasizing the key role of communities in addressing
social, cultural, political, and economic determinants that
impact maternal health and sexual reproductive health, and
reproductive rights.
SEC. 3. INTERNATIONAL OB/GYN AND UROGYNECOLOGY PROMOTION PROGRAM.
(a) Purpose.--The purpose of assistance under this section is to
train and retain obstetrician-gynecologists (OB-GYNs) and sub-
specialists in urogynecology and to help improve the quality of care to
meet the health care needs of women in least developed countries.
(b) Authorization.--
(1) In general.--To carry out the purpose of subsection
(a), the President, acting through the Director of the John E.
Fogarty International Center for Advanced Study in the Health
Sciences, is authorized to provide assistance for least
developed countries to support the activities described in
subsection (c).
(2) Reference.--Assistance authorized under this section
may be referred to as the ``International OB/GYN and
Urogynecology Promotion Program''.
(c) Activities Supported.--Activities that may be supported by
assistance under subsection (b) include the following:
(1) Fellowship and residency programs.--Establishment of
fellowship and residency programs to be carried out in
coordination with institutions of higher education (as such
term is defined in section 101 of the Higher Education Act of
1965 (20 U.S.C. 1001)), institutions of higher learning,
midwifery programs, and existing clinical centers in least
developed countries--
(A) to support existing academic curricula for
education training for midwifery students;
(B) to develop and help sustain existing
specialized curriculum training for medical students
and residents to become knowledgeable and proficient in
women's health care; and
(C) to allow medical students, residents, and
midwifery students to practice and develop expertise in
geographical areas in which childbirth-related injuries
are most prevalent.
(2) Training centers.--Establishment of training centers--
(A) to address the shortage of OB-GYNs and sub-
specialists in the urogynecology profession; and
(B) 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 fashion.
SEC. 4. COMPREHENSIVE 10-YEAR STRATEGY TO ADDRESS THE SHORTAGE OF
PHYSICIANS IN LEAST DEVELOPED COUNTRIES.
(a) In General.--The President, acting through the Director of the
John E. Fogarty International Center for Advanced Study in the Health
Sciences, shall establish a comprehensive, integrated, 10-year strategy
to address the shortage of physicians in least developed countries.
(b) Elements.--Such strategy shall maintain sufficient flexibility
and remain responsive to the needs of women afflicted with childbirth-
related injuries and shall include the following:
(1) A plan for implementation and coordination of programs
and activities under this Act, including grants and contracts
for prevention, treatment, and monitoring of childbirth-related
injuries.
(2) Specific objectives, multi-sector approaches, and
specific strategies to treat women who suffer from childbirth-
related injuries and to prevent further occurrences of
childbirth-related injuries.
(3) Assignment of priorities for relevant executive branch
agencies.
(4) Public health and health care delivery system research
on the prevention, repair, and rehabilitation of childbirth-
related injuries.
(5) Social science research in fields such as anthropology,
sociology, and related fields to monitor and evaluate the
underlying social and economic factors that contribute to
childbirth-related injuries.
(6) Development, implementation, and evaluation of
evidence-based systems of care connecting maternity care
facilities with local care delivery and community education
programs. Such systems of care should promote rapid and long-
term prevention of childbirth-related injuries, including--
(A) culturally appropriate childbirth education,
preparation, and planning; and
(B) access to obstetrician-gynecologists (OB-GYNs),
urogynecology care, or midwifery care.
(7) Expansion of training centers and partnerships with
institutions of higher learning for medical students and
residents.
(8) Priorities for the distribution of resources based on
factors such as the size and demographics of the population
suffering from childbirth-related injuries, the needs of that
population, and the existing infrastructure or funding levels
that may exist to treat and prevent childbirth-related
injuries, including obstetric fistula.
(9) A plan for institutional capacity-building of
partnerships to strengthen universities, research centers,
health-profession training programs, and government institutes
to build the in-country capacity needed to eradicate
childbirth-related injuries in least developed countries.
(c) Report.--Not later than 2 years after the date of the enactment
of this Act, the President shall submit to Congress a report that
contains the strategy required under this section.
SEC. 5. REPORT.
(a) In General.--The President, acting through the Director of the
John E. Fogarty International Center for Advanced Study in the Health
Sciences, shall submit to Congress, on an annual basis, a report on the
implementation of this Act for the preceding year.
(b) Matters To Be Included.--The report required under subsection
(a) shall include an evaluation of the effectiveness and performance of
the International OB/GYN and Urogynecology Promotion Program
established under section 3 and all related community outreach and
medical programs.
SEC. 6. DEFINITIONS.
In this Act:
(1) Childbirth-related injuries.--The term ``childbirth-
related injuries'' means injuries associated with obstructed
labor, including--
(A) pelvic organ prolapse;
(B) a displacement of pelvic organs such as the
uterus, bladder, or bowel; and
(C) obstetric fistula.
(2) Low-income country.--The term ``low-income country''
means a country with a per capita gross national income of
$1,035 or less.
(3) Least developed country.--The term ``least developed
country'' means a country that--
(A) is a low-income country; and
(B) according to the United Nations Economic
Analysis and Policy Division, is confronting severe
structural impediments to sustainable development.
(4) Relevant executive branch agencies.--The term
``relevant executive branch agencies'' means the Department of
State, the United States Agency for International Development,
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 1961.
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