I 

116TH CONGRESS 

1ST SESSION H. R. 4864 

To develop and implement policies to advance early childhood development, 

to provide assistance for orphans and other vulnerable children in developing countries, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 28, 2019 

Mr. CASTRO of Texas (for himself, Mr. FITZPATRICK, Mrs. WATSON COLEMAN, Mr. CISNEROS, and Ms. MOORE) introduced the following bill; 

which was referred to the Committee on Foreign Affairs 

A BILL 

To develop and implement policies to advance early childhood 

development, to provide assistance for orphans and other 

vulnerable children in developing countries, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Global Child Thrive 

5 Act of 2019’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) According to a 2019 report from the United 

2 Nations Inter-Agency Group for Child Mortality Es3 timation entitled ‘‘Levels & Trends in Child Mor4 tality’’, the total number of deaths among children 

5 younger than 15 years of age dropped by 56 percent 

6 between 1990 and 2018, from approximately 

7 14,200,000 to approximately 6,200,000. 

8 (2) According to a 2016 article published in 

9 The Lancet entitled ‘‘Early childhood development: 

10 the foundation of sustainable development’’— 

11 (A) an estimated 250,000,000 children in 

12 low-income and middle-income countries suffer 

13 suboptimal development due to poverty and 

14 stunting alone; and 

15 (B) children who do not meet develop16 mental milestones are expected to lose about 25 

17 percent of their average yearly income once 

18 they become adults. 

19 (3) According to a report from the United Na20 tions Children’s Fund (UNICEF), entitled ‘‘The 

21 State of the World’s Children 2016: A fair chance 

22 for every child’’, nearly 250,000,000 of the world’s 

23 650,000,000 primary school age children do not 

24 master basic literacy and numeracy. 


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1 (4) According to a 2018 report from the World 

2 Health Organization entitled ‘‘Nurturing Care for 

3 early childhood development’’— 

4 (A) the environment in which a child grows 

5 has a profound impact on future learning, be6 havior, and health; and 

7 (B) a country’s economic diversity and 

8 growth could be improved by investment in 

9 early childhood development. 

10 (5) According to a 2017 UNICEF report enti11 tled ‘‘UNICEF’s Programme Guidance for Early 

12 Childhood Development’’, nurturing care, which is 

13 key to early childhood development, consists of a 

14 core set of interrelated components, including— 

15 (A) behaviors, attitudes, and knowledge 

16 about caregiving, including health, hygiene care, 

17 and feeding; 

18 (B) stimulation, such as talking, singing, 

19 and playing; 

20 (C) responsiveness, such as early bonding, 

21 secure attachment, trust, and sensitive commu22 nication; and 

23 (D) safety, including routines, protection 

24 from violence, abuse, neglect, harm, and envi25 ronmental pollution. 


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1 (6) According to a 2016 report published in 

2 The Lancet entitled ‘‘Advancing Early Childhood 

3 Development: From Science to Scale’’— 

4 (A) nurturing care from parents, relatives, 

5 and other caregivers and services are formative 

6 experiences for young children; 

7 (B) programs promoting nurturing care 

8 can improve early childhood development out9 comes; and 

10 (C) children who do not receive nurturing 

11 care display negative development outcomes, 

12 such as greater sensitivity to the effects of 

13 stress or behavioral problems, especially chil14 dren who do not receive nurturing care before 

15 their second birthday. 

16 (7) According to the ‘‘United States Govern17 ment Action Plan on Children in Adversity, A 

18 Framework for International Assistance: 2012– 

19 2017’’, children who live without protective family 

20 care, in abusive households, on the streets, or in in21 stitutions, or who are trafficked, are participating in 

22 armed groups, or are being exploited for their labor 

23 are more likely to be exposed to violence, exploi24 tation, abuse, and neglect. 


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1 (8) According to a 2017 UNICEF report enti2 tled ‘‘Early Moments Matter for every child’’, vio3 lence, abuse, neglect, and traumatic experiences 

4 produce toxic stress that limits neural connectivity 

5 in developing brains. 

6 (9) According to a 2014 working paper from 

7 the National Scientific Council on the Developing 

8 Child at Harvard University entitled ‘‘Excessive 

9 Stress Disrupts the Architecture of the Developing 

10 Brain’’— 

11 (A) situations that produce toxic stress in12 crease the production of cortisol in a child’s 

13 brain, which disrupts its healthy development; 

14 and 

15 (B) chronic stress can potentially affect 

16 the expression of genes that regulate the stress 

17 response across the life course. 

18 (10) According to a 2018 article in the North 

19 Carolina Medical Journal entitled ‘‘Adverse Child20 hood Experiences (ACEs): An Important Element of 

21 a Comprehensive Approach to the Opioid Crisis’’, 

22 adverse childhood experiences (ACEs) are traumatic 

23 or stressful experiences, including emotional, phys24 ical, or sexual abuse, domestic violence, household 

25 substance abuse, household mental illness, parental 


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1 separation or divorce, and the incarceration of a 

2 household family member. 

3 (11) According to a 2016 report in Develop4 ment and Psychopathology entitled ‘‘Childhood Ad5 versity and Epigenetic Regulation of Glucocorticoid 

6 Signaling Genes: Associations in Children and 

7 Adults’’— 

8 (A) children and adults are at risk of de9 veloping psychiatric disorders and other medical 

10 conditions if they have had an adverse child11 hood experience (ACE); and 

12 (B) adults who have had numerous ACEs 

13 die nearly 20 years earlier, on average, than 

14 adults who have not had numerous ACEs. 

15 SEC. 3. SENSE OF CONGRESS. 

16 It is the sense of Congress that— 

17 (1) it is time to build on the reduction in pre18 ventable child deaths worldwide achieved by focusing 

19 new efforts and attention on— 

20 (A) saving children’s lives; and 

21 (B) supporting the healthy development of 

22 children’s brains; 

23 (2) methods of delivering parent training and 

24 education on nurturing care, such as the Center for 

25 Disease Control and Prevention’s Maternal, Infant, 


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1 and Early Childhood Home Visiting programs, could 

2 help other countries realize greater gains in early 

3 childhood development; 

4 (3) negative early childhood experiences can ob5 struct lifelong health and opportunity; 

6 (4) well-developed and inquisitive children are 

7 the global leaders of tomorrow; 

8 (5) countries will only be able to reach and ex9 ceed their development goals if their youngest chil10 dren get a strong start; and 

11 (6) focused cross-sectoral coordination for pro12 moting early childhood development is essential for 

13 the efficiency, effectiveness, and sustainability of all 

14 early childhood development initiatives. 

15 SEC. 4. ASSISTANCE TO IMPROVE EARLY CHILDHOOD OUT16 COMES GLOBALLY. 

17 Chapter 1 of part I of the Foreign Assistance Act 

18 of 1961 (22 U.S.C. 2151 et seq.) is amended— 

19 (1) in section 135(f)(1) (22 U.S.C. 

20 2152f(f)(1)), by striking ‘‘2006 and 2007’’ and in21 serting ‘‘2020 through 2025’’; and 

22 (2) by adding at the end the following: 

23 ‘‘SEC. 137. ASSISTANCE TO IMPROVE EARLY CHILDHOOD 

24 OUTCOMES GLOBALLY. 

25 ‘‘(a) DEFINITIONS.—In this section: 


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1 ‘‘(1) APPROPRIATE CONGRESSIONAL COMMIT2 TEES.—The term ‘appropriate congressional com3 mittees’ means— 

4 ‘‘(A) the Committee on Appropriations of 

5 the Senate; 

6 ‘‘(B) the Committee on Foreign Relations 

7 of the Senate; 

8 ‘‘(C) the Committee on Appropriations of 

9 the House of Representatives; and 

10 ‘‘(D) the Committee on Foreign Affairs of 

11 the House of Representatives. 

12 ‘‘(2) CHILDREN.—The term ‘children’ means 

13 persons who are younger than 18 years of age. 

14 ‘‘(3) DEINSTITUTIONALIZATION.—The term 

15 ‘deinstitutionalization’ means the process of 

16 transitioning from a child care protection system 

17 that relies on residential care to a system that pri18 marily supports family-based care. 

19 ‘‘(4) EARLY CHILDHOOD DEVELOPMENT.—The 

20 term ‘early childhood development’ means the devel21 opment and learning of a child younger than 8 years 

22 of age, including physical, cognitive, social, and emo23 tional development and approaches to learning that 

24 allow a child to reach his or her full developmental 

25 potential. 


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1 ‘‘(5) EARLY CHILDHOOD DEVELOPMENT PRO2 GRAM.—The term ‘early childhood development pro3 gram’ means a program that ensures that every 

4 child has the conditions for healthy growth, nur5 turing family-based care, development and learning, 

6 and protection from violence, exploitation, abuse, 

7 and neglect, including— 

8 ‘‘(A) a health, clean water, sanitation, and 

9 hygiene program that serves pregnant women, 

10 children younger than 5 years of age, and the 

11 parents of such children; 

12 ‘‘(B) a nutrition program, combined with 

13 stimulating child development activity; 

14 ‘‘(C) age appropriate cognitive stimulation, 

15 especially for newborns, infants, and toddlers, 

16 including an early childhood intervention pro17 gram for children experiencing at-risk situa18 tions, developmental delays, disabilities, and be19 havioral and mental health conditions; 

20 ‘‘(D) an early learning (36 months and 

21 younger), preschool, and basic education pro22 gram for children until they reach 8 years of 

23 age or complete primary school; and 

24 ‘‘(E) a child protection program, with an 

25 emphasis on the promotion of permanent, safe, 


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1 and nurturing families, rather than placement 

2 in residential care or institutions, including for 

3 children with disabilities. 

4 ‘‘(6) INCLUSIVE EARLY CHILDHOOD DEVELOP5 MENT.—The term ‘inclusive early childhood develop6 ment’ means the full and effective participation, ac7 cessibility, attendance, and achievement of all chil8 dren, especially children who are excluded or at risk 

9 of being marginalized, such as children with disabil10 ities. 

11 ‘‘(7) RELEVANT EXECUTIVE BRANCH AGENCIES

12 AND OFFICIALS.—The term ‘relevant Executive 

13 branch agencies and officials’ means— 

14 ‘‘(A) the Department of State; 

15 ‘‘(B) the United States Agency for Inter16 national Development; 

17 ‘‘(C) the Department of the Treasury; 

18 ‘‘(D) the Department of Labor; 

19 ‘‘(E) the Department of Education; 

20 ‘‘(F) the Department of Agriculture; 

21 ‘‘(G) the Department of Defense; 

22 ‘‘(H) the Department of Health and 

23 Human Services, including— 

24 ‘‘(i) the Centers for Disease Control 

25 and Prevention; and 


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1 ‘‘(ii) the National Institutes of 

2 Health; 

3 ‘‘(I) the Office of the Global AIDS Coordi4 nator; 

5 ‘‘(J) the Chief Executive Officer of the 

6 Millennium Challenge Corporation; 

7 ‘‘(K) the National Security Advisor; and 

8 ‘‘(L) the Director of the Peace Corps. 

9 ‘‘(8) RESIDENTIAL CARE.—The term ‘residen10 tial care’ means care provided in any nonfamily11 based group setting, including orphanages, transit or 

12 interim care centers, children’s homes, children’s vil13 lages or cottage complexes, group homes, and board14 ing schools used primarily for care purposes as an 

15 alternative to a children’s home. 

16 ‘‘(b) STATEMENT OF POLICY.—It is the policy of the 

17 United States— 

18 ‘‘(1) to support early childhood development in 

19 all child-focused international assistance programs, 

20 in partnership with affected countries, other donor 

21 country governments, international financial institu22 tions, nongovernmental organizations, faith-based 

23 organizations, international organizations, multilat24 eral organizations, and the private sector; and 


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1 ‘‘(2) to encourage partner countries to lead 

2 early childhood development initiatives that include 

3 incentives for building local capacity for sustainable 

4 implementation by— 

5 ‘‘(A) scaling up the most effective, evi6 dence-based, national interventions, including 

7 for the most vulnerable populations and chil8 dren with disabilities and developmental delays, 

9 with a focus on adaptation to country re10 sources, cultures, and languages; 

11 ‘‘(B) designing, implementing, monitoring, 

12 and evaluating programs in a way that en13 hances their quality, transparency, equity, and 

14 accountability, increases sustainability, and im15 proves child and family outcomes in partner 

16 countries; and 

17 ‘‘(C) utilizing and expanding innovative 

18 public-private financing mechanisms. 

19 ‘‘(c) IMPLEMENTATION.— 

20 ‘‘(1) IN GENERAL.—Not later than 1 year after 

21 the date of the enactment of the Global Child Thrive 

22 Act of 2019, the Administrator of the United States 

23 Agency for International Development, on behalf of 

24 the President, shall direct relevant Executive branch 

25 agencies and officials supporting young children— 


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1 ‘‘(A) to incorporate early childhood devel2 opment into current programming to be carried 

3 out during the following 5 fiscal years; and 

4 ‘‘(B) to promote inclusive early childhood 

5 development in partner countries. 

6 ‘‘(2) ELEMENTS.—In carrying out paragraph 

7 (1), the Administrator and relevant Executive 

8 branch agencies and officials shall— 

9 ‘‘(A) build on the evidence and priorities 

10 outlined in ‘Advancing Protection and Care for 

11 Children in Adversity: A U.S. Government 

12 Strategy for International Assistance 2019– 

13 2023’, published in June 2019 (referred to in 

14 this section as ‘APCCA’); 

15 ‘‘(B) to the extent practicable, identify evi16 dence-based strategic priorities, indicators, out17 comes, and targets, particularly emphasizing 

18 the most vulnerable populations and children 

19 with disabilities and developmental delays, to 

20 support inclusive early childhood development; 

21 ‘‘(C) support the design, implementation, 

22 and evaluation of pilot projects in partner coun23 tries, with the goal of taking such projects to 

24 scale; 


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1 ‘‘(D) support inclusive early childhood de2 velopment by supporting bureaus, working 

3 groups, and task forces implementing relevant 

4 sector strategies and public laws, including— 

5 ‘‘(i) the Global Water Strategy re6 quired under section 136(j) of the Foreign 

7 Assistance Act of 1961 (22 U.S.C. 

8 2152h(j)); 

9 ‘‘(ii) the whole-of-government strategy 

10 required under section 5 of the Global 

11 Food Security Act of 2016 (22 U.S.C. 

12 9304 note); 

13 ‘‘(iii) the Basic Education Strategy 

14 set forth in section 105(c) of the Foreign 

15 Assistance Act of 1961 (22 U.S.C. 

16 2151c(c)); 

17 ‘‘(iv) the U.S. Government Global Nu18 trition Coordination Plan, 2016–2021; and 

19 ‘‘(v) APCCA; 

20 ‘‘(E) focus on improving coordination with 

21 foreign governments and international and re22 gional organizations with respect to official 

23 country policies and plans for early childhood 

24 development, maternal, newborn, and child 

25 health and nutrition care, basic education plans, 


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1 water, sanitation and hygiene, and child protec2 tion plans; 

3 ‘‘(F) support strategies that— 

4 ‘‘(i) enable parents to care for their 

5 children; 

6 ‘‘(ii) prevent unnecessary family-child 

7 separation; 

8 ‘‘(iii) assist families with children with 

9 disabilities; 

10 ‘‘(iv) assist countries in planning and 

11 implementing deinstitutionalization pro12 grams; and 

13 ‘‘(v) promote nurturing, appropriate, 

14 protective, and permanent family care, 

15 while reducing the percentage of children 

16 living in residential care or on the street; 

17 and 

18 ‘‘(G) consult with governments, inter19 national financial institutions, nongovernmental 

20 organizations, local and international civil soci21 ety groups, multilateral organizations, the pri22 vate sector, faith-based organizations, commu23 nity-based organizations, organizations run by 

24 people with disabilities, and early childhood netVerDate Sep 11 2014 03:52 Nov 01, 2019 Jkt 099200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H4864.IH H4864

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1 works academic and professional associations, 

2 and local field workers, as appropriate. 

3 ‘‘(d) ANNUAL REPORT ON THE IMPLEMENTATION OF

4 THE STRATEGY.—The Special Adviser for Children in Ad5 versity shall include, in the annual report required under 

6 section 5 of the Assistance for Orphans and Other Vulner7 able Children in Developing Countries Act of 2005 (22 

8 U.S.C. 2152g), which shall be submitted to the appro9 priate congressional committees and made available to the 

10 public, a description of— 

11 ‘‘(1) the progress made toward integrating early 

12 childhood development interventions into current 

13 programming; 

14 ‘‘(2) the efforts made by relevant Executive 

15 branch agencies and officials to implement sub16 section (c), with a particular focus on the activities 

17 described in such subsection; 

18 ‘‘(3) the progress achieved during the reporting 

19 period toward meeting the goals, objectives, bench20 marks, and timeframes described in subsection (c); 

21 and 

22 ‘‘(4) the progress achieved during the reporting 

23 period toward meeting the goals, objectives, bench24 marks, and timeframes described in subsection (c) at 

25 the program level, along with specific challenges or 


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1 gaps that may require shifts in targeting, financing, 

2 or timeframes in the following fiscal year. 

3 ‘‘(e) INTERAGENCY TASK FORCE.—The Special Advi4 sor for Children in Adversity shall regularly convene an 

5 interagency task force, which should— 

6 ‘‘(1) provide intergovernmental and interagency 

7 coordination, monitoring, evaluation, and reporting 

8 of the activities carried out pursuant to this Act; 

9 ‘‘(2) promote coordination on early childhood 

10 development initiatives that include children with a 

11 variety of needs and circumstances; and 

12 ‘‘(3) establish a coordination mechanism within 

13 United States Agency for International Development 

14 to oversee and coordinate United States Government 

15 Early Childhood Development programs, strategies, 

16 and partnerships across Federal departments and 

17 agencies.’’. 

18 SEC. 5. SPECIAL ADVISOR FOR ASSISTANCE TO ORPHANS 

19 AND VULNERABLE CHILDREN. 

20 Section 135(e)(2) of the Foreign Assistance Act of 

21 1961 (22 U.S.C. 2152f(e)(2)) is amended— 

22 (1) by amending subparagraph (A) to read as 

23 follows: 


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1 ‘‘(A) Coordinate assistance to orphans and 

2 other vulnerable children among the relevant 

3 Executive branch agencies and officials.’’; and 

4 (2) in subparagraph (B), by striking ‘‘the var5 ious offices, bureaus, and field missions within the 

6 United States Agency for International Develop7 ment’’ and inserting ‘‘the relevant Executive branch 

8 agencies and officials, partner governments, multi9 lateral institutions, the private sector, and non10 governmental and civil society organizations’’. 

11 SEC. 6. RULE OF CONSTRUCTION. 

12 Nothing in the amendments made by sections 4 and 

13 5 of this Act may be construed to restrict or abrogate any 

14 other authorization for United States Agency for Inter15 national Development activities or programs. 

Æ 


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