IIB 

116TH CONGRESS 

2D SESSION H. R. 4864 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 23, 2020 

Received; read twice and referred to the Committee on Foreign Relations 

AN ACT 

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, 


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1 SECTION 1. SHORT TITLE. 

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

3 Act of 2020’’. 

4 SEC. 2. FINDINGS. 

5 Congress finds the following: 

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

7 Nations Inter-Agency Group for Child Mortality Es8 timation entitled ‘‘Levels & Trends in Child Mor9 tality’’, the annual number of deaths among children 

10 younger than 15 years of age dropped by 56 percent 

11 between 1990 and 2018, from approximately 

12 14,200,000 to approximately 6,200,000. 

13 (2) According to a 2016 article published in 

14 The Lancet entitled ‘‘Early childhood development: 

15 the foundation of sustainable development’’— 

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

17 low-income and middle-income countries suffer 

18 suboptimal development due to poverty and 

19 stunting alone; and 

20 (B) children who do not meet develop21 mental milestones are expected to lose about 25 

22 percent of their average yearly income once 

23 they become adults. 

24 (3) According to a report from the United Na25 tions Children’s Fund (UNICEF), entitled ‘‘The 

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


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

2 650,000,000 primary school age children do not 

3 master basic literacy and numeracy. 

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

5 Health Organization entitled ‘‘Nurturing Care for 

6 early childhood development’’— 

7 (A) the environment in which a child grows 

8 has a profound impact on future learning, be9 havior, and health; and 

10 (B) a country’s economic diversity and 

11 growth could be improved by investment in 

12 early childhood development. 

13 (5) According to a 2017 UNICEF report enti14 tled ‘‘UNICEF’s Programme Guidance for Early 

15 Childhood Development’’, nurturing care, which is 

16 key to early childhood development, consists of a 

17 core set of interrelated components, including— 

18 (A) behaviors, attitudes, and knowledge 

19 about caregiving, including health, hygiene care, 

20 and feeding; 

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

22 and playing; 

23 (C) responsiveness, such as early bonding, 

24 secure attachment, trust, and sensitive commu25 nication; and 


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1 (D) safety, including routines, protection 

2 from violence, abuse, neglect, harm, and envi3 ronmental pollution. 

4 (6) According to a 2016 report published in 

5 The Lancet entitled ‘‘Advancing Early Childhood 

6 Development: From Science to Scale’’— 

7 (A) nurturing care from parents, relatives, 

8 and other caregivers and services are formative 

9 experiences for young children; 

10 (B) programs promoting nurturing care 

11 can improve early childhood development out12 comes; and 

13 (C) children who do not receive nurturing 

14 care display negative development outcomes, 

15 such as greater sensitivity to the effects of 

16 stress or behavioral problems, especially chil17 dren who do not receive nurturing care before 

18 their second birthday. 

19 (7) According to the ‘‘Advancing Protection and 

20 Care for Children in Adversity 2019–2023: A U.S. 

21 Government Strategy for International Assistance’’, 

22 children who live without protective family care, in 

23 abusive households, on the streets, or in institutions, 

24 or who are trafficked, are participating in armed 

25 groups, or are being exploited for their labor are 


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1 more likely to be exposed to violence, exploitation, 

2 abuse, and neglect. 

3 (8) According to a 2017 UNICEF report enti4 tled ‘‘Early Moments Matter for every child’’, vio5 lence, abuse, neglect, and traumatic experiences 

6 produce toxic stress that limits neural connectivity 

7 in developing brains. 

8 (9) According to a 2014 working paper from 

9 the National Scientific Council on the Developing 

10 Child at Harvard University entitled ‘‘Excessive 

11 Stress Disrupts the Architecture of the Developing 

12 Brain’’— 

13 (A) situations that produce toxic stress in14 crease the production of cortisol in a child’s 

15 brain, which disrupts its healthy development; 

16 and 

17 (B) chronic stress can potentially affect 

18 the expression of genes that regulate the stress 

19 response across the life course. 

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

21 Carolina Medical Journal entitled ‘‘Adverse Child22 hood Experiences (ACEs): An Important Element of 

23 a Comprehensive Approach to the Opioid Crisis’’, 

24 adverse childhood experiences (ACEs) are traumatic 

25 or stressful experiences, including emotional, physVerDate Sep 11 2014 18:08 Sep 24, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4864.RFS H4864

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1 ical, or sexual abuse, domestic violence, household 

2 substance abuse, household mental illness, parental 

3 separation or divorce, and the incarceration of a 

4 household family member. 

5 (11) According to a 2016 report in Develop6 ment and Psychopathology entitled ‘‘Childhood Ad7 versity and Epigenetic Regulation of Glucocorticoid 

8 Signaling Genes: Associations in Children and 

9 Adults’’— 

10 (A) children and adults are at risk of de11 veloping psychiatric disorders and other medical 

12 conditions if they have had an adverse child13 hood experience; and 

14 (B) adults who have had numerous ACEs 

15 die nearly 20 years earlier, on average, than 

16 adults who have not had numerous ACEs. 

17 SEC. 3. SENSE OF CONGRESS. 

18 It is the sense of Congress that— 

19 (1) the United States Government should con20 tinue efforts to reduce child mortality rates and in21 crease attention on prevention efforts and early 

22 childhood development programs; 

23 (2) investments in early childhood development 

24 ensure healthy and well-developed future generations 


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1 that contribute to a country’s stability, security and 

2 economic prosperity; 

3 (3) efforts to provide training and education on 

4 nurturing care could result in improved early child5 hood development outcomes and support healthy 

6 brain development; and 

7 (4) integration and cross-sector coordination of 

8 early childhood development programs is critical to 

9 ensure the efficiency, effectiveness, and continued 

10 implementation of such programs. 

11 SEC. 4. ASSISTANCE TO IMPROVE EARLY CHILDHOOD OUT12 COMES GLOBALLY. 

13 (a) AUTHORIZATION OF ASSISTANCE.—Amounts au14 thorized to be appropriated to carry out section 135 in 

15 chapter 1 of part 1 of the Foreign Assistance Act of 1961 

16 (22 U.S.C. 2151 et seq.) for each of the fiscal years 2021 

17 through 2025 are authorized to be made available to sup18 port early childhood development activities in conjunction 

19 with relevant, existing programming, such as water, sani20 tation and hygiene, maternal and child health, basic edu21 cation, nutrition and child protection. 

22 (b) ASSISTANCE TO IMPROVE EARLY CHILDHOOD

23 OUTCOMES GLOBALLY.—Chapter 1 of part I of the For24 eign Assistance Act of 1961 (22 U.S.C. 2151 et seq.) is 

25 amended by adding at the end the following: 


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

2 OUTCOMES GLOBALLY. 

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

4 ‘‘(1) APPROPRIATE CONGRESSIONAL COMMIT5 TEES.—The term ‘appropriate congressional com6 mittees’ means— 

7 ‘‘(A) the Committee on Appropriations of 

8 the Senate; 

9 ‘‘(B) the Committee on Foreign Relations 

10 of the Senate; 

11 ‘‘(C) the Committee on Appropriations of 

12 the House of Representatives; and 

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

14 the House of Representatives. 

15 ‘‘(2) EARLY CHILDHOOD DEVELOPMENT.—The 

16 term ‘early childhood development’ means the devel17 opment and learning of a child younger than 8 years 

18 of age, including physical, cognitive, social, and emo19 tional development and approaches to learning that 

20 allow a child to reach his or her full developmental 

21 potential. 

22 ‘‘(3) EARLY CHILDHOOD DEVELOPMENT PRO23 GRAM.—The term ‘early childhood development pro24 gram’ means a program that ensures that every 

25 child has the conditions for healthy growth, nur26 turing family-based care, development and learning, 


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1 and protection from violence, exploitation, abuse, 

2 and neglect, which may include— 

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

4 hygiene program that serves pregnant women, 

5 children younger than 5 years of age, and the 

6 parents of such children; 

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

8 stimulating child development activity; 

9 ‘‘(C) age appropriate cognitive stimulation, 

10 especially for newborns, infants, and toddlers, 

11 including an early childhood intervention pro12 gram for children experiencing at-risk situa13 tions, developmental delays, disabilities, and be14 havioral and mental health conditions; 

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

16 younger), preschool, and basic education pro17 gram for children until they reach 8 years of 

18 age or complete primary school; or 

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

20 emphasis on the promotion of permanent, safe, 

21 and nurturing families, rather than placement 

22 in residential care or institutions, including for 

23 children with disabilities. 


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1 ‘‘(4) FEDERAL DEPARTMENTS AND AGEN2 CIES.—The term ‘Federal departments and agencies’ 

3 means— 

4 ‘‘(A) the Department of State; 

5 ‘‘(B) the United States Agency for Inter6 national Development; 

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

8 ‘‘(D) the Department of Labor; 

9 ‘‘(E) the Department of Education; 

10 ‘‘(F) the Department of Agriculture; 

11 ‘‘(G) the Department of Defense; 

12 ‘‘(H) the Department of Health and 

13 Human Services, including— 

14 ‘‘(i) the Centers for Disease Control 

15 and Prevention; and 

16 ‘‘(ii) the National Institutes of 

17 Health; 

18 ‘‘(I) the Millennium Challenge Corpora19 tion; 

20 ‘‘(J) the Peace Corps; and 

21 ‘‘(K) any other department or agency spec22 ified by the President for the purposes of this 

23 section. 

24 ‘‘(5) RESIDENTIAL CARE.—The term ‘residen25 tial care’ means care provided in any non-familyVerDate Sep 11 2014 18:08 Sep 24, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4864.RFS H4864

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1 based group setting, including orphanages, transit or 

2 interim care centers, children’s homes, children’s vil3 lages or cottage complexes, group homes, and board4 ing schools used primarily for care purposes as an 

5 alternative to a children’s home. 

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

7 United States— 

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

9 relevant foreign assistance programs, including by 

10 integrating evidence-based, efficient, and effective 

11 interventions into relevant strategies and programs, 

12 in coordination with partner countries, other donors, 

13 international organizations, international financial 

14 institutions, local and international nongovernmental 

15 organizations, private sector partners, civil society, 

16 and faith-based and community-based organizations; 

17 and 

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

19 early childhood development initiatives that include 

20 incentives for building local capacity for continued 

21 implementation and measurable results, by— 

22 ‘‘(A) scaling up the most effective, evi23 dence-based, national interventions, including 

24 for the most vulnerable populations and chil25 dren with disabilities and developmental delays, 


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1 with a focus on adaptation to country re2 sources, cultures, and languages; 

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

4 and evaluating programs in a manner that en5 hances their quality, transparency, equity, ac6 countability, efficiency and effectiveness in im7 proving child and family outcomes in partner 

8 countries; and 

9 ‘‘(C) utilizing and expanding innovative 

10 public-private financing mechanisms. 

11 ‘‘(c) IMPLEMENTATION.— 

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

13 the date of the enactment of this section, the Admin14 istrator of the United States Agency for Inter15 national Development, in coordination with the Sec16 retary of State, shall direct relevant Federal depart17 ments and agencies— 

18 ‘‘(A) to incorporate, to the extent practical 

19 and relevant, early childhood development into 

20 foreign assistance programs to be carried out 

21 during the following 5 fiscal years; and 

22 ‘‘(B) to promote inclusive early childhood 

23 development in partner countries. 

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

25 (1), the Administrator, the Secretary, and the heads 


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1 of other relevant Federal departments and agencies 

2 as appropriate shall— 

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

4 outlined in ‘Advancing Protection and Care for 

5 Children in Adversity: A U.S. Government 

6 Strategy for International Assistance 2019– 

7 2023’, published in June 2019 (referred to in 

8 this section as ‘APCCA’); 

9 ‘‘(B) to the extent practicable, identify evi10 dence-based strategic priorities, indicators, out11 comes, and targets, particularly emphasizing 

12 the most vulnerable populations and children 

13 with disabilities and developmental delays, to 

14 support inclusive early childhood development; 

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

16 and evaluation of pilot projects in partner coun17 tries, with the goal of taking such projects to 

18 scale; 

19 ‘‘(D) support inclusive early childhood de20 velopment within all relevant sector strategies 

21 and public laws, including— 

22 ‘‘(i) the Global Water Strategy re23 quired under section 136(j); 

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

25 required under section 5 of the Global 


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

2 9304 note); 

3 ‘‘(iii) the Basic Education Strategy 

4 set forth in section 105(c); 

5 ‘‘(iv) the U.S. Government Global Nu6 trition Coordination Plan, 2016–2021; and 

7 ‘‘(v) APCCA; and others as appro8 priate; 

9 ‘‘(E) improve coordination with foreign 

10 governments and international and regional or11 ganizations with respect to official country poli12 cies and plans to improve early childhood devel13 opment, maternal, newborn, and child health 

14 and nutrition care, basic education, water, sani15 tation and hygiene, and child protection plans 

16 which promote nurturing, appropriate, protec17 tive, and permanent family care, while reducing 

18 the percentage of children living in residential 

19 care or on the street; and 

20 ‘‘(F) consult with partner countries, other 

21 donors, international organizations, inter22 national financial institutions, local and inter23 national nongovernmental organizations, private 

24 sector partners and faith-based and community25 based organizations, as appropriate. 


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

2 THE STRATEGY.—The Special Advisor for Children in Ad3 versity shall include, in the annual report required under 

4 section 5 of the Assistance for Orphans and Other Vulner5 able Children in Developing Countries Act of 2005 (22 

6 U.S.C. 2152g), which shall be submitted to the appro7 priate congressional committees and made publicly avail8 able, a description of— 

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

10 childhood development interventions into relevant 

11 strategies and programs; 

12 ‘‘(2) the efforts made by relevant Federal de13 partments and agencies to implement subsection (c), 

14 with a particular focus on the activities described in 

15 such subsection; 

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

17 period toward meeting the goals, objectives, bench18 marks, described in subsection (c); and 

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

20 period toward meeting the goals, objectives, bench21 marks, and timeframes described in subsection (c) at 

22 the program level, along with specific challenges or 

23 gaps that may require shifts in targeting or financ24 ing in the following fiscal year. 


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1 ‘‘(e) INTERAGENCY TASK FORCE.—The Special Advi2 sor for Assistance to Orphans and Vulnerable Children 

3 should regularly convene an interagency task force, to co4 ordinate— 

5 ‘‘(1) intergovernmental and interagency moni6 toring, evaluation, and reporting of the activities 

7 carried out pursuant to this section; 

8 ‘‘(2) early childhood development initiatives 

9 that include children with a variety of needs and cir10 cumstances; and 

11 ‘‘(3) United States Government early childhood 

12 development programs, strategies, and partnerships 

13 across relevant Federal departments and agencies.’’. 

14 SEC. 5. SPECIAL ADVISOR FOR ASSISTANCE TO ORPHANS 

15 AND VULNERABLE CHILDREN. 

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

17 1961 (22 U.S.C. 2152f(e)(2)) is amended— 

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

19 follows: 

20 ‘‘(A) Coordinate assistance to orphans and 

21 other vulnerable children among the relevant 

22 Executive branch agencies and officials.’’; and 

23 (2) in subparagraph (B), by striking ‘‘the var24 ious offices, bureaus, and field missions within the 

25 United States Agency for International DevelopVerDate Sep 11 2014 18:08 Sep 24, 2020 Jkt 099200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H4864.RFS H4864

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1 ment’’ and inserting ‘‘the relevant Executive branch 

2 agencies and officials’’. 

3 SEC. 6. RULE OF CONSTRUCTION. 

4 Nothing in the amendments made by this Act may 

5 be construed to restrict or abrogate any other authoriza6 tion for United States Agency for International Develop7 ment activities or programs. 

Passed the House of Representatives September 22, 

2020. 

Attest: CHERYL L. JOHNSON, 

Clerk. 


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