I 

109TH CONGRESS 

1ST SESSION H. R. 2811 

To provide a United States voluntary contribution to the United Nations 

Population Fund only for the prevention and repair of obstetric fistula. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 8, 2005 

Mrs. MALONEY (for herself, Mr. CROWLEY, Mr. RUSH, Mr. LANTOS, Ms. 

JACKSON-LEE of Texas, Ms. LEE, Mr. MCDERMOTT, Mr. OWENS, Mr. 

MCNULTY, Ms. EDDIE BERNICE JOHNSON of Texas, Mr. SMITH of 

Washington, Mr. GRIJALVA, and Mr. HONDA) introduced the following 

bill; which was referred to the Committee on International Relations 

A BILL 

To provide a United States voluntary contribution to the 

United Nations Population Fund only for the prevention 

and repair of obstetric fistula. 

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 ‘‘Repairing Young 

5 Women’s Lives Around the World Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 
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1 (1) Every minute, one woman dies from preg2 nancy-related complications. Ninety-five percent of 

3 these women live in Africa and Asia. 

4 (2) For every woman who dies from pregnancy5 related complications, 15 to 30 women survive but 

6 experience chronic disabilities. The worst is obstetric 

7 fistula which is caused when a woman who needs 

8 trained medical assistance for a safe delivery, includ9 ing Caesarian section, cannot get it. The con10 sequences are life-shattering. The baby usually dies, 

11 and the woman is left with chronic incontinence. 

12 (3) Obstetric fistula is a hole that is formed be13 tween the bladder and the vagina, or the rectum and 

14 the vagina, after a woman suffers from prolonged 

15 obstructed labor. In the struggle to pass through the 

16 birth canal, the fetus puts constant pressure, some17 times for several days, on the bladder and vaginal or 

18 rectal wall, destroying the tissue and leaving a 

19 wound. 

20 (4) According to the Department of State: 

21 ‘‘Pregnancy at an early age often leads to obstetric 

22 fistulae and permanent incontinence. In Ethiopia, 

23 treatment is available at only 1 hospital in Addis 

24 Ababa that performs over 1,000 fistula operations a 

25 year. It estimates that for every successful operation 
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1 performed, 10 other young women need the treat2 ment. The maternal mortality rate is extremely high 

3 due, in part, to food taboos for pregnant women, 

4 poverty, early marriage, and birth complications re5 lated to FGM [Female Genital Mutilation], espe6 cially infibulation.’’. 

7 (5) Obstetric fistula affects women who survive 

8 obstructed labor. In nearly every case of obstetric 

9 fistula, the baby will be stillborn and the mother will 

10 have physical pain as well as social and emotional 

11 trauma from the loss of her child. 

12 (6) The physical symptoms of obstetric fistula 

13 include incontinence or constant uncontrollable leak14 ing of urine or feces, frequent bladder infections, in15 fertility, and foul odor. The smell often drives hus16 bands and loving family members away. In many 

17 communities, women with fistula are considered 

18 ‘‘unclean’’ and stigmatized. 

19 (7) Fistula is a relatively hidden problem, large20 ly because it affects the most marginalized members 

21 of society: young, poor, illiterate women in remote 

22 areas. Many of these women never seek treatment. 

23 Because they often suffer alone, their injuries may 

24 be ignored or misunderstood. 
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1 (8) Adolescents are at greater risk of complica2 tions during childbirth that can lead to fistula be3 cause they have less access to health care and are 

4 subject to other significant risk factors. Young girls 

5 suddenly find themselves marginalized, alone, and 

6 are often blamed for their condition. 

7 (9) Although data on obstetric fistula are 

8 scarce, the World Health Organization (WHO) esti9 mates there are more than 2,000,000 women living 

10 with fistula and 50,000 to 100,000 new cases each 

11 year. These figures are based on the number of 

12 women who seek medical care. Many more suffer in 

13 silence, unaware that treatment is available. 

14 (10) Obstetric fistula was once common 

15 throughout the world, but over the last century has 

16 been eradicated in Europe, North America, and 

17 other developed regions through improved medical 

18 care. 

19 (11) Obstetric fistula is fully preventable by 

20 having a trained medical attendant present during 

21 labor and childbirth, access to emergency obstetric 

22 care in the event of complications, delaying early 

23 marriage and childbirth, and gaining access to edu24 cation and family planning. 
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1 (12) Obstetric fistula can also be surgically re2 paired. Surgery requires a specially trained surgeon 

3 and support staff, access to an operating theater 

4 and to attentive post-operative care. Success rates 

5 for surgical repair of fistula can be as high as 90 

6 percent and cost an average of $300. 

7 (13) In 2003, the United Nations Population 

8 Fund (UNFPA) launched the first-ever global Cam9 paign to End Fistula. This campaign includes inter10 ventions to prevent fistula from occurring, treat 

11 women who are affected and support women after 

12 surgery. 

13 (14) The Campaign to End Fistula currently 

14 supports projects in more than 30 countries in sub15 Saharan Africa, South Asia, and the Middle East. In 

16 each country the Campaign identifies the extent of 

17 the problem and the resources available to treat fis18 tula, develops a national strategy and builds partner19 ships to address the problem, and implements activi20 ties to prevent and treat fistula, including efforts to 

21 reintegrate women into their communities once they 

22 are healed. 

23 (15) The United States Government provided a 

24 voluntary contribution of $21,500,000 to UNFPA 

25 for fiscal year 2001 and the Administration’s budget 
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1 request for fiscal year 2006 allocates $25,000,000 

2 for UNFPA. 

3 (16) UNFPA is working in more than 79 coun4 tries to reduce maternal death and disability, such 

5 as obstetric fistula, and to save women’s lives. 

6 (17) In the winter of 2001, the Secretary of 

7 State submitted written testimony to the Committee 

8 on Foreign Relations of the Senate expressing sup9 port for the invaluable work of UNFPA and for se10 curing funding for the organization. 

11 (18) The United States Government, as part of 

12 its efforts to improve the dire health conditions of 

13 Afghan women, pledged in October 2001 an addi14 tional $600,000 to UNFPA to address the reproduc15 tive health care needs of Afghan refugees in sur16 rounding nations and of internally displaced persons 

17 within Afghanistan. 

18 (19) Congress demonstrated its strong bipar19 tisan support for a voluntary United States con20 tribution to UNFPA of up to $34,000,000 in the 

21 Foreign Operations, Export Financing, and Related 

22 Programs Appropriations Act, 2002, which was 

23 passed by the House of Representatives on a vote of 

24 357 to 66 and by the Senate by unanimous consent 

25 and signed into law (Public Law 107–115) by the 
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1 President on January 10, 2002. However, the Presi2 dent decided not to obligate the funds. 

3 (20) In May 2002, the President sent a three4 person delegation to investigate UNFPA programs 

5 in China and allegations that the agency was in6 volved in coercive abortion practices. 

7 (21) This independent delegation concluded 

8 that such allegations were untrue. 

9 (22) On May 29, 2002, the delegation sent a 

10 letter to the Secretary of State stating the following: 

11 ‘‘First Finding: We find no evidence that UNFPA 

12 has knowingly supported or participated in the man13 agement of a program of coercive abortion or invol14 untary sterilization in the PRC. First Recommenda15 tion: We therefore recommend that not more than 

16 $34,000,000 which has already been appropriated be 

17 released to UNFPA.’’. 

18 (23) Regrettably, the Administration overruled 

19 the recommendation of its own delegation and in20 voked an overly broad interpretation of the law in 

21 order to eliminate funding for UNFPA. 

22 SEC. 3. UNITED STATES VOLUNTARY CONTRIBUTION TO 

23 THE UNITED NATIONS POPULATION FUND. 

24 Notwithstanding any other provision of law, in addi25 tion to amounts otherwise available to carry out the pur-
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1 poses of chapter 3 of part 1 of the Foreign Assistance 

2 Act of 1961, there are authorized to be appropriated 

3 $34,000,000 for fiscal year 2006 and each subsequent fis4 cal year to be available only for United States voluntary 

5 contributions to the United Nations Population Fund 

6 (UNFPA) only for prevention and repair of obstetric fis7 tula. 

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