I 

110TH CONGRESS 

1ST SESSION H. R. 2114 

To provide a United States voluntary contribution to the United Nations 

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

IN THE HOUSE OF REPRESENTATIVES 

MAY 2, 2007 

Mrs. MALONEY of New York (for herself, Mr. SHAYS, Ms. LEE, Mr. CROWLEY, Mr. HONDA, Ms. MCCOLLUM of Minnesota, Mr. CASTLE, Mr. 

MICHAUD, Mr. JACKSON of Illinois, Mr. MEEKS of New York, Mr. LANTOS, Mr. ALLEN, Mr. GRIJALVA, Mr. MCNULTY, Ms. WOOLSEY, Mr. 

CARNAHAN, Ms. SCHAKOWSKY, and Ms. WATSON) introduced the following bill; which was referred to the Committee on Foreign Affairs 

A BILL 

To provide a United States voluntary contribution to the 

United Nations Population Fund only for the prevention, 

treatment, 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, 20 women survive but experi6 ence long or short term illnesses or disabilities. One 

7 of the most devastating is obstetric fistula which is 

8 caused when a woman who needs trained medical as9 sistance for a safe delivery, including Caesarian sec10 tion, cannot get it. The consequences are life-shat11 tering. The baby usually dies, and the woman is left 

12 with chronic incontinence. 

13 (3) Obstetric fistula is a hole that is formed be14 tween the bladder and the vagina, or the rectum and 

15 the vagina, after a woman suffers from prolonged 

16 obstructed labor. In the struggle to pass through the 

17 birth canal, the fetus puts constant pressure, some18 times for several days, on the bladder and vaginal or 

19 rectal wall, destroying the tissue and leaving a 

20 wound. 

21 (4) Country specific obstetric fistula prevention 

22 and treatment needs assessments undertaken by the 

23 United Nations Population Fund (UNFPA) across 

24 Africa and Asia found services for fistula treatment 

25 to be largely unavailable in most countries where fismstockstill on PROD1PC66 with BILLS

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1 tula occurs. For example, Kenya estimates that 

2 3,000 cases occur per year, but only 7.5 percent of 

3 those women receive treatment. In Burkina Faso, 

4 women reported waiting as long as five years before 

5 they were able to receive treatment. 

6 (5) According to the Department of State 2006 

7 Human Rights Report for Ethiopia: ‘‘The combina8 tion of pregnancy at an early age, chronic maternal 

9 malnutrition, and a lack of skilled care at delivery 

10 often led to obstetric fistulae and permanent inconti11 nence. Approximately 8,700 women developed ob12 stetric fistulae annually, and 27,000 women with un13 treated fistulae were estimated to be living in rural 

14 areas. Treatment for fistulae was available at only 

15 one hospital, the Addis Ababa Fistula Hospital, 

16 which annually performed over 1,000 fistula oper17 ations. It estimated that for every successful oper18 ation performed, 10 other young women needed the 

19 treatment but did not receive it. The maternal mor20 tality rate was extremely high, partly due to food ta21 boos for pregnant women, poverty, early marriage, 

22 and birth complications related to FGM [Female 

23 Genital Mutilation], particularly infibulation.’’ 

24 (6) Obstetric fistula affects women who survive 

25 obstructed labor. In nearly every case of obstetric 

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

2 have physical pain as well as social and emotional 

3 trauma from the loss of her child. 

4 (7) The physical symptoms of obstetric fistula 

5 include incontinence or constant uncontrollable leak6 ing of urine or feces, frequent bladder infections, in7 fertility, and foul odor. The social consequences may 

8 be even more severe. The smell often drives hus9 bands and loving family members away. In many 

10 communities, women with fistula are considered 

11 ‘‘unclean’’ and stigmatized. Women may also isolate 

12 themselves due to the shame they feel about their 

13 condition. 

14 (8) Fistula is a relatively hidden problem, large15 ly because it affects the most marginalized members 

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

17 areas. Many of these women never seek treatment. 

18 Because they often suffer alone, their injuries may 

19 be ignored or misunderstood. 

20 (9) Adolescents are at greater risk of complica21 tions during childbirth that can lead to fistula be22 cause they have less access to health care and are 

23 subject to other significant risk factors. Young girls 

24 suddenly find themselves marginalized, alone, and 

25 are often blamed for their condition. 

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1 (10) Although data on obstetric fistula are 

2 scarce, it is generally accepted that there are more 

3 than 2,000,000 women living with fistula and 

4 50,000 to 100,000 new cases each year. These fig5 ures are based on the number of women who seek 

6 medical care. Many more suffer in silence, unaware 

7 that treatment is available. 

8 (11) Obstetric fistula was once common 

9 throughout the world, but over the last century has 

10 been eliminated in Europe, North America, and 

11 other developed regions through improved medical 

12 care. 

13 (12) Obstetric fistula is fully preventable by 

14 having a trained medical attendant present during 

15 labor and childbirth, access to emergency obstetric 

16 care in the event of complications, delaying early 

17 marriage and childbirth, and gaining access to edu18 cation and family planning. 

19 (13) Obstetric fistula can also be surgically re20 paired. Surgery requires a specially trained surgeon 

21 and support staff, access to an operating theater 

22 and to attentive post-operative care. Success rates 

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

24 percent and cost an average of $300. 

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1 (14) In 2003, UNFPA launched the first-ever 

2 global Campaign to End Fistula. It is working with 

3 partners all over the world to support interventions 

4 to prevent fistula from occurring, treat women who 

5 are affected, and support women after surgery. 

6 (15) The Campaign to End Fistula currently 

7 supports projects in over 40 countries in sub-Saha8 ran Africa, South Asia, and the Middle East. In 

9 each country the Campaign identifies the extent of 

10 the problem and the resources available to treat fis11 tula, develops a national strategy and builds partner12 ships to address the problem, and implements activi13 ties to prevent and treat fistula, including efforts to 

14 reintegrate women into their communities once they 

15 are healed. 

16 (16) The United States Government provided a 

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

18 for fiscal year 2001 and the Administration’s budget 

19 request for fiscal year 2008 allocates $25,000,000 

20 for UNFPA. 

21 (17) UNFPA is working in more than 140 

22 countries to reduce maternal death and disability, 

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

24 (18) In the winter of 2001, the Secretary of 

25 State submitted written testimony to the Committee 

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1 on Foreign Relations of the Senate expressing sup2 port for the invaluable work of UNFPA and for se3 curing funding for the organization. 

4 (19) The United States Government, as part of 

5 its efforts to improve the dire health conditions of 

6 Afghan women, pledged in October 2001 an addi7 tional $600,000 to UNFPA to address the reproduc8 tive health care needs of Afghan refugees in sur9 rounding nations and of internally displaced persons 

10 within Afghanistan. 

11 (20) Congress demonstrated its strong bipar12 tisan support for a voluntary United States con13 tribution to UNFPA of up to $34,000,000 in the 

14 Foreign Operations, Export Financing, and Related 

15 Programs Appropriations Act, 2002, which was 

16 passed by the House of Representatives on a vote of 

17 357 to 66 and by the Senate by unanimous consent 

18 and signed into law (Public Law 107–115) by the 

19 President on January 10, 2002. However, the Presi20 dent decided not to obligate the funds. 

21 (21) In May 2002, the President sent a three22 person delegation to investigate UNFPA programs 

23 in China and allegations that the agency was in24 volved in coercive abortion practices. 

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1 (22) This independent delegation concluded 

2 that such allegations were untrue. 

3 (23) On May 29, 2002, the delegation sent a 

4 letter to the Secretary of State stating the following: 

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

6 has knowingly supported or participated in the man7 agement of a program of coercive abortion or invol8 untary sterilization in the PRC. First Recommenda9 tion: We therefore recommend that not more than 

10 $34,000,000 which has already been appropriated be 

11 released to UNFPA.’’. 

12 (24) Regrettably, the Administration overruled 

13 the recommendation of its own delegation and in14 voked an overly broad interpretation of the law in 

15 order to eliminate funding for UNFPA. 

16 SEC. 3. UNITED STATES VOLUNTARY CONTRIBUTION TO 

17 THE UNITED NATIONS POPULATION FUND. 

18 Notwithstanding any other provision of law, in addi19 tion to amounts otherwise available to carry out the pur20 poses of chapter 3 of part 1 of the Foreign Assistance 

21 Act of 1961, there are authorized to be appropriated 

22 $34,000,000 for fiscal year 2008 and each subsequent fis23 cal year to be available only for United States voluntary 

24 contributions to the United Nations Population Fund 

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1 (UNFPA) only for prevention, treatment, and repair of 

2 obstetric fistula. 

Æ 

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