I 

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. 

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 ‘‘Physician Education 

5 for Fistula Treatment Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) Obstetric fistula, an abnormal opening be2 tween a woman’s genital tract and her urinary tract 

3 or rectum, is a devastating childbirth injury caused 

4 by prolonged, obstructed labor in the absence of 

5 timely and quality medical care. 

6 (2) Worldwide, an estimated 500,000 women 

7 and girls live with obstetric fistula with thousands 

8 more occurring annually. It occurs disproportion9 ately among impoverished, vulnerable, and 

10 marginalized girls and women. 

11 (3) Women who experience an obstetric fistula 

12 suffer life-shattering consequences including chronic 

13 incontinence, shame, social isolation, poverty, and 

14 physical, mental, and emotional health problems. 

15 (4) Obstetric fistula is a violation of human 

16 rights and an indicator of the failure of health sys17 tems to deliver universally accessible, timely, and 

18 quality health care to women and girls who need it. 

19 (5) Obstetric fistula is preventable. Universal 

20 health coverage and universal access to quality care 

21 are essential in ending preventable maternal and 

22 newborn deaths and disabilities, including fistula. 

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1 ern contraception are the most effective interven2 tions to prevent maternal mortality and fistula. 

3 (6) Safeguarding the rights and dignity of 

4 women and girls and addressing underlying gender 

5 and socioeconomic inequalities and discrimination 

6 which drive obstetric fistula are equally important to 

7 end the condition. 

8 (7) In 2018 and 2020, the United Nations Gen9 eral Assembly resolutions on fistula were adopted, 

10 calling for ‘‘Ending fistula within a decade’’. This 

11 represents a turning point in the global fight to 

12 eliminate fistula, as it brings the global objective and 

13 timeline for ending fistula into alignment with 

14 achieving the Sustainable Development Goals 

15 (SDGs)/Agenda 2030. The resolutions also call for 

16 an increased focus on social determinants to tackle 

17 the root causes of fistula. 

18 (8) Obstetric fistula can be surgically treated. 

19 The impact of an obstetric fistula-repair surgery is 

20 immediate and women can be reintegrated into soci21 ety. There is however a high unmet need for treat22 ment and social reintegration of fistula survivors. 

23 (9) The Covid–19 pandemic caused overloaded 

24 health systems and reallocation of human and finan25 cial resources with disruptions to services resulting 


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1 in an undermining of the sexual and reproductive 

2 health and rights of women and girls. In 2020, fis3 tula repairs were widely halted or slowed down due 

4 to Covid–19, as they were deemed non-urgent and 

5 unsafe during the pandemic. This may result in an 

6 increased backlog of fistula cases. 

7 (10) The United Nations Population Fund 

8 (UNFPA)-led global Campaign to End Fistula, is a 

9 key contributor to promoting the rights, dignity, and 

10 well-being of women and girls. The Campaign fo11 cuses on prevention, treatment, social reintegration, 

12 and advocacy. Aimed at ‘‘leaving no one behind’’ and 

13 ‘‘reaching the furthest behind’’, it contributes to 

14 achieving the SDGs and has also helped restore 

15 overall health, dignity, hope, and a sense of self16 worth and agency to some of the poorest, most 

17 marginalized women and girls worldwide through its 

18 holistic, gender-sensitive, and rights-based approach 

19 to policies and programs for the elimination of ob20 stetric fistula and several other maternal 

21 morbidities. 

22 (11) UNFPA has supported over 1140,000 sur23 gical repairs over the last two decades. The Cam24 paign to End Fistula and its partners has made re25 markable progress, but the needs remain great. 


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1 (12) With 8 years to reach the global goal of 

2 ending fistula by 2030, significantly intensified in3 vestment, efforts, and partnerships at the inter4 national and national levels are required. 

5 (13) The International Day to End Obstetric 

6 Fistula which takes place on May 23, 2024, will be 

7 commemorated this year with the theme: ‘‘Breaking 

8 the Cycle: Preventing Fistula Worldwide’’, calling 

9 for investments to improve the quality of care and 

10 emphasizing the key role of communities in address11 ing social, cultural, political, and economic deter12 minants that impact maternal health and sexual re13 productive health, and reproductive rights. 

14 SEC. 3. INTERNATIONAL OB/GYN AND UROGYNECOLOGY 

15 PROMOTION PROGRAM. 

16 (a) PURPOSE.—The purpose of assistance under this 

17 section is to train and retain obstetrician-gynecologists 

18 (OB–GYNs) and sub-specialists in urogynecology and to 

19 help improve the quality of care to meet the health care 

20 needs of women in least developed countries. 

21 (b) AUTHORIZATION.— 

22 (1) IN GENERAL.—To carry out the purpose of 

23 subsection (a), the President, acting through the Di24 rector of the John E. Fogarty International Center 

25 for Advanced Study in the Health Sciences, is auVerDate Sep 11 2014 04:27 Jul 11, 2024 Jkt 049200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H8529.IH H8529

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1 thorized to provide assistance for least developed 

2 countries to support the activities described in sub3 section (c). 

4 (2) REFERENCE.—Assistance authorized under 

5 this section may be referred to as the ‘‘International 

6 OB/GYN and Urogynecology Promotion Program’’. 

7 (c) ACTIVITIES SUPPORTED.—Activities that may be 

8 supported by assistance under subsection (b) include the 

9 following: 

10 (1) FELLOWSHIP AND RESIDENCY PRO11 GRAMS.—Establishment of fellowship and residency 

12 programs to be carried out in coordination with in13 stitutions of higher education (as such term is de14 fined in section 101 of the Higher Education Act of 

15 1965 (20 U.S.C. 1001)), institutions of higher learn16 ing, midwifery programs, and existing clinical cen17 ters in least developed countries— 

18 (A) to support existing academic curricula 

19 for education training for midwifery students; 

20 (B) to develop and help sustain existing 

21 specialized curriculum training for medical stu22 dents and residents to become knowledgeable 

23 and proficient in women’s health care; and 

24 (C) to allow medical students, residents, 

25 and midwifery students to practice and develop 


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1 expertise in geographical areas in which child2 birth-related injuries are most prevalent. 

3 (2) TRAINING CENTERS.—Establishment of 

4 training centers— 

5 (A) to address the shortage of OB–GYNs 

6 and sub-specialists in the urogynecology profes7 sion; and 

8 (B) to carry out specialized programs that 

9 are located at health care institutions that pro10 vide exceptionally high concentrations of exper11 tise and related resources related to these med12 ical professions and are delivered in a com13 prehensive and interdisciplinary fashion. 

14 SEC. 4. COMPREHENSIVE 10-YEAR STRATEGY TO ADDRESS 

15 THE SHORTAGE OF PHYSICIANS IN LEAST DE16 VELOPED COUNTRIES. 

17 (a) IN GENERAL.—The President, acting through the 

18 Director of the John E. Fogarty International Center for 

19 Advanced Study in the Health Sciences, shall establish a 

20 comprehensive, integrated, 10-year strategy to address the 

21 shortage of physicians in least developed countries. 

22 (b) ELEMENTS.—Such strategy shall maintain suffi23 cient flexibility and remain responsive to the needs of 

24 women afflicted with childbirth-related injuries and shall 

25 include the following: 


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1 (1) A plan for implementation and coordination 

2 of programs and activities under this Act, including 

3 grants and contracts for prevention, treatment, and 

4 monitoring of childbirth-related injuries. 

5 (2) Specific objectives, multi-sector approaches, 

6 and specific strategies to treat women who suffer 

7 from childbirth-related injuries and to prevent fur8 ther occurrences of childbirth-related injuries. 

9 (3) Assignment of priorities for relevant execu10 tive branch agencies. 

11 (4) Public health and health care delivery sys12 tem research on the prevention, repair, and rehabili13 tation of childbirth-related injuries. 

14 (5) Social science research in fields such as an15 thropology, sociology, and related fields to monitor 

16 and evaluate the underlying social and economic fac17 tors that contribute to childbirth-related injuries. 

18 (6) Development, implementation, and evalua19 tion of evidence-based systems of care connecting 

20 maternity care facilities with local care delivery and 

21 community education programs. Such systems of 

22 care should promote rapid and long-term prevention 

23 of childbirth-related injuries, including— 

24 (A) culturally appropriate childbirth edu25 cation, preparation, and planning; and 


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1 (B) access to obstetrician-gynecologists 

2 (OB–GYNs), urogynecology care, or midwifery 

3 care. 

4 (7) Expansion of training centers and partner5 ships with institutions of higher learning for medical 

6 students and residents. 

7 (8) Priorities for the distribution of resources 

8 based on factors such as the size and demographics 

9 of the population suffering from childbirth-related 

10 injuries, the needs of that population, and the exist11 ing infrastructure or funding levels that may exist to 

12 treat and prevent childbirth-related injuries, includ13 ing obstetric fistula. 

14 (9) A plan for institutional capacity-building of 

15 partnerships to strengthen universities, research cen16 ters, health-profession training programs, and gov17 ernment institutes to build the in-country capacity 

18 needed to eradicate childbirth-related injuries in 

19 least developed countries. 

20 (c) REPORT.—Not later than 2 years after the date 

21 of the enactment of this Act, the President shall submit 

22 to Congress a report that contains the strategy required 

23 under this section. 


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1 SEC. 5. REPORT. 

2 (a) IN GENERAL.—The President, acting through the 

3 Director of the John E. Fogarty International Center for 

4 Advanced Study in the Health Sciences, shall submit to 

5 Congress, on an annual basis, a report on the implementa6 tion of this Act for the preceding year. 

7 (b) MATTERS TO BE INCLUDED.—The report re8 quired under subsection (a) shall include an evaluation of 

9 the effectiveness and performance of the International 

10 OB/GYN and Urogynecology Promotion Program estab11 lished under section 3 and all related community outreach 

12 and medical programs. 

13 SEC. 6. DEFINITIONS. 

14 In this Act: 

15 (1) CHILDBIRTH-RELATED INJURIES.—The 

16 term ‘‘childbirth-related injuries’’ means injuries as17 sociated with obstructed labor, including— 

18 (A) pelvic organ prolapse; 

19 (B) a displacement of pelvic organs such 

20 as the uterus, bladder, or bowel; and 

21 (C) obstetric fistula. 

22 (2) LOW-INCOME COUNTRY.—The term ‘‘low-in23 come country’’ means a country with a per capita 

24 gross national income of $1,035 or less. 

25 (3) LEAST DEVELOPED COUNTRY.—The term 

26 ‘‘least developed country’’ means a country that— 


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1 (A) is a low-income country; and 

2 (B) according to the United Nations Eco3 nomic Analysis and Policy Division, is con4 fronting severe structural impediments to sus5 tainable development. 

6 (4) RELEVANT EXECUTIVE BRANCH AGEN7 CIES.—The term ‘‘relevant executive branch agen8 cies’’ means the Department of State, the United 

9 States Agency for International Development, and 

10 any other department or agency of the United States 

11 that participates in international health and humani12 tarian activities pursuant to the authorities of such 

13 department or agency or the Foreign Assistance Act 

14 of 1961. 

Æ 


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