69–010 

Calendar No. 633 

110TH CONGRESS REPORT " ! SENATE 2d Session 110–282 

UNITED STATES COMMITMENT TO GLOBAL CHILD 

SURVIVAL ACT 

APRIL 9, 2008.—Ordered to be printed 

Mr. BIDEN, from the Committee on Foreign Relations, 

submitted the following 

R E P O R T 

[To accompany S. 1418] 

The Committee on Foreign Relations, having had under consideration the bill (S. 1418), to provide assistance to improve the health 

of newborns, children, and mothers in developing countries, and for 

other purposes, reports favorably thereon with an amendment in 

the nature of a substitute, and recommends that the bill, as 

amended, do pass. 

CONTENTS 

Page 

I. Purpose ........................................................................................................... 1 

II. Committee Action .......................................................................................... 1 

III. Discussion ....................................................................................................... 2 

IV. Cost Estimate ................................................................................................. 2 

V. Evaluation of Regulatory Impact .................................................................. 4 

VI. Changes in Existing Law .............................................................................. 4 

I. PURPOSE

The purpose of S. 1418 is to reduce the mortality rate of children 

and mothers in the developing world through the development and 

implementation of an integrated child and maternal health strategy; the creation of an interagency child and maternal health task 

force to achieve health goals; and the authorization of increased 

funding for child and maternal health interventions. 

II. COMMITTEE ACTION

S. 1418 was introduced by Senators Dodd, Smith, Leahy, and 

Brown on May 15, 2007. An additional 19 members cosponsored 

the legislation. On February 13, 2008, the committee ordered the 

bill, with an amendment in the nature of a substitute, reported favorably by voice vote. 


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III. DISCUSSION

Every year, nearly 10.5 million children under age 5 die from 

highly preventable and treatable causes, while more than 500,000 

mothers die from causes related to pregnancy and childbirth. Nearly 40 percent of under-5 childhood deaths occur during the first 4 

weeks of life. To combat this public health crisis, in 2000 the 

United States joined the international community in committing to 

achieve Millennium Development Goals (MGDs) 4 and 5, which 

aim to reduce the mortality rate of children under the age of 5 by 

two-thirds and the maternal mortality rate by three-fourths in the 

developing world, respectively. 

S. 1418 seeks to support these goals and to improve child and 

maternal health in the developing world by increasing funding for 

and delivery of proven low-cost, life saving health interventions. 

The bill requires the President to develop a holistic strategy which 

will include an identification of not less than 60 countries with priority needs in maternal and child health, a detailed analysis of 

those needs, and prescriptions for interventions designed to improve health outcomes in each country. The President will transmit 

to Congress a report on this strategy 180 days after the enactment 

of this bill. 

In implementing this strategy, the President is authorized to provide assistance for a wide range of activities including immunization interventions; vitamin and micronutrient supplementation; 

oral rehydration therapy; essential newborn care; improved sanitation and drinking water; childhood illness treatment; promotion of 

breast-feeding; training of clinicians, nurses, technicians, and other 

persons integral to health care delivery; and support health information management systems in host countries. 

This legislation creates an interagency task force to assess, monitor, and evaluate the progress and contributions of relevant U.S. 

departments and agencies in achieving child and maternal health 

goals. The task force will consult outside experts in child and maternal health, including members of academic institutions, nongovernmental organizations, and international organizations such 

as the World Bank. The task force is required to transmit to the 

President an annual report, for 4 years, on the implementation of 

this new strategy. 

S. 1418 authorizes the appropriation of up to $600 million for fiscal year 2008, up to $900 million for fiscal year 2009, up to $1.2 

billion for fiscal year 2010, and up to $1.6 billion for fiscal years 

2011 and 2012 to support activities to expand child and maternal 

health interventions. 

IV. COST ESTIMATE

Pursuant to Rule XXVI, paragraph 11(a) of the Standing Rules 

of the Senate, the following cost estimate has been provided by the 

Congressional Budget Office. 


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U.S. CONGRESS, CONGRESSIONAL BUDGET OFFICE, Washington, DC, April 3, 2008. 

Hon. JOSEPH R. BIDEN, Jr., 

Chairman, Committee on Foreign Relations, 

U.S. Senate, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for S. 1418, the United States 

Commitment to Global Child Survival Act of 2007. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Michelle S. Patterson. 

Sincerely, 

ROBERT A. SUNSHINE

(For Peter R. Orszag, Director). 

Enclosure. 

S. 1418—United States Commitment to Global Child Survival Act 

of 2007 

Summary: S. 1418 would require the President to develop a comprehensive strategy to improve the health of newborns, children, 

and mothers in developing countries and to furnish assistance to 

accomplish those goals. For those purposes, the bill would authorize the appropriation of $5.9 billion over a 5-year period. CBO estimates that implementing S. 1418 would cost about $30 million in 

2008 and $4.9 billion over the 2008–2013 period, assuming appropriation of the authorized amounts. Enacting the bill would not 

affect direct spending or receipts. 

S. 1418 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act (UMRA) 

and would not affect the budgets of state, local, or tribal governments. 

Estimated cost to the Federal Government: The estimated budgetary impact of S. 1418 is shown in the following table. The costs 

of this legislation fall within budget function 150 (international 

affairs). 

By fiscal year, in millions of dollars— 

2008 2009 2010 2011 2012 2013 

CHANGES IN SPENDING SUBJECT TO APPROPRIATION 

Authorization Level ............................................... 600 900 1,200 1,600 1,600 0 

Estimated Outlays ................................................ 30 510 787 1,081 1,367 1,171 

Basis of estimate: S. 1418 would require the United States 

Agency for International Development (USAID) to expand several 

existing programs focused on improving the health of newborns, 

children, and mothers in developing countries. The bill would double to 60 the number of countries in which USAID operates those 

programs and require an interagency task force to assess the effectiveness of the aid and activities. 

For those purposes, S. 1418 would authorize the appropriation of 

up to $600 million in 2008, $900 million in 2009, $1.2 billion in 

2010, and $1.6 billion for each of years 2011 and 2012. To date, the 

Congress has provided USAID with $450 million to fund its current 

children’s and mothers’ health programs in fiscal year 2008. 


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For the estimate CBO assumes that S. 1418 will be enacted by 

early summer, that the maximum authorized amounts are appropriated each year, and that outlays will follow historical patterns 

for existing programs. (Funding for 2008 would have to be provided 

in a supplemental appropriation act; most of any such 2008 supplemental would be spent in later years.) 

Based on information from USAID, CBO estimates that the 

amount authorized to be appropriated is sufficient to fund the expanded requirements and that implementing S. 1418 would cost 

about $4.9 billion over the 2008–2013 period. Most of the remaining amount from the authorized funding would be spent by 2018. 

Intergovernmental and private-sector impact: S. 1418 contains no 

intergovernmental or private-sector mandates as defined in UMRA 

and would not affect the budgets of state, local, or tribal governments. 

Estimate prepared by: Federal Costs: Michelle S. Patterson; Impact on State, Local, and Tribal Governments: Neil Hood; Impact 

on the Private Sector: Jacob Kuipers. 

Estimate approved by: Peter H. Fontaine, Assistant Director for 

Budget Analysis. 

V. EVALUATION OF REGULATORY IMPACT

Pursuant to Rule XXVI, paragraph 11(b) of the Standing Rules 

of the Senate, the committee has determined that there is no regulatory impact as a result of this legislation. 

VI. CHANGES IN EXISTING LAW

Pursuant to Rule XXVI, paragraph 12 of the Standing Rules of 

the Senate, changes in existing law made by the bill, as reported, 

are shown as follows (existing proposed to be omitted is enclosed 

in black brackets, new matter is printed in italic, existing law in 

which no change is proposed is shown in roman). 

The Foreign Assistance Act of 1961 

Public Law 87–195 [S. 1983], 75 Stat. 424, approved 

September 4, 1961, as amended 

* * * * * * * 

PART I 

* * * * * * * 

Sec. 104. Population and Health.—(a) * * * 

* * * * * * * 

(c) ASSISTANCE FOR HEALTH AND DISEASE PREVENTION.—(1) In 

order to contribute to improvements in the health of the greatest 

number of poor people in developing countries, the President is authorized to furnish assistance, on such terms and conditions as he 

may determine, for health programs. Assistance under this subsection shall be used primarily for basic integrated health services, 

safe water and sanitation, disease prevention and control, and related health planning and research. The assistance shall emphasize 

self-sustaining community-based health programs by means such 

as training of health auxiliary and other appropriate personnel, 

support for the establishment and evaluation of projects that can 


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be replicated on a broader scale, measures to improve management 

of health programs, and other services and suppliers to support 

health and disease prevention programs. 

ø(2)(A) In carrying out the purposes of this subsection, the President shall promote, encourage, and undertake activities designed to 

deal directly with the special health needs of children and mothers. 

Such activities should utilize simple, available technologies which 

can significantly reduce childhood mortality, such as improved and 

expanded immunization programs, oral rehydration to combat 

diarrhoeal diseases, and education programs aimed at improving 

nutrition and sanitation and at promoting child spacing. In carrying out this paragraph, guidance shall be sought from knowledgeable health professionals from outside the agency primarily responsible for administering this part. In addition to government-togovernment programs, activities pursuant to this paragraph should 

include support for appropriate activities of the types described in 

this paragraph which are carried out by international organizations 

(which may include international organizations receiving funds 

under chapter 3 of this part) and by private and voluntary organizations, and should include encouragement to other donors to support such types of activities. 

ø(B) In addition to amounts otherwise available for such purpose, 

there are authorized to be appropriated to the President 

$25,000,000 for fiscal year 1986 and $75,000,000 for fiscal year 

1987 for use in carrying out this paragraph. Amounts appropriated 

under this subparagraph are authorized to remain available until 

expended. 

ø(C) Appropriations pursuant to subparagraph (B) may be referred to as the ‘‘Child Survival Fund.’’ ø(3) The Congress recognizes that the promotion of primary 

health care is a major objective of the foreign assistance program. 

The Congress further recognizes that simple, relatively low-cost 

means already exist to reduce incidence of communicable diseases 

among children, mothers, and infants. The promotion of vaccines 

for immunization, and salts for oral rehydration, therefore, is an 

essential feature of the health assistance program. To this end, the 

Congress expects the agency primarily responsible for administering this part to set as a goal the protection of not less than 

80 percent of all children, in those countries in which such agency 

has established development programs, from immunizable diseases 

by January 1, 1991. Of the aggregate amounts made available for 

fiscal year 1987 to carry out paragraph (2) of this subsection (relating to the Child Survival Fund) and to carry out subsection (c) (relating to development assistance for health), $50,000,000 shall be 

used to carry out this paragraph.¿ 

ø(4)¿ (2) RELATIONSHIP TO OTHER LAWS.—Assistance made available under this subsection and sections 104A, 104B, øand 104C¿ 

104C, and 104D, and assistance made available under chapter 4 of 

part II to carry out the purposes of this subsection and the provisions cited in this paragraph, may be made available notwithstanding any other provision of law that restricts assistance to foreign countries, except for the provisions of this subsection, the provisions of law cited in this paragraph, subsection (f), section 634A 

of this Act, and provisions of law that limit assistance to organizations that support or participate in a program of coercive abortion 


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or involuntary sterilization included under the Child Survival and 

Health Programs Fund heading in the Consolidated Appropriations 

Resolution, 2003 (Public Law 108-7). 

* * * * * * * 

SEC. 104A. ASSISTANCE TO COMBAT HIV/AIDS. 

* * * * * * * 

(c) AUTHORIZATION.—

(1) IN GENERAL.—Consistent with section 104(c) and section 

104D, the President is authorized to furnish assistance, on 

such terms and conditions as the President may determine, for 

HIV/AIDS, including to prevent, treat, and monitor HIV/AIDS, 

and carry out related activities, in countries in sub-Saharan 

Africa, the Caribbean, and other countries and areas. 

* * * * * * * 

(f) FUNDING LIMITATION.—Of the funds made available to carryout this section in any fiscal year, not more than 7 percent may be 

used for the administrative expenses of the United States Agency 

for International Development in support of activities described in 

øsection 104(c), this section, section 104B, and section 104C¿ section 104(c), this section, section 104B, section 104C, and section 

104D. Such amount shall be in addition to other amounts otherwise available for such purposes. 

* * * * * * * 

SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS. 

* * * * * * * 

(c) AUTHORIZATION.—To carry out this section and consistent 

with section 104(c) and section 104D, the President is authorized 

to furnish assistance, on such terms and conditions as the President may determine, for the prevention, treatment, control, and 

elimination of tuberculosis. 

* * * * * * * 

SEC. 104C. ASSISTANCE TO COMBAT MALARIA. 

* * * * * * * 

(c) AUTHORIZATION.—To carry out this section and consistent 

with section 104(c) and section 104D, the President is authorized 

to furnish assistance, on such terms and conditions as the President may determine, for the prevention, treatment, control, and 

elimination of malaria 

* * * * * * * 

(c) FUNDING LEVEL.—For fiscal year 1987, not less than 

$2,500,000 of the funds available to carry out this part (excluding 

funds made available to carry out øsection 104(c)(2), relating to the 

Child Survival Fund¿ section 104D) shall be allocated for assistance pursuant to subsection (b) for activities which were not funded prior to fiscal year 1987. In addition, the Agency for International Development shall, to the fullest extent possible, continue 

and increase assistance pursuant to subsection (b) for activities for 

which assistance was provided in fiscal years prior to fiscal year 

1987. 


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SEC. 104D. ASSISTANCE TO REDUCE MORTALITY AND IMPROVE THE 

HEALTH OF NEWBORNS, CHILDREN, AND MOTHERS. 

(a) AUTHORIZATION.—Consistent with section 104(c), the President 

is authorized to furnish assistance, on such terms and conditions as 

the President may determine, to reduce mortality and improve the 

health of newborns, children, and mothers in developing countries. 

(b) ACTIVITIES SUPPORTED.—Assistance provided under subsection (a) shall, to the maximum extent practicable, include 

(1) activities to improve newborn care and treatment; 

(2) activities to treat childhood illness, including increasing 

access to appropriate treatment for diarrhea, pneumonia, and 

other life-threatening childhood illnesses; 

(3) activities to improve child and maternal nutrition, including the delivery of iron, zinc, vita-min A, iodine, and other key 

micronutrients and the promotion of breast feeding; 

(4) activities to strengthen the delivery of immunization services, including efforts to eliminate polio; 

(5) activities to improve birth preparedness and maternity 

services; 

(6) activities to improve the recognition and treatment of obstetric complications and disabilities; 

(7) activities to improve household-level behavior related to 

safe water, hygiene, exposure to indoor smoke, and environmental toxins such as lead; 

(8) activities to improve capacity for health governance, 

health finance, and the health work-force, including support for 

training clinicians, nurses, technicians, sanitation and public 

health workers, community-based health workers, midwives, 

birth attendants, peer educators, volunteers, and private sector 

enterprises; 

(9) activities to address antimicrobial resistance in child and 

maternal health; 

(10) activities to establish and support the management information systems of host country institutions and the development and use of tools and models to collect, analyze, and disseminate information related to newborn, child, and maternal 

health; 

(11) activities to develop and conduct needs assessments, 

baseline studies, targeted evaluations, or other informationgathering efforts for the design, monitoring, and evaluation of 

newborn, child, and maternal health efforts; and 

(12) activities to integrate and coordinate assistance provided 

under this section with existing health programs for—

(A) the prevention of the transmission of HIV from mother-to-child and other HIV/AIDS counseling, care, and 

treatment activities; 

(B) malaria; 

(C) tuberculosis; and 

(D) child spacing. 

(c) GUIDELINES.—To the maximum extent practicable, programs, 

projects, and activities carried out using assistance provided under 

this section shall be—

(1) carried out through private and voluntary organizations, 

including faith-based organizations, and relevant international 

and multilateral organizations, including the GAVI Alliance 


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and UNICEF, that demonstrate effectiveness and commitment 

to improving the health of newborns, children, and mothers; 

(2) carried out with input by host countries, including civil 

society and local communities, as well as other donors and multilateral organizations; 

(3) carried out with input by beneficiaries and other directly 

affected populations, especially women and marginalized communities; and 

(4) designed to build the capacity of host country governments 

and civil society organizations. 

(d) ANNUAL REPORT.—Not later than January 31, 2009, and annually thereafter for 4 years, the President shall transmit to Congress a report on the implementation of this section for the prior fiscal year. The report shall include the most recent report submitted 

to the President by the Interagency Task Force on Child Survival 

and Maternal Health in Developing Countries under section 5(f) of 

the United States Commitment to Global Child Survival Act of 

2007. 

(e) DEFINITIONS.—In this section: 

(1) AIDS.—The term ‘‘AIDS’’ has the meaning given the term 

in section 104A(g) (1) of this Act. 

(2) HIV.—The term ‘‘HIV’’ has the meaning given the term in 

section 104A(g) (2) of this Act. 

(3) HIV/AIDS.—The term ‘‘HIV/AIDS’’ has the meaning 

given the term in section 104A(g) (3) of this Act. 

Æ 


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