II

103D CONGRESS

1ST SESSION S. 1096

To amend the Foreign Assistance Act of 1961 to establish and strengthen

policies and programs for the early stabilization of world population

through the global expansion of reproductive choice, and for other

purposes.

IN THE SENATE OF THE UNITED STATES

JUNE 10, 1993

Mr. BINGAMAN (for himself and Mr. SIMPSON) introduced the following bill;

which was read twice and referred to the Committee on Foreign Relations

A BILL

To amend the Foreign Assistance Act of 1961 to establish

and strengthen policies and programs for the early stabilization of world population through the global expansion of reproductive choice, 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 ‘‘International Popu5 lation Stabilization and Reproductive Health Act’’.
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1 SEC. 2. AUTHORITIES RELATING TO UNITED STATES POPU2 LATION ASSISTANCE.

3 Part I of the Foreign Assistance Act of 1961 is

4 amended—

5 (1) in section 104(b), by striking ‘‘on such

6 terms and conditions as he may determine’’ and in7 serting ‘‘in accordance with the provisions of chapter

8 12’’; and

9 (2) by adding at the end the following new

10 chapter:

11 ‘‘CHAPTER 12—UNITED STATES

12 POPULATION ASSISTANCE

13 ‘‘SEC. 499. DEFINITION.—For purposes of this chap14 ter, the term ‘United States population assistance’ means

15 assistance provided under section 104(b) of this Act.

16 ‘‘SEC. 499A. CONGRESSIONAL FINDINGS.—The Con17 gress makes the following findings:

18 ‘‘(1) Throughout much of the world, the inabil19 ity of women, particularly poor women, to exercise

20 choice over childbearing undermines women’s strug21 gle for self-determination, contributes to death and

22 suffering among women and their children, puts

23 pressure on the land, forests, and other natural re24 sources on which many poor families depend for

25 their survival, and in other ways vitiates the efforts

26 of families to lift themselves out of the poverty in
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1 which over one billion of the world’s more than five

2 billion people live.

3 ‘‘(2) During the 1980s, nearly 800 million peo4 ple, a number three times greater than the popu5 lation of the United States, were added to the

6 world’s population.

7 ‘‘(3) Birthrates in many developing countries

8 are declining too slowly to prevent a near tripling of

9 the world’s population before stabilization can occur,

10 and although birthrates in some countries have de11 clined faster in recent years than anticipated, world

12 progress toward stabilization was noticeably slower

13 in the 1980s than in the 1970s.

14 ‘‘(4) After more than a quarter century of expe15 rience and research, the actions needed to bring

16 about a rapid decline in birthrates are well docu17 mented. First, the ability to exercise reproductive

18 choice must be expanded. Such expansion should

19 occur through broader dissemination of fertility reg20 ulation services that involve the community and are

21 competent to meet the needs and values of those

22 who use them.

23 ‘‘(5) Although a number of religious and cul24 tural barriers to family planning remain, attitudes

25 toward modern birth control have changed over the
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1 last decade, and in many countries a large and

2 growing unmet desire exists for fertility regulation

3 among women and men who are too poor to pay the

4 full cost of services.

5 ‘‘(6) Although many social and economic factors

6 affect desired family size, organized family planning

7 programs have the most rapid and strongest effect

8 on birthrate because they enable women and their

9 families to control the timing and number of their

10 children. Widespread voluntary adoption of modern

11 family planning methods and their successful long12 term use depend on the quality of reproductive

13 health care services offered and their responsiveness

14 to individual and community needs and values.

15 ‘‘(7) Millions of women, most of them mothers,

16 are killed or injured each year as a result of unsafe

17 abortions. The availability of safe and effective fer18 tility regulation methods and services can help pre19 vent many of these tragedies.

20 ‘‘(8) The impact of human population growth

21 and widespread poverty is evident in mounting signs

22 of stress on the world’s environment, particularly in

23 tropical deforestation, erosion of arable land and wa24 tersheds, extinction of plant and animal species,
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1 global climate change, waste management, and air

2 and water pollution.

3 ‘‘(9) Traditionally, United States population as4 sistance has not focused on achieving specific goals

5 with respect to international population stabilization

6 or the expansion of reproductive choice. The absence

7 of clear goals in those areas has led to a lack of cri8 teria for allocating funds and evaluating program

9 success.

10 ‘‘SEC. 499B. DECLARATION OF POLICY. (a) IN GEN11 ERAL.—Congress declares that to reduce population

12 growth and stabilize world population at the lowest level

13 feasible and thereby protect the global environment, to

14 provide greater self-determination for women, and to im15 prove the health and well-being of the world’s families, an

16 important objective of the foreign policy of the United

17 States shall be to assist the international community to

18 achieve universal availability of quality fertility regulation

19 services through a wide choice of safe and effective means

20 of family planning, including programs of public education

21 and other health and development efforts in support of

22 smaller families.

23 ‘‘(b) FINANCIAL TARGETS.—The Congress estab24 lishes a target for global expenditures in developing coun25 tries from all domestic and international sources by the
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1 year 2000 of at least $11,000,000,000 for population pro2 grams described in section 499C, and establishes a goal

3 for United States population assistance by the year 2000

4 of $1,400,000,000 in constant 1990 dollars, not including

5 funds available for other reproductive health programs.

6 ‘‘SEC. 499C. AUTHORIZED ACTIVITIES.—United

7 States population assistance is authorized to provide—

8 ‘‘(1) support for the expansion of quality, af9 fordable, voluntary family planning services, which

10 emphasize informed choice among a variety of safe

11 and effective fertility regulation methods and closely

12 related reproductive health care services, including

13 the prevention and control of sexually transmitted

14 diseases and reproductive tract infections;

15 ‘‘(2) support for adequate and regular supplies

16 of quality contraceptive and other commodities, com17 prehensive counseling, appropriate followup, and

18 support for programs that emphasize the use of the

19 mass media to improve public knowledge of fertility

20 regulation and related disease prevention methods

21 and where they may be obtained and to promote the

22 benefits of family planning and reproductive health

23 to individuals, families, and communities;

24 ‘‘(3) support to United States and foreign re25 search institutions and other appropriate entities for
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1 biomedical research to develop and evaluate im2 proved methods of safe fertility regulation and relat3 ed disease control, with particular emphasis on

4 methods which—

5 ‘‘(A) are likely to be safer, easier to use,

6 easier to make available in developing country

7 settings, and less expensive than current meth8 ods;

9 ‘‘(B) are controlled by women, including

10 barrier methods and vaginal microbicides;

11 ‘‘(C) are likely to prevent the spread of

12 sexually transmitted diseases; and

13 ‘‘(D) encourage and allow men to take

14 greater responsibility for their own fertility;

15 ‘‘(4) support for field research on the character16 istics of programs most likely to result in sustained

17 use of effective family planning in meeting each indi18 vidual’s lifetime reproductive goals, with particular

19 emphasis on the perspectives of family planning

20 users, including support for relevant social and be21 havioral research focusing on such factors as the

22 use, non-use, and unsafe or ineffective use of various

23 fertility regulation and related-disease control meth24 ods;
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1 ‘‘(5) support for the development of new evalua2 tion techniques and performance criteria for family

3 planning programs, emphasizing the family planning

4 user’s perspective and reproductive goals;

5 ‘‘(6) support for research and research dissemi6 nation related to population policy development, in7 cluding demographic and health surveys to assess

8 population trends, measure unmet needs, and evalu9 ate program impact, and support for policy-relevant

10 research on the relationships between population

11 trends, poverty, and environmental management, in12 cluding implications for sustainable agriculture,

13 agroforestry, biodiversity, water resources, energy

14 use, and local and global climate change;

15 ‘‘(7) support for research and public informa16 tion dissemination on the health and welfare con17 sequences of unsafe abortions and for the equipment

18 and training necessary for the medical treatment of

19 the complications of unsafe abortions;

20 ‘‘(8) support for special programs to reach ado21 lescents and young adults before they begin child22 bearing, including health education programs which

23 stress responsible parenthood and the health risks of

24 unprotected sexual intercourse, as well as service
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1 programs designed to meet the information and con2 traception needs of adolescents; and

3 ‘‘(9) support for a broad array of governmental

4 and nongovernmental communication strategies de5 signed—

6 ‘‘(A) to create public awareness worldwide;

7 ‘‘(B) to generate a consensus on the need

8 to address reproductive health issues and the

9 problems associated with continued world popu10 lation growth;

11 ‘‘(C) to emphasize the need to educate men

12 as well as women and mobilize their support for

13 reproductive rights and responsibilities; and

14 ‘‘(D) to make family planning an estab15 lished community norm.

16 ‘‘SEC. 499D. TERMS AND CONDITIONS.—United

17 States population assistance is authorized to be provided

18 subject to the following conditions:

19 ‘‘(1) Such assistance may only support, directly

20 or through referral, those activities which provide a

21 broad range of fertility regulation methods permitted

22 by individual country policy and a broad choice of

23 public and private family planning services, includ24 ing networks for community-based and subsidized

25 commercial distribution of contraceptives.
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1 ‘‘(2) No program supported by United States

2 population assistance may deny an individual family

3 planning services because of such individual’s inabil4 ity to pay all or part of the cost of such services.

5 ‘‘(3) Family planning services and related re6 productive health care services supported by United

7 States population assistance shall maintain the high8 est medical standards possible under local conditions

9 and shall ensure regular oversight of the quality of

10 medical care and other services offered.

11 ‘‘(4) United States population assistance pro12 grams shall furnish only those contraceptive drugs

13 and devices which have received approval for mar14 keting in the United States by the Food and Drug

15 Administration or which have been tested and deter16 mined to be safe and effective under research proto17 cols comparable to those required by the Food and

18 Drug Administration or have been determined to be

19 safe by an appropriate international organization or

20 the relevant health authority in the country to which

21 they are provided.

22 ‘‘(5) Family planning services supported by

23 United States population assistance shall be de24 signed to take into account the needs of the family

25 planning user, including the constraints on women’s
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1 time, by involving members of the community, in2 cluding both men and women, in the design, man3 agement, and ongoing evaluation of the services

4 through appropriate training and recruitment ef5 forts. The design of services shall stress easy acces6 sibility, by locating services as close as possible to

7 potential users, by keeping hours of service conven8 ient, and by improving communications between

9 users and providers through community outreach

10 and involvement.

11 ‘‘(6) United States population assistance to ad12 olescent fertility programs shall be provided in the

13 context of prevailing norms and customs in the re14 cipient country.

15 ‘‘(7) None of the funds made available by the

16 United States Government to foreign governments,

17 international organizations, or nongovernmental or18 ganizations may be used to coerce any person to un19 dergo contraceptive sterilization or involuntary abor20 tion or to accept any other method of fertility regu21 lation.

22 ‘‘SEC. 499E. ELIGIBILITY FOR POPULATION ASSIST23 ANCE. (a) ELIGIBLE COUNTRIES.—Notwithstanding any

24 other provision of law, United States population assistance

25 shall be available, directly or through intermediary organi-
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1 zations, to any country which the President determines

2 has met one or more of the following criteria:

3 ‘‘(1) The country accounts for a significant pro4 portion of the world’s annual population increment.

5 ‘‘(2) The country has significant unmet needs

6 for fertility regulation and requires foreign assist7 ance to implement, expand, or sustain quality family

8 planning services for all its people.

9 ‘‘(3) The country demonstrates a strong policy

10 commitment to population stabilization through the

11 expansion of reproductive choice.

12 ‘‘(b) ELIGIBILITY OF NONGOVERNMENTAL AND MUL13 TILATERAL ORGANIZATIONS.—In determining eligibility

14 for United States population assistance, the President

15 shall not subject nongovernmental and multilateral organi16 zations to requirements which are more restrictive than

17 requirements applicable to foreign governments for such

18 assistance.

19 ‘‘SEC. 499F. PARTICIPATION IN MULTILATERAL OR20 GANIZATIONS. (a) FINDING.—The Congress recognizes

21 that the recent attention, in government policies toward

22 population stabilization owes much to the efforts of the

23 United Nations and its specialized agencies and organiza24 tions, particularly the United Nations Population Fund.
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1 ‘‘(b) AVAILABILITY OF FUNDS.—United States popu2 lation assistance shall be available for contributions to the

3 United Nations Population Fund in such amounts as the

4 President determines would be commensurate with United

5 States contributions to other multilateral organizations

6 and with the contributions of other donor countries.

7 ‘‘(c) PROHIBITIONS.—(1) The prohibitions contained

8 in section 104(f) of this Act shall apply to the funds made

9 available for the United Nations Population Fund.

10 ‘‘(2) No United States population assistance may be

11 available to the United Nations Population Fund unless

12 such assistance is held in a separate account and not com13 mingled with any other funds.

14 ‘‘(3) No funds may be available for the United Na15 tions Population Fund unless the Fund agrees to prohibit

16 the use of those funds to carry out any program, project,

17 or activity that involves the use of coerced abortion or in18 voluntary sterilization.

19 ‘‘(d) ALLOCATION OF FUNDS.—Of the funds made

20 available for United States population assistance, the

21 President shall make available for the Special Programme

22 of Research, Development and Research Training in

23 Human Reproduction for each of the fiscal years 1994 and

24 1995 an amount commensurate with the contributions of

25 the other donor countries for the purpose of furthering
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1 international cooperation in the development and evalua2 tion of fertility regulation technology.

3 ‘‘SEC. 499G. SUPPORT FOR NONGOVERNMENTAL OR4 GANIZATIONS. (a) FINDING.—Congress finds that in many

5 developing countries, nongovernmental entities, including

6 private and voluntary organizations and private sector en7 tities, such as the International Planned Parenthood Fed8 eration and the Planned Parenthood Federation of Amer9 ica, are the most appropriate and effective providers of

10 United States assistance to population and family plan11 ning activities.

12 ‘‘(b) PROCEDURES.—The President shall establish

13 simplified procedures for the development and approval of

14 programs to be carried out by nongovernmental organiza15 tions that have demonstrated—

16 ‘‘(1) a capacity to undertake effective popu17 lation and family planning activities which encourage

18 significant involvement by private health practition19 ers, employer-based health services, unions, and co20 operative health organizations; and

21 ‘‘(2) a commitment to quality reproductive

22 health care for women.

23 ‘‘(c) PRIORITY FOR NONGOVERNMENTAL ORGANIZA24 TIONS.—The largest share of United States population as25 sistance made available for any fiscal year shall be made
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1 available through United States and foreign nongovern2 mental organizations.

3 ‘‘SEC. 499H. REPORTS TO CONGRESS.—The Presi4 dent shall prepare and submit to the Congress, as part

5 of the annual presentation materials on foreign assistance,

6 a report on world progress toward population stabilization

7 and universal reproductive choice. The report shall in8 clude—

9 ‘‘(1) estimates of expenditures on the popu10 lation activities described in section 499C by na11 tional governments, donor agencies, and private sec12 tor entities;

13 ‘‘(2) an assessment by country, of the availabil14 ity and use of all methods of fertility regulation and

15 abortion, whether lawful or unlawful in that country;

16 ‘‘(3) an analysis by country and region of the

17 impact of population trends on a set of key social,

18 economic, political, and environment indicators,

19 which shall be identified by the President in the first

20 report submitted pursuant to this section and ana21 lyzed in that report and each subsequent report; and

22 ‘‘(4) a detailed statement of prior year and pro23 posed direct and indirect allocations of population

24 assistance, by country, which describes how each
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1 country allocation meets the criteria set forth in this

2 section.’’.

3 SEC. 3. AUTHORIZATIONS OF APPROPRIATIONS.

4 Section 104(g)(1) of the Foreign Assistance Act of

5 1961 (22 U.S.C. 2151b(g)(1) is amended by amending

6 subparagraph (A) to read as follows:

7 ‘‘(A) $725,000,000 for fiscal year 1994 and

8 $800,000,000 for fiscal year 1995 to carry out sub9 section (b) of this section; and’’.

10 SEC. 4. OVERSIGHT OF MULTILATERAL DEVELOPMENT

11 BANKS.

12 (a) FINDING.—The Congress considers insufficient

13 the role currently played in global population efforts by

14 the International Bank for Reconstruction and Develop15 ment, the Asian Development Bank, the Inter-American

16 Development Bank and the African Development Bank.

17 Although these multilateral development banks are sin18 gularly important sources of support for development ac19 tivities, together they provided less than $200,000,000 in

20 1990 in assistance for core population programs. Nor have

21 these institutions consistently encouraged appropriate

22 population and reproductive health care policies.

23 (b) REPORT REQUIRED.—(1) The Congress believes

24 that the multilateral development banks should together

25 increase their support for the population activities de-
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1 scribed in section 499C of the Foreign Assistance Act of

2 1961 to no less than $1,000,000,000 by the end of 1999.

3 (2) Not later than July 31 of each year, the United

4 States Executive Directors of the International Bank for

5 Reconstruction and Development, the Asian Development

6 Bank, the Inter-American Development Bank and the Af7 rican Development Bank shall prepare and transmit to

8 Congress a report which sets forth information on alloca9 tions by each of these institutions to the population activi10 ties described in section 499C of the Foreign Assistance

11 Act of 1961 and, if such allocations total less than

12 $1,000,000,000, set forth any specific actions taken by the

13 Executive Directors to encourage increases in such alloca14 tions and in policy level discussions with donor and devel15 oping country governments.

16 SEC. 5. COMMISSION ON WORLD POPULATION STABILIZA17 TION AND REPRODUCTIVE HEALTH.

18 (a) ESTABLISHMENT OF COMMISSION.—There is es19 tablished the Commission on World Population Stabiliza20 tion and Reproductive Health for the purpose of coordi21 nating United States preparation for, and participation in,

22 the 1994 International Conference on Population and De23 velopment and for other purposes.

24 (b) COMPOSITION OF COMMISSION.—The Commis25 sion shall be composed of—
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1 (1) the Under Secretary of State for Global

2 Population, Environment and National Resources;

3 (2) the Administrator of the Agency for Inter4 national Development;

5 (3) the Deputy Assistant Secretary for Popu6 lation Affairs of the Department of Health and

7 Human Services;

8 (4) the Director of the Congressional Office of

9 Technology Assessment; and

10 (5) three individuals appointed by the Presi11 dent, one of whom the President shall designate as

12 Chairman.

13 (c) PERIOD OF APPOINTMENT; VACANCIES.—Mem14 bers shall be appointed for the life of the Commission. Any

15 vacancy in the Commission shall not affect its powers, but

16 shall be filled in the same manner as the original appoint17 ment.

18 (d) QUORUM.—A majority of the members of the

19 Commission shall constitute a quorum, but a lesser num20 ber of members may hold hearings.

21 (e) HEARINGS.—The Commission may hold such

22 hearings, sit and act at such times and places, take such

23 testimony, and receive such evidence as the Commission

24 considers advisable to carry out the purposes of this sec25 tion.
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1 (f) INFORMATION FROM FEDERAL AGENCIES.—The

2 Commission may secure directly from any Federal depart3 ment or agency such information as the Commission con4 siders necessary to carry out the provisions of this Act.

5 Upon request of the Chairman of the Commission, the

6 head of such department or agency shall furnish such in7 formation to the Commission.

8 (g) POSTAL SERVICES.—The Commission may use

9 the United States mails in the same manner and under

10 the same conditions as other departments and agencies of

11 the Federal Government.

12 (h) GIFTS.—The Commission may accept, use, and

13 dispose of gifts or donations of services or property.

14 (i) COMPENSATION OF MEMBERS.—Each member of

15 the Commission who is not an officer or employee of the

16 Federal Government shall be compensated at a rate equal

17 to the daily equivalent of the annual rate of basic pay pre18 scribed for level IV of the Executive Schedule under sec19 tion 5315 of title 5, United States Code, for each day (in20 cluding travel time) during which such member is engaged

21 in the performance of the duties of the Commission. All

22 members of the Commission who are officers or employees

23 of the United States shall serve without compensation in

24 addition to that received for their services as officers or

25 employees of the United States.
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1 (j) TRAVEL EXPENSES.—The members of the Com2 mission shall be allowed travel expenses, including per

3 diem in lieu of subsistence, at rates authorized for employ4 ees of agencies under subchapter I of chapter 57 of title

5 5, United States Code, while away from their homes or

6 regular places of business in the performance of services

7 for the Commission.

8 (k) STAFF COMPENSATION.—The Chairman of the

9 Commission may fix the compensation of personnel with10 out regard to the provisions of chapter 51 and subchapter

11 III of chapter 53 of title 5, United States Code, relating

12 to classification of positions and General Schedule pay

13 rates, except that the rate of pay for the executive director

14 and other personnel may not exceed the rate payable for

15 level V of the Executive Schedule under section 5316 of

16 such title.

17 (l) DETAIL OF GOVERNMENT EMPLOYEES.—Any

18 Federal Government employee may be detailed to the

19 Commission without reimbursement, and such detail shall

20 be without interruption or loss of civil service status or

21 privilege.

22 (m) PROCUREMENT OF TEMPORARY AND INTERMIT23 TENT SERVICES.—The Chairman of the Commission may

24 procure temporary and intermittent services under section

25 3109(b) of title 5, United States Code, at rates for individ-
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1 uals which do not exceed the daily equivalent of the annual

2 rate of basic pay prescribed for level V of the Executive

3 Schedule under section 5316 of such title.

4 (n) REPORT.—Not later than June 30, 1994, the

5 Commission shall submit to the President a public report

6 on national and international population trends and the

7 probable impact of such trends on efforts to alleviate pov8 erty and protect the environment. The report, which

9 should be made available for consideration at the 1994

10 International Conference on Population and Development,

11 shall specify, among other things, modifications in policy

12 and financial commitments required by foreign govern13 ments to achieve universal reproductive choice and early

14 population stabilization.

15 (o) TERMINATION OF THE COMMISSION.—The Com16 mission shall terminate 90 days after the date on which

17 the Commission submits its report under subsection (n).

18 (p) AUTHORIZATION OF APPROPRIATIONS.—To carry

19 out this section, there are authorized to be appropriated

20 to the Commission $1,000,000 for fiscal year 1994.

21 SEC. 6. ECONOMIC AND SOCIAL DEVELOPMENT INITIA22 TIVES TO STABILIZE WORLD POPULATION.

23 (a) CONGRESSIONAL FINDINGS.—The Congress

24 makes the following findings:
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1 (1) Women represent 50 percent of the world’s

2 human resource potential. Therefore, improving the

3 health, social, and economic status of women and in4 creasing their productivity are essential for economic

5 progress in all countries.

6 (2) Throughout the world, women who partici7 pate in the social, economic, and political affairs of

8 their communities are more likely to exercise their

9 choice about childbearing than women who do not

10 participate in such activities.

11 (3) Effective economic development strategies

12 address issues such as infant and child survival

13 rates, educational opportunities for girls and women,

14 and gender equality in development.

15 (4) Comprehensive population stabilization ef16 forts which include both family planning services

17 and economic development activities achieve lower

18 birth rates and stimulate more development than

19 those which pursue these objectives independently.

20 (5) The most powerful, long-term influence on

21 birthrates is education, especially educational attain22 ment among women. The education of women also

23 has a strong influence on other aspects of family

24 welfare, including child survival. World-wide statis25 tics, however, indicate that the number of school-age
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1 children, especially girls, not attending school is

2 growing annually.

3 (6) Each year, nearly 15 million children under

4 the age of 5 die, most from preventable causes.

5 Wider availability of vaccines, simple treatments for

6 diarrheal disease and respiratory infections, and im7 proved nutrition could prevent many of these deaths.

8 (7) Each year, 500,000 or more women world9 wide die from complications related to pregnancy,

10 childbirth, or illegal abortion. Another 10 million

11 women annually suffer long-term illness or perma12 nent physical impairment from such causes.

13 (8) In many countries, high levels of mortality

14 and morbidity among women of childbearing age are

15 directly related to inadequate or inaccessible repro16 ductive health care services.

17 (9) Many women are their family’s principal

18 caregiver and chief source of economic support. The

19 death of a mother substantially increases the risk of

20 neglect, abandonment, or death for her young chil21 dren.

22 (10) Malnutrition and anemia are widespread

23 among poor women in their childbearing years, yet

24 the worldwide campaign to encourage breastfeeding
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1 has devoted little attention to the nutritional needs

2 of nursing mothers.

3 (11) During the 1990s, women, especially in

4 Africa, face substantially increased risks of death or

5 disability from sexually transmitted diseases. During

6 the 1990s, more than 3 million women in Africa will

7 die of the acquired immune deficiency syndrome

8 (AIDS), leaving more than 5 million orphans.

9 (b) DECLARATION OF POLICY.—Congress declares

10 that, in order to further the United States foreign policy

11 objective of assisting the international community in

12 achieving universal availability of quality fertility regula13 tion services and stabilizing world population, additional

14 objectives of the foreign policy of the United States shall

15 be—

16 (1) to expand basic education opportunities for

17 girls and women;

18 (2) to reduce the gap between male and female

19 levels of literacy and between male and female levels

20 of primary and secondary school enrollment;

21 (3) to help ensure that women worldwide have

22 the opportunity to become equal partners with men

23 in the development of their societies;

24 (4) to reduce global maternal and infant mor25 tality rates; and
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1 (5) to improve worldwide maternal and child

2 health status and quality of life.

3 (c) AUTHORIZED ACTIVITIES.—United States devel4 opment assistance shall be available, on a priority basis,

5 for—

6 (1) countries which either have adopted and im7 plemented, or have agreed to adopt and implement,

8 strategies to help ensure, by the year 2000—

9 (A) the completion of primary school edu10 cation by no less than 80 percent of the coun11 try’s primary school-age children;

12 (B) the reduction of adult illiteracy by at

13 least one-half the country’s 1990 level; and

14 (C) the elimination of the gap between

15 male and female levels of literacy and between

16 male and female levels of primary and second17 ary school enrollment;

18 (2) governmental and nongovernmental pro19 grams which, with respect to a targeted country, are

20 intended—

21 (A) to reduce significantly malnutrition

22 among the country’s children under 5 years of

23 age;
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1 (B) to maintain immunizations against

2 childhood diseases for significant segments of

3 the country’s children; and

4 (C) to reduce the number of childhood

5 deaths in the country which result from diar6 rheal disease and acute respiratory infections;

7 (3) governmental and nongovernmental pro8 grams which are intended to increase women’s pro9 ductivity through improved access to appropriate

10 labor-saving technology, vocational training, and ex11 tension services and access to credit and child care;

12 and

13 (4) governmental and nongovernmental pro14 grams which are intended to increase the access of

15 girls and women to comprehensive reproductive

16 health care services pursuant to subsection (d).

17 (d) SAFE MOTHERHOOD INITIATIVE.—(1)(A) The

18 President is authorized to establish a grant program, to

19 be known as the Safe Motherhood Initiative, to help im20 prove the access of girls and women worldwide to com21 prehensive reproductive health care services.

22 (B) Such program shall be carried out in accordance

23 with this section and shall be subject to the same terms,

24 conditions, prohibitions, and restrictions as are applicable
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1 to assistance made available under sections 499D, 499E,

2 and 499F of the Foreign Assistance Act of 1961.

3 (2) Comprehensive reproductive health care programs

4 which are eligible for assistance under this section in5 clude—

6 (A) fertility regulation services;

7 (B) prenatal care and screening for high risk

8 pregnancies and improved access to safe delivery

9 services for women with high risk pregnancies;

10 (C) supplemental food programs for pregnant

11 and nursing women;

12 (D) expanded and coordinated programs to pre13 vent, detect, and treat sexually transmitted diseases,

14 including AIDS, reproductive tract infections, and

15 other chronic reproductive health problems; and

16 (E) improvements in the practice of midwifery,

17 including outreach to traditional birth attendants.

18 (e) REPORTS TO CONGRESS.—(1) Not later than De19 cember 31, 1994, the President shall prepare and submit

20 to Congress a report which includes—

21 (A) estimates of the total financial resources

22 needed to achieve, by the year 2000, the specific ob23 jectives set forth in subsection (c) with respect to

24 education, rates of illiteracy, malnutrition, immuni25 zation, maternal and child mortality and morbidity,
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1 and improvements in the economic productivity of

2 women;

3 (B) an analysis of such estimates which sepa4 rately lists the total financial resources needed from

5 the United States, other donor nations, and non-gov6 ernmental organizations;

7 (C) an analysis, by country, which—

8 (i) identifies the legal, social, economic,

9 and cultural barriers to women’s self-determina10 tion and to improvements in the economic pro11 ductivity of women in traditional and modern

12 labor sectors; and

13 (ii) describes initiatives needed to develop

14 appropriate technologies for use by women,

15 credit programs for low-income women, ex16 panded child care, vocational training, and ex17 tension services for women; and

18 (D) a comprehensive description of—

19 (i) new and expanded initiatives to ensure

20 safe motherhood worldwide;

21 (ii) findings on the major causes of mortal22 ity and morbidity among women of childbearing

23 age in various regions of the world;
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1 (iii) actions needed to reduce, by the year

2 2000, world maternal mortality by one-half of

3 the worldwide 1990 level; and

4 (iv) the finance resources needed to meet

5 this goal from the United States, other donor

6 nations, and nongovernmental organizations.

7 (2) In each annual country human rights report, the

8 Secretary of State shall include information on any pat9 terns within the country of discrimination against women

10 in inheritance laws, property rights, family law, access to

11 credit and technology, hiring practices, formal education,

12 and vocational training.

13 (f) AUTHORIZATION OF APPROPRIATIONS.—(1) Of

14 the aggregate amounts available for United States devel15 opment and economic assistance programs for education

16 activities, $350,000,000 for fiscal year 1994 and

17 $350,000,000 for fiscal year 1995 shall be available only

18 for programs in support of equalizing male and female lev19 els of primary and secondary school enrollment.

20 (2) There are authorized to be appropriated

21 $405,000,000 for fiscal year 1994 and $490,000,000 for

22 fiscal year 1995 to the Child Survival Fund under section

23 104(c)(2) of the Foreign Assistance Act of 1961, which

24 amounts shall be available for child survival activities only,
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1 including the Children’s Vaccine Initiative, the worldwide

2 immunization effort, and oral rehydration programs.

3 (3) There are authorized to be appropriated

4 $100,000,000 for the Safe Motherhood Initiative for each

5 of fiscal years 1994 and 1995.

6 (g) DEFINITIONS.—For purposes of this section—

7 (1) the term ‘‘annual country human rights re8 port’’ refers to the report required to be submitted

9 pursuant to section 502B(b) of the Foreign Assist10 ance Act of 1961 (22 U.S.C. 2304(b)); and

11 (2) the term ‘‘United States development and

12 economic assistance’’ means assistance made avail13 able under chapter 1 of part I and chapter 4 of part

14 II of the Foreign Assistance Act of 1961.

15 SEC. 7. AIDS PREVENTION AND CONTROL FUND.

16 (a) IN GENERAL.—Section 104(c) of the Foreign As17 sistance Act of 1961 (22 U.S.C. 2151b(c)) is amended by

18 adding at the end the following new paragraph:

19 ‘‘(4)(A)(i) The President is authorized to provide as20 sistance, under such terms and conditions as he may de21 termine, with respect to activities relating to research on,

22 and the treatment and control of, acquired immune defi23 ciency syndrome (AIDS) in developing countries.

24 ‘‘(ii) Assistance provided under clause (i) shall in25 clude—
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1 ‘‘(I) funds made available directly to the World

2 Health Organization for its use in financing the

3 Global Program on AIDS (including activities imple4 mented by the Pan American Health Organization);

5 and

6 ‘‘(II) funds made available to the United Na7 tions Children’s Fund (UNICEF) for AIDS-related

8 activities.

9 ‘‘(B) Appropriations pursuant to subparagraph (A)

10 may be referred to as the ‘AIDS Prevention and Control

11 Fund’.’’.

12 (b) AUTHORIZATION OF APPROPRIATIONS.—Section

13 104(g)(1) of the Foreign Assistance Act of 1961 (22

14 U.S.C. 2151b(g)) is amended—

15 (1) by striking ‘‘and’’ at the end of subpara16 graph (A);

17 (2) in subparagraph (B), by striking ‘‘sub18 section (c) of this section.’’ and inserting ‘‘sub19 section (c) of this section (other than paragraph (4)

20 thereof); and’’; and

21 (3) by adding at the end thereof the following

22 new subparagraph:

23 ‘‘(C) $100,000,000 for fiscal year 1994

24 and $165,000,000 for fiscal year 1995 to carry

25 out subsection (c)(4) of this section.’’.
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1 (c) EFFECTIVE DATE.—The amendments made by

2 this section shall take effect October 1, 1993.

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