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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1966 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                S. 1966

To provide assistance to improve the health of newborns, children, and 
        mothers in developing countries, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                            October 28, 2009

   Mr. Dodd (for himself, Mr. Corker, and Mr. Durbin) introduced the 
 following bill; which was read twice and referred to the Committee on 
                           Foreign Relations

_______________________________________________________________________

                                 A BILL

 
To provide assistance to improve the health of newborns, children, and 
        mothers in developing countries, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Global Child Survival Act of 2009''.

SEC. 2. FINDINGS AND PURPOSES.

    (a) Findings.--Congress makes the following findings:
            (1) In 2000, the United States joined 188 countries in 
        committing to achieve 8 Millennium Development Goals (MDGs) by 
        2015, including ``MDG 4 (Reduce child mortality)'', which aims 
        to reduce the mortality rate of children under the age of 5 by 
        \2/3\.
            (2) The significant commitment of the United States to 
        reducing child mortality in the developing world contributed to 
        a 25 percent reduction in the mortality rate of children under 
        the age of 5 between 1990 and 2006, and over the past 20 years, 
        the United States has invested over $6,000,000,000 in child 
        survival programs run by the United States Agency for 
        International Development (USAID). In 15 countries in Africa, 
        Asia, and Latin America that received assistance from USAID, 
        under-5 mortality declined by an average of 33 percent between 
        1996 and 2006 alone, with some countries achieving a reduction 
        as high as 50 percent.
            (3) According to one of the world's leading medical 
        journals, the Lancet, despite United States and global efforts 
        to achieve MDG 4, of the 60 countries that account for 94 
        percent of under-5 child deaths, ``only seven countries are on 
        track to meet MDG 4, thirty-nine countries are making some 
        progress, although they need to accelerate the speed, and 
        fourteen countries are cause for serious concern''.
            (4) 8,800,000 children under the age of 5 die annually, 
        more than 24,000 children per day, mostly from preventable and 
        treatable causes, including 4,000,000 newborns who die in the 
        first 4 weeks of life, according to UNICEF.
            (5) Pneumonia, diarrhea, low birth weight, sepsis, birth 
        trauma, and malaria, all of which are preventable and treatable 
        diseases, are the top contributors of deaths of children under 
        the age of 5.
            (6) More than 3,000,000 children die each year due to lack 
        of access to low-cost antibiotics, oral rehydration therapy, 
        and antimalarial drugs, and 2,500,000 die from diseases for 
        which vaccines are readily available.
            (7) Nearly 1 of every 5 children die before the age of 5, 
        more than 2,000,000 deaths per year, in the 10 countries with 
        the highest child mortality rates in the world: Sierra Leone, 
        Afghanistan, Chad, Equatorial Guinea, Guinea-Bissau, Mali, 
        Burkina Faso, Nigeria, Rwanda, and Burundi.
            (8) Approximately 536,000 women die every year, 99 percent 
        of them in the developing world, from causes related to 
        pregnancy and childbirth.
            (9) Maternal death rates are inextricably tied to neonatal 
        survival, with death rates for newborns increasing by 100 
        percent in some countries in the developing world following 
        maternal death.
            (10) Risk factors for maternal death in developing 
        countries include pregnancy and childbirth at an early age, 
        closely spaced births, infectious diseases, malnutrition, and 
        complications during childbirth.
            (11) According to the Lancet, nearly \2/3\ of annual child 
        and newborn deaths, or nearly 6,000,000 children under age 5, 
        can be avoided in accordance with MDG 4 if a package of high-
        impact, low-cost interventions were made available, including 
        oral rehydration therapy for diarrhea ($0.54 per course of 
        treatment) and antibiotics to treat respiratory infections 
        ($0.71 per course of treatment).
            (12) 2,000,000 lives could be saved annually by providing 
        oral rehydration therapy prepared with clean water.
            (13) According to the World Health Organization (WHO), 
        Ready to Use Therapeutic Foods (RUTF) have proven to be safe, 
        cost-effective and highly effective in treating children with 
        severe malnutrition and in facilitating home-based, locally 
        produced, care regimens. Furthermore, according to the Journal 
        of the American Medical Association (JAMA), utilization of RUTF 
        has shown promise in preventing at-risk children from becoming 
        malnourished.
            (14) Exclusive breast feeding--giving only breast milk for 
        the first 6 months of life--could prevent an estimated 
        1,400,000 newborn and infant deaths each year, primarily by 
        protecting against diarrhea and pneumonia.
            (15) Expansion of clinical care for newborns and mothers, 
        such as clean delivery by skilled attendants, emergency 
        obstetric care, and essential newborn care (neonatal 
        resuscitation, infection management, and special care for low 
        weight newborns) can avert 50 percent of newborn deaths and 
        reduce maternal mortality.
            (16) Controlling intestinal worms will help prevent 
        16,000,000 cases of mental retardation and 200,000,000 years of 
        lost primary schooling among children in developing countries.
            (17) The United Nations Children's Fund (UNICEF), with 
        support from the World Health Organization, the World Bank, and 
        the African Union, has successfully demonstrated the 
        accelerated child survival and development program in Senegal, 
        Mali, Benin, and Ghana, reducing mortality of children under 
        the age of 5 by 20 percent in targeted areas using low-cost, 
        high-impact interventions.
            (18) The experiences of United States Government-supported 
        and nongovernmental organization maternal and child health 
        programs in countries such as Nepal, Ethiopia, and Senegal have 
        demonstrated that community-based approaches, linked to primary 
        and referral care when possible, can deliver high-impact 
        interventions to prevent or treat many of the life-threatening 
        conditions affecting mothers, newborns, and children under the 
        age of 5.
            (19) On January 15, 2009, United States Permanent 
        Representative to the United Nations Susan Rice stated before 
        the Committee on Foreign Relations of the Senate that President 
        Barack Obama is committed to ``making the Millennium 
        Development Goals (MDGs) America's goals.''.
            (20) Nearing the halfway point of attaining the MDGs by 
        2015 with thousands of avoidable newborn and child deaths still 
        occurring, the United States will need to immediately scale up 
        its funding and delivery of proven low-cost, life-saving 
        interventions in order to fulfill its commitment to help ensure 
        that MDG 4 is met.
            (21) More than half of all children and pregnant women in 
        developing countries suffer from anemia, which is exacerbated 
        by malaria, neglected tropical diseases, and nutritional 
        deficits, causing adverse pregnancy outcomes and even death. 
        According to the United States Agency for International 
        Development, hemorrhage, hypertensive disorders, anemia, and 
        sepsis account for 60 percent of all maternal deaths in the 
        developing world.
            (22) According to the World Bank, the number of orphaned 
        children is expected to rise to 35,000,000 by 2010 due to the 
        legacy of AIDS and other diseases, war, and high rates of death 
        in pregnancy and childbirth.
            (23) According to the World Health Organization, women that 
        have undergone female genital cutting (FGC) are significantly 
        more likely than those without FGC to experience serious 
        postpartum health problems, and children born to mothers who 
        have undergone FGC face higher death rates immediately after 
        birth. According to the United Nations Interagency Statement on 
        Eliminating Female Genital Mutilation, programs that include 
        education, community involvement, public pledges and organized 
        diffusion have been shown to bring about the necessary 
        consensus and coordination for the abandonment of female 
        genital cutting at the community level.
            (24) According to the Director of National Intelligence's 
        (DNI) 2009 Annual Threat Assessment, widespread poor maternal 
        and child health and malnutrition has the potential to weaken 
        central governments and empower non-state actors, including 
        terrorist and paramilitary groups.
            (25) On March 27, 2009, Secretary of State Hillary Clinton 
        stated, ``Countries with higher infant mortality rates are more 
        vulnerable to political upheaval.''.
            (26) According to UNICEF, relatively inexpensive healthcare 
        interventions, such as immunization programs, distribution of 
        insecticide-treated bed nets, and the utilization of 
        micronutrient supplements, have contributed to the lowest 
        under-5 mortality rate since records began in 1960.
    (b) Purposes.--The purposes of this Act are--
            (1) to develop a strategy to reduce mortality and improve 
        the health of newborns, children, and mothers, and authorize 
        assistance for its implementation; and
            (2) to establish a task force to assess, monitor, and 
        evaluate the progress and contributions of relevant departments 
        and agencies of the United States Government in achieving MDG 
        4.

SEC. 3. ASSISTANCE TO IMPROVE THE HEALTH OF NEWBORNS, CHILDREN, AND 
              MOTHERS IN DEVELOPING COUNTRIES.

    (a) In General.--Chapter 1 of part I of the Foreign Assistance Act 
of 1961 (22 U.S.C. 2151 et seq.) is amended--
            (1) in section 102(b)(4)(B), by striking ``reduction of 
        infant mortality'' and inserting ``reduction of newborn and 
        child mortality'';
            (2) in section 104(c)--
                    (A) by striking paragraphs (2) and (3); and
                    (B) by redesignating paragraph (4) as paragraph 
                (2); and
            (3) by inserting after section 104C the following new 
        section:

``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 and to 
support efforts to strengthen systems needed to build a continuum of 
maternal, newborn, and child health services and link the formal health 
system with communities.
    ``(b) Activities Supported.--Assistance provided under subsection 
(a) shall, to the maximum extent practicable, include--
            ``(1) activities to improve essential newborn care and 
        treatment, including tetanus toxoid immunization, 
        breastfeeding, skin-to-skin care, birth asphyxia management, 
        and treatment of infections;
            ``(2) activities to prevent and treat childhood illness, 
        including increasing access to appropriate treatment for 
        diarrhea, pneumonia, malaria, and other life-threatening 
        childhood illnesses;
            ``(3) activities to improve child and maternal nutrition, 
        including the delivery of iron, zinc, vitamin A, iodine, and 
        other key micronutrients, the promotion of breast feeding and 
        appropriate complementary feeding, and the utilization of Ready 
        to Use Therapeutic Foods (RUTF) to treat and prevent severe 
        childhood malnutrition that, to the extent practicable, are 
        developed, purchased or produced in the country or region that 
        they are utilized;
            ``(4) activities to strengthen the delivery of immunization 
        services, including efforts to strengthen routine immunization, 
        introduce new vaccines, and eliminate polio;
            ``(5) activities to improve birth preparedness, maternity 
        services, and recognition and treatment of obstetric 
        complications and disabilities, including both near-term 
        approaches such as household and facility-based prevention and 
        treatment of post-partum hemorrhage as well as longer term 
        investments in human and health system capabilities to deliver 
        emergency and comprehensive obstetric care;
            ``(6) activities to improve household-level behavior 
        related to safe water, hygiene, exposure to indoor smoke, and 
        environmental toxins such as lead;
            ``(7) activities to improve capacity for health governance, 
        health finance, and the health workforce, 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;
            ``(8) activities to address antimicrobial resistance in 
        treating child and maternal health infections;
            ``(9) 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;
            ``(10) activities to develop and conduct needs assessments, 
        baseline studies, targeted evaluations, or other information-
        gathering efforts for the design, monitoring, and evaluation of 
        newborn, child, and maternal health efforts including--
                    ``(A) studying the effects of critical medicines, 
                particularly those of importance in the developing 
                world, on pregnant women; and
                    ``(B) studying the state of orphan care services;
            ``(11) 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;
                    ``(D) child spacing;
                    ``(E) counseling for new mothers and victims of 
                sexual violence; and
                    ``(F) neglected tropical diseases;
            ``(12) activities to support scholarships to educate girls 
        through secondary education;
            ``(13) activities to improve orphan care services and to 
        support innovative orphan and vulnerable children programs;
            ``(14) activities to end female genital cutting through 
        proven programs that combine empowering human-rights based 
        education, organized diffusion, and public pledges for FGC 
        abandonment;
            ``(15) activities to improve access to clean water and 
        improved sanitation through community-based hygiene education 
        programs, the use of personal water purification tools and 
        devices, and latrine construction; and
            ``(16) activities to prevent, control, and in some cases 
        eliminate neglected tropical diseases for both children and 
        mothers.
    ``(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 and UNICEF, that demonstrate 
        effectiveness and commitment to improving the health of 
        newborns, children, and mothers;
            ``(2) in all cases possible, carried out in the context of 
        country-led plans in whose development the United States 
        Government participates along with other donors and 
        multilateral organizations, non-government organizations, and 
        civil society;
            ``(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, 2010, 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 in Developing 
Countries under section 5(f) of the Global Child Survival Act of 2009.
    ``(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.''.
    (b) Conforming Amendments.--The Foreign Assistance Act of 1961 (22 
U.S.C. 2151 et seq.) is amended--
            (1) in section 104(c)(2) (as redesignated by subsection 
        (a)(1)(B) of this section), by striking ``and 104C'' and 
        inserting ``104C, and 104D'';
            (2) in section 104A--
                    (A) in subsection (c)(1), by inserting ``and 
                section 104D'' after ``section 104(c)''; and
                    (B) in subsection (f), by striking ``section 
                104(c), this section, section 104B, and section 104C'' 
                and inserting ``section 104(c), this section, section 
                104B, section 104C, and section 104D'';
            (3) in subsection (c) of section 104B, by inserting ``and 
        section 104D'' after ``section 104(c)'';
            (4) in subsection (c) of section 104C, by inserting ``and 
        section 104D'' after ``section 104(c)''; and
            (5) in the first sentence of section 119(c), by striking 
        ``section 104(c)(2), relating to Child Survival Fund'' and 
        inserting ``section 104D''.

SEC. 4. DEVELOPMENT OF STRATEGY TO REDUCE MORTALITY AND IMPROVE THE 
              HEALTH OF NEWBORNS, CHILDREN, AND MOTHERS IN DEVELOPING 
              COUNTRIES.

    (a) Development of Strategy.--The President shall develop and 
implement a comprehensive strategy to reduce mortality and improve the 
health of newborns, children, and mothers in developing countries.
    (b) Components.--The comprehensive United States Government 
strategy developed pursuant to subsection (a) shall include the 
following:
            (1) Using data compiled by the United Nations, the World 
        Bank, and other international organizations, an identification 
        of not less than 40 countries with priority needs for the 5-
        year period beginning on the date of the enactment of this Act, 
        to include--
                    (A) the number and rate of neonatal deaths;
                    (B) the number and rate of child deaths; and
                    (C) the number and ratio of maternal deaths.
            (2) For each country identified in paragraph (1)--
                    (A) an assessment of the most common causes of 
                newborn, child, and maternal mortality;
                    (B) a description of the programmatic areas and 
                interventions providing maximum health benefits to 
                populations at risk and maximum reduction in mortality;
                    (C) an assessment of the investments needed in 
                identified programs and interventions to achieve the 
                greatest results;
                    (D) a description of how United States assistance 
                complements and leverages efforts by other donors and 
                builds capacity and self-sufficiency among recipient 
                countries; and
                    (E) a description of goals and objectives for 
                improving newborn, child, and maternal health, 
                including, to the extent feasible, objective and 
                quantifiable indicators.
            (3) An expansion of the Child Survival and Health Grants 
        Program of the United States Agency for International 
        Development, at least proportionate to any increase in child 
        and maternal health assistance, to provide additional support 
        programs and interventions determined to be efficacious and 
        cost-effective.
            (4) Enhanced coordination among relevant departments and 
        agencies of the United States Government engaged in activities 
        to improve the health and well-being of newborns, children, and 
        mothers in developing countries.
            (5) A description of the measured or estimated impact on 
        child and maternal morbidity and mortality of each project or 
        program.
    (c) Report.--Not later than 180 days after the date of the 
enactment of this Act, the President shall transmit to Congress a 
report that contains the strategy described in this section.

SEC. 5. INTERAGENCY TASK FORCE ON CHILD SURVIVAL IN DEVELOPING 
              COUNTRIES.

    (a) Establishment.--There is established a task force to be known 
as the Interagency Task Force on Child Survival in Developing Countries 
(in this section referred to as the ``Task Force'').
    (b) Duties.--
            (1) In general.--The Task Force shall assess, monitor, and 
        evaluate the progress and contributions of relevant departments 
        and agencies of the United States Government in achieving MDG 4 
        in developing countries, including by--
                    (A) identifying and evaluating programs and 
                interventions that directly or indirectly contribute to 
                the reduction of newborn, child, and maternal mortality 
                rates;
                    (B) assessing effectiveness of programs, 
                interventions, and strategies toward achieving the 
                maximum reduction of newborn, child, and maternal 
                mortality rates;
                    (C) assessing the level of coordination among 
                relevant departments and agencies of the United States 
                Government, the international community, international 
                organizations, faith-based organizations, academic 
                institutions, the private sector, and host country for 
                input and coordination;
                    (D) assessing the contributions made by United 
                States-funded programs toward achieving MDG 4;
                    (E) identifying the bilateral efforts of other 
                nations and multilateral efforts toward achieving MDG 
                4; and
                    (F) preparing the annual report required by 
                subsection (f).
            (2) Consultation.--To the maximum extent practicable, the 
        Task Force shall consult with individuals with expertise in the 
        matters to be considered by the Task Force who are not officers 
        or employees of the United States Government, including 
        representatives of United States-based nongovernmental 
        organizations, the United Nations Children's Fund (UNICEF), the 
        World Bank, relevant agencies of foreign governments, academic 
        institutions, and private corporations.
    (c) Membership.--
            (1) Number and appointment.--The Task Force shall be 
        composed of the following members:
                    (A) The Administrator of the United States Agency 
                for International Development.
                    (B) The Assistant Secretary of State for 
                Population, Refugees and Migration.
                    (C) The Coordinator of United States Government 
                Activities to Combat HIV/AIDS Globally.
                    (D) The Director of the Office of Global Health 
                Affairs of the Department of Health and Human Services.
                    (E) The Administrator of the Foreign Agricultural 
                Service of the Department of Agriculture.
                    (F) The Chief Executive Officer of the Millennium 
                Challenge Corporation.
                    (G) Other officials of relevant departments and 
                agencies of the Federal Government who shall be 
                appointed by the President.
                    (H) Two ex officio members appointed by the Speaker 
                of the House of Representatives in consultation with 
                the minority leader of the House of Representatives who 
                may be members of the private sector or nongovernmental 
                organization community.
                    (I) Two ex officio members appointed by the 
                majority leader of the Senate in consultation with the 
                minority leader of the Senate who may be members of the 
                private sector or nongovernmental organization 
                community.
                    (J) The Ambassador-at-Large for Global Women's 
                Issues.
            (2) Chairperson.--The Administrator of the United States 
        Agency for International Development shall serve as chairperson 
        of the Task Force.
    (d) Meetings.--Members of the Task Force or their designees shall 
meet on a regular basis, not less often than quarterly, on a schedule 
to be agreed upon by the members of the Task Force, and starting not 
later than 90 days after the date of the enactment of this Act.
    (e) Definition.--In this subsection, the term ``Millennium 
Development Goals'' means the key development objectives described in 
the United Nations Millennium Declaration, as contained in United 
Nations General Assembly Resolution 55/2 (September 2000).
    (f) Report.--Not later than 180 days after the date of the 
enactment of this Act and annually thereafter for 4 years, the Task 
Force shall submit to the President a report on the implementation of 
this section.

SEC. 6. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--There are authorized to be appropriated to carry 
out this Act, and the amendments made by this Act such sums as may be 
necessary for each of fiscal years 2010 through 2014, including such 
sums as may be necessary under the development assistance (DA) account 
pursuant to section 104D(b)(14) of the Foreign Assistance Act of 1961, 
as added by section 3(a)(2).
    (b) Availability of Funds.--Amounts appropriated pursuant to the 
authorization of appropriations under subsection (a) are authorized to 
remain available until expended.
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