II 

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. 

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 ‘‘Global Child Survival 

5 Act of 2009’’. 

6 SEC. 2. FINDINGS AND PURPOSES. 

7 (a) FINDINGS.—Congress makes the following find8 ings: 


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1 (1) In 2000, the United States joined 188 

2 countries in committing to achieve 8 Millennium De3 velopment Goals (MDGs) by 2015, including ‘‘MDG 

4 4 (Reduce child mortality)’’, which aims to reduce 

5 the mortality rate of children under the age of 5 by 

2 6 ⁄3. 

7 (2) The significant commitment of the United 

8 States to reducing child mortality in the developing 

9 world contributed to a 25 percent reduction in the 

10 mortality rate of children under the age of 5 be11 tween 1990 and 2006, and over the past 20 years, 

12 the United States has invested over $6,000,000,000 

13 in child survival programs run by the United States 

14 Agency for International Development (USAID). In 

15 15 countries in Africa, Asia, and Latin America that 

16 received assistance from USAID, under-5 mortality 

17 declined by an average of 33 percent between 1996 

18 and 2006 alone, with some countries achieving a re19 duction as high as 50 percent. 

20 (3) According to one of the world’s leading 

21 medical journals, the Lancet, despite United States 

22 and global efforts to achieve MDG 4, of the 60 

23 countries that account for 94 percent of under-5 

24 child deaths, ‘‘only seven countries are on track to 

25 meet MDG 4, thirty-nine countries are making some 


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1 progress, although they need to accelerate the speed, 

2 and fourteen countries are cause for serious con3 cern’’. 

4 (4) 8,800,000 children under the age of 5 die 

5 annually, more than 24,000 children per day, mostly 

6 from preventable and treatable causes, including 

7 4,000,000 newborns who die in the first 4 weeks of 

8 life, according to UNICEF. 

9 (5) Pneumonia, diarrhea, low birth weight, sep10 sis, birth trauma, and malaria, all of which are pre11 ventable and treatable diseases, are the top contribu12 tors of deaths of children under the age of 5. 

13 (6) More than 3,000,000 children die each year 

14 due to lack of access to low-cost antibiotics, oral re15 hydration therapy, and antimalarial drugs, and 

16 2,500,000 die from diseases for which vaccines are 

17 readily available. 

18 (7) Nearly 1 of every 5 children die before the 

19 age of 5, more than 2,000,000 deaths per year, in 

20 the 10 countries with the highest child mortality 

21 rates in the world: Sierra Leone, Afghanistan, Chad, 

22 Equatorial Guinea, Guinea-Bissau, Mali, Burkina 

23 Faso, Nigeria, Rwanda, and Burundi. 


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1 (8) Approximately 536,000 women die every 

2 year, 99 percent of them in the developing world, 

3 from causes related to pregnancy and childbirth. 

4 (9) Maternal death rates are inextricably tied to 

5 neonatal survival, with death rates for newborns in6 creasing by 100 percent in some countries in the de7 veloping world following maternal death. 

8 (10) Risk factors for maternal death in devel9 oping countries include pregnancy and childbirth at 

10 an early age, closely spaced births, infectious dis11 eases, malnutrition, and complications during child12 birth. 

(11) According to the Lancet, nearly 2 13 ⁄3 of an14 nual child and newborn deaths, or nearly 6,000,000 

15 children under age 5, can be avoided in accordance 

16 with MDG 4 if a package of high-impact, low-cost 

17 interventions were made available, including oral re18 hydration therapy for diarrhea ($0.54 per course of 

19 treatment) and antibiotics to treat respiratory infec20 tions ($0.71 per course of treatment). 

21 (12) 2,000,000 lives could be saved annually by 

22 providing oral rehydration therapy prepared with 

23 clean water. 

24 (13) According to the World Health Organiza25 tion (WHO), Ready to Use Therapeutic Foods 


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1 (RUTF) have proven to be safe, cost-effective and 

2 highly effective in treating children with severe mal3 nutrition and in facilitating home-based, locally pro4 duced, care regimens. Furthermore, according to the 

5 Journal of the American Medical Association 

6 (JAMA), utilization of RUTF has shown promise in 

7 preventing at-risk children from becoming malnour8 ished. 

9 (14) Exclusive breast feeding—giving only 

10 breast milk for the first 6 months of life—could pre11 vent an estimated 1,400,000 newborn and infant 

12 deaths each year, primarily by protecting against di13 arrhea and pneumonia. 

14 (15) Expansion of clinical care for newborns 

15 and mothers, such as clean delivery by skilled at16 tendants, emergency obstetric care, and essential 

17 newborn care (neonatal resuscitation, infection man18 agement, and special care for low weight newborns) 

19 can avert 50 percent of newborn deaths and reduce 

20 maternal mortality. 

21 (16) Controlling intestinal worms will help pre22 vent 16,000,000 cases of mental retardation and 

23 200,000,000 years of lost primary schooling among 

24 children in developing countries. 


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1 (17) The United Nations Children’s Fund 

2 (UNICEF), with support from the World Health Or3 ganization, the World Bank, and the African Union, 

4 has successfully demonstrated the accelerated child 

5 survival and development program in Senegal, Mali, 

6 Benin, and Ghana, reducing mortality of children 

7 under the age of 5 by 20 percent in targeted areas 

8 using low-cost, high-impact interventions. 

9 (18) The experiences of United States Govern10 ment-supported and nongovernmental organization 

11 maternal and child health programs in countries 

12 such as Nepal, Ethiopia, and Senegal have dem13 onstrated that community-based approaches, linked 

14 to primary and referral care when possible, can de15 liver high-impact interventions to prevent or treat 

16 many of the life-threatening conditions affecting 

17 mothers, newborns, and children under the age of 5. 

18 (19) On January 15, 2009, United States Per19 manent Representative to the United Nations Susan 

20 Rice stated before the Committee on Foreign Rela21 tions of the Senate that President Barack Obama is 

22 committed to ‘‘making the Millennium Development 

23 Goals (MDGs) America’s goals.’’. 

24 (20) Nearing the halfway point of attaining the 

25 MDGs by 2015 with thousands of avoidable newborn 


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1 and child deaths still occurring, the United States 

2 will need to immediately scale up its funding and de3 livery of proven low-cost, life-saving interventions in 

4 order to fulfill its commitment to help ensure that 

5 MDG 4 is met. 

6 (21) More than half of all children and preg7 nant women in developing countries suffer from ane8 mia, which is exacerbated by malaria, neglected 

9 tropical diseases, and nutritional deficits, causing 

10 adverse pregnancy outcomes and even death. Accord11 ing to the United States Agency for International 

12 Development, hemorrhage, hypertensive disorders, 

13 anemia, and sepsis account for 60 percent of all ma14 ternal deaths in the developing world. 

15 (22) According to the World Bank, the number 

16 of orphaned children is expected to rise to 

17 35,000,000 by 2010 due to the legacy of AIDS and 

18 other diseases, war, and high rates of death in preg19 nancy and childbirth. 

20 (23) According to the World Health Organiza21 tion, women that have undergone female genital cut22 ting (FGC) are significantly more likely than those 

23 without FGC to experience serious postpartum 

24 health problems, and children born to mothers who 

25 have undergone FGC face higher death rates immeVerDate Nov 24 2008 03:03 Oct 29, 2009 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1966.IS S1966

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1 diately after birth. According to the United Nations 

2 Interagency Statement on Eliminating Female Gen3 ital Mutilation, programs that include education, 

4 community involvement, public pledges and orga5 nized diffusion have been shown to bring about the 

6 necessary consensus and coordination for the aban7 donment of female genital cutting at the community 

8 level. 

9 (24) According to the Director of National 

10 Intelligence’s (DNI) 2009 Annual Threat Assess11 ment, widespread poor maternal and child health 

12 and malnutrition has the potential to weaken central 

13 governments and empower non-state actors, includ14 ing terrorist and paramilitary groups. 

15 (25) On March 27, 2009, Secretary of State 

16 Hillary Clinton stated, ‘‘Countries with higher infant 

17 mortality rates are more vulnerable to political up18 heaval.’’. 

19 (26) According to UNICEF, relatively inexpen20 sive healthcare interventions, such as immunization 

21 programs, distribution of insecticide-treated bed 

22 nets, and the utilization of micronutrient supple23 ments, have contributed to the lowest under-5 mor24 tality rate since records began in 1960. 

25 (b) PURPOSES.—The purposes of this Act are— 


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1 (1) to develop a strategy to reduce mortality 

2 and improve the health of newborns, children, and 

3 mothers, and authorize assistance for its implemen4 tation; and 

5 (2) to establish a task force to assess, monitor, 

6 and evaluate the progress and contributions of rel7 evant departments and agencies of the United States 

8 Government in achieving MDG 4. 

9 SEC. 3. ASSISTANCE TO IMPROVE THE HEALTH OF 

10 NEWBORNS, CHILDREN, AND MOTHERS IN 

11 DEVELOPING COUNTRIES. 

12 (a) IN GENERAL.—Chapter 1 of part I of the Foreign 

13 Assistance Act of 1961 (22 U.S.C. 2151 et seq.) is amend14 ed— 

15 (1) in section 102(b)(4)(B), by striking ‘‘reduc16 tion of infant mortality’’ and inserting ‘‘reduction of 

17 newborn and child mortality’’; 

18 (2) in section 104(c)— 

19 (A) by striking paragraphs (2) and (3); 

20 and 

21 (B) by redesignating paragraph (4) as 

22 paragraph (2); and 

23 (3) by inserting after section 104C the fol24 lowing new section: 


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1 ‘‘SEC. 104D. ASSISTANCE TO REDUCE MORTALITY AND IM2 PROVE THE HEALTH OF NEWBORNS, CHIL3 DREN, AND MOTHERS. 

4 ‘‘(a) AUTHORIZATION.—Consistent with section 

5 104(c), the President is authorized to furnish assistance, 

6 on such terms and conditions as the President may deter7 mine, to reduce mortality and improve the health of 

8 newborns, children, and mothers in developing countries 

9 and to support efforts to strengthen systems needed to 

10 build a continuum of maternal, newborn, and child health 

11 services and link the formal health system with commu12 nities. 

13 ‘‘(b) ACTIVITIES SUPPORTED.—Assistance provided 

14 under subsection (a) shall, to the maximum extent prac15 ticable, include— 

16 ‘‘(1) activities to improve essential newborn 

17 care and treatment, including tetanus toxoid immu18 nization, breastfeeding, skin-to-skin care, birth as19 phyxia management, and treatment of infections; 

20 ‘‘(2) activities to prevent and treat childhood ill21 ness, including increasing access to appropriate 

22 treatment for diarrhea, pneumonia, malaria, and 

23 other life-threatening childhood illnesses; 

24 ‘‘(3) activities to improve child and maternal 

25 nutrition, including the delivery of iron, zinc, vita26 min A, iodine, and other key micronutrients, the 


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1 promotion of breast feeding and appropriate com2 plementary feeding, and the utilization of Ready to 

3 Use Therapeutic Foods (RUTF) to treat and pre4 vent severe childhood malnutrition that, to the ex5 tent practicable, are developed, purchased or pro6 duced in the country or region that they are utilized; 

7 ‘‘(4) activities to strengthen the delivery of im8 munization services, including efforts to strengthen 

9 routine immunization, introduce new vaccines, and 

10 eliminate polio; 

11 ‘‘(5) activities to improve birth preparedness, 

12 maternity services, and recognition and treatment of 

13 obstetric complications and disabilities, including 

14 both near-term approaches such as household and 

15 facility-based prevention and treatment of post16 partum hemorrhage as well as longer term invest17 ments in human and health system capabilities to 

18 deliver emergency and comprehensive obstetric care; 

19 ‘‘(6) activities to improve household-level behav20 ior related to safe water, hygiene, exposure to indoor 

21 smoke, and environmental toxins such as lead; 

22 ‘‘(7) activities to improve capacity for health 

23 governance, health finance, and the health work24 force, including support for training clinicians, 

25 nurses, technicians, sanitation and public health 


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1 workers, community-based health workers, midwives, 

2 birth attendants, peer educators, volunteers, and pri3 vate sector enterprises; 

4 ‘‘(8) activities to address antimicrobial resist5 ance in treating child and maternal health infec6 tions; 

7 ‘‘(9) activities to establish and support the 

8 management information systems of host country in9 stitutions and the development and use of tools and 

10 models to collect, analyze, and disseminate informa11 tion related to newborn, child, and maternal health; 

12 ‘‘(10) activities to develop and conduct needs 

13 assessments, baseline studies, targeted evaluations, 

14 or other information-gathering efforts for the design, 

15 monitoring, and evaluation of newborn, child, and 

16 maternal health efforts including— 

17 ‘‘(A) studying the effects of critical medi18 cines, particularly those of importance in the 

19 developing world, on pregnant women; and 

20 ‘‘(B) studying the state of orphan care 

21 services; 

22 ‘‘(11) activities to integrate and coordinate as23 sistance provided under this section with existing 

24 health programs for— 


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1 ‘‘(A) the prevention of the transmission of 

2 HIV from mother-to-child and other HIV/AIDS 

3 counseling, care, and treatment activities; 

4 ‘‘(B) malaria; 

5 ‘‘(C) tuberculosis; 

6 ‘‘(D) child spacing; 

7 ‘‘(E) counseling for new mothers and vic8 tims of sexual violence; and 

9 ‘‘(F) neglected tropical diseases; 

10 ‘‘(12) activities to support scholarships to edu11 cate girls through secondary education; 

12 ‘‘(13) activities to improve orphan care services 

13 and to support innovative orphan and vulnerable 

14 children programs; 

15 ‘‘(14) activities to end female genital cutting 

16 through proven programs that combine empowering 

17 human-rights based education, organized diffusion, 

18 and public pledges for FGC abandonment; 

19 ‘‘(15) activities to improve access to clean water 

20 and improved sanitation through community-based 

21 hygiene education programs, the use of personal 

22 water purification tools and devices, and latrine con23 struction; and 


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1 ‘‘(16) activities to prevent, control, and in some 

2 cases eliminate neglected tropical diseases for both 

3 children and mothers. 

4 ‘‘(c) GUIDELINES.—To the maximum extent prac5 ticable, programs, projects, and activities carried out using 

6 assistance provided under this section shall be— 

7 ‘‘(1) carried out through private and voluntary 

8 organizations, including faith-based organizations, 

9 and relevant international and multilateral organiza10 tions, including the GAVI Alliance and UNICEF, 

11 that demonstrate effectiveness and commitment to 

12 improving the health of newborns, children, and 

13 mothers; 

14 ‘‘(2) in all cases possible, carried out in the con15 text of country-led plans in whose development the 

16 United States Government participates along with 

17 other donors and multilateral organizations, non18 government organizations, and civil society; 

19 ‘‘(3) carried out with input by beneficiaries and 

20 other directly affected populations, especially women 

21 and marginalized communities; and 

22 ‘‘(4) designed to build the capacity of host 

23 country governments and civil society organizations. 

24 ‘‘(d) ANNUAL REPORT.—Not later than January 31, 

25 2010, and annually thereafter for 4 years, the President 


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1 shall transmit to Congress a report on the implementation 

2 of this section for the prior fiscal year. The report shall 

3 include the most recent report submitted to the President 

4 by the Interagency Task Force on Child Survival in Devel5 oping Countries under section 5(f) of the Global Child 

6 Survival Act of 2009. 

7 ‘‘(e) DEFINITIONS.—In this section: 

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

9 given the term in section 104A(g)(1) of this Act. 

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

11 given the term in section 104A(g)(2) of this Act. 

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

13 the meaning given the term in section 104A(g)(3) of 

14 this Act.’’. 

15 (b) CONFORMING AMENDMENTS.—The Foreign As16 sistance Act of 1961 (22 U.S.C. 2151 et seq.) is amend17 ed— 

18 (1) in section 104(c)(2) (as redesignated by 

19 subsection (a)(1)(B) of this section), by striking 

20 ‘‘and 104C’’ and inserting ‘‘104C, and 104D’’; 

21 (2) in section 104A— 

22 (A) in subsection (c)(1), by inserting ‘‘and 

23 section 104D’’ after ‘‘section 104(c)’’; and 

24 (B) in subsection (f), by striking ‘‘section 

25 104(c), this section, section 104B, and section 


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1 104C’’ and inserting ‘‘section 104(c), this sec2 tion, section 104B, section 104C, and section 

3 104D’’; 

4 (3) in subsection (c) of section 104B, by insert5 ing ‘‘and section 104D’’ after ‘‘section 104(c)’’; 

6 (4) in subsection (c) of section 104C, by insert7 ing ‘‘and section 104D’’ after ‘‘section 104(c)’’; and 

8 (5) in the first sentence of section 119(c), by 

9 striking ‘‘section 104(c)(2), relating to Child Sur10 vival Fund’’ and inserting ‘‘section 104D’’. 

11 SEC. 4. DEVELOPMENT OF STRATEGY TO REDUCE MOR12 TALITY AND IMPROVE THE HEALTH OF 

13 NEWBORNS, CHILDREN, AND MOTHERS IN 

14 DEVELOPING COUNTRIES. 

15 (a) DEVELOPMENT OF STRATEGY.—The President 

16 shall develop and implement a comprehensive strategy to 

17 reduce mortality and improve the health of newborns, chil18 dren, and mothers in developing countries. 

19 (b) COMPONENTS.—The comprehensive United 

20 States Government strategy developed pursuant to sub21 section (a) shall include the following: 

22 (1) Using data compiled by the United Nations, 

23 the World Bank, and other international organiza24 tions, an identification of not less than 40 countries 

25 with priority needs for the 5-year period beginning 


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1 on the date of the enactment of this Act, to in2 clude— 

3 (A) the number and rate of neonatal 

4 deaths; 

5 (B) the number and rate of child deaths; 

6 and 

7 (C) the number and ratio of maternal 

8 deaths. 

9 (2) For each country identified in paragraph 

10 (1)— 

11 (A) an assessment of the most common 

12 causes of newborn, child, and maternal mor13 tality; 

14 (B) a description of the programmatic 

15 areas and interventions providing maximum 

16 health benefits to populations at risk and max17 imum reduction in mortality; 

18 (C) an assessment of the investments need19 ed in identified programs and interventions to 

20 achieve the greatest results; 

21 (D) a description of how United States as22 sistance complements and leverages efforts by 

23 other donors and builds capacity and self-suffi24 ciency among recipient countries; and 


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1 (E) a description of goals and objectives 

2 for improving newborn, child, and maternal 

3 health, including, to the extent feasible, objec4 tive and quantifiable indicators. 

5 (3) An expansion of the Child Survival and 

6 Health Grants Program of the United States Agency 

7 for International Development, at least propor8 tionate to any increase in child and maternal health 

9 assistance, to provide additional support programs 

10 and interventions determined to be efficacious and 

11 cost-effective. 

12 (4) Enhanced coordination among relevant de13 partments and agencies of the United States Gov14 ernment engaged in activities to improve the health 

15 and well-being of newborns, children, and mothers in 

16 developing countries. 

17 (5) A description of the measured or estimated 

18 impact on child and maternal morbidity and mor19 tality of each project or program. 

20 (c) REPORT.—Not later than 180 days after the date 

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

22 to Congress a report that contains the strategy described 

23 in this section. 


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1 SEC. 5. INTERAGENCY TASK FORCE ON CHILD SURVIVAL IN 

2 DEVELOPING COUNTRIES. 

3 (a) ESTABLISHMENT.—There is established a task 

4 force to be known as the Interagency Task Force on Child 

5 Survival in Developing Countries (in this section referred 

6 to as the ‘‘Task Force’’). 

7 (b) DUTIES.— 

8 (1) IN GENERAL.—The Task Force shall assess, 

9 monitor, and evaluate the progress and contributions 

10 of relevant departments and agencies of the United 

11 States Government in achieving MDG 4 in devel12 oping countries, including by— 

13 (A) identifying and evaluating programs 

14 and interventions that directly or indirectly con15 tribute to the reduction of newborn, child, and 

16 maternal mortality rates; 

17 (B) assessing effectiveness of programs, 

18 interventions, and strategies toward achieving 

19 the maximum reduction of newborn, child, and 

20 maternal mortality rates; 

21 (C) assessing the level of coordination 

22 among relevant departments and agencies of 

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1 tutions, the private sector, and host country for 

2 input and coordination; 

3 (D) assessing the contributions made by 

4 United States-funded programs toward achiev5 ing MDG 4; 

6 (E) identifying the bilateral efforts of other 

7 nations and multilateral efforts toward achiev8 ing MDG 4; and 

9 (F) preparing the annual report required 

10 by subsection (f). 

11 (2) CONSULTATION.—To the maximum extent 

12 practicable, the Task Force shall consult with indi13 viduals with expertise in the matters to be consid14 ered by the Task Force who are not officers or em15 ployees of the United States Government, including 

16 representatives of United States-based nongovern17 mental organizations, the United Nations Children’s 

18 Fund (UNICEF), the World Bank, relevant agencies 

19 of foreign governments, academic institutions, and 

20 private corporations. 

21 (c) MEMBERSHIP.— 

22 (1) NUMBER AND APPOINTMENT.—The Task 

23 Force shall be composed of the following members: 

24 (A) The Administrator of the United 

25 States Agency for International Development. 


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1 (B) The Assistant Secretary of State for 

2 Population, Refugees and Migration. 

3 (C) The Coordinator of United States Gov4 ernment Activities to Combat HIV/AIDS Glob5 ally. 

6 (D) The Director of the Office of Global 

7 Health Affairs of the Department of Health 

8 and Human Services. 

9 (E) The Administrator of the Foreign Ag10 ricultural Service of the Department of Agri11 culture. 

12 (F) The Chief Executive Officer of the Mil13 lennium Challenge Corporation. 

14 (G) Other officials of relevant departments 

15 and agencies of the Federal Government who 

16 shall be appointed by the President. 

17 (H) Two ex officio members appointed by 

18 the Speaker of the House of Representatives in 

19 consultation with the minority leader of the 

20 House of Representatives who may be members 

21 of the private sector or nongovernmental orga22 nization community. 

23 (I) Two ex officio members appointed by 

24 the majority leader of the Senate in consulta25 tion with the minority leader of the Senate who 


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1 may be members of the private sector or non2 governmental organization community. 

3 (J) The Ambassador-at-Large for Global 

4 Women’s Issues. 

5 (2) CHAIRPERSON.—The Administrator of the 

6 United States Agency for International Development 

7 shall serve as chairperson of the Task Force. 

8 (d) MEETINGS.—Members of the Task Force or their 

9 designees shall meet on a regular basis, not less often than 

10 quarterly, on a schedule to be agreed upon by the members 

11 of the Task Force, and starting not later than 90 days 

12 after the date of the enactment of this Act. 

13 (e) DEFINITION.—In this subsection, the term ‘‘Mil14 lennium Development Goals’’ means the key development 

15 objectives described in the United Nations Millennium 

16 Declaration, as contained in United Nations General As17 sembly Resolution 55/2 (September 2000). 

18 (f) REPORT.—Not later than 180 days after the date 

19 of the enactment of this Act and annually thereafter for 

20 4 years, the Task Force shall submit to the President a 

21 report on the implementation of this section. 

22 SEC. 6. AUTHORIZATION OF APPROPRIATIONS. 

23 (a) IN GENERAL.—There are authorized to be appro24 priated to carry out this Act, and the amendments made 

25 by this Act such sums as may be necessary for each of 


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1 fiscal years 2010 through 2014, including such sums as 

2 may be necessary under the development assistance (DA) 

3 account pursuant to section 104D(b)(14) of the Foreign 

4 Assistance Act of 1961, as added by section 3(a)(2). 

5 (b) AVAILABILITY OF FUNDS.—Amounts appro6 priated pursuant to the authorization of appropriations 

7 under subsection (a) are authorized to remain available 

8 until expended. 

Æ 


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