I 

112TH CONGRESS 

1ST SESSION H. R. 1319 

To promote the sexual and reproductive health of individuals and couples 

in developing countries, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 1, 2011 

Ms. CLARKE of New York (for herself, Mr. GRIJALVA, Ms. CHU, Mr. PAYNE, 

Ms. WILSON of Florida, Mrs. DAVIS of California, Mr. MORAN, Mr. MARKEY, Mr. RANGEL, Mr. ENGEL, Mrs. MALONEY, Mr. COHEN, Ms. 

SPEIER, Ms. SCHAKOWSKY, Mr. GUTIERREZ, Mr. HOLT, Ms. DEGETTE, 

Ms. HIRONO, Ms. BROWN of Florida, Mr. STARK, Mr. HONDA, Mr. 

TOWNS, Ms. MOORE, Ms. BALDWIN, Mr. CONYERS, Ms. MATSUI, Ms. 

WOOLSEY, Mr. RUSH, Ms. RICHARDSON, Mr. FILNER, Mr. CLAY, Mr. 

MCGOVERN, Mr. JOHNSON of Georgia, Mrs. CAPPS, Mr. QUIGLEY, Mr. 

BLUMENAUER, Ms. WASSERMAN SCHULTZ, Mr. MCDERMOTT, and Ms. 

LORETTA SANCHEZ of California) introduced the following bill; which was 

referred to the Committee on Foreign Affairs 

A BILL 

To promote the sexual and reproductive health of individuals 

and couples 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 Sexual and Re5 productive Health Act of 2011’’. 


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1 SEC. 2. FINDINGS AND PURPOSES. 

2 (a) FINDINGS.—Congress makes the following find3 ings: 

4 (1) The advancement of sexual and reproduc5 tive health is necessary to meeting most of the eight 

6 United Nations Millennium Development Goals 

7 (MDGs), the current international development 

8 framework developed by 189 countries in 2000, in9 cluding the United States. Target 5B, which is 

10 found under MDG 5 on improving maternal health 

11 and which requires achieving universal access to re12 productive health by the year 2015, is an essential 

13 element in attaining MDGs related to eradicating 

14 poverty (MDG 1), achieving universal education 

15 (MDG 2), promoting gender equality (MDG 3), re16 ducing child mortality (MDG 4), improving maternal 

17 health (MDG 5), combating HIV/AIDS (MDG 6), 

18 and ensuring environmental sustainability (MDG 7). 

19 (2) The report of the United Nations Secretary20 General to the 2009 Commission on Population and 

21 Development ‘‘. . . reaffirms that population, repro22 ductive health and gender issues are central to devel23 opment and to the achievement of the Millennium 

24 Development Goals.’’. 

25 (3) Throughout much of the world, the lack of 

26 access of women, particularly poor women, to basic 


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1 reproductive health services and information contrib2 utes to death and suffering among women and their 

3 families, undermines women’s struggle for self-deter4 mination, and vitiates the efforts of families to lift 

5 themselves out of the poverty in which over a billion 

6 of the world’s people live. By allowing individuals 

7 and couples to choose the number and timing of 

8 their children, reproductive health care gives families 

9 and individuals greater control over their economic 

10 resources. 

11 (4) Aspects of sexual and reproductive health, 

12 including maternal mortality and morbidity, repro13 ductive cancers, and sexually transmitted infections 

14 (STIs), including HIV, account for nearly 20 per15 cent of the global burden of ill-health for women and 

16 some 14 percent for men, according to the World 

17 Health Organization (WHO). 

18 (5) According to the Joint United Nations Pro19 gramme on HIV/AIDS (UNAIDS), HIV/AIDS is 

20 the leading cause of death among women of child21 bearing age. 

22 (6) School-based education and family planning 

23 play an interrelated role in lifting the status of 

24 women. Delaying sexual debut, along with contracep25 tive use among young women already sexually active, 


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1 lowers the likelihood that young women will leave 

2 their schooling due to pregnancy, and education in3 creases the chances that young women will delay the 

4 age at which they marry and give birth. 

5 (7) Sexual and reproductive health programs 

6 can empower women to make informed decisions and 

7 better control their lives, and by engaging men and 

8 boys in taking responsibility for the sexual and re9 productive health of their partners, can contribute to 

10 greater gender equality. 

11 (8) Access to sexual and reproductive health 

12 services, including family planning, has a direct and 

13 important impact on infant and child mortality. By 

14 allowing women to choose the timing, number, and 

15 spacing of their pregnancies, high-risk births are 

16 averted, and the children that are born have a great17 er chance of surviving to adulthood. Three million 

18 newborns die in the first 4 weeks of life, which ac19 counts for 38 percent of all deaths of children under 

20 the age of 5. By providing women family planning 

21 services to space their births 3 years apart, rates for 

22 infant and under-5 mortality would drop by 24 per23 cent and 35 percent, respectively. 

24 (9) Increasing access to sexual and reproductive 

25 health could significantly decrease pregnancy-related 


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1 mortality and morbidity by reducing the number of 

2 pregnancies that place women at increased risk of 

3 experiencing such complications. 

4 (10) An estimated 215,000,000 women in devel5 oping countries have an unmet need for effective, 

6 modern contraceptives and would like to postpone 

7 childbearing, space births, or want no more children 

8 but are not using a modern method of contraception. 

9 Providing modern contraceptives to fill this unmet 

10 need would avert an estimated 53,000,000 unin11 tended pregnancies each year. Simultaneously meet12 ing the need for both family planning and maternal 

13 and newborn health services would save the lives of 

14 251,000 women and 1,700,000 newborns, and pre15 vent 14,500,000 unsafe abortions. 

16 (11) Complications due to pregnancy and child17 birth are the leading cause of death among women 

18 ages 15 to 19. Each year, an estimated 356,000 

19 women worldwide die from complications related to 

20 pregnancy, childbirth, or unsafe abortion. 

21 (12) Unsafe abortion accounts for 13 percent of 

22 maternal deaths worldwide. More than half of abor23 tions (55 percent) in the developing world are un24 safe. Of the 20,000,000 unsafe abortions that take 

25 place each year, nearly all occur in the developing 


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1 world. Around 46,000 women die and millions more 

2 suffer serious injuries from the complications of 

3 unsafely performed abortions. Abortion rates are 

4 similar in countries whether abortion is illegal or 

5 legal. However, death and injury from unsafe abor6 tion is greatly reduced where abortion is legal for a 

7 broad range of indications and where safe abortion 

8 is accessible. 

9 (13) Meeting the need for family planning serv10 ices and pregnancy-related care, by doubling the cur11 rent global investment for both, would reduce mater12 nal mortality by more than two-thirds and deaths to 

13 newborns by more than half. These goals can be 

14 achieved for $1,500,000,000 less than the cost of 

15 achieving maternal and newborn health alone. Every 

16 dollar invested in family planning saves $1.40 in ma17 ternal and newborn health care services. 

18 (14) Worldwide, women of childbearing age ac19 count for more than half of people living with HIV/ 

20 AIDS. Integrating reproductive health services, in21 cluding family planning, with HIV prevention pro22 grams, such as those for voluntary counseling and 

23 testing and prevention of mother-to-child trans24 mission, is essential to effectively combating HIV/ 

25 AIDS and other STIs. 


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1 (15) The world is witnessing the largest genera2 tion of young people in history—almost half of the 

3 world’s population, approximately 3,000,000,000 

4 people, are under the age of 25. Unmet need for sex5 ual and reproductive health services is highest 

6 among this age cohort. Fewer than 5 percent of the 

7 poorest sexually active youth use modern contracep8 tion. 

9 (16) The WHO has identified unsafe sex as the 

10 second most important risk factor for disability and 

11 death among young people in the world’s poorest 

12 communities. Forty-one percent of all new HIV in13 fections occur among young people. 

14 (17) Sixty percent of unsafe abortions in Afri15 ca, 42 percent in Latin America and the Caribbean, 

16 and 30 percent in Asia are performed on women 

17 under the age of 25. 

18 (18) The WHO has identified a 4-pronged ap19 proach to preventing HIV infection in infants, which 

20 includes prevention of unintended pregnancy among 

21 HIV-infected women as a key strategy to prevent 

22 mother-to-child transmission of HIV. 

23 (19) According to the United States Agency for 

24 International Development, enabling HIV-positive 

25 women who want to avoid a pregnancy with contraVerDate Mar 15 2010 03:36 Apr 05, 2011 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1319.IH H1319

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1 ceptive services can prevent an additional 55,000 

2 child deaths and avert more than 150,000 unin3 tended pregnancies in high HIV prevalence coun4 tries. 

5 (20) Demographic factors exacerbate problems 

6 related to environmental sustainability. The past 

7 century of population growth has put increasing 

8 pressure on natural resources as the scale of human 

9 needs and activities expands. At the same time, ac10 tual family size in most developing countries remains 

11 greater than the desired family size. Access to family 

12 planning services helps couples to determine their 

13 own family size, hence mitigating the depletion of 

14 natural resources like clean water, air, and land. 

15 (21) Practices like early marriage, female gen16 ital mutilation, and early sexual debut adversely im17 pact the sexual and reproductive health of young 

18 people in many developing countries, and strong bar19 riers exist to providing the information, services, and 

20 other forms of support that young people need to 

21 lead healthy sexual and reproductive lives. 

22 (22) Comprehensive sexuality education seeks 

23 to help young people develop the interpersonal skills 

24 necessary for the formation of caring, supportive, 

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1 cise responsibility regarding sexual relationships by 

2 addressing such issues as abstinence and the use of 

3 condoms, contraceptives, and other protective sexual 

4 health measures. 

5 (23) The United Nations has estimated that the 

6 minimum financial requirements for sexual and re7 productive health, including family planning and ma8 ternal health, are roughly $23,500,000,000 in 2009 

9 and increase to approximately $33,000,000,000 in 

10 2015. The minimum financial requirement for HIV/ 

11 AIDS is estimated at $24,000,000,000 in 2009, and 

12 increases to $36,200,000,000 in 2015. As agreed in 

13 the International Conference on Population and De14 velopment’s Programme of Action, which the United 

15 States committed to, developed-country donors are 

16 responsible for one-third of the total cost needed per 

17 year. Developing countries are responsible for the re18 maining two-thirds, on average, with low income 

19 countries requiring a larger share of external fund20 ing. 

21 (24) The United States has had a history of 

22 supporting and recognizing the fundamental health 

23 and human rights of all people through the signing 

24 or ratifying of various international agreements. 

25 Those agreements include the Universal Declaration 


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1 of Human Rights (1948), the International Cov2 enant on Civil and Political Rights (1966), the 

3 International Covenant on Economic, Social, and 

4 Cultural Rights (1966), the Convention on the 

5 Elimination of All Forms of Discrimination Against 

6 Women (1979), the Convention on the Rights of the 

7 Child (1989), the International Conference on Popu8 lation and Development Programme of Action 

9 (1994), and the United Nations Millennium Devel10 opment Goals (2000). 

11 (25) The United States has been the largest 

12 donor to international family planning and reproduc13 tive health efforts over the last 40 years and has 

14 been an unparalleled source of leadership and inno15 vation in the field. Nonetheless, it has not met its 

16 fair share of financial assistance to global sexual and 

17 reproductive health programs. Now is the time to 

18 shore up the United States political and financial 

19 commitment in order to satisfy the large unmet need 

20 for these services, thereby helping to improve wom21 en’s sexual and reproductive health worldwide. 

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

23 (1) authorize assistance to improve the sexual 

24 and reproductive health of individuals and couples in 

25 developing countries; and 


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1 (2) implement comprehensive sexual and repro2 ductive health programs offering a continuum of 

3 care that are responsive to the sexual and reproduc4 tive health needs of young people and adults. 

5 SEC. 3. STATEMENT OF POLICY. 

6 The following shall be the policy of the United States 

7 Government: 

8 (1) All individuals and couples shall have the 

9 basic reproductive right to decide freely and respon10 sibly the number, spacing, and timing of their chil11 dren and shall have the information and means to 

12 do so, and the right to attain the highest standard 

13 of sexual and reproductive health. 

14 (2) All individuals and couples also shall have 

15 the right to make decisions concerning reproduction 

16 free of discrimination, coercion, and violence, as ex17 pressed in human rights documents. 

18 (3) The promotion of the responsible exercise of 

19 these reproductive rights for all people shall be the 

20 fundamental basis for sexual and reproductive health 

21 programs supported by United States Government 

22 assistance. 

23 (4) The principle of free and informed consent 

24 must underlie all sexual and reproductive health pro25 grams and services. This principle applies to individVerDate Mar 15 2010 03:36 Apr 05, 2011 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1319.IH H1319

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1 uals whether they choose to continue or terminate 

2 their pregnancies—thus, forced pregnancies as well 

3 as forced abortions or sterilizations are prohibited. 

4 Decisions relating to contraceptive use should be 

5 made on an informed and voluntary basis after ade6 quate information, counseling, and services are pro7 vided on a range of methods. 

8 (5) Incentives and disincentives should not be 

9 used in family planning programs in order to meet 

10 numerical population targets or quotas for fertility 

11 goals. Instead, governments should use other indica12 tors, such as unmet needs, to define family planning 

13 goals. 

14 (6) In sexual and reproductive health programs 

15 funded by the United States Government, special at16 tention should be paid to serving the needs of young 

17 people. 

18 SEC. 4. ASSISTANCE TO SUPPORT THE ACHIEVEMENT OF 

19 UNIVERSAL ACCESS TO SEXUAL AND REPRO20 DUCTIVE HEALTH. 

21 (a) ASSISTANCE AUTHORIZED.—The President is au22 thorized to provide assistance in order to support the 

23 achievement of universal access to sexual and reproductive 

24 health in developing countries and to ensure individuals 

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1 sibly determine the number, timing, and spacing of their 

2 children and have the means to do so. 

3 (b) ACTIVITIES SUPPORTED.—Assistance provided 

4 under subsection (a) may be used to— 

5 (1) expand access to and use of voluntary fam6 ily planning information and services, to enable indi7 viduals and couples to avoid unintended pregnancies 

8 and other risks to sexual and reproductive health, 

9 including those associated with pregnancy, reproduc10 tive tract infections, and sexually transmitted infec11 tions (STIs), including HIV; 

12 (2) improve public knowledge of contraceptives, 

13 including where methods may be obtained, and risk14 reduction strategies, and to promote the benefits of 

15 family planning and other sexual and reproductive 

16 health care to individuals, families, and commu17 nities, including through the use of education and 

18 awareness programs, mass media, and community 

19 mobilization and outreach; 

20 (3) increase the responsiveness of sexual and 

21 reproductive health programs to the needs of the in22 tended beneficiaries during the entirety of their sex23 ual and reproductive lives, including young people 

24 and older adults; 


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1 (4) reduce the incidence of unsafe abortion, in2 cluding research on the health consequences of un3 safe abortion, and provide for the equipment and 

4 training necessary for medical treatment of the con5 sequences of unsafe abortions; 

6 (5) notwithstanding any other provision of law, 

7 provide safe abortion, to the extent permitted by the 

8 laws of the recipient country; 

9 (6) promote the integration of family planning 

10 services in HIV and other STI prevention, treat11 ment, care, and support; 

12 (7) integrate family planning services with ma13 ternal and newborn health care, especially in 

14 antenatal, post-partum, and post-abortion care set15 tings; 

16 (8) ensure the consistent availability and af17 fordability of high-quality sexual and reproductive 

18 health supplies and services, including male and fe19 male condoms, for the prevention of HIV and other 

20 STIs; 

21 (9) encourage the abandonment of female gen22 ital mutilation, early marriage, early childbearing, 

23 and other harmful traditional practices that have 

24 negative reproductive health consequences; 

25 (10) prevent and repair obstetric fistula; 


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1 (11) promote the constructive engagement of 

2 men and boys, the empowerment of women and 

3 girls, and more equitable gender norms in order to 

4 improve health outcomes and support the adoption 

5 of healthy reproductive behaviors; 

6 (12) prevent and mitigate gender-based vio7 lence; 

8 (13) provide comprehensive sexuality education 

9 for young people; 

10 (14) prevent, diagnose, and treat, where appro11 priate, infertility and cancers of the reproductive 

12 system and refer as appropriate; 

13 (15) develop improved methods of safe and ef14 fective contraception and related disease control 

15 through investments in biomedical research, with 

16 particular emphasis on methods which— 

17 (A) are likely to be safer, easier to use, 

18 more efficient to make available in developing 

19 country settings, and less expensive than cur20 rent methods; 

21 (B) are controlled by women, including 

22 barrier methods and microbicides; 

23 (C) are likely to prevent the spread of 

24 STIs; and 


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1 (D) encourage and enable men to take 

2 greater responsibility for their own fertility and 

3 the protection of their partner; 

4 (16) support an enabling environment for 

5 women to access sexual and reproductive health care 

6 services by working with communities to identify and 

7 lower or remove barriers to access, including finan8 cial, gender, socio-cultural, and transportation bar9 riers; 

10 (17) train health care professionals on edu11 cating individuals, including young people, about 

12 their sexual and reproductive health care options, in13 cluding family planning options; and 

14 (18) foster conditions to create favorable policy 

15 environments, improve quality, strengthen systems, 

16 and contribute to the sustainability of family plan17 ning and other reproductive health programs. 

18 SEC. 5. ASSISTANCE TO REDUCE THE INCIDENCE OF UN19 SAFE ABORTION AND ITS CONSEQUENCES. 

20 (a) ASSISTANCE AUTHORIZED.—The President is au21 thorized to provide assistance to reduce the incidence of 

22 unsafe abortion in developing countries and provide care 

23 for women experiencing injury or illness from complica24 tions of unsafe abortion in developing countries. 


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1 (b) ACTIVITIES SUPPORTED.—Assistance provided 

2 under subsection (a) shall be used to— 

3 (1) ensure access to family planning services to 

4 prevent unintended pregnancies; 

5 (2) ensure that women who experience an unin6 tended pregnancy have access to reliable information 

7 and compassionate counseling on all of their options, 

8 including access to antenatal care and safe abortion 

9 when permitted by the laws of the recipient country; 

10 (3) where local laws permit abortion, support 

11 safe abortion services, including referrals, and sup12 port the training of abortion providers and the nec13 essary equipment and commodities for surgical and 

14 medical abortion; and 

15 (4) support emergency treatment for complica16 tions of induced or spontaneous abortion, including 

17 provision of services and training and equipping of 

18 providers. 

19 (c) ELIGIBILITY FOR ASSISTANCE.—Notwithstanding 

20 any other provision of law, regulation, or policy, in deter21 mining eligibility for assistance authorized under this sec22 tion, sections 104, 104A, 104B, and 104C of the Foreign 

23 Assistance Act of 1961 (22 U.S.C. 2151b, 2151b–2, 

24 2151b–3, and 2151b–4), foreign nongovernmental organi25 zations— 


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1 (1) shall not be ineligible for such assistance 

2 solely on the basis of health or medical services, in3 cluding counseling and referral services, provided by 

4 such organizations with non-United States Govern5 ment funds if such services are permitted in the 

6 country in which they are being provided and would 

7 not violate United States Federal law if provided in 

8 the United States; and 

9 (2) shall not be subject to requirements relating 

10 to the use of non-United States Government funds 

11 for advocacy and lobbying activities other than those 

12 that apply to United States nongovernmental organi13 zations receiving assistance under part I of the For14 eign Assistance Act of 1961. 

15 SEC. 6. ASSISTANCE TO PROVIDE SEXUAL AND REPRODUC16 TIVE HEALTH SERVICES DURING EMER17 GENCY SITUATIONS. 

18 (a) ASSISTANCE AUTHORIZED.—The President is au19 thorized to provide assistance, including through inter20 national organizations, national governments, and inter21 national and local nongovernmental organizations, to en22 sure that sexual and reproductive health services are pro23 vided in developing countries at every phase of a humani24 tarian emergency, including early recovery. 


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1 (b) PRIORITY.—In providing assistance authorized 

2 under subsection (a), the President shall give priority to— 

3 (1) those reproductive health services that are 

4 essential in emergencies, whether they are conflict or 

5 natural disaster settings, to save lives and help sur6 vivors fulfill their potential even under the most dif7 ficult circumstances; and 

8 (2) building local capacity and improving na9 tional systems whenever possible during displace10 ment and early recovery. 

11 (c) ACTIVITIES SUPPORTED.—Assistance provided 

12 under subsection (a) shall be used to— 

13 (1) direct the Secretary of State and the Ad14 ministrator of the United States Agency for Inter15 national Development to implement the Minimum 

16 Initial Services Package (MISP), a set of life-saving 

17 priority activities that must be put in place in the 

18 earliest days of an emergency and that is set out in 

19 the Sphere Project’s Humanitarian Charter and 

20 Minimum Standards in Disaster Response; 

21 (2) among other activities, establish critical re22 productive health coordination mechanisms, prevent 

23 sexual violence and assist survivors by providing es24 sential medical care including psychosocial services, 

25 prevent transmission of HIV and other sexually 


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1 transmitted infections (STIs), ensure access to 

2 emergency obstetric and newborn care, to contracep3 tive methods, and to treatment of STIs, continue 

4 antiretroviral treatment, and lay the groundwork for 

5 comprehensive reproductive health care; and 

6 (3) as soon as conditions permit, ensure that 

7 comprehensive reproductive health care programs, 

8 including comprehensive family planning, are put in 

9 place for the duration of displacement and are main10 tained as the relief phase ends and communities 

11 transition to early recovery. 

12 (d) COORDINATION.—Assistance authorized under 

13 subsection (a) shall be coordinated in terms of policy, 

14 practice, and funding across and within relevant United 

15 States Government departments and agencies involved in 

16 emergency situations. 

17 SEC. 7. ASSISTANCE TO PROMOTE SEXUAL AND REPRODUC18 TIVE HEALTH CARE FOR YOUNG PEOPLE. 

19 (a) ASSISTANCE AUTHORIZED.—The President is au20 thorized to provide assistance to ensure access to sexual 

21 and reproductive health care for young people in devel22 oping countries. 

23 (b) PRIORITY.—In providing assistance authorized 

24 under subsection (a), the President shall prioritize a plan 

25 to increase comprehensive knowledge about sexuality 


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1 among young people and improve sexual and reproductive 

2 health outcomes among young people, while improving co3 ordination and implementation of host country and United 

4 States Government activities focused on adolescent and 

5 youth sexual and reproductive health. 

6 (c) ACTIVITIES SUPPORTED.—Assistance provided 

7 under subsection (a) shall be used, among other things, 

8 to— 

9 (1) provide universal and affordable access to— 

10 (A) evidence-based comprehensive sexuality 

11 education and reproductive health education, in 

12 consultation with local communities, in and out13 side schools to ensure young people can delay 

14 sexual debut and make informed decisions 

15 about their sexual and reproductive health; and 

16 (B) youth-friendly comprehensive sexual 

17 and reproductive health care, including activi18 ties described in section 4(b), as appropriate; 

19 (2) coordinate the achievement of the goals of 

20 sexual and reproductive health programming for 

21 young people in United States Government-funded 

22 programs; 

23 (3) educate implementers on best practices in 

24 adolescent and youth programming and delivery and 


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1 for effective dissemination of policy guidelines re2 garding adolescent and youth programming; and 

3 (4) incorporate the recommendations of young 

4 people in program design and service delivery ori5 ented for young people. 

6 SEC. 8. STRATEGY TO INTEGRATE AND LINK SEXUAL AND 

7 REPRODUCTIVE HEALTH SERVICES. 

8 (a) STRATEGY REQUIRED.— 

9 (1) IN GENERAL.—The President shall develop 

10 and implement a strategy to improve and create 

11 linkages among the various components of sexual 

12 and reproductive health with each other and with 

13 other global health care services, delivery, and poli14 cies in order to meet the goal described in paragraph 

15 (2). 

16 (2) GOAL DESCRIBED.—The goal of better link17 ages and integration referred to in paragraph (1) is 

18 to ensure that individual men and women are pro19 vided with a continuum of sexual and reproductive 

20 health services that meet their needs. Integration 

21 does not require that all of these services should be 

22 provided by the same clinician or even in the same 

23 setting; rather, there should be a mechanism in 

24 place, so that every person has access to the sexual 


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1 and reproductive health services he or she needs, ei2 ther directly or by referral. 

3 (b) ELEMENTS.—The strategy required by subsection 

4 (a) shall include the following: 

5 (1) In general, at the program level, supporting 

6 health systems to link the various components of 

7 sexual and reproductive health services both in terms 

8 of health system management, such as integrating 

9 commodity and supply systems, training, super10 vision, data collection and analysis, and service pro11 vision, to ensure that people have access to a full 

12 range of services in their community. 

13 (2) In general, such services should include pre14 vention of ill-health, provision of information and 

15 counseling, screening, diagnosis and curative care 

16 and referral for a full range of sexual and reproduc17 tive health and other health and social services. 

18 (3) With respect to linkages and program inte19 gration of sexual and reproductive health services, 

20 such services shall include activities described in sec21 tion 4(b). 

22 (4) With respect to linkages of sexual and re23 productive health services with other global health 

24 services, such services shall include— 


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1 (A) counseling about and referrals to other 

2 related health services such as addressing new3 born, infant, and child health (including edu4 cating families about proper antenatal and de5 livery care, breastfeeding, hygiene, and inter6 ventions for neonatal infections and life-threat7 ening childhood illnesses), malaria, tuberculosis, 

8 neglected tropical diseases, and proper nutrition 

9 for all ages; and 

10 (B) referrals to nearby, quality services 

11 that cannot be provided by the primary provider 

12 and other social services. 

13 SEC. 9. COORDINATION; RESEARCH, MONITORING, AND 

14 EVALUATION. 

15 (a) COORDINATION.—Assistance authorized under 

16 this Act shall promote coordination between and among 

17 donors, the private sector, nongovernmental and civil soci18 ety organizations, and governments in order to support 

19 comprehensive and responsive sexual and reproductive 

20 health programs in developing countries. 

21 (b) RESEARCH, MONITORING, AND EVALUATION.— 

22 (1) IN GENERAL.—Assistance authorized under 

23 this Act shall be used for the conduct of formative 

24 research and to monitor and evaluate the effective25 ness and efficiency of programs. 


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1 (2) REQUIREMENTS.—In carrying out para2 graph (1), the President shall ensure that there is— 

3 (A) support for formative research on the 

4 determinants of accessing sexual and reproduc5 tive health products and services, and adopting 

6 healthy behaviors related to sexuality and re7 production, to inform program design; 

8 (B) support for the ongoing, regular, and 

9 systematic collection of information to serve as 

10 the basis for monitoring change in population11 based outcomes; 

12 (C) support for evaluations of pro13 grammatic effectiveness by measuring the ex14 tent to which change in population-based out15 comes can be attributed to program interven16 tions or environmental factors; 

17 (D) support for operations research that 

18 uses appropriate scientific methods to compare 

19 different interventions with the objective of in20 creasing the efficiency, effectiveness, and qual21 ity of programs; 

22 (E) support for field research on the char23 acteristics of programs most likely to result in 

24 sustained use of effective family planning in 

25 meeting each individual’s lifetime reproductive 


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1 goals, with particular emphasis on the perspec2 tives of family planning users, including support 

3 for relevant social and behavioral research fo4 cusing on such factors as the use, nonuse, and 

5 unsafe or ineffective use of various contracep6 tive and related-disease control methods; and 

7 (F) support for the development of new 

8 evaluation techniques and performance criteria 

9 for sexual and reproductive health programs, 

10 emphasizing the user’s perspective and repro11 ductive goals. 

12 SEC. 10. DEFINITIONS. 

13 In this Act: 

14 (1) ADOLESCENT.—The term ‘‘adolescent’’ 

15 means an individual who has attained the age of 10 

16 years but not 20 years. 

17 (2) COMPREHENSIVE SEXUALITY EDUCATION.— 

18 The term ‘‘comprehensive sexuality education’’ 

19 means helping young people develop the inter20 personal skills necessary for the formation of caring, 

21 supportive, and non-coercive relationships and the 

22 ability to exercise responsibility regarding sexual re23 lationships by addressing such issues as sexual di24 versity, abstinence, and the use of condoms, contraVerDate Mar 15 2010 03:36 Apr 05, 2011 Jkt 099200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\H1319.IH H1319

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1 ceptives, and other protective sexual health meas2 ures. 

3 (3) INTEGRATION.—The term ‘‘integration’’ 

4 means joining together different kinds of services or 

5 operational programs, either directly or by referral, 

6 to ensure more comprehensive services, promote a 

7 continuum of care, and to maximize health out8 comes. 

9 (4) LINKAGES.—The term ‘‘linkages’’ means— 

10 (A) the bi-directional synergies in policy, 

11 programs, services, and advocacy related to sex12 ual and reproductive health, including HIV/ 

13 AIDS; and 

14 (B) refers to a broader human rights based 

15 approach, of which service integration is a sub16 set. 

17 (5) REPRODUCTIVE HEALTH.—The term ‘‘re18 productive health’’— 

19 (A) means a state of complete physical, 

20 mental, and social well-being and not merely 

21 the absence of disease or infirmity, in all mat22 ters relating to the reproductive system and to 

23 its functions and processes; and 

24 (B) implies that an individual is able to 

25 have a satisfying and safe sex life and that such 


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1 individual has the capability to reproduce and 

2 the freedom to decide if, when, and how often 

3 to do so, including the right of men and women 

4 to be informed and to have access to safe, effec5 tive, affordable, and acceptable methods of fam6 ily planning of their choice, as well as other 

7 methods of their choice for regulation of fer8 tility which are not against the law, and the 

9 right of access to appropriate health-care serv10 ices that will enable women to go safely through 

11 pregnancy and childbirth and provide couples 

12 with the best chance of having a healthy infant. 

13 (6) REPRODUCTIVE RIGHTS.—The term ‘‘repro14 ductive rights’’— 

15 (A) means those rights that embrace cer16 tain human rights that are already recognized 

17 in national laws, international human rights 

18 documents, and other consensus documents; 

19 (B) includes the recognition of the basic 

20 right of all couples and individuals to decide 

21 freely and responsibly the number, spacing, and 

22 timing of their children and to have the infor23 mation and means to do so, and the right to at24 tain the highest standard of sexual and repro25 ductive health; and 


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1 (C) further includes the right of all couples 

2 and individuals to make decisions concerning 

3 reproduction free of discrimination, coercion, 

4 and violence, as expressed in human rights doc5 uments. 

6 (7) SEXUAL HEALTH.—The term ‘‘sexual 

7 health’’— 

8 (A) means a state of physical, emotional, 

9 mental, and social well-being in relation to sex10 uality and not merely the absence of disease, 

11 dysfunction, or infirmity; 

12 (B) includes a positive and respectful ap13 proach to sexuality and sexual relationships, as 

14 well as the possibility of having pleasurable and 

15 safe sexual experiences, free of coercion, dis16 crimination, and violence; and 

17 (C) further includes the sexual rights of all 

18 persons to be respected, protected, and fulfilled. 

19 (8) UNMET NEED.—The term ‘‘unmet need’’ 

20 refers to nonuse of a modern contraceptive method 

21 by an individual who is married or unmarried and 

22 sexually active, is able to become pregnant, and 

23 wants to stop childbearing or to wait at least 2 years 

24 before having a child. 


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1 (9) YOUNG PEOPLE.—The term ‘‘young people’’ 

2 means those individuals who have attained the age 

3 of 10 years but not 25 years. 

4 (10) YOUTH.—The term ‘‘youth’’ means an in5 dividual who has attained the age of 15 years but 

6 not 25 years. 

Æ 


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