I 

113TH CONGRESS 

1ST SESSION H. R. 3206 

To promote the sexual and reproductive health of individuals and couples 

in developing countries, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 27, 2013 

Ms. CLARKE (for herself, Ms. BASS, Ms. BROWN of Florida, Mr. CLAY, Mr. 

CONYERS, Mrs. DAVIS of California, Mr. ELLISON, Mr. ENYART, Mr. 

GRIJALVA, Ms. NORTON, Mr. HONDA, Mr. HUFFMAN, Ms. JACKSON LEE, 

Mr. JEFFRIES, Ms. LEE of California, Mrs. CAROLYN B. MALONEY of 

New York, Mr. MCGOVERN, Ms. MOORE, Mr. MORAN, Mr. QUIGLEY, Mr. 

RANGEL, Mr. RUSH, Ms. SCHAKOWSKY, Ms. SLAUGHTER, Ms. 

WASSERMAN SCHULTZ, Ms. WATERS, and Mr. BERA 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 2013’’. 


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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 central to the global development agen6 da and necessary to meeting most of the eight 

7 United Nations Millennium Development Goals 

8 (MDGs), the current international development 

9 framework developed by 189 countries, including the 

10 United States. Target 5B, which is found under 

11 MDG 5 on improving maternal health and which re12 quires achieving universal access to reproductive 

13 health, is an essential element in attaining MDGs 

14 related to eradicating poverty (MDG 1), achieving 

15 universal education (MDG 2), promoting gender 

16 equality (MDG 3), reducing child mortality (MDG 

17 4), improving maternal health (MDG 5), combating 

18 HIV/AIDS (MDG 6), and ensuring environmental 

19 sustainability (MDG 7). Furthermore, advancement 

20 of sexual and reproductive health and rights will be 

21 critical in building on the achievements of the MDGs 

22 when they expire in 2015 and realizing the core 

23 goals of poverty reduction and sustainable develop24 ment in the post-2015 development agenda. 

25 (2) The resolution of the 2013 United Nations 

26 Commission on Population and Development 


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1 ‘‘recognize[es] that . . . sexual and reproductive 

2 health and reproductive rights . . . as well as . . . 

3 population and development, education and gender 

4 equality, are integrally linked to global efforts to 

5 eradicate poverty and achieve sustainable develop6 ment . . . .’’. 

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

8 access of women, particularly poor women, to basic 

9 reproductive health services and information contrib10 utes to death and suffering among women and their 

11 families, undermines women’s struggle for self-deter12 mination, and vitiates the efforts of families to lift 

13 themselves out of the poverty in which over a billion 

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

15 and couples to choose the number and timing of 

16 their children, reproductive health care gives families 

17 and individuals greater control over their economic 

18 resources. 

19 (4) Aspects of sexual and reproductive health, 

20 including maternal mortality and morbidity, repro21 ductive cancers, and sexually transmitted infections 

22 (STIs), including HIV, account for nearly 20 per23 cent of the global burden of ill-health for women and 

24 some 14 percent for men, according to the World 

25 Health Organization (WHO). 


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1 (5) According to the Joint United Nations Pro2 gramme on HIV/AIDS (UNAIDS), HIV/AIDS is 

3 the leading cause of death among women of child4 bearing age. 

5 (6) School-based education and family planning 

6 play an interrelated role in lifting the status of 

7 women. Delaying sexual debut, along with contracep8 tive use among young women already sexually active, 

9 lowers the likelihood that young women will leave 

10 their schooling due to pregnancy, and education in11 creases the chances that young women will delay the 

12 age at which they marry and give birth. 

13 (7) Sexual and reproductive health programs 

14 can empower women to make informed decisions and 

15 better control their lives, and by engaging men and 

16 boys in taking responsibility for the sexual and re17 productive health of their partners, can contribute to 

18 greater gender equality. 

19 (8) Access to sexual and reproductive health 

20 services, including family planning, has a direct and 

21 important impact on infant and child mortality. By 

22 allowing women to choose the timing, number, and 

23 spacing of their pregnancies, high-risk births are 

24 averted, and the children that are born have a great25 er chance of surviving to adulthood. Over 3,000,000 


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1 newborns die in the first 4 weeks of life, which ac2 counts for nearly 40 percent of all deaths of children 

3 under the age of 5. By providing women family plan4 ning services to space their births 3 years apart, 

5 rates for under-5 mortality would drop by 25 per6 cent, averting 1,800,000 children’s deaths each year. 

7 (9) Increasing access to sexual and reproductive 

8 health could significantly decrease pregnancy-related 

9 mortality and morbidity by reducing the number of 

10 pregnancies that place women at increased risk of 

11 experiencing such complications. 

12 (10) An estimated 222,000,000 women in devel13 oping countries have an unmet need for effective, 

14 modern contraceptives and would like to postpone 

15 childbearing, space births, or want no more children 

16 but are not using a modern method of contraception. 

17 Providing modern contraceptives to fill this unmet 

18 need would avert an estimated additional 54,000,000 

19 unintended pregnancies each year, including 

20 21,000,000 unplanned births and 26,000,000 abor21 tions, 16,000,000 of which would be unsafe. In turn, 

22 this would prevent 79,000 maternal deaths and 

23 1,100,000 infant deaths. 

24 (11) Complications due to pregnancy and child25 birth are a leading cause of death among adolescent 


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1 females ages 15 to 19 in low- and middle-income 

2 countries. Each year, an estimated 287,000 women 

3 worldwide die from complications related to preg4 nancy, childbirth, or unsafe abortion. 

5 (12) Unsafe abortion accounts for 13 percent of 

6 maternal deaths worldwide. More than half of abor7 tions (56 percent) in the developing world are un8 safe. Of the 22,000,000 unsafe abortions that take 

9 place each year, nearly all occur in the developing 

10 world. Around 47,000 women die and millions more 

11 suffer serious injuries from the complications of 

12 unsafely performed abortions. Abortion rates are 

13 similar in countries whether abortion is illegal or 

14 legal, with evidence suggesting abortion rates may in 

15 fact be higher in countries where it is illegal. Re16 gardless, death and injury from unsafe abortion is 

17 greatly reduced where abortion is legal for a broad 

18 range of indications and where safe abortion is ac19 cessible. 

20 (13) Meeting the need for family planning serv21 ices and pregnancy-related care, by doubling the cur22 rent global investment for both, would prevent mil23 lions of needless cases of maternal and newborn 

24 deaths and disabilities. 


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1 (14) Worldwide, women of childbearing age ac2 count for more than half of people living with HIV/ 

3 AIDS. Integrating reproductive health services, in4 cluding family planning, with HIV prevention pro5 grams, such as those for voluntary counseling and 

6 testing and prevention of mother-to-child trans7 mission, is essential to effectively combating HIV/ 

8 AIDS and other STIs. 

9 (15) The world is witnessing the largest genera10 tion of young people in history—almost half of the 

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

12 people, are under the age of 25. Unmet need for sex13 ual and reproductive health services is highest 

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

15 poorest sexually active youth use modern contracep16 tion. 

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

18 second most important risk factor for disability and 

19 death among young people in the world’s poorest 

20 communities. Forty percent of all new adult HIV in21 fections occur among young people ages 15–24. 

22 (17) Sixty percent of unsafe abortions in Afri23 ca, 42 percent in Latin America and the Caribbean, 

24 and 30 percent in Asia are undergone by women 

25 under the age of 25. 


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1 (18) The WHO has identified a 4-pronged ap2 proach to preventing HIV infection in infants, which 

3 includes prevention of unintended pregnancy among 

4 HIV-infected women as a key strategy to prevent 

5 mother-to-child transmission of HIV. 

6 (19) According to the World Health Organiza7 tion, enabling HIV-positive women who want to 

8 avoid a pregnancy access to contraceptive services 

9 can prevent as many as 160,000 additional HIV10 positive births each year in high HIV prevalence 

11 countries. 

12 (20) Demographic factors exacerbate problems 

13 related to environmental sustainability. The past 

14 century of population growth has put increasing 

15 pressure on natural resources as the scale of human 

16 needs and activities expands. At the same time, ac17 tual family size in most developing countries remains 

18 greater than the desired family size. Access to family 

19 planning services helps couples to determine their 

20 own family size, hence mitigating the depletion of 

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

22 (21) Practices like early and forced marriage, 

23 female genital mutilation/cutting, and early sexual 

24 debut adversely impact the sexual and reproductive 

25 health of young people in many developing countries, 


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1 and strong barriers exist to providing the informa2 tion, services, and other forms of support that young 

3 people need to lead healthy sexual and reproductive 

4 lives. 

5 (22) Comprehensive sexuality education seeks 

6 to help young people develop the interpersonal skills 

7 necessary for the formation of caring, supportive, 

8 and noncoercive relationships and the ability to exer9 cise responsibility regarding sexual relationships by 

10 addressing such issues as abstinence and the use of 

11 condoms, contraceptives, and other protective sexual 

12 health measures. 

13 (23) The United Nations has estimated that the 

14 minimum financial requirements for sexual and re15 productive health, including family planning and ma16 ternal health, are roughly $32,700,000,000 in 2013 

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

18 2015. The minimum financial requirement for HIV/ 

19 AIDS is estimated at $34,700,000,000 in 2013, and 

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

21 the International Conference on Population and De22 velopment’s Programme of Action, which the United 

23 States committed to, developed-country donors are 

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

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1 maining two-thirds, on average, with low income 

2 countries requiring a larger share of external fund3 ing. 

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

5 supporting and recognizing the fundamental health 

6 and human rights of all people through the signing 

7 or ratifying of various international agreements. 

8 Those agreements include the Universal Declaration 

9 of Human Rights (1948), the International Cov10 enant on Civil and Political Rights (1966), the 

11 International Covenant on Economic, Social, and 

12 Cultural Rights (1966), the Convention on the 

13 Elimination of All Forms of Discrimination Against 

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

15 Child (1989), the International Conference on Popu16 lation and Development Programme of Action 

17 (1994), the United Nations Millennium Development 

18 Goals (2000), and the Convention on the Rights of 

19 Persons with Disabilities (2009). 

20 (25) The United States has been the largest 

21 donor to international family planning and reproduc22 tive health efforts over the last 40 years and has 

23 been an unparalleled source of leadership and inno24 vation in the field. Nonetheless, it has not met its 

25 fair share of financial assistance to global sexual and 


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1 reproductive health programs. Now is the time to 

2 shore up the United States political and financial 

3 commitment in order to satisfy the large unmet need 

4 for these services, thereby helping to improve wom5 en’s and young people’s sexual and reproductive 

6 health worldwide. 

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

8 (1) authorize assistance to improve the sexual 

9 and reproductive health of individuals and couples in 

10 developing countries; and 

11 (2) implement comprehensive sexual and repro12 ductive health programs offering a continuum of 

13 care that are responsive to the sexual and reproduc14 tive health needs of young people and adults. 

15 SEC. 3. STATEMENT OF POLICY. 

16 The following shall be the policy of the United States 

17 Government: 

18 (1) All individuals and couples shall have the 

19 basic reproductive right to decide freely and respon20 sibly the number, spacing, and timing of their chil21 dren and shall have the information and means to 

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

23 of sexual and reproductive health. 

24 (2) All individuals and couples also shall have 

25 the right to make decisions concerning reproduction 


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1 free of discrimination, coercion, and violence, as ex2 pressed in human rights documents. 

3 (3) The promotion of the responsible exercise of 

4 these reproductive rights for all people shall be the 

5 fundamental basis for sexual and reproductive health 

6 programs supported by United States Government 

7 assistance. 

8 (4) The principle of free and informed consent 

9 must underlie all sexual and reproductive health pro10 grams and services. This principle applies to individ11 uals whether they choose to continue or terminate 

12 their pregnancies—thus, forced pregnancies as well 

13 as forced abortions or sterilizations are prohibited. 

14 Decisions relating to contraceptive use should be 

15 made on an informed and voluntary basis after ade16 quate information, counseling, and services are pro17 vided on a range of methods. 

18 (5) Incentives and disincentives should not be 

19 used in family planning programs in order to meet 

20 numerical population targets or quotas for fertility 

21 goals. Instead, governments should use other indica22 tors, such as unmet needs, to define family planning 

23 goals. 

24 (6) In sexual and reproductive health programs 

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1 tention should be paid to serving the needs of young 

2 people. 

3 SEC. 4. ASSISTANCE TO SUPPORT THE ACHIEVEMENT OF 

4 UNIVERSAL ACCESS TO SEXUAL AND REPRO5 DUCTIVE HEALTH. 

6 (a) ASSISTANCE AUTHORIZED.—The President is au7 thorized to provide assistance in order to support the 

8 achievement of universal access to sexual and reproductive 

9 health in developing countries and to ensure individuals 

10 and couples in developing countries can freely and respon11 sibly determine the number, timing, and spacing of their 

12 children and have the means to do so. 

13 (b) ACTIVITIES SUPPORTED.—Assistance provided 

14 under subsection (a) may be used to— 

15 (1) expand access to and use of voluntary fam16 ily planning information and services, to enable indi17 viduals and couples to avoid unintended pregnancies 

18 and other risks to sexual and reproductive health, 

19 including those associated with pregnancy, reproduc20 tive tract infections, and sexually transmitted infec21 tions (STIs), including HIV; 

22 (2) improve public knowledge of contraceptives, 

23 including where methods may be obtained, and risk24 reduction strategies, and to promote the benefits of 

25 family planning and other sexual and reproductive 


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1 health care to individuals, families, and commu2 nities, including through the use of education and 

3 awareness programs, mass media, and community 

4 mobilization and outreach; 

5 (3) increase the responsiveness of sexual and 

6 reproductive health programs to the needs of the in7 tended beneficiaries during the entirety of their sex8 ual and reproductive lives, including young people 

9 and older adults; 

10 (4) reduce the incidence of unsafe abortion, in11 cluding research on the health consequences of un12 safe abortion, and provide for the equipment and 

13 training necessary for medical treatment of the con14 sequences of unsafe abortions; 

15 (5) notwithstanding any other provision of law, 

16 provide safe abortion, to the extent permitted by the 

17 laws of the recipient country; 

18 (6) promote the integration of family planning 

19 services in HIV and other STI prevention, treat20 ment, care, and support; 

21 (7) integrate family planning services with ma22 ternal and newborn health care, especially in 

23 antenatal, post-partum, and post-abortion care set24 tings; 


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1 (8) ensure the consistent availability and af2 fordability of high-quality sexual and reproductive 

3 health supplies and services, including male and fe4 male condoms, for the prevention of HIV and other 

5 STIs; 

6 (9) encourage the abandonment of female gen7 ital mutilation, early marriage, early childbearing, 

8 and other harmful traditional practices that have 

9 negative reproductive health consequences; 

10 (10) prevent and repair obstetric fistula; 

11 (11) promote the constructive engagement of 

12 men and boys, the empowerment of women and 

13 girls, and more equitable gender norms in order to 

14 improve health outcomes and support the adoption 

15 of healthy reproductive behaviors; 

16 (12) prevent and mitigate gender-based vio17 lence; 

18 (13) provide comprehensive sexuality education 

19 for young people; 

20 (14) prevent, diagnose, and treat, where appro21 priate, infertility and cancers of the reproductive 

22 system and refer as appropriate; 

23 (15) develop improved methods of safe and ef24 fective contraception and related disease control 


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1 through investments in biomedical research, with 

2 particular emphasis on methods which— 

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

4 more efficient to make available in developing 

5 country settings, and less expensive than cur6 rent methods; 

7 (B) are controlled by women, including 

8 barrier methods and microbicides; 

9 (C) are likely to prevent the spread of 

10 STIs; and 

11 (D) encourage and enable men to take 

12 greater responsibility for their own fertility and 

13 the protection of their partner; 

14 (16) support an enabling environment for 

15 women to access sexual and reproductive health care 

16 services by working with communities to identify and 

17 lower or remove barriers to access, including finan18 cial, gender, sociocultural, and transportation bar19 riers; 

20 (17) train health care professionals on edu21 cating individuals, including young people, about 

22 their sexual and reproductive health care options, in23 cluding family planning options; and 

24 (18) foster conditions to create favorable policy 

25 environments, improve quality, strengthen systems, 


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1 and contribute to the sustainability of family plan2 ning and other reproductive health programs. 

3 SEC. 5. ASSISTANCE TO REDUCE THE INCIDENCE OF UN4 SAFE ABORTION AND ITS CONSEQUENCES. 

5 (a) ASSISTANCE AUTHORIZED.—The President is au6 thorized to provide assistance to reduce the incidence of 

7 unsafe abortion in developing countries and provide care 

8 for women experiencing injury or illness from complica9 tions of unsafe abortion in developing countries. 

10 (b) ACTIVITIES SUPPORTED.—Assistance provided 

11 under subsection (a) shall be used to— 

12 (1) ensure access to family planning services to 

13 prevent unintended pregnancies; 

14 (2) ensure that women who experience an unin15 tended pregnancy have access to reliable information 

16 and compassionate counseling on all of their options, 

17 including access to antenatal care and safe abortion 

18 when permitted by the laws of the recipient country; 

19 (3) where local laws permit abortion, support 

20 safe abortion services, including referrals, and sup21 port the training of abortion providers and the nec22 essary equipment and commodities for surgical and 

23 medical abortion; and 

24 (4) support emergency treatment for complica25 tions of induced or spontaneous abortion, including 


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1 provision of services and training and equipping of 

2 providers. 

3 (c) ELIGIBILITY FOR ASSISTANCE.—Notwithstanding 

4 any other provision of law, regulation, or policy, in deter5 mining eligibility for assistance authorized under this sec6 tion, sections 104, 104A, 104B, and 104C of the Foreign 

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

8 2151b–3, and 2151b–4), foreign nongovernmental organi9 zations— 

10 (1) shall not be ineligible for such assistance 

11 solely on the basis of health or medical services, in12 cluding counseling and referral services, provided by 

13 such organizations with non-United States Govern14 ment funds if such services are permitted in the 

15 country in which they are being provided and would 

16 not violate United States Federal law if provided in 

17 the United States; and 

18 (2) shall not be subject to requirements relating 

19 to the use of non-United States Government funds 

20 for advocacy and lobbying activities other than those 

21 that apply to United States nongovernmental organi22 zations receiving assistance under part I of the For23 eign Assistance Act of 1961. 


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1 SEC. 6. ASSISTANCE TO PROVIDE SEXUAL AND REPRODUC2 TIVE HEALTH SERVICES DURING EMER3 GENCY SITUATIONS. 

4 (a) ASSISTANCE AUTHORIZED.—The President is au5 thorized to provide assistance, including through inter6 national organizations, national governments, and inter7 national and local nongovernmental organizations, to en8 sure that sexual and reproductive health services are pro9 vided in developing countries at every phase of a humani10 tarian emergency, including early recovery. 

11 (b) PRIORITY.—In providing assistance authorized 

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

13 (1) those reproductive health services that are 

14 essential in emergencies, whether they are conflict or 

15 natural disaster settings, to save lives and help sur16 vivors fulfill their potential even under the most dif17 ficult circumstances; and 

18 (2) building local capacity and improving na19 tional systems whenever possible during displace20 ment and early recovery. 

21 (c) ACTIVITIES SUPPORTED.—Assistance provided 

22 under subsection (a) shall be used to— 

23 (1) direct the Secretary of State and the Ad24 ministrator of the United States Agency for Inter25 national Development to implement the Minimum 

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


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1 priority activities that must be put in place in the 

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

3 the Sphere Project’s Humanitarian Charter and 

4 Minimum Standards in Disaster Response; 

5 (2) among other activities, establish critical re6 productive health coordination mechanisms, prevent 

7 sexual violence and assist survivors by providing es8 sential medical care including psychosocial services, 

9 prevent transmission of HIV and other sexually 

10 transmitted infections (STIs), ensure access to 

11 emergency obstetric and newborn care, to contracep12 tive methods, and to treatment of STIs, continue 

13 antiretroviral treatment, and lay the groundwork for 

14 comprehensive reproductive health care; and 

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

16 comprehensive reproductive health care programs, 

17 including comprehensive family planning, are put in 

18 place for the duration of displacement and are main19 tained as the relief phase ends and communities 

20 transition to early recovery. 

21 (d) COORDINATION.—Assistance authorized under 

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

23 practice, and funding across and within relevant United 

24 States Government departments and agencies involved in 

25 emergency situations. 


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1 SEC. 7. ASSISTANCE TO PROMOTE SEXUAL AND REPRODUC2 TIVE HEALTH CARE FOR YOUNG PEOPLE. 

3 (a) ASSISTANCE AUTHORIZED.—The President is au4 thorized to provide assistance to ensure access to sexual 

5 and reproductive health care for young people in devel6 oping countries. 

7 (b) PRIORITY.—In providing assistance authorized 

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

9 to increase comprehensive knowledge about sexuality 

10 among young people and improve sexual and reproductive 

11 health outcomes among young people, while improving co12 ordination and implementation of host country and United 

13 States Government activities focused on adolescent and 

14 youth sexual and reproductive health. 

15 (c) ACTIVITIES SUPPORTED.—Assistance provided 

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

17 to— 

18 (1) provide universal and affordable access to— 

19 (A) evidence-based comprehensive sexuality 

20 education and reproductive health education, in 

21 consultation with local communities, in and out22 side schools to ensure young people can delay 

23 sexual debut and make informed decisions 

24 about their sexual and reproductive health; and 


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1 (B) youth-friendly comprehensive sexual 

2 and reproductive health care, including activi3 ties described in section 4(b), as appropriate; 

4 (2) coordinate the achievement of the goals of 

5 sexual and reproductive health programming for 

6 young people in United States Government-funded 

7 programs; 

8 (3) educate implementers on best practices in 

9 adolescent and youth programming and delivery and 

10 for effective dissemination of policy guidelines re11 garding adolescent and youth programming; and 

12 (4) incorporate the recommendations of young 

13 people in program design and service delivery ori14 ented for young people. 

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

16 REPRODUCTIVE HEALTH SERVICES. 

17 (a) STRATEGY REQUIRED.— 

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

19 and implement a strategy to improve and create 

20 linkages among the various components of sexual 

21 and reproductive health with each other and with 

22 other global health care services, delivery, and poli23 cies in order to meet the goal described in paragraph 

24 (2). 


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1 (2) GOAL DESCRIBED.—The goal of better link2 ages and integration referred to in paragraph (1) is 

3 to ensure that individual men and women are pro4 vided with a continuum of sexual and reproductive 

5 health services that meet their needs. Integration 

6 does not require that all of these services should be 

7 provided by the same clinician or even in the same 

8 setting; rather, there should be a mechanism in 

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

10 and reproductive health services he or she needs, ei11 ther directly or by referral. 

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

13 (a) shall include the following: 

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

15 health systems to link the various components of 

16 sexual and reproductive health services both in terms 

17 of health system management, such as integrating 

18 commodity and supply systems, training, super19 vision, data collection and analysis, and service pro20 vision, to ensure that people have access to a full 

21 range of services in their community. 

22 (2) In general, such services should include pre23 vention of ill-health, provision of information and 

24 counseling, screening, diagnosis and curative care 


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1 and referral for a full range of sexual and reproduc2 tive health and other health and social services. 

3 (3) With respect to linkages and program inte4 gration of sexual and reproductive health services, 

5 such services shall include activities described in sec6 tion 4(b). 

7 (4) With respect to linkages of sexual and re8 productive health services with other global health 

9 services, such services shall include— 

10 (A) counseling about and referrals to other 

11 related health services such as addressing new12 born, infant, and child health (including edu13 cating families about proper antenatal and de14 livery care, breastfeeding, hygiene, and inter15 ventions for neonatal infections and life-threat16 ening childhood illnesses), malaria, tuberculosis, 

17 neglected tropical diseases, and proper nutrition 

18 for all ages; and 

19 (B) referrals to nearby quality services 

20 that cannot be provided by the primary provider 

21 and other social services. 

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

23 EVALUATION. 

24 (a) COORDINATION.—Assistance authorized under 

25 this Act shall promote coordination between and among 


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1 donors, the private sector, nongovernmental and civil soci2 ety organizations, and governments in order to support 

3 comprehensive and responsive sexual and reproductive 

4 health programs in developing countries. 

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

6 (1) IN GENERAL.—Assistance authorized under 

7 this Act shall be used for the conduct of formative 

8 research and to monitor and evaluate the effective9 ness and efficiency of programs. 

10 (2) REQUIREMENTS.—In carrying out para11 graph (1), the President shall ensure that there is— 

12 (A) support for formative research on the 

13 determinants of accessing sexual and reproduc14 tive health products and services, and adopting 

15 healthy behaviors related to sexuality and re16 production, to inform program design; 

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

18 systematic collection of information to serve as 

19 the basis for monitoring change in population20 based outcomes; 

21 (C) support for evaluations of pro22 grammatic effectiveness by measuring the ex23 tent to which change in population-based out24 comes can be attributed to program interven25 tions or environmental factors; 


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1 (D) support for operations research that 

2 uses appropriate scientific methods to compare 

3 different interventions with the objective of in4 creasing the efficiency, effectiveness, and qual5 ity of programs; 

6 (E) support for field research on the char7 acteristics of programs most likely to result in 

8 sustained use of effective family planning in 

9 meeting each individual’s lifetime reproductive 

10 goals, with particular emphasis on the perspec11 tives of family planning users, including support 

12 for relevant social and behavioral research fo13 cusing on such factors as the use, nonuse, and 

14 unsafe or ineffective use of various contracep15 tive and related-disease control methods; and 

16 (F) support for the development of new 

17 evaluation techniques and performance criteria 

18 for sexual and reproductive health programs, 

19 emphasizing the user’s perspective and repro20 ductive goals. 

21 SEC. 10. DEFINITIONS. 

22 In this Act: 

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

24 means an individual who has attained the age of 10 

25 years but not 20 years. 


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1 (2) COMPREHENSIVE SEXUALITY EDUCATION.— 

2 The term ‘‘comprehensive sexuality education’’ 

3 means helping young people develop the inter4 personal skills necessary for the formation of caring, 

5 supportive, and non-coercive relationships and the 

6 ability to exercise responsibility regarding sexual re7 lationships by addressing such issues as sexual di8 versity, abstinence, and the use of condoms, contra9 ceptives, and other protective sexual health meas10 ures. 

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

12 means joining together different kinds of services or 

13 operational programs, either directly or by referral, 

14 to ensure more comprehensive services, promote a 

15 continuum of care, and to maximize health out16 comes. 

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

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

19 programs, services, and advocacy related to sex20 ual and reproductive health, including HIV/ 

21 AIDS; and 

22 (B) refers to a broader human rights based 

23 approach, of which service integration is a sub24 set. 


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1 (5) REPRODUCTIVE HEALTH.—The term ‘‘re2 productive health’’— 

3 (A) means a state of complete physical, 

4 mental, and social well-being and not merely 

5 the absence of disease or infirmity, in all mat6 ters relating to the reproductive system and to 

7 its functions and processes; and 

8 (B) implies that an individual is able to 

9 have a satisfying and safe sex life and that such 

10 individual has the capability to reproduce and 

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

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

13 to be informed and to have access to safe, effec14 tive, affordable, and acceptable methods of fam15 ily planning of their choice, as well as other 

16 methods of their choice for regulation of fer17 tility which are not against the law, and the 

18 right of access to appropriate health care serv19 ices that will enable women to go safely through 

20 pregnancy and childbirth and provide couples 

21 with the best chance of having a healthy infant. 

22 (6) REPRODUCTIVE RIGHTS.—The term ‘‘repro23 ductive rights’’— 

24 (A) means those rights that embrace cer25 tain human rights that are already recognized 


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1 in national laws, international human rights 

2 documents, and other consensus documents; 

3 (B) includes the recognition of the basic 

4 right of all couples and individuals to decide 

5 freely and responsibly the number, spacing, and 

6 timing of their children and to have the infor7 mation and means to do so, and the right to at8 tain the highest standard of sexual and repro9 ductive health; and 

10 (C) further includes the right of all couples 

11 and individuals to make decisions concerning 

12 reproduction free of discrimination, coercion, 

13 and violence, as expressed in human rights doc14 uments. 

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

16 health’’— 

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

18 mental, and social well-being in relation to sex19 uality and not merely the absence of disease, 

20 dysfunction, or infirmity; 

21 (B) includes a positive and respectful ap22 proach to sexuality and sexual relationships, as 

23 well as the possibility of having pleasurable and 

24 safe sexual experiences, free of coercion, dis25 crimination, and violence; and 


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1 (C) further includes the sexual rights of all 

2 persons to be respected, protected, and fulfilled. 

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

4 refers to nonuse of a modern contraceptive method 

5 by an individual who is married or unmarried and 

6 sexually active, is able to become pregnant, and 

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

8 before having a child. 

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

10 means those individuals who have attained the age 

11 of 10 years but not 25 years. 

12 (10) YOUTH.—The term ‘‘youth’’ means an in13 dividual who has attained the age of 15 years but 

14 not 25 years. 

Æ 


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