I 

113TH CONGRESS 

2D SESSION H. R. 5862 

To provide assistance to improve maternal and newborn health in developing 

countries, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 11, 2014 

Mrs. CAPPS introduced the following bill; which was referred to the Committee 

on Foreign Affairs 

A BILL 

To provide assistance to improve maternal and newborn 

health 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 ‘‘Improvements in Glob5 al Maternal and Newborn Health Outcomes while Maxi6 mizing Successes Act’’ or ‘‘Improvements in Global 

7 MOMS Act’’. 

8 SEC. 2. FINDINGS AND PURPOSES. 

9 (a) FINDINGS.—Congress finds the following: 


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

2 countries in supporting the 8 United Nations Millen3 nium Development Goals (MDGs), including MDG 

4 4, which aims to reduce child mortality by two-thirds 

5 and MDG 5, which aims to reduce the maternal 

6 mortality ratio by three-quarters by 2015. In 2005, 

7 universal access to reproductive health was added as 

8 a target for MDG 5. 

9 (2) Substantial progress in maternal health has 

10 been made. The total number of maternal deaths de11 creased by over 50 percent from 529,000 maternal 

12 deaths in 2000 to 287,000 maternal deaths in 2010. 

13 Egypt, Honduras, Malaysia, Sri Lanka, and parts of 

14 Bangladesh have all halved their maternal mortality 

15 ratios over the past few decades. 

16 (3) While significant progress has been made in 

17 reducing maternal mortality, the United Nations re18 ports that current maternal mortality levels are ‘‘far 

19 removed from the 2015 target’’. 

20 (4) Women in developing countries are nearly 

21 100 times more likely to die of complications during 

22 pregnancy or childbirth than in developed countries, 

23 with higher rates for women living in rural areas 

24 and among poorer communities. 


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1 (5) The United States Agency for International 

2 Development (USAID) estimates the global eco3 nomic impact of maternal and newborn mortality at 

4 $15 billion in lost productivity every year. 

5 (6) Annually, 287,000 women die from com6 plications during pregnancy or childbirth, with 99 

7 percent of these deaths occurring in developing 

8 countries. Six countries—Afghanistan, the Demo9 cratic Republic of Congo, Ethiopia, India, Nigeria, 

10 and Pakistan—account for almost one-half of all 

11 maternal deaths worldwide. 

12 (7) It is estimated that up to 90 percent of 

13 these maternal deaths are preventable. With access 

14 to medicines and skilled health care providers, most 

15 women across the world can expect a successful de16 livery and a healthy newborn. 

17 (8) The leading cause of maternal deaths is 

18 hemorrhage. Other primary causes of maternal 

19 death include sepsis, hypertensive disorder (pre-ec20 lampsia/eclampsia), unsafe abortion, and prolonged 

21 or obstructed labor. 

22 (9) An essential part of ensuring a woman sur23 vives pregnancy and childbirth includes access to 

24 maternal health medicines and other supplies. 

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1 rhage by causing contractions of the uterus during 

2 and after childbirth, effectively controlling excessive 

3 bleeding. If uterotonic medicines, such as oxytocin 

4 and misoprostol, were available to all women giving 

5 birth over a 10-year period, approximately 41 million 

6 postpartum hemorrhage cases could be prevented 

7 and 1.4 million women’s lives saved. 

8 (10) Pregnancy is the leading killer of adoles9 cent girls ages 15 to 19 in the developing world. 

10 Nearly 70,000 adolescent girls die every year be11 cause their bodies are not ready for childbirth. Com12 pared to women in their twenties, adolescent girls 

13 aged 15 to 19 are twice as likely to die in childbirth, 

14 and girls under 15 are five times as likely to die, 

15 and mortality and morbidity rates are also higher 

16 among infants born to young mothers. 

17 (11) For every maternal death, approximately 

18 20 women and girls experience serious or long-term 

19 negative health consequences. Severe pregnancy-re20 lated injuries include fistula, uterine prolapse, infec21 tions, diseases, and disabilities. Maternal morbidities 

22 accrue an estimated global cost of $6.8 billion. 

23 (12) Healthy timing and spacing of pregnancy 

24 has a powerful impact on the chances of survival for 

25 women, newborns, infants, and children. Access to 


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1 voluntary family planning plays an essential role in 

2 improving maternal health. 

3 (13) Delaying a first pregnancy until at least 

4 18 years old, waiting at least 24 months to become 

5 pregnant after a live birth, and waiting at least 6 

6 months after a miscarriage or induced abortion, can 

7 reduce all maternal mortality by 30 percent and pre8 vent 70,000 deaths per year of women who die from 

9 unsafe abortion. 

10 (14) Healthy timing and spacing of birth can 

11 also reduce newborn and child death by more than 

12 50 percent. Children born less than two years after 

13 the previous birth are approximately 2.5 times more 

14 likely to die before the age of five than children born 

15 three to five years after the previous birth. 

16 (15) If all women who wanted to delay or avoid 

17 pregnancy had access to modern contraception, 26 

18 million abortions would be averted. 

19 (16) More than 220 million women in devel20 oping countries who would prefer to delay or avoid 

21 childbearing lack access to safe and effective family 

22 planning methods. Less than one-half of married 

23 women of reproductive age in South Asia and less 

24 than 25 percent of women in sub-Saharan Africa use 

25 modern contraceptives. In 2012, an estimated 80 


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1 million women in developing countries had an unin2 tended pregnancy. 

3 (17) It is estimated that if 120 million more 

4 women had access to family planning information, 

5 services and supplies, without coercion or discrimina6 tion by 2020, 200,000 fewer girls and women would 

7 die during pregnancy and childbirth, there would be 

8 100 million fewer unintended pregnancies, there 

9 would be 50 million fewer abortions, and 3 million 

10 fewer infants would die in their first year of life. 

11 (18) Violent acts against pregnant women can 

12 also lead to poor health outcomes for women and 

13 their babies, including miscarriage, pre-term birth, 

14 low birthweight, stillbirths, and maternal deaths. 

15 The risk for maternal mortality is 3 times as high 

16 for abused mothers. In emergency settings, gender17 based violence rates continue to increase. 

18 (19) According to the World Health Organiza19 tion (WHO), women that have undergone female 

20 genital mutilation/cutting are significantly more like21 ly to experience serious postpartum health problems 

22 than those who have not undergone female genital 

23 mutilation, and children born to mothers who have 

24 undergone female genital mutilation face higher 

25 death rates immediately after birth. 


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1 (20) Maternal health is inextricably tied to new2 born health and survival. In some countries in the 

3 developing world the risk of newborn death doubles 

4 following maternal death. The conditions in utero, 

5 during labor, delivery, and shortly after birth have 

6 a direct relationship on newborn outcomes. 

7 (21) In 2012, 2.9 million newborns or 44 per8 cent of total under-five mortality did not survive the 

9 first month of life. One million of these deaths oc10 curred during the first day of life. 

11 (22) The leading causes of newborn mortality 

12 include prematurity, intrapartum complications (in13 cluding birth asphyxia), and neonatal infections. 

14 Over two-thirds of these deaths could be prevented 

15 through low-cost medicines, products, and interven16 tions that would not require intensive care. 

17 (23) In addition to newborn mortality there are 

18 an additional 2.65 million stillbirths each year that 

19 are not included in newborn or under-five mortality 

20 statistics. 

21 (24) Women in Africa are 24 times more likely 

22 to have a stillbirth than women in high-income coun23 tries. 

24 (25) In developing countries, nearly one-third of 

25 stillbirth babies were alive when labor began. If 99 


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1 percent of women in developing countries had com2 prehensive emergency obstetric care, nearly 700,000 

3 stillbirths could be prevented each year. 

4 (26) In many developing countries, lack of ac5 cess to quality health care facilities, health services, 

6 and trained providers results in deaths for mothers, 

7 newborns, and children—the majority of births in 

8 Africa take place without a skilled attendant present 

9 or the necessary medicines and medical supplies, in10 creasing the risk of death or disability for both 

11 mother and newborn. 

12 (27) If family planning and maternal and new13 born services were provided simultaneously, the costs 

14 of these services would decline by $1.5 billion and 

15 would result in a 70 percent decline in maternal 

16 deaths and a 44 percent decline in newborn deaths. 

17 (28) More than one-half of all children and 

18 pregnant women in developing countries suffer from 

19 anemia, which is exacerbated by malaria, neglected 

20 tropical diseases, and nutritional deficits, causing 

21 adverse pregnancy outcomes and even death. 

22 (29) Maternal deaths worldwide could be re23 duced by 60,000 per year if women received appro24 priate HIV diagnosis and treatment. 


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1 (30) With proper interventions, the trans2 mission of HIV between women and their infants 

3 during pregnancy and breastfeeding can be reduced 

4 to 5 percent in the developing world. The WHO rec5 ommends early diagnosis and immediate treatment 

6 for children identified as HIV positive because, with7 out treatment, half of these children will die before 

8 the age of two. 

9 (31) Nine out of ten women in sub-Saharan Af10 rica will lose a child during their lifetimes, and only 

11 30 percent of women in sub-Saharan Africa have 

12 contact with a health worker after giving birth. 

13 (32) According to the Director of National 

14 Intelligence’s 2009 Annual Threat Assessment, wide15 spread poor maternal and child health and malnutri16 tion has the potential to weaken central governments 

17 and empower non-state actors, including terrorist 

18 and paramilitary groups. 

19 (33) The experiences of United States Govern20 ment-supported and nongovernmental organization 

21 maternal and child health programs in countries 

22 such as Nepal, Ethiopia, and Senegal have dem23 onstrated that community-based approaches, linked 

24 to primary and referral care when possible, can de25 liver high-impact interventions to prevent or treat 


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1 many of the life-threatening conditions affecting 

2 mothers and newborns. 

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

4 (1) to authorize assistance to improve maternal 

5 and newborn health in developing countries; and 

6 (2) to develop a strategy to reduce mortality 

7 and morbidity and improve maternal and newborn 

8 health in developing countries. 

9 SEC. 3. ASSISTANCE TO REDUCE MORTALITY AND IMPROVE 

10 MATERNAL AND NEWBORN HEALTH IN DE11 VELOPING 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 maternal and newborn mortality, morbidity, and 

18 stillbirths’’; and 

19 (2) by inserting after section 104C the fol20 lowing new section: 

21 ‘‘SEC. 104D. ASSISTANCE TO REDUCE MORTALITY AND IM22 PROVE MATERNAL AND NEWBORN HEALTH. 

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

24 104(c), the President is authorized to furnish assistance, 

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1 mine, to reduce maternal and newborn mortality and mor2 bidity and improve maternal health and the health of 

3 newborns in developing countries. 

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

5 under subsection (a) shall, to the maximum extent prac6 ticable, include— 

7 ‘‘(1) activities to expand access to and improve 

8 quality of maternal health services, including— 

9 ‘‘(A) birth preparedness through the provi10 sion of quality pre-pregnancy and antenatal 

11 care with a skilled provider (midwife, nurse, or 

12 doctor), which should consist of, at minimum— 

13 ‘‘(i) iron and folic acid supplemen14 tation; 

15 ‘‘(ii) tetanus vaccine; 

16 ‘‘(iii) smoking cessation; 

17 ‘‘(iv) prevention and management of 

18 sexually transmitted infections and HIV, 

19 including access to Preventing Mother-to20 Child Transmission; 

21 ‘‘(v) screening, diagnosis, and treat22 ment of existing conditions, such as syphi23 lis, HIV/AIDS, malaria, and tuberculosis, 

24 and ensuring that women are provided 

25 with, or referred to, appropriate care and 


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1 treatment and prophylaxis for those condi2 tions, including access to antiretrovirals 

3 (ARVs); 

4 ‘‘(vi) magnesium sulfate and low-dose 

5 aspirin to prevent pre-eclampsia and cal6 cium supplementation to prevent hyper7 tension; 

8 ‘‘(vii) screening for complications, in9 cluding blood pressure screenings; 

10 ‘‘(viii) magnesium sulfate for eclamp11 sia; antihypertensive medication; 

12 ‘‘(ix) corticosteroids to prevent res13 piratory distress syndrome; 

14 ‘‘(x) induction of labor at term to 

15 manage pre-labor rupture of membranes; 

16 ‘‘(xi) nutrition treatment of malnour17 ished pregnant women; and 

18 ‘‘(xii) antibiotics for pre-term labor; 

19 ‘‘(B) expanding access to skilled childbirth 

20 and postnatal care, particularly in areas with 

21 low utilization of skilled delivery, including— 

22 ‘‘(i) the presence of a skilled health 

23 professional (nurse, midwife, or doctor) 

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1 mal or uncomplicated pregnancies or refer2 ral of complications in women and 

3 newborns, 

4 ‘‘(ii) clean delivery; 

5 ‘‘(iii) uterotonics and active manage6 ment of third stage of labor to prevent 

7 postpartum hemorrhage; 

8 ‘‘(iv) social support during childbirth; 

9 ‘‘(v) screening for HIV, linkages to 

10 HIV care and treatment services, and fol11 low up tracking; 

12 ‘‘(vi) induction of labor for prolonged 

13 pregnancy; 

14 ‘‘(vii) nutrition counseling; 

15 ‘‘(viii) management of postpartum 

16 hemorrhage; 

17 ‘‘(ix) caesarean section for maternal/ 

18 fetal indication with prophylactic anti19 biotics; 

20 ‘‘(x) treating maternal anemia; and 

21 ‘‘(xi) postpartum family planning 

22 methods; 

23 ‘‘(C) comprehensive voluntary family plan24 ning services, integrated into antenatal and 

25 postnatal care, to support women and men in 


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1 making informed decisions and having timely, 

2 intended, well-spaced pregnancies, and to help 

3 women with pre-existing conditions avoid high4 risk, unintended pregnancies, including— 

5 ‘‘(i) provision of family planning/birth 

6 spacing counseling and services; and 

7 ‘‘(ii) emergency treatment of com8 plications of unsafe abortions and linkages 

9 to other reproductive health services; 

10 ‘‘(2) activities to expand access to and improve 

11 quality of services that reduce newborn and infant 

12 mortality, including— 

13 ‘‘(A) immediate thermal care; 

14 ‘‘(B) initiation of early, exclusive, and con15 tinued breastfeeding; 

16 ‘‘(C) hygienic cord and skin care; 

17 ‘‘(D) kangaroo mother care; 

18 ‘‘(E) extra support for feeding small and 

19 preterm infants; 

20 ‘‘(F) antibiotic therapy for newborns at 

21 risk of bacterial infection; 

22 ‘‘(G) use of surfactant in pre-term infants; 

23 ‘‘(H) initiate prophylactic antiretroviral 

24 therapy for infants exposed to HIV; 


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1 ‘‘(I) neonatal resuscitation with a bag and 

2 mask for infants suffering from birth asphyxia; 

3 ‘‘(J) continuous positive airway pressure to 

4 manage respiratory distress syndrome; 

5 ‘‘(K) case management of neonatal sepsis, 

6 neonatal meningitis, and pneumonia; 

7 ‘‘(L) case management of meningitis, ma8 laria, diarrhea, pneumonia, and severe acute 

9 malnutrition; and 

10 ‘‘(M) comprehensive care of HIV, including 

11 ARVs, cotrimoxazole, nutrition support, and 

12 psychosocial support; 

13 ‘‘(3) activities to support communities and 

14 health care providers in identifying and removing 

15 barriers to maternal health care services, includ16 ing— 

17 ‘‘(A) financial and sociocultural barriers; 

18 ‘‘(B) child marriage; 

19 ‘‘(C) transportation; 

20 ‘‘(D) gender discrimination and gender21 based violence; 

22 ‘‘(E) stigma based on pre-existing health 

23 concerns; and 

24 ‘‘(F) female genital mutilation/cutting; 


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1 ‘‘(4) activities that focus on empowering women 

2 and girls and engaging men and boys at the indi3 vidual, household, and community levels to improve 

4 the health outcomes of women, newborns, and chil5 dren, including education and awareness programs 

6 about gender-based violence, the health risks of fe7 male genital mutilation, and shared responsibility 

8 for, and benefits of, family planning; 

9 ‘‘(5) activities to improve the supply of critical 

10 maternal and newborn health commodities, including 

11 lifesaving medicines and supplies, such as activities 

12 designed to strengthen regulatory systems to ensure 

13 the quality of commodities in circulation and those 

14 related to strengthening supply chain systems so 

15 that these commodities reach the women and chil16 dren who need them; 

17 ‘‘(6) activities supporting country-led efforts to 

18 improve capacity for health governance, health fi19 nance, and the health workforce, including in the 

20 private sector, and support for training clinicians, 

21 nurses, technicians, sanitation and public health 

22 workers, community-based health workers, midwives, 

23 birth attendants, peer educators, volunteers, and pri24 vate sector enterprises to provide integrated health 


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1 and nutrition services and referrals that meet the 

2 needs of patients across a continuum of care; 

3 ‘‘(7) activities that support country-led plans to 

4 reduce maternal and newborn mortality and mor5 bidity and stillbirths, including— 

6 ‘‘(A) management of host country institu7 tions’ information systems and the development 

8 and use of tools and models to collect, analyze, 

9 and disseminate information related to mater10 nal and newborn health; and 

11 ‘‘(B) activities to develop and conduct 

12 needs assessments, baseline studies, targeted 

13 evaluations, or other information-gathering ef14 forts for the design, monitoring, and evaluation 

15 of maternal and newborn health efforts, includ16 ing— 

17 ‘‘(i) the study of the availability and 

18 effects of critical medicines and devices, 

19 particularly those of importance in devel20 oping countries, on pregnant women and 

21 newborns; 

22 ‘‘(ii) the collection, evaluation, and 

23 use of data on the medical and socio24 economic factors that led to a maternal or 


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1 newborn death or stillbirths at the commu2 nity and health facility levels; and 

3 ‘‘(iii) the improvement of vital reg4 istries to capture live births, neonatal 

5 deaths, and the number of stillbirths; and 

6 ‘‘(8) activities to integrate and coordinate as7 sistance provided under this section with existing 

8 health programs for the prevention of the trans9 mission of HIV from mother to child and other HIV/ 

10 AIDS prevention, care, treatment, and counseling 

11 activities, including better integration with programs 

12 addressing— 

13 ‘‘(A) malaria; 

14 ‘‘(B) tuberculosis; 

15 ‘‘(C) family planning and reproductive 

16 health; 

17 ‘‘(D) counseling for survivors of sexual18 and gender-based violence; 

19 ‘‘(E) neglected tropical diseases; 

20 ‘‘(F) nutrition; and 

21 ‘‘(G) child survival. 

22 ‘‘(c) GUIDELINES.—To the maximum extent prac23 ticable, programs, projects, and activities carried out using 

24 assistance provided under this section shall be— 


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

2 organizations, including community and faith-based 

3 organizations, local organizations, and relevant 

4 international and multilateral organizations that 

5 demonstrate effectiveness, including the United Na6 tions Population Fund, the United Nations Chil7 dren’s Fund, and the Global Alliance for Vaccines 

8 and Immunizations, and that demonstrate commit9 ment to improving the health and rights of mothers 

10 and newborns and reducing the number of still11 births; 

12 ‘‘(2) carried out in the context of country-driv13 en plans in whose development the United States 

14 Government participates along with other donors 

15 and multilateral organizations, nongovernmental or16 ganizations, and civil society; 

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

18 other directly affected populations, especially women 

19 and marginalized communities; and 

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

21 country governments and civil society organizations. 

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

23 2016, and annually thereafter for 4 years, the President 

24 shall transmit to Congress a report on the implementation 

25 of this section for the prior fiscal year. 


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

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

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

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

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

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

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

8 this Act.’’. 

9 SEC. 4. DEVELOPMENT OF STRATEGY TO REDUCE MOR10 TALITY AND MORBIDITY AND IMPROVE MA11 TERNAL AND NEWBORN HEALTH IN DEVEL12 OPING COUNTRIES. 

13 (a) DEVELOPMENT OF STRATEGY.—The President 

14 shall develop and implement a comprehensive strategy to 

15 reduce mortality and morbidity and improve the health of 

16 mothers and newborns in developing countries that inte17 grates all current United States Government efforts on 

18 improving maternal and newborn health, including strate19 gies with respect to HIV/AIDS, gender, child survival. 

20 (b) COMPONENTS.—The comprehensive United 

21 States Government strategy developed pursuant to sub22 section (a) shall include the following: 

23 (1) An identification of not less than 24 coun24 tries, including fragile states and countries affected 

25 by conflict, with priority needs for the 5-year period 


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1 beginning on the date of the enactment of this Act 

2 based on— 

3 (A) the number and rate of neonatal 

4 deaths; 

5 (B) the number and rate of near-miss mor6 bidity for women and newborns; 

7 (C) the number and rate of maternal 

8 deaths; 

9 (D) the number and rate of caesarean sec10 tions; 

11 (E) the number and rate of malnourished 

12 women of reproductive age; and 

13 (F) the number of individuals with an 

14 unmet need for family planning. 

15 (2) For each country identified in paragraph 

16 (1)— 

17 (A) an assessment of the most common 

18 causes of maternal and newborn mortality and 

19 morbidity; 

20 (B) a description of the programmatic 

21 areas and interventions providing maximum 

22 health benefits to populations at risk and max23 imum reduction in mortality and morbidity; 


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1 (C) an assessment of the investments need2 ed in identified programs and interventions to 

3 achieve the greatest results; 

4 (D) a description of how United States as5 sistance complements and leverages efforts by 

6 other donors and builds capacity and self-suffi7 ciency among recipient countries; and 

8 (E) a description of goals and objectives 

9 for improving maternal and newborn health, in10 cluding, to the extent feasible, objective and 

11 quantifiable indicators. 

12 (3) 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 mothers and newborns in devel16 oping countries. 

17 (4) A description of the measured or estimated 

18 impact on maternal and newborn morbidity and 

19 mortality of each project or program receiving as20 sistance under section 104D of the Foreign Assist21 ance Act of 1961 (as added by section 3 of this Act). 

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

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

24 to Congress a report that contains the strategy described 

25 in this section. 


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1 SEC. 5. AUTHORIZATION OF APPROPRIATIONS. 

2 (a) IN GENERAL.—There are authorized to be appro3 priated to carry out this Act, and the amendments made 

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

5 fiscal years 2016 through 2020. 

6 (b) AVAILABILITY OF FUNDS.—Amounts appro7 priated pursuant to the authorization of appropriations 

8 under subsection (a) are authorized to remain available 

9 until expended. 

Æ 


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