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[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5862 Introduced in House (IH)]

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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Improvements in Global Maternal and 
Newborn Health Outcomes while Maximizing Successes Act'' or 
``Improvements in Global MOMS Act''.

SEC. 2. FINDINGS AND PURPOSES.

    (a) Findings.--Congress finds the following:
            (1) In 2000, the United States joined 188 other countries 
        in supporting the 8 United Nations Millennium Development Goals 
        (MDGs), including MDG 4, which aims to reduce child mortality 
        by two-thirds and MDG 5, which aims to reduce the maternal 
        mortality ratio by three-quarters by 2015. In 2005, universal 
        access to reproductive health was added as a target for MDG 5.
            (2) Substantial progress in maternal health has been made. 
        The total number of maternal deaths decreased by over 50 
        percent from 529,000 maternal deaths in 2000 to 287,000 
        maternal deaths in 2010. Egypt, Honduras, Malaysia, Sri Lanka, 
        and parts of Bangladesh have all halved their maternal 
        mortality ratios over the past few decades.
            (3) While significant progress has been made in reducing 
        maternal mortality, the United Nations reports that current 
        maternal mortality levels are ``far removed from the 2015 
        target''.
            (4) Women in developing countries are nearly 100 times more 
        likely to die of complications during pregnancy or childbirth 
        than in developed countries, with higher rates for women living 
        in rural areas and among poorer communities.
            (5) The United States Agency for International Development 
        (USAID) estimates the global economic impact of maternal and 
        newborn mortality at $15 billion in lost productivity every 
        year.
            (6) Annually, 287,000 women die from complications during 
        pregnancy or childbirth, with 99 percent of these deaths 
        occurring in developing countries. Six countries--Afghanistan, 
        the Democratic Republic of Congo, Ethiopia, India, Nigeria, and 
        Pakistan--account for almost one-half of all maternal deaths 
        worldwide.
            (7) It is estimated that up to 90 percent of these maternal 
        deaths are preventable. With access to medicines and skilled 
        health care providers, most women across the world can expect a 
        successful delivery and a healthy newborn.
            (8) The leading cause of maternal deaths is hemorrhage. 
        Other primary causes of maternal death include sepsis, 
        hypertensive disorder (pre-eclampsia/eclampsia), unsafe 
        abortion, and prolonged or obstructed labor.
            (9) An essential part of ensuring a woman survives 
        pregnancy and childbirth includes access to maternal health 
        medicines and other supplies. Uterotonics prevent and treat 
        postpartum hemorrhage by causing contractions of the uterus 
        during and after childbirth, effectively controlling excessive 
        bleeding. If uterotonic medicines, such as oxytocin and 
        misoprostol, were available to all women giving birth over a 
        10-year period, approximately 41 million postpartum hemorrhage 
        cases could be prevented and 1.4 million women's lives saved.
            (10) Pregnancy is the leading killer of adolescent girls 
        ages 15 to 19 in the developing world. Nearly 70,000 adolescent 
        girls die every year because their bodies are not ready for 
        childbirth. Compared to women in their twenties, adolescent 
        girls aged 15 to 19 are twice as likely to die in childbirth, 
        and girls under 15 are five times as likely to die, and 
        mortality and morbidity rates are also higher among infants 
        born to young mothers.
            (11) For every maternal death, approximately 20 women and 
        girls experience serious or long-term negative health 
        consequences. Severe pregnancy-related injuries include 
        fistula, uterine prolapse, infections, diseases, and 
        disabilities. Maternal morbidities accrue an estimated global 
        cost of $6.8 billion.
            (12) Healthy timing and spacing of pregnancy has a powerful 
        impact on the chances of survival for women, newborns, infants, 
        and children. Access to voluntary family planning plays an 
        essential role in improving maternal health.
            (13) Delaying a first pregnancy until at least 18 years 
        old, waiting at least 24 months to become pregnant after a live 
        birth, and waiting at least 6 months after a miscarriage or 
        induced abortion, can reduce all maternal mortality by 30 
        percent and prevent 70,000 deaths per year of women who die 
        from unsafe abortion.
            (14) Healthy timing and spacing of birth can also reduce 
        newborn and child death by more than 50 percent. Children born 
        less than two years after the previous birth are approximately 
        2.5 times more likely to die before the age of five than 
        children born three to five years after the previous birth.
            (15) If all women who wanted to delay or avoid pregnancy 
        had access to modern contraception, 26 million abortions would 
        be averted.
            (16) More than 220 million women in developing countries 
        who would prefer to delay or avoid childbearing lack access to 
        safe and effective family planning methods. Less than one-half 
        of married women of reproductive age in South Asia and less 
        than 25 percent of women in sub-Saharan Africa use modern 
        contraceptives. In 2012, an estimated 80 million women in 
        developing countries had an unintended pregnancy.
            (17) It is estimated that if 120 million more women had 
        access to family planning information, services and supplies, 
        without coercion or discrimination by 2020, 200,000 fewer girls 
        and women would die during pregnancy and childbirth, there 
        would be 100 million fewer unintended pregnancies, there would 
        be 50 million fewer abortions, and 3 million fewer infants 
        would die in their first year of life.
            (18) Violent acts against pregnant women can also lead to 
        poor health outcomes for women and their babies, including 
        miscarriage, pre-term birth, low birthweight, stillbirths, and 
        maternal deaths. The risk for maternal mortality is 3 times as 
        high for abused mothers. In emergency settings, gender-based 
        violence rates continue to increase.
            (19) According to the World Health Organization (WHO), 
        women that have undergone female genital mutilation/cutting are 
        significantly more likely to experience serious postpartum 
        health problems than those who have not undergone female 
        genital mutilation, and children born to mothers who have 
        undergone female genital mutilation face higher death rates 
        immediately after birth.
            (20) Maternal health is inextricably tied to newborn health 
        and survival. In some countries in the developing world the 
        risk of newborn death doubles following maternal death. The 
        conditions in utero, during labor, delivery, and shortly after 
        birth have a direct relationship on newborn outcomes.
            (21) In 2012, 2.9 million newborns or 44 percent of total 
        under-five mortality did not survive the first month of life. 
        One million of these deaths occurred during the first day of 
        life.
            (22) The leading causes of newborn mortality include 
        prematurity, intrapartum complications (including birth 
        asphyxia), and neonatal infections. Over two-thirds of these 
        deaths could be prevented through low-cost medicines, products, 
        and interventions that would not require intensive care.
            (23) In addition to newborn mortality there are an 
        additional 2.65 million stillbirths each year that are not 
        included in newborn or under-five mortality statistics.
            (24) Women in Africa are 24 times more likely to have a 
        stillbirth than women in high-income countries.
            (25) In developing countries, nearly one-third of 
        stillbirth babies were alive when labor began. If 99 percent of 
        women in developing countries had comprehensive emergency 
        obstetric care, nearly 700,000 stillbirths could be prevented 
        each year.
            (26) In many developing countries, lack of access to 
        quality health care facilities, health services, and trained 
        providers results in deaths for mothers, newborns, and 
        children--the majority of births in Africa take place without a 
        skilled attendant present or the necessary medicines and 
        medical supplies, increasing the risk of death or disability 
        for both mother and newborn.
            (27) If family planning and maternal and newborn services 
        were provided simultaneously, the costs of these services would 
        decline by $1.5 billion and would result in a 70 percent 
        decline in maternal deaths and a 44 percent decline in newborn 
        deaths.
            (28) More than one-half of all children and pregnant women 
        in developing countries suffer from anemia, which is 
        exacerbated by malaria, neglected tropical diseases, and 
        nutritional deficits, causing adverse pregnancy outcomes and 
        even death.
            (29) Maternal deaths worldwide could be reduced by 60,000 
        per year if women received appropriate HIV diagnosis and 
        treatment.
            (30) With proper interventions, the transmission of HIV 
        between women and their infants during pregnancy and 
        breastfeeding can be reduced to 5 percent in the developing 
        world. The WHO recommends early diagnosis and immediate 
        treatment for children identified as HIV positive because, 
        without treatment, half of these children will die before the 
        age of two.
            (31) Nine out of ten women in sub-Saharan Africa will lose 
        a child during their lifetimes, and only 30 percent of women in 
        sub-Saharan Africa have contact with a health worker after 
        giving birth.
            (32) According to the Director of National Intelligence's 
        2009 Annual Threat Assessment, widespread poor maternal and 
        child health and malnutrition has the potential to weaken 
        central governments and empower non-state actors, including 
        terrorist and paramilitary groups.
            (33) The experiences of United States Government-supported 
        and nongovernmental organization maternal and child health 
        programs in countries such as Nepal, Ethiopia, and Senegal have 
        demonstrated that community-based approaches, linked to primary 
        and referral care when possible, can deliver high-impact 
        interventions to prevent or treat many of the life-threatening 
        conditions affecting mothers and newborns.
    (b) Purposes.--The purposes of this Act are--
            (1) to authorize assistance to improve maternal and newborn 
        health in developing countries; and
            (2) to develop a strategy to reduce mortality and morbidity 
        and improve maternal and newborn health in developing 
        countries.

SEC. 3. ASSISTANCE TO REDUCE MORTALITY AND IMPROVE MATERNAL AND NEWBORN 
              HEALTH IN DEVELOPING COUNTRIES.

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

``SEC. 104D. ASSISTANCE TO REDUCE MORTALITY AND IMPROVE MATERNAL AND 
              NEWBORN HEALTH.

    ``(a) Authorization.--Consistent with section 104(c), the President 
is authorized to furnish assistance, on such terms and conditions as 
the President may determine, to reduce maternal and newborn mortality 
and morbidity and improve maternal health and the health of newborns in 
developing countries.
    ``(b) Activities Supported.--Assistance provided under subsection 
(a) shall, to the maximum extent practicable, include--
            ``(1) activities to expand access to and improve quality of 
        maternal health services, including--
                    ``(A) birth preparedness through the provision of 
                quality pre-pregnancy and antenatal care with a skilled 
                provider (midwife, nurse, or doctor), which should 
                consist of, at minimum--
                            ``(i) iron and folic acid supplementation;
                            ``(ii) tetanus vaccine;
                            ``(iii) smoking cessation;
                            ``(iv) prevention and management of 
                        sexually transmitted infections and HIV, 
                        including access to Preventing Mother-to-Child 
                        Transmission;
                            ``(v) screening, diagnosis, and treatment 
                        of existing conditions, such as syphilis, HIV/
                        AIDS, malaria, and tuberculosis, and ensuring 
                        that women are provided with, or referred to, 
                        appropriate care and treatment and prophylaxis 
                        for those conditions, including access to 
                        antiretrovirals (ARVs);
                            ``(vi) magnesium sulfate and low-dose 
                        aspirin to prevent pre-eclampsia and calcium 
                        supplementation to prevent hypertension;
                            ``(vii) screening for complications, 
                        including blood pressure screenings;
                            ``(viii) magnesium sulfate for eclampsia; 
                        antihypertensive medication;
                            ``(ix) corticosteroids to prevent 
                        respiratory distress syndrome;
                            ``(x) induction of labor at term to manage 
                        pre-labor rupture of membranes;
                            ``(xi) nutrition treatment of malnourished 
                        pregnant women; and
                            ``(xii) antibiotics for pre-term labor;
                    ``(B) expanding access to skilled childbirth and 
                postnatal care, particularly in areas with low 
                utilization of skilled delivery, including--
                            ``(i) the presence of a skilled health 
                        professional (nurse, midwife, or doctor) who 
                        has been educated and trained to proficiency in 
                        the skills needed to manage normal or 
                        uncomplicated pregnancies or referral of 
                        complications in women and newborns,
                            ``(ii) clean delivery;
                            ``(iii) uterotonics and active management 
                        of third stage of labor to prevent postpartum 
                        hemorrhage;
                            ``(iv) social support during childbirth;
                            ``(v) screening for HIV, linkages to HIV 
                        care and treatment services, and follow up 
                        tracking;
                            ``(vi) induction of labor for prolonged 
                        pregnancy;
                            ``(vii) nutrition counseling;
                            ``(viii) management of postpartum 
                        hemorrhage;
                            ``(ix) caesarean section for maternal/fetal 
                        indication with prophylactic antibiotics;
                            ``(x) treating maternal anemia; and
                            ``(xi) postpartum family planning methods;
                    ``(C) comprehensive voluntary family planning 
                services, integrated into antenatal and postnatal care, 
                to support women and men in making informed decisions 
                and having timely, intended, well-spaced pregnancies, 
                and to help women with pre-existing conditions avoid 
                high-risk, unintended pregnancies, including--
                            ``(i) provision of family planning/birth 
                        spacing counseling and services; and
                            ``(ii) emergency treatment of complications 
                        of unsafe abortions and linkages to other 
                        reproductive health services;
            ``(2) activities to expand access to and improve quality of 
        services that reduce newborn and infant mortality, including--
                    ``(A) immediate thermal care;
                    ``(B) initiation of early, exclusive, and continued 
                breastfeeding;
                    ``(C) hygienic cord and skin care;
                    ``(D) kangaroo mother care;
                    ``(E) extra support for feeding small and preterm 
                infants;
                    ``(F) antibiotic therapy for newborns at risk of 
                bacterial infection;
                    ``(G) use of surfactant in pre-term infants;
                    ``(H) initiate prophylactic antiretroviral therapy 
                for infants exposed to HIV;
                    ``(I) neonatal resuscitation with a bag and mask 
                for infants suffering from birth asphyxia;
                    ``(J) continuous positive airway pressure to manage 
                respiratory distress syndrome;
                    ``(K) case management of neonatal sepsis, neonatal 
                meningitis, and pneumonia;
                    ``(L) case management of meningitis, malaria, 
                diarrhea, pneumonia, and severe acute malnutrition; and
                    ``(M) comprehensive care of HIV, including ARVs, 
                cotrimoxazole, nutrition support, and psychosocial 
                support;
            ``(3) activities to support communities and health care 
        providers in identifying and removing barriers to maternal 
        health care services, including--
                    ``(A) financial and sociocultural barriers;
                    ``(B) child marriage;
                    ``(C) transportation;
                    ``(D) gender discrimination and gender-based 
                violence;
                    ``(E) stigma based on pre-existing health concerns; 
                and
                    ``(F) female genital mutilation/cutting;
            ``(4) activities that focus on empowering women and girls 
        and engaging men and boys at the individual, household, and 
        community levels to improve the health outcomes of women, 
        newborns, and children, including education and awareness 
        programs about gender-based violence, the health risks of 
        female genital mutilation, and shared responsibility for, and 
        benefits of, family planning;
            ``(5) activities to improve the supply of critical maternal 
        and newborn health commodities, including lifesaving medicines 
        and supplies, such as activities designed to strengthen 
        regulatory systems to ensure the quality of commodities in 
        circulation and those related to strengthening supply chain 
        systems so that these commodities reach the women and children 
        who need them;
            ``(6) activities supporting country-led efforts to improve 
        capacity for health governance, health finance, and the health 
        workforce, including in the private sector, and support for 
        training clinicians, nurses, technicians, sanitation and public 
        health workers, community-based health workers, midwives, birth 
        attendants, peer educators, volunteers, and private sector 
        enterprises to provide integrated health and nutrition services 
        and referrals that meet the needs of patients across a 
        continuum of care;
            ``(7) activities that support country-led plans to reduce 
        maternal and newborn mortality and morbidity and stillbirths, 
        including--
                    ``(A) management of host country institutions' 
                information systems and the development and use of 
                tools and models to collect, analyze, and disseminate 
                information related to maternal and newborn health; and
                    ``(B) activities to develop and conduct needs 
                assessments, baseline studies, targeted evaluations, or 
                other information-gathering efforts for the design, 
                monitoring, and evaluation of maternal and newborn 
                health efforts, including--
                            ``(i) the study of the availability and 
                        effects of critical medicines and devices, 
                        particularly those of importance in developing 
                        countries, on pregnant women and newborns;
                            ``(ii) the collection, evaluation, and use 
                        of data on the medical and socioeconomic 
                        factors that led to a maternal or newborn death 
                        or stillbirths at the community and health 
                        facility levels; and
                            ``(iii) the improvement of vital registries 
                        to capture live births, neonatal deaths, and 
                        the number of stillbirths; and
            ``(8) activities to integrate and coordinate assistance 
        provided under this section with existing health programs for 
        the prevention of the transmission of HIV from mother to child 
        and other HIV/AIDS prevention, care, treatment, and counseling 
        activities, including better integration with programs 
        addressing--
                    ``(A) malaria;
                    ``(B) tuberculosis;
                    ``(C) family planning and reproductive health;
                    ``(D) counseling for survivors of sexual- and 
                gender-based violence;
                    ``(E) neglected tropical diseases;
                    ``(F) nutrition; and
                    ``(G) child survival.
    ``(c) Guidelines.--To the maximum extent practicable, programs, 
projects, and activities carried out using assistance provided under 
this section shall be--
            ``(1) carried out through private and voluntary 
        organizations, including community and faith-based 
        organizations, local organizations, and relevant international 
        and multilateral organizations that demonstrate effectiveness, 
        including the United Nations Population Fund, the United 
        Nations Children's Fund, and the Global Alliance for Vaccines 
        and Immunizations, and that demonstrate commitment to improving 
        the health and rights of mothers and newborns and reducing the 
        number of stillbirths;
            ``(2) carried out in the context of country-driven plans in 
        whose development the United States Government participates 
        along with other donors and multilateral organizations, 
        nongovernmental organizations, and civil society;
            ``(3) carried out with input by beneficiaries and other 
        directly affected populations, especially women and 
        marginalized communities; and
            ``(4) designed to build the capacity of host country 
        governments and civil society organizations.
    ``(d) Annual Report.--Not later than January 31, 2016, and annually 
thereafter for 4 years, the President shall transmit to Congress a 
report on the implementation of this section for the prior fiscal year.
    ``(e) Definitions.--In this section:
            ``(1) AIDS.--The term `AIDS' has the meaning given the term 
        in section 104A(g)(1) of this Act.
            ``(2) HIV.--The term `HIV' has the meaning given the term 
        in section 104A(g)(2) of this Act.
            ``(3) HIV/AIDS.--The term `HIV/AIDS' has the meaning given 
        the term in section 104A(g)(3) of this Act.''.

SEC. 4. DEVELOPMENT OF STRATEGY TO REDUCE MORTALITY AND MORBIDITY AND 
              IMPROVE MATERNAL AND NEWBORN HEALTH IN DEVELOPING 
              COUNTRIES.

    (a) Development of Strategy.--The President shall develop and 
implement a comprehensive strategy to reduce mortality and morbidity 
and improve the health of mothers and newborns in developing countries 
that integrates all current United States Government efforts on 
improving maternal and newborn health, including strategies with 
respect to HIV/AIDS, gender, child survival.
    (b) Components.--The comprehensive United States Government 
strategy developed pursuant to subsection (a) shall include the 
following:
            (1) An identification of not less than 24 countries, 
        including fragile states and countries affected by conflict, 
        with priority needs for the 5-year period beginning on the date 
        of the enactment of this Act based on--
                    (A) the number and rate of neonatal deaths;
                    (B) the number and rate of near-miss morbidity for 
                women and newborns;
                    (C) the number and rate of maternal deaths;
                    (D) the number and rate of caesarean sections;
                    (E) the number and rate of malnourished women of 
                reproductive age; and
                    (F) the number of individuals with an unmet need 
                for family planning.
            (2) For each country identified in paragraph (1)--
                    (A) an assessment of the most common causes of 
                maternal and newborn mortality and morbidity;
                    (B) a description of the programmatic areas and 
                interventions providing maximum health benefits to 
                populations at risk and maximum reduction in mortality 
                and morbidity;
                    (C) an assessment of the investments needed in 
                identified programs and interventions to achieve the 
                greatest results;
                    (D) a description of how United States assistance 
                complements and leverages efforts by other donors and 
                builds capacity and self-sufficiency among recipient 
                countries; and
                    (E) a description of goals and objectives for 
                improving maternal and newborn health, including, to 
                the extent feasible, objective and quantifiable 
                indicators.
            (3) Enhanced coordination among relevant departments and 
        agencies of the United States Government engaged in activities 
        to improve the health and well-being of mothers and newborns in 
        developing countries.
            (4) A description of the measured or estimated impact on 
        maternal and newborn morbidity and mortality of each project or 
        program receiving assistance under section 104D of the Foreign 
        Assistance Act of 1961 (as added by section 3 of this Act).
    (c) Report.--Not later than 180 days after the date of the 
enactment of this Act, the President shall transmit to Congress a 
report that contains the strategy described in this section.

SEC. 5. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--There are authorized to be appropriated to carry 
out this Act, and the amendments made by this Act, such sums as may be 
necessary for each of fiscal years 2016 through 2020.
    (b) Availability of Funds.--Amounts appropriated pursuant to the 
authorization of appropriations under subsection (a) are authorized to 
remain available until expended.
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