I 

111TH CONGRESS 

2D SESSION H. R. 5121 

To promote the sexual and reproductive health of individuals and couples 

in developing countries, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 22, 2010 

Ms. CLARKE (for herself, Ms. WOOLSEY, Mr. ELLISON, Mrs. MALONEY, Mr. 

STARK, Ms. CHU, Mrs. DAVIS of California, Ms. WATSON, Mr. GRIJALVA, 

Ms. KILPATRICK of Michigan, Ms. BALDWIN, Mrs. CAPPS, Mr. MOORE

of Kansas, Ms. SCHAKOWSKY, Mr. COHEN, Mr. MEEK of Florida, Ms. 

LEE of California, and Ms. SLAUGHTER) 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 2010’’. 

6 SEC. 2. FINDINGS AND PURPOSES. 

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


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1 (1) The advancement of sexual and reproduc2 tive health is necessary to meeting most of the eight 

3 United Nations Millennium Development Goals 

4 (MDGs), the current international development 

5 framework developed by 189 countries in 2000, in6 cluding the United States. Target 5B, which is 

7 found under MDG 5 on improving maternal health 

8 and which requires achieving universal access to re9 productive health by the year 2015, is an essential 

10 element in attaining MDGs related to eradicating 

11 poverty (MDG 1), achieving universal education 

12 (MDG 2), promoting gender equality (MDG 3), re13 ducing child mortality (MDG 4), improving maternal 

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

15 and ensuring environmental sustainability (MDG 7). 

16 (2) The report of the United Nations Secretary17 General to the 2009 Commission on Population and 

18 Development ‘‘. . . reaffirms that population, repro19 ductive health and gender issues are central to devel20 opment and to the achievement of the Millennium 

21 Development Goals.’’. 

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

23 access of women, particularly poor women, to basic 

24 reproductive health services and information contrib25 utes to death and suffering among women and their 


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1 families, undermines women’s struggle for self-deter2 mination, and vitiates the efforts of families to lift 

3 themselves out of the poverty in which over a billion 

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

5 and couples to choose the number and timing of 

6 their children, reproductive health care gives families 

7 and individuals greater control over their economic 

8 resources. 

9 (4) Aspects of sexual and reproductive health, 

10 including maternal mortality and morbidity, repro11 ductive cancers, and sexually transmitted infections 

12 (STIs), including HIV, account for nearly 20 per13 cent of the global burden of ill-health for women and 

14 some 14 percent for men, according to the World 

15 Health Organization (WHO). 

16 (5) Poor sexual and reproductive health is the 

17 leading cause of death and disability among women 

18 of child-bearing age. 

19 (6) School-based education and family planning 

20 play an interrelated role in lifting the status of 

21 women. Delaying sexual debut, along with contracep22 tive use among young women already sexually active, 

23 lowers the likelihood that young women will leave 

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1 creases the chances that young women will delay the 

2 age at which they marry and give birth. 

3 (7) Sexual and reproductive health programs 

4 can empower women to make informed decisions and 

5 better control their lives, and by engaging men and 

6 boys in taking responsibility for the sexual and re7 productive health of their partners, can contribute to 

8 greater gender equality. 

9 (8) Access to sexual and reproductive health 

10 services, including family planning, has a direct and 

11 important impact on infant and child mortality. By 

12 allowing women to choose the timing, number, and 

13 spacing of their pregnancies, high-risk births are 

14 averted, and the children that are born have a great15 er chance of surviving to adulthood. Four million 

16 newborns die in the first four weeks of life, which 

17 accounts for 43 percent of all deaths of children 

18 under the age of 5. By providing women family plan19 ning services to space their births 3 years apart, 

20 rates for infant and under-5 mortality would drop by 

21 24 percent and 35 percent, respectively. 

22 (9) Increasing access to sexual and reproductive 

23 health could significantly decrease pregnancy-related 

24 mortality and morbidity by reducing the number of 


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1 pregnancies that place women at increased risk of 

2 experiencing such complications. 

3 (10) An estimated 215,000,000 women in devel4 oping countries have an unmet need for effective, 

5 modern contraceptives and would like to postpone 

6 childbearing, space births, or want no more children 

7 but are not using a modern method of contraception. 

8 Providing modern contraceptives to fill this unmet 

9 need would avert an estimated 53,000,000 unin10 tended pregnancies each year, thereby preventing 

11 150,000 women from dying of pregnancy-related 

12 complications, 600,000 children from losing their 

13 mothers, and 25,000,000 induced abortions. 

14 (11) Complications due to pregnancy and child15 birth are the leading cause of death among women 

16 ages 15 to 19. Each year, an estimated 550,000 

17 women worldwide die from complications related to 

18 pregnancy, childbirth, or unsafe abortion. Another 

19 50,000,000 women annually suffer long-term illness 

20 or permanent physical impairment from such causes. 

21 (12) Unsafe abortion accounts for 13 percent of 

22 maternal deaths worldwide. More than half of abor23 tions (55 percent) in the developing world are un24 safe. Of the 19,000,000 unsafe abortions that take 

25 place each year, most occur in the developing world. 


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1 Around 70,000 women die and millions more suffer 

2 serious injuries from the complications of unsafely 

3 performed abortions. Abortion rates are similar in 

4 countries whether abortion is illegal or legal. How5 ever, death and injury from unsafe abortion is great6 ly reduced where abortion is legal for a broad range 

7 of indications and where safe abortion is accessible. 

8 (13) Meeting the need for family planning serv9 ices and pregnancy-related care, by doubling the cur10 rent global investment for both, would reduce mater11 nal mortality by 70 percent and deaths to newborns 

12 by 44 percent. These goals can be achieved for 

13 $1,500,000,000 less than the cost of achieving ma14 ternal and newborn health alone. Every dollar in15 vested in family planning saves $1.40 in maternal 

16 and newborn health care services. 

17 (14) Worldwide, women of childbearing age ac18 count for more than half of people living with HIV/ 

19 AIDS. Integrating reproductive health services, in20 cluding family planning, with HIV prevention pro21 grams, such as those for voluntary counseling and 

22 testing and prevention of mother-to-child trans23 mission, is essential to effectively combating HIV/ 

24 AIDS and other STIs. 


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

3 world’s population, some 3,000,000,000 people, is 

4 under the age of 25. Unmet need for sexual and re5 productive health services is highest among this age 

6 cohort. Fewer than 5 percent of the poorest sexually 

7 active youth use modern contraception. 

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

9 second most important risk factor for disability and 

10 death among young people in the world’s poorest 

11 communities. Forty-five percent of all new HIV in12 fections occur among young people. 

13 (17) Sixty percent of unsafe abortions in Afri14 ca, 42 percent in Latin America and the Caribbean, 

15 and 30 percent in Asia are performed on women 

16 under the age of 25. 

17 (18) The WHO has identified a 4-pronged ap18 proach to preventing HIV infection in infants, which 

19 includes prevention of unintended pregnancy among 

20 HIV-infected women as a key strategy to prevent 

21 mother-to-child transmission of HIV. 

22 (19) According to the United States Agency for 

23 International Development, enabling HIV-positive 

24 women who want to avoid a pregnancy with contra25 ceptive services can prevent an additional 55,000 


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1 child deaths and avert more than 150,000 unin2 tended pregnancies in high HIV prevalence coun3 tries. 

4 (20) Demographic factors exacerbate problems 

5 related to environmental sustainability. The past 

6 century of population growth has put increasing 

7 pressure on natural resources as the scale of human 

8 needs and activities expands. At the same time, ac9 tual family size in most developing countries remains 

10 greater than the desired family size. Access to family 

11 planning services helps couples to determine their 

12 own family size, hence mitigating the depletion of 

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

14 (21) Practices like early marriage, female gen15 ital mutilation, and early sexual debut adversely im16 pact the sexual and reproductive health of young 

17 people in many developing countries, and strong bar18 riers exist to providing the information, services, and 

19 other forms of support that young people need to 

20 lead healthy sexual and reproductive lives. 

21 (22) Comprehensive sexuality education seeks 

22 to help young people develop the interpersonal skills 

23 necessary for the formation of caring, supportive, 

24 and non-coercive relationships and the ability to ex25 ercise responsibility regarding sexual relationships 


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1 by addressing such issues as abstinence and the use 

2 of condoms, contraceptives, and other protective sex3 ual health measures. 

4 (23) The United Nations has estimated that the 

5 minimum financial requirements for sexual and re6 productive health, including family planning and ma7 ternal health, are roughly $23,500,000,000 in 2009 

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

9 2015. The minimum financial requirement for HIV/ 

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

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

12 the International Conference on Population and De13 velopment’s Programme of Action, which the United 

14 States committed to, developed-country donors are 

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

16 year. Developing countries are responsible for the re17 maining two-thirds. 

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

19 supporting and recognizing the fundamental health 

20 and human rights of all people through the signing 

21 or ratifying of various international agreements. 

22 Those agreements include the Universal Declaration 

23 of Human Rights (1948), the International Cov24 enant on Civil and Political Rights (1966), the 

25 International Covenant on Economic, Social, and 


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1 Cultural Rights (1966), the Convention on the 

2 Elimination of All Forms of Discrimination Against 

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

4 Child (1989), the International Conference on Popu5 lation and Development Programme of Action 

6 (1994), and the United Nations Millennium Devel7 opment Goals (2000). 

8 (25) The United States has been the largest 

9 donor to international family planning and reproduc10 tive health efforts over the last 40 years and has 

11 been an unparalleled source of leadership and inno12 vation in the field. Nonetheless, it has not met its 

13 fair share of financial assistance to global sexual and 

14 reproductive health programs. Now is the time to 

15 shore up the United States political and financial 

16 commitment in order to satisfy the large unmet need 

17 for these services, thereby helping to improve wom18 en’s sexual and reproductive health worldwide. 

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

20 (1) authorize assistance to improve the sexual 

21 and reproductive health of individuals and couples in 

22 developing countries; and 

23 (2) implement comprehensive sexual and repro24 ductive health programs offering a continuum of 


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1 care that are responsive to the sexual and reproduc2 tive health needs of young people and adults. 

3 SEC. 3. STATEMENT OF POLICY. 

4 The following shall be the policy of the United States 

5 Government: 

6 (1) All individuals and couples shall have the 

7 basic reproductive right to decide freely and respon8 sibly the number, spacing, and timing of their chil9 dren and shall have the information and means to 

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

11 of sexual and reproductive health. 

12 (2) All individuals and couples also shall have 

13 the right to make decisions concerning reproduction 

14 free of discrimination, coercion, and violence, as ex15 pressed in human rights documents. 

16 (3) The promotion of the responsible exercise of 

17 these reproductive rights for all people shall be the 

18 fundamental basis for sexual and reproductive health 

19 programs supported by United States Government 

20 assistance. 

21 (4) The principle of free and informed consent 

22 must underlie all sexual and reproductive health pro23 grams and services. This principle applies to individ24 uals whether they choose to continue or terminate 

25 their pregnancies—thus, forced pregnancies as well 


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1 as forced abortions or sterilizations are prohibited. 

2 Decisions relating to contraceptive use should be 

3 made on an informed and voluntary basis after ade4 quate information, counseling, and services are pro5 vided on a range of methods. 

6 (5) Incentives and disincentives should not be 

7 used in family planning programs in order to meet 

8 numerical population targets or quotas for fertility 

9 goals. Instead, governments should use other indica10 tors, such as unmet needs, to define family planning 

11 goals. 

12 (6) In sexual and reproductive health programs 

13 funded by the United States Government, special at14 tention should be paid to serving the needs of young 

15 people. 

16 SEC. 4. ASSISTANCE TO SUPPORT THE ACHIEVEMENT OF 

17 UNIVERSAL ACCESS TO SEXUAL AND REPRO18 DUCTIVE HEALTH. 

19 (a) ASSISTANCE AUTHORIZED.—The President is au20 thorized to provide assistance in order to support the 

21 achievement of universal access to sexual and reproductive 

22 health in developing countries and to ensure individuals 

23 and couples in developing countries can freely and respon24 sibly determine the number, timing, and spacing of their 

25 children and have the means to do so. 


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1 (b) ACTIVITIES SUPPORTED.—Assistance provided 

2 under subsection (a) may be used to— 

3 (1) expand access to and use of voluntary fam4 ily planning information and services, to enable indi5 viduals and couples to avoid unintended pregnancies 

6 and other risks to sexual and reproductive health, 

7 including those associated with pregnancy, reproduc8 tive tract infections, and sexually transmitted infec9 tions (STIs), including HIV; 

10 (2) improve public knowledge of contraceptives, 

11 including where methods may be obtained, and risk12 reduction strategies, and to promote the benefits of 

13 family planning and other sexual and reproductive 

14 health care to individuals, families, and commu15 nities, including through the use of education and 

16 awareness programs, mass media, and community 

17 mobilization and outreach; 

18 (3) increase the responsiveness of sexual and 

19 reproductive health programs to the needs of the in20 tended beneficiaries during the entirety of their sex21 ual and reproductive lives, including young people 

22 and older adults; 

23 (4) reduce the incidence of unsafe abortion, in24 cluding research on the health consequences of un25 safe abortion, and provide for the equipment and 


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1 training necessary for medical treatment of the con2 sequences of unsafe abortions; 

3 (5) notwithstanding any other provision of law, 

4 provide safe abortion, to the extent permitted by the 

5 laws of the recipient country; 

6 (6) promote the integration of family planning 

7 services in HIV and other STI prevention, treat8 ment, care, and support; 

9 (7) integrate family planning services with ma10 ternal and newborn health care, especially in 

11 antenatal, post-partum, and post-abortion care set12 tings; 

13 (8) ensure the consistent availability and af14 fordability of high quality sexual and reproductive 

15 health supplies and services, including male and fe16 male condoms, for the prevention of HIV and other 

17 STIs; 

18 (9) encourage the abandonment of female gen19 ital mutilation, early marriage, early childbearing, 

20 and other harmful traditional practices that have 

21 negative reproductive health consequences; 

22 (10) prevent and repair obstetric fistula; 

23 (11) promote the constructive engagement of 

24 men and boys, the empowerment of women and 

25 girls, and more equitable gender norms in order to 


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1 improve health outcomes and support the adoption 

2 of healthy reproductive behaviors; 

3 (12) prevent and mitigate gender-based vio4 lence; 

5 (13) provide comprehensive sexuality education 

6 for young people; 

7 (14) prevent, diagnose, and treat, where appro8 priate, infertility and cancers of the reproductive 

9 system and refer as appropriate; 

10 (15) develop improved methods of safe and ef11 fective contraception and related disease control 

12 through investments in biomedical research, with 

13 particular emphasis on methods which— 

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

15 more efficient to make available in developing 

16 country settings, and less expensive than cur17 rent methods; 

18 (B) are controlled by women, including 

19 barrier methods and microbicides; 

20 (C) are likely to prevent the spread of 

21 STIs; and 

22 (D) encourage and enable men to take 

23 greater responsibility for their own fertility and 

24 the protection of their partner; 


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1 (16) support an enabling environment for 

2 women to access sexual and reproductive health care 

3 services by working with communities to identify and 

4 lower or remove barriers to access, including finan5 cial, gender, socio-cultural, and transportation bar6 riers; 

7 (17) train health care professionals on edu8 cating individuals, including young people, about 

9 their sexual and reproductive health care options, in10 cluding family planning options; and 

11 (18) foster conditions to create favorable policy 

12 environments, improve quality, strengthen systems, 

13 and contribute to the sustainability of family plan14 ning and other reproductive health programs. 

15 SEC. 5. ASSISTANCE TO REDUCE THE INCIDENCE OF UN16 SAFE ABORTION AND ITS CONSEQUENCES. 

17 (a) ASSISTANCE AUTHORIZED.—The President is au18 thorized to provide assistance to reduce the incidence of 

19 unsafe abortion in developing countries and provide care 

20 for women experiencing injury or illness from complica21 tions of unsafe abortion in developing countries. 

22 (b) ACTIVITIES SUPPORTED.—Assistance provided 

23 under subsection (a) shall be used to— 

24 (1) ensure access to family planning services to 

25 prevent unintended pregnancies; 


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1 (2) ensure that women who experience an unin2 tended pregnancy have access to reliable information 

3 and compassionate counseling on all of their options, 

4 including access to antenatal care and safe abortion 

5 when permitted by the laws of the recipient country; 

6 (3) where local laws permit abortion, support 

7 safe abortion services, including referrals, and sup8 port the training of abortion providers and the nec9 essary equipment and commodities for surgical and 

10 medical abortion; and 

11 (4) support emergency treatment for complica12 tions of induced or spontaneous abortion, including 

13 provision of services and training and equipping of 

14 providers. 

15 (c) ELIGIBILITY FOR ASSISTANCE.—Notwithstanding 

16 any other provision of law, regulation, or policy, in deter17 mining eligibility for assistance authorized under this sec18 tion, sections 104, 104A, 104B, and 104C of the Foreign 

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

20 2151b–3, and 2151b–4), foreign nongovernmental organi21 zations— 

22 (1) shall not be ineligible for such assistance 

23 solely on the basis of health or medical services, in24 cluding counseling and referral services, provided by 

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1 ment funds if such services are permitted in the 

2 country in which they are being provided and would 

3 not violate United States Federal law if provided in 

4 the United States; and 

5 (2) shall not be subject to requirements relating 

6 to the use of non-United States Government funds 

7 for advocacy and lobbying activities other than those 

8 that apply to United States nongovernmental organi9 zations receiving assistance under part I of the For10 eign Assistance Act of 1961. 

11 SEC. 6. ASSISTANCE TO PROVIDE SEXUAL AND REPRODUC12 TIVE HEALTH SERVICES DURING EMER13 GENCY SITUATIONS. 

14 (a) ASSISTANCE AUTHORIZED.—The President is au15 thorized to provide assistance, including through inter16 national organizations, national governments, and inter17 national and local nongovernmental organizations, to en18 sure that sexual and reproductive health services are pro19 vided in developing countries at every phase of a humani20 tarian emergency, including early recovery. 

21 (b) PRIORITY.—In providing assistance authorized 

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

23 (1) those reproductive health services that are 

24 essential in emergencies, whether they are conflict or 

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1 vivors fulfill their potential even under the most dif2 ficult circumstances; and 

3 (2) building local capacity and improving na4 tional systems whenever possible during displace5 ment and early recovery. 

6 (c) ACTIVITIES SUPPORTED.—Assistance provided 

7 under subsection (a) shall be used to— 

8 (1) direct the Secretary of State and the Ad9 ministrator of the United States Agency for Inter10 national Development to implement the Minimum 

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

12 priority activities that must be put in place in the 

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

14 the Sphere Project’s Humanitarian Charter and 

15 Minimum Standards in Disaster Response; 

16 (2) among other activities, establish critical re17 productive health coordination mechanisms, prevent 

18 sexual violence and assist survivors by providing es19 sential medical care including psychosocial services, 

20 prevent transmission of HIV and other sexually 

21 transmitted infections (STIs), ensure access to 

22 emergency obstetric and newborn care, to contracep23 tive methods, and to treatment of STIs, continue 

24 antiretroviral treatment, and lay the groundwork for 

25 comprehensive reproductive health care; and 


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

2 comprehensive reproductive health care programs, 

3 including comprehensive family planning, are put in 

4 place for the duration of displacement and are main5 tained as the relief phase ends and communities 

6 transition to early recovery. 

7 (d) COORDINATION.—Assistance authorized under 

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

9 practice, and funding across and within relevant United 

10 States Government departments and agencies involved in 

11 emergency situations. 

12 SEC. 7. ASSISTANCE TO PROMOTE SEXUAL AND REPRODUC13 TIVE HEALTH CARE FOR YOUNG PEOPLE. 

14 (a) ASSISTANCE AUTHORIZED.—The President is au15 thorized to provide assistance to ensure access to sexual 

16 and reproductive health care for young people in devel17 oping countries. 

18 (b) PRIORITY.—In providing assistance authorized 

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

20 to increase comprehensive knowledge about sexuality 

21 among young people and improve sexual and reproductive 

22 health outcomes among young people, while improving co23 ordination and implementation of host country and United 

24 States Government activities focused on adolescent and 

25 youth sexual and reproductive health. 


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1 (c) ACTIVITIES SUPPORTED.—Assistance provided 

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

3 to— 

4 (1) provide universal and affordable access to— 

5 (A) evidence-based comprehensive sexuality 

6 education and reproductive health education, in 

7 consultation with local communities, in and out8 side schools to ensure young people can delay 

9 sexual debut and make informed decisions 

10 about their sexual and reproductive health; and 

11 (B) youth-friendly comprehensive sexual 

12 and reproductive health care, including activi13 ties described in section 4(b), as appropriate; 

14 (2) coordinate the achievement of the goals of 

15 sexual and reproductive health programming for 

16 young people in United States Government-funded 

17 programs; 

18 (3) educate implementers on best practices in 

19 adolescent and youth programming and delivery and 

20 for effective dissemination of policy guidelines re21 garding adolescent and youth programming; and 

22 (4) incorporate the recommendations of young 

23 people in program design and service delivery ori24 ented for young people. 


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

2 REPRODUCTIVE HEALTH SERVICES. 

3 (a) STRATEGY REQUIRED.— 

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

5 and implement a strategy to improve and create 

6 linkages among the various components of sexual 

7 and reproductive health with each other and with 

8 other global health care services, delivery, and poli9 cies in order to meet the goal described in paragraph 

10 (2). 

11 (2) GOAL DESCRIBED.—The goal of better link12 ages and integration referred to in paragraph (1) is 

13 to ensure that individual men and women are pro14 vided with a continuum of sexual and reproductive 

15 health services that meet their needs. Integration 

16 does not require that all of these services should be 

17 provided by the same clinician or even in the same 

18 setting; rather, there should be a mechanism in 

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

20 and reproductive health services he or she needs, ei21 ther directly or by referral. 

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

23 (a) shall include the following: 

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

25 health systems to link the various components of 

26 sexual and reproductive health services both in terms 


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1 of health system management, such as integrating 

2 commodity and supply systems, training, super3 vision, data collection and analysis, and service pro4 vision, to ensure that people have access to a full 

5 range of services in their community. 

6 (2) In general, such services should include pre7 vention of ill-health, provision of information and 

8 counseling, screening, diagnosis and curative care 

9 and referral for a full range of sexual and reproduc10 tive health and other health and social services. 

11 (3) With respect to linkages and program inte12 gration of sexual and reproductive health services, 

13 such services shall include activities described in sec14 tion 4(b). 

15 (4) With respect to linkages of sexual and re16 productive health services with other global health 

17 services, such services shall include— 

18 (A) counseling about and referrals to other 

19 related health services such as addressing new20 born, infant, and child health (including edu21 cating families about proper antenatal and de22 livery care, breastfeeding, hygiene, and inter23 ventions for neonatal infections and life-threat24 ening childhood illnesses), malaria, tuberculosis, 


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1 neglected tropical diseases, and proper nutrition 

2 for all ages; and 

3 (B) referrals to nearby, quality services 

4 that cannot be provided by the primary provider 

5 and other social services. 

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

7 EVALUATION. 

8 (a) COORDINATION.—Assistance authorized under 

9 this Act shall promote coordination between and among 

10 donors, the private sector, nongovernmental and civil soci11 ety organizations, and governments in order to support 

12 comprehensive and responsive sexual and reproductive 

13 health programs in developing countries. 

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

15 (1) IN GENERAL.—Assistance authorized under 

16 this Act shall be used for the conduct of formative 

17 research and to monitor and evaluate the effective18 ness and efficiency of programs. 

19 (2) REQUIREMENTS.—In carrying out para20 graph (1), the President shall ensure that there is— 

21 (A) support for formative research on the 

22 determinants of accessing sexual and reproduc23 tive health products and services, and adopting 

24 healthy behaviors related to sexuality and re25 production, to inform program design; 


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

2 systematic collection of information to serve as 

3 the basis for monitoring change in population4 based outcomes; 

5 (C) support for evaluations of pro6 grammatic effectiveness by measuring the ex7 tent to which change in population-based out8 comes can be attributed to program interven9 tions or environmental factors; 

10 (D) support for operations research that 

11 uses appropriate scientific methods to compare 

12 different interventions with the objective of in13 creasing the efficiency, effectiveness, and qual14 ity of programs; 

15 (E) support for field research on the char16 acteristics of programs most likely to result in 

17 sustained use of effective family planning in 

18 meeting each individual’s lifetime reproductive 

19 goals, with particular emphasis on the perspec20 tives of family planning users, including support 

21 for relevant social and behavioral research fo22 cusing on such factors as the use, nonuse, and 

23 unsafe or ineffective use of various contracep24 tive and related-disease control methods; and 


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1 (F) support for the development of new 

2 evaluation techniques and performance criteria 

3 for sexual and reproductive health programs, 

4 emphasizing the user’s perspective and repro5 ductive goals. 

6 SEC. 10. DEFINITIONS. 

7 In this Act: 

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

9 means an individual who has attained the age of 10 

10 years but not 20 years. 

11 (2) COMPREHENSIVE SEXUALITY EDUCATION.— 

12 The term ‘‘comprehensive sexuality education’’ 

13 means helping young people develop the inter14 personal skills necessary for the formation of caring, 

15 supportive, and non-coercive relationships and the 

16 ability to exercise responsibility regarding sexual re17 lationships by addressing such issues as sexual di18 versity, abstinence, and the use of condoms, contra19 ceptives, and other protective sexual health meas20 ures. 

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

22 means joining together different kinds of services or 

23 operational programs, either directly or by referral, 

24 to ensure more comprehensive services, promote a 


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1 continuum of care, and to maximize health out2 comes. 

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

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

5 programs, services, and advocacy related to sex6 ual and reproductive health, including HIV/ 

7 AIDS; and 

8 (B) refers to a broader human rights based 

9 approach, of which service integration is a sub10 set. 

11 (5) REPRODUCTIVE HEALTH.—The term ‘‘re12 productive health’’— 

13 (A) means a state of complete physical, 

14 mental, and social well-being and not merely 

15 the absence of disease or infirmity, in all mat16 ters relating to the reproductive system and to 

17 its functions and processes; and 

18 (B) implies that an individual is able to 

19 have a satisfying and safe sex life and that such 

20 individual has the capability to reproduce and 

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

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

23 to be informed and to have access to safe, effec24 tive, affordable, and acceptable methods of fam25 ily planning of their choice, as well as other 


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1 methods of their choice for regulation of fer2 tility which are not against the law, and the 

3 right of access to appropriate health-care serv4 ices that will enable women to go safely through 

5 pregnancy and childbirth and provide couples 

6 with the best chance of having a healthy infant. 

7 (6) REPRODUCTIVE RIGHTS.—The term ‘‘repro8 ductive rights’’— 

9 (A) means those rights that embrace cer10 tain human rights that are already recognized 

11 in national laws, international human rights 

12 documents, and other consensus documents; 

13 (B) includes the recognition of the basic 

14 right of all couples and individuals to decide 

15 freely and responsibly the number, spacing, and 

16 timing of their children and to have the infor17 mation and means to do so, and the right to at18 tain the highest standard of sexual and repro19 ductive health; and 

20 (C) further includes the right of all couples 

21 and individuals to make decisions concerning 

22 reproduction free of discrimination, coercion, 

23 and violence, as expressed in human rights doc24 uments. 


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

2 health’’— 

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

4 mental, and social well-being in relation to sex5 uality and not merely the absence of disease, 

6 dysfunction, or infirmity; 

7 (B) includes a positive and respectful ap8 proach to sexuality and sexual relationships, as 

9 well as the possibility of having pleasurable and 

10 safe sexual experiences, free of coercion, dis11 crimination, and violence; and 

12 (C) further includes the sexual rights of all 

13 persons to be respected, protected, and fulfilled. 

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

15 refers to nonuse of a modern contraceptive method 

16 by an individual who is married or unmarried and 

17 sexually active, is able to become pregnant, and 

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

19 before having a child. 

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

21 means those individuals who have attained the age 

22 of 10 years but not 25 years. 


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1 (10) YOUTH.—The term ‘‘youth’’ means an in2 dividual who has attained the age of 15 years but 

3 not 25 years. 

Æ 


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