I 

111TH CONGRESS 

2D SESSION H. R. 5268 

To provide assistance to improve maternal and newborn health in developing 

countries, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 11, 2010 

Mrs. CAPPS (for herself, Ms. MCCOLLUM, Mrs. CHRISTENSEN, Ms. WOOLSEY, 

Mrs. MALONEY, Ms. MOORE of Wisconsin, Ms. DELAURO, Ms. CLARKE, 

Ms. LEE of California, Ms. WASSERMAN SCHULTZ, Mr. LOEBSACK, Mr. 

GRIJALVA, Ms. SCHAKOWSKY, Ms. SHEA-PORTER, Ms. NORTON, Mrs. 

DAVIS of California, Mr. CONYERS, and Ms. MATSUI) 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’’. 


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1 SEC. 2. FINDINGS AND PURPOSES. 

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

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

5 countries in supporting 8 United Nations Millen6 nium Development Goals (MDGs), including MDG 

7 5, to reduce the maternal mortality ratio by three8 quarters by 2015. In 2005, universal access to re9 productive health was added as a target for MDG 5. 

10 (2) On January 15, 2009, United States Per11 manent Representative to the United Nations Susan 

12 Rice stated before the Committee on Foreign Rela13 tions of the Senate that President Barack Obama is 

14 committed to ‘‘making the Millennium Development 

15 Goals America’s goals.’’. 

16 (3) With thousands of avoidable maternal 

17 deaths still occurring, the United States will need to 

18 immediately scale up its funding and delivery of 

19 proven low-cost, lifesaving interventions in order to 

20 fulfill its commitment to help ensure that MDG 5 is 

21 met. 

22 (4) Substantial progress in maternal health has 

23 been made in some countries and regions: Egypt, 

24 Honduras, Malaysia, Sri Lanka, and parts of Ban25 gladesh have all halved their maternal mortality ra26 tios over the past few decades. 


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1 (5) However, MDG 5 has made the least 

2 progress of all the MDGs. At the current pace, 

3 MDG 5 will not be met in Asia until 2076 and much 

4 later in Africa. 

5 (6) An estimated 8,800,000 children under the 

6 age of 5 die each year. Over 40 percent of these die 

7 in the first month of life. And mortality rates are in8 creasing for those born to young mothers or where 

9 pregnancies are less than a year apart. 

10 (7) Hundreds of thousands of women die each 

11 year from causes related to pregnancy and child12 birth. Ninety-nine percent of these deaths occur in 

13 the developing world and the vast majority are pre14 ventable. 

15 (8) In sub-Saharan Africa, a woman’s lifetime 

16 risk of maternal death is a staggering 1 in 22, com17 pared with 1 in 4,800 in the United States, accord18 ing to the United Nations Children’s Fund 

19 (UNICEF). 

20 (9) Nine out of 10 women in sub-Saharan Afri21 ca will lose a child during their lifetimes. 

22 (10) For every maternal death, approximately 

23 20 women—or 10,000,000 women per year—suffer 

24 complications with severe consequences, including 


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1 pregnancy-related injuries such as fistula, uterine 

2 prolapse, infections, diseases, and disabilities. 

3 (11) The number one cause of maternal deaths 

4 is hemorrhage. Other primary causes of maternal 

5 death include sepsis, unsafe abortion, hypertensive 

6 disorder, and prolonged or obstructed labor. 

7 (12) Violent acts against pregnant women can 

8 lead to poor health outcomes, including preterm 

9 labor, preterm delivery, miscarriage, and stillbirths, 

10 and even maternal deaths, and the risk for maternal 

11 mortality is 3 times as high for abused mothers. 

12 (13) The spacing of births has a powerful im13 pact on a child’s chances of survival. Children born 

14 less than 2 years after the previous birth are about 

15 2.5 times more likely to die before age 5 than chil16 dren born 3 to 5 years after the previous birth. 

17 (14) Pregnancy is the leading cause of death 

18 for young women aged 15 to 19 worldwide. Com19 pared to girls in their twenties, girls aged 15 to 19 

20 are twice as likely, and girls under 15 five times as 

21 likely, to die in childbirth, and mortality and mor22 bidity rates are also higher among infants born to 

23 young mothers. 

24 (15) Globally, 215,000,000 women would like to 

25 delay or end childbearing, but do not have access to 


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1 modern contraceptives. Fully addressing this need 

2 would prevent an additional 53,000,000 unintended 

3 pregnancies each year and reduce maternal deaths 

4 due to unsafe abortion by 82 percent. 

5 (16) If family planning and maternal and new6 born services were provided simultaneously, the costs 

7 of these services would decline by $1,500,000,000 

8 compared with investing in maternal and newborn 

9 care alone—this dual investment would result in a 

10 70 percent decline in maternal deaths and 44 per11 cent decline in newborn deaths. 

12 (17) Maternal death rates are inextricably tied 

13 to neonatal survival, with the risk of death doubling 

14 for newborns in some countries in the developing 

15 world following maternal death. 

16 (18) In many developing countries, including 

17 fragile states and countries affected by conflict, lack 

18 of access to quality health care facilities, health serv19 ices, and trained providers results in deaths for 

20 mothers, newborns, and children—the majority of 

21 births in Africa take place without a skilled attend22 ant present, increasing the risk of death or disability 

23 for both mother and newborn. 

24 (19) The experiences of United States Govern25 ment-supported and nongovernmental organization 


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1 maternal and child health programs in countries 

2 such as Nepal, Ethiopia, and Senegal have dem3 onstrated that community-based approaches, linked 

4 to primary and referral care when possible, can de5 liver high-impact interventions to prevent or treat 

6 many of the life-threatening conditions affecting 

7 mothers, newborns, and children under the age of 5. 

8 (20) More than half of all children and preg9 nant women in developing countries suffer from ane10 mia, which is exacerbated by malaria, neglected 

11 tropical diseases, and nutritional deficits, causing 

12 adverse pregnancy outcomes and even death. 

13 (21) According to WHO, women that have un14 dergone female genital mutilation are significantly 

15 more likely than those who have not undergone fe16 male genital mutilation to experience serious 

17 postpartum health problems, and children born to 

18 mothers who have undergone female genital mutila19 tion face higher death rates immediately after birth. 

20 (22) According to the Director of National 

21 Intelligence’s 2009 Annual Threat Assessment, wide22 spread poor maternal and child health and malnutri23 tion has the potential to weaken central governments 

24 and empower non-state actors, including terrorist 

25 and paramilitary groups. 


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1 (23) The United States Agency for Inter2 national Development has estimated the economic 

3 impact of maternal and newborn mortality to be a 

4 global loss of over $15,000,000,000 due to dimin5 ished productivity. 

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

7 (1) to authorize assistance to improve maternal 

8 and newborn health in developing countries; and 

9 (2) to develop a strategy to reduce mortality 

10 and improve maternal and newborn health in devel11 oping countries. 

12 SEC. 3. ASSISTANCE TO IMPROVE MATERNAL AND NEW13 BORN HEALTH IN DEVELOPING COUNTRIES. 

14 (a) IN GENERAL.—Chapter 1 of part I of the Foreign 

15 Assistance Act of 1961 (22 U.S.C. 2151 et seq.) is amend16 ed— 

17 (1) in section 102(b)(4)(B), by striking ‘‘reduc18 tion of infant mortality’’ and inserting ‘‘reduction of 

19 maternal and newborn mortality’’; and 

20 (2) by inserting after section 104C the fol21 lowing new section: 

22 ‘‘SEC. 104D. ASSISTANCE TO REDUCE MORTALITY AND IM23 PROVE MATERNAL AND NEWBORN HEALTH. 

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

25 104(c), the President is authorized to furnish assistance, 


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1 on such terms and conditions as the President may deter2 mine, to reduce mortality and improve maternal health 

3 and the health of 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 and improve 

8 quality of maternal health services, including— 

9 ‘‘(A) comprehensive voluntary family plan10 ning services, integrated into antenatal and 

11 postnatal care and in child health services, to 

12 support women and men in making informed 

13 decisions and having timely, intended, well14 spaced pregnancies and to help women with 

15 preexisting conditions avoid high-risk, unin16 tended pregnancies; 

17 ‘‘(B) birth preparedness through the provi18 sion of quality antenatal care, including— 

19 ‘‘(i) educating women and families 

20 about danger signs to look for, potential 

21 complications during pregnancy and child22 birth, and where to access care; 

23 ‘‘(ii) providing counseling about hy24 giene, nutrition, and the care and feeding 

25 of babies; 


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1 ‘‘(iii) helping women and families de2 velop a birth plan that includes skilled de3 livery care and a transport plan in case of 

4 emergencies; 

5 ‘‘(iv) screening for complications in6 cluding blood pressure screenings; 

7 ‘‘(v) diagnosis and treatment of exist8 ing conditions, such as HIV/AIDS, syphi9 lis, malaria, and tuberculosis, and ensuring 

10 that women are provided with, or referred 

11 to, appropriate care and treatment for 

12 those conditions; 

13 ‘‘(vi) ensuring that women infected 

14 with HIV are provided mother-to-child 

15 transmission prevention services, including 

16 access to voluntary family planning, medi17 cations to prevent such transmission, and 

18 counseling on infant feeding; and 

19 ‘‘(vii) making vaccines, micronutri20 ents, and treatment for infections and 

21 parasites available and accessible; 

22 ‘‘(C) skilled delivery care, including— 

23 ‘‘(i) the presence of an accredited 

24 health professional, such as midwife, doc25 tor, or nurse, who has been educated and 


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1 trained to proficiency in the skills needed 

2 to manage normal or uncomplicated preg3 nancies, childbirth, and the immediate 

4 postnatal period, and in the identification, 

5 management, or referral of complications 

6 in women and newborns, including active 

7 management of the third stage of labor; 

8 and 

9 ‘‘(ii) an enabling environment that in10 cludes access to a referral system, commu11 nication and transport, drugs and supplies, 

12 and equipment appropriate for a normal 

13 delivery; 

14 ‘‘(D) quality emergency obstetric care, in15 cluding— 

16 ‘‘(i) increasing the technical com17 petence of health care providers; 

18 ‘‘(ii) increasing the essential supplies 

19 and equipment including fluids, blood 

20 products, and drugs to treat complications 

21 such as infection, bleeding, and hyper22 tension; 

23 ‘‘(iii) providing the information and 

24 counseling for the client, including quality 

25 of client-provider interaction; 


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1 ‘‘(iv) ensuring continuity of com2 prehensive, acceptable care, referrals and 

3 followup; and 

4 ‘‘(v) access to cesarean section when 

5 necessary; 

6 ‘‘(E) postpartum care and support, includ7 ing— 

8 ‘‘(i) activities to promote immediate 

9 exclusive breastfeeding; 

10 ‘‘(ii) activities to promote essential 

11 care of newborns; 

12 ‘‘(iii) activities to treat, repair, and 

13 provide followup services for injuries re14 sulting from pregnancy and childbirth, in15 cluding fistula; and 

16 ‘‘(iv) family planning counseling and 

17 service provision; and 

18 ‘‘(F) postabortion care, including— 

19 ‘‘(i) emergency treatment of complica20 tions of unsafe abortion; 

21 ‘‘(ii) family planning counseling and 

22 services; and 

23 ‘‘(iii) linkages to other reproductive 

24 health services; 


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1 ‘‘(2) working with communities and health care 

2 providers to identify and remove barriers to mater3 nal health care services, including barriers such as 

4 financial, sociocultural, transportation, gender dis5 crimination, and stigma based on preexisting health 

6 concerns, and ensure that those services are based in 

7 individual human rights, as recognized by inter8 national agreements and instruments; 

9 ‘‘(3) comprehensive sexuality education pro10 grams and services for youth that provide adoles11 cents with information, skills, and materials nec12 essary to postpone childbearing; 

13 ‘‘(4) promotion of activities that focus on em14 powering women and girls and engaging men and 

15 boys at the individual, household, and community 

16 levels to improve the health outcomes of women, 

17 newborns, and children including education and 

18 awareness programs about gender-based violence, 

19 the health risks of female genital mutilation, and 

20 shared responsibility for and benefits of family plan21 ning; 

22 ‘‘(5) activities to improve essential newborn 

23 care and treatment, including educating families and 

24 communities about proper antenatal and skilled de25 livery care, tetanus toxoid immunization during 


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1 pregnancy, immediate and exclusive breastfeeding, 

2 keeping the newborn warm, such as by providing 

3 skin-to-skin care, keeping the cord clean, resuscita4 tion of newborns who are not breathing properly, 

5 and treatment of infections; 

6 ‘‘(6) activities to prevent and treat childhood ill7 ness, including early infant diagnosis of HIV infec8 tion and increasing access to appropriate prevention 

9 and treatment for diarrhea, pneumonia, malaria, 

10 HIV/AIDS, and other life-threatening childhood ill11 nesses; 

12 ‘‘(7) activities to improve child and maternal 

13 nutrition, including the delivery of iron, zinc, vita14 min A, iodine, and other key micronutrients, the 

15 promotion of breastfeeding and appropriate com16 plementary feeding, and the utilization of Ready to 

17 Use Therapeutic Foods (RUTF) that, to the extent 

18 practicable, are developed, purchased, or produced in 

19 the country or region that they are utilized; 

20 ‘‘(8) activities to strengthen the delivery of im21 munization services, including efforts to strengthen 

22 routine immunization, introduce new vaccines for 

23 diseases such as rotavirus and pneuomcoccal disease, 

24 and eliminate polio; 


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1 ‘‘(9) activities to improve household-level behav2 ior related to safe water, hygiene, safe and hygienic 

3 food preparation and storage, exposure to indoor 

4 smoke, and environmental toxins such as lead; 

5 ‘‘(10) activities to improve capacity for health 

6 governance, health finance, and the health work7 force, including in the private sector, and support 

8 for training clinicians, nurses, technicians, sanitation 

9 and public health workers, community-based health 

10 workers, midwives, birth attendants, peer educators, 

11 volunteers, and private sector enterprises to provide 

12 integrated health services and referrals that meet 

13 the needs of patients across a continuum of care; 

14 ‘‘(11) activities to address antimicrobial resist15 ance in treating maternal health infections; 

16 ‘‘(12) activities to establish and support man17 agement of host country institutions’ information 

18 systems and the development and use of tools and 

19 models to collect, analyze, and disseminate informa20 tion related to maternal and newborn health; 

21 ‘‘(13) activities to develop and conduct needs 

22 assessments, baseline studies, targeted evaluations, 

23 or other information-gathering efforts for the design, 

24 monitoring, and evaluation of maternal and newborn 

25 health efforts, including— 


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1 ‘‘(A) studying the availability and effects 

2 of critical medicines, particularly those of im3 portance in the developing world, on pregnant 

4 women and newborns; 

5 ‘‘(B) collection, evaluation, and use of data 

6 on the medical and socioeconomic factors that 

7 led to a maternal or newborn death or ‘near 

8 miss’ at the community and health facility lev9 els; and 

10 ‘‘(C) sociocultural barriers, influencers, 

11 and enhancers of health and nutrition behav12 iors; 

13 ‘‘(14) activities to integrate and coordinate as14 sistance provided under this section with existing 

15 health programs for— 

16 ‘‘(A) the prevention of the transmission of 

17 HIV from mother to child and other HIV/AIDS 

18 prevention, care, treatment, and counseling ac19 tivities; 

20 ‘‘(B) malaria; 

21 ‘‘(C) tuberculosis; 

22 ‘‘(D) family planning and reproductive 

23 health; 

24 ‘‘(E) counseling for survivors of sexual25 and gender-based violence; 


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1 ‘‘(F) neglected tropical diseases; and 

2 ‘‘(G) nutrition; 

3 ‘‘(15) activities to improve orphan care services 

4 and to support innovative orphan and vulnerable 

5 children programs; 

6 ‘‘(16) activities to end harmful traditional prac7 tices including female genital mutilation and child 

8 marriage; 

9 ‘‘(17) activities to train health care providers to 

10 prevent, identify, and manage cases of gender-based 

11 violence as part of family planning and maternal and 

12 newborn health services; 

13 ‘‘(18) activities to support mental health care 

14 and provide psychosocial support; 

15 ‘‘(19) activities to improve access to clean water 

16 and improved sanitation through community-based 

17 hygiene education programs, access to household18 and community-level water purification tools and de19 vices, and latrine construction; and 

20 ‘‘(20) activities to prevent, control, and in some 

21 cases eliminate neglected tropical diseases for both 

22 newborns and mothers. 

23 ‘‘(c) GUIDELINES.—To the maximum extent prac24 ticable, programs, projects, and activities carried out using 

25 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, and relevant international and multi4 lateral organizations, including the United Nations 

5 Population Fund, the United Nations Children’s 

6 Fund, and the Global Alliance for Vaccines and Im7 munizations, that demonstrate effectiveness and 

8 commitment to improving the health and rights of 

9 mothers, newborns, and children; 

10 ‘‘(2) carried out in the context of country-driv11 en plans in whose development the United States 

12 Government participates along with other donors 

13 and multilateral organizations, nongovernmental or14 ganizations, and civil society; 

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

16 other directly affected populations, especially women 

17 and marginalized communities; and 

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

19 country governments and civil society organizations. 

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

21 2011, and annually thereafter for 4 years, the President 

22 shall transmit to Congress a report on the implementation 

23 of this section for the prior fiscal year. 

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


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

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

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

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

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

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

7 this Act.’’. 

8 SEC. 4. DEVELOPMENT OF STRATEGY TO REDUCE MOR9 TALITY AND IMPROVE MATERNAL AND NEW10 BORN HEALTH IN DEVELOPING COUNTRIES. 

11 (a) DEVELOPMENT OF STRATEGY.—The President 

12 shall develop and implement a comprehensive strategy as 

13 part of the Global Health Initiative to reduce mortality 

14 and improve the health of mothers and newborns in devel15 oping countries. 

16 (b) COMPONENTS.—The comprehensive United 

17 States Government strategy developed pursuant to sub18 section (a) shall include the following: 

19 (1) An identification of not less than 30 coun20 tries, including fragile states and countries affected 

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

22 beginning on the date of the enactment of this Act 

23 based on— 

24 (A) the number and rate of neonatal 

25 deaths; 


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1 (B) the number and rate of maternal 

2 deaths; 

3 (C) the number and rate of malnourished 

4 women of reproductive age; and 

5 (D) the number of individuals with an 

6 unmet need for family planning. 

7 (2) For each country identified in paragraph 

8 (1)— 

9 (A) an assessment of the most common 

10 causes of maternal and newborn mortality and 

11 morbidity; 

12 (B) a description of the programmatic 

13 areas and interventions providing maximum 

14 health benefits to populations at risk and max15 imum reduction in mortality and morbidity; 

16 (C) an assessment of the investments need17 ed in identified programs and interventions to 

18 achieve the greatest results; 

19 (D) a description of how United States as20 sistance complements and leverages efforts by 

21 other donors and builds capacity and self-suffi22 ciency among recipient countries; and 

23 (E) a description of goals and objectives 

24 for improving maternal and newborn health, inVerDate Mar 15 2010 03:18 May 12, 2010 Jkt 089200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H5268.IH H5268

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1 cluding, to the extent feasible, objective and 

2 quantifiable indicators. 

3 (3) Enhanced coordination among relevant de4 partments and agencies of the United States Gov5 ernment engaged in activities to improve the health 

6 and well-being of mothers and newborns in devel7 oping countries. 

8 (4) A description of the measured or estimated 

9 impact on maternal and newborn morbidity and 

10 mortality of each project or program. 

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

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

13 to Congress a report that contains the strategy described 

14 in this section. 

15 SEC. 5. AUTHORIZATION OF APPROPRIATIONS. 

16 (a) IN GENERAL.—There are authorized to be appro17 priated to carry out this Act, and the amendments made 

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

19 fiscal years 2011 through 2015. 

20 (b) AVAILABILITY OF FUNDS.—Amounts appro21 priated pursuant to the authorization of appropriations 

22 under subsection (a) are authorized to remain available 

23 until expended. 

Æ 


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