II 

116TH CONGRESS 

1ST SESSION S. 1766 

To implement policies to end preventable maternal, newborn, and child deaths 

globally. 

IN THE SENATE OF THE UNITED STATES 

JUNE 10, 2019 

Ms. COLLINS (for herself, Mr. COONS, Mr. ROBERTS, Ms. DUCKWORTH, Mr. 

SULLIVAN, Mr. VAN HOLLEN, Mrs. CAPITO, Mr. MARKEY, Mr. ISAKSON, 

Mr. MERKLEY, Mr. MORAN, Mr. CARDIN, Mr. CORNYN, Ms. ROSEN, Mr. 

YOUNG, Ms. STABENOW, Mr. ENZI, Mr. WYDEN, Mr. CRAMER, Mr. MURPHY, Mr. RUBIO, and Mr. REED) introduced the following bill; which was 

read twice and referred to the Committee on Foreign Relations 

A BILL 

To implement policies to end preventable maternal, newborn, 

and child deaths globally. 

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 ‘‘Reach Every Mother 

5 and Child Act of 2019’’. 


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1 SEC. 2. ASSISTANCE TO END PREVENTABLE MATERNAL, 

2 NEWBORN, AND CHILD DEATHS GLOBALLY. 

3 The Foreign Assistance Act of 1961 (22 U.S.C. 2151 

4 et seq.) is amended by adding at the end of chapter I of 

5 part I the following new section: 

6 ‘‘SEC. 137. ASSISTANCE TO END PREVENTABLE MATERNAL, 

7 NEWBORN, AND CHILD DEATHS GLOBALLY. 

8 ‘‘(a) PURPOSE.—The purpose of this section is to im9 plement a strategic approach for providing foreign assist10 ance in order to end preventable child and maternal deaths 

11 globally by 2030. 

12 ‘‘(b) DEFINITIONS.—In this section: 

13 ‘‘(1) ADMINISTRATOR.—The term ‘Adminis14 trator’ means the Administrator of the United 

15 States Agency for International Development. 

16 ‘‘(2) APPROPRIATE CONGRESSIONAL COMMIT17 TEES.—The term ‘appropriate congressional com18 mittees’ means— 

19 ‘‘(A) the Committee on Foreign Relations 

20 and the Committee on Appropriations of the 

21 Senate; and 

22 ‘‘(B) the Committee on Foreign Affairs 

23 and the Committee on Appropriations of the 

24 House of Representatives. 


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1 ‘‘(3) COORDINATOR.—The term ‘Coordinator’ 

2 means the Child and Maternal Survival Coordinator 

3 established under subsection (e). 

4 ‘‘(4) INTERNATIONAL MATERNAL AND CHILD

5 HEALTH AND NUTRITION PROGRAMS.—The term 

6 ‘international maternal and child health and nutri7 tion programs’ means all programs carried out using 

8 funds appropriated or otherwise made available for 

9 international maternal and child health and nutri10 tion that are managed by the United States Agency 

11 for International Development Bureau of Global 

12 Health. 

13 ‘‘(5) RELEVANT PARTNER ENTITIES.—The 

14 term ‘relevant partner entities’ means each of the 

15 following: 

16 ‘‘(A) The governments of other donor 

17 countries. 

18 ‘‘(B) International financial institutions. 

19 ‘‘(C) Nongovernmental organizations. 

20 ‘‘(D) Faith-based organizations. 

21 ‘‘(E) Professional organizations. 

22 ‘‘(F) The private sector. 

23 ‘‘(G) Multilateral organizations. 

24 ‘‘(H) Local and international civil society 

25 groups. 


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1 ‘‘(I) Local health workers. 

2 ‘‘(J) International organizations. 

3 ‘‘(6) TARGET COUNTRIES.—The term ‘target 

4 countries’ means specific countries that have the 

5 greatest need and highest burden of child and ma6 ternal deaths, taking into consideration countries 

7 that— 

8 ‘‘(A) have high-need communities in fragile 

9 states or conflict-affected states; 

10 ‘‘(B) are low- or middle-income countries; 

11 or 

12 ‘‘(C) are located in regions with weak 

13 health systems. 

14 ‘‘(c) STATEMENT OF POLICY.—It is the policy of the 

15 United States, in partnership with target countries and 

16 relevant partner entities, to establish and implement a co17 ordinated, integrated, and comprehensive strategy to com18 bat the leading causes of maternal, newborn, and child 

19 mortality globally and ensure healthy and productive lives 

20 by— 

21 ‘‘(1) focusing on bringing to scale, specific to 

22 each country’s needs, the highest impact, evidence23 based interventions, including for the most vulner24 able populations, with a focus on country and com25 munity ownership; 


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1 ‘‘(2) designing, implementing, monitoring, and 

2 evaluating programs in a way that enhances trans3 parency and accountability, increases sustainability, 

4 and improves outcomes in target countries; and 

5 ‘‘(3) supporting the research, development, and 

6 introduction of innovative tools and approaches to 

7 accelerate progress toward ending preventable child 

8 and maternal deaths. 

9 ‘‘(d) STRATEGY.— 

10 ‘‘(1) IN GENERAL.—Not later than one year 

11 after the date of the enactment of the Reach Every 

12 Mother and Child Act of 2019, the President shall 

13 establish and implement a comprehensive five-year, 

14 whole-of-government strategy, together with target 

15 countries and donors, to contribute toward the glob16 al goal of ending preventable child and maternal 

17 deaths by 2030 as a foundation for ensuring healthy 

18 and productive lives. 

19 ‘‘(2) ELEMENTS.—The strategy established 

20 under paragraph (1) shall— 

21 ‘‘(A) set outcome-based targets to achieve 

22 the goals of the strategy and ascertain baseline 

23 data relevant for each target country and for all 

24 areas of focus and programming as of the date 

25 of the release of the strategy; 


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1 ‘‘(B) utilize United States Government 

2 strategies and frameworks relevant to ending 

3 preventable child and maternal deaths, includ4 ing specific objectives, programs, and ap5 proaches to achieve the highest-impact, evi6 dence-based interventions to address the leading 

7 causes of death, particularly among the most 

8 vulnerable populations, of— 

9 ‘‘(i) women related to pregnancy, 

10 childbirth, and post-delivery; 

11 ‘‘(ii) newborns in their first 28 days; 

12 and 

13 ‘‘(iii) infants and children under the 

14 age of five years old; 

15 ‘‘(C) include development and scale up of 

16 new technologies and approaches, including 

17 those supported by public-private partnerships, 

18 for research and innovation; 

19 ‘‘(D) promote coordination and efficiency 

20 within and amongst the relevant executive 

21 branch agencies and initiatives, including the 

22 United States Agency for International Devel23 opment, the Department of State, the Depart24 ment of Health and Human Services, the Cen25 ters for Disease Control and Prevention, the 


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1 National Institutes of Health, the Millennium 

2 Challenge Corporation, the Peace Corps, the 

3 Department of the Treasury, the Office of the 

4 Global AIDS Coordinator, and the President’s 

5 Malaria Initiative; 

6 ‘‘(E) project general levels of resources 

7 needed to achieve the strategy’s stated objec8 tives; 

9 ‘‘(F) identify strategies for leveraging re10 sources in new and innovative ways; 

11 ‘‘(G) align with country- and community12 driven maternal, newborn, and child health and 

13 survival plans and improve coordination with 

14 foreign governments and international organiza15 tions; 

16 ‘‘(H) outline consultations with relevant 

17 partner entities as appropriate; 

18 ‘‘(I) implement results-based contracting 

19 (such as pay-for-success) and financial and 

20 operational risk reduction; 

21 ‘‘(J) promote a shift towards investments 

22 that support inclusive and sustainable business 

23 models; and 

24 ‘‘(K) support the transition to domestic 

25 sustainably financed health systems. 


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1 ‘‘(3) INITIAL STRATEGY.—For the purposes of 

2 this section, a strategy meeting the criteria described 

3 in paragraph (2) that is in effect as of the date of 

4 enactment of this section may be deemed to fulfill 

5 the establishment requirement in paragraph (1). 

6 ‘‘(e) ESTABLISHMENT OF CHILD AND MATERNAL

7 SURVIVAL COORDINATOR.— 

8 ‘‘(1) IN GENERAL.—The President shall des9 ignate a current USAID employee serving in a ca10 reer or non-career position in the Senior Executive 

11 Service or at the level of a Deputy Assistant Admin12 istrator or higher to serve concurrently as the Child 

13 and Maternal Survival Coordinator. The Coordinator 

14 shall be responsible for— 

15 ‘‘(A) overseeing the strategy established 

16 under subsection (d); and 

17 ‘‘(B) international maternal and child 

18 health and nutrition programs. 

19 ‘‘(2) DUTIES.—The Coordinator shall— 

20 ‘‘(A) have the primary responsibility for 

21 the oversight and coordination of all resources 

22 and international activities, as determined ap23 propriate by the Administrator of the United 

24 States Agency for International Development, 

25 of the United States Government appropriated 


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1 or used for international maternal and child 

2 health and nutrition programs; 

3 ‘‘(B) direct the budget, planning, and 

4 staffing to implement international maternal 

5 and child health and nutrition programs for the 

6 purpose of ending preventable child and mater7 nal deaths; 

8 ‘‘(C) lead implementation and revision, not 

9 less frequently than once every 5 years, of the 

10 strategy established under subsection (d)(1); 

11 ‘‘(D) coordinate with relevant executive 

12 branch agencies, target countries, and relevant 

13 partner entities as appropriate, to carry out the 

14 strategy established under section 5(a) and to 

15 align current and future investments with high16 impact, evidence-based interventions to save 

17 lives; 

18 ‘‘(E) provide guidance on the design and 

19 oversight of grants, contracts, and cooperative 

20 agreements with nongovernmental organizations 

21 (including community, faith-based, and civil so22 ciety organizations) and private sector entities 

23 for the purpose of carrying out the strategy es24 tablished under subsection (d)(1); and 


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1 ‘‘(F) report directly to the Administrator 

2 regarding implementation of the strategy estab3 lished under subsection (d)(1). 

4 ‘‘(3) RESTRICTION ON ADDITIONAL OR SUPPLE5 MENTAL COMPENSATION.—The Coordinator shall re6 ceive no additional or supplemental compensation as 

7 a result of carrying out responsibilities and duties 

8 under this section. 

9 ‘‘(f) AUTHORITY TO ASSIST IN IMPLEMENTATION OF

10 THE STRATEGY.— 

11 ‘‘(1) IN GENERAL.—The President shall provide 

12 assistance to implement the strategy established 

13 under subsection (d)(1). 

14 ‘‘(2) FOCUS ON IMPACT.— 

15 ‘‘(A) TARGETS FOR INCREASED IMPLE16 MENTATION REQUIRED.—Consistent with the 

17 requirements for foreign assistance programs 

18 included in the Foreign Aid Transparency and 

19 Accountability Act of 2016 (Public Law 114– 

20 119), USAID grants, contracts, and cooperative 

21 agreements for the purposes of the strategy es22 tablished under subsection (d)(1) shall be re23 quired to include targets for increased imple24 mentation of high-impact, evidence-based inter25 ventions and strengthening health systems, as 


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1 appropriate, including the establishment of 

2 baseline measurements from which to quantify 

3 progress. 

4 ‘‘(B) EXCEPTION.—In exceptional cir5 cumstances where USAID determines that in6 clusion of coverage targets or baseline measures 

7 are not reasonable or practicable for the grant, 

8 contract, or cooperative agreement, the funding 

9 mechanism shall include an explanation of the 

10 omission and explicitly state how measurable 

11 impact will be targeted and tracked. 

12 ‘‘(g) REPORTS.— 

13 ‘‘(1) REPORT REQUIRED.—Not later than one 

14 year after the date of the enactment of this section, 

15 and annually thereafter for 5 additional years, the 

16 President shall submit to the appropriate congres17 sional committees a report on progress made to 

18 achieve the strategy established under subsection 

19 (d)(1) as well as progress toward the goal to end 

20 preventable child and maternal deaths globally. The 

21 report shall be made publicly available. 

22 ‘‘(2) INFORMATION INCLUDED IN REPORT.— 

23 The report required under paragraph (1) shall in24 clude the following elements: 


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1 ‘‘(A) Indicators of progress made by 

2 United States Government programs carried 

3 out under international maternal and child 

4 health and nutrition programs for the purposes 

5 of improving maternal, newborn, and child 

6 health and survival, particularly among the 

7 most vulnerable populations, in each target 

8 country and overall, including— 

9 ‘‘(i) maternal mortality ratio per 

10 100,000 live births and under-5 mortality 

11 ratio per 1,000 live births; 

12 ‘‘(ii) number of maternal, newborn, 

13 and child deaths averted; 

14 ‘‘(iii) percentage of births attended by 

15 skilled health personnel; 

16 ‘‘(iv) an analysis of gaps in the health 

17 workforce required to end preventable child 

18 and maternal deaths, including an analysis 

19 of health workforce density (number of cer20 tified health workers, including commu21 nity-based health workers, per population); 

22 ‘‘(v) a description of the measured or 

23 estimated impact on maternal, newborn, 

24 and child survival of each ongoing program 

25 or project; 


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1 ‘‘(vi) progress towards achieving the 

2 goal to save 15,000,000 children’s lives 

3 and 600,000 women’s lives, and any subse4 quent goals established under the strategy 

5 required under subsection (d); and 

6 ‘‘(vii) any other targets identified by 

7 the Coordinator as essential to meeting the 

8 goals of the strategy for ending prevent9 able child and maternal deaths. 

10 ‘‘(B) Assessments of progress made toward 

11 achieving the targets set forth under subpara12 graph (A). 

13 ‘‘(C) A description of how the interventions 

14 or programs are designed to— 

15 ‘‘(i) increase activities in target coun16 tries; 

17 ‘‘(ii) reach underserved, marginalized, 

18 vulnerable, under nourished or malnour19 ished, and impoverished populations; 

20 ‘‘(iii) address causes of maternal, new21 born, and child mortality with innovative 

22 efforts and interventions posed to go to 

23 scale; 


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1 ‘‘(iv) invest in activities that empower 

2 women, support voluntarism, and provide 

3 respectful maternity care; 

4 ‘‘(v) improve transparency and ac5 countability at all levels and include com6 mon metrics for tracking progress; 

7 ‘‘(vi) ensure that high-impact, evi8 dence-based interventions are prioritized; 

9 and 

10 ‘‘(vii) expand access to quality services 

11 through community-based approaches and 

12 include community accountability meas13 ures. 

14 ‘‘(D) Reporting on each aspect of the 

15 strategy established under subsection (d)(1), in16 cluding— 

17 ‘‘(i) multi-sectoral approaches, specific 

18 strategies, and programming utilizing high19 impact, evidence-based interventions to ad20 dress the leading causes of preventable 

21 child and maternal deaths; 

22 ‘‘(ii) activities to develop and scale up 

23 new technologies and approaches, including 

24 those identified by public-private partner25 ships, for research and innovation; 


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1 ‘‘(iii) coordination with United States 

2 agencies, foreign governments, nongovern3 mental organizations, and international or4 ganizations; 

5 ‘‘(iv) methods used to leverage new fi6 nancial and other public and private re7 sources in innovative ways; and 

8 ‘‘(v) best practices identified by the 

9 executive branch. 

10 ‘‘(E) Reporting on grants, contracts, and 

11 cooperative agreements awarded, including— 

12 ‘‘(i) a comprehensive list of USAID 

13 grants, contracts, and cooperative agree14 ments awarded in implementation of the 

15 strategy established under subsection 

16 (d)(1); and 

17 ‘‘(ii) a description of— 

18 ‘‘(I) the targets for coverage of 

19 interventions or services and the base20 line against which they are measured 

21 and the status of progress in meeting 

22 the targets; or 

23 ‘‘(II) in the case of exceptional 

24 circumstances where USAID deter25 mines that inclusion of targets or 


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1 baseline measurements is not reason2 able or practicable, an explanation of 

3 how the impact of the grant, contract, 

4 agreement, or resulting program is 

5 being measured. 

6 ‘‘(F) Reporting on the innovative public7 private financing tools, including an analysis of 

8 the feasibility and potential effectiveness of new 

9 financing tools that could be used to fund ef10 forts to end preventable child and maternal 

11 deaths globally. 

12 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.— 

13 ‘‘(1) AUTHORIZATION.—For each of fiscal years 

14 2020 and 2021, there is authorized to be appro15 priated to the Secretary of State and the Adminis16 trator of the United States Agency for International 

17 Development to carry out this section— 

18 ‘‘(A) $545,000,000 for bilateral maternal 

19 and child health; 

20 ‘‘(B) $290,000,000 for Gavi, the Vaccine 

21 Alliance; and 

22 ‘‘(C) $145,000,000 for nutrition. 

23 ‘‘(2) APPLICATION.—Funds appropriated or 

24 otherwise made available to carry out activities 


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1 under this section shall be subject to all applicable 

2 restrictions under Federal law. 

3 ‘‘(3) EXPIRATION OF FUNDS.—Amounts appro4 priated or otherwise made available to carry out ac5 tivities under this section shall remain available for 

6 obligation for a period of 5 years.’’. 

Æ 


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