I 

113TH CONGRESS 

2D SESSION H. R. 4997 

To provide assistance to sub-Saharan Africa to combat obstetric fistula. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 26, 2014 

Ms. DELAURO (for herself, Ms. MCCOLLUM, and Ms. LEE of California) introduced the following bill; which was referred to the Committee on Foreign 

Affairs 

A BILL 

To provide assistance to sub-Saharan Africa to combat 

obstetric fistula. 

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 AND TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘United States Leadership to Eradicate Obstetric Fistula 

6 Act of 2014’’. 

7 (b) TABLE OF CONTENTS.—The table of contents for 

8 this Act is as follows: 

Sec. 1. Short title and table of contents. 

Sec. 2. Findings. 

Sec. 3. Definitions. 

Sec. 4. Comprehensive, integrated, 10-year strategy to combat obstetric fistula 

in sub-Saharan Africa. 


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Sec. 5. Prevention, treatment, and monitoring of obstetric fistula in sub-Saharan African countries. 

Sec. 6. United States Advisory Committee for the Eradication of Obstetric Fistula. 

Sec. 7. Report. 

Sec. 8. Authorization of appropriations. 

1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) Obstetric fistula is a catastrophic childbirth 

4 injury which arises as a complication of obstructed 

5 labor. 

6 (2) An estimated 2 to 3 million women cur7 rently are afflicted by the devastating physical and 

8 social effects of obstetric fistula—a scourge of epi9 demic proportions. As many as 130,000 new cases 

10 occur each year. 

11 (3) Historically, obstetric fistula affected 

12 women in the United States and around the world. 

13 Advances in obstetric care and access to improved 

14 surgical techniques resulted in a drastic reduction in 

15 obstetric fistula by the early 20th century in the 

16 United States. 

17 (4) Today, obstetric fistula primarily affects the 

18 poorest women in the poorest parts of the world. It 

19 disproportionately affects women in sub-Saharan Af20 rica and girls—some as young as 13 years old—who 

21 are subjected to child marriage and whose bodies are 

22 not fully capable of handling the demands of childVerDate Mar 15 2010 03:27 Jul 08, 2014 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4997.IH H4997

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1 birth. Many of these young girls and women have 

2 been subjected to female genital mutilation, which 

3 can increase the risk for and be a direct cause of ob4 stetric fistula. 

5 (5) Obstetric fistula, which usually results in 

6 fetal death by asphyxia, occurs when the tissues that 

7 normally separate a woman’s vagina from her blad8 der or rectum are destroyed by prolonged pressure 

9 from the fetal head trapped in the birth canal. 

10 (6) Obstetric fistula typically occurs because a 

11 woman does not have access to emergency obstetric 

12 care or because she does not have the financial 

13 means, transportation, or access to surgical repair. 

14 (7) Left untreated, an obstetric fistula afflicts 

15 a woman with devastating physical conditions: incon16 tinence, painful ulcers, and constant and uncontrol17 lable emission of offensive odors. These symptoms 

18 leave a woman indelibly and perpetually stigmatized 

19 by her condition. 

20 (8) Because obstetric fistula does not heal on 

21 its own, women affected by this condition are 

22 marginalized for the remainder of their lives. Ex23 pelled from their communities and denied education 

24 and health care, obstetric fistula victims are left in 

25 desperate economic circumstances. 


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1 (9) Victims also suffer social ostracism that re2 sults in involuntary divorce, exclusion from religious 

3 activities, deepening poverty, malnutrition, deterio4 rating physical health, depression, and despair. As a 

5 result, victims are left defenseless and vulnerable. 

6 (10) This social isolation compounds already ex7 isting problems such as illiteracy and lack of eco8 nomic opportunities. 

9 (11) Because obstetric fistula are not them10 selves fatal, millions of women live with this horrific 

11 condition and have been overlooked by the inter12 national medical community. At present, humani13 tarian aid and nongovernmental programs treat fis14 tula cases on a small scale and are not equipped to 

15 systematically prevent, treat, and eradicate obstetric 

16 fistula. 

17 (12) Obstetric fistula can be prevented when 

18 women and their families are educated about the 

19 birthing process and are provided access to emer20 gency obstetric care. 

21 (13) Today, doctors can surgically repair ob22 stetric fistula with a low-cost, low-technology sur23 gery. 

24 (14) The impact of an obstetric fistula-repair 

25 surgery is immediate and consequential. Women can 


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1 be re-integrated into society and are afforded basic 

2 human necessities such as familial relationships, 

3 health care, and the opportunity to earn a living. 

4 (15) The prevention, treatment, and ultimately 

5 the eradication of obstetric fistula will advance the 

6 emancipation and empowerment of women, strength7 en families and communities, and improve the over8 all economic, educational, and social well-being of af9 fected societies. 

10 (16) Basic interventions to identify and repair 

11 obstetric fistula have achieved meaningful and cost12 effective results. 

13 (17) The best available data suggests that ex14 isting programs can only repair 10 percent of new 

15 obstetric fistula cases each year, and less than 1 

16 percent of existing obstetric fistula cases are re17 paired each year. 

18 (18) The challenge is to expand existing pilot 

19 programs into a scalable, comprehensive, and sus20 tainable campaign to eradicate obstetric fistula. 

21 (19) Nongovernmental organizations with expe22 rience in obstetric care, surgery, and women’s rights 

23 have proven effective in making progress towards 

24 eliminating the scourge of obstetric fistula and can 

25 be a resource in assisting indigenous organizations 


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1 in severely afflicted countries in their efforts to treat 

2 and care for women with obstetric fistula. 

3 (20) The nature of obstetric fistula—and the 

4 fact that it affects vulnerable women in poor and 

5 isolated communities which offer little or no access 

6 to obstetric care—demands a comprehensive, coordi7 nated, long-term, international response focused on 

8 the prevention and treatment of obstetric fistula, in9 cluding— 

10 (A) safe-childbirth education and obstetric 

11 fistula prevention, care, and treatment; post-op12 erative care, including rehabilitation, social re13 integration, and post-surgical follow-up; basic 

14 and applied research and clinical work; and 

15 training of health care workers and educators, 

16 particularly local, grassroots educators and 

17 medical workers; 

18 (B) designation of a university-based med19 ical center in the United States, designated as 

20 the International Obstetric Fistula Institute for 

21 Sub-Saharan Africa established under section 

22 5(d), responsible for marshaling surgical and 

23 other necessary health resources to effectuate 

24 the campaign against obstetric fistula; for 

25 building prevention and treatment capacity in 


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1 sub-Saharan Africa, including coordinating 

2 partnerships with sub-Saharan African institu3 tions and governments; and for developing and 

4 managing community education and mobiliza5 tion programs at home and abroad; 

6 (C) development of health care infrastruc7 ture and delivery systems through Centers of 

8 Clinical Excellence for Obstetric Fistula Care 

9 for Sub-Saharan Africa as well as through co10 operative and coordinated public efforts and 

11 public-private partnerships; 

12 (D) strengthening universities, research 

13 centers, and training programs for health pro14 fessionals through institutional capacity-build15 ing partnerships; 

16 (E) development and implementation of a 

17 United States Obstetric Fistula Treatment and 

18 Prevention Corps which recruits and trains doc19 tors—especially obstetricians, gynecologists, 

20 urologists, general surgeons, and anesthesiol21 ogists—nurses, and other community-develop22 ment and public-health personnel to serve re23 gions affected by obstetric fistula and which 

24 partners United States medical professionals 

25 with sub-Saharan African professionals, proVerDate Mar 15 2010 03:27 Jul 08, 2014 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4997.IH H4997

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1 moting a joint effort to eradicate this dev2 astating condition; 

3 (F) coordination of efforts to make the 

4 treatment of obstetric fistula a higher priority 

5 in sub-Saharan African hospitals, specifically 

6 aimed at ameliorating the paucity of training 

7 related to obstetric fistula treatment; and 

8 (G) coordination of efforts between the 

9 medical community, nongovernmental organiza10 tions, national governments, and private sector 

11 organizations, including faith-based organiza12 tions. 

13 (21) The United States has the capacity to lead 

14 and enhance the effectiveness of the international 

15 community’s response by— 

16 (A) providing substantial resources, med17 ical expertise, and training, particularly of 

18 health care personnel and community workers 

19 and leaders; 

20 (B) making United States surgeons and 

21 health care professionals available to serve, 

22 train, and build workforce capacity in afflicted 

23 countries through a United States Obstetric 

24 Fistula Treatment and Prevention Corps; 


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1 (C) encouraging governments and faith2 based and community organizations to adopt 

3 policies that treat obstetric fistula and its 

4 causes as a multi-sector, public-health problem 

5 that profoundly affects women’s health, wom6 en’s empowerment, education, the economy, and 

7 promotion of strong and successful families; 

8 (D) encouraging education about healthy 

9 practices, including education about the health 

10 risks associated with child marriage and female 

11 genital mutilation; 

12 (E) building successful communities by 

13 preventing obstetric fistula and the ensuing so14 cial stigma which often separates an obstetric 

15 fistula victim from her family; 

16 (F) contributing to public health and 

17 health-care delivery system research to improve 

18 obstetric fistula prevention, treatment, and re19 integration; 

20 (G) encouraging active involvement and co21 operation across sectors, including the medical 

22 and scientific communities, charitable founda23 tions, private and voluntary organizations and 

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1 ganizations, community-based organizations, 

2 and other not-for-profit entities; and 

3 (H) engaging in medical diplomacy, with a 

4 particular focus on the further empowerment 

5 and emancipation of women. 

6 (22) Unaddressed obstetric emergencies and 

7 untreated obstetric fistula result in the needless, sys8 tematic degradation and marginalization of women. 

9 It should be the policy of the United States to help 

10 eradicate this preventable and curable condition. 

11 (23) Strong coordination must exist among the 

12 implementing agencies of the United States to en13 sure effective and efficient use of financial, medical, 

14 and technical resources within the United States 

15 Government with respect to international obstetric 

16 fistula eradication. 

17 (24) Obstetric fistula is a medical condition 

18 which historically affected women around the globe. 

19 The United States long ago eliminated this need20 lessly oppressive condition because of access to 

21 skilled medical professionals and medical care. Ob22 stetric fistula can be prevented and repaired. No 

23 woman should suffer a lifetime of debilitating phys24 ical and social consequences—as obstetric fistula vicVerDate Mar 15 2010 03:27 Jul 08, 2014 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4997.IH H4997

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1 tims do—simply because she lacks access to basic 

2 obstetric care. 

3 SEC. 3. DEFINITIONS. 

4 In this Act: 

5 (1) ADVISORY COMMITTEE.—The term ‘‘Advi6 sory Committee’’ means the United States Advisory 

7 Committee for the Eradication of Obstetric Fistula 

8 established under section 6. 

9 (2) CLINICAL CENTER OF EXCELLENCE.—The 

10 term ‘‘Center of Clinical Excellence’’ means a Center 

11 of Clinical Excellence for Obstetric Fistula Care in 

12 sub-Saharan Africa established under section 

13 5(d)(5). 

14 (3) CORPS.—The term ‘‘Corps’’ means the 

15 United States Obstetric Fistula Treatment and Pre16 vention Corps established under section 5(d)(6). 

17 (4) INSTITUTE.—The term ‘‘Institute’’ means 

18 the International Obstetric Fistula Institute for Sub19 Saharan Africa established under section 5(d)(1). 

20 (5) RELEVANT EXECUTIVE BRANCH AGEN21 CIES.—The term ‘‘relevant executive branch agen22 cies’’ means the Department of State, the United 

23 States Agency for International Development, and 

24 any other department or agency of the United States 

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1 tarian activities pursuant to the authorities of such 

2 department or agency or the Foreign Assistance Act 

3 of 1961. 

4 (6) SECRETARY.—The term ‘‘Secretary’’ means 

5 the Secretary of State. 

6 (7) SUB-SAHARAN AFRICA.—The terms ‘‘sub7 Saharan Africa’’, ‘‘sub-Saharan African’’, and ‘‘sub8 Saharan African country’’ shall have the meanings 

9 given to such terms for purposes of this Act by the 

10 Secretary. 

11 SEC. 4. COMPREHENSIVE, INTEGRATED, 10-YEAR STRATEGY 

12 TO COMBAT OBSTETRIC FISTULA IN SUB-SA13 HARAN AFRICA. 

14 (a) IN GENERAL.—The President, acting through the 

15 Administrator of the United States Agency for Inter16 national Development, shall establish a comprehensive, in17 tegrated, 10-year strategy to combat obstetric fistula in 

18 sub-Saharan Africa that strengthens the capacity of the 

19 United States to be an effective leader in the movement 

20 for international women’s health and empowerment. 

21 (b) ELEMENTS.—Such strategy shall maintain suffi22 cient flexibility and remain responsive to the needs of 

23 women afflicted with obstetric fistula or who stand at risk 

24 of suffering from obstetric fistula and shall include the 

25 following: 


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1 (1) A plan for implementation and coordination 

2 of programs and activities under this Act, including 

3 grants and contracts for prevention, treatment, and 

4 monitoring of obstetric fistula under section 5. 

5 (2) Specific objectives, multi-sector approaches, 

6 and specific strategies to treat women who suffer 

7 from obstetric fistula and to prevent further occur8 rences of obstetric fistula. 

9 (3) Assignment of priorities for relevant execu10 tive branch agencies. 

11 (4) Public health and health care delivery sys12 tem research on the prevention, repair, and rehabili13 tation of obstetric fistula. 

14 (5) Development, implementation, and evalua15 tion of evidence-based systems of care connecting 

16 maternity and obstetric fistula care facilities with 

17 local care delivery and community education pro18 grams. Such systems of care should promote rapid 

19 and long-term prevention of obstetric fistula, includ20 ing— 

21 (A) referral to prenatal care to identify 

22 and mitigate risk factors for obstetric fistula; 

23 (B) culturally appropriate childbirth edu24 cation, preparation, and planning; 

25 (C) access to skilled obstetric care; and 


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1 (D) promoting prompt detection of pro2 longed labor and appropriate action to address 

3 it. 

4 (6) Provision that the reduction of health and 

5 social risks which increase the likelihood of obstetric 

6 fistula shall be a priority of all prevention efforts in 

7 terms of funding, educational messages, and activi8 ties promoting a decrease in child marriage and the 

9 adolescent pregnancy rate, prompt detection of pro10 longed labor, and immediate intervention in cases of 

11 obstructed labor through improved access to emer12 gency obstetric services provided by partner hos13 pitals. 

14 (7) Improvement of coordination and reduce 

15 duplication among relevant executive branch agen16 cies, foreign governments, and international organi17 zations. 

18 (8) Projection of general levels of resources 

19 needed to achieve the stated objectives. 

20 (9) Expansion of public-private partnerships 

21 and the leveraging of resources. 

22 (10) Maximization of United States capabilities 

23 in the areas of medical training and research and 

24 application of those capabilities in sub-Saharan Afri25 ca. Such efforts may include the provision of grants 


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1 by relevant executive branch agencies for institu2 tional capacity-building partnerships between United 

3 States and foreign institutions, as well as between 

4 in-country institutions, for the purpose of mobilizing 

5 in-country capacity, resources, and expertise to pre6 vent and repair cases of obstetric fistula. 

7 (11) Priorities for the distribution of resources 

8 based on factors such as the size and demographics 

9 of the population suffering from obstetric fistula, the 

10 needs of that population, and the existing infrastruc11 ture or funding levels that may exist to treat and 

12 prevent obstetric fistula. 

13 (12) A long-term commitment to the eradi14 cation of obstetric fistula by expanding health sys15 tem capacity and training opportunities for doctors 

16 and other health service providers in sub-Saharan 

17 Africa. 

18 (13) A plan to maximize United States efforts 

19 in workforce training, capacity-building, and reten20 tion relating to obstetric fistula prevention, treat21 ment, rehabilitation, and research. Such plan shall 

22 be coordinated with existing United States and in23 country workforce capacity-building plans and ef24 forts. Such plan may include training of foreign 


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1 health workers at United States institutions and 

2 ‘‘train-the-trainer’’ programs. 

3 (14) A plan for institutional capacity-building 

4 partnerships to strengthen universities, research cen5 ters, health-profession training programs, and gov6 ernment institutes to build the in-country capacity 

7 needed to eradicate obstetric fistula. 

8 (c) REPORT.—Not later than 1 year after the date 

9 of the enactment of this Act, the President shall submit 

10 to Congress a report that contains the strategy required 

11 under this section. 

12 SEC. 5. PREVENTION, TREATMENT, AND MONITORING OF 

13 OBSTETRIC FISTULA IN SUB-SAHARAN AFRI14 CAN COUNTRIES. 

15 (a) IN GENERAL.—The President, acting through the 

16 Administrator of the United States Agency for Inter17 national Development, is authorized to provide grants to 

18 or enter into contracts with an eligible entity described 

19 in subsection (b) to carry out activities to prevent, treat, 

20 and monitor obstetric fistula in sub-Saharan African coun21 tries in accordance with this section. 

22 (b) ELIGIBLE ENTITY DESCRIBED.—In this section, 

23 the term ‘‘eligible entity’’ means a major, university-based 

24 medical center in the United States. 

25 (c) APPLICATION AND SELECTION.— 


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1 (1) APPLICATION.—The President shall provide 

2 for eligible entities to submit applications to the 

3 President for grants or contracts under this section 

4 in such form and manner as the President may re5 quire to carry out the purposes of this section. 

6 (2) SELECTION.— 

7 (A) IN GENERAL.—From among the appli8 cations submitted under paragraph (1), the 

9 President shall select an eligible entity to re10 ceive grants or contracts under this section pur11 suant to a competitive selection process. 

12 (B) CRITERIA.—The competitive selection 

13 process referred to in subparagraph (A) shall be 

14 based upon selection criteria, which shall in15 clude— 

16 (i) the breadth and depth of medical 

17 faculty, particularly with experience in ob18 stetrics and reconstructive pelvic surgery; 

19 (ii) breadth and depth of public health 

20 and international health faculty; 

21 (iii) experience in and capacity to con22 duct training of the global health work23 force and to strengthen capacity-building 

24 and health systems; 


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1 (iv) experience in building institu2 tional capacity in sub-Saharan Africa, in3 cluding through institutional partnerships; 

4 (v) willingness to supplement amounts 

5 received under grants or contracts under 

6 subsection (a) by engaging in community 

7 partnerships; and 

8 (vi) whether the applicant, for pur9 poses of this Act, has entered into a coop10 erative agreement with one or more major, 

11 university-based medical centers in sub-Sa12 haran Africa. 

13 (d) USE OF FUNDS.— 

14 (1) INTERNATIONAL OBSTETRIC FISTULA INSTI15 TUTE FOR SUB-SAHARAN AFRICA.—Amounts re16 ceived under grants or contracts under subsection 

17 (a) shall be used to establish and operate at the eli18 gible entity’s medical center in the United States an 

19 institute to carry out paragraphs (2) through (7), to 

20 be known as the International Obstetric Fistula In21 stitute for Sub-Saharan Africa. The purpose of the 

22 Institute shall be to prevent, treat, and monitor ob23 stetric fistula in sub-Saharan African countries. 

24 (2) ADMINISTRATION AND TRAINING.—The In25 stitute shall— 


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1 (A) serve as the primary administrative 

2 and medical-training hub for the campaign to 

3 prevent, treat, and monitor obstetric fistula in 

4 sub-Saharan African countries; 

5 (B) ensure the campaign described in sub6 paragraph (A) is carried out on both a scientific 

7 and humanitarian basis; 

8 (C) initiate and oversee the training and 

9 clinical activities of physicians, other health 

10 professionals, and educators serving at Centers 

11 of Clinical Excellence; and 

12 (D) ensure a progressive increase in health 

13 system and workforce capacity to prevent, treat, 

14 and monitor obstetric fistula in each country in 

15 which a Center of Clinical Excellence is located. 

16 (3) ENFORCE CLINICAL STANDARDS AND AC17 COUNTABILITY.—The Institute shall— 

18 (A) promote the utilization of standard 

19 clinical protocols, facilitate data collection, co20 ordinate research efforts, and oversee and par21 ticipate in multi-center randomized surgical 

22 trials; and 

23 (B) enforce the highest standards of clin24 ical practice and ethical behavior as described 


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1 in the published code of medical ethics for ob2 stetric fistula surgeons. 

3 (4) DEVELOP EVIDENCE-BASED PROGRAMS FOR

4 PREVENTION AND ACCESS TO EMERGENCY OBSTET5 RIC CARE.—The Institute shall— 

6 (A) develop and implement comprehensive 

7 and culturally appropriate protocols to prevent 

8 the formation of obstetric fistula, including the 

9 development and implementation of evidence10 based systems of care, which identify, track, 

11 and evaluate obstetric fistula prevention pro12 grams; 

13 (B) develop and implement prevention pro14 grams that— 

15 (i) teach women and family members, 

16 in a culturally appropriate manner, how to 

17 identify prolonged labor; 

18 (ii) inform women and family mem19 bers of the risks of not seeking appropriate 

20 medical care; 

21 (iii) refer women and family members 

22 to prenatal, perinatal, and postnatal care; 

23 (iv) teach women and family members 

24 how to mobilize community resources to 


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1 assist in seeking emergency obstetric care; 

2 and 

3 (v) teach women and family members 

4 to identify symptoms of obstetric fistula 

5 and refer women to treatment; 

6 (C) assist Centers of Clinical Excellence in 

7 developing localized programs for childbirth 

8 education, preparation and planning, prolonged9 labor detection, labor monitoring, and transpor10 tation from villages to local hospitals for obstet11 ric care and to Centers of Clinical Excellence 

12 for obstetric fistula care, accounting for factors 

13 such as transportation, geography, and 

14 scalability of such solutions; and 

15 (D) seek to partner with United States 

16 medical personnel and volunteers to train and 

17 employ local men and women as community18 based labor monitors who can educate and as19 sist other women at risk of suffering from ob20 stetric fistula, thereby empowering an entire 

21 sector of women in sub-Saharan Africa with in22 formation and employment. 

23 (5) CENTERS OF CLINICAL EXCELLENCE FOR

24 OBSTETRIC FISTULA CARE IN SUB-SAHARAN AFRI25 CA.— 


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1 (A) IN GENERAL.—The Institute, in co2 operation with each medical center in sub-Saha3 ran African described in subsection (b), shall 

4 establish not less than 8 centers in sub-Saharan 

5 Africa to treat and prevent obstetric fistula in 

6 countries and areas in which obstetric fistula is 

7 widespread, as determined by the Institute in 

8 consultation with the Advisory Committee. Such 

9 centers shall be known as Centers of Clinical 

10 Excellence for Obstetric Fistula Care in sub-Sa11 haran Africa. 

12 (B) GENERAL DUTIES.—Each Center of 

13 Clinical Excellence shall establish programs to 

14 treat and prevent obstetric fistula at hospitals 

15 and to expand the networks of such hospitals. 

16 the Centers of Excellence shall be co-located or 

17 located within reasonable proximity to hospitals 

18 capable of providing emergency and routine ob19 stetric care, in order to fulfill its duties and to 

20 ensure hospitals meet emergency obstetric 

21 needs. 

22 (C) SPECIFIC DUTIES.—Each Center of 

23 Clinical Excellence shall function as localized 

24 epicenters of training and clinical excellence for 

25 obstetric fistula care, and shall— 


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1 (i) be a major locus of medical and 

2 surgical care for obstetric fistula patients; 

3 (ii) be centers for the training of ob4 stetric fistula surgeons, nurses, and other 

5 medical personnel; 

6 (iii) coordinate and implement com7 munity outreach and prevention programs; 

8 (iv) partner with the national ministry 

9 of health or equivalent government body 

10 and medical educators in the country in 

11 which the Center of Clinical Excellence is 

12 located to develop country-specific training 

13 programs for surgeons and other health 

14 care personnel involved in obstetric fistula 

15 care; 

16 (v) be a vehicle for expanding access 

17 to emergency obstetric services in affiliated 

18 communities; 

19 (vi) establish a consulting and referral 

20 relationship with a hospital in its geo21 graphic vicinity, assist the hospital by com22 pleting an initial, comprehensive assess23 ment of what resources the hospital would 

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1 sessments and subject to the approval of 

2 the Institute approve funding for each hos3 pital to undergo appropriate physical ren4 ovation and reimburse the hospital for 

5 emergency obstetric care and cesarean de6 liveries; and 

7 (vii) coordinate a system of village 

8 ‘‘labor monitors’’ to help prevent obstetric 

9 fistula by identifying pregnant women in 

10 their communities, monitoring their labors, 

11 and activating an organized emergency12 transport system to move high-risk women 

13 to local hospitals with adequate obstetric 

14 care. 

15 (6) UNITED STATES OBSTETRIC FISTULA

16 TREATMENT AND PREVENTION CORPS.— 

17 (A) IN GENERAL.—The Institute, in co18 operation with each medical center in sub-Saha19 ran African described in subsection (b), shall 

20 establish and operate a United States Obstetric 

21 Fistula Treatment and Prevention Corps. 

22 (B) DUTIES.—The Corps shall— 

23 (i) provide volunteer medical services 

24 at Centers of Clinical Excellence and train 

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1 sionals in techniques of obstetric fistula re2 pair and in other aspects of the care of 

3 women with obstetric fistula; 

4 (ii) seek to establish an enabling envi5 ronment in which patient care can be pro6 vided effectively, consistently, humanely, 

7 and ethically to women with obstetric fis8 tula; and 

9 (iii) develop evidence-based systems of 

10 care for the prevention of obstetric fistula. 

11 (C) MEMBERSHIP.—The Corps shall con12 sist of— 

13 (i) graduates of United States or Afri14 can residency programs in such fields as 

15 obstetrics and gynecology, general surgery, 

16 urology, and anesthesiology; and 

17 (ii) other doctors, nurses, community18 health professionals, public-health profes19 sionals, and other expert personnel as 

20 needed to further the duties of the Insti21 tute to prevent, treat, and monitor obstet22 ric fistula in sub-Saharan African coun23 tries. 


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1 (D) DURATION OF SERVICE.—Members of 

2 the Corps shall commit to a duration of service 

3 of not less than 28 months. 

4 (E) COMPENSATION, OTHER BENEFITS.— 

5 The Institute may provide compensation, other 

6 employment benefits, and loan guarantees to in7 dividuals who agree to serve as members of the 

8 Corps. 

9 (F) ALUMNI CORPS.—The Institute is au10 thorized to establish an Alumni Corps, com11 prised of former members of the Corps who 

12 have completed successfully at least one period 

13 of service described in subparagraph (D) in 

14 order to augment medical personnel at Centers 

15 for Clinical Excellence. 

16 (7) ANNUAL REPORT.—The Institute shall sub17 mit to Congress and make available to the public an 

18 annual report on the implementation of this sub19 section, including a description of— 

20 (A) the recruitment for and implementa21 tion of the Corps; and 

22 (B) the activities of each Center of Clinical 

23 Excellence, including— 

24 (i) the number of women served at the 

25 Center; 


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1 (ii) the success rate of obstetric fis2 tula-repair surgeries, prevention efforts, 

3 and other programs used by the Center 

4 and surrounding communities; and 

5 (iii) other delivery system and quality 

6 measures as appropriate. 

7 (e) PERSONNEL.—The Institute shall be adminis8 tered by qualified, essential personnel including— 

9 (1) a director, who reports directly to the head 

10 of the medical center in the United States referred 

11 to in subsection (b); 

12 (2) expert leadership to oversee key aspects of 

13 the duties of the Institute, including— 

14 (A) medical and surgical activities; 

15 (B) prevention, education, and outreach; 

16 (C) partnerships and capacity building; 

17 (D) emergency obstetric services; and 

18 (E) program management; 

19 (3) professional and administrative staff re20 sponsible for administration, coordination, and cam21 paign performance; 

22 (4) dedicated, full-time, experienced surgeons 

23 responsible for the medical supervision and training 

24 of United States and sub-Saharan African surgeons 

25 assigned to Centers of Clinical Excellence, and for 


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1 medical research, data collection, and successful im2 plementation of medical programs in sub-Saharan 

3 Africa; 

4 (5) full-time prevention, education, and out5 reach coordinators, responsible for the Institute’s 

6 outreach, education, prevention, and social reintegra7 tion programs as well as for the supervision and 

8 training of outreach and education staff assigned to 

9 the Centers of Clinical Excellence; 

10 (6) an advisory panel for surgical outcomes and 

11 quality comprised of no fewer than 15 senior prac12 ticing surgeons from the United States and other 

13 countries— 

14 (A) to ensure a high, uniform level of sur15 gical care; 

16 (B) to engage in clinical practice with Cen17 ters of Clinical Excellence for Sub-Saharan Af18 rica to share their surgical experience and to 

19 provide clinical oversight; and 

20 (C) to liaise with Centers of Clinical Excel21 lence for Sub-Saharan Africa and the Institute 

22 to ensure the Centers of Clinical Excellence are 

23 accountable for providing a consistent and high 

24 level of surgical care; and 


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1 (7) an internal oversight and steering com2 mittee comprised of individuals who are medical pro3 fessionals, public health professionals, international 

4 social welfare advisors, economists specializing in 

5 international development, or professors of law or 

6 political science. 

7 (f) ADDITIONAL PERSONNEL.—The Institute may 

8 appoint and fix the pay of additional personnel as the In9 stitute considers appropriate. 

10 SEC. 6. UNITED STATES ADVISORY COMMITTEE FOR THE 

11 ERADICATION OF OBSTETRIC FISTULA. 

12 (a) ESTABLISHMENT.—There is established an advi13 sory committee to be known as the United States Advisory 

14 Committee for the Eradication of Obstetric Fistula. 

15 (b) MEMBERSHIP.— 

16 (1) SELECTION; QUALIFICATIONS.—The Advi17 sory Committee shall be composed of 14 members 

18 selected by the Secretary (through a competitive 

19 process) from among individuals who are distin20 guished scholars, clinicians, scientists, advocates, 

21 and philanthropists and who, collectively— 

22 (A) have knowledge and experience in 

23 health care and global health policy, including 

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1 powerment, human rights, and international 

2 law; and 

3 (B) have direct experience abroad espe4 cially in sub-Saharan Africa. 

5 (2) SELECTION.—The Advisory Committee 

6 shall be composed of 14 members selected by the 

7 Secretary through a competitive process. 

8 (3) DISQUALIFICATION.—An individual shall 

9 not be appointed as a member of the Advisory Com10 mittee if such individual possesses any personal or 

11 financial interest in the discharge of any duties of 

12 the Advisory Committee. 

13 (4) TERMS.—The term of office of each mem14 ber of the Advisory Committee shall be 5 years. 

15 Members of the Advisory Committee shall be eligible 

16 for reappointment for up to 2 terms. 

17 (c) MEETINGS.— 

18 (1) INITIAL MEETING.—The Advisory Com19 mittee shall hold its initial meeting on the date that 

20 is no later than 120 days after the date of the enact21 ment of this Act. 

22 (2) MEETINGS.—The Advisory Committee shall 

23 meet at the call of the Chairman or a majority of 

24 its members. The Advisory Committee shall meet no 

25 less than twice per calendar year. 


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1 (3) QUORUM.—Six members of the Advisory 

2 Committee shall constitute a quorum for purposes of 

3 conducting business, except that 2 members of the 

4 Advisory Committee shall constitute a quorum for 

5 purposes of receiving testimony. 

6 (4) VACANCIES.—Any vacancy of the Advisory 

7 Committee shall not affect its powers, but shall be 

8 filled promptly in the manner in which the original 

9 appointment was made. 

10 (d) ADMINISTRATION.— 

11 (1) TRAVEL EXPENSES.—Members of the Advi12 sory Committee shall be allowed travel expenses, in13 cluding per diem in lieu of subsistence, at rates au14 thorized for employees of agencies under subchapter 

15 I of chapter 57 of title 5, United States Code, while 

16 away from their homes or regular places of business 

17 in performance of services for the Advisory Com18 mittee. 

19 (2) ADMINISTRATIVE SUPPORT.—The Secretary 

20 shall assist the Advisory Committee by providing to 

21 the Advisory Committee such staff and administra22 tive services as may be necessary and appropriate 

23 for the Advisory Committee to perform its functions. 

24 Upon request of the Advisory Committee, the head 

25 of any Federal department or agency may detail any 


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1 of the personnel of that department or agency to the 

2 Advisory Committee without reimbursement to the 

3 department or agency of that employee and such de4 tail shall be without interruption or loss of civil serv5 ice status or privilege. 

6 (3) EXPERTS AND CONSULTANTS.—The Advi7 sory Committee may procure temporary and inter8 mittent services under section 3109(b) of title 5, 

9 United States Code. 

10 (4) OTHER RESOURCES.—The Advisory Com11 mittee shall have reasonable access to materials, re12 sources, statistical data, and other information the 

13 Advisory Committee determines to be necessary to 

14 carry out its duties from the Library of Congress, 

15 the Department of State, the National Library of 

16 Medicine, and other departments and agencies of the 

17 executive and legislative branches of the Federal 

18 Government. The Chairman of the Advisory Com19 mittee shall make requests for such access in writing 

20 when necessary. 

21 (5) OBTAINING OFFICIAL DATA.—The Advisory 

22 Committee may secure directly from any department 

23 or agency of the United States information nec24 essary to enable it to carry out this section. Upon 

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1 mittee, the head of that department or agency shall 

2 furnish that information to the Advisory Committee. 

3 (e) DUTIES.—The primary duties of the Advisory 

4 Committee shall include— 

5 (1) advising the Institute on an ongoing basis 

6 in carrying out the duties of the Institute; 

7 (2) evaluating programs and activities to eradi8 cate obstetric fistula and making recommendations 

9 regarding the programs of the Institute; 

10 (3) advising the Department of State and the 

11 United States Agency for International Development 

12 on an ongoing basis in carrying out programs and 

13 activities to eradicate obstetric fistula; 

14 (4) monitoring funds available for programs 

15 and activities to eradicate obstetric fistula to ensure 

16 such funds are used efficiently and are accounted for 

17 properly, including through the conduct of periodic 

18 audits; and 

19 (5) advising the Administrator of the United 

20 States Agency for International Development in an 

21 annual written report of the Institute’s performance 

22 and success in carrying out its duties. 

23 (f) ACTIONS AGAINST GOVERNMENTS FAILING TO

24 MEET MINIMUM STANDARDS.— 


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1 (1) BY ADVISORY COMMITTEE.—The Advisory 

2 Committee— 

3 (A) shall advise the Administrator of the 

4 United States Agency for International Devel5 opment, based on information provided to the 

6 Advisory Committee by the Institute or based 

7 on independent sources of information, of each 

8 county that by reason of corruption, indiffer9 ence, or ineffectiveness, significantly impedes 

10 the Institute’s ability to provide services to vic11 tims of obstetric fistula and women who are 

12 vulnerable to obstetric fistula; and 

13 (B) may request the Administrator to rec14 ommend suspension of the provision of United 

15 States nonhumanitarian, nontrade-related for16 eign assistance to each country described in 

17 subparagraph (A). 

18 (2) BY USAID.—Based on the advice of the Ad19 visory Committee under paragraph (1), the Adminis20 trator may accept the advice and, in consultation 

21 with the Secretary, recommend to the President the 

22 suspension of United States nonhumanitarian, 

23 nontrade-related foreign assistance to a county de24 scribed in paragraph (1)(A). 


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1 SEC. 7. REPORT. 

2 The President, acting through the Administrator of 

3 the United States Agency for International Development, 

4 shall submit to Congress on an annual basis a report on 

5 the implementation of this Act for the preceding year, in6 cluding an evaluation of the effectiveness and performance 

7 of the Institute, the Centers of Clinical Excellence, the 

8 Corps, and all related community outreach and medical 

9 programs. 

10 SEC. 8. AUTHORIZATION OF APPROPRIATIONS. 

11 (a) IN GENERAL.—There are authorized to be appro12 priated to the President to carry out this Act— 

13 (1) $10,000,000 for fiscal year 2015; and 

14 (2) $180,000,000 for the period of fiscal years 

15 2016 through 2024. 

16 (b) AVAILABILITY.—Amounts appropriated pursuant 

17 to the authorization of appropriations under subsection (a) 

18 are authorized to remain available until expended. 

Æ 


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