II 

113TH CONGRESS 

2D SESSION S. 2853 

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

globally. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 18, 2014 

Mr. COONS (for himself, Mr. GRAHAM, and Mr. CARDIN) 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 ‘‘Accelerating Action 

5 in Maternal and Child Health Act of 2014’’. 

6 SEC. 2. PURPOSE. 

7 The purpose of this Act is to provide tools for the 

8 United States Government to use to accelerate the reduc9 tion of preventable maternal, newborn, and child deaths 

10 in 24 United States Agency for International Development 


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1 (USAID) focus countries by 2020, saving 15,000,000 chil2 dren and 600,000 mothers. 

3 SEC. 3. FINDINGS. 

4 Congress makes the following findings: 

5 (1) Over the past 2 decades, child mortality has 

6 reduced by nearly 50 percent and maternal mortality 

7 has reduced by 40 percent, thanks in large part to 

8 United States Government action and intervention. 

9 (2) In the last 3 years, 24 priority countries— 

10 of which 16 are in Africa—have achieved an 8 per11 cent reduction in under-5 mortality, saving 500,000 

12 lives. 

13 (3) The report ‘‘Acting on the Call: Ending 

14 Preventable Child and Maternal Deaths’’ developed 

15 by USAID provides a critical foundation of evidence, 

16 knowledge, modeling, and policy development on 

17 ending maternal, newborn, and child deaths world18 wide. 

19 (4) To achieve Millennium Development Goal 

4—to reduce child mortality by 2 20 ⁄3 between 1990 

21 and 2015—on time, the global annual rate of reduc22 tion in under-5 mortality would need to rise to 15.6 

23 percent from 2012 through 2015, much faster than 

24 the 3.9 percent achieved from 2005 through 2012. 


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1 (5) According to the World Health Organiza2 tion (WHO), every year 6,600,000 children under 

3 the age of 5—primarily infants—die from prevent4 able or treatable causes, and more than 800 women 

5 die every day from complications during pregnancy 

6 and childbirth. 

7 (6) The vast majority of these deaths occur in 

8 the developing world and countries in Africa have 

9 the highest burden. 

10 (7) The highest rates of child mortality are still 

11 in sub-Saharan Africa, with an under-5 mortality 

12 rate of 98 deaths per 1,000 live births—more than 

13 15 times the average for developed regions. 

14 (8) Investing in women and children reduces 

15 poverty, stimulates economic growth, and most im16 portantly, saves lives. 

17 (9) Health products, such as vaccines and 

18 treatments, have contributed significantly to recent 

19 successes in child and maternal survival globally. 

20 New approaches and technologies are critically need21 ed to accelerate progress toward ending preventable 

22 maternal and child deaths. 

23 (10) The WHO identifies the following leading 

24 causes of maternal, newborn, and child mortality: 


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1 (A) Leading causes of maternal mortality 

2 in low-income countries include post-partum 

3 bleeding, infection, and hypertension. 

4 (B) Newborn deaths account for approxi5 mately 44 percent of deaths among children 

6 under age 5 and are predominantly caused by 

7 infections, premature birth, and asphyxia. 

8 (C) Most deaths of children under the age 

9 of 5 are a result of preventable causes, such as 

10 respiratory infections (commonly from pneu11 monia), diarrhea, and malaria. 

12 (D) Malnutrition is the underlying contrib13 uting factor in about 45 percent of all child 

14 deaths, making children more vulnerable to se15 vere diseases. 

16 SEC. 4. STATEMENT OF POLICY. 

17 It is the policy of the United States, in partnership 

18 with host governments, international financial institutions, 

19 nongovernmental organizations, faith-based organizations, 

20 and the private sector, to establish a comprehensive, co21 ordinated, integrated strategy to combat the leading 

22 causes of maternal, newborn, and child mortality globally 

23 by— 

24 (1) building on progress and success to date; 


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1 (2) scaling up the most effective evidence-based 

2 interventions with a focus on country ownership; 

3 (3) focusing on USAID’s 24 priority countries; 

4 (4) streamlining existing resources and scaling 

5 up increased targeted resources; 

6 (5) increasing transparency and accountability; 

7 and 

8 (6) creating innovative new public-private fi9 nancing mechanisms. 

10 SEC. 5. STRATEGY. 

11 (a) IN GENERAL.—The President shall establish a 

12 strategy to accelerate action in each of the 24 priority 

13 countries set forth in section 7, building on the evidence 

14 outlined in USAID’s ‘‘Acting on the Call: Ending Prevent15 able Child and Maternal Deaths’’. The strategy will use 

16 the current modeling and data that outlines the most prov17 en effective interventions. The strategy shall further 

18 strengthen the capability of the United States to be an 

19 effective leader in maternal, newborn, and child health, 

20 particularly in Africa, and will be a first step toward a 

21 broader, concerted effort to end maternal, newborn, and 

22 child deaths worldwide. 

23 (b) ELEMENTS.—The strategy established under sub24 section (a) shall— 


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1 (1) include specific objectives, multisectoral ap2 proaches, and specific strategies to address the lead3 ing causes of death among mothers during preg4 nancy, childbirth, and post-delivery; newborns in 

5 their first 28 days; and children under the age of 5; 

6 (2) clarify the responsibilities of the country, 

7 the implementing organization, and the United 

8 States in the achievement of such objectives; 

9 (3) include regular benchmarks to measure, 

10 where appropriate, progress toward achieving such 

11 objectives; 

12 (4) utilize data and modeling to implement the 

13 most effective interventions for saving 15,000,000 

14 children and 600,000 mothers; 

15 (5) illustrate the result of coordination among 

16 relevant executive branch agencies, foreign govern17 ments, and international organizations; 

18 (6) provide projected levels of resources needed 

19 to achieve the stated objectives; 

20 (7) expand public-private partnerships for re21 search and innovation and for leveraging resources 

22 in new and innovative ways; and 

23 (8) use open, fair, and competitive procedures 

24 wherever appropriate and possible in the administra25 tion, execution, and evaluation of the program. 


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1 (c) TARGETED SERVICES.—The strategy established 

2 under subsection (a) should focus on the following evi3 dence-based categories of intervention: 

4 (1) Safe motherhood and newborn survival, in5 cluding— 

6 (A) prenatal and postnatal care for moth7 ers and newborns; 

8 (B) quality care during labor and delivery, 

9 including in emergencies; and 

10 (C) education on healthy timing and spac11 ing of pregnancies. 

12 (2) Healthy households and schools, including 

13 Water, Sanitation, and Hygiene (WASH). 

14 (3) Nutrition, including— 

15 (A) maternal and child nutrition during 

16 the first 1,000 days; and 

17 (B) prevention of maternal malnutrition. 

18 (4) Healthy childhood, including— 

19 (A) vaccines for the leading causes of ma20 ternal, newborn, and child deaths; 

21 (B) prevention and treatment for pneu22 monia and diarrhea; 

23 (C) prevention of mother-to-child trans24 mission of HIV (PMTCT); 


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1 (D) prevention and treatment of malaria; 

2 and 

3 (E) capacity-building of health profes4 sionals. 

5 SEC. 6. ESTABLISHMENT OF AN INNOVATIVE PUBLIC-PRI6 VATE FINANCING MECHANISM. 

7 The United States Government shall establish a pilot 

8 program for innovative financing mechanisms for deliv9 ering maternal, newborn, and child health interventions in 

10 the 24 priority countries set forth in section 7 based on 

11 the specific recommendations outlined by the convening of 

12 high-level global experts at the 2014 United Nations Gen13 eral Assembly. The innovative financing framework will 

14 establish a method to mobilize capital for health utilizing 

15 tools, including loans and loan guarantees, volume guaran16 tees, development impact bonds, or partner government 

17 taxes, levies, fees, and funds. 

18 SEC. 7. PRIORITY COUNTRIES. 

19 (a) IN GENERAL.—Based on the global target list de20 veloped by USAID, the priority countries for receiving ma21 ternal and child health programming under this Act are 

22 the following: 

23 (1) Afghanistan. 

24 (2) Bangladesh. 


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1 (3) The Democratic Republic of the Congo 

2 (DRC). 

3 (4) Ethiopia. 

4 (5) Ghana. 

5 (6) Haiti. 

6 (7) India. 

7 (8) Indonesia. 

8 (9) Kenya. 

9 (10) Liberia. 

10 (11) Madagascar. 

11 (12) Malawi. 

12 (13) Mali. 

13 (14) Mozambique. 

14 (15) Nepal. 

15 (16) Nigeria. 

16 (17) Pakistan. 

17 (18) Rwanda. 

18 (19) Senegal. 

19 (20) South Sudan. 

20 (21) Tanzania. 

21 (22) Uganda. 

22 (23) Yemen. 

23 (24) Zambia. 

24 (b) ELIGIBILITY CRITERIA.—The United States Gov25 ernment should give preference to applying mechanisms 


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1 under this Act to the countries listed under subsection (a) 

2 that have reached or made progress towards 2001 Abuja 

3 Declaration commitments involving pledges to increase 

4 government funding for health to at least 15 percent with5 in the next 5 years. A candidate country should be also 

6 considered to be an eligible country by demonstrating a 

7 commitment to— 

8 (1) peaceful and democratic governance; 

9 (2) civil society engagement; 

10 (3) economic freedom; and 

11 (4) investments in the people of such country, 

12 particularly in maternal, newborn, and child health. 

13 SEC. 8. PROGRESS REPORT. 

14 Beginning 2 years after the date of the enactment 

15 of this Act, the President shall provide an annual progress 

16 report to Congress on activities under this Act, includ17 ing— 

18 (1) data on mechanisms implemented under 

19 this Act, including a description of how they are de20 signed, managed, and monitored and evaluated; 

21 (2) how many mechanisms are implemented 

22 and where; and 

23 (3) the results of implementation of such mech24 anisms, and recommendations for improving these 

25 mechanisms to ensure future growth and success. 


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1 SEC. 9. AUTHORIZATION OF APPROPRIATIONS. 

2 There are authorized to be appropriated to carry out 

3 this Act such sums as may be necessary for each of fiscal 

4 years 2015 through 2019, to remain available until ex5 pended. 

Æ 


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