I 

115TH CONGRESS 

2D SESSION H. R. 7301 

To authorize assistance to train and retain obstetrician-gynecologists and 

sub-specialists in urogynecology and to help improve the quality of care 

to meet the health care needs of women in least developed countries, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 13, 2018 

Ms. DELAURO (for herself, Ms. NORTON, Mr. GRIJALVA, Ms. JACKSON LEE, 

Mr. MCGOVERN, Ms. MCCOLLUM, and Ms. LOFGREN) introduced the following bill; which was referred to the Committee on Foreign Affairs 

A BILL 

To authorize assistance to train and retain obstetrician-gynecologists and sub-specialists in urogynecology and to help 

improve the quality of care to meet the health care 

needs of women in least developed 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 ‘‘Physician Education 

5 for Fistula Treatment Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) Historically, obstetric fistulas affected 

2 women in the United States and around the world. 

3 Advances in obstetric care and access to improved 

4 surgical techniques resulted in a drastic reduction in 

5 obstetric fistula by the early 20th century in the 

6 United States. 

7 (2) Each year between 50,000 to 100,000 

8 women worldwide are affected by obstetric fistulas, 

9 an abnormal opening between a woman’s genital 

10 tract and her urinary tract or rectum. 

11 (3) Women who experience an obstetric fistula 

12 suffer constant incontinence, shame, and social seg13 regation and health problems. It is estimated that 2 

14 to 3 million women live with untreated obstetric fis15 tulas, a scourge of epidemic proportions. 

16 (4) A lack of available resources and training 

17 programs to develop expertise in comprehensive ad18 vanced pelvic reconstructive surgery continues to 

19 pose a challenge for the health care workforce in 

20 least developed countries. 

21 (5) Retention rates of OB–GYNs and sub-spe22 cialists in urogynecology have seen improvement 

23 with fellowships, residencies, and programs that pro24 vide resources and training. 


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1 (6) Today, obstetric fistula primarily affects the 

2 poorest women in the poorest parts of the world. Ob3 stetric fistulas typically occur because women do not 

4 have timely access to emergency obstetric care dur5 ing obstructed labor, and continue to have fistulas 

6 due to lack of access to adequate surgical services 

7 once they sustain the injury. 

8 (7) Left untreated, an obstetric fistula afflicts 

9 a woman with devastating physical conditions: incon10 tinence, painful ulcers, and constant and uncontrol11 lable emission of offensive odors. These symptoms 

12 leave a woman indelibly and perpetually stigmatized 

13 by her condition. 

14 (8) Because obstetric fistulas are not them15 selves fatal, millions of women live with this horrific 

16 condition and have been overlooked by the inter17 national medical community. At present, humani18 tarian aid and nongovernmental programs treat fis19 tula cases on a small scale and are not equipped to 

20 systematically prevent, treat, and eradicate obstetric 

21 fistula. 

22 (9) Obstetric fistula can be prevented when 

23 women and their families are educated about the 

24 birthing process and are provided timely access to 

25 emergency obstetric care. Basic interventions to 


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1 identify and repair obstetric fistula have achieved 

2 meaningful and cost-effective results. The impact of 

3 an obstetric fistula-repair surgery is immediate and 

4 women can be reintegrated into society. However, 

5 access to prevention, effective midwifery services, 

6 and OB–GYN care can significantly decrease child7 birth-related injuries. 

8 SEC. 3. INTERNATIONAL OB/GYN AND UROGYNECOLOGY 

9 PROMOTION PROGRAM. 

10 (a) PURPOSE.—The purpose of assistance under this 

11 section is to train and retain obstetrician-gynecologists 

12 (OB–GYNs) and sub-specialists in urogynecology and to 

13 help improve the quality of care to meet the health care 

14 needs of women in least developed countries. 

15 (b) AUTHORIZATION.— 

16 (1) IN GENERAL.—To carry out the purpose of 

17 subsection (a), the President, acting through the Di18 rector of the John E. Fogarty International Center 

19 for Advanced Study in the Health Sciences, is au20 thorized to provide assistance for least developed 

21 countries to support the activities described in sub22 section (c). 

23 (2) REFERENCE.—Assistance authorized under 

24 this section may be referred to as the ‘‘International 

25 OB/GYN and Urogynecology Promotion Program’’. 


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1 (c) ACTIVITIES SUPPORTED.—Activities that may be 

2 supported by assistance under subsection (b) include the 

3 following: 

4 (1) FELLOWSHIP AND RESIDENCY PRO5 GRAMS.—Establishment of fellowship and residency 

6 programs to be carried out in coordination with in7 stitutions of higher education (as such term is de8 fined in section 101 of the Higher Education Act of 

9 1965 (20 U.S.C. 1001)), institutions of higher learn10 ing, midwifery programs, and existing clinical cen11 ters in least developed countries— 

12 (A) to support existing academic curricula 

13 for education training for midwifery students; 

14 (B) to develop and help sustain existing 

15 specialized curriculum training for medical stu16 dents and residents to become knowledgeable 

17 and proficient in women’s health care; and 

18 (C) to allow medical students, residents, 

19 and midwifery students to practice and develop 

20 expertise in geographical areas in which child21 birth-related injuries are most prevalent. 

22 (2) TRAINING CENTERS.—Establishment of 

23 training centers— 


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1 (A) to address the shortage of OB–GYNs 

2 and sub-specialists in the urogynecology profes3 sion; and 

4 (B) to carry out specialized programs that 

5 are located at health care institutions that pro6 vide exceptionally high concentrations of exper7 tise and related resources related to these med8 ical professions and are delivered in a com9 prehensive and interdisciplinary fashion. 

10 SEC. 4. COMPREHENSIVE 10-YEAR STRATEGY TO ADDRESS 

11 THE SHORTAGE OF PHYSICIANS IN LEAST DE12 VELOPED COUNTRIES. 

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

14 Director of the John E. Fogarty International Center for 

15 Advanced Study in the Health Sciences, shall establish a 

16 comprehensive, integrated, 10-year strategy to address the 

17 shortage of physicians in least developed countries. 

18 (b) ELEMENTS.—Such strategy shall maintain suffi19 cient flexibility and remain responsive to the needs of 

20 women afflicted with childbirth-related injuries and shall 

21 include the following: 

22 (1) A plan for implementation and coordination 

23 of programs and activities under this Act, including 

24 grants and contracts for prevention, treatment, and 

25 monitoring of childbirth-related injuries. 


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

2 and specific strategies to treat women who suffer 

3 from childbirth-related injuries and to prevent fur4 ther occurrences of childbirth-related injuries. 

5 (3) Assignment of priorities for relevant execu6 tive branch agencies. 

7 (4) Public health and health care delivery sys8 tem research on the prevention, repair, and rehabili9 tation of childbirth-related injuries. 

10 (5) Social science research in fields such as an11 thropology, sociology, and related fields to monitor 

12 and evaluate the underlying social and economic fac13 tors that contribute to childbirth-related injuries. 

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

16 maternity care facilities with local care delivery and 

17 community education programs. Such systems of 

18 care should promote rapid and long-term prevention 

19 of childbirth-related injuries, including— 

20 (A) culturally appropriate childbirth edu21 cation, preparation, and planning; and 

22 (B) access to obstetrician-gynecologists 

23 (OB–GYNs), urogynecology care, or midwifery 

24 care. 


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1 (7) Expansion of training centers and partner2 ships with institutions of higher learning for medical 

3 students and residents. 

4 (8) Priorities for the distribution of resources 

5 based on factors such as the size and demographics 

6 of the population suffering from childbirth-related 

7 injuries, the needs of that population, and the exist8 ing infrastructure or funding levels that may exist to 

9 treat and prevent childbirth-related injuries, includ10 ing obstetric fistula. 

11 (9) A plan for institutional capacity-building of 

12 partnerships to strengthen universities, research cen13 ters, health-profession training programs, and gov14 ernment institutes to build the in-country capacity 

15 needed to eradicate childbirth-related injuries in 

16 least developed countries. 

17 (c) REPORT.—Not later than 2 years after the date 

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

19 to Congress a report that contains the strategy required 

20 under this section. 

21 SEC. 5. REPORT. 

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

23 Director of the John E. Fogarty International Center for 

24 Advanced Study in the Health Sciences, shall submit to 


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1 Congress, on an annual basis, a report on the implementa2 tion of this Act for the preceding year. 

3 (b) MATTERS TO BE INCLUDED.—The report re4 quired under subsection (a) shall include an evaluation of 

5 the effectiveness and performance of the International 

6 OB/GYN and Urogynecology Promotion Program estab7 lished under section 3 and all related community outreach 

8 and medical programs. 

9 SEC. 6. DEFINITIONS. 

10 In this Act: 

11 (1) CHILDBIRTH-RELATED INJURIES.—The 

12 term ‘‘childbirth-related injuries’’ means injuries as13 sociated with obstructed labor, including— 

14 (A) pelvic organ prolapse; 

15 (B) a displacement of pelvic organs such 

16 as the uterus, bladder, or bowel; and 

17 (C) obstetric fistula. 

18 (2) LOW-INCOME COUNTRY.—The term ‘‘low-in19 come country’’ means a country with a per capita 

20 gross national income of $1,035 or less. 

21 (3) LEAST DEVELOPED COUNTRY.—The term 

22 ‘‘least developed country’’ means a country that— 

23 (A) is a low-income country; and 

24 (B) according to the United Nations Eco25 nomic Analysis and Policy Division, is conVerDate Sep 11 2014 20:28 Dec 19, 2018 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H7301.IH H7301

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1 fronting severe structural impediments to sus2 tainable development. 

3 (4) RELEVANT EXECUTIVE BRANCH AGEN4 CIES.—The term ‘‘relevant executive branch agen5 cies’’ means the Department of State, the United 

6 States Agency for International Development, and 

7 any other department or agency of the United States 

8 that participates in international health and humani9 tarian activities pursuant to the authorities of such 

10 department or agency or the Foreign Assistance Act 

11 of 1961. 

Æ 


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