I 

108TH CONGRESS 

2D SESSION H. R. 3810

To provide a United States voluntary contribution to the United Nations 

Population Fund only for the prevention, remedy, and repair of obstetric 

fistula. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 11, 2004

Mrs. MALONEY (for herself, Mr. TOWNS, Mr. CROWLEY, Mr. JACKSON of Illinois, Mrs. CHRISTENSEN, Mrs. JONES of Ohio, Mr. SCOTT of Georgia, 

Mr. STARK, Mr. KENNEDY of Rhode Island, Ms. MCCOLLUM, Mr. 

ISRAEL, Mr. WAXMAN, Mr. DOGGETT, Mr. NADLER, Mr. EVANS, Mr. 

GRIJALVA, Mr. LANTOS, Ms. NORTON, Ms. JACKSON-LEE of Texas, Ms. 

SCHAKOWSKY, Ms. LEE, Mr. OWENS, Ms. MILLENDER-MCDONALD, Mrs. 

LOWEY, Ms. SLAUGHTER, and Ms. ROYBAL-ALLARD) introduced the following bill; which was referred to the Committee on International Relations 

A BILL

To provide a United States voluntary contribution to the 

United Nations Population Fund only for the prevention, 

remedy, and repair of 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. 

4 This Act may be cited as the ‘‘Repairing Young 

5 Women’s Lives Around the World Act’’. 
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1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) Every minute, 1 woman dies from preg4 nancy-related complications. 95 percent of these 

5 women live in Africa and Asia. 

6 (2) For every woman who dies from pregnancy7 related complications, 15 to 30 women survive but 

8 experience chronic disabilities. The worst is obstetric 

9 fistula which is caused when a woman who needs 

10 trained medical assistance for a safe delivery, includ11 ing Caesarian section, cannot get it. 

12 (3) Obstetric fistula is a hole that is formed be13 tween the bladder and the vagina, or the rectum and 

14 the vagina, after a woman suffers from prolonged 

15 obstructed labor. In the struggle to pass through the 

16 birth canal, the fetus puts constant pressure, some17 times for several days, on the bladder and vaginal or 

18 rectal wall, destroying the tissue and leaving a 

19 wound. 

20 (4) According to the Department of State: 

21 ‘‘Pregnancy at an early age often leads to obstetric 

22 fistulae and permanent incontinence. [In Ethiopia], 

23 treatment is available at only 1 hospital in Addis 

24 Ababa that performs over 1,000 fistula operations a 

25 year. It estimates that for every successful operation 

26 performed, 10 other young women need the treat-
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1 ment. The maternal mortality rate is extremely high 

2 due, in part, to food taboos for pregnant women, 

3 poverty, early marriage, and birth complications re4 lated to FGM [Female Genital Mutilation], espe5 cially infibulation.’’. 

6 (5) Obstetric fistula affects women who survive 

7 obstructed labor. 

8 (6) In nearly every case of obstetric fistula, the 

9 baby will be stillborn and the mother will have phys10 ical pain as well as social and emotional trauma 

11 from the loss of her child. 

12 (7) The physical symptoms of obstetric fistula 

13 include incontinence or constant uncontrollable leak14 ing of urine or feces, frequent bladder infections, in15 fertility, and foul odor. 

16 (8) The social consequences for women with ob17 stetric fistula include isolation and lack of oppor18 tunity, divorce or abandonment, ridicule and shame, 

19 inability to start a family, illness, and risk of vio20 lence. 

21 (9) Although data on obstetric fistula are 

22 scarce, the World Health Organization (WHO) esti23 mates there are more than 2,000,000 women living 

24 with fistula and 50,000 to 100,000 new cases each 

25 year. 
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1 (10) Obstetric fistula was once common 

2 throughout the world, but over the last century has 

3 been eradicated in Europe, North America, and 

4 other developed regions through improved medical 

5 care. 

6 (11) Obstetric fistula is fully preventable by 

7 having a trained medical attendant present during 

8 labor and childbirth, delaying early marriage and 

9 childbirth, and gaining access to family planning. 

10 (12) Obstetric fistula can also be surgically re11 paired. Surgery requires a specially trained surgeon 

12 and support staff, access to an operating theater 

13 and to attentive post-operative care. Success rates 

14 for surgical repair of fistula are close to 90 percent 

15 and cost between $100 and $400. 

16 (13) In 2003, the United Nations Population 

17 Fund (UNFPA) launched a global campaign to iden18 tify and address the incidence of obstetric fistula in 

19 Africa and Asia in an effort to develop a means to 

20 repair those who are suffering and provide the nec21 essary health services to prevent further cases. The 

22 campaign currently supports 20 countries in Africa 

23 and Asia and provides surgery to women, trains doc24 tors and nurses, equips hospitals, and undertakes 

25 community outreach to prevent further cases. 
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1 (14) The United States Government provided a 

2 voluntary contribution of $21,500,000 to UNFPA 

3 for fiscal year 2001 and the Administration’s budget 

4 request for fiscal year 2002 allocated $25,000,000 

5 for UNFPA. 

6 (15) The UNFPA is working in 89 countries to 

7 reduce maternal death and disability, including ob8 stetric fistula, through preventive, curative, and re9 habilitative methods. 

10 (16) In the winter of 2001, the Secretary of 

11 State submitted written testimony to the Committee 

12 on Foreign Relations of the Senate expressing sup13 port for the invaluable work of the UNFPA and for 

14 securing funding for the organization. 

15 (17) The United States Government, as part of 

16 its efforts to improve the dire health conditions of 

17 Afghan women, pledged in October 2001 an addi18 tional $600,000 to the UNFPA to address the re19 productive health care needs of Afghan refugees in 

20 surrounding nations and of internally displaced per21 sons within Afghanistan. 

22 (18) Congress demonstrated its strong bipar23 tisan support for a voluntary United States con24 tribution to the UNFPA of up to $34,000,000 in the 

25 Foreign Operations, Export Financing, and Related 
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1 Programs Appropriations Act, 2002, which was 

2 passed by the House of Representatives on a vote of 

3 357 to 66 and by the Senate by unanimous consent 

4 and signed into law (Public Law 107–115) by the 

5 President on January 10, 2002. However, the Presi6 dent decided not to obligate the funds. 

7 (19) In May 2002, the President sent a 3-per8 son delegation to investigate UNFPA programs in 

9 China and allegations that the agency was involved 

10 in coercive abortion practices. 

11 (20) This independent delegation concluded 

12 that such allegations were untrue. 

13 (21) On May 29, 2002, the delegation sent a 

14 letter to the Secretary of State stating the following: 

15 ‘‘First Finding: We find no evidence that UNFPA 

16 has knowingly supported or participated in the man17 agement of a program of coercive abortion or invol18 untary sterilization in the PRC. First Recommenda19 tion: We therefore recommend that not more than 

20 $34,000,000 which has already been appropriated be 

21 released to UNFPA.’’. 

22 (22) Regrettably, the Administration overruled 

23 the recommendation of its own delegation and in24 voked an overly broad interpretation of the law in 

25 order to eliminate funding for UNFPA. 
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1 SEC. 3. UNITED STATES VOLUNTARY CONTRIBUTION TO 

2 THE UNITED NATIONS POPULATION FUND. 

3 Notwithstanding any other provision of law, in addi4 tion to amounts otherwise available to carry out the pur5 poses of chapter 3 of part 1 of the Foreign Assistance 

6 Act of 1961, there are authorized to be appropriated 

7 $34,000,000 for fiscal year 2004 and each subsequent fis8 cal year to be available only for United States voluntary 

9 contributions to the United Nations Population Fund 

10 (UNFPA) only for prevention, remedy, and repair of ob11 stetric fistula.

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