I 

108TH CONGRESS 

2D SESSION H. R. 4848 

To amend the Foreign Assistance Act of 1961 to provide for the establishment 

of centers for the treatment of obstetric fistula in developing countries. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 15, 2004 

Mr. SMITH of New Jersey (for himself, Ms. ROS-LEHTINEN, Mr. PITTS, Mr. 

PAYNE, and Mr. PENCE) introduced the following bill; which was referred 

to the Committee on International Relations 

A BILL 

To amend the Foreign Assistance Act of 1961 to provide 

for the establishment of centers for the treatment of 

obstetric fistula in developing countries. 

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 ‘‘Obstetric Fistula Sur5 gical Repair, Assistance, and Prevention Act of 2004’’. 

6 SEC. 2. FINDINGS AND PURPOSE. 

7 (a) FINDINGS.—Congress finds the following: 

8 (1) Obstetric fistula is a devastating condition 

9 that occurs during childbirth when prolonged pres-
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1 sure of the baby’s head against the mother’s pelvis 

2 can lead to the child’s death as well as cut off the 

3 blood supply of the tissues surrounding the woman’s 

4 vagina, bladder, or rectum, causing those tissues to 

5 deteriorate, and thus leaving an open hole, or fistula. 

6 (2) Obstetric fistula can be excruciatingly pain7 ful and often causes a woman to lose control of her 

8 bowel movements. 

9 (3) To date, an estimated 2,000,000 cases of 

10 obstetric fistula have been reported worldwide— 

11 mostly in Africa among women who are very young, 

12 delivering their first child, lacking proper nutrition 

13 and maternity care, and living in rural areas. 

14 (4) The actual number of women who have ob15 stetric fistula may actually be much higher due to a 

16 lack of adequate reporting. For example, an addi17 tional estimate contends that in Nigeria alone, ap18 proximately 1,000,000 women suffer from obstetric 

19 fistula. 

20 (5) It is estimated that 50,000 to 100,000 new 

21 cases of obstetric fistula occur each year, mostly in22 volving women under the age of 20. 

23 (6) Women who suffer from obstetric fistula 

24 may also suffer from social isolation because they 
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1 are often abandoned by their husbands, families, and 

2 employers. 

3 (7) Women who suffer from obstetric fistula 

4 may also suffer severe emotional stress from their 

5 condition and social isolation that is often magnified 

6 by the death of their child during labor. 

7 (8) Obstetric fistula can be prevented through 

8 increased access by women to emergency obstetrical 

9 care, a postponement of sexual activity and child10 bearing past the teenage years, and increased train11 ing for birth attendants in local communities. 

12 (9) Obstetric fistula can also be treated through 

13 a relatively minor surgical procedure that is 90 per14 cent effective and which can cost as little as $150. 

15 (10) A large percentage of women who suffer 

16 from obstetric fistula are unaware that treatment 

17 exists and may spend their entire lives suffering 

18 from this condition needlessly. 

19 (11) Unfortunately, there are few treatment 

20 centers or hospitals with the capacity to treat obstet21 ric fistula in developing countries, particularly coun22 tries in Africa, and demand for services and surgery 

23 far exceed the supply. 

24 (12) Currently the United States Agency for 

25 International Development provides assistance for 
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1 programs that target prevention of obstetric fistula 

2 but not programs that target treatment of obstetric 

3 fistula. 

4 (13) Tens of thousands of women in developing 

5 countries suffering from obstetric fistula could be 

6 successfully treated if adequate resources were de7 voted to this objective. 

8 (b) PURPOSE.—The purpose of this Act is to ensure 

9 that, in addition to the prevention of obstetric fistula, 

10 treatment of obstetric fistula is an important priority of 

11 United States bilateral foreign assistance programs, in12 cluding through— 

13 (1) the establishment and expansion of the ca14 pacity to treat obstetric fistula in developing coun15 tries, including through the provision of surgery and 

16 post-surgery care; and 

17 (2) the reduction of the incidence of obstetric 

18 fistula in developing countries, including through the 

19 conduct of appropriate seminars and the dissemina20 tion of appropriate educational materials, such as 

21 brochures, pamphlets, and posters. 

22 SEC. 3. DEFINITION. 

23 In this Act, the term ‘‘obstetric fistula’’ means a rup24 ture or hole in tissues surround a woman’s vagina, blad25 der, or rectum that occurs when the woman is in ob-
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1 structed childbirth for a prolonged period of time without 

2 adequate medical attention. 

3 SEC. 4. AMENDMENTS TO THE FOREIGN ASSISTANCE ACT 

4 OF 1961. 

5 Section 104(c) of the Foreign Assistance Act of 1961 

6 (22 U.S.C. 2151b(c)) is amended— 

7 (1) by redesignating paragraph (4) as para8 graph (5); and 

9 (2) by inserting after paragraph (3) the fol10 lowing new paragraph: 

11 ‘‘(4)(A) In carrying out the purposes of this sub12 section, the President is authorized to furnish assistance, 

13 on such terms and conditions as the President may deter14 mine, for the establishment and operation of not less than 

15 twelve centers for the treatment of obstetric fistula at ap16 propriate sites in developing countries. 

17 ‘‘(B) In selecting sites for the establishment of cen18 ters pursuant to subparagraph (A), the President should 

19 seek the consultation and advice of United States embassy 

20 officials, appropriate nongovernmental organizations, and 

21 local government officials in developing countries with 

22 high rates of obstetric fistula, with particular emphasis on 

23 countries in Africa. 
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1 ‘‘(C) Each center established pursuant to subpara2 graph (A) shall, to the maximum extent practicable, carry 

3 out the following activities: 

4 ‘‘(i) The provision of surgery to repair obstetric 

5 fistula in women who do not otherwise have the re6 sources to pay for such surgery and the provision of 

7 necessary post-surgery care and support for such 

8 women. 

9 ‘‘(ii) Assistance related to surgery and post-sur10 gery care and support described in clause (i), includ11 ing the provision of transportation to and from the 

12 center for women in need of such transportation and 

13 the provision of necessary temporary shelter and 

14 food assistance to women in need of such shelter and 

15 food assistance. 

16 ‘‘(iii) Activities to reduce the incidence of ob17 stetric fistula, including the conduct of appropriate 

18 seminars and the dissemination of appropriate edu19 cational materials, such as brochures, pamphlets, 

20 and posters. 

21 ‘‘(D) Not later than January 31 of each year, the 

22 President shall prepare and transmit to Congress a report 

23 on the implementation of this paragraph for the prior fis24 cal year. 
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1 ‘‘(E) In addition to amounts otherwise available for 

2 such purpose, there are authorized to be appropriated to 

3 the President $35,000,000 for each of the fiscal years 

4 2005 and 2006 to carry out this paragraph. Amounts ap5 propriated under this clause are authorized to remain 

6 available until expended. 

7 ‘‘(F) In this paragraph, the term ‘obstetric fistula’ 

8 means a rupture or hole in tissues surrounding a woman’s 

9 vagina, bladder, or rectum that occurs when the woman 

10 is in obstructed childbirth for a prolonged period of time 

11 without adequate medical attention.’’. 

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