I

103D CONGRESS

1ST SESSION H. R. 2501

To assist in implementing the Plan of Action adopted by the World Summit

for Children.

IN THE HOUSE OF REPRESENTATIVES

JUNE 23, 1993

Mr. HALL of Ohio (for himself, Mr. WALSH, Mrs. KENNELLY, Mr. MCCOLLUM, Mr. MCDERMOTT, Mr. SCHIFF, Mr. SYNAR, Mr. COYNE, Mrs.

SCHROEDER, Mr. JACOBS, Mr. BEILENSON, Ms. NORTON, Mr. RAVENEL,

Mr. BACCHUS of Florida, Mr. DEUTSCH, Mr. SANDERS, Ms. BYRNE, Mr.

FILNER, and Mr. PASTOR) introduced the following bill; which was referred jointly to the Committees on Education and Labor, Foreign Affairs, and Banking, Finance and Urban Affairs

A BILL

To assist in implementing the Plan of Action adopted by

the World Summit for Children.

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 ‘‘World Summit for

5 Children Implementation Act of 1993’’.

6 SEC. 2. FINDINGS AND PURPOSES.

7 (a) FINDINGS.—The Congress finds the following:
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1 (1) The United Nations Children’s Fund

2 (UNICEF) estimates that 35,000 children die each

3 day from malnutrition and preventable disease.

4 (2) The World Summit for Children held in

5 1990, the largest gathering of heads of state and

6 heads of government up until that time, united the

7 world in a commitment to protect the lives of chil8 dren, diminish their suffering, and enhance their

9 futures.

10 (3) This commitment is reflected in specific

11 goals that require international cooperation and the

12 commitment of all nations, goals which were incor13 porated in Agenda 21 at the 1992 Earth Summit

14 and which were also endorsed in the World Declara15 tion on Nutrition adopted at the 1992 International

16 Conference on Nutrition. The World Summit for

17 Children goals include cutting child deaths by at

least 1 18 ⁄3, halving maternal mortality and child mal19 nutrition, providing all children access to a basic

20 education, and providing all families access to clean

21 water, safe sanitation, and family planning services.

22 (4) The United Nations Children’s Fund esti23 mates that these goals could be implemented by the

24 year 2000 with a global commitment of just

25 $25,000,000,000 annually, to be achieved through
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1 reallocation of resources to increase the proportion

2 of resources going to meet basic human needs, with

2 3 ⁄3 of those resources coming from the developing

nations themselves and 1 4 ⁄3 from the industrialized

5 nations.

6 (5) The United Nations Children’s Fund esti7 mates that currently only 10 percent of developing

8 country budgets and less than 10 percent of all

9 international assistance for development is devoted

10 to meeting basic human needs.

11 (6) If that proportion were doubled to just 20

12 percent, through reallocation of current resources

13 and without requiring additional resources, this

14 would provide the additional $25,000,000,000 the

15 United Nations Children’s Fund estimates is re16 quired annually to achieve by the year 2000 the

17 goals of the World Summit for Children.

18 (7) The United States Government participated

19 in the World Summit for Children and signed the

20 Declaration and Plan of Action adopted at that

21 Summit.

22 (8) Participants in the Summit committed

23 themselves and their governments—
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1 (A) to prepare, before the end of 1991, na2 tional programs of action to help implement the

3 goals and objectives of the Summit, and

4 (B) to take steps to ensure that child sur5 vival, protection, and development programs will

6 have a priority in the allocation of resources.

7 (9) The United States Government should im8 plement a plan of action to fulfill its commitment to

9 children, both at home and abroad.

10 (b) PURPOSES.—The purposes of this Act are—

11 (1) to help fulfill the commitment of the United

12 States Government to children; and

13 (2) to provide the necessary authorities to im14 plement the United States plan of action.

15 SEC. 3. SPECIAL SUPPLEMENTAL FOOD PROGRAM FOR

16 WOMEN, INFANTS, AND CHILDREN (WIC).

17 (a) FINDINGS.—The Congress finds the following:

18 (1) In 1990, the Surgeon General and the Unit19 ed States Public Health Service announced Healthy

20 People 2000 goals for America’s children. These

21 goals include reducing the United States infant mor22 tality rate and the incidence of low birthweight by

1 23 ⁄3 by the year 2000, as well as the initiation of

24 breastfeeding by 75 percent of mothers and the con-
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1 tinuation of breastfeeding at 6 months postpartum

2 by 50 percent of mothers.

3 (2) The special supplemental food program for

4 women, infants, and children authorized under sec5 tion 17 of the Child Nutrition Act of 1966 (in this

6 section referred to as the ‘‘WIC Program’’) is in7 tended to benefit low-income women at risk of deliv8 ering low birthweight babies, low-income infants and

9 children at risk of malnutrition, and low-income

10 nursing mothers.

11 (3) It has been demonstrated that participation

12 in the WIC Program reduces, in a cost-effective

13 manner, the number of premature births and the

14 percentage of infants born at low birthweight, a

15 major cause of infant mortality and developmental

16 disabilities, and decreases the prevalence of iron de17 ficiency anemia in children, and improves children’s

18 cognitive development.

19 (4) Increasing the rate of breastfeeding among

20 mothers participating in the WIC Program would re21 sult in greater improvements in the health of infants

22 and mothers, further reductions in infant mortality,

23 and decreases in health care costs and infant for24 mula expenditures.
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1 (5) Particular attention needs to be given to

2 promoting breastfeeding within the WIC Program

3 through activities which include support of peer

4 counselors working through the WIC Program, utili5 zation of lactation consultants in WIC Program clin6 ics and in hospitals, and training of health profes7 sionals in lactation management and development of

8 education materials.

9 (6) The WIC Program currently serves 58 per10 cent of the eligible population and actions need to be

11 taken to move toward service to the entire eligible

12 population.

13 (b) FULL PARTICIPATION IN THE WIC PROGRAM.—

14 It is the sense of the Congress that—

15 (1) the United States Government should make

16 a commitment to achieving full participation in the

17 WIC Program by fiscal year 1996; and

18 (2) in order to reach the goal of full participa19 tion, not less than $3,287,000,000 for fiscal year

20 1994 and not less than $3,564,000,000 for the fiscal

21 year 1995 should be appropriated to carry out the

22 WIC Program.

23 SEC. 4. PROGRAMS UNDER THE HEAD START ACT.

24 (a) FINDINGS.—The Congress finds the following:
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1 (1) In 1990, the President and the Governors

2 of the 50 States met at the Education Summit and

3 set United States education goals for the year 2000,

4 including the goal that all children start school ready

5 to learn.

6 (2) Since their inception in 1964, programs

7 under the Head Start Act have established an im8 pressive record in providing preschool-age children

9 from low-income families with comprehensive serv10 ices to address educational, social, nutritional, and

11 health needs.

(3) Head Start programs serve only about 1 12 ⁄3 of

13 eligible children between 3 and 5 years of age.

14 (b) FULL FUNDING FOR THE HEAD START ACT.—

15 It is the sense of the Congress that—

16 (1) the Federal Government should make a

17 commitment to achieving full participation of all eli18 gible 3- and 4-year-old children in Head Start pro19 grams by the fiscal year 1999, and

20 (2) in order to reach the goal of such full par21 ticipation, not less than $4,150,000,000 for the fis22 cal year 1994, and not less than $4,970,000,000 for

23 the fiscal year 1995, should be appropriated to carry

24 out the Head Start Act.
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1 SEC. 5. INTERNATIONAL INFANT AND CHILD MORTALITY.

2 (a) FINDINGS.—The Congress finds the following:

3 (1) During the last decade the international

4 campaign to save the lives of children has resulted

5 in dramatic increases in the adoption of low-cost

6 measures to save children’s lives, such as immuniza7 tions and oral rehydration therapy.

8 (2) In September 1991, the United Nations

9 Children’s Fund and the World Health Organization

10 were able to report that the goal of 80 percent child11 hood immunization had been achieved, saving over

12 12,000,000 young lives during the last decade and

13 continuing to save over 3,000,000 children’s lives

14 each year.

15 (3) The Plan of Action adopted by the World

16 Summit for Children calls for the reduction of

under-5 mortality rates by at least 1 17 ⁄3 by the year

18 2000.

19 (4) Such progress is possible by consolidating

20 gains already made, and by pursuing new goals and

21 effective programs in such areas as measles,

22 neonatal tetanus, poliomyelitis, and acute respiratory

23 infections.

24 (5) Efforts should focus on the delivery of com25 munity-based primary health care and health edu26 cation services which directly benefit the poorest of
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1 the poor, with an emphasis toward small scale

2 projects rather than large scale infrastructure

3 projects. Such assistance should be provided through

4 private and voluntary organizations and inter5 national organizations whenever possible.

6 (6) Both the United Nations Children’s Fund

7 and the United States Agency for International De8 velopment have provided strong leadership as well as

9 financial and technical support for these goals.

10 (b) CONTRIBUTIONS TO UNICEF.—To carry out sec11 tion 301 of the Foreign Assistance Act of 1961 (22 U.S.C.

12 2221; relating to voluntary contributions to international

13 organizations and programs), there are authorized to be

14 appropriated $115,000,000 for fiscal year 1994 and

15 $130,000,000 for fiscal year 1995 for contributions to the

16 United Nations Children’s Fund for activities to promote

17 child health and other assistance programs on behalf of

18 children.

19 (c) CHILD SURVIVAL ACTIVITIES.—Section 104(c)(2)

20 of the Foreign Assistance Act of 1961 (22 U.S.C.

21 2151b(c)(2); relating to the Child Survival Fund) is

22 amended—

23 (1) in subparagraph (B), by striking out

24 ‘‘$25,000,000 for fiscal year 1986 and $75,000,000

25 for fiscal year 1987’’ and inserting in lieu thereof
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1 ‘‘$150,000,000 for fiscal year 1994 and

2 $210,000,000 for fiscal year 1995’’; and

3 (2) by inserting after subparagraph (C) the

4 following:

5 ‘‘(D) Of the aggregate of the amounts made available

6 to carry out subparagraph (B) of this paragraph, sections

7 103(a) and section 106 of this chapter, chapter 10 of this

8 part, and chapter 4 of part II and for the Multilateral

9 Assistance Initiative for the Philippines, not less than

10 $405,000,000 for fiscal year 1994 and not less than

11 $490,000,000 for fiscal year 1995 shall be available only

12 for activities described in subparagraph (A), with a par13 ticular emphasis on delivery of community-based primary

14 health care and health education services which benefit the

15 poorest of the poor. Such assistance shall be provided

16 through private and voluntary organizations and inter17 national organizations whenever possible.’’.

18 SEC. 6. GLOBAL MALNUTRITION.

19 (a) FINDINGS.—The Congress finds the following:

20 (1) Malnutrition (including protein-calorie mal21 nutrition and micronutrient deficiencies), which is

22 currently the underlying cause of death in the vast

23 majority of childhood diseases, is preventable at low

24 cost.
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1 (2) Vitamin A deficiency remains a scourge of

2 children in developing countries. If access to vitamin

3 A is not increased, an estimated 2,000,000 children

4 face blindness in the 1990s and tens of millions

5 more face increased risk of infection and death. Vi6 tamin A intake has been associated with significant

7 reductions in infant mortality rates.

8 (3) One billion people are at risk of iodine defi9 ciency disease, with the very young being most vul10 nerable. Iodine deficiency is a major cause of mental

11 retardation worldwide.

12 (4) Two billion people suffer from some degree

13 of iron deficiency anemia, particularly women of

14 childbearing age and young children.

15 (5) The Plan of Action adopted at the World

16 Summit for Children calls for halving severe and

17 moderate malnutrition among children under 5 years

18 of age by the year 2000, for the virtual elimination

19 of vitamin A deficiency and iodine deficiency dis20 orders by the year 2000, and for the reduction of

21 iron deficiency anemia among women of childbearing

age by 1 22 ⁄3 of the 1990 levels.

23 (6) The Congress has already undertaken sub24 stantial action to address this problem in the Food,

25 Agriculture, Conservation, and Trade Act of 1990,
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1 which established food security for the poorest and

2 the prevention of malnutrition as priorities in food

3 assistance programs administered by the Agency for

4 International Development under the Agriculture

5 Trade Development and Assistance Act of 1954.

6 (7) Child survival activities are also key to re7 ducing child malnutrition and must be pursued in

8 conjunction with efforts to ensure food security.

9 (8) Section 411 of the Agricultural Trade De10 velopment and Assistance Act of 1954 (7 U.S.C.

11 1736e), as amended by the Food, Agriculture, Con12 servation, and Trade Act of 1990, authorizes the

13 forgiveness of Public Law 480 debt owed by least

14 developed countries that are pursuing national eco15 nomic policy reforms that would promote long-term

16 economic development, but the exercise of that au17 thority requires further action by the Congress in an

18 appropriations Act.

19 (b) PUBLIC LAW 480 DEBT AUTHORITY.—It is the

20 sense of the Congress that authority, in such amounts as

21 may be required, should be granted to the President in

22 an appropriations Act to exercise the debt authority with

23 respect to least developed countries that is provided in sec24 tion 411 of the Agricultural Trade Development and As25 sistance Act of 1954.
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1 (c) VITAMIN A DEFICIENCY PROGRAM.—Section 103

2 of the Foreign Assistance Act of 1961 (22 U.S.C. 2151a;

3 relating to development assistance for agriculture, rural

4 development, and nutrition) is amended by adding at the

5 end the following new subsection:

6 ‘‘(h) VITAMIN A DEFICIENCY PROGRAM.—(1) The

7 Congress finds that—

8 ‘‘(A) vitamin A deficiency is a major cause of

9 childhood mortality;

10 ‘‘(B) vitamin A intervention programs are inex11 pensive, practical to administer, and cost-effective in

12 terms of human productivity; and

13 ‘‘(C) the Agency for International Development

14 is already implementing a Vitamin A Deficiency

15 Program.

16 ‘‘(2) Of the amounts made available to carry out this

17 section, not less than $28,000,000 for fiscal year 1994

18 and not less than $42,000,000 for fiscal year 1995 shall

19 be available only for Vitamin A supplementation and for20 tification through the Vitamin A Deficiency Program.’’.

21 (d) OTHER MICRONUTRIENT DEFICIENCIES.—In ad22 dition to amounts otherwise available for such programs,

23 there are authorized to be appropriated $22,000,000 for

24 fiscal year 1994 and $33,000,000 for fiscal year 1995 for

25 iodine and iron fortification programs, and for iron
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1 supplementation programs for pregnant women, under

2 part I of the Foreign Assistance Act of 1961.

3 SEC. 7. MATERNAL AND CHILD MORTALITY RESULTING

4 FROM AIDS.

5 (a) FINDINGS.—The Congress finds the following:

6 (1) As of 1992, nearly 5,000,000 women of

7 childbearing age and over 1,000,000 children were

8 infected with the human immunodeficiency virus

9 (HIV), the virus that causes the acquired immune

10 deficiency syndrome (AIDS). The vast majority of

11 these women and children live in developing coun12 tries.

13 (2) The maternal and child mortality rate in

14 many developing countries will increase dramatically,

15 as will the number of orphans infected with the

16 human immunodeficiency virus, until prevention and

17 control efforts are successful.

18 (3) The most effective efforts to respond to the

19 human immunodeficiency virus and acquired im20 mune deficiency syndrome are based at the commu21 nity level and involve nongovernmental organizations

22 as well as government agencies.

23 (4) The Agency for International Development

24 should expand its assistance to developing countries

25 for community-based prevention, care, and control
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1 programs and activities relating to the human

2 immunodeficiency virus and acquired immune defi3 ciency syndrome, and should participate in coordi4 nated efforts with other donors.

5 (5) Coordination of efforts of bilateral, multilat6 eral, and nongovernmental agencies and organiza7 tions is essential.

8 (b) INTERNATIONAL AIDS PREVENTION AND CON9 TROL FUND.—Section 104(c) of the Foreign Assistance

10 Act of 1961 (22 U.S.C. 2151b(c); relating to development

11 assistance for health related activities) is amended by add12 ing at the end the following new paragraph:

13 ‘‘(4)(A) In carrying out this subsection, the President

14 shall promote, encourage, and undertake community-based

15 prevention, care, and control programs and activities relat16 ing to the human immunodeficiency virus (HIV) and ac17 quired immune deficiency syndrome (AIDS) in developing

18 countries, including research as to the effectiveness of

19 such programs and activities.

20 ‘‘(B) There are authorized to be appropriated

21 $100,000,000 for fiscal year 1994 and $120,000,000 for

22 fiscal year 1995 for use in carrying out this paragraph,

23 which shall be in addition to amounts made available

24 under subsection (g) or otherwise available for such pur-
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1 pose. Amounts appropriated under this subparagraph are

2 authorized to remain available until expended.

3 ‘‘(C) Appropriations pursuant to subparagraph (B)

4 may be referred to as the ‘International AIDS Prevention

5 and Control Fund’.’’.

6 SEC. 8. INTERNATIONAL BASIC EDUCATION.

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

8 (1) Primary education, early childhood develop9 ment activities, and programs to achieve literacy, are

10 essential for increasing the productive capacity of

11 people and their ability to earn income.

12 (2) At least 130,000,000 children of primary

school age, 2 13 ⁄3 of them girls, are not enrolled in

14 school. Thirty-four countries have literacy rates of

15 40 percent or less.

16 (3) The share of government resources devoted

17 to education in more than half of the 40 poorest

18 countries in the world has decreased since 1980.

19 (4) The Plan of Action adopted by the World

20 Summit for Children calls for basic education for all

21 children and for completion of primary education by

22 at least 80 percent of all children.

23 (5) United States assistance for basic education

24 in developing countries has accounted for less than
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1 2 percent of all United States foreign assistance in

2 recent years.

3 (b) INTERNATIONAL BASIC EDUCATION.—Section

4 105 of the Foreign Assistance Act of 1961 (22 U.S.C.

5 2151c; relating to development assistance for education

6 and human resource development) is amended by adding

7 at the end the following new subsection:

8 ‘‘(c) BASIC EDUCATION.—Of the aggregate of the

9 amounts made available to carry out this section, chapter

10 10 of this part, and chapter 4 of part II and for the Multi11 lateral Assistance Initiative for the Philippines, not less

12 than $225,000,000 for fiscal year 1994 and not less than

13 $380,000,000 for fiscal year 1995 shall be available only

14 for programs in support of basic education, including early

15 childhood education, primary education, teacher training,

16 and other necessary activities in support of early childhood

17 and primary education, and literacy training for adults.’’.

18 SEC. 9. INTERNATIONAL FAMILY PLANNING AND CHILD

19 SPACING.

20 (a) FINDINGS.—The Congress finds the following:

21 (1) Universal access to voluntary family plan22 ning could save the lives of several million children

23 each year and could significantly improve the health

24 of children throughout the developing world by re-
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1 ducing prematurity and low birthweight and allowing

2 longer breastfeeding.

3 (2) The risk of maternal death or illness in the

4 developing world is highest for women who bear chil5 dren when they are under the age of 18 or over the

6 age of 35, for pregnancies spaced less than 2 years

7 apart, and for women who already have 4 or more

8 children. Universal access to voluntary family planning could prevent up to 1 9 ⁄3 of the 500,000 maternal

10 deaths annually.

11 (3) The inability of couples to plan births de12 creases the quality of women’s lives and undermines

13 their opportunities for education, for earning in14 come, for improving the care of children, and for

15 community activities and personal development.

16 (4) Rapid world population growth, combined

17 with unsustainable patterns of natural resource con18 sumption, has become an urgent economic, social,

19 and environmental problem.

20 (5) Demographic and health surveys indicate

21 that if all women in the developing world who do not

22 wish to become pregnant were empowered to plan

23 the size of their families, then the rate of population

24 growth would fall by approximately 30 percent.
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1 (6) The Plan of Action adopted at the World

2 Summit for Children calls for voluntary family plan3 ning services and education to be made available to

4 all couples to empower them to prevent unwanted

5 pregnancies and births which are ‘‘too many and too

6 close’’ and to women who are ‘‘too young or too

7 old’’.

8 (b) AUTHORIZATIONS OF APPROPRIATIONS.—In ad9 dition to any other amounts made available for such pur10 poses, there are authorized to be appropriated to the

11 President for United States population assistance pro12 grams and activities under part I of the Foreign Assist13 ance Act of 1961 $725,000,000 for fiscal year 1994 and

14 $800,000,000 for fiscal year 1995.

15 SEC. 10. REFUGEES.

16 (a) FINDINGS.—The Congress finds the following:

17 (1) The number of refugees worldwide has

18 grown from 10,000,000 in 1985 to 17,400,000 in

19 1993. In addition, there are estimated to be more

20 than 24,000,000 internally displaced persons. More

21 than half of these refugees and internally displaced

22 persons are children.

23 (2) The dramatic growth in the number of refu24 gees and displaced persons has resulted in serious

25 reductions in legal assistance and protection, health,
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1 nutrition, and basic education services available to

2 them.

3 (3) Refugee children are particularly vulnerable

4 in first asylum camps from Africa to Southeast Asia

5 where they languish without the comfort of a parent

6 or adult guardian.

7 (b) FUNDING FOR REFUGEE ASSISTANCE PRO8 GRAMS.—It is the sense of the Congress that—

9 (1) not less than $760,000,000 for each of fis10 cal years 1994 and 1995 should be appropriated for

11 the ‘‘Migration and Refugee Assistance’’ account, of

12 which not less than $420,000,000 for each fiscal

13 year should be available only for programs of refu14 gee assistance overseas (in addition to the amounts

15 available for programs for refugees from the former

16 Soviet Union, Eastern Europe, and elsewhere who

17 resettle in Israel); and

18 (2) not less than $100,000,000 for each of fis19 cal years 1994 and 1995 should be appropriated for

20 the ‘‘United States Emergency Refugee and Migra21 tion Assistance Fund’’ account.

22 SEC. 11. THE WORLD BANK.

23 (a) INSTRUCTIONS TO U.S. EXECUTIVE DIREC24 TORS.—The Secretary of the Treasury shall instruct the
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1 United States Executive Director of the World Bank to

2 promote vigorously that the World Bank take action—

3 (1) to ensure that poverty reduction and sup4 port of basic human needs become a higher priority

5 within the Bank, specifically through increasing the

6 proportion of International Development Association

7 investments that fall within the program of targeted

8 interventions against poverty to 40 percent of all

9 International Development Association investments

10 by fiscal year 1994 and to at least 50 percent of all

11 International Development Association investments

12 by fiscal year 1995;

13 (2) within the field of water and sanitation, to

14 ensure that the majority of water and sanitation

15 projects fall within the program of targeted interven16 tions against poverty and to increase significantly

17 the proportion of World Bank lending for projects

18 utilizing basic low-cost technologies to provide water

19 and sanitation to underserved poor populations in

20 deprived rural and periurban areas; and

21 (3) to increase the proportion of total World

22 Bank lending which supports primary health care

23 and basic education, with a minimum of 5 percent

24 of total lending devoted to each area.
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1 (b) DEFINITION.—As used in this section the term

2 ‘‘World Bank’’ means the International Bank for Recon3 struction and Development and the International Develop4 ment Association.

5 SEC. 12. EFFORTS BY OTHER COUNTRIES.

6 The President shall call upon the governments of

7 other countries to provide their share of the resources re8 quired to achieve the World Summit for Children goals

9 by the year 2000, specifically through giving highest prior10 ity to increasing the proportion of public expenditures and

11 foreign assistance devoted to priority human needs areas

12 outlined in the Declaration and Plan of Action of the

13 World Summit for Children.

14 SEC. 13. ANNUAL REPORT.

15 (a) REQUIREMENT FOR REPORT.—In order that the

16 Congress and the American people may be fully informed

17 of efforts undertaken by the United States Government

18 to fulfill agreements signed by the United States at the

19 World Summit for Children, the President shall report an20 nually to the Congress on United States contributions to

21 the achievement of the goals of the World Summit for

22 Children. Each such report should include—

23 (1) a discussion of efforts by the United States

24 to achieve those goals both within the United States

25 and in other countries; and
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1 (2) a comparative analysis of current and past

2 funding levels and planned funding levels for the

3 next 2 fiscal years.

4 (b) SUBMISSION DATE.—The reports required by this

5 section shall be submitted to the Congress no later than

6 February 1 of each year.

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