I 
113TH CONGRESS 
1ST SESSION H. R. 3206 
To promote the sexual and reproductive health of individuals and couples 
in developing countries, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 27, 2013 
Ms. CLARKE (for herself, Ms. BASS, Ms. BROWN of Florida, Mr. CLAY, Mr. 
CONYERS, Mrs. DAVIS of California, Mr. ELLISON, Mr. ENYART, Mr. 
GRIJALVA, Ms. NORTON, Mr. HONDA, Mr. HUFFMAN, Ms. JACKSON LEE, 
Mr. JEFFRIES, Ms. LEE of California, Mrs. CAROLYN B. MALONEY of 
New York, Mr. MCGOVERN, Ms. MOORE, Mr. MORAN, Mr. QUIGLEY, Mr. 
RANGEL, Mr. RUSH, Ms. SCHAKOWSKY, Ms. SLAUGHTER, Ms. 
WASSERMAN SCHULTZ, Ms. WATERS, and Mr. BERA of California) intro-
duced the following bill; which was referred to the Committee on Foreign 
Affairs 
A BILL 
To promote the sexual and reproductive health of individuals 
and couples in developing countries, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Global Sexual and Re-
productive Health Act of 2013’’. 
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SEC. 2. FINDINGS AND PURPOSES. 
(a) FINDINGS.—Congress makes the following find-
ings: 
(1) The advancement of sexual and reproduc-
tive health is central to the global development agen-
da and necessary to meeting most of the eight 
United Nations Millennium Development Goals 
(MDGs), the current international development 
framework developed by 189 countries, including the 
United States. Target 5B, which is found under 
MDG 5 on improving maternal health and which re-
quires achieving universal access to reproductive 
health, is an essential element in attaining MDGs 
related to eradicating poverty (MDG 1), achieving 
universal education (MDG 2), promoting gender 
equality (MDG 3), reducing child mortality (MDG 
4), improving maternal health (MDG 5), combating 
HIV/AIDS (MDG 6), and ensuring environmental 
sustainability (MDG 7). Furthermore, advancement 
of sexual and reproductive health and rights will be 
critical in building on the achievements of the MDGs 
when they expire in 2015 and realizing the core 
goals of poverty reduction and sustainable develop-
ment in the post-2015 development agenda. 
(2) The resolution of the 2013 United Nations 
Commission 
on 
Population 
and 
Development 
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‘‘recognize[es] that . . . sexual and reproductive 
health and reproductive rights . . . as well as . . . 
population and development, education and gender 
equality, are integrally linked to global efforts to 
eradicate poverty and achieve sustainable develop-
ment . . . .’’. 
(3) Throughout much of the world, the lack of 
access of women, particularly poor women, to basic 
reproductive health services and information contrib-
utes to death and suffering among women and their 
families, undermines women’s struggle for self-deter-
mination, and vitiates the efforts of families to lift 
themselves out of the poverty in which over a billion 
of the world’s people live. By allowing individuals 
and couples to choose the number and timing of 
their children, reproductive health care gives families 
and individuals greater control over their economic 
resources. 
(4) Aspects of sexual and reproductive health, 
including maternal mortality and morbidity, repro-
ductive cancers, and sexually transmitted infections 
(STIs), including HIV, account for nearly 20 per-
cent of the global burden of ill-health for women and 
some 14 percent for men, according to the World 
Health Organization (WHO). 
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(5) According to the Joint United Nations Pro-
gramme on HIV/AIDS (UNAIDS), HIV/AIDS is 
the leading cause of death among women of child-
bearing age. 
(6) School-based education and family planning 
play an interrelated role in lifting the status of 
women. Delaying sexual debut, along with contracep-
tive use among young women already sexually active, 
lowers the likelihood that young women will leave 
their schooling due to pregnancy, and education in-
creases the chances that young women will delay the 
age at which they marry and give birth. 
(7) Sexual and reproductive health programs 
can empower women to make informed decisions and 
better control their lives, and by engaging men and 
boys in taking responsibility for the sexual and re-
productive health of their partners, can contribute to 
greater gender equality. 
(8) Access to sexual and reproductive health 
services, including family planning, has a direct and 
important impact on infant and child mortality. By 
allowing women to choose the timing, number, and 
spacing of their pregnancies, high-risk births are 
averted, and the children that are born have a great-
er chance of surviving to adulthood. Over 3,000,000 
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newborns die in the first 4 weeks of life, which ac-
counts for nearly 40 percent of all deaths of children 
under the age of 5. By providing women family plan-
ning services to space their births 3 years apart, 
rates for under-5 mortality would drop by 25 per-
cent, averting 1,800,000 children’s deaths each year. 
(9) Increasing access to sexual and reproductive 
health could significantly decrease pregnancy-related 
mortality and morbidity by reducing the number of 
pregnancies that place women at increased risk of 
experiencing such complications. 
(10) An estimated 222,000,000 women in devel-
oping countries have an unmet need for effective, 
modern contraceptives and would like to postpone 
childbearing, space births, or want no more children 
but are not using a modern method of contraception. 
Providing modern contraceptives to fill this unmet 
need would avert an estimated additional 54,000,000 
unintended 
pregnancies 
each 
year, 
including 
21,000,000 unplanned births and 26,000,000 abor-
tions, 16,000,000 of which would be unsafe. In turn, 
this would prevent 79,000 maternal deaths and 
1,100,000 infant deaths. 
(11) Complications due to pregnancy and child-
birth are a leading cause of death among adolescent 
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females ages 15 to 19 in low- and middle-income 
countries. Each year, an estimated 287,000 women 
worldwide die from complications related to preg-
nancy, childbirth, or unsafe abortion. 
(12) Unsafe abortion accounts for 13 percent of 
maternal deaths worldwide. More than half of abor-
tions (56 percent) in the developing world are un-
safe. Of the 22,000,000 unsafe abortions that take 
place each year, nearly all occur in the developing 
world. Around 47,000 women die and millions more 
suffer serious injuries from the complications of 
unsafely performed abortions. Abortion rates are 
similar in countries whether abortion is illegal or 
legal, with evidence suggesting abortion rates may in 
fact be higher in countries where it is illegal. Re-
gardless, death and injury from unsafe abortion is 
greatly reduced where abortion is legal for a broad 
range of indications and where safe abortion is ac-
cessible. 
(13) Meeting the need for family planning serv-
ices and pregnancy-related care, by doubling the cur-
rent global investment for both, would prevent mil-
lions of needless cases of maternal and newborn 
deaths and disabilities. 
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(14) Worldwide, women of childbearing age ac-
count for more than half of people living with HIV/ 
AIDS. Integrating reproductive health services, in-
cluding family planning, with HIV prevention pro-
grams, such as those for voluntary counseling and 
testing and prevention of mother-to-child trans-
mission, is essential to effectively combating HIV/ 
AIDS and other STIs. 
(15) The world is witnessing the largest genera-
tion of young people in history—almost half of the 
world’s population, approximately 3,000,000,000 
people, are under the age of 25. Unmet need for sex-
ual and reproductive health services is highest 
among this age cohort. Fewer than 5 percent of the 
poorest sexually active youth use modern contracep-
tion. 
(16) The WHO has identified unsafe sex as the 
second most important risk factor for disability and 
death among young people in the world’s poorest 
communities. Forty percent of all new adult HIV in-
fections occur among young people ages 15–24. 
(17) Sixty percent of unsafe abortions in Afri-
ca, 42 percent in Latin America and the Caribbean, 
and 30 percent in Asia are undergone by women 
under the age of 25. 
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(18) The WHO has identified a 4-pronged ap-
proach to preventing HIV infection in infants, which 
includes prevention of unintended pregnancy among 
HIV-infected women as a key strategy to prevent 
mother-to-child transmission of HIV. 
(19) According to the World Health Organiza-
tion, enabling HIV-positive women who want to 
avoid a pregnancy access to contraceptive services 
can prevent as many as 160,000 additional HIV- 
positive births each year in high HIV prevalence 
countries. 
(20) Demographic factors exacerbate problems 
related to environmental sustainability. The past 
century of population growth has put increasing 
pressure on natural resources as the scale of human 
needs and activities expands. At the same time, ac-
tual family size in most developing countries remains 
greater than the desired family size. Access to family 
planning services helps couples to determine their 
own family size, hence mitigating the depletion of 
natural resources like clean water, air, and land. 
(21) Practices like early and forced marriage, 
female genital mutilation/cutting, and early sexual 
debut adversely impact the sexual and reproductive 
health of young people in many developing countries, 
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and strong barriers exist to providing the informa-
tion, services, and other forms of support that young 
people need to lead healthy sexual and reproductive 
lives. 
(22) Comprehensive sexuality education seeks 
to help young people develop the interpersonal skills 
necessary for the formation of caring, supportive, 
and noncoercive relationships and the ability to exer-
cise responsibility regarding sexual relationships by 
addressing such issues as abstinence and the use of 
condoms, contraceptives, and other protective sexual 
health measures. 
(23) The United Nations has estimated that the 
minimum financial requirements for sexual and re-
productive health, including family planning and ma-
ternal health, are roughly $32,700,000,000 in 2013 
and increase to approximately $33,000,000,000 in 
2015. The minimum financial requirement for HIV/ 
AIDS is estimated at $34,700,000,000 in 2013, and 
increases to $36,200,000,000 in 2015. As agreed in 
the International Conference on Population and De-
velopment’s Programme of Action, which the United 
States committed to, developed-country donors are 
responsible for one-third of the total cost needed per 
year. Developing countries are responsible for the re-
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maining two-thirds, on average, with low income 
countries requiring a larger share of external fund-
ing. 
(24) The United States has had a history of 
supporting and recognizing the fundamental health 
and human rights of all people through the signing 
or ratifying of various international agreements. 
Those agreements include the Universal Declaration 
of Human Rights (1948), the International Cov-
enant on Civil and Political Rights (1966), the 
International Covenant on Economic, Social, and 
Cultural Rights (1966), the Convention on the 
Elimination of All Forms of Discrimination Against 
Women (1979), the Convention on the Rights of the 
Child (1989), the International Conference on Popu-
lation and Development Programme of Action 
(1994), the United Nations Millennium Development 
Goals (2000), and the Convention on the Rights of 
Persons with Disabilities (2009). 
(25) The United States has been the largest 
donor to international family planning and reproduc-
tive health efforts over the last 40 years and has 
been an unparalleled source of leadership and inno-
vation in the field. Nonetheless, it has not met its 
fair share of financial assistance to global sexual and 
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reproductive health programs. Now is the time to 
shore up the United States political and financial 
commitment in order to satisfy the large unmet need 
for these services, thereby helping to improve wom-
en’s and young people’s sexual and reproductive 
health worldwide. 
(b) PURPOSES.—The purposes of this Act are to— 
(1) authorize assistance to improve the sexual 
and reproductive health of individuals and couples in 
developing countries; and 
(2) implement comprehensive sexual and repro-
ductive health programs offering a continuum of 
care that are responsive to the sexual and reproduc-
tive health needs of young people and adults. 
SEC. 3. STATEMENT OF POLICY. 
The following shall be the policy of the United States 
Government: 
(1) All individuals and couples shall have the 
basic reproductive right to decide freely and respon-
sibly the number, spacing, and timing of their chil-
dren and shall have the information and means to 
do so, and the right to attain the highest standard 
of sexual and reproductive health. 
(2) All individuals and couples also shall have 
the right to make decisions concerning reproduction 
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free of discrimination, coercion, and violence, as ex-
pressed in human rights documents. 
(3) The promotion of the responsible exercise of 
these reproductive rights for all people shall be the 
fundamental basis for sexual and reproductive health 
programs supported by United States Government 
assistance. 
(4) The principle of free and informed consent 
must underlie all sexual and reproductive health pro-
grams and services. This principle applies to individ-
uals whether they choose to continue or terminate 
their pregnancies—thus, forced pregnancies as well 
as forced abortions or sterilizations are prohibited. 
Decisions relating to contraceptive use should be 
made on an informed and voluntary basis after ade-
quate information, counseling, and services are pro-
vided on a range of methods. 
(5) Incentives and disincentives should not be 
used in family planning programs in order to meet 
numerical population targets or quotas for fertility 
goals. Instead, governments should use other indica-
tors, such as unmet needs, to define family planning 
goals. 
(6) In sexual and reproductive health programs 
funded by the United States Government, special at-
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tention should be paid to serving the needs of young 
people. 
SEC. 4. ASSISTANCE TO SUPPORT THE ACHIEVEMENT OF 
UNIVERSAL ACCESS TO SEXUAL AND REPRO-
DUCTIVE HEALTH. 
(a) ASSISTANCE AUTHORIZED.—The President is au-
thorized to provide assistance in order to support the 
achievement of universal access to sexual and reproductive 
health in developing countries and to ensure individuals 
and couples in developing countries can freely and respon-
sibly determine the number, timing, and spacing of their 
children and have the means to do so. 
(b) ACTIVITIES SUPPORTED.—Assistance provided 
under subsection (a) may be used to— 
(1) expand access to and use of voluntary fam-
ily planning information and services, to enable indi-
viduals and couples to avoid unintended pregnancies 
and other risks to sexual and reproductive health, 
including those associated with pregnancy, reproduc-
tive tract infections, and sexually transmitted infec-
tions (STIs), including HIV; 
(2) improve public knowledge of contraceptives, 
including where methods may be obtained, and risk- 
reduction strategies, and to promote the benefits of 
family planning and other sexual and reproductive 
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health care to individuals, families, and commu-
nities, including through the use of education and 
awareness programs, mass media, and community 
mobilization and outreach; 
(3) increase the responsiveness of sexual and 
reproductive health programs to the needs of the in-
tended beneficiaries during the entirety of their sex-
ual and reproductive lives, including young people 
and older adults; 
(4) reduce the incidence of unsafe abortion, in-
cluding research on the health consequences of un-
safe abortion, and provide for the equipment and 
training necessary for medical treatment of the con-
sequences of unsafe abortions; 
(5) notwithstanding any other provision of law, 
provide safe abortion, to the extent permitted by the 
laws of the recipient country; 
(6) promote the integration of family planning 
services in HIV and other STI prevention, treat-
ment, care, and support; 
(7) integrate family planning services with ma-
ternal and newborn health care, especially in 
antenatal, post-partum, and post-abortion care set-
tings; 
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(8) ensure the consistent availability and af-
fordability of high-quality sexual and reproductive 
health supplies and services, including male and fe-
male condoms, for the prevention of HIV and other 
STIs; 
(9) encourage the abandonment of female gen-
ital mutilation, early marriage, early childbearing, 
and other harmful traditional practices that have 
negative reproductive health consequences; 
(10) prevent and repair obstetric fistula; 
(11) promote the constructive engagement of 
men and boys, the empowerment of women and 
girls, and more equitable gender norms in order to 
improve health outcomes and support the adoption 
of healthy reproductive behaviors; 
(12) prevent and mitigate gender-based vio-
lence; 
(13) provide comprehensive sexuality education 
for young people; 
(14) prevent, diagnose, and treat, where appro-
priate, infertility and cancers of the reproductive 
system and refer as appropriate; 
(15) develop improved methods of safe and ef-
fective contraception and related disease control 
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through investments in biomedical research, with 
particular emphasis on methods which— 
(A) are likely to be safer, easier to use, 
more efficient to make available in developing 
country settings, and less expensive than cur-
rent methods; 
(B) are controlled by women, including 
barrier methods and microbicides; 
(C) are likely to prevent the spread of 
STIs; and 
(D) encourage and enable men to take 
greater responsibility for their own fertility and 
the protection of their partner; 
(16) support an enabling environment for 
women to access sexual and reproductive health care 
services by working with communities to identify and 
lower or remove barriers to access, including finan-
cial, gender, sociocultural, and transportation bar-
riers; 
(17) train health care professionals on edu-
cating individuals, including young people, about 
their sexual and reproductive health care options, in-
cluding family planning options; and 
(18) foster conditions to create favorable policy 
environments, improve quality, strengthen systems, 
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and contribute to the sustainability of family plan-
ning and other reproductive health programs. 
SEC. 5. ASSISTANCE TO REDUCE THE INCIDENCE OF UN-
SAFE ABORTION AND ITS CONSEQUENCES. 
(a) ASSISTANCE AUTHORIZED.—The President is au-
thorized to provide assistance to reduce the incidence of 
unsafe abortion in developing countries and provide care 
for women experiencing injury or illness from complica-
tions of unsafe abortion in developing countries. 
(b) ACTIVITIES SUPPORTED.—Assistance provided 
under subsection (a) shall be used to— 
(1) ensure access to family planning services to 
prevent unintended pregnancies; 
(2) ensure that women who experience an unin-
tended pregnancy have access to reliable information 
and compassionate counseling on all of their options, 
including access to antenatal care and safe abortion 
when permitted by the laws of the recipient country; 
(3) where local laws permit abortion, support 
safe abortion services, including referrals, and sup-
port the training of abortion providers and the nec-
essary equipment and commodities for surgical and 
medical abortion; and 
(4) support emergency treatment for complica-
tions of induced or spontaneous abortion, including 
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provision of services and training and equipping of 
providers. 
(c) ELIGIBILITY FOR ASSISTANCE.—Notwithstanding 
any other provision of law, regulation, or policy, in deter-
mining eligibility for assistance authorized under this sec-
tion, sections 104, 104A, 104B, and 104C of the Foreign 
Assistance Act of 1961 (22 U.S.C. 2151b, 2151b–2, 
2151b–3, and 2151b–4), foreign nongovernmental organi-
zations— 
(1) shall not be ineligible for such assistance 
solely on the basis of health or medical services, in-
cluding counseling and referral services, provided by 
such organizations with non-United States Govern-
ment funds if such services are permitted in the 
country in which they are being provided and would 
not violate United States Federal law if provided in 
the United States; and 
(2) shall not be subject to requirements relating 
to the use of non-United States Government funds 
for advocacy and lobbying activities other than those 
that apply to United States nongovernmental organi-
zations receiving assistance under part I of the For-
eign Assistance Act of 1961. 
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SEC. 6. ASSISTANCE TO PROVIDE SEXUAL AND REPRODUC-
TIVE 
HEALTH 
SERVICES 
DURING 
EMER-
GENCY SITUATIONS. 
(a) ASSISTANCE AUTHORIZED.—The President is au-
thorized to provide assistance, including through inter-
national organizations, national governments, and inter-
national and local nongovernmental organizations, to en-
sure that sexual and reproductive health services are pro-
vided in developing countries at every phase of a humani-
tarian emergency, including early recovery. 
(b) PRIORITY.—In providing assistance authorized 
under subsection (a), the President shall give priority to— 
(1) those reproductive health services that are 
essential in emergencies, whether they are conflict or 
natural disaster settings, to save lives and help sur-
vivors fulfill their potential even under the most dif-
ficult circumstances; and 
(2) building local capacity and improving na-
tional systems whenever possible during displace-
ment and early recovery. 
(c) ACTIVITIES SUPPORTED.—Assistance provided 
under subsection (a) shall be used to— 
(1) direct the Secretary of State and the Ad-
ministrator of the United States Agency for Inter-
national Development to implement the Minimum 
Initial Services Package (MISP), a set of life-saving 
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priority activities that must be put in place in the 
earliest days of an emergency and that is set out in 
the Sphere Project’s Humanitarian Charter and 
Minimum Standards in Disaster Response; 
(2) among other activities, establish critical re-
productive health coordination mechanisms, prevent 
sexual violence and assist survivors by providing es-
sential medical care including psychosocial services, 
prevent transmission of HIV and other sexually 
transmitted infections (STIs), ensure access to 
emergency obstetric and newborn care, to contracep-
tive methods, and to treatment of STIs, continue 
antiretroviral treatment, and lay the groundwork for 
comprehensive reproductive health care; and 
(3) as soon as conditions permit, ensure that 
comprehensive reproductive health care programs, 
including comprehensive family planning, are put in 
place for the duration of displacement and are main-
tained as the relief phase ends and communities 
transition to early recovery. 
(d) COORDINATION.—Assistance authorized under 
subsection (a) shall be coordinated in terms of policy, 
practice, and funding across and within relevant United 
States Government departments and agencies involved in 
emergency situations. 
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SEC. 7. ASSISTANCE TO PROMOTE SEXUAL AND REPRODUC-
TIVE HEALTH CARE FOR YOUNG PEOPLE. 
(a) ASSISTANCE AUTHORIZED.—The President is au-
thorized to provide assistance to ensure access to sexual 
and reproductive health care for young people in devel-
oping countries. 
(b) PRIORITY.—In providing assistance authorized 
under subsection (a), the President shall prioritize a plan 
to increase comprehensive knowledge about sexuality 
among young people and improve sexual and reproductive 
health outcomes among young people, while improving co-
ordination and implementation of host country and United 
States Government activities focused on adolescent and 
youth sexual and reproductive health. 
(c) ACTIVITIES SUPPORTED.—Assistance provided 
under subsection (a) shall be used, among other things, 
to— 
(1) provide universal and affordable access to— 
(A) evidence-based comprehensive sexuality 
education and reproductive health education, in 
consultation with local communities, in and out-
side schools to ensure young people can delay 
sexual debut and make informed decisions 
about their sexual and reproductive health; and 
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(B) youth-friendly comprehensive sexual 
and reproductive health care, including activi-
ties described in section 4(b), as appropriate; 
(2) coordinate the achievement of the goals of 
sexual and reproductive health programming for 
young people in United States Government-funded 
programs; 
(3) educate implementers on best practices in 
adolescent and youth programming and delivery and 
for effective dissemination of policy guidelines re-
garding adolescent and youth programming; and 
(4) incorporate the recommendations of young 
people in program design and service delivery ori-
ented for young people. 
SEC. 8. STRATEGY TO INTEGRATE AND LINK SEXUAL AND 
REPRODUCTIVE HEALTH SERVICES. 
(a) STRATEGY REQUIRED.— 
(1) IN GENERAL.—The President shall develop 
and implement a strategy to improve and create 
linkages among the various components of sexual 
and reproductive health with each other and with 
other global health care services, delivery, and poli-
cies in order to meet the goal described in paragraph 
(2). 
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(2) GOAL DESCRIBED.—The goal of better link-
ages and integration referred to in paragraph (1) is 
to ensure that individual men and women are pro-
vided with a continuum of sexual and reproductive 
health services that meet their needs. Integration 
does not require that all of these services should be 
provided by the same clinician or even in the same 
setting; rather, there should be a mechanism in 
place, so that every person has access to the sexual 
and reproductive health services he or she needs, ei-
ther directly or by referral. 
(b) ELEMENTS.—The strategy required by subsection 
(a) shall include the following: 
(1) In general, at the program level, supporting 
health systems to link the various components of 
sexual and reproductive health services both in terms 
of health system management, such as integrating 
commodity and supply systems, training, super-
vision, data collection and analysis, and service pro-
vision, to ensure that people have access to a full 
range of services in their community. 
(2) In general, such services should include pre-
vention of ill-health, provision of information and 
counseling, screening, diagnosis and curative care 
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and referral for a full range of sexual and reproduc-
tive health and other health and social services. 
(3) With respect to linkages and program inte-
gration of sexual and reproductive health services, 
such services shall include activities described in sec-
tion 4(b). 
(4) With respect to linkages of sexual and re-
productive health services with other global health 
services, such services shall include— 
(A) counseling about and referrals to other 
related health services such as addressing new-
born, infant, and child health (including edu-
cating families about proper antenatal and de-
livery care, breastfeeding, hygiene, and inter-
ventions for neonatal infections and life-threat-
ening childhood illnesses), malaria, tuberculosis, 
neglected tropical diseases, and proper nutrition 
for all ages; and 
(B) referrals to nearby quality services 
that cannot be provided by the primary provider 
and other social services. 
SEC. 9. COORDINATION; RESEARCH, MONITORING, AND 
EVALUATION. 
(a) COORDINATION.—Assistance authorized under 
this Act shall promote coordination between and among 
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donors, the private sector, nongovernmental and civil soci-
ety organizations, and governments in order to support 
comprehensive and responsive sexual and reproductive 
health programs in developing countries. 
(b) RESEARCH, MONITORING, AND EVALUATION.— 
(1) IN GENERAL.—Assistance authorized under 
this Act shall be used for the conduct of formative 
research and to monitor and evaluate the effective-
ness and efficiency of programs. 
(2) REQUIREMENTS.—In carrying out para-
graph (1), the President shall ensure that there is— 
(A) support for formative research on the 
determinants of accessing sexual and reproduc-
tive health products and services, and adopting 
healthy behaviors related to sexuality and re-
production, to inform program design; 
(B) support for the ongoing, regular, and 
systematic collection of information to serve as 
the basis for monitoring change in population- 
based outcomes; 
(C) 
support 
for 
evaluations 
of 
pro-
grammatic effectiveness by measuring the ex-
tent to which change in population-based out-
comes can be attributed to program interven-
tions or environmental factors; 
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(D) support for operations research that 
uses appropriate scientific methods to compare 
different interventions with the objective of in-
creasing the efficiency, effectiveness, and qual-
ity of programs; 
(E) support for field research on the char-
acteristics of programs most likely to result in 
sustained use of effective family planning in 
meeting each individual’s lifetime reproductive 
goals, with particular emphasis on the perspec-
tives of family planning users, including support 
for relevant social and behavioral research fo-
cusing on such factors as the use, nonuse, and 
unsafe or ineffective use of various contracep-
tive and related-disease control methods; and 
(F) support for the development of new 
evaluation techniques and performance criteria 
for sexual and reproductive health programs, 
emphasizing the user’s perspective and repro-
ductive goals. 
SEC. 10. DEFINITIONS. 
In this Act: 
(1) ADOLESCENT.—The term ‘‘adolescent’’ 
means an individual who has attained the age of 10 
years but not 20 years. 
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(2) COMPREHENSIVE SEXUALITY EDUCATION.— 
The term ‘‘comprehensive sexuality education’’ 
means helping young people develop the inter-
personal skills necessary for the formation of caring, 
supportive, and non-coercive relationships and the 
ability to exercise responsibility regarding sexual re-
lationships by addressing such issues as sexual di-
versity, abstinence, and the use of condoms, contra-
ceptives, and other protective sexual health meas-
ures. 
(3) INTEGRATION.—The term ‘‘integration’’ 
means joining together different kinds of services or 
operational programs, either directly or by referral, 
to ensure more comprehensive services, promote a 
continuum of care, and to maximize health out-
comes. 
(4) LINKAGES.—The term ‘‘linkages’’ means— 
(A) the bi-directional synergies in policy, 
programs, services, and advocacy related to sex-
ual and reproductive health, including HIV/ 
AIDS; and 
(B) refers to a broader human rights based 
approach, of which service integration is a sub-
set. 
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(5) REPRODUCTIVE HEALTH.—The term ‘‘re-
productive health’’— 
(A) means a state of complete physical, 
mental, and social well-being and not merely 
the absence of disease or infirmity, in all mat-
ters relating to the reproductive system and to 
its functions and processes; and 
(B) implies that an individual is able to 
have a satisfying and safe sex life and that such 
individual has the capability to reproduce and 
the freedom to decide if, when, and how often 
to do so, including the right of men and women 
to be informed and to have access to safe, effec-
tive, affordable, and acceptable methods of fam-
ily planning of their choice, as well as other 
methods of their choice for regulation of fer-
tility which are not against the law, and the 
right of access to appropriate health care serv-
ices that will enable women to go safely through 
pregnancy and childbirth and provide couples 
with the best chance of having a healthy infant. 
(6) REPRODUCTIVE RIGHTS.—The term ‘‘repro-
ductive rights’’— 
(A) means those rights that embrace cer-
tain human rights that are already recognized 
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in national laws, international human rights 
documents, and other consensus documents; 
(B) includes the recognition of the basic 
right of all couples and individuals to decide 
freely and responsibly the number, spacing, and 
timing of their children and to have the infor-
mation and means to do so, and the right to at-
tain the highest standard of sexual and repro-
ductive health; and 
(C) further includes the right of all couples 
and individuals to make decisions concerning 
reproduction free of discrimination, coercion, 
and violence, as expressed in human rights doc-
uments. 
(7) SEXUAL
HEALTH.—The term ‘‘sexual 
health’’— 
(A) means a state of physical, emotional, 
mental, and social well-being in relation to sex-
uality and not merely the absence of disease, 
dysfunction, or infirmity; 
(B) includes a positive and respectful ap-
proach to sexuality and sexual relationships, as 
well as the possibility of having pleasurable and 
safe sexual experiences, free of coercion, dis-
crimination, and violence; and 
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