I 
109TH CONGRESS 
1ST SESSION H. R. 2811 
To provide a United States voluntary contribution to the United Nations 
Population Fund only for the prevention and repair of obstetric fistula. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 8, 2005 
Mrs. MALONEY (for herself, Mr. CROWLEY, Mr. RUSH, Mr. LANTOS, Ms. 
JACKSON-LEE of Texas, Ms. LEE, Mr. MCDERMOTT, Mr. OWENS, Mr. 
MCNULTY, Ms. EDDIE BERNICE JOHNSON of Texas, Mr. SMITH of 
Washington, Mr. GRIJALVA, and Mr. HONDA) 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 
and repair of obstetric fistula. 
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 ‘‘Repairing Young 
Women’s Lives Around the World Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following:
(1) Every minute, one woman dies from preg-
nancy-related complications. Ninety-five percent of 
these women live in Africa and Asia. 
(2) For every woman who dies from pregnancy- 
related complications, 15 to 30 women survive but 
experience chronic disabilities. The worst is obstetric 
fistula which is caused when a woman who needs 
trained medical assistance for a safe delivery, includ-
ing Caesarian section, cannot get it. The con-
sequences are life-shattering. The baby usually dies, 
and the woman is left with chronic incontinence. 
(3) Obstetric fistula is a hole that is formed be-
tween the bladder and the vagina, or the rectum and 
the vagina, after a woman suffers from prolonged 
obstructed labor. In the struggle to pass through the 
birth canal, the fetus puts constant pressure, some-
times for several days, on the bladder and vaginal or 
rectal wall, destroying the tissue and leaving a 
wound. 
(4) According to the Department of State: 
‘‘Pregnancy at an early age often leads to obstetric 
fistulae and permanent incontinence. In Ethiopia, 
treatment is available at only 1 hospital in Addis 
Ababa that performs over 1,000 fistula operations a 
year. It estimates that for every successful operation
performed, 10 other young women need the treat-
ment. The maternal mortality rate is extremely high 
due, in part, to food taboos for pregnant women, 
poverty, early marriage, and birth complications re-
lated to FGM [Female Genital Mutilation], espe-
cially infibulation.’’. 
(5) Obstetric fistula affects women who survive 
obstructed labor. In nearly every case of obstetric 
fistula, the baby will be stillborn and the mother will 
have physical pain as well as social and emotional 
trauma from the loss of her child. 
(6) The physical symptoms of obstetric fistula 
include incontinence or constant uncontrollable leak-
ing of urine or feces, frequent bladder infections, in-
fertility, and foul odor. The smell often drives hus-
bands and loving family members away. In many 
communities, women with fistula are considered 
‘‘unclean’’ and stigmatized. 
(7) Fistula is a relatively hidden problem, large-
ly because it affects the most marginalized members 
of society: young, poor, illiterate women in remote 
areas. Many of these women never seek treatment. 
Because they often suffer alone, their injuries may 
be ignored or misunderstood.
(8) Adolescents are at greater risk of complica-
tions during childbirth that can lead to fistula be-
cause they have less access to health care and are 
subject to other significant risk factors. Young girls 
suddenly find themselves marginalized, alone, and 
are often blamed for their condition. 
(9) Although data on obstetric fistula are 
scarce, the World Health Organization (WHO) esti-
mates there are more than 2,000,000 women living 
with fistula and 50,000 to 100,000 new cases each 
year. These figures are based on the number of 
women who seek medical care. Many more suffer in 
silence, unaware that treatment is available. 
(10) Obstetric fistula was once common 
throughout the world, but over the last century has 
been eradicated in Europe, North America, and 
other developed regions through improved medical 
care. 
(11) Obstetric fistula is fully preventable by 
having a trained medical attendant present during 
labor and childbirth, access to emergency obstetric 
care in the event of complications, delaying early 
marriage and childbirth, and gaining access to edu-
cation and family planning.
(12) Obstetric fistula can also be surgically re-
paired. Surgery requires a specially trained surgeon 
and support staff, access to an operating theater 
and to attentive post-operative care. Success rates 
for surgical repair of fistula can be as high as 90 
percent and cost an average of $300. 
(13) In 2003, the United Nations Population 
Fund (UNFPA) launched the first-ever global Cam-
paign to End Fistula. This campaign includes inter-
ventions to prevent fistula from occurring, treat 
women who are affected and support women after 
surgery. 
(14) The Campaign to End Fistula currently 
supports projects in more than 30 countries in sub- 
Saharan Africa, South Asia, and the Middle East. In 
each country the Campaign identifies the extent of 
the problem and the resources available to treat fis-
tula, develops a national strategy and builds partner-
ships to address the problem, and implements activi-
ties to prevent and treat fistula, including efforts to 
reintegrate women into their communities once they 
are healed. 
(15) The United States Government provided a 
voluntary contribution of $21,500,000 to UNFPA 
for fiscal year 2001 and the Administration’s budget
request for fiscal year 2006 allocates $25,000,000 
for UNFPA. 
(16) UNFPA is working in more than 79 coun-
tries to reduce maternal death and disability, such 
as obstetric fistula, and to save women’s lives. 
(17) In the winter of 2001, the Secretary of 
State submitted written testimony to the Committee 
on Foreign Relations of the Senate expressing sup-
port for the invaluable work of UNFPA and for se-
curing funding for the organization. 
(18) The United States Government, as part of 
its efforts to improve the dire health conditions of 
Afghan women, pledged in October 2001 an addi-
tional $600,000 to UNFPA to address the reproduc-
tive health care needs of Afghan refugees in sur-
rounding nations and of internally displaced persons 
within Afghanistan. 
(19) Congress demonstrated its strong bipar-
tisan support for a voluntary United States con-
tribution to UNFPA of up to $34,000,000 in the 
Foreign Operations, Export Financing, and Related 
Programs Appropriations Act, 2002, which was 
passed by the House of Representatives on a vote of 
357 to 66 and by the Senate by unanimous consent 
and signed into law (Public Law 107–115) by the
President on January 10, 2002. However, the Presi-
dent decided not to obligate the funds. 
(20) In May 2002, the President sent a three- 
person delegation to investigate UNFPA programs 
in China and allegations that the agency was in-
volved in coercive abortion practices. 
(21) This independent delegation concluded 
that such allegations were untrue. 
(22) On May 29, 2002, the delegation sent a 
letter to the Secretary of State stating the following: 
‘‘First Finding: We find no evidence that UNFPA 
has knowingly supported or participated in the man-
agement of a program of coercive abortion or invol-
untary sterilization in the PRC. First Recommenda-
tion: We therefore recommend that not more than 
$34,000,000 which has already been appropriated be 
released to UNFPA.’’. 
(23) Regrettably, the Administration overruled 
the recommendation of its own delegation and in-
voked an overly broad interpretation of the law in 
order to eliminate funding for UNFPA. 
SEC. 3. UNITED STATES VOLUNTARY CONTRIBUTION TO 
THE UNITED NATIONS POPULATION FUND. 
Notwithstanding any other provision of law, in addi-
tion to amounts otherwise available to carry out the pur-
poses of chapter 3 of part 1 of the Foreign Assistance 
Act of 1961, there are authorized to be appropriated 
$34,000,000 for fiscal year 2006 and each subsequent fis-
cal year to be available only for United States voluntary 
contributions to the United Nations Population Fund 
(UNFPA) only for prevention and repair of obstetric fis-
tula. 
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