I 
115TH CONGRESS 
2D SESSION 
H. R. 7301 
To authorize assistance to train and retain obstetrician-gynecologists and 
sub-specialists in urogynecology and to help improve the quality of care 
to meet the health care needs of women in least developed countries, 
and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 13, 2018 
Ms. DELAURO (for herself, Ms. NORTON, Mr. GRIJALVA, Ms. JACKSON LEE, 
Mr. MCGOVERN, Ms. MCCOLLUM, and Ms. LOFGREN) introduced the fol-
lowing bill; which was referred to the Committee on Foreign Affairs 
A BILL 
To authorize assistance to train and retain obstetrician-gyne-
cologists and sub-specialists in urogynecology and to help 
improve the quality of care to meet the health care 
needs of women in least developed 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 ‘‘Physician Education 
for Fistula Treatment Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) Historically, obstetric fistulas affected 
women in the United States and around the world. 
Advances in obstetric care and access to improved 
surgical techniques resulted in a drastic reduction in 
obstetric fistula by the early 20th century in the 
United States. 
(2) Each year between 50,000 to 100,000 
women worldwide are affected by obstetric fistulas, 
an abnormal opening between a woman’s genital 
tract and her urinary tract or rectum. 
(3) Women who experience an obstetric fistula 
suffer constant incontinence, shame, and social seg-
regation and health problems. It is estimated that 2 
to 3 million women live with untreated obstetric fis-
tulas, a scourge of epidemic proportions. 
(4) A lack of available resources and training 
programs to develop expertise in comprehensive ad-
vanced pelvic reconstructive surgery continues to 
pose a challenge for the health care workforce in 
least developed countries. 
(5) Retention rates of OB–GYNs and sub-spe-
cialists in urogynecology have seen improvement 
with fellowships, residencies, and programs that pro-
vide resources and training. 
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(6) Today, obstetric fistula primarily affects the 
poorest women in the poorest parts of the world. Ob-
stetric fistulas typically occur because women do not 
have timely access to emergency obstetric care dur-
ing obstructed labor, and continue to have fistulas 
due to lack of access to adequate surgical services 
once they sustain the injury. 
(7) Left untreated, an obstetric fistula afflicts 
a woman with devastating physical conditions: incon-
tinence, painful ulcers, and constant and uncontrol-
lable emission of offensive odors. These symptoms 
leave a woman indelibly and perpetually stigmatized 
by her condition. 
(8) Because obstetric fistulas are not them-
selves fatal, millions of women live with this horrific 
condition and have been overlooked by the inter-
national medical community. At present, humani-
tarian aid and nongovernmental programs treat fis-
tula cases on a small scale and are not equipped to 
systematically prevent, treat, and eradicate obstetric 
fistula. 
(9) Obstetric fistula can be prevented when 
women and their families are educated about the 
birthing process and are provided timely access to 
emergency obstetric care. Basic interventions to 
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identify and repair obstetric fistula have achieved 
meaningful and cost-effective results. The impact of 
an obstetric fistula-repair surgery is immediate and 
women can be reintegrated into society. However, 
access to prevention, effective midwifery services, 
and OB–GYN care can significantly decrease child-
birth-related injuries. 
SEC. 3. INTERNATIONAL OB/GYN AND UROGYNECOLOGY 
PROMOTION PROGRAM. 
(a) PURPOSE.—The purpose of assistance under this 
section is to train and retain obstetrician-gynecologists 
(OB–GYNs) and sub-specialists in urogynecology and to 
help improve the quality of care to meet the health care 
needs of women in least developed countries. 
(b) AUTHORIZATION.— 
(1) IN GENERAL.—To carry out the purpose of 
subsection (a), the President, acting through the Di-
rector of the John E. Fogarty International Center 
for Advanced Study in the Health Sciences, is au-
thorized to provide assistance for least developed 
countries to support the activities described in sub-
section (c). 
(2) REFERENCE.—Assistance authorized under 
this section may be referred to as the ‘‘International 
OB/GYN and Urogynecology Promotion Program’’. 
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(c) ACTIVITIES SUPPORTED.—Activities that may be 
supported by assistance under subsection (b) include the 
following: 
(1) 
FELLOWSHIP
AND
RESIDENCY
PRO-
GRAMS.—Establishment of fellowship and residency 
programs to be carried out in coordination with in-
stitutions of higher education (as such term is de-
fined in section 101 of the Higher Education Act of 
1965 (20 U.S.C. 1001)), institutions of higher learn-
ing, midwifery programs, and existing clinical cen-
ters in least developed countries— 
(A) to support existing academic curricula 
for education training for midwifery students; 
(B) to develop and help sustain existing 
specialized curriculum training for medical stu-
dents and residents to become knowledgeable 
and proficient in women’s health care; and 
(C) to allow medical students, residents, 
and midwifery students to practice and develop 
expertise in geographical areas in which child-
birth-related injuries are most prevalent. 
(2) TRAINING
CENTERS.—Establishment of 
training centers— 
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(A) to address the shortage of OB–GYNs 
and sub-specialists in the urogynecology profes-
sion; and 
(B) to carry out specialized programs that 
are located at health care institutions that pro-
vide exceptionally high concentrations of exper-
tise and related resources related to these med-
ical professions and are delivered in a com-
prehensive and interdisciplinary fashion. 
SEC. 4. COMPREHENSIVE 10-YEAR STRATEGY TO ADDRESS 
THE SHORTAGE OF PHYSICIANS IN LEAST DE-
VELOPED COUNTRIES. 
(a) IN GENERAL.—The President, acting through the 
Director of the John E. Fogarty International Center for 
Advanced Study in the Health Sciences, shall establish a 
comprehensive, integrated, 10-year strategy to address the 
shortage of physicians in least developed countries. 
(b) ELEMENTS.—Such strategy shall maintain suffi-
cient flexibility and remain responsive to the needs of 
women afflicted with childbirth-related injuries and shall 
include the following: 
(1) A plan for implementation and coordination 
of programs and activities under this Act, including 
grants and contracts for prevention, treatment, and 
monitoring of childbirth-related injuries. 
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(2) Specific objectives, multi-sector approaches, 
and specific strategies to treat women who suffer 
from childbirth-related injuries and to prevent fur-
ther occurrences of childbirth-related injuries. 
(3) Assignment of priorities for relevant execu-
tive branch agencies. 
(4) Public health and health care delivery sys-
tem research on the prevention, repair, and rehabili-
tation of childbirth-related injuries. 
(5) Social science research in fields such as an-
thropology, sociology, and related fields to monitor 
and evaluate the underlying social and economic fac-
tors that contribute to childbirth-related injuries. 
(6) Development, implementation, and evalua-
tion of evidence-based systems of care connecting 
maternity care facilities with local care delivery and 
community education programs. Such systems of 
care should promote rapid and long-term prevention 
of childbirth-related injuries, including— 
(A) culturally appropriate childbirth edu-
cation, preparation, and planning; and 
(B) access to obstetrician-gynecologists 
(OB–GYNs), urogynecology care, or midwifery 
care. 
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(7) Expansion of training centers and partner-
ships with institutions of higher learning for medical 
students and residents. 
(8) Priorities for the distribution of resources 
based on factors such as the size and demographics 
of the population suffering from childbirth-related 
injuries, the needs of that population, and the exist-
ing infrastructure or funding levels that may exist to 
treat and prevent childbirth-related injuries, includ-
ing obstetric fistula. 
(9) A plan for institutional capacity-building of 
partnerships to strengthen universities, research cen-
ters, health-profession training programs, and gov-
ernment institutes to build the in-country capacity 
needed to eradicate childbirth-related injuries in 
least developed countries. 
(c) REPORT.—Not later than 2 years after the date 
of the enactment of this Act, the President shall submit 
to Congress a report that contains the strategy required 
under this section. 
SEC. 5. REPORT. 
(a) IN GENERAL.—The President, acting through the 
Director of the John E. Fogarty International Center for 
Advanced Study in the Health Sciences, shall submit to 
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Congress, on an annual basis, a report on the implementa-
tion of this Act for the preceding year. 
(b) MATTERS TO BE INCLUDED.—The report re-
quired under subsection (a) shall include an evaluation of 
the effectiveness and performance of the International 
OB/GYN and Urogynecology Promotion Program estab-
lished under section 3 and all related community outreach 
and medical programs. 
SEC. 6. DEFINITIONS. 
In this Act: 
(1) 
CHILDBIRTH-RELATED
INJURIES.—The 
term ‘‘childbirth-related injuries’’ means injuries as-
sociated with obstructed labor, including— 
(A) pelvic organ prolapse; 
(B) a displacement of pelvic organs such 
as the uterus, bladder, or bowel; and 
(C) obstetric fistula. 
(2) LOW-INCOME COUNTRY.—The term ‘‘low-in-
come country’’ means a country with a per capita 
gross national income of $1,035 or less. 
(3) LEAST DEVELOPED COUNTRY.—The term 
‘‘least developed country’’ means a country that— 
(A) is a low-income country; and 
(B) according to the United Nations Eco-
nomic Analysis and Policy Division, is con-
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fronting severe structural impediments to sus-
tainable development. 
(4) RELEVANT
EXECUTIVE
BRANCH
AGEN-
CIES.—The term ‘‘relevant executive branch agen-
cies’’ means the Department of State, the United 
States Agency for International Development, and 
any other department or agency of the United States 
that participates in international health and humani-
tarian activities pursuant to the authorities of such 
department or agency or the Foreign Assistance Act 
of 1961. 
Æ 
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