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. 
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 ‘‘Obstetric Fistula Sur-
gical Repair, Assistance, and Prevention Act of 2004’’. 
SEC. 2. FINDINGS AND PURPOSE. 
(a) FINDINGS.—Congress finds the following: 
(1) Obstetric fistula is a devastating condition 
that occurs during childbirth when prolonged pres-
sure of the baby’s head against the mother’s pelvis 
can lead to the child’s death as well as cut off the 
blood supply of the tissues surrounding the woman’s 
vagina, bladder, or rectum, causing those tissues to 
deteriorate, and thus leaving an open hole, or fistula. 
(2) Obstetric fistula can be excruciatingly pain-
ful and often causes a woman to lose control of her 
bowel movements. 
(3) To date, an estimated 2,000,000 cases of 
obstetric fistula have been reported worldwide— 
mostly in Africa among women who are very young, 
delivering their first child, lacking proper nutrition 
and maternity care, and living in rural areas. 
(4) The actual number of women who have ob-
stetric fistula may actually be much higher due to a 
lack of adequate reporting. For example, an addi-
tional estimate contends that in Nigeria alone, ap-
proximately 1,000,000 women suffer from obstetric 
fistula. 
(5) It is estimated that 50,000 to 100,000 new 
cases of obstetric fistula occur each year, mostly in-
volving women under the age of 20. 
(6) Women who suffer from obstetric fistula 
may also suffer from social isolation because they
are often abandoned by their husbands, families, and 
employers. 
(7) Women who suffer from obstetric fistula 
may also suffer severe emotional stress from their 
condition and social isolation that is often magnified 
by the death of their child during labor. 
(8) Obstetric fistula can be prevented through 
increased access by women to emergency obstetrical 
care, a postponement of sexual activity and child-
bearing past the teenage years, and increased train-
ing for birth attendants in local communities. 
(9) Obstetric fistula can also be treated through 
a relatively minor surgical procedure that is 90 per-
cent effective and which can cost as little as $150. 
(10) A large percentage of women who suffer 
from obstetric fistula are unaware that treatment 
exists and may spend their entire lives suffering 
from this condition needlessly. 
(11) Unfortunately, there are few treatment 
centers or hospitals with the capacity to treat obstet-
ric fistula in developing countries, particularly coun-
tries in Africa, and demand for services and surgery 
far exceed the supply. 
(12) Currently the United States Agency for 
International Development provides assistance for
programs that target prevention of obstetric fistula 
but not programs that target treatment of obstetric 
fistula. 
(13) Tens of thousands of women in developing 
countries suffering from obstetric fistula could be 
successfully treated if adequate resources were de-
voted to this objective. 
(b) PURPOSE.—The purpose of this Act is to ensure 
that, in addition to the prevention of obstetric fistula, 
treatment of obstetric fistula is an important priority of 
United States bilateral foreign assistance programs, in-
cluding through— 
(1) the establishment and expansion of the ca-
pacity to treat obstetric fistula in developing coun-
tries, including through the provision of surgery and 
post-surgery care; and 
(2) the reduction of the incidence of obstetric 
fistula in developing countries, including through the 
conduct of appropriate seminars and the dissemina-
tion of appropriate educational materials, such as 
brochures, pamphlets, and posters. 
SEC. 3. DEFINITION. 
In this Act, the term ‘‘obstetric fistula’’ means a rup-
ture or hole in tissues surround a woman’s vagina, blad-
der, or rectum that occurs when the woman is in ob-
structed childbirth for a prolonged period of time without 
adequate medical attention. 
SEC. 4. AMENDMENTS TO THE FOREIGN ASSISTANCE ACT 
OF 1961. 
Section 104(c) of the Foreign Assistance Act of 1961 
(22 U.S.C. 2151b(c)) is amended— 
(1) by redesignating paragraph (4) as para-
graph (5); and 
(2) by inserting after paragraph (3) the fol-
lowing new paragraph: 
‘‘(4)(A) In carrying out the purposes of this sub-
section, the President is authorized to furnish assistance, 
on such terms and conditions as the President may deter-
mine, for the establishment and operation of not less than 
twelve centers for the treatment of obstetric fistula at ap-
propriate sites in developing countries. 
‘‘(B) In selecting sites for the establishment of cen-
ters pursuant to subparagraph (A), the President should 
seek the consultation and advice of United States embassy 
officials, appropriate nongovernmental organizations, and 
local government officials in developing countries with 
high rates of obstetric fistula, with particular emphasis on 
countries in Africa.
‘‘(C) Each center established pursuant to subpara-
graph (A) shall, to the maximum extent practicable, carry 
out the following activities: 
‘‘(i) The provision of surgery to repair obstetric 
fistula in women who do not otherwise have the re-
sources to pay for such surgery and the provision of 
necessary post-surgery care and support for such 
women. 
‘‘(ii) Assistance related to surgery and post-sur-
gery care and support described in clause (i), includ-
ing the provision of transportation to and from the 
center for women in need of such transportation and 
the provision of necessary temporary shelter and 
food assistance to women in need of such shelter and 
food assistance. 
‘‘(iii) Activities to reduce the incidence of ob-
stetric fistula, including the conduct of appropriate 
seminars and the dissemination of appropriate edu-
cational materials, such as brochures, pamphlets, 
and posters. 
‘‘(D) Not later than January 31 of each year, the 
President shall prepare and transmit to Congress a report 
on the implementation of this paragraph for the prior fis-
cal year.