I 
113TH CONGRESS 
2D SESSION 
H. R. 5862 
To provide assistance to improve maternal and newborn health in developing 
countries, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 11, 2014 
Mrs. CAPPS introduced the following bill; which was referred to the Committee 
on Foreign Affairs 
A BILL 
To provide assistance to improve maternal and newborn 
health 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 ‘‘Improvements in Glob-
al Maternal and Newborn Health Outcomes while Maxi-
mizing Successes Act’’ or ‘‘Improvements in Global 
MOMS Act’’. 
SEC. 2. FINDINGS AND PURPOSES. 
(a) FINDINGS.—Congress finds the following: 
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(1) In 2000, the United States joined 188 other 
countries in supporting the 8 United Nations Millen-
nium Development Goals (MDGs), including MDG 
4, which aims to reduce child mortality by two-thirds 
and MDG 5, which aims to reduce the maternal 
mortality ratio by three-quarters by 2015. In 2005, 
universal access to reproductive health was added as 
a target for MDG 5. 
(2) Substantial progress in maternal health has 
been made. The total number of maternal deaths de-
creased by over 50 percent from 529,000 maternal 
deaths in 2000 to 287,000 maternal deaths in 2010. 
Egypt, Honduras, Malaysia, Sri Lanka, and parts of 
Bangladesh have all halved their maternal mortality 
ratios over the past few decades. 
(3) While significant progress has been made in 
reducing maternal mortality, the United Nations re-
ports that current maternal mortality levels are ‘‘far 
removed from the 2015 target’’. 
(4) Women in developing countries are nearly 
100 times more likely to die of complications during 
pregnancy or childbirth than in developed countries, 
with higher rates for women living in rural areas 
and among poorer communities. 
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(5) The United States Agency for International 
Development (USAID) estimates the global eco-
nomic impact of maternal and newborn mortality at 
$15 billion in lost productivity every year. 
(6) Annually, 287,000 women die from com-
plications during pregnancy or childbirth, with 99 
percent of these deaths occurring in developing 
countries. Six countries—Afghanistan, the Demo-
cratic Republic of Congo, Ethiopia, India, Nigeria, 
and Pakistan—account for almost one-half of all 
maternal deaths worldwide. 
(7) It is estimated that up to 90 percent of 
these maternal deaths are preventable. With access 
to medicines and skilled health care providers, most 
women across the world can expect a successful de-
livery and a healthy newborn. 
(8) The leading cause of maternal deaths is 
hemorrhage. Other primary causes of maternal 
death include sepsis, hypertensive disorder (pre-ec-
lampsia/eclampsia), unsafe abortion, and prolonged 
or obstructed labor. 
(9) An essential part of ensuring a woman sur-
vives pregnancy and childbirth includes access to 
maternal health medicines and other supplies. 
Uterotonics prevent and treat postpartum hemor-
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rhage by causing contractions of the uterus during 
and after childbirth, effectively controlling excessive 
bleeding. If uterotonic medicines, such as oxytocin 
and misoprostol, were available to all women giving 
birth over a 10-year period, approximately 41 million 
postpartum hemorrhage cases could be prevented 
and 1.4 million women’s lives saved. 
(10) Pregnancy is the leading killer of adoles-
cent girls ages 15 to 19 in the developing world. 
Nearly 70,000 adolescent girls die every year be-
cause their bodies are not ready for childbirth. Com-
pared to women in their twenties, adolescent girls 
aged 15 to 19 are twice as likely to die in childbirth, 
and girls under 15 are five times as likely to die, 
and mortality and morbidity rates are also higher 
among infants born to young mothers. 
(11) For every maternal death, approximately 
20 women and girls experience serious or long-term 
negative health consequences. Severe pregnancy-re-
lated injuries include fistula, uterine prolapse, infec-
tions, diseases, and disabilities. Maternal morbidities 
accrue an estimated global cost of $6.8 billion. 
(12) Healthy timing and spacing of pregnancy 
has a powerful impact on the chances of survival for 
women, newborns, infants, and children. Access to 
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voluntary family planning plays an essential role in 
improving maternal health. 
(13) Delaying a first pregnancy until at least 
18 years old, waiting at least 24 months to become 
pregnant after a live birth, and waiting at least 6 
months after a miscarriage or induced abortion, can 
reduce all maternal mortality by 30 percent and pre-
vent 70,000 deaths per year of women who die from 
unsafe abortion. 
(14) Healthy timing and spacing of birth can 
also reduce newborn and child death by more than 
50 percent. Children born less than two years after 
the previous birth are approximately 2.5 times more 
likely to die before the age of five than children born 
three to five years after the previous birth. 
(15) If all women who wanted to delay or avoid 
pregnancy had access to modern contraception, 26 
million abortions would be averted. 
(16) More than 220 million women in devel-
oping countries who would prefer to delay or avoid 
childbearing lack access to safe and effective family 
planning methods. Less than one-half of married 
women of reproductive age in South Asia and less 
than 25 percent of women in sub-Saharan Africa use 
modern contraceptives. In 2012, an estimated 80 
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million women in developing countries had an unin-
tended pregnancy. 
(17) It is estimated that if 120 million more 
women had access to family planning information, 
services and supplies, without coercion or discrimina-
tion by 2020, 200,000 fewer girls and women would 
die during pregnancy and childbirth, there would be 
100 million fewer unintended pregnancies, there 
would be 50 million fewer abortions, and 3 million 
fewer infants would die in their first year of life. 
(18) Violent acts against pregnant women can 
also lead to poor health outcomes for women and 
their babies, including miscarriage, pre-term birth, 
low birthweight, stillbirths, and maternal deaths. 
The risk for maternal mortality is 3 times as high 
for abused mothers. In emergency settings, gender- 
based violence rates continue to increase. 
(19) According to the World Health Organiza-
tion (WHO), women that have undergone female 
genital mutilation/cutting are significantly more like-
ly to experience serious postpartum health problems 
than those who have not undergone female genital 
mutilation, and children born to mothers who have 
undergone female genital mutilation face higher 
death rates immediately after birth. 
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(20) Maternal health is inextricably tied to new-
born health and survival. In some countries in the 
developing world the risk of newborn death doubles 
following maternal death. The conditions in utero, 
during labor, delivery, and shortly after birth have 
a direct relationship on newborn outcomes. 
(21) In 2012, 2.9 million newborns or 44 per-
cent of total under-five mortality did not survive the 
first month of life. One million of these deaths oc-
curred during the first day of life. 
(22) The leading causes of newborn mortality 
include prematurity, intrapartum complications (in-
cluding birth asphyxia), and neonatal infections. 
Over two-thirds of these deaths could be prevented 
through low-cost medicines, products, and interven-
tions that would not require intensive care. 
(23) In addition to newborn mortality there are 
an additional 2.65 million stillbirths each year that 
are not included in newborn or under-five mortality 
statistics. 
(24) Women in Africa are 24 times more likely 
to have a stillbirth than women in high-income coun-
tries. 
(25) In developing countries, nearly one-third of 
stillbirth babies were alive when labor began. If 99 
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percent of women in developing countries had com-
prehensive emergency obstetric care, nearly 700,000 
stillbirths could be prevented each year. 
(26) In many developing countries, lack of ac-
cess to quality health care facilities, health services, 
and trained providers results in deaths for mothers, 
newborns, and children—the majority of births in 
Africa take place without a skilled attendant present 
or the necessary medicines and medical supplies, in-
creasing the risk of death or disability for both 
mother and newborn. 
(27) If family planning and maternal and new-
born services were provided simultaneously, the costs 
of these services would decline by $1.5 billion and 
would result in a 70 percent decline in maternal 
deaths and a 44 percent decline in newborn deaths. 
(28) More than one-half of all children and 
pregnant women in developing countries suffer from 
anemia, which is exacerbated by malaria, neglected 
tropical diseases, and nutritional deficits, causing 
adverse pregnancy outcomes and even death. 
(29) Maternal deaths worldwide could be re-
duced by 60,000 per year if women received appro-
priate HIV diagnosis and treatment. 
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(30) With proper interventions, the trans-
mission of HIV between women and their infants 
during pregnancy and breastfeeding can be reduced 
to 5 percent in the developing world. The WHO rec-
ommends early diagnosis and immediate treatment 
for children identified as HIV positive because, with-
out treatment, half of these children will die before 
the age of two. 
(31) Nine out of ten women in sub-Saharan Af-
rica will lose a child during their lifetimes, and only 
30 percent of women in sub-Saharan Africa have 
contact with a health worker after giving birth. 
(32) According to the Director of National 
Intelligence’s 2009 Annual Threat Assessment, wide-
spread poor maternal and child health and malnutri-
tion has the potential to weaken central governments 
and empower non-state actors, including terrorist 
and paramilitary groups. 
(33) The experiences of United States Govern-
ment-supported and nongovernmental organization 
maternal and child health programs in countries 
such as Nepal, Ethiopia, and Senegal have dem-
onstrated that community-based approaches, linked 
to primary and referral care when possible, can de-
liver high-impact interventions to prevent or treat 
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many of the life-threatening conditions affecting 
mothers and newborns. 
(b) PURPOSES.—The purposes of this Act are— 
(1) to authorize assistance to improve maternal 
and newborn health in developing countries; and 
(2) to develop a strategy to reduce mortality 
and morbidity and improve maternal and newborn 
health in developing countries. 
SEC. 3. ASSISTANCE TO REDUCE MORTALITY AND IMPROVE 
MATERNAL AND NEWBORN HEALTH IN DE-
VELOPING COUNTRIES. 
(a) IN GENERAL.—Chapter 1 of part I of the Foreign 
Assistance Act of 1961 (22 U.S.C. 2151 et seq.) is amend-
ed— 
(1) in section 102(b)(4)(B), by striking ‘‘reduc-
tion of infant mortality’’ and inserting ‘‘reduction of 
maternal and newborn mortality, morbidity, and 
stillbirths’’; and 
(2) by inserting after section 104C the fol-
lowing new section: 
‘‘SEC. 104D. ASSISTANCE TO REDUCE MORTALITY AND IM-
PROVE MATERNAL AND NEWBORN HEALTH. 
‘‘(a) 
AUTHORIZATION.—Consistent 
with 
section 
104(c), the President is authorized to furnish assistance, 
on such terms and conditions as the President may deter-
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mine, to reduce maternal and newborn mortality and mor-
bidity and improve maternal health and the health of 
newborns in developing countries. 
‘‘(b) ACTIVITIES SUPPORTED.—Assistance provided 
under subsection (a) shall, to the maximum extent prac-
ticable, include— 
‘‘(1) activities to expand access to and improve 
quality of maternal health services, including— 
‘‘(A) birth preparedness through the provi-
sion of quality pre-pregnancy and antenatal 
care with a skilled provider (midwife, nurse, or 
doctor), which should consist of, at minimum— 
‘‘(i) iron and folic acid supplemen-
tation; 
‘‘(ii) tetanus vaccine; 
‘‘(iii) smoking cessation; 
‘‘(iv) prevention and management of 
sexually transmitted infections and HIV, 
including access to Preventing Mother-to- 
Child Transmission; 
‘‘(v) screening, diagnosis, and treat-
ment of existing conditions, such as syphi-
lis, HIV/AIDS, malaria, and tuberculosis, 
and ensuring that women are provided 
with, or referred to, appropriate care and 
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treatment and prophylaxis for those condi-
tions, including access to antiretrovirals 
(ARVs); 
‘‘(vi) magnesium sulfate and low-dose 
aspirin to prevent pre-eclampsia and cal-
cium supplementation to prevent hyper-
tension; 
‘‘(vii) screening for complications, in-
cluding blood pressure screenings; 
‘‘(viii) magnesium sulfate for eclamp-
sia; antihypertensive medication; 
‘‘(ix) corticosteroids to prevent res-
piratory distress syndrome; 
‘‘(x) induction of labor at term to 
manage pre-labor rupture of membranes; 
‘‘(xi) nutrition treatment of malnour-
ished pregnant women; and 
‘‘(xii) antibiotics for pre-term labor; 
‘‘(B) expanding access to skilled childbirth 
and postnatal care, particularly in areas with 
low utilization of skilled delivery, including— 
‘‘(i) the presence of a skilled health 
professional (nurse, midwife, or doctor) 
who has been educated and trained to pro-
ficiency in the skills needed to manage nor-
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mal or uncomplicated pregnancies or refer-
ral 
of 
complications 
in 
women 
and 
newborns, 
‘‘(ii) clean delivery; 
‘‘(iii) uterotonics and active manage-
ment of third stage of labor to prevent 
postpartum hemorrhage; 
‘‘(iv) social support during childbirth; 
‘‘(v) screening for HIV, linkages to 
HIV care and treatment services, and fol-
low up tracking; 
‘‘(vi) induction of labor for prolonged 
pregnancy; 
‘‘(vii) nutrition counseling; 
‘‘(viii) management of postpartum 
hemorrhage; 
‘‘(ix) caesarean section for maternal/ 
fetal indication with prophylactic anti-
biotics; 
‘‘(x) treating maternal anemia; and 
‘‘(xi) 
postpartum 
family 
planning 
methods; 
‘‘(C) comprehensive voluntary family plan-
ning services, integrated into antenatal and 
postnatal care, to support women and men in 
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making informed decisions and having timely, 
intended, well-spaced pregnancies, and to help 
women with pre-existing conditions avoid high- 
risk, unintended pregnancies, including— 
‘‘(i) provision of family planning/birth 
spacing counseling and services; and 
‘‘(ii) emergency treatment of com-
plications of unsafe abortions and linkages 
to other reproductive health services; 
‘‘(2) activities to expand access to and improve 
quality of services that reduce newborn and infant 
mortality, including— 
‘‘(A) immediate thermal care; 
‘‘(B) initiation of early, exclusive, and con-
tinued breastfeeding; 
‘‘(C) hygienic cord and skin care; 
‘‘(D) kangaroo mother care; 
‘‘(E) extra support for feeding small and 
preterm infants; 
‘‘(F) antibiotic therapy for newborns at 
risk of bacterial infection; 
‘‘(G) use of surfactant in pre-term infants; 
‘‘(H) initiate prophylactic antiretroviral 
therapy for infants exposed to HIV; 
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‘‘(I) neonatal resuscitation with a bag and 
mask for infants suffering from birth asphyxia; 
‘‘(J) continuous positive airway pressure to 
manage respiratory distress syndrome; 
‘‘(K) case management of neonatal sepsis, 
neonatal meningitis, and pneumonia; 
‘‘(L) case management of meningitis, ma-
laria, diarrhea, pneumonia, and severe acute 
malnutrition; and 
‘‘(M) comprehensive care of HIV, including 
ARVs, cotrimoxazole, nutrition support, and 
psychosocial support; 
‘‘(3) activities to support communities and 
health care providers in identifying and removing 
barriers to maternal health care services, includ-
ing— 
‘‘(A) financial and sociocultural barriers; 
‘‘(B) child marriage; 
‘‘(C) transportation; 
‘‘(D) gender discrimination and gender- 
based violence; 
‘‘(E) stigma based on pre-existing health 
concerns; and 
‘‘(F) female genital mutilation/cutting; 
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‘‘(4) activities that focus on empowering women 
and girls and engaging men and boys at the indi-
vidual, household, and community levels to improve 
the health outcomes of women, newborns, and chil-
dren, including education and awareness programs 
about gender-based violence, the health risks of fe-
male genital mutilation, and shared responsibility 
for, and benefits of, family planning; 
‘‘(5) activities to improve the supply of critical 
maternal and newborn health commodities, including 
lifesaving medicines and supplies, such as activities 
designed to strengthen regulatory systems to ensure 
the quality of commodities in circulation and those 
related to strengthening supply chain systems so 
that these commodities reach the women and chil-
dren who need them; 
‘‘(6) activities supporting country-led efforts to 
improve capacity for health governance, health fi-
nance, and the health workforce, including in the 
private sector, and support for training clinicians, 
nurses, technicians, sanitation and public health 
workers, community-based health workers, midwives, 
birth attendants, peer educators, volunteers, and pri-
vate sector enterprises to provide integrated health 
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and nutrition services and referrals that meet the 
needs of patients across a continuum of care; 
‘‘(7) activities that support country-led plans to 
reduce maternal and newborn mortality and mor-
bidity and stillbirths, including— 
‘‘(A) management of host country institu-
tions’ information systems and the development 
and use of tools and models to collect, analyze, 
and disseminate information related to mater-
nal and newborn health; and 
‘‘(B) activities to develop and conduct 
needs assessments, baseline studies, targeted 
evaluations, or other information-gathering ef-
forts for the design, monitoring, and evaluation 
of maternal and newborn health efforts, includ-
ing— 
‘‘(i) the study of the availability and 
effects of critical medicines and devices, 
particularly those of importance in devel-
oping countries, on pregnant women and 
newborns; 
‘‘(ii) the collection, evaluation, and 
use of data on the medical and socio-
economic factors that led to a maternal or 
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newborn death or stillbirths at the commu-
nity and health facility levels; and 
‘‘(iii) the improvement of vital reg-
istries to capture live births, neonatal 
deaths, and the number of stillbirths; and 
‘‘(8) activities to integrate and coordinate as-
sistance provided under this section with existing 
health programs for the prevention of the trans-
mission of HIV from mother to child and other HIV/ 
AIDS prevention, care, treatment, and counseling 
activities, including better integration with programs 
addressing— 
‘‘(A) malaria; 
‘‘(B) tuberculosis; 
‘‘(C) family planning and reproductive 
health; 
‘‘(D) counseling for survivors of sexual- 
and gender-based violence; 
‘‘(E) neglected tropical diseases; 
‘‘(F) nutrition; and 
‘‘(G) child survival. 
‘‘(c) GUIDELINES.—To the maximum extent prac-
ticable, programs, projects, and activities carried out using 
assistance provided under this section shall be— 
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‘‘(1) carried out through private and voluntary 
organizations, including community and faith-based 
organizations, local organizations, and relevant 
international and multilateral organizations that 
demonstrate effectiveness, including the United Na-
tions Population Fund, the United Nations Chil-
dren’s Fund, and the Global Alliance for Vaccines 
and Immunizations, and that demonstrate commit-
ment to improving the health and rights of mothers 
and newborns and reducing the number of still-
births; 
‘‘(2) carried out in the context of country-driv-
en plans in whose development the United States 
Government participates along with other donors 
and multilateral organizations, nongovernmental or-
ganizations, and civil society; 
‘‘(3) carried out with input by beneficiaries and 
other directly affected populations, especially women 
and marginalized communities; and 
‘‘(4) designed to build the capacity of host 
country governments and civil society organizations. 
‘‘(d) ANNUAL REPORT.—Not later than January 31, 
2016, and annually thereafter for 4 years, the President 
shall transmit to Congress a report on the implementation 
of this section for the prior fiscal year. 
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‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) AIDS.—The term ‘AIDS’ has the meaning 
given the term in section 104A(g)(1) of this Act. 
‘‘(2) HIV.—The term ‘HIV’ has the meaning 
given the term in section 104A(g)(2) of this Act. 
‘‘(3) HIV/AIDS.—The term ‘HIV/AIDS’ has 
the meaning given the term in section 104A(g)(3) of 
this Act.’’. 
SEC. 4. DEVELOPMENT OF STRATEGY TO REDUCE MOR-
TALITY AND MORBIDITY AND IMPROVE MA-
TERNAL AND NEWBORN HEALTH IN DEVEL-
OPING COUNTRIES. 
(a) DEVELOPMENT OF STRATEGY.—The President 
shall develop and implement a comprehensive strategy to 
reduce mortality and morbidity and improve the health of 
mothers and newborns in developing countries that inte-
grates all current United States Government efforts on 
improving maternal and newborn health, including strate-
gies with respect to HIV/AIDS, gender, child survival. 
(b) 
COMPONENTS.—The 
comprehensive 
United 
States Government strategy developed pursuant to sub-
section (a) shall include the following: 
(1) An identification of not less than 24 coun-
tries, including fragile states and countries affected 
by conflict, with priority needs for the 5-year period 
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beginning on the date of the enactment of this Act 
based on— 
(A) the number and rate of neonatal 
deaths; 
(B) the number and rate of near-miss mor-
bidity for women and newborns; 
(C) the number and rate of maternal 
deaths; 
(D) the number and rate of caesarean sec-
tions; 
(E) the number and rate of malnourished 
women of reproductive age; and 
(F) the number of individuals with an 
unmet need for family planning. 
(2) For each country identified in paragraph 
(1)— 
(A) an assessment of the most common 
causes of maternal and newborn mortality and 
morbidity; 
(B) a description of the programmatic 
areas and interventions providing maximum 
health benefits to populations at risk and max-
imum reduction in mortality and morbidity; 
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(C) an assessment of the investments need-
ed in identified programs and interventions to 
achieve the greatest results; 
(D) a description of how United States as-
sistance complements and leverages efforts by 
other donors and builds capacity and self-suffi-
ciency among recipient countries; and 
(E) a description of goals and objectives 
for improving maternal and newborn health, in-
cluding, to the extent feasible, objective and 
quantifiable indicators. 
(3) Enhanced coordination among relevant de-
partments and agencies of the United States Gov-
ernment engaged in activities to improve the health 
and well-being of mothers and newborns in devel-
oping countries. 
(4) A description of the measured or estimated 
impact on maternal and newborn morbidity and 
mortality of each project or program receiving as-
sistance under section 104D of the Foreign Assist-
ance Act of 1961 (as added by section 3 of this Act). 
(c) REPORT.—Not later than 180 days after the date 
of the enactment of this Act, the President shall transmit 
to Congress a report that contains the strategy described 
in this section. 
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SEC. 5. AUTHORIZATION OF APPROPRIATIONS. 
(a) IN GENERAL.—There are authorized to be appro-
priated to carry out this Act, and the amendments made 
by this Act, such sums as may be necessary for each of 
fiscal years 2016 through 2020. 
(b) AVAILABILITY
OF
FUNDS.—Amounts appro-
priated pursuant to the authorization of appropriations 
under subsection (a) are authorized to remain available 
until expended. 
Æ 
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Frm 00023
Fmt 6652
Sfmt 6301
E:\BILLS\H5862.IH
H5862
SSpencer on DSK4SPTVN1PROD with BILLS