I 
118TH CONGRESS 
2D SESSION 
H. R. 8529 
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 
MAY 23, 2024 
Ms. DELAURO introduced the following 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) Obstetric fistula, an abnormal opening be-
tween a woman’s genital tract and her urinary tract 
or rectum, is a devastating childbirth injury caused 
by prolonged, obstructed labor in the absence of 
timely and quality medical care. 
(2) Worldwide, an estimated 500,000 women 
and girls live with obstetric fistula with thousands 
more occurring annually. It occurs disproportion-
ately 
among 
impoverished, 
vulnerable, 
and 
marginalized girls and women. 
(3) Women who experience an obstetric fistula 
suffer life-shattering consequences including chronic 
incontinence, shame, social isolation, poverty, and 
physical, mental, and emotional health problems. 
(4) Obstetric fistula is a violation of human 
rights and an indicator of the failure of health sys-
tems to deliver universally accessible, timely, and 
quality health care to women and girls who need it. 
(5) Obstetric fistula is preventable. Universal 
health coverage and universal access to quality care 
are essential in ending preventable maternal and 
newborn deaths and disabilities, including fistula. 
Skilled health personnel at birth, emergency obstet-
ric and newborn care, and universal access to mod-
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ern contraception are the most effective interven-
tions to prevent maternal mortality and fistula. 
(6) Safeguarding the rights and dignity of 
women and girls and addressing underlying gender 
and socioeconomic inequalities and discrimination 
which drive obstetric fistula are equally important to 
end the condition. 
(7) In 2018 and 2020, the United Nations Gen-
eral Assembly resolutions on fistula were adopted, 
calling for ‘‘Ending fistula within a decade’’. This 
represents a turning point in the global fight to 
eliminate fistula, as it brings the global objective and 
timeline for ending fistula into alignment with 
achieving 
the 
Sustainable 
Development 
Goals 
(SDGs)/Agenda 2030. The resolutions also call for 
an increased focus on social determinants to tackle 
the root causes of fistula. 
(8) Obstetric fistula can be surgically treated. 
The impact of an obstetric fistula-repair surgery is 
immediate and women can be reintegrated into soci-
ety. There is however a high unmet need for treat-
ment and social reintegration of fistula survivors. 
(9) The Covid–19 pandemic caused overloaded 
health systems and reallocation of human and finan-
cial resources with disruptions to services resulting 
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in an undermining of the sexual and reproductive 
health and rights of women and girls. In 2020, fis-
tula repairs were widely halted or slowed down due 
to Covid–19, as they were deemed non-urgent and 
unsafe during the pandemic. This may result in an 
increased backlog of fistula cases. 
(10) The United Nations Population Fund 
(UNFPA)-led global Campaign to End Fistula, is a 
key contributor to promoting the rights, dignity, and 
well-being of women and girls. The Campaign fo-
cuses on prevention, treatment, social reintegration, 
and advocacy. Aimed at ‘‘leaving no one behind’’ and 
‘‘reaching the furthest behind’’, it contributes to 
achieving the SDGs and has also helped restore 
overall health, dignity, hope, and a sense of self- 
worth and agency to some of the poorest, most 
marginalized women and girls worldwide through its 
holistic, gender-sensitive, and rights-based approach 
to policies and programs for the elimination of ob-
stetric 
fistula 
and 
several 
other 
maternal 
morbidities. 
(11) UNFPA has supported over 1140,000 sur-
gical repairs over the last two decades. The Cam-
paign to End Fistula and its partners has made re-
markable progress, but the needs remain great. 
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(12) With 8 years to reach the global goal of 
ending fistula by 2030, significantly intensified in-
vestment, efforts, and partnerships at the inter-
national and national levels are required. 
(13) The International Day to End Obstetric 
Fistula which takes place on May 23, 2024, will be 
commemorated this year with the theme: ‘‘Breaking 
the Cycle: Preventing Fistula Worldwide’’, calling 
for investments to improve the quality of care and 
emphasizing the key role of communities in address-
ing social, cultural, political, and economic deter-
minants that impact maternal health and sexual re-
productive health, and reproductive rights. 
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-
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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’’. 
(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 
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expertise in geographical areas in which child-
birth-related injuries are most prevalent. 
(2) TRAINING
CENTERS.—Establishment of 
training centers— 
(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: 
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(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. 
(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 
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(B) access to obstetrician-gynecologists 
(OB–GYNs), urogynecology care, or midwifery 
care. 
(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. 
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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 
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— 
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(A) is a low-income country; and 
(B) according to the United Nations Eco-
nomic Analysis and Policy Division, is con-
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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