I 
111TH CONGRESS 
2D SESSION 
H. R. 5121 
To promote the sexual and reproductive health of individuals and couples 
in developing countries, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 22, 2010 
Ms. CLARKE (for herself, Ms. WOOLSEY, Mr. ELLISON, Mrs. MALONEY, Mr. 
STARK, Ms. CHU, Mrs. DAVIS of California, Ms. WATSON, Mr. GRIJALVA, 
Ms. KILPATRICK of Michigan, Ms. BALDWIN, Mrs. CAPPS, Mr. MOORE 
of Kansas, Ms. SCHAKOWSKY, Mr. COHEN, Mr. MEEK of Florida, Ms. 
LEE of California, and Ms. SLAUGHTER) introduced the following bill; 
which was referred to the Committee on Foreign Affairs 
A BILL 
To promote the sexual and reproductive health of individuals 
and couples 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 ‘‘Global Sexual and Re-
productive Health Act of 2010’’. 
SEC. 2. FINDINGS AND PURPOSES. 
(a) FINDINGS.—Congress makes the following find-
ings: 
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(1) The advancement of sexual and reproduc-
tive health is necessary to meeting most of the eight 
United Nations Millennium Development Goals 
(MDGs), the current international development 
framework developed by 189 countries in 2000, in-
cluding the United States. Target 5B, which is 
found under MDG 5 on improving maternal health 
and which requires achieving universal access to re-
productive health by the year 2015, is an essential 
element in attaining MDGs related to eradicating 
poverty (MDG 1), achieving universal education 
(MDG 2), promoting gender equality (MDG 3), re-
ducing child mortality (MDG 4), improving maternal 
health (MDG 5), combating HIV/AIDS (MDG 6), 
and ensuring environmental sustainability (MDG 7). 
(2) The report of the United Nations Secretary- 
General to the 2009 Commission on Population and 
Development ‘‘. . . reaffirms that population, repro-
ductive health and gender issues are central to devel-
opment and to the achievement of the Millennium 
Development Goals.’’. 
(3) Throughout much of the world, the lack of 
access of women, particularly poor women, to basic 
reproductive health services and information contrib-
utes to death and suffering among women and their 
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families, undermines women’s struggle for self-deter-
mination, and vitiates the efforts of families to lift 
themselves out of the poverty in which over a billion 
of the world’s people live. By allowing individuals 
and couples to choose the number and timing of 
their children, reproductive health care gives families 
and individuals greater control over their economic 
resources. 
(4) Aspects of sexual and reproductive health, 
including maternal mortality and morbidity, repro-
ductive cancers, and sexually transmitted infections 
(STIs), including HIV, account for nearly 20 per-
cent of the global burden of ill-health for women and 
some 14 percent for men, according to the World 
Health Organization (WHO). 
(5) Poor sexual and reproductive health is the 
leading cause of death and disability among women 
of child-bearing age. 
(6) School-based education and family planning 
play an interrelated role in lifting the status of 
women. Delaying sexual debut, along with contracep-
tive use among young women already sexually active, 
lowers the likelihood that young women will leave 
their schooling due to pregnancy, and education in-
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creases the chances that young women will delay the 
age at which they marry and give birth. 
(7) Sexual and reproductive health programs 
can empower women to make informed decisions and 
better control their lives, and by engaging men and 
boys in taking responsibility for the sexual and re-
productive health of their partners, can contribute to 
greater gender equality. 
(8) Access to sexual and reproductive health 
services, including family planning, has a direct and 
important impact on infant and child mortality. By 
allowing women to choose the timing, number, and 
spacing of their pregnancies, high-risk births are 
averted, and the children that are born have a great-
er chance of surviving to adulthood. Four million 
newborns die in the first four weeks of life, which 
accounts for 43 percent of all deaths of children 
under the age of 5. By providing women family plan-
ning services to space their births 3 years apart, 
rates for infant and under-5 mortality would drop by 
24 percent and 35 percent, respectively. 
(9) Increasing access to sexual and reproductive 
health could significantly decrease pregnancy-related 
mortality and morbidity by reducing the number of 
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pregnancies that place women at increased risk of 
experiencing such complications. 
(10) An estimated 215,000,000 women in devel-
oping countries have an unmet need for effective, 
modern contraceptives and would like to postpone 
childbearing, space births, or want no more children 
but are not using a modern method of contraception. 
Providing modern contraceptives to fill this unmet 
need would avert an estimated 53,000,000 unin-
tended pregnancies each year, thereby preventing 
150,000 women from dying of pregnancy-related 
complications, 600,000 children from losing their 
mothers, and 25,000,000 induced abortions. 
(11) Complications due to pregnancy and child-
birth are the leading cause of death among women 
ages 15 to 19. Each year, an estimated 550,000 
women worldwide die from complications related to 
pregnancy, childbirth, or unsafe abortion. Another 
50,000,000 women annually suffer long-term illness 
or permanent physical impairment from such causes. 
(12) Unsafe abortion accounts for 13 percent of 
maternal deaths worldwide. More than half of abor-
tions (55 percent) in the developing world are un-
safe. Of the 19,000,000 unsafe abortions that take 
place each year, most occur in the developing world. 
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Around 70,000 women die and millions more suffer 
serious injuries from the complications of unsafely 
performed abortions. Abortion rates are similar in 
countries whether abortion is illegal or legal. How-
ever, death and injury from unsafe abortion is great-
ly reduced where abortion is legal for a broad range 
of indications and where safe abortion is accessible. 
(13) Meeting the need for family planning serv-
ices and pregnancy-related care, by doubling the cur-
rent global investment for both, would reduce mater-
nal mortality by 70 percent and deaths to newborns 
by 44 percent. These goals can be achieved for 
$1,500,000,000 less than the cost of achieving ma-
ternal and newborn health alone. Every dollar in-
vested in family planning saves $1.40 in maternal 
and newborn health care services. 
(14) Worldwide, women of childbearing age ac-
count for more than half of people living with HIV/ 
AIDS. Integrating reproductive health services, in-
cluding family planning, with HIV prevention pro-
grams, such as those for voluntary counseling and 
testing and prevention of mother-to-child trans-
mission, is essential to effectively combating HIV/ 
AIDS and other STIs. 
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(15) The world is witnessing the largest genera-
tion of young people in history—almost half of the 
world’s population, some 3,000,000,000 people, is 
under the age of 25. Unmet need for sexual and re-
productive health services is highest among this age 
cohort. Fewer than 5 percent of the poorest sexually 
active youth use modern contraception. 
(16) The WHO has identified unsafe sex as the 
second most important risk factor for disability and 
death among young people in the world’s poorest 
communities. Forty-five percent of all new HIV in-
fections occur among young people. 
(17) Sixty percent of unsafe abortions in Afri-
ca, 42 percent in Latin America and the Caribbean, 
and 30 percent in Asia are performed on women 
under the age of 25. 
(18) The WHO has identified a 4-pronged ap-
proach to preventing HIV infection in infants, which 
includes prevention of unintended pregnancy among 
HIV-infected women as a key strategy to prevent 
mother-to-child transmission of HIV. 
(19) According to the United States Agency for 
International Development, enabling HIV-positive 
women who want to avoid a pregnancy with contra-
ceptive services can prevent an additional 55,000 
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child deaths and avert more than 150,000 unin-
tended pregnancies in high HIV prevalence coun-
tries. 
(20) Demographic factors exacerbate problems 
related to environmental sustainability. The past 
century of population growth has put increasing 
pressure on natural resources as the scale of human 
needs and activities expands. At the same time, ac-
tual family size in most developing countries remains 
greater than the desired family size. Access to family 
planning services helps couples to determine their 
own family size, hence mitigating the depletion of 
natural resources like clean water, air, and land. 
(21) Practices like early marriage, female gen-
ital mutilation, and early sexual debut adversely im-
pact the sexual and reproductive health of young 
people in many developing countries, and strong bar-
riers exist to providing the information, services, and 
other forms of support that young people need to 
lead healthy sexual and reproductive lives. 
(22) Comprehensive sexuality education seeks 
to help young people develop the interpersonal skills 
necessary for the formation of caring, supportive, 
and non-coercive relationships and the ability to ex-
ercise responsibility regarding sexual relationships 
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by addressing such issues as abstinence and the use 
of condoms, contraceptives, and other protective sex-
ual health measures. 
(23) The United Nations has estimated that the 
minimum financial requirements for sexual and re-
productive health, including family planning and ma-
ternal health, are roughly $23,500,000,000 in 2009 
and increase to approximately $33,000,000,000 in 
2015. The minimum financial requirement for HIV/ 
AIDS is estimated at $24,000,000,000 in 2009, and 
increases to $36,200,000,000 in 2015. As agreed in 
the International Conference on Population and De-
velopment’s Programme of Action, which the United 
States committed to, developed-country donors are 
responsible for one-third of the total cost needed per 
year. Developing countries are responsible for the re-
maining two-thirds. 
(24) The United States has had a history of 
supporting and recognizing the fundamental health 
and human rights of all people through the signing 
or ratifying of various international agreements. 
Those agreements include the Universal Declaration 
of Human Rights (1948), the International Cov-
enant on Civil and Political Rights (1966), the 
International Covenant on Economic, Social, and 
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Cultural Rights (1966), the Convention on the 
Elimination of All Forms of Discrimination Against 
Women (1979), the Convention on the Rights of the 
Child (1989), the International Conference on Popu-
lation and Development Programme of Action 
(1994), and the United Nations Millennium Devel-
opment Goals (2000). 
(25) The United States has been the largest 
donor to international family planning and reproduc-
tive health efforts over the last 40 years and has 
been an unparalleled source of leadership and inno-
vation in the field. Nonetheless, it has not met its 
fair share of financial assistance to global sexual and 
reproductive health programs. Now is the time to 
shore up the United States political and financial 
commitment in order to satisfy the large unmet need 
for these services, thereby helping to improve wom-
en’s sexual and reproductive health worldwide. 
(b) PURPOSES.—The purposes of this Act are to— 
(1) authorize assistance to improve the sexual 
and reproductive health of individuals and couples in 
developing countries; and 
(2) implement comprehensive sexual and repro-
ductive health programs offering a continuum of 
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care that are responsive to the sexual and reproduc-
tive health needs of young people and adults. 
SEC. 3. STATEMENT OF POLICY. 
The following shall be the policy of the United States 
Government: 
(1) All individuals and couples shall have the 
basic reproductive right to decide freely and respon-
sibly the number, spacing, and timing of their chil-
dren and shall have the information and means to 
do so, and the right to attain the highest standard 
of sexual and reproductive health. 
(2) All individuals and couples also shall have 
the right to make decisions concerning reproduction 
free of discrimination, coercion, and violence, as ex-
pressed in human rights documents. 
(3) The promotion of the responsible exercise of 
these reproductive rights for all people shall be the 
fundamental basis for sexual and reproductive health 
programs supported by United States Government 
assistance. 
(4) The principle of free and informed consent 
must underlie all sexual and reproductive health pro-
grams and services. This principle applies to individ-
uals whether they choose to continue or terminate 
their pregnancies—thus, forced pregnancies as well 
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as forced abortions or sterilizations are prohibited. 
Decisions relating to contraceptive use should be 
made on an informed and voluntary basis after ade-
quate information, counseling, and services are pro-
vided on a range of methods. 
(5) Incentives and disincentives should not be 
used in family planning programs in order to meet 
numerical population targets or quotas for fertility 
goals. Instead, governments should use other indica-
tors, such as unmet needs, to define family planning 
goals. 
(6) In sexual and reproductive health programs 
funded by the United States Government, special at-
tention should be paid to serving the needs of young 
people. 
SEC. 4. ASSISTANCE TO SUPPORT THE ACHIEVEMENT OF 
UNIVERSAL ACCESS TO SEXUAL AND REPRO-
DUCTIVE HEALTH. 
(a) ASSISTANCE AUTHORIZED.—The President is au-
thorized to provide assistance in order to support the 
achievement of universal access to sexual and reproductive 
health in developing countries and to ensure individuals 
and couples in developing countries can freely and respon-
sibly determine the number, timing, and spacing of their 
children and have the means to do so. 
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(b) ACTIVITIES SUPPORTED.—Assistance provided 
under subsection (a) may be used to— 
(1) expand access to and use of voluntary fam-
ily planning information and services, to enable indi-
viduals and couples to avoid unintended pregnancies 
and other risks to sexual and reproductive health, 
including those associated with pregnancy, reproduc-
tive tract infections, and sexually transmitted infec-
tions (STIs), including HIV; 
(2) improve public knowledge of contraceptives, 
including where methods may be obtained, and risk- 
reduction strategies, and to promote the benefits of 
family planning and other sexual and reproductive 
health care to individuals, families, and commu-
nities, including through the use of education and 
awareness programs, mass media, and community 
mobilization and outreach; 
(3) increase the responsiveness of sexual and 
reproductive health programs to the needs of the in-
tended beneficiaries during the entirety of their sex-
ual and reproductive lives, including young people 
and older adults; 
(4) reduce the incidence of unsafe abortion, in-
cluding research on the health consequences of un-
safe abortion, and provide for the equipment and 
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training necessary for medical treatment of the con-
sequences of unsafe abortions; 
(5) notwithstanding any other provision of law, 
provide safe abortion, to the extent permitted by the 
laws of the recipient country; 
(6) promote the integration of family planning 
services in HIV and other STI prevention, treat-
ment, care, and support; 
(7) integrate family planning services with ma-
ternal and newborn health care, especially in 
antenatal, post-partum, and post-abortion care set-
tings; 
(8) ensure the consistent availability and af-
fordability of high quality sexual and reproductive 
health supplies and services, including male and fe-
male condoms, for the prevention of HIV and other 
STIs; 
(9) encourage the abandonment of female gen-
ital mutilation, early marriage, early childbearing, 
and other harmful traditional practices that have 
negative reproductive health consequences; 
(10) prevent and repair obstetric fistula; 
(11) promote the constructive engagement of 
men and boys, the empowerment of women and 
girls, and more equitable gender norms in order to 
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improve health outcomes and support the adoption 
of healthy reproductive behaviors; 
(12) prevent and mitigate gender-based vio-
lence; 
(13) provide comprehensive sexuality education 
for young people; 
(14) prevent, diagnose, and treat, where appro-
priate, infertility and cancers of the reproductive 
system and refer as appropriate; 
(15) develop improved methods of safe and ef-
fective contraception and related disease control 
through investments in biomedical research, with 
particular emphasis on methods which— 
(A) are likely to be safer, easier to use, 
more efficient to make available in developing 
country settings, and less expensive than cur-
rent methods; 
(B) are controlled by women, including 
barrier methods and microbicides; 
(C) are likely to prevent the spread of 
STIs; and 
(D) encourage and enable men to take 
greater responsibility for their own fertility and 
the protection of their partner; 
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