I 
109TH CONGRESS 
1ST SESSION H. R. 4222 
To provide assistance to improve the health of newborns, children, and 
mothers in developing countries, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 3, 2005 
Ms. MCCOLLUM of Minnesota (for herself, Mr. SHAYS, Mrs. CHRISTENSEN, 
Ms. JACKSON-LEE
of Texas, Mr. MCGOVERN, Mr. LEACH, Ms. 
DELAURO, Mr. BERMAN, Mr. PAYNE, Mr. GRIJALVA, Mr. MCDERMOTT, 
Mr. SANDERS, Mr. HONDA, Mrs. MALONEY, Mr. CASE, Mr. MCNULTY, 
Mrs. JOHNSON of Connecticut, and Mr. LARSON of Connecticut) intro-
duced the following bill; which was referred to the Committee on Inter-
national Relations 
A BILL 
To provide assistance to improve the health of newborns, 
children, and mothers 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 ‘‘Child Health Invest-
ment for Long-term Development (CHILD and Newborn) 
Act of 2005’’.
SEC. 2. FINDINGS AND PURPOSES. 
(a) FINDINGS.—Congress finds the following: 
(1) Around the world, approximately 10.8 mil-
lion children under the age of five die each year, 
more than 30,000 per day, almost all in the devel-
oping world. 
(2) Each year in the developing world, four mil-
lion newborns die in their first four weeks of life. 
(3) Sub-Saharan Africa, with only 10 percent of 
the world’s population, accounts for 43 percent of all 
deaths among children under the age of five. 
(4) Countries such as Afghanistan, Angola and 
Niger experience extreme levels of child mortality, 
with 25 percent of children dying before their fifth 
birthday. 
(5) For children under the age of five in the de-
veloping world, preventable or treatable diseases, 
such as measles, tetanus, diarrhea, pneumonia, and 
malaria, are the most common causes of death. 
(6) Throughout the developing world, the lack 
of basic health services, clean water, adequate sani-
tation, and proper nutrition contribute significantly 
to child mortality. 
(7) Hunger and malnutrition contribute to over 
five million child deaths annually.
(8) The lack of low-cost antibiotics and anti- 
malarial drugs contribute to three million child 
deaths each year. 
(9) Lack of access to health services results in 
30 million children under the age of one year going 
without necessary immunizations. 
(10) Every year an estimated 250,000 to 
500,000 vitamin A-deficient children become blind, 
with one-half of such children dying within 12 
months of losing their sight. 
(11) Iron deficiency, affecting over 30 percent 
of the world’s population, causes premature birth, 
low birth weight, and infections, elevating the risk of 
death in children. 
(12) Two-thirds of deaths of children under five 
years of age, or 7.1 million children, including three 
million newborn deaths, could be prevented by low- 
cost, low-tech health and nutritional interventions. 
(13) 
Exclusive 
breastfeeding—giving 
only 
breast milk for the first six months of life—could 
prevent an estimated 1.3 million newborn and infant 
deaths each year, primarily by protecting against di-
arrhea and pneumonia.
(14) An additional two million lives could be 
saved annually by providing oral-rehydration therapy 
prepared with clean water. 
(15) During the 1990s, successful immuniza-
tion programs reduced polio by 99 percent, tetanus 
deaths by 50 percent, and measles cases by 40 per-
cent. 
(16) Between 1998 and 2000, distribution of 
low-cost vitamin A supplements saved an estimated 
one million lives. 
(17) Expansion of clinical care of newborns and 
mothers, such as clean delivery by skilled attendants, 
emergency obstetric care, and neonatal resuscitation, 
can avert 50 percent of newborn deaths. 
(18) Keeping mothers healthy is essential for 
child survival because illness, complications, or ma-
ternal death during or following pregnancy increases 
the risk for death in newborns and infants. 
(19) Each year more than 525,000 women die 
from causes related to pregnancy and childbirth, 
with 99 percent of these deaths occurring in devel-
oping countries. 
(20) The lifetime risk of an African woman 
dying from a complication related to pregnancy or
childbirth is 1 in 16, while the same risk for a 
woman in a developed country is 1 in 2,800. 
(21) Risk factors for maternal death in devel-
oping countries include early pregnancy and child-
birth, closely spaced births, infectious diseases, mal-
nutrition, and complications during childbirth. 
(22) Reducing maternal mortality requires birth 
spacing, access to preventive care, skilled birth at-
tendants, and emergency obstetric care. 
(23) The role of the United States in promoting 
child survival and maternal health over the past 
three decades has resulted in millions of lives being 
saved around the world. 
(24) In 2000, the United States joined 188 
other countries in supporting eight Millennium De-
velopment Goals designed to achieve ‘‘a more peace-
ful, prosperous and just world’’. 
(25) Two of the Millennium Development Goals 
call for a reduction in the mortality rate of children 
under the age of five by two-thirds and a reduction 
in maternal deaths by three-quarters by 2015. 
(26) On September 14, 2005, President George 
W. Bush stated before the leaders of the world: ‘‘To 
spread a vision of hope, the United States is deter-
mined to help nations that are struggling with pov-
erty. We are committed to the Millennium Develop-
ment Goals.’’. 
(b) PURPOSES.—The purposes of this Act are to— 
(1) authorize assistance to improve the health 
of newborns, children, and mothers in developing 
countries, including by strengthening the capacity of 
health systems and health workers; 
(2) develop and implement a strategy to im-
prove the health of newborns, children, and mothers, 
including reducing child and maternal mortality, in 
developing countries; 
(3) to establish a task force to assess, monitor, 
and evaluate the progress and contributions of rel-
evant departments and agencies of the Government 
of the United States in achieving the United Nations 
Millennium Development Goals by 2015 for reducing 
the mortality of children under the age of five by 
two-thirds and reducing maternal mortality by three- 
quarters in developing countries. 
SEC. 
3. 
ASSISTANCE 
TO 
IMPROVE 
THE 
HEALTH 
OF 
NEWBORNS, CHILDREN, AND MOTHERS IN 
DEVELOPING 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 104(c)— 
(A) by striking paragraphs (2) and (3); 
and 
(B) by redesignating paragraph (4) as 
paragraph (2); 
(2) by redesignating sections 104A, 104B, and 
104C as sections 104B, 104C, and 104D, respec-
tively; and 
(3) by inserting after section 104 the following 
new section: 
‘‘SEC. 104A. ASSISTANCE TO IMPROVE THE HEALTH OF 
NEWBORNS, CHILDREN, AND MOTHERS. 
‘‘(a) 
AUTHORIZATION.—Consistent 
with 
section 
104(c), the President is authorized to furnish assistance, 
on such terms and conditions as the President may deter-
mine, to improve the health of newborns, children, and 
mothers in developing countries. 
‘‘(b) ACTIVITIES SUPPORTED.—Assistance provided 
under subsection (b) shall, to the maximum extent prac-
ticable, be used to carry out the following activities: 
‘‘(1) Activities to strengthen the capacity of 
health systems in developing countries, including 
training for clinicians, nurses, technicians, sanitation 
and public health workers, community-based health
workers, midwives and birth attendants, peer edu-
cators, and private sector enterprises. 
‘‘(2) Activities to provide health care access to 
underserved and marginalized populations. 
‘‘(3) Activities to ensure the supply, logistical 
support, and distribution of essential drugs, vac-
cines, commodities, and equipment to regional, dis-
trict, and local levels. 
‘‘(4) Activities to educate underserved and 
marginalized populations to seek health care when 
appropriate, including clinical and community-based 
activities. 
‘‘(5) Activities to integrate and coordinate as-
sistance provided under this section with existing 
health programs for— 
‘‘(A) the prevention of the transmission of 
HIV from mother-to-child and other HIV/AIDS 
counseling, care, and treatment activities; 
‘‘(B) malaria; 
‘‘(C) tuberculosis; and 
‘‘(D) child spacing. 
‘‘(6) Activities to expand access to safe water 
and sanitation. 
‘‘(7) Activities to expand the use of and tech-
nical support for appropriate technology to reduce
acute respiratory infection from firewood smoke in-
halation. 
‘‘(c) GUIDELINES.—To the maximum extent prac-
ticable, programs, projects, and activities carried out using 
assistance provided under this section shall be— 
‘‘(1) carried out through private and voluntary 
organizations, as well as faith-based organizations, 
giving priority to organizations that demonstrate ef-
fectiveness and commitment to improving the health 
of newborns, children, and mothers; 
‘‘(2) carried out with input by host countries, 
including civil society and local communities, as well 
as other donors and multilateral organizations; 
‘‘(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 
of each year, the President shall transmit to Congress a 
report on the implementation of this section for the prior 
fiscal year. 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) AIDS.—The term ‘AIDS’ has the meaning 
given the term in section 104B(g)(1) of this Act.
‘‘(2) HIV.—The term ‘HIV’ has the meaning 
given the term in section 104B(g)(2) of this Act. 
‘‘(3) HIV/AIDS.—The term ‘HIV/AIDS’ has 
the meaning given the term in section 104B(g)(3) of 
this Act. ’’. 
(b) CONFORMING AMENDMENTS.—The Foreign As-
sistance Act of 1961 (22 U.S.C. 2151 et seq.) is amend-
ed— 
(1) in section 104(c)(2) (as redesignated by 
subsection (a)(1)(B) of this section), by striking 
‘‘and 104C’’ and inserting ‘‘104C, and 104D’’; 
(2) in section 104B (as redesignated by sub-
section (a)(2) of this section)— 
(A) in subsection (c)(1), by inserting ‘‘and 
section 104A’’ after ‘‘section 104(c)’’; 
(B) in subsection (e)(2), by striking ‘‘sec-
tion 104B, and section 104C’’ and inserting 
‘‘section 104C, and section 104D’’; and 
(C) in subsection (f), by striking ‘‘section 
104(c), this section, section 104B, and section 
104C’’ and inserting ‘‘section 104(c), section 
104A, this section, section 104C, and section 
104D’’;
(3) in subsection (c) of section 104C (as redes-
ignated by subsection (a)(2) of this section), by in-
serting ‘‘and section 104A’’ after ‘‘section 104(c)’’; 
(4) in subsection (c) of section 104D (as redes-
ignated by subsection (a)(2) of this section), by in-
serting ‘‘and section 104A’’ after ‘‘section 104(c)’’; 
and 
(5) in the first sentence of section 119(c), by 
striking ‘‘section 104(c)(2), relating to Child Sur-
vival Fund’’ and inserting ‘‘section 104A’’. 
SEC. 4. DEVELOPMENT OF STRATEGY TO IMPROVE THE 
HEALTH OF NEWBORNS, CHILDREN, AND 
MOTHERS IN DEVELOPING COUNTRIES. 
(a) DEVELOPMENT OF STRATEGY.—The President 
shall develop a comprehensive strategy to improve the 
health of newborns, children, and mothers, including re-
ducing newborn, child, and maternal mortality, in devel-
oping countries. 
(b) COMPONENTS.—The strategy developed pursuant 
to subsection (a) shall include the following: 
(1) Programmatic areas and interventions pro-
viding maximum health benefits to populations at 
risk as well as maximum reduction in mortality, in-
cluding—
(A) costs and benefits of programs and 
interventions; and 
(B) investments needed in identified pro-
grams and interventions to achieve the greatest 
results. 
(2) An identification of countries with priority 
needs for the five-year period beginning on the date 
of the enactment of this Act based on— 
(A) the neonatal mortality rate; 
(B) the mortality rate of children under 
the age of five; 
(C) the maternal mortality rate; 
(D) the percentage of women and children 
with limited or no access to basic health care; 
and 
(E) additional criteria for evaluation such 
as— 
(i) the percentage of one-year old chil-
dren who are fully immunized; 
(ii) the percentage of children under 
the age of five who sleep under insecticide- 
treated bed nets; 
(iii) the percentage of children under 
the age of five with fever treated with anti- 
malarial drugs;
(iv) the percentage of children under 
the age of five who are covered by vitamin 
A supplementation; 
(v) the percentage of children under 
the age of five with diarrhea who are re-
ceiving oral-rehydration therapy and con-
tinued feeding; 
(vi) the percentage of children under 
the age of five with pneumonia who are re-
ceiving appropriate care; 
(vii) the percentage of the population 
with access to improved sanitation facili-
ties; 
(viii) the percentage of the population 
with access to safe drinking water; 
(ix) the percentage of children under 
the age of five who are underweight for 
their age; 
(x) the percentage of births attended 
by skilled health care personnel; 
(xi) the percentage of women with ac-
cess to emergency obstetric care; 
(xii) the potential for implementing 
newborn, child, and maternal health inter-
ventions at scale; and
(xiii) the demonstrated commitment of 
countries to newborn, child, and maternal 
health. 
(3) A description of how United States assist-
ance complements and leverages efforts by other do-
nors, as well as builds capacity and self-sufficiency 
among recipient countries. 
(4) An expansion of the Child Survival and 
Health Grants Program of the United States Agency 
for International Development to provide additional 
support programs and interventions determined to 
be efficacious and cost-effective improving health 
and reducing mortality. 
(5) Enhanced coordination among relevant de-
partments and agencies of the Government of the 
United States engaged in activities to improve the 
health of newborns, children, and mothers in devel-
oping countries. 
(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.
SEC. 5. INTERAGENCY TASK FORCE ON CHILD SURVIVAL 
AND MATERNAL HEALTH IN DEVELOPING 
COUNTRIES. 
(a) ESTABLISHMENT.—There is established a task 
force to be known as the Interagency Task Force on Child 
Survival and Maternal Health in Developing Countries (in 
this section referred to as the ‘‘Task Force’’). 
(b) DUTIES.— 
(1) IN GENERAL.—The Task Force shall assess, 
monitor, and evaluate the progress and contributions 
of relevant departments and agencies of the Govern-
ment of the United States in achieving the Millen-
nium Development Goals by 2015 for reducing the 
mortality of children under the age of five by two- 
thirds and reducing maternal mortality by three- 
quarters in developing countries, including by— 
(A) identifying and evaluating programs 
and interventions that directly or indirectly con-
tribute to the reduction of child and maternal 
mortality rates; 
(B) assessing effectiveness of programs, 
interventions, and strategies toward achieving 
the maximum reduction of child and maternal 
mortality rates; 
(C) assessing the level of coordination 
among relevant departments and agencies of
the Government of the United States, the inter-
national community, international organiza-
tions, faith-based organizations, academic insti-
tutions, and the private sector; 
(D) assessing the contributions made by 
United States-funded programs toward achiev-
ing the Millennium Development Goals; 
(E) identifying the bilateral efforts of other 
nations and multilateral efforts toward achiev-
ing the Millennium Development Goals; and 
(F) preparing the annual report required 
by subsection (f). 
(2) CONSULTATION.—To the maximum extent 
practicable, the Task Force shall consult with indi-
viduals with expertise in the matters to be consid-
ered by the Task Force who are not officers or em-
ployees of the Government of the United States, in-
cluding representatives of United States-based non-
governmental organizations (including faith-based 
organizations and private foundations), academic in-
stitutions, private corporations, the United Nations 
Children’s Fund (UNICEF), and the World Bank. 
(c) MEMBERSHIP.— 
(1) NUMBER
AND
APPOINTMENT.—The Task 
Force shall be composed of the following members:
(A) The Administrator of the United 
States Agency for International Development. 
(B) The Assistant Secretary of State for 
Population, Refugees and Migration. 
(C) The Coordinator of United States Gov-
ernment Activities to Combat HIV/AIDS Glob-
ally. 
(D) The Director of the Office of Global 
Health Affairs of the Department of Health 
and Human Services. 
(E) The Under Secretary for Food, Nutri-
tion and Consumer Services of the Department 
of Agriculture. 
(F) The Chief Executive Officer of the Mil-
lennium Challenge Corporation. 
(G) The Director of the Peace Corps. 
(H) Other officials of relevant departments 
and agencies of the Federal Government who 
shall be appointed by the President. 
(2) CHAIRPERSON.—The Administrator of the 
United States Agency for International Development 
shall serve as chairperson of the Task Force. 
(d) MEETINGS.—The Task Force shall meet on a reg-
ular basis, not less often than quarterly, on a schedule 
to be agreed upon by the members of the Task Force, and
starting not later than 90 days after the date of the enact-
ment of this Act. 
(e) DEFINITION.—In this subsection, the term ‘‘Mil-
lennium Development Goals’’ means the key development 
objectives described in the United Nations Millennium 
Declaration, as contained in United Nations General As-
sembly Resolution 55/2 (September 2000). 
(f) REPORT.—Not later than 120 days after the date 
of the enactment of this Act, and not later than April 30 
of each year thereafter, the Task Force shall submit to 
Congress and the President a report on the implementa-
tion of this section. 
SEC. 6. 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, $660,000,000 for fiscal year 2007 and 
$1,200,000,000 for each of the fiscal years 2008 through 
2011. 
(b) AVAILABILITY
OF
FUNDS.—Amounts appro-
priated pursuant to the authorization of appropriations 
under subsection (a) are authorized to remain available 
until expended. 
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