I 
108TH CONGRESS 
2D SESSION 
H. R. 3810
To provide a United States voluntary contribution to the United Nations 
Population Fund only for the prevention, remedy, and repair of obstetric 
fistula. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 11, 2004
Mrs. MALONEY (for herself, Mr. TOWNS, Mr. CROWLEY, Mr. JACKSON of Illi-
nois, Mrs. CHRISTENSEN, Mrs. JONES of Ohio, Mr. SCOTT of Georgia, 
Mr. STARK, Mr. KENNEDY of Rhode Island, Ms. MCCOLLUM, Mr. 
ISRAEL, Mr. WAXMAN, Mr. DOGGETT, Mr. NADLER, Mr. EVANS, Mr. 
GRIJALVA, Mr. LANTOS, Ms. NORTON, Ms. JACKSON-LEE of Texas, Ms. 
SCHAKOWSKY, Ms. LEE, Mr. OWENS, Ms. MILLENDER-MCDONALD, Mrs. 
LOWEY, Ms. SLAUGHTER, and Ms. ROYBAL-ALLARD) introduced the fol-
lowing bill; which was referred to the Committee on International Rela-
tions 
A BILL 
To provide a United States voluntary contribution to the 
United Nations Population Fund only for the prevention, 
remedy, and repair of obstetric fistula.
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 ‘‘Repairing Young 
Women’s Lives Around the World Act’’.
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Every minute, 1 woman dies from preg-
nancy-related complications. 95 percent of these 
women live in Africa and Asia. 
(2) For every woman who dies from pregnancy-
related complications, 15 to 30 women survive but 
experience chronic disabilities. The worst is obstetric 
fistula which is caused when a woman who needs 
trained medical assistance for a safe delivery, includ-
ing Caesarian section, cannot get it. 
(3) Obstetric fistula is a hole that is formed be-
tween the bladder and the vagina, or the rectum and 
the vagina, after a woman suffers from prolonged 
obstructed labor. In the struggle to pass through the 
birth canal, the fetus puts constant pressure, some-
times for several days, on the bladder and vaginal or 
rectal wall, destroying the tissue and leaving a 
wound. 
(4) According to the Department of State: 
‘‘Pregnancy at an early age often leads to obstetric 
fistulae and permanent incontinence. [In Ethiopia], 
treatment is available at only 1 hospital in Addis 
Ababa that performs over 1,000 fistula operations a 
year. It estimates that for every successful operation 
performed, 10 other young women need the treat-
ment. The maternal mortality rate is extremely high 
due, in part, to food taboos for pregnant women, 
poverty, early marriage, and birth complications re-
lated to FGM [Female Genital Mutilation], espe-
cially infibulation.’’. 
(5) Obstetric fistula affects women who survive 
obstructed labor. 
(6) In nearly every case of obstetric fistula, the 
baby will be stillborn and the mother will have phys-
ical pain as well as social and emotional trauma 
from the loss of her child. 
(7) The physical symptoms of obstetric fistula 
include incontinence or constant uncontrollable leak-
ing of urine or feces, frequent bladder infections, in-
fertility, and foul odor. 
(8) The social consequences for women with ob-
stetric fistula include isolation and lack of oppor-
tunity, divorce or abandonment, ridicule and shame, 
inability to start a family, illness, and risk of vio-
lence. 
(9) Although data on obstetric fistula are 
scarce, the World Health Organization (WHO) esti-
mates there are more than 2,000,000 women living 
with fistula and 50,000 to 100,000 new cases each 
year.
(10) Obstetric fistula was once common 
throughout the world, but over the last century has 
been eradicated in Europe, North America, and 
other developed regions through improved medical 
care. 
(11) Obstetric fistula is fully preventable by 
having a trained medical attendant present during 
labor and childbirth, delaying early marriage and 
childbirth, and gaining access to family planning. 
(12) Obstetric fistula can also be surgically re-
paired. Surgery requires a specially trained surgeon 
and support staff, access to an operating theater 
and to attentive post-operative care. Success rates 
for surgical repair of fistula are close to 90 percent 
and cost between $100 and $400. 
(13) In 2003, the United Nations Population 
Fund (UNFPA) launched a global campaign to iden-
tify and address the incidence of obstetric fistula in 
Africa and Asia in an effort to develop a means to 
repair those who are suffering and provide the nec-
essary health services to prevent further cases. The 
campaign currently supports 20 countries in Africa 
and Asia and provides surgery to women, trains doc-
tors and nurses, equips hospitals, and undertakes 
community outreach to prevent further cases.
(14) The United States Government provided a 
voluntary contribution of $21,500,000 to UNFPA 
for fiscal year 2001 and the Administration’s budget 
request for fiscal year 2002 allocated $25,000,000 
for UNFPA. 
(15) The UNFPA is working in 89 countries to 
reduce maternal death and disability, including ob-
stetric fistula, through preventive, curative, and re-
habilitative methods. 
(16) In the winter of 2001, the Secretary of 
State submitted written testimony to the Committee 
on Foreign Relations of the Senate expressing sup-
port for the invaluable work of the UNFPA and for 
securing funding for the organization. 
(17) The United States Government, as part of 
its efforts to improve the dire health conditions of 
Afghan women, pledged in October 2001 an addi-
tional $600,000 to the UNFPA to address the re-
productive health care needs of Afghan refugees in 
surrounding nations and of internally displaced per-
sons within Afghanistan. 
(18) Congress demonstrated its strong bipar-
tisan support for a voluntary United States con-
tribution to the UNFPA of up to $34,000,000 in the 
Foreign Operations, Export Financing, and Related
Programs Appropriations Act, 2002, which was 
passed by the House of Representatives on a vote of 
357 to 66 and by the Senate by unanimous consent 
and signed into law (Public Law 107–115) by the 
President on January 10, 2002. However, the Presi-
dent decided not to obligate the funds. 
(19) In May 2002, the President sent a 3-per-
son delegation to investigate UNFPA programs in 
China and allegations that the agency was involved 
in coercive abortion practices. 
(20) This independent delegation concluded 
that such allegations were untrue. 
(21) On May 29, 2002, the delegation sent a 
letter to the Secretary of State stating the following: 
‘‘First Finding: We find no evidence that UNFPA 
has knowingly supported or participated in the man-
agement of a program of coercive abortion or invol-
untary sterilization in the PRC. First Recommenda-
tion: We therefore recommend that not more than 
$34,000,000 which has already been appropriated be 
released to UNFPA.’’. 
(22) Regrettably, the Administration overruled 
the recommendation of its own delegation and in-
voked an overly broad interpretation of the law in 
order to eliminate funding for UNFPA.
SEC. 3. UNITED STATES VOLUNTARY CONTRIBUTION TO 
THE UNITED NATIONS POPULATION FUND. 
Notwithstanding any other provision of law, in addi-
tion to amounts otherwise available to carry out the pur-
poses of chapter 3 of part 1 of the Foreign Assistance 
Act of 1961, there are authorized to be appropriated 
$34,000,000 for fiscal year 2004 and each subsequent fis-
cal year to be available only for United States voluntary 
contributions to the United Nations Population Fund 
(UNFPA) only for prevention, remedy, and repair of ob-
stetric fistula.
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