I
103D CONGRESS
1ST SESSION
H. R. 2715
To improve programs for women’s health in the Department of Defense.
IN THE HOUSE OF REPRESENTATIVES
JULY 22, 1993
Mrs. SCHROEDER (for herself, Mrs. LLOYD, Ms. FURSE, and Ms. HARMAN)
introduced the following bill; which was referred to the Committee on
Armed Services
A BILL
To improve programs for women’s health in the Department
of Defense.
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 ‘‘Defense Women’s
Health Improvement Act of 1993’’.
TITLE I—WOMEN’S HEALTH
CARE
SEC. 101. PRIMARY AND PREVENTIVE HEALTH-CARE SERV-
ICES FOR WOMEN.
(a) FEMALE MEMBERS AND RETIREES OF THE UNI-
FORMED SERVICES.—(1) Chapter 55 of title 10, United
States Code, is amended by inserting after section 1074c
the following new section:
‘‘§ 1074d. Primary and preventive health-care serv-
ices for women
‘‘Female members and former members of the uni-
formed services who are entitled to medical care under sec-
tion 1074 or 1074a of this title shall be furnished with
primary and preventive health-care services for women as
part of such medical care.’’.
(2) The table of sections at the beginning of such
chapter is amended by inserting after the item relating
to section 1074c the following new item:
‘‘1074d. Primary and preventive health-care services for women.’’.
(b) FEMALE DEPENDENTS.—Section 1077(a) of such
title is amended by adding at the end the following new
paragraph:
‘‘(13) Primary and preventive health-care serv-
ices for women.’’.
(c) DEFINITION.—Section 1072 of such title is
amended by adding at the end the following new para-
graph:
‘‘(6) The term ‘primary and preventive health-
care services for women’ means health-care services
provided to women, including counseling, relating to
the following:
‘‘(A) Papanicolaou tests (pap smear).
‘‘(B) Breast examinations and mammog-
raphy.
‘‘(C) Comprehensive reproductive health
care, including care related to pregnancy.
‘‘(D) Infertility and sexually transmitted
diseases, including prevention.
‘‘(E) Menopause.
‘‘(F) Physical or psychological conditions
arising out of acts of sexual violence.’’.
SEC. 102. REPORT ON THE PROVISION OF HEALTH-CARE
SERVICES TO WOMEN.
(a) REPORT REQUIRED.—The Secretary of Defense
shall prepare a report evaluating the provision of health-
care services through military medical treatment facilities
and the Civilian Health and Medical Program of the Uni-
formed Services to female members of the uniformed serv-
(C) to replace departing personnel who
provided such services.
(3) A description of any existing or proposed
programs to encourage specialization of health care
professionals in fields related to primary and preven-
tive health-care services for women.
(4) An assessment of any difficulties experi-
enced by military medical treatment facilities or the
Civilian Health and Medical Program of the Uni-
formed Services in furnishing primary and preven-
tive health-care services for women and a description
of those actions taken by the Secretary to resolve
such difficulties.
(5) An assessment of the extent to which gen-
der-related factors impede or complicate diagnoses
(such as inappropriate psychiatric referrals and ad-
missions) made by medical personnel described in
paragraph (1).
(6) A description of the actions taken by the
Secretary to foster and encourage the expansion of
research relating to health care issues of concern to
female members of the uniformed services and fe-
male covered beneficiaries.
(c) POPULATION STUDY OF THE NEED OF FEMALE
MEMBERS AND FEMALE COVERED BENEFICIARIES FOR
HEALTH-CARE SERVICES.—(1) As part of the report re-
quired by subsection (a), the Secretary shall conduct a
study to determine the needs of female members of the
uniformed services and female covered beneficiaries for
health-care services, including primary and preventive
health-care services for women.
(2) The study shall examine the health needs of cur-
rent members and covered beneficiaries and future mem-
bers and covered beneficiaries based upon the anticipated
size and composition of the Armed Forces in the year
2000 and should be based on the demographics of society
as a whole.
(d) SUBMISSION AND REVISION.—The Secretary of
Defense shall submit the report required by subsection (a)
to Congress not later than April 1, 1994. The Secretary
shall revise and resubmit the report to Congress not later
than April 1, 1999.
(e) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘primary and preventive health
care services for women’’ has the meaning given
such term in paragraph (6) of section 1072 of title
10, United States Code, as added by section 101(c)).
(2) The term ‘‘covered beneficiary’’ has the
meaning given such term in paragraph (5) of such
section.
TITLE II—WOMEN’S HEALTH
RESEARCH
SEC. 201. DEFENSE WOMEN’S HEALTH RESEARCH CENTER.
(a) ESTABLISHMENT OF THE CENTER.—The Sec-
retary of Defense shall establish a Defense Women’s
Health Research Center (hereinafter in this section re-
ferred to as the ‘‘Center’’) in the Department of the Army.
The Center shall be under the authority of the Army
Health Services Command.
(b) PURPOSES.—(1) The Center shall be the coordi-
nating agent for multidisciplinary and multiinstitutional
research within the Department of Defense on women’s
health issues related to service in the Armed Forces. The
Center shall be dedicated to development and application
of new knowledge, procedures, techniques, training, and
equipment for the improvement of the health of women
in the Armed Forces.
(2) In carrying out or sponsoring research studies,
the Center shall provide that the cohort of women in the
Armed Forces shall be considered as a control groups.
(3) The Center shall support the goals and objectives
recognized by the Department of Defense under the plan
of the Department of Health and Human Services des-
ignated as ‘‘Healthy People 2000’’.
(4) The Center shall support initiation and expansion
of research into matters relating to women’s health in the
military, including the following matters as they relate to
women in the military:
(A) Combat stress and trauma.
(B) Exposure to toxins and other environmental
hazards associated with military hardware.
(C) Psychology related stresses in warfare situ-
ations.
(D) Breast cancer.
(E) Reproductive health, including pregnancy.
(F) Gynecological cancers.
(G) Infertility and sexually transmitted dis-
eases.
(H) HIV and AIDS.
(I) Mental health, including post-traumatic
stress disorder and depression.
(J) Menopause, osteoporosis, Alzheimer’s dis-
ease, and other conditions and diseases related to
aging.
(K) Substance abuse.
(L) Sexual violence and related trauma.
(M) Human factor studies related to women in
combat.
(c) PREPARATION OF A PLAN.—The Secretary of De-
fense, acting through the Secretary of the Army and in
coordination with the other military departments, shall
prepare a plan for the implementation of this section. The
plan shall be submitted to the Committees on Armed Serv-
ices of the Senate and House of Representatives before
May 1, 1994.
(d) REQUIREMENTS RELATING TO ESTABLISHMENT
OF CENTER.—(1) The Secretary shall provide for the es-
tablishment of the Center at an existing Army facility.
(2) The Center may be established only at a facility
having the following characteristics:
(A) A physical plant immediately available to
serve as headquarters for the medical activities to be
carried out by the Center.
(B) Ongoing fellowship and residency programs
colocated with ongoing collaborative health-related
and interdisciplinary research of (i) a facility of the
Department of Veterans Affairs, (ii) an accredited
university with specialties in medical research and
clinical diagnostics, and (iii) a hospital owned and
operated by a municipality.
(C) A technologically modern laboratory capa-
bility at the site and at the affiliated sites referred
to in subparagraph (B), with the capability to in-
clude state-of-the-art clinical diagnostic instrumenta-
tion, data processing, telecommunication, and data
storage systems.
(D) Compatibility with and capability to effec-
tively expand its existing mission in accordance with
the mission of the Center under this section.
(E) Maximum multi-State geographic jurisdic-
tion to permit regional health-related issues to be re-
searched and integrated into national military
databases.
(F) An existing relationship for the provision of
services to Native Americans through the Indian
Health Service.
(e) ACTIVITIES FOR FISCAL YEAR 1994.—During fis-
cal year 1994, the Center shall address the following:
(1) Program planning, infrastructure develop-
ment, baseline information gathering, technology in-
fusion, and connectivity.
(2) Management and technical staffing.
(3) Data base development of health issues re-
lated to service on active duty as compared to serv-
ice in the National Guard or Reserves.
(4) Research protocols, cohort development,
health surveillance and epidemiologic studies.
SEC. 202. CONTINUATION OF ARMY BREAST CANCER RE-
SEARCH PROGRAM.
During fiscal year 1994, the Secretary of the Army
shall continue the breast cancer research program estab-
lished in the second and third provisos in the paragraph
in title IV of the Department of Defense Appropriations
Act, 1993 (Public Law 102–396; 106 Stat. 1890) under
the heading ‘‘RESEARCH, DEVELOPMENT, TEST, AND
EVALUATION, ARMY’’ .
SEC. 203. INCLUSION OF WOMEN AND MINORITIES IN CLIN-
ICAL RESEARCH PROJECTS.
(a) GENERAL RULE.—In conducting or supporting
clinical research, the Secretary of Defense shall ensure
that—
(1) women who are members of the Armed
Forces are included as subjects in each project of
such research; and
(2) members of minority groups who are mem-
bers of the Armed Forces are included as subjects
of such research.
(b) WAIVER AUTHORITY.—The requirement in sub-
section (a) regarding women and members of minority
groups who are members of the Armed Forces may be
waived by the Secretary of Defense with respect to a
project of clinical research if the Secretary determines that
the inclusion, as subjects in the project, of women and
members of minority groups, respectively—
(1) is inappropriate with respect to the health
of the subjects;
(2) is inappropriate with respect to the purpose
of the research; or
(3) is inappropriate under such other cir-
cumstances as the Secretary of Defense may des-
ignate.
(c) REQUIREMENT FOR ANALYSIS OF RESEARCH.—
In the case of a project of clinical research in which women
or members of minority groups will under subsection (a)
be included as subjects of the research, the Secretary of
Defense shall ensure that the project is designed and car-
ried out so as to provide for a valid analysis of whether
the variables being tested in the research affect women
or members of minority groups, as the case may be, dif-
ferently than other persons who are subjects of the re-
search.
SEC. 204. REPORT ON RESEARCH RELATING TO FEMALE
MEMBERS OF THE UNIFORMED SERVICES
AND FEMALE COVERED BENEFICIARIES.
Not later than July 1 of each of 1995, 1996, and
1997, the Secretary of Defense shall submit to Congress
a report containing—
(1) a description (as of May 31 of the year in
which the report is submitted) of the status of any
health research that is being carried out by or under
the jurisdiction of the Secretary relating to female
members of the uniformed services and female cov-
ered beneficiaries under chapter 55 of title 10, Unit-
ed States Code; and
(2) recommendations of the Secretary as to fu-
ture health research (including a proposal for any
legislation relating to such research) relating to such
female members and covered beneficiaries.
TITLE III—WOMEN’S HEALTH
EDUCATION
SEC. 301. WOMEN’S HEALTH CURRICULUM ADVISORY COM-
MITTEE.
The Secretary of Defense shall establish at the F.
Edward Hebert School of Medicine of the Uniformed Serv-
ices University of the Health Sciences a women’s health
curriculum advisory committee to promote the comprehen-
sive integration of women’s health issues into the curricu-
lum at the University. The committee shall include the
surgeon general of each of the military departments and
the dean of the School of Medicine. The committee shall
be established by April 1, 1994.
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