163
‘‘SEC. 478. STANDBY GUARDIANSHIP LAWS AND PROCE-
DURES.
‘‘To be eligible for payments under this part, a State
must have in effect laws and procedures that permit any
parent who is chronically ill or near death, without surren-
dering parental rights, to designate a standby guardian
for the parent’s minor children, whose authority would
take effect upon—
‘‘(1) the death of the parent;
‘‘(2) the mental incapacity of the parent; or
‘‘(3) the physical debilitation and consent of the
parent.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall take effect at the end of the first cal-
endar quarter that begins 60 or more months after the
date of the enactment of this Act, and shall apply to pay-
ments under part E of title IV of the Social Security Act
for the quarter and payments made under such part for
any succeeding quarter.
Subtitle M—Federal Prohibition of
Female Genital Mutilation Act
of 1993
SEC. 261. SHORT TITLE.
This subtitle may be cited as the ‘‘Federal Prohibi-
tion of Female Genital Mutilation Act of 1993’’.
164
SEC. 262. TITLE 18 AMENDMENT.
(a) IN GENERAL.—Chapter 7 of title 18, United
States Code, is amended by adding at the end the follow-
ing new section:
‘‘§ 116. Female genital mutilation
‘‘(a) Except as provided in subsection (b), whoever
knowingly circumcises, excises, or infibulates the whole or
any part of the labia majora or labia minora or clitoris
of another person who has not attained the age of 18 years
shall be fined under this title or imprisoned not more than
5 years, or both.
‘‘(b) A surgical operation is not a violation of this
section if the operation is—
‘‘(1) necessary to the health of the person on
whom it is performed, and is performed by a person
licensed in the place of its performance as a medical
practitioner; or
‘‘(2) performed on a person in labor or who has
just given birth and is performed for medical pur-
poses connected with that labor or birth by a person
licensed in the place it is performed as a medical
practitioner, midwife, or person in training to be-
come such a practitioner or midwife.
‘‘(c) In applying subsection (b)(1), no account shall
be taken of the effect on the person on whom the operation
is to be performed of any belief on the part of that or
165
any other person that the operation is required as a mat-
ter of custom or ritual.
‘‘(d) Whoever knowingly denies to any person medical
care or services or otherwise discriminates against any
person in the provision of medical care or services, be-
cause—
‘‘(1) that person has undergone female cir-
cumcision, excision, or infibulation; or
‘‘(2) that person has requested that female cir-
cumcision, excision, or infibuation be performed on
any person;
shall be fined under this title or imprisoned not more than
one year, or both.’’.
(b) CLERICAL AMENDMENT.—The table of sections
at the beginning of chapter 7 of title 18, United States
Code, is amended by adding at the end the following new
item:
‘‘116. Female genital mutilation.’’.
SEC. 263. EDUCATION AND OUTREACH.
The Secretary of Health and Human Services shall
carry our appropriate education, preventive, and outreach
activities in communities that traditionally practice female
circumcision, excision, or infibulation, to inform people in
those communities about the health risks and emotional
trauma inflicted by those practices, and to inform them
166
and the medical community about the provisions of section
262.
SEC. 264. EFFECTIVE DATES.
Section 263 shall take effect immediately, and the
Secretary of Health and Human Services shall commence
carrying it out not later than 90 days after the date of
the enactment of this Act. Section 262 shall take effect
180 days after the date of the enactment of this Act.
Subtitle N—Smoking Prevention
and Cessation in WIC Clinics Act
SEC. 266. SHORT TITLE.
This subtitle may be cited as the ‘‘Smoking Preven-
tion and Cessation in WIC Clinics Act’’.
SEC. 267. SMOKING CESSATION DEMONSTRATION PRO-
GRAMS FOR WIC PARTICIPANTS.
Section 17(e) of the Child Nutrition Act of 1966 (42
U.S.C. 1786(e)) is amended—
(1) by redesignating paragraphs (3) (the second
place it appears), (4), and (5) as paragraphs (4)
through (6), respectively; and
(2) by adding at the end the following new
paragraph:
‘‘(7)(A) The State agency shall ensure that each local
agency operating the program under this section—
167
‘‘(i) establishes and carries out an on-site smok-
ing cessation demonstration program for pregnant
participants on a voluntary basis; and
‘‘(ii) educates all participants about the adverse
health effects of cigarette smoking.
‘‘(B) The program described in subparagraph (A)(i)
shall—
‘‘(i) be provided to participants during regular
visits to the clinic;
‘‘(ii) be incorporated into the program under
this section;
‘‘(iii) include a public information and edu-
cation component, which shall include the dissemina-
tion of risk information and materials relating to the
adverse health effects of cigarette smoking during
pregnancy; and
‘‘(iv) include a self-monitoring component,
which shall include—
‘‘(I) one-on-one counseling designed to help
participants quit smoking; and
‘‘(II) the utilization of a process whereby
the participant develops and signs, and a rep-
resentative from the local agency and an indi-
vidual chosen by the participant also sign, a
written statement containing a promise by the
168
participant to quit smoking beginning on a cer-
tain date.
‘‘(C)(i) The State agency shall ensure that each local
agency operating the program under this section submits
to such State agency an annual report containing a de-
scription and evaluation of the program established and
carried out by such local agency, including a description
of the total number of participants receiving services
under such program and the success rate of such partici-
pants in quitting smoking. The State agency shall compile
such reports into 1 annual report and submit such report
to the Secretary.
‘‘(ii) The Secretary shall submit to the Congress an
annual report containing—
‘‘(I) a compilation of the information contained
in the reports received by the Secretary from each
State agency under clause (i); and
‘‘(II) an evaluation of the effectiveness of the
smoking cessation demonstration programs.’’.
Subtitle O—Family and Medical
Leave Health Care Reform Res-
olution of 1993
SEC. 271. SHORT TITLE.
This subtitle may be cited as the ‘‘Family and Medi-
cal Leave Health Care Reform Resolution of 1993’’.
169
SEC. 272. FINDINGS.
The Congress finds that—
(1) the number of single-parent and 2-parent house-
holds in which the single parent or both parents work is
increasing significantly;
(2) it is important for the development of chil-
dren and the family unit that fathers and mothers
be able to participate in early childrearing and the
care of family members who have serious health con-
ditions;
(3) the lack of employment policies to accom-
modate working parents can force individuals to
choose between job security and parenting;
(4) there is inadequate job security for employ-
ees who have serious health conditions that prevent
them from working for temporary periods;
(5) due to the nature of the roles of men and
women in the society of the United States, the pri-
mary responsibility for family caretaking often falls
on women, and such responsibility affects the work-
ing lives of women more than it affects the working
lives of men;
(6) more than 70 percent of women with school-
aged children and 56 percent of women with pre-
school-aged children work outside the home;
170
(7) employment standards that apply only to 1
gender have serious potential for encouraging em-
ployers to discriminate against employees and appli-
cants for employment who are of the gender;
(8) numerous bills to reform the health insur-
ance system in the United States have been intro-
duced in the Senate and the House of Representa-
tives;
(9) several of the bills, if they were enacted,
would significantly alter the existing health insur-
ance system; and
(10) granting employees family and temporary
medical leave as part of a reform of the health in-
surance system promises to improve both the preven-
tion and cure of serious health conditions by avert-
ing undue stress on the part of employees and per-
mitting them personally to attend to family members
who have such conditions.
SEC. 273. SENSE OF CONGRESS.
It is the sense of the Congress that any bill to address
the ongoing and unmet health insurance needs of the peo-
ple of the United States that is enacted should require
that paid or unpaid leave, as detailed in the Family and
Medical Leave Act of 1993, be incorporated as a basic or
171
elective option for plan participants for 1 or more of the
following:
(1) Because of the birth of a son or daughter
of an employee and in order to care for the son or
daughter.
(2) Because of the placement of a son or
daughter with an employee for adoption or foster
care.
(3) In order to care for the spouse, or a son,
daughter, or parent, of an employee, if the spouse,
son, daughter, or parent has a serious health condi-
tion.
(4) Because of a serious health condition that
makes an employee unable to perform the functions
of the position of the employee.
Subtitle P—Veteran Women’s
Health Improvement Act of 1993
SEC. 276. SHORT TITLE.
This subtitle may be cited as the ‘‘Veteran Women’s
Health Improvement Act of 1993’’.
SEC. 277. WOMEN’S HEALTH SERVICES.
(a) WOMEN’S HEALTH SERVICES.—Section 1701 of
title 38, United States Code, is amended—
172
(1) in paragraph (6)(A)(i), by inserting ‘‘wom-
en’s health services,’’ after ‘‘preventive health serv-
ices,’’; and
(2) by adding at the end the following:
‘‘(10) The term ‘women’s health services’ means
health care services provided to women, including counsel-
ing and services relating to the following:
‘‘(A) Papanicolaou tests (pap smear).
‘‘(B) Breast examinations and mammography.
‘‘(C) Comprehensive reproductive health care,
including pregnancy-related care.
‘‘(D) The management of infertility.
‘‘(E) The management and prevention of sexu-
ally-transmitted diseases.
‘‘(F) Menopause, osteoporosis, and other condi-
tions relating to aging.
‘‘(G) Physical or psychological conditions aris-
ing out of acts of sexual violence.’’.
(b) CONTRACTS FOR WOMEN’S HEALTH SERVICES.—
Section 1703(a) of such title is amended by adding at the
end the following:
‘‘(9) Women’s health services for veterans on
an ambulatory or outpatient basis.’’.
173
(c) REPEAL OF SUPERSEDED AUTHORITY.—Section
106 of the Veterans Health Care Act of 1992 (Public Law
102–585; 38 U.S.C. 1710 note) is amended—
(1) by striking out subsection (a); and
(2) by striking out ‘‘(b) RESPONSIBILITIES OF
DIRECTORS
OF FACILITIES.—’’ before ‘‘The Sec-
retary’’.
(d) REPORT ON HEALTH CARE AND RESEARCH.—
Section 107(b) of such Act (38 U.S.C. 1710 note) is
amended—
(1) in paragraph (1), by inserting ‘‘and wom-
en’s health services (as such term is defined in sec-
tion 1701(10) of title 38, United States Code)’’ after
‘‘section 106 of this Act’’;
(2) in paragraph (2), by striking out ‘‘and (B)’’
and inserting in lieu thereof ‘‘(B) the type and
amount of services provided by such personnel, in-
cluding information on the numbers of inpatient
stays and the number of outpatient visits through
which such services were provided, and (C)’’;
(3) by redesignating paragraph (4) as para-
graph (7);
(4) by adding after paragraph (3) the following
new paragraphs:
174
‘‘(4) A description of the personnel of the De-
partment who provided such services to women vet-
erans, including the number of employees (including
both the number of individual employees and the
number of full-time employee equivalents) and the
professional qualifications or specialty training of
such employees and the Department facilities to
which such personnel were assigned.
‘‘(5) A description of any actions taken by the
Secretary to ensure the retention of the personnel
described in paragraph (4) and any actions under-
taken to recruit additional such personnel or person-
nel to replace such personnel.
‘‘(6) An assessment by the Secretary of any dif-
ficulties experienced by the Secretary in the furnish-
ing of such services and the actions taken by the
Secretary to resolve such difficulties.’’; and
(5) by adding after paragraph (7), as redesig-
nated by paragraph (3) of this subsection, the fol-
lowing:
‘‘(8) A description of the actions taken by the
Secretary to foster and encourage the expansion of
such research.’’.
175
SEC. 278. EXPANSION OF RESEARCH RELATING TO WOMEN
VETERANS.
(a) HEALTH RESEARCH.—Section 109(a) of the Vet-
erans Health Care Act of 1992 (Public Law 102–585; 38
U.S.C. 7303 note) is amended—
(1) by inserting ‘‘(1)’’ before ‘‘The Secretary’’;
(2) in paragraph (1), as so designated, by strik-
ing out ‘‘veterans who are women’’ and inserting in
lieu thereof ‘‘women veterans’’; and
(3) by adding at the end the following:
‘‘(2) In carrying out this section, the Secretary shall
consult with the following:
‘‘(A) The Director of the Nursing Service.
‘‘(B) Officials of the Central Office assigned re-
sponsibility for women’s health programs and sexual
trauma services.
‘‘(C) The members of the Advisory Committee
on Women Veterans established under section 542 of
title 38, United States Code.
‘‘(D) Members of appropriate task forces and
working groups within the Department of Veterans
Affairs (including the Women Veterans Working
Group and the Task Force on Treatment of Women
Who Suffer Sexual Abuse).
176
‘‘(3) The Secretary shall foster and encourage re-
search under this section on the following matters as they
relate to women:
‘‘(A) Breast cancer.
‘‘(B) Gynecological and reproductive health, in-
cluding gynecological cancer, infertility, sexually-
transmitted diseases, and pregnancy.
‘‘(C) Human Immunodeficiency Virus and Ac-
quired Immune Deficiency Syndrome.
‘‘(D) Mental health, including post-traumatic
stress disorder, depression, combat related stress,
and trauma.
‘‘(E) Diseases related to aging, including meno-
pause, osteoporosis, and Alzheimer’s Disease.
‘‘(F) Substance abuse.
‘‘(G) Sexual violence and related trauma.
‘‘(H) Exposure to toxic chemicals and other en-
vironmental hazards.
‘‘(4) The Secretary shall, to the maximum extent
practicable, ensure that personnel of the Department of
Veterans Affairs engaged in the research referred to in
paragraph (1) include the following:
‘‘(A) Personnel of the geriatric research, edu-
cation, and clinical centers designated pursuant to
section 7314 of title 38, United States Code.
177
‘‘(B) Personnel of the National Center for Post-
Traumatic Stress Disorder established pursuant to
section 110(c) of the Veterans Health Care Act of
1984 (Public Law 98–528; 98 Stat. 2692).
‘‘(5) The Secretary shall ensure that personnel of the
Department engaged in research relating to the health of
women veterans are advised and informed of such research
engaged in by other personnel of the Department.’’.
(b) INCLUSION
OF WOMEN
AND MINORITIES
IN
CLINICAL RESEARCH PROJECTS.—(1) In conducting or
supporting clinical research, the Secretary of Veterans Af-
fairs shall ensure that—
(A) women who are veterans are included as
subjects in each project of such research; and
(B) members of minority groups who are veter-
ans are included as subjects of such research.
(2) The requirement in paragraph (1) regarding
women and members of minority groups who are veterans
may be waived by the Secretary of Veterans Affairs 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—
(A) is inappropriate with respect to the health
of the subjects;
178
(B) is inappropriate with respect to the purpose
of the research; or
(C) is inappropriate under such other cir-
cumstances as the Secretary of Veterans Affairs may
designate.
(3) In the case of a project of clinical research in
which women or members of minority groups will under
paragraph (1) be included as subjects of the research, the
Secretary of Veterans Affairs shall ensure that the project
is designed and carried out so as to provide for a valid
analysis of whether the variables being tested in the re-
search affect women or members of minority groups, as
the case may be, differently than other persons who are
subjects of the research.
(c) POPULATION STUDY.—Section 110(a) of such Act
(38 U.S.C. 1710 note) is amended—
(1) in paragraph (1), by striking out the second
sentence; and
(2) by amending paragraph (3) to read as fol-
lows:
‘‘(3)(A) Subject to subparagraph (B), the study shall
be based on—
‘‘(i) an appropriate sample of veterans who are
women; and
179
‘‘(ii) an examination of the medical and demo-
graphic histories of the women comprising such sam-
ple.
‘‘(B) The sample referred to in subparagraph (A)
shall constitute a representative sampling (as determined
by the Secretary) of the ages, the ethnic, social and eco-
nomic backgrounds, the enlisted and officer grades, and
the branches of service of all veterans who are women.
‘‘(C) In carrying out the examination referred to in
subparagraph (A)(ii), the Secretary shall determine the
number of women of the sample who have used medical
facilities of the Department, nursing home facilities of or
under the jurisdiction of the Department, and outpatient
care facilities of or under the jurisdiction of the Depart-
ment.’’.
SEC. 279. MAMMOGRAPHY QUALITY STANDARDS.
(a) APPLICABILITY TO DEPARTMENT OF VETERANS
AFFAIRS OF MAMMOGRAPHY QUALITY STANDARDS ACT
OF 1992.—Subsections (a) through (k) of section 354 of
the Public Health Service Act (42 U.S.C. 263b) shall
apply with respect to facilities of the Department of Veter-
ans Affairs without regard to the last sentence of subpara-
graph (A) of subsection (a)(3) of such section.
(b) EXTENSION OF DEADLINES.—Any deadline for
the completion of any action prescribed under any provi-
180
sion referred to in subsection (a) shall be applied with re-
spect to facilities of the Department of Veterans Affairs
by extending such deadline so as to be two years after
the date of the enactment of this Act or two years after
the date which would otherwise be applicable under such
provision, whichever is later.
(c) INTERAGENCY COOPERATION.—The Secretary of
Veterans Affairs shall take appropriate steps to cooperate
with the Secretary of Health and Human Services in the
implementation of this section.
Subtitle Q—Defense Women’s
Health Improvement Act of 1993
SEC. 281. SHORT TITLE.
This subtitle may be cited as the ‘‘Defense Women’s
Health Improvement Act of 1993’’.
PART I—WOMEN’S HEALTH CARE
SEC. 282. 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:
181
‘‘§ 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 part 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.
182
‘‘(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. 283. 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-
ices and female covered beneficiaries eligible for health
care under chapter 55 of title 10, United States Code.
(b) CONTENTS.—The report required by subsection
(a) shall contain the following:
(1) A description of the medical personnel of
the Department of Defense who provided health-care
services during fiscal year 1993 to female members
and covered beneficiaries, including—
(A) the number of such personnel (includ-
ing both the number of individual employees
183
and the number of full-time employee equiva-
lents);
(B) the professional qualifications or spe-
cialty training of such personnel; and
(C) the medical facilities to which such
personnel were assigned.
(2) A description of any actions, including the
use of special pays and incentives, taken by the Sec-
retary during fiscal year 1993—
(A) to ensure the retention of the medical
personnel described in paragraph (1);
(B) to recruit additional personnel to pro-
vide health-care services to female members and
female covered beneficiaries; and
(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
184
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
185
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.
PART II—WOMEN’S HEALTH RESEARCH
SEC. 284. 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
186
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 group.
(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.
187
(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:
188
(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.
189
(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. 285. 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’’ .
190
SEC. 286. 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.
191
(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. 287. 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
192
legislation relating to such research) relating to such
female members and covered beneficiaries.
PART III—WOMEN’S HEALTH EDUCATION
SEC. 288. 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.
Subtitle 
R—International 
Popu-
lation Stabilization and Repro-
ductive Health Act
SEC. 291. SHORT TITLE.
This subtitle may be cited as the ‘‘International Pop-
ulation Stabilization and Reproductive Health Act’’.
SEC. 292. AUTHORITIES RELATING TO UNITED STATES POP-
ULATION ASSISTANCE.
Part I of the Foreign Assistance Act of 1961 is
amended—
193
(1) in section 104(b), by striking ‘‘on such
terms and conditions as he may determine’’ and in-
serting ‘‘in accordance with the provisions of chapter
12’’; and
(2) by adding at the end the following new
chapter:
‘‘CHAPTER 12—UNITED STATES
POPULATION ASSISTANCE
‘‘SEC. 499. DEFINITION.
‘‘For purposes of this chapter, the term ‘United
States population assistance’ means assistance provided
under section 104(b) of this Act.
‘‘SEC. 499A. CONGRESSIONAL FINDINGS.
‘‘The Congress makes the following findings:
‘‘(1) Throughout much of the world, the lack of
access of women, particularly poor women, to basic
reproductive health services and information under-
mines women’s struggle for self-determination, con-
tributes to death and suffering among women and
their children, puts pressure on the land, forests,
and other natural resources on which many poor
families depend for their survival, and in other ways
vitiates the efforts of families to lift themselves out
of the poverty in which over 1,000,000,000 of the
world’s more than 5,000,000,000 people live.
194
‘‘(2) During the 1980s, nearly 800,000,000
people, a number three times greater than the popu-
lation of the United States, were added to the
world’s population.
‘‘(3) Birthrates in many developing countries
are declining too slowly to prevent a near tripling of
the world’s population before stabilization can occur,
and although birthrates in some countries have de-
clined faster in recent years than anticipated, world
progress toward stabilization was noticeably slower
in the 1980s than in the 1970s.
‘‘(4) After more than a quarter century of expe-
rience and research, the actions needed to bring
about a rapid decline in birthrates are well docu-
mented. The ability to exercise reproductive choice
must be expanded, and such expansion should occur
through broader dissemination and choice of contra-
ceptive services that involve the community and are
sufficient to meet the needs and values of those who
use them.
‘‘(5) Although a number of religious and cul-
tural barriers to family planning remain, attitudes
toward modern contraception have changed over the
last decade, and in many countries a large and
growing unmet desire exists for deferring or prevent-
195
ing pregnancy among women and men who are too
poor to pay the full cost of services.
‘‘(6) Although many social and economic factors
affect desired family size, organized, accessible, and
affordable family planning programs have the most
rapid and strongest effect on birthrate because they
enable women and their families to determine the
timing and number of their children. Widespread
voluntary adoption of modern family planning meth-
ods and their successful long-term use depend on the
quality of reproductive health care services offered
and their responsiveness to individual and commu-
nity needs and values.
‘‘(7) Millions of women, most of them mothers,
are killed or injured each year as a result of unsafe
abortions. The availability of safe and effective fam-
ily planning methods and services can help prevent
many of these tragedies.
‘‘(8) The impact of human population growth,
combined with widespread poverty and unsustainable
patterns of natural resource consumption, is evident
in mounting signs of stress on the world’s environ-
ment, particularly in tropical deforestation, erosion
of arable land and watersheds, extinction of plant
196
and animal species, global climate change, waste
management, and air and water pollution.
‘‘(9) Traditionally, United States population as-
sistance has not focused on achieving specific goals
with respect to international population stabilization
or the expansion of reproductive choice. The absence
of clear goals in those areas has led to a lack of cri-
teria for allocating funds and evaluating program
success.
‘‘SEC. 499B. DECLARATION OF POLICY.
‘‘(a) IN GENERAL.—The Congress declares that to
reduce population growth and stabilize world population
at the lowest level feasible and thereby protect the global
environment, to provide greater self-determination for
women, and to improve the health and well-being of the
world’s families, a principal objective of the foreign policy
of the United States shall be to assist the international
community to—
‘‘(1) achieve universal availability of high qual-
ity family planning services through a wide choice of
safe and effective means of contraception, including
programs of public education and other health and
development efforts that enable individuals to choose
smaller families;
197
‘‘(2) ensure that all individuals and couples, re-
gardless of age or marital status, are able to exercise
their right to decide whether and how many children
to have and their right to reproductive health by im-
proving the quality and accessibility of accountable
family planning and reproductive health programs;
‘‘(3) improve reproductive health, especially of
women and young people, through maternal and
child health and nutrition services, and through sex-
uality and gender education services, especially for
young people; and
‘‘(4) achieve population stabilization at a level
consistent with the maintenance of the natural re-
source base and with investment in human re-
sources, within a broad strategy to adjust consump-
tion levels and patterns in all countries.
‘‘(b) FINANCIAL TARGETS.—The Congress estab-
lishes a target for global expenditures in developing coun-
tries from all domestic and international sources by the
year 2000 of at least $11,000,000,000 for population pro-
grams described in section 499C, and establishes a goal
for United States population assistance by the year 2000
of $1,400,000,000 in constant 1990 dollars, not including
funds available for other reproductive health programs.
198
‘‘SEC. 499C. AUTHORIZED ACTIVITIES.
‘‘United States population assistance is authorized to
provide—
‘‘(1) support for the expansion of quality, af-
fordable, voluntary family planning services, which
emphasize informed choice among a variety of safe
and effective family planning methods and closely re-
lated reproductive health care services, including the
prevention and control of sexually transmitted dis-
eases and reproductive tract infections;
‘‘(2) support for adequate and regular supplies
of quality contraceptive and other commodities, com-
prehensive counseling, appropriate followup, and
support for programs that emphasize the use of the
mass media to improve public knowledge of contra-
ceptive methods and related disease prevention
methods and where they may be obtained and to
promote the benefits of family planning and repro-
ductive health to individuals, families, and commu-
nities;
‘‘(3) support to United States and foreign re-
search institutions and other appropriate entities for
biomedical research to develop and evaluate im-
proved methods of safe and effective contraception
and related disease control, with particular emphasis
on methods which—
199
‘‘(A) are likely to be safer, easier to use,
easier to make available in developing country
settings, and less expensive than current
methods;
‘‘(B) are controlled by women, including
barrier methods and vaginal microbicides;
‘‘(C) are likely to prevent the spread of
sexually transmitted diseases; and
‘‘(D) encourage and enable men to take
greater responsibility for their own fertility;
‘‘(4) support for field research on the character-
istics of programs most likely to result in sustained
use of effective family planning in meeting each indi-
vidual’s lifetime reproductive goals, with particular
emphasis on the perspectives of family planning
users, including support for relevant social and be-
havioral research focusing on such factors as the
use, non-use, and unsafe or ineffective use of various
contraceptive and related-disease control methods;
‘‘(5) support for the development of new evalua-
tion techniques and performance criteria for family
planning programs, emphasizing the family planning
user’s perspective and reproductive goals;
‘‘(6) support for research and research dissemi-
nation related to population policy development, in-
200
cluding demographic and health surveys to assess
population trends, measure unmet needs, and evalu-
ate program impact, and support for policy-relevant
research on the relationships between population
trends, poverty, and environmental management, in-
cluding implications for sustainable agriculture,
agroforestry, biodiversity, water resources, energy
use, and local and global climate change;
‘‘(7) support for research and public informa-
tion dissemination on the health and welfare con-
sequences of unsafe abortions and for the equipment
and training necessary for the medical treatment of
the complications of unsafe abortions;
‘‘(8) support for special programs to reach ado-
lescents and young adults, regardless of marital sta-
tus, before they begin childbearing, including health
education programs which stress responsible parent-
hood and the health risks of unprotected sexual
intercourse, as well as service programs designed to
meet the information and contraception needs of
adolescents and young adults; and
‘‘(9) support for a broad array of governmental
and nongovernmental communication strategies de-
signed—
‘‘(A) to create public awareness worldwide;
201
‘‘(B) to generate a consensus on the need
to address reproductive health issues and the
problems associated with continued world popu-
lation growth;
‘‘(C) to emphasize the need to educate men
as well as women and mobilize their support for
reproductive rights and responsibilities; and
‘‘(D) to make family planning an estab-
lished community norm.
‘‘SEC. 499D. TERMS AND CONDITIONS.
‘‘United States population assistance is authorized to
be provided subject to the following conditions:
‘‘(1) Such assistance may only support, directly
or through referral, those activities which provide a
broad range of contraceptive methods permitted by
individual country policy and a broad choice of pub-
lic and private family planning services, including
networks for community-based and subsidized com-
mercial distribution of contraceptives.
‘‘(2) No program supported by United States
population assistance may deny an individual family
planning services because of such individual’s inabil-
ity to pay all or part of the cost of such services.
‘‘(3) Family planning services and related re-
productive health care services supported by United
202
States population assistance shall maintain the high-
est medical standards possible under local conditions
and shall ensure regular oversight of the quality of
medical care and other services offered.
‘‘(4) 
United 
States-supported 
reproductive
health programs shall in each recipient country sup-
port to the extent possible an integrated approach,
consistent with respect for the rights of women as
decisionmakers in matters of reproduction and sexu-
ality, for the provision of public and private repro-
ductive health services.
‘‘(5) United States population assistance pro-
grams shall furnish only those contraceptive drugs
and devices which have received approval for mar-
keting in the United States by the Food and Drug
Administration or which have been tested and deter-
mined to be safe and effective under research proto-
cols comparable to those required by the Food and
Drug Administration or have been determined to be
safe by an appropriate international organization or
the relevant health authority in the country to which
they are provided.
‘‘(6) Reproductive health services supported by
the United States shall be designed to take into ac-
count the needs of individuals and couples, including
203
the constraints on women’s time, by involving com-
munities, particularly representatives of women,
through appropriate training and recruitment ef-
forts, in the design, management, and ongoing eval-
uation of services. The design of such services shall
stress easy accessibility, by locating services as close
as possible to potential users, by keeping hours of
service convenient, and by improving communica-
tions between users and providers through commu-
nity outreach and involvement. The evaluation of re-
productive health services also shall not use as a
measure of program success the degree of longevity
or permanency of any contraceptive method.
‘‘(7) United States population assistance to ad-
olescent fertility programs shall be provided in the
context of prevailing norms and customs in the re-
cipient country.
‘‘(8) None of the funds made available by the
United States Government to foreign governments,
international organizations, or nongovernmental or-
ganizations may be used to coerce any person to un-
dergo contraceptive sterilization or involuntary abor-
tion or to accept any other method of fertility
control.
204
‘‘SEC. 499E. ELIGIBILITY FOR POPULATION ASSISTANCE.
‘‘(a) ELIGIBLE COUNTRIES.—Notwithstanding any
other provision of law, United States population assistance
shall be available, directly or through intermediary organi-
zations, to any country which the President determines
has met one or more of the following criteria:
‘‘(1) The country accounts for a significant pro-
portion of the world’s annual population increment.
‘‘(2) The country has significant unmet needs
for methods of contraception, prevention and treat-
ment of sexually transmitted diseases and acquired
immune deficiency syndrome (AIDS), and obstetric
and gynecological care, and requires foreign assist-
ance to directly implement, expand, or sustain qual-
ity reproductive health services for all its people.
‘‘(3) The country demonstrates a strong com-
mitment to population stabilization and to com-
prehensive 
reproductive 
health 
care 
strategies
through policies, programs and the commitment of
domestic funds to improve service and make services
more widely available.
‘‘(b) ELIGIBILITY OF NONGOVERNMENTAL AND MUL-
TILATERAL ORGANIZATIONS.—In determining eligibility
for United States population assistance, the President
shall not subject nongovernmental and multilateral organi-
zations to requirements which are more restrictive than
205
requirements applicable to foreign governments for such
assistance.
‘‘SEC. 499F. PARTICIPATION IN MULTILATERAL ORGANIZA-
TIONS.
‘‘(a) FINDING.—The Congress recognizes that the re-
cent attention in government policies toward population
stabilization owes much to the efforts of the United Na-
tions and its specialized agencies and organizations, par-
ticularly the United Nations Population Fund.
‘‘(b) AVAILABILITY OF FUNDS.—United States popu-
lation assistance shall be available for contributions to the
United Nations Population Fund in such amounts as the
President determines would be commensurate with United
States contributions to other multilateral organizations
and with the contributions of other donor countries.
‘‘(c) PROHIBITIONS.—(1) The prohibitions contained
in section 104(f) of this Act shall apply to the funds made
available for the United Nations Population Fund.
‘‘(2) No United States population assistance may be
available to the United Nations Population Fund unless
such assistance is held in a separate account and not com-
mingled with any other funds.
‘‘(3) No funds may be available for the United Na-
tions Population Fund unless the Fund agrees to prohibit
the use of those funds to carry out any program, project,
206
or activity that involves the use of coerced abortion or in-
voluntary sterilization.
‘‘(d) ALLOCATION OF FUNDS.—Of the funds made
available for United States population assistance, the
President shall make available for the Special Programme
of Research, Development and Research Training in
Human Reproduction for each of the fiscal years 1994 and
1995 an amount commensurate with the contributions of
the other donor countries for the purpose of furthering
international cooperation in the development and evalua-
tion of contraceptive technology.
‘‘SEC. 499G. SUPPORT FOR NONGOVERNMENTAL ORGANIZA-
TIONS.
‘‘(a) FINDINGS.—The Congress finds that—
‘‘(1) in many developing countries, nongovern-
mental entities, including private and voluntary or-
ganizations and private sector entities, such as the
International Planned Parenthood Federation and
the Planned Parenthood Federation of America, are
the most appropriate and effective providers of Unit-
ed States assistance to population and family plan-
ning activities; and
‘‘(2) in particular, organizations and groups
founded by women or in which women have signifi-
cant and meaningful participation, and which are
207
committed to promoting women’s reproductive health
rights through client-oriented programs and activi-
ties, have proven the most effective of all.
‘‘(b) PROCEDURES.—The President shall establish
simplified procedures for the development and approval of
programs to be carried out by nongovernmental organiza-
tions that have demonstrated—
‘‘(1) a capacity to undertake quality, effective,
client-oriented reproductive health and population
activities which encourage significant involvement by
private health practitioners, employer-based health
services, unions, and cooperative health organiza-
tions; and
‘‘(2) a commitment to quality, client-oriented
reproductive health care for women.
‘‘(c) PRIORITY FOR NONGOVERNMENTAL ORGANIZA-
TIONS.—The largest share of United States population as-
sistance made available for any fiscal year shall be made
available through United States and foreign nongovern-
mental organizations.
‘‘SEC. 499H. REPORTS TO CONGRESS.
‘‘The President shall prepare and submit to the Con-
gress, as part of the annual presentation materials on for-
eign assistance, a report on world progress toward popu-
208
lation stabilization and universal reproductive choice. The
report shall include—
‘‘(1) estimates of expenditures on the popu-
lation activities described in section 499C by na-
tional governments, donor agencies, and private sec-
tor entities;
‘‘(2) an assessment by country of the availabil-
ity and use of all methods of contraception and
abortion, whether lawful or unlawful in that country;
‘‘(3) an analysis by country and region of the
impact of population trends on a set of key social,
economic, political, and environmental indicators,
which shall be identified by the President in the first
report submitted pursuant to this section and ana-
lyzed in that report and each subsequent report; and
‘‘(4) a detailed statement of prior year and pro-
posed direct and indirect allocations of population
assistance, by country, which describes how each
country allocation meets the criteria set forth in this
section.’’.
SEC. 293. AUTHORIZATIONS OF APPROPRIATIONS.
Section 104(g)(1) of the Foreign Assistance Act of
1961 (22 U.S.C. 2151b(g)(1) is amended by amending
subparagraph (A) to read as follows:
209
‘‘(A) $725,000,000 for fiscal year 1994 and
$800,000,000 for fiscal year 1995 to carry out sub-
section (b) of this section; and’’.
SEC. 294. ECONOMIC AND SOCIAL DEVELOPMENT INITIA-
TIVES TO STABILIZE WORLD POPULATION.
(a) 
CONGRESSIONAL
FINDINGS.—The 
Congress
makes the following findings:
(1) Women represent 50 percent of the world’s
human resource potential. Therefore, improving the
health, social, and economic status of women and in-
creasing their productivity are essential for economic
progress in all countries.
(2) Throughout the world, women who partici-
pate in the social, economic, and political affairs of
their communities are more likely to exercise their
choice about childbearing than women who do not
participate in such activities.
(3) Effective economic development strategies
address issues such as infant and child survival
rates, educational opportunities, especially literacy
programs, for girls and women, and gender equality
in development.
(4) Comprehensive population stabilization ef-
forts which include both family planning services
and economic development activities achieve lower
210
birth rates and stimulate more development than
those which pursue these objectives independently.
(5) The most powerful, long-term influence on
birthrates is education, especially educational attain-
ment among women. The education of women also
has a strong influence on other aspects of family
welfare, including child survival. World-wide statis-
tics, however, indicate that the number of school-age
children, especially girls, not attending school is
growing annually.
(6) Each year, nearly 15,000,000 children
under the age of 5 die, most from preventable
causes. Wider availability of vaccines, simple treat-
ments for diarrheal disease and respiratory infec-
tions, and improved nutrition could prevent many of
these deaths.
(7) Each year, 500,000 or more women world-
wide die from complications related to pregnancy,
childbirth, or illegal abortion. Another 10 million
women annually suffer long-term illness or perma-
nent physical impairment from such causes.
(8) In many countries, high levels of mortality
and morbidity among women of childbearing age are
directly related to inadequate or inaccessible repro-
ductive health care services.
211
(9) Many women are their family’s principal
caregiver and chief source of economic support. The
death of a mother substantially increases the risk of
neglect, abandonment, or death for her young
children.
(10) Malnutrition and anemia are widespread
among poor women in their childbearing years, yet
the worldwide campaign to encourage breastfeeding
has devoted little attention to the nutritional needs
of nursing mothers, or in the improvement of nutri-
tional and health levels of women in general.
(11) During the 1990s, women, especially in
Africa, face substantially increased risks of death or
disability from sexually transmitted diseases. During
the 1990s, more than 3,000,000 women in Africa
will die of the acquired immune deficiency syndrome
(AIDS), leaving more than 5,000,000 orphans.
(b) DECLARATION OF POLICY.—Congress declares
that, in order to further the United States foreign policy
objective of assisting the international community in
achieving universal availability of quality family planning
services and stabilizing world population, additional objec-
tives of the foreign policy of the United States shall be—
(1) to expand basic education opportunities for
girls and women;
212
(2) to reduce the gap between male and female
levels of literacy and between male and female levels
of primary and secondary school enrollment;
(3) to help ensure that women worldwide have
the opportunity to become equal partners with men
in the development of their societies;
(4) to reduce global maternal and infant mor-
tality rates; and
(5) to improve worldwide overall reproductive
health, maternal and child health status, and quality
of life.
(c) AUTHORIZED ACTIVITIES.—United States devel-
opment assistance shall be available, on a priority basis,
for—
(1) countries which either have adopted and im-
plemented, or have agreed to adopt and implement,
strategies to help ensure, by the year 2000—
(A) the completion of primary school edu-
cation by no less than 80 percent of the coun-
try’s primary school-age children;
(B) the reduction of adult illiteracy by at
least one-half the country’s 1990 level; and
(C) the elimination of the gap between
male and female levels of literacy and between
213
male and female levels of primary and second-
ary school enrollment;
(2) governmental and nongovernmental pro-
grams which, with respect to a targeted country, are
intended—
(A) to reduce significantly malnutrition
among the country’s children under 5 years of
age;
(B) to maintain immunizations against
childhood diseases for significant segments of
the country’s children; and
(C) to reduce the number of childhood
deaths in the country which result from diar-
rheal disease and acute respiratory infections;
(3) governmental and nongovernmental pro-
grams which are intended to increase women’s pro-
ductivity through improved access to appropriate
labor-saving technology, vocational training, and ex-
tension services and access to credit and child care;
and
(4) governmental and nongovernmental pro-
grams which are intended to increase the access of
girls and women to comprehensive reproductive
health care services pursuant to subsection (d).
214
(d) SAFE MOTHERHOOD INITIATIVE.—(1)(A) The
President is authorized to establish a grant program, to
be known as the Safe Motherhood Initiative, to help im-
prove the access of girls and women worldwide to com-
prehensive reproductive health care services.
(B) Such program shall be carried out in accordance
with this section and shall be subject to the same terms,
conditions, prohibitions, and restrictions as are applicable
to assistance made available under sections 499D, 499E,
and 499F of the Foreign Assistance Act of 1961.
(2) Eligible for assistance under this section are com-
prehensive reproductive health programs which empha-
size—
(A) contraceptive services;
(B) prenatal care and screening for high risk
pregnancies, and improved access to safe delivery
services for women with high risk pregnancies;
(C) supplemental food programs for pregnant
and nursing women;
(D) expanded and coordinated programs to pre-
vent, detect, and treat sexually transmitted diseases,
including acquired immune deficiency syndrome
(AIDS), reproductive tract infections, and other
chronic reproductive health problems;
215
(E) programs to eliminate traditional practices
injurious to women’s health, including female genital
mutilation; and
(F) improvements in the practice of midwifery,
including outreach to traditional birth attendants.
(e) REPORTS TO CONGRESS.—(1) Not later than De-
cember 31, 1994, the President shall prepare and submit
to the Congress a report which includes—
(A) estimates of the total financial resources
needed to achieve, by the year 2000, the specific ob-
jectives set forth in subsection (c) with respect to
education, rates of illiteracy, malnutrition, immuni-
zation, maternal and child mortality and morbidity,
and improvements in the economic productivity of
women;
(B) an analysis of such estimates which sepa-
rately lists the total financial resources needed from
the United States, other donor nations, and non-gov-
ernmental organizations;
(C) an analysis, by country, which—
(i) identifies the legal, social, economic,
and cultural barriers to women’s self-determina-
tion and to improvements in the economic pro-
ductivity of women in traditional and modern
labor sectors; and
216
(ii) describes initiatives needed to develop
appropriate technologies for use by women,
credit programs for low-income women, ex-
panded child care, vocational training, and ex-
tension services for women; and
(D) a comprehensive description of—
(i) new and expanded initiatives to ensure
safe motherhood worldwide;
(ii) findings on the major causes of mortal-
ity and morbidity among women of childbearing
age in various regions of the world;
(iii) actions needed to reduce, by the year
2000, world maternal mortality by one-half of
the worldwide 1990 level; and
(iv) the financial resources needed to meet
this goal from the United States, other donor
nations, and nongovernmental organizations.
(2) In each annual country human rights report, the
Secretary of State shall include—
(A) information on any patterns within the
country of discrimination against women in in-
heritance laws, property rights, family law, ac-
cess to credit and technology, hiring practices,
formal education, and vocational training; and
217
(B) an assessment which makes reference
to all significant forms of violence against
women, including rape, domestic violence, and
female genital mutilation, the extent of involun-
tary marriage and childbearing, and the preva-
lence of marriage among women under the age
of 18 years.
(f) AUTHORIZATION OF APPROPRIATIONS.—(1) Of
the aggregate amounts available for United States devel-
opment and economic assistance programs for education
activities, $350,000,000 for fiscal year 1994 and
$350,000,000 for fiscal year 1995 shall be available only
for programs in support of equalizing male and female lev-
els of primary and secondary school enrollment.
(2) There are authorized to be appropriated
$405,000,000 for fiscal year 1994 and $490,000,000 for
fiscal year 1995 to the Child Survival Fund under section
104(c)(2) of the Foreign Assistance Act of 1961, which
amounts shall be available for child survival activities only,
including the Children’s Vaccine Initiative, the worldwide
immunization effort, and oral rehydration programs.
(3) There are authorized to be appropriated
$100,000,000 for the Safe Motherhood Initiative for each
of fiscal years 1994 and 1995.
(g) DEFINITIONS.—For purposes of this section—