I 
109TH CONGRESS 
1ST SESSION H. R. 4188 
To amend the Foreign Assistance Act of 1961 to improve voluntary family 
planning programs in developing countries, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 1, 2005 
Ms. MCCOLLUM of Minnesota (for herself, Mr. RAMSTAD, Mr. OBERSTAR, and 
Mr. SHAYS) introduced the following bill; which was referred to the Com-
mittee on International Relations 
A BILL 
To amend the Foreign Assistance Act of 1961 to improve 
voluntary family planning programs in developing coun-
tries, 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 ‘‘Focus on Family 
Health Worldwide Act of 2005’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Since 1965, the people and Government of 
the United States have supported international vol-
untary family planning programs, increasing the use 
of modern contraceptives in the developing world 
from fewer than 10 percent of couples in 1965 to 
more than 40 percent of couples today. 
(2) United States funding for international 
family planning is today providing services to 20 
million couples in the world’s poorest countries, con-
tributing to family well-being by improving maternal 
health, reducing maternal and infant deaths, pre-
venting abortions, and improving the lives of millions 
of families. 
(3) The United States spends on average three 
cents per American per week for international family 
planning programs. 
(4) In the developing world, the use of modern 
contraceptives reduces unintended pregnancies and 
the probability that a woman will have an abortion 
by 85 percent. 
(5) President George W. Bush has stated that 
one of the best ways to prevent abortion is by pro-
viding quality voluntary family planning programs. 
(6) In developing countries at least 120 million 
married couples who would like to postpone their 
next pregnancy, or have no more children, do not
have access to or are not using modern contracep-
tion. 
(7) In sub-Saharan Africa, 46 percent of 
women who desire to delay or end childbearing re-
main without access to voluntary family planning 
and at risk of unintended pregnancy. 
(8) Each year more than 525,000 women die 
from causes related to pregnancy and childbirth with 
99 percent of these deaths occurring in developing 
countries. An additional eight million women each 
year suffer serious health complications from preg-
nancy and childbirth. 
(9) A lack of birth spacing resulting in birth in-
tervals of 9 to 14 months increases the risk of ma-
ternal death by 250 percent. 
(10) Birth spacing of at least 36 months is as-
sociated with the lowest mortality risk for infants 
and children under five years of age. 
(11) Approximately 10.8 million children under 
the age of five die each year, more than 30,000 
every day, frequently from low birth-weight or from 
causes related to complications in the mother’s preg-
nancy. 
(12) Providing access to modern contraception 
in less developed countries could prevent 1.4 million
infant deaths and 142,000 maternal deaths annu-
ally. 
(13) Linking family planning programs with 
HIV/AIDS prevention, care, and treatment pro-
grams helps to meet the multiple health needs of 
couples while effectively using scarce financial and 
human resources. 
(14) For HIV-positive women, family planning 
is the most efficacious and cost-effective intervention 
to prevent unintended pregnancies, decrease the risk 
of maternal death, and avoid the transmission of 
HIV from mother-to-child, premature birth, low 
birth weight, or infant death. 
(15) Rapid population growth over-stresses vital 
resources, such as water, agricultural land, forests, 
and wildlife, contributing to extreme poverty, infec-
tious disease, limited access to education, environ-
mental destruction, food insecurity, and resultant 
malnutrition. 
(16) Malnutrition in children is a contributing 
factor to more than one-half of all child mortality, 
and malnutrition in mothers account for a substan-
tial proportion of neonatal mortality. 
(17) United States-funded family planning pro-
grams have been successfully linked with the con-
servation of natural resources to ease growing popu-
lation pressures, improve food security, and keep 
families healthy and communities economically via-
ble. 
(18) Between 2005 and 2050, if family plan-
ning needs remain unmet, the population is expected 
to grow by more than 300 percent in the developing 
countries of Afghanistan, Burkina Faso, Burundi, 
Chad, the Democratic Republic of the Congo, the 
Republic of the Congo, Guinea-Bissau, Liberia, Mali, 
Niger, the Democratic Republic of Timor-Leste, and 
Uganda. 
SEC. 3. SENSE OF CONGRESS. 
It is the sense of Congress that it should be a United 
States policy objective to— 
(1) partner with developing countries to expand 
access to voluntary family planning programs and 
the supply of modern contraceptives in order to— 
(A) meet growing demand to allow couples 
to achieve their desired family size; 
(B) reduce maternal and child mortality; 
(C) reduce unintended pregnancies and re-
sulting abortions; 
(D) reduce the incidence of HIV trans-
mission from mother-to-child and extend the
lives of HIV-positive women thus reducing the 
number of orphaned children; 
(E) conserve vital natural resources, in-
cluding water, agricultural land, and forested 
lands; 
(F) improve food security; and 
(G) enhance opportunities for lasting social 
and economic development; and 
(2) strengthen public heath initiatives world-
wide by provide training, research, and services for 
a wide variety of modern contraceptives and family 
planning methods that are designed and imple-
mented based on— 
(A) community participation; 
(B) the needs and values of beneficiaries; 
and 
(C) adherence to the principles of vol-
untary participation and informed consent. 
SEC. 4. ASSISTANCE TO IMPROVE VOLUNTARY FAMILY 
PLANNING 
PROGRAMS 
IN 
DEVELOPING 
COUNTRIES. 
(a) AMENDMENTS.—Section 104(b) of the Foreign 
Assistance Act of 1961 (22 U.S.C. 2151b(b)) is amend-
ed—
(1) in the first sentence, by striking ‘‘In order 
to’’ and inserting the following: 
‘‘(1) IN GENERAL.—In order to’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(2) ASSISTANCE
TO
IMPROVE
VOLUNTARY 
FAMILY PLANNING PROGRAMS.— 
‘‘(A) IN GENERAL.—The President, acting 
through the Administrator of the United States 
Agency for International Development, is au-
thorized to provide assistance, on such terms 
and conditions as the President may determine, 
to improve voluntary family planning programs 
in developing countries. 
‘‘(B) ACTIVITIES SUPPORTED.—Assistance 
provided under subparagraph (A) shall, to the 
maximum extent practicable, be used to— 
‘‘(i) improve public knowledge of vol-
untary family planning programs, includ-
ing the availability of modern contracep-
tives and the health, economic, and natural 
resource benefits of voluntary family plan-
ning for individuals, families, and commu-
nities;
‘‘(ii) support a wide range of public 
and private voluntary family planning pro-
grams, including networks for community- 
based and subsidized commercial distribu-
tion of modern contraceptives; 
‘‘(iii) expand formal and informal 
training for health care providers, health 
educators, including peer educators and 
outreach workers, managers, traditional 
birth attendants, counselors, and commu-
nity-based distribution agents; 
‘‘(iv) provide improved coordination 
between voluntary family planning pro-
grams and programs that receive United 
States Government assistance for the pre-
vention of HIV/AIDS and other sexually 
transmitted infections, the prevention of 
mother-to-child HIV transmission, and the 
testing, treatment, and care of persons in-
fected with HIV/AIDS and affected by 
HIV/AIDS to strengthen activities under 
such programs and enhance the cost-effec-
tiveness of such programs; and 
‘‘(v) strengthen supply chain logistics 
for the procurement and reliable distribu-
tion of safe and effective modern contra-
ceptives, including coordination with the 
supply chain for HIV/AIDS prevention, 
care, and treatment, to allow for maximum 
efficiency and cost-savings. 
‘‘(C) PRIORITY.—In providing assistance 
under this paragraph, priority shall be given to 
developing countries with acute family planning 
and maternal health needs based on criteria 
such as— 
‘‘(i) the level of unmet need for vol-
untary family planning and modern contra-
ceptives; 
‘‘(ii) fertility rates; 
‘‘(iii) high-risk birth rates; 
‘‘(iv) the number of births unattended 
by skilled attendants; 
‘‘(v) maternal mortality rates; 
‘‘(vi) rates of mortality for infants 
and children under the age of five; 
‘‘(vii) abortion rates; 
‘‘(viii) the level of HIV/AIDS in 
women of reproductive age; and 
‘‘(ix) additional criteria or country 
conditions, such as conflict, humanitarian
crisis, large populations of refugees or in-
ternally displaced persons, or areas in 
which population growth threatens food se-
curity, vital natural resources, biodiversity, 
or endangered species. 
‘‘(D) DEFINITIONS.—In this paragraph: 
‘‘(i) AIDS.—The term ‘AIDS’ has the 
meaning 
given 
the 
term 
in 
section 
104A(g)(1) of this Act. 
‘‘(ii) HIV.—The term ‘HIV’ has the 
meaning 
given 
the 
term 
in 
section 
104A(g)(2) of this Act. 
‘‘(iii) HIV/AIDS.—The term ‘HIV/ 
AIDS’ has the meaning given the term in 
section 104A(g)(3) of this Act.’’. 
(b) EFFECTIVE DATE.—The authority to provide as-
sistance under section 104(b)(2) of the Foreign Assistance 
Act of 1961, as added by subsection (a), applies with re-
spect to fiscal year 2007 and subsequent fiscal years. 
SEC. 5. REPORT. 
(a) REPORT.—Not later than one year after the date 
of the enactment of this Act, and biennially thereafter, the 
President, acting through the Administrator of the United 
States Agency for International Development, shall trans-
mit to the Committee on International Relations of the
House of Representatives and the Committee on Foreign 
Relations of the Senate a report on the implementation 
of section 104(b)(2) of the Foreign Assistance Act of 1961 
(as added by section 4(a)). 
(b) CONTENTS.—The report shall include— 
(1) a description of efforts to implement the 
policies set forth in section 104(b)(2) of the Foreign 
Assistance Act of 1961; 
(2) a description of the programs established 
pursuant to such section; and 
(3) a detailed assessment of the impact of pro-
grams established pursuant to such section, includ-
ing— 
(A) an estimate of annual expenditures on 
modern contraceptive commodities and activities 
in support of voluntary family planning pro-
grams on a country-by-country basis, to be 
based on information supplied by national gov-
ernments, donor agencies, and private sector 
entities, to the maximum extent practicable; 
(B) an assessment by country of the cur-
rent unmet need for, availability, and use of 
modern contraception; 
(C) an assessment of prior year and pro-
posed allocations of modern contraceptives in
voluntary family planning assistance by coun-
try, which describes how each country’s alloca-
tion meets the country’s needs; and 
(D) a description of the quality of funded 
voluntary family planning programs, as meas-
ured by survey data or best available estimates, 
including— 
(i) types of modern contraceptive 
methods offered to significant subgroups 
(defined by age, gender, income, and 
health profile, among others) on a reliable 
basis; 
(ii) information provided to bene-
ficiaries to enable decision making regard-
ing benefits, risks, and efficacy of modern 
contraceptives; 
(iii) mechanisms to encourage sustain-
ability of voluntary family planning pro-
grams; and 
(iv) voluntary family planning pro-
grams that are effective in responding to 
individual health needs of beneficiaries.
SEC. 6. AUTHORIZATION OF APPROPRIATIONS. 
There are authorized to be appropriated to the Presi-
dent to carry out section 104(b)(2) of the Foreign Assist-
ance Act of 1961, as added by section 4(a) of this Act— 
(1) $600,000,000 for fiscal year 2007; 
(2) $700,000,000 for fiscal year 2008; 
(3) $800,000,000 for fiscal year 2009; 
(4) $900,000,000 for fiscal year 2010; and 
(5) $1,000,000,000 for fiscal year 2011. 
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