I 
112TH CONGRESS 
2D SESSION 
H. R. 5748 
To provide assistance to sub-Saharan Africa to combat obstetric fistula. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 15, 2012 
Ms. DELAURO (for herself, Mr. CARNAHAN, Ms. LEE of California, and Ms. 
MCCOLLUM) introduced the following bill; which was referred to the Com-
mittee on Foreign Affairs 
A BILL 
To provide assistance to sub-Saharan Africa to combat 
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 AND TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘United States Leadership to Eradicate Obstetric Fistula 
Act of 2012’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title and table of contents. 
Sec. 2. Findings. 
Sec. 3. Definitions. 
Sec. 4. Comprehensive, integrated, 10-year strategy to combat obstetric fistula 
in sub-Saharan Africa. 
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Sec. 5. Prevention, treatment, and monitoring of obstetric fistula in sub-Saha-
ran African countries. 
Sec. 6. United States Advisory Committee for the Eradication of Obstetric Fis-
tula. 
Sec. 7. Report. 
Sec. 8. Authorization of appropriations. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) Obstetric fistula is a catastrophic childbirth 
injury which arises as a complication of obstructed 
labor. 
(2) An estimated 2 to 3 million women cur-
rently are afflicted by the devastating physical and 
social effects of obstetric fistula—a scourge of epi-
demic proportions. As many as 130,000 new cases 
occur each year. 
(3) 
Historically, 
obstetric 
fistula 
affected 
women in the United States and around the world. 
Advances in obstetric care and access to improved 
surgical techniques resulted in a drastic reduction in 
obstetric fistula by the early 20th century in the 
United States. 
(4) Today, obstetric fistula primarily affects the 
poorest women in the poorest parts of the world. It 
disproportionately affects women in sub-Saharan Af-
rica and girls—some as young as 13 years old—who 
are subjected to child marriage and whose bodies are 
not fully capable of handling the demands of child-
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birth. Many of these young girls and women have 
been subjected to female genital mutilation, which 
can increase the risk for and be a direct cause of ob-
stetric fistula. 
(5) Obstetric fistula, which usually results in 
fetal death by asphyxia, occurs when the tissues that 
normally separate a woman’s vagina from her blad-
der or rectum are destroyed by prolonged pressure 
from the fetal head trapped in the birth canal. 
(6) Obstetric fistula typically occurs because a 
woman does not have access to emergency obstetric 
care or because she does not have the financial 
means, transportation, or access to surgical repair. 
(7) Left untreated, an obstetric fistula afflicts 
a woman with devastating physical conditions: incon-
tinence, painful ulcers, and constant and uncontrol-
lable emission of offensive odors. These symptoms 
leave a woman indelibly and perpetually stigmatized 
by her condition. 
(8) Because obstetric fistula does not heal on 
its own, women affected by this condition are 
marginalized for the remainder of their lives. Ex-
pelled from their communities and denied education 
and health care, obstetric fistula victims are left in 
desperate economic circumstances. 
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(9) Victims also suffer social ostracism that re-
sults in involuntary divorce, exclusion from religious 
activities, deepening poverty, malnutrition, deterio-
rating physical health, depression, and despair. As a 
result, victims are left defenseless and vulnerable. 
(10) This social isolation compounds already ex-
isting problems such as illiteracy and lack of eco-
nomic opportunities. 
(11) Because obstetric fistula are not them-
selves fatal, millions of women live with this horrific 
condition and have been overlooked by the inter-
national medical community. At present, humani-
tarian aid and nongovernmental programs treat fis-
tula cases on a small scale and are not equipped to 
systematically prevent, treat, and eradicate obstetric 
fistula. 
(12) Obstetric fistula can be prevented when 
women and their families are educated about the 
birthing process and are provided access to emer-
gency obstetric care. 
(13) Today, doctors can surgically repair ob-
stetric fistula with a low-cost, low-technology sur-
gery. 
(14) The impact of an obstetric fistula-repair 
surgery is immediate and consequential. Women can 
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be re-integrated into society and are afforded basic 
human necessities such as familial relationships, 
health care, and the opportunity to earn a living. 
(15) The prevention, treatment, and ultimately 
the eradication of obstetric fistula will advance the 
emancipation and empowerment of women, strength-
en families and communities, and improve the over-
all economic, educational, and social well-being of af-
fected societies. 
(16) Basic interventions to identify and repair 
obstetric fistula have achieved meaningful and cost- 
effective results. 
(17) The best available data suggests that ex-
isting programs can only repair 10 percent of new 
obstetric fistula cases each year, and less than 1 
percent of existing obstetric fistula cases are re-
paired each year. 
(18) The challenge is to expand existing pilot 
programs into a scalable, comprehensive, and sus-
tainable campaign to eradicate obstetric fistula. 
(19) Nongovernmental organizations with expe-
rience in obstetric care, surgery, and women’s rights 
have proven effective in making progress towards 
eliminating the scourge of obstetric fistula and can 
be a resource in assisting indigenous organizations 
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in severely afflicted countries in their efforts to treat 
and care for women with obstetric fistula. 
(20) The nature of obstetric fistula—and the 
fact that it affects vulnerable women in poor and 
isolated communities which offer little or no access 
to obstetric care—demands a comprehensive, coordi-
nated, long-term, international response focused on 
the prevention and treatment of obstetric fistula, in-
cluding— 
(A) safe-childbirth education and obstetric 
fistula prevention, care, and treatment; post-op-
erative care, including rehabilitation, social re-
integration, and post-surgical follow-up; basic 
and applied research and clinical work; and 
training of health care workers and educators, 
particularly local, grassroots educators and 
medical workers; 
(B) designation of a university-based med-
ical center in the United States, designated as 
the International Obstetric Fistula Institute for 
Sub-Saharan Africa established under section 
5(d), responsible for marshaling surgical and 
other necessary health resources to effectuate 
the campaign against obstetric fistula; for 
building prevention and treatment capacity in 
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sub-Saharan 
Africa, 
including 
coordinating 
partnerships with sub-Saharan African institu-
tions and governments; and for developing and 
managing community education and mobiliza-
tion programs at home and abroad; 
(C) development of health care infrastruc-
ture and delivery systems through Centers of 
Clinical Excellence for Obstetric Fistula Care 
for Sub-Saharan Africa as well as through co-
operative and coordinated public efforts and 
public-private partnerships; 
(D) strengthening universities, research 
centers, and training programs for health pro-
fessionals through institutional capacity-build-
ing partnerships; 
(E) development and implementation of a 
United States Obstetric Fistula Treatment and 
Prevention Corps which recruits and trains doc-
tors—especially 
obstetricians, 
gynecologists, 
urologists, general surgeons, and anesthesiol-
ogists—nurses, and other community-develop-
ment and public-health personnel to serve re-
gions affected by obstetric fistula and which 
partners United States medical professionals 
with sub-Saharan African professionals, pro-
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moting a joint effort to eradicate this dev-
astating condition; 
(F) coordination of efforts to make the 
treatment of obstetric fistula a higher priority 
in sub-Saharan African hospitals, specifically 
aimed at ameliorating the paucity of training 
related to obstetric fistula treatment; and 
(G) coordination of efforts between the 
medical community, nongovernmental organiza-
tions, national governments, and private sector 
organizations, including faith-based organiza-
tions. 
(21) The United States has the capacity to lead 
and enhance the effectiveness of the international 
community’s response by— 
(A) providing substantial resources, med-
ical expertise, and training, particularly of 
health care personnel and community workers 
and leaders; 
(B) making United States surgeons and 
health care professionals available to serve, 
train, and build workforce capacity in afflicted 
countries through a United States Obstetric 
Fistula Treatment and Prevention Corps; 
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(C) encouraging governments and faith- 
based and community organizations to adopt 
policies that treat obstetric fistula and its 
causes as a multi-sector, public-health problem 
that profoundly affects women’s health, wom-
en’s empowerment, education, the economy, and 
promotion of strong and successful families; 
(D) encouraging education about healthy 
practices, including education about the health 
risks associated with child marriage and female 
genital mutilation; 
(E) building successful communities by 
preventing obstetric fistula and the ensuing so-
cial stigma which often separates an obstetric 
fistula victim from her family; 
(F) contributing to public health and 
health-care delivery system research to improve 
obstetric fistula prevention, treatment, and re-
integration; 
(G) encouraging active involvement and co-
operation across sectors, including the medical 
and scientific communities, charitable founda-
tions, private and voluntary organizations and 
nongovernmental organizations, faith-based or-
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ganizations, 
community-based 
organizations, 
and other not-for-profit entities; and 
(H) engaging in medical diplomacy, with a 
particular focus on the further empowerment 
and emancipation of women. 
(22) Unaddressed obstetric emergencies and 
untreated obstetric fistula result in the needless, sys-
tematic degradation and marginalization of women. 
It should be the policy of the United States to help 
eradicate this preventable and curable condition. 
(23) Strong coordination must exist among the 
implementing agencies of the United States to en-
sure effective and efficient use of financial, medical, 
and technical resources within the United States 
Government with respect to international obstetric 
fistula eradication. 
(24) Obstetric fistula is a medical condition 
which historically affected women around the globe. 
The United States long ago eliminated this need-
lessly oppressive condition because of access to 
skilled medical professionals and medical care. Ob-
stetric fistula can be prevented and repaired. No 
woman should suffer a lifetime of debilitating phys-
ical and social consequences—as obstetric fistula vic-
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tims do—simply because she lacks access to basic 
obstetric care. 
SEC. 3. DEFINITIONS. 
In this Act: 
(1) ADVISORY COMMITTEE.—The term ‘‘Advi-
sory Committee’’ means the United States Advisory 
Committee for the Eradication of Obstetric Fistula 
established under section 6. 
(2) CLINICAL CENTER OF EXCELLENCE.—The 
term ‘‘Center of Clinical Excellence’’ means a Center 
of Clinical Excellence for Obstetric Fistula Care in 
sub-Saharan 
Africa 
established 
under 
section 
5(d)(5). 
(3) CORPS.—The term ‘‘Corps’’ means the 
United States Obstetric Fistula Treatment and Pre-
vention Corps established under section 5(d)(6). 
(4) INSTITUTE.—The term ‘‘Institute’’ means 
the International Obstetric Fistula Institute for Sub- 
Saharan Africa established under section 5(d)(1). 
(5) RELEVANT
EXECUTIVE
BRANCH
AGEN-
CIES.—The term ‘‘relevant executive branch agen-
cies’’ means the Department of State, the United 
States Agency for International Development, and 
any other department or agency of the United States 
that participates in international health and humani-
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tarian activities pursuant to the authorities of such 
department or agency or the Foreign Assistance Act 
of 1961. 
(6) SUB-SAHARAN
AFRICA.—The terms ‘‘sub- 
Saharan Africa’’, ‘‘sub-Saharan African’’, and ‘‘sub- 
Saharan African country’’ shall have the meanings 
given to such terms for purposes of this Act by the 
Secretary. 
SEC. 4. COMPREHENSIVE, INTEGRATED, 10-YEAR STRATEGY 
TO COMBAT OBSTETRIC FISTULA IN SUB-SA-
HARAN AFRICA. 
(a) IN GENERAL.—The President, acting through the 
Administrator of the United States Agency for Inter-
national Development, shall establish a comprehensive, in-
tegrated, 10-year strategy to combat obstetric fistula in 
sub-Saharan Africa that strengthens the capacity of the 
United States to be an effective leader in the movement 
for international women’s health and empowerment. 
(b) ELEMENTS.—Such strategy shall maintain suffi-
cient flexibility and remain responsive to the needs of 
women afflicted with obstetric fistula or who stand at risk 
of suffering from obstetric fistula and shall include the 
following: 
(1) A plan for implementation and coordination 
of programs and activities under this Act, including 
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grants and contracts for prevention, treatment, and 
monitoring of obstetric fistula under section 5. 
(2) Specific objectives, multi-sector approaches, 
and specific strategies to treat women who suffer 
from obstetric fistula and to prevent further occur-
rences of obstetric fistula. 
(3) Assignment of priorities for relevant execu-
tive branch agencies. 
(4) Public health and health care delivery sys-
tem research on the prevention, repair, and rehabili-
tation of obstetric fistula. 
(5) Development, implementation, and evalua-
tion of evidence-based systems of care connecting 
maternity and obstetric fistula care facilities with 
local care delivery and community education pro-
grams. Such systems of care should promote rapid 
and long-term prevention of obstetric fistula, includ-
ing— 
(A) referral to prenatal care to identify 
and mitigate risk factors for obstetric fistula; 
(B) culturally appropriate childbirth edu-
cation, preparation, and planning; 
(C) access to skilled obstetric care; and 
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(D) promoting prompt detection of pro-
longed labor and appropriate action to address 
it. 
(6) Provision that the reduction of health and 
social risks which increase the likelihood of obstetric 
fistula shall be a priority of all prevention efforts in 
terms of funding, educational messages, and activi-
ties promoting a decrease in child marriage and the 
adolescent pregnancy rate, prompt detection of pro-
longed labor, and immediate intervention in cases of 
obstructed labor through improved access to emer-
gency obstetric services provided by partner hos-
pitals. 
(7) Improvement of coordination and reduce 
duplication among relevant executive branch agen-
cies, foreign governments, and international organi-
zations. 
(8) Projection of general levels of resources 
needed to achieve the stated objectives. 
(9) Expansion of public-private partnerships 
and the leveraging of resources. 
(10) Maximization of United States capabilities 
in the areas of medical training and research and 
application of those capabilities in sub-Saharan Afri-
ca. Such efforts may include the provision of grants 
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by relevant executive branch agencies for institu-
tional capacity-building partnerships between United 
States and foreign institutions, as well as between 
in-country institutions, for the purpose of mobilizing 
in-country capacity, resources, and expertise to pre-
vent and repair cases of obstetric fistula. 
(11) Priorities for the distribution of resources 
based on factors such as the size and demographics 
of the population suffering from obstetric fistula, the 
needs of that population, and the existing infrastruc-
ture or funding levels that may exist to treat and 
prevent obstetric fistula. 
(12) A long-term commitment to the eradi-
cation of obstetric fistula by expanding health sys-
tem capacity and training opportunities for doctors 
and other health service providers in sub-Saharan 
Africa. 
(13) A plan to maximize United States efforts 
in workforce training, capacity-building, and reten-
tion relating to obstetric fistula prevention, treat-
ment, rehabilitation, and research. Such plan shall 
be coordinated with existing United States and in- 
country workforce capacity-building plans and ef-
forts. Such plan may include training of foreign 
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health workers at United States institutions and 
‘‘train-the-trainer’’ programs. 
(14) A plan for institutional capacity-building 
partnerships to strengthen universities, research cen-
ters, health-profession training programs, and gov-
ernment institutes to build the in-country capacity 
needed to eradicate obstetric fistula. 
(c) REPORT.—Not later than 1 year after the date 
of the enactment of this Act, the President shall submit 
to Congress a report that contains the strategy required 
under this section. 
SEC. 5. PREVENTION, TREATMENT, AND MONITORING OF 
OBSTETRIC FISTULA IN SUB-SAHARAN AFRI-
CAN COUNTRIES. 
(a) IN GENERAL.—The President, acting through the 
Administrator of the United States Agency for Inter-
national Development, is authorized to provide grants to 
or enter into contracts with an eligible entity described 
in subsection (b) to carry out activities to prevent, treat, 
and monitor obstetric fistula in sub-Saharan African coun-
tries in accordance with this section. 
(b) ELIGIBLE ENTITY DESCRIBED.—In this section, 
the term ‘‘eligible entity’’ means a major, university-based 
medical center in the United States. 
(c) APPLICATION AND SELECTION.— 
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(1) APPLICATION.—The President shall provide 
for eligible entities to submit applications to the 
President for grants or contracts under this section 
in such form and manner as the President may re-
quire to carry out the purposes of this section. 
(2) SELECTION.— 
(A) IN GENERAL.—From among the appli-
cations submitted under paragraph (1), the 
President shall select an eligible entity to re-
ceive grants or contracts under this section pur-
suant to a competitive selection process. 
(B) CRITERIA.—The competitive selection 
process referred to in subparagraph (A) shall be 
based upon selection criteria, which shall in-
clude— 
(i) the breadth and depth of medical 
faculty, particularly with experience in ob-
stetrics and reconstructive pelvic surgery; 
(ii) breadth and depth of public health 
and international health faculty; 
(iii) experience in and capacity to con-
duct training of the global health work-
force and to strengthen capacity-building 
and health systems; 
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(iv) experience in building institu-
tional capacity in sub-Saharan Africa, in-
cluding through institutional partnerships; 
(v) willingness to supplement amounts 
received under grants or contracts under 
subsection (a) by engaging in community 
partnerships; and 
(vi) whether the applicant, for pur-
poses of this Act, has entered into a coop-
erative agreement with one or more major, 
university-based medical centers in sub-Sa-
haran Africa. 
(d) USE OF FUNDS.— 
(1) INTERNATIONAL OBSTETRIC FISTULA INSTI-
TUTE
FOR
SUB-SAHARAN
AFRICA.—Amounts re-
ceived under grants or contracts under subsection 
(a) shall be used to establish and operate at the eli-
gible entity’s medical center in the United States an 
institute to carry out paragraphs (2) through (7), to 
be known as the International Obstetric Fistula In-
stitute for Sub-Saharan Africa. The purpose of the 
Institute shall be to prevent, treat, and monitor ob-
stetric fistula in sub-Saharan African countries. 
(2) ADMINISTRATION AND TRAINING.—The In-
stitute shall— 
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(A) serve as the primary administrative 
and medical-training hub for the campaign to 
prevent, treat, and monitor obstetric fistula in 
sub-Saharan African countries; 
(B) ensure the campaign described in sub-
paragraph (A) is carried out on both a scientific 
and humanitarian basis; 
(C) initiate and oversee the training and 
clinical activities of physicians, other health 
professionals, and educators serving at Centers 
of Clinical Excellence; and 
(D) ensure a progressive increase in health 
system and workforce capacity to prevent, treat, 
and monitor obstetric fistula in each country in 
which a Center of Clinical Excellence is located. 
(3) ENFORCE CLINICAL STANDARDS AND AC-
COUNTABILITY.—The Institute shall— 
(A) promote the utilization of standard 
clinical protocols, facilitate data collection, co-
ordinate research efforts, and oversee and par-
ticipate in multi-center randomized surgical 
trials; and 
(B) enforce the highest standards of clin-
ical practice and ethical behavior as described 
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in the published code of medical ethics for ob-
stetric fistula surgeons. 
(4) DEVELOP EVIDENCE-BASED PROGRAMS FOR 
PREVENTION AND ACCESS TO EMERGENCY OBSTET-
RIC CARE.—The Institute shall— 
(A) develop and implement comprehensive 
and culturally appropriate protocols to prevent 
the formation of obstetric fistula, including the 
development and implementation of evidence- 
based systems of care, which identify, track, 
and evaluate obstetric fistula prevention pro-
grams; 
(B) develop and implement prevention pro-
grams that— 
(i) teach women and family members, 
in a culturally appropriate manner, how to 
identify prolonged labor; 
(ii) inform women and family mem-
bers of the risks of not seeking appropriate 
medical care; 
(iii) refer women and family members 
to prenatal, perinatal, and postnatal care; 
(iv) teach women and family members 
how to mobilize community resources to 
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assist in seeking emergency obstetric care; 
and 
(v) teach women and family members 
to identify symptoms of obstetric fistula 
and refer women to treatment; 
(C) assist Centers of Clinical Excellence in 
developing localized programs for childbirth 
education, preparation and planning, prolonged- 
labor detection, labor monitoring, and transpor-
tation from villages to local hospitals for obstet-
ric care and to Centers of Clinical Excellence 
for obstetric fistula care, accounting for factors 
such 
as 
transportation, 
geography, 
and 
scalability of such solutions; and 
(D) seek to partner with United States 
medical personnel and volunteers to train and 
employ local men and women as community- 
based labor monitors who can educate and as-
sist other women at risk of suffering from ob-
stetric fistula, thereby empowering an entire 
sector of women in sub-Saharan Africa with in-
formation and employment. 
(5) CENTERS OF CLINICAL EXCELLENCE FOR 
OBSTETRIC FISTULA CARE IN SUB-SAHARAN AFRI-
CA.— 
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(A) IN
GENERAL.—The Institute, in co-
operation with each medical center in sub-Saha-
ran African described in subsection (b), shall 
establish not less than 8 centers in sub-Saharan 
Africa to treat and prevent obstetric fistula in 
countries and areas in which obstetric fistula is 
widespread, as determined by the Institute in 
consultation with the Advisory Committee. Such 
centers shall be known as Centers of Clinical 
Excellence for Obstetric Fistula Care in sub-Sa-
haran Africa. 
(B) GENERAL
DUTIES.—Each Center of 
Clinical Excellence shall establish programs to 
treat and prevent obstetric fistula at hospitals 
and to expand the networks of such hospitals. 
the Centers of Excellence shall be co-located or 
located within reasonable proximity to hospitals 
capable of providing emergency and routine ob-
stetric care, in order to fulfill its duties and to 
ensure hospitals meet emergency obstetric 
needs. 
(C) SPECIFIC
DUTIES.—Each Center of 
Clinical Excellence shall function as localized 
epicenters of training and clinical excellence for 
obstetric fistula care, and shall— 
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(i) be a major locus of medical and 
surgical care for obstetric fistula patients; 
(ii) be centers for the training of ob-
stetric fistula surgeons, nurses, and other 
medical personnel; 
(iii) coordinate and implement com-
munity outreach and prevention programs; 
(iv) partner with the national ministry 
of health or equivalent government body 
and medical educators in the country in 
which the Center of Clinical Excellence is 
located to develop country-specific training 
programs for surgeons and other health 
care personnel involved in obstetric fistula 
care; 
(v) be a vehicle for expanding access 
to emergency obstetric services in affiliated 
communities; 
(vi) establish a consulting and referral 
relationship with a hospital in its geo-
graphic vicinity, assist the hospital by com-
pleting an initial, comprehensive assess-
ment of what resources the hospital would 
need to improve delivery of emergency ob-
stetric services, and based on the needs as-
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sessments and subject to the approval of 
the Institute approve funding for each hos-
pital to undergo appropriate physical ren-
ovation and reimburse the hospital for 
emergency obstetric care and cesarean de-
liveries; and 
(vii) coordinate a system of village 
‘‘labor monitors’’ to help prevent obstetric 
fistula by identifying pregnant women in 
their communities, monitoring their labors, 
and activating an organized emergency- 
transport system to move high-risk women 
to local hospitals with adequate obstetric 
care. 
(6) 
UNITED
STATES
OBSTETRIC
FISTULA 
TREATMENT AND PREVENTION CORPS.— 
(A) IN
GENERAL.—The Institute, in co-
operation with each medical center in sub-Saha-
ran African described in subsection (b), shall 
establish and operate a United States Obstetric 
Fistula Treatment and Prevention Corps. 
(B) DUTIES.—The Corps shall— 
(i) provide volunteer medical services 
at Centers of Clinical Excellence and train 
local surgeons and other health profes-
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sionals in techniques of obstetric fistula re-
pair and in other aspects of the care of 
women with obstetric fistula; 
(ii) seek to establish an enabling envi-
ronment in which patient care can be pro-
vided effectively, consistently, humanely, 
and ethically to women with obstetric fis-
tula; and 
(iii) develop evidence-based systems of 
care for the prevention of obstetric fistula. 
(C) MEMBERSHIP.—The Corps shall con-
sist of— 
(i) graduates of United States or Afri-
can residency programs in such fields as 
obstetrics and gynecology, general surgery, 
urology, and anesthesiology; and 
(ii) other doctors, nurses, community- 
health professionals, public-health profes-
sionals, and other expert personnel as 
needed to further the duties of the Insti-
tute to prevent, treat, and monitor obstet-
ric fistula in sub-Saharan African coun-
tries. 
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(D) DURATION OF SERVICE.—Members of 
the Corps shall commit to a duration of service 
of not less than 28 months. 
(E) COMPENSATION, OTHER BENEFITS.— 
The Institute may provide compensation, other 
employment benefits, and loan guarantees to in-
dividuals who agree to serve as members of the 
Corps. 
(F) ALUMNI CORPS.—The Institute is au-
thorized to establish an Alumni Corps, com-
prised of former members of the Corps who 
have completed successfully at least one period 
of service described in subparagraph (D) in 
order to augment medical personnel at Centers 
for Clinical Excellence. 
(7) ANNUAL REPORT.—The Institute shall sub-
mit to Congress and make available to the public an 
annual report on the implementation of this sub-
section, including a description of— 
(A) the recruitment for and implementa-
tion of the Corps; and 
(B) the activities of each Center of Clinical 
Excellence, including— 
(i) the number of women served at the 
Center; 
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(ii) the success rate of obstetric fis-
tula-repair surgeries, prevention efforts, 
and other programs used by the Center 
and surrounding communities; and 
(iii) other delivery system and quality 
measures as appropriate. 
(e) PERSONNEL.—The Institute shall be adminis-
tered by qualified, essential personnel including— 
(1) a director, who reports directly to the head 
of the medical center in the United States referred 
to in subsection (b); 
(2) expert leadership to oversee key aspects of 
the duties of the Institute, including— 
(A) medical and surgical activities; 
(B) prevention, education, and outreach; 
(C) partnerships and capacity building; 
(D) emergency obstetric services; and 
(E) program management; 
(3) professional and administrative staff re-
sponsible for administration, coordination, and cam-
paign performance; 
(4) dedicated, full-time, experienced surgeons 
responsible for the medical supervision and training 
of United States and sub-Saharan African surgeons 
assigned to Centers of Clinical Excellence, and for 
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medical research, data collection, and successful im-
plementation of medical programs in sub-Saharan 
Africa; 
(5) full-time prevention, education, and out-
reach coordinators, responsible for the Institute’s 
outreach, education, prevention, and social reintegra-
tion programs as well as for the supervision and 
training of outreach and education staff assigned to 
the Centers of Clinical Excellence; 
(6) an advisory panel for surgical outcomes and 
quality comprised of no fewer than 15 senior prac-
ticing surgeons from the United States and other 
countries— 
(A) to ensure a high, uniform level of sur-
gical care; 
(B) to engage in clinical practice with Cen-
ters of Clinical Excellence for Sub-Saharan Af-
rica to share their surgical experience and to 
provide clinical oversight; and 
(C) to liaise with Centers of Clinical Excel-
lence for Sub-Saharan Africa and the Institute 
to ensure the Centers of Clinical Excellence are 
accountable for providing a consistent and high 
level of surgical care; and 
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(7) an internal oversight and steering com-
mittee comprised of individuals who are medical pro-
fessionals, public health professionals, international 
social welfare advisors, economists specializing in 
international development, or professors of law or 
political science. 
(f) ADDITIONAL PERSONNEL.—The Institute may 
appoint and fix the pay of additional personnel as the In-
stitute considers appropriate. 
SEC. 6. UNITED STATES ADVISORY COMMITTEE FOR THE 
ERADICATION OF OBSTETRIC FISTULA. 
(a) ESTABLISHMENT.—There is established an advi-
sory committee to be known as the United States Advisory 
Committee for the Eradication of Obstetric Fistula. 
(b) MEMBERSHIP.— 
(1) SELECTION; QUALIFICATIONS.—The Advi-
sory Committee shall be composed of 14 members 
selected by the Secretary (through a competitive 
process) from among individuals who are distin-
guished scholars, clinicians, scientists, advocates, 
and philanthropists and who, collectively— 
(A) have knowledge and experience in 
health care and global health policy, including 
international health, obstetrics, women’s em-
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powerment, human rights, and international 
law; and 
(B) have direct experience abroad espe-
cially in sub-Saharan Africa. 
(2) 
SELECTION.—The 
Advisory 
Committee 
shall be composed of 14 members selected by the 
Secretary through a competitive process. 
(3) DISQUALIFICATION.—An individual shall 
not be appointed as a member of the Advisory Com-
mittee if such individual possesses any personal or 
financial interest in the discharge of any duties of 
the Advisory Committee. 
(4) TERMS.—The term of office of each mem-
ber of the Advisory Committee shall be 5 years. 
Members of the Advisory Committee shall be eligible 
for reappointment for up to 2 terms. 
(c) MEETINGS.— 
(1) INITIAL
MEETING.—The Advisory Com-
mittee shall hold its initial meeting on the date that 
is no later than 120 days after the date of the enact-
ment of this Act. 
(2) MEETINGS.—The Advisory Committee shall 
meet at the call of the Chairman or a majority of 
its members. The Advisory Committee shall meet no 
less than twice per calendar year. 
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(3) QUORUM.—Six members of the Advisory 
Committee shall constitute a quorum for purposes of 
conducting business, except that 2 members of the 
Advisory Committee shall constitute a quorum for 
purposes of receiving testimony. 
(4) VACANCIES.—Any vacancy of the Advisory 
Committee shall not affect its powers, but shall be 
filled promptly in the manner in which the original 
appointment was made. 
(d) ADMINISTRATION.— 
(1) TRAVEL EXPENSES.—Members of the Advi-
sory Committee shall be allowed travel expenses, in-
cluding per diem in lieu of subsistence, at rates au-
thorized for employees of agencies under subchapter 
I of chapter 57 of title 5, United States Code, while 
away from their homes or regular places of business 
in performance of services for the Advisory Com-
mittee. 
(2) ADMINISTRATIVE SUPPORT.—The Secretary 
of State shall assist the Advisory Committee by pro-
viding to the Advisory Committee such staff and ad-
ministrative services as may be necessary and appro-
priate for the Advisory Committee to perform its 
functions. Upon request of the Advisory Committee, 
the head of any Federal department or agency may 
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detail any of the personnel of that department or 
agency to the Advisory Committee without reim-
bursement to the department or agency of that em-
ployee and such detail shall be without interruption 
or loss of civil service status or privilege. 
(3) EXPERTS AND CONSULTANTS.—The Advi-
sory Committee may procure temporary and inter-
mittent services under section 3109(b) of title 5, 
United States Code. 
(4) OTHER RESOURCES.—The Advisory Com-
mittee shall have reasonable access to materials, re-
sources, statistical data, and other information the 
Advisory Committee determines to be necessary to 
carry out its duties from the Library of Congress, 
the Department of State, the National Library of 
Medicine, and other departments and agencies of the 
executive and legislative branches of the Federal 
Government. The Chairman of the Advisory Com-
mittee shall make requests for such access in writing 
when necessary. 
(5) OBTAINING OFFICIAL DATA.—The Advisory 
Committee may secure directly from any department 
or agency of the United States information nec-
essary to enable it to carry out this section. Upon 
the request of the Chairman of the Advisory Com-
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mittee, the head of that department or agency shall 
furnish that information to the Advisory Committee. 
(e) DUTIES.—The primary duties of the Advisory 
Committee shall include— 
(1) advising the Institute on an ongoing basis 
in carrying out the duties of the Institute; 
(2) evaluating programs and activities to eradi-
cate obstetric fistula and making recommendations 
regarding the programs of the Institute; 
(3) advising the Department of State and the 
United States Agency for International Development 
on an ongoing basis in carrying out programs and 
activities to eradicate obstetric fistula; 
(4) monitoring funds available for programs 
and activities to eradicate obstetric fistula to ensure 
such funds are used efficiently and are accounted for 
properly, including through the conduct of periodic 
audits; and 
(5) advising the Administrator of the United 
States Agency for International Development in an 
annual written report of the Institute’s performance 
and success in carrying out its duties. 
(f) ACTIONS AGAINST GOVERNMENTS FAILING TO 
MEET MINIMUM STANDARDS.— 
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(1) BY ADVISORY COMMITTEE.—The Advisory 
Committee— 
(A) shall advise the Administrator of the 
United States Agency for International Devel-
opment, based on information provided to the 
Advisory Committee by the Institute or based 
on independent sources of information, of each 
county that by reason of corruption, indiffer-
ence, or ineffectiveness, significantly impedes 
the Institute’s ability to provide services to vic-
tims of obstetric fistula and women who are 
vulnerable to obstetric fistula; and 
(B) may request the Administrator to rec-
ommend suspension of the provision of United 
States nonhumanitarian, nontrade-related for-
eign assistance to each country described in 
subparagraph (A). 
(2) BY USAID.—Based on the advice of the Ad-
visory Committee under paragraph (1), the Adminis-
trator may accept the advice and, in consultation 
with the Secretary of State, recommend to the Presi-
dent the suspension of United States nonhumani-
tarian, nontrade-related foreign assistance to a coun-
ty described in paragraph (1)(A). 
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SEC. 7. REPORT. 
The President, acting through the Administrator of 
the United States Agency for International Development, 
shall submit to Congress on an annual basis a report on 
the implementation of this Act for the preceding year, in-
cluding an evaluation of the effectiveness and performance 
of the Institute, the Centers of Clinical Excellence, the 
Corps, and all related community outreach and medical 
programs. 
SEC. 8. AUTHORIZATION OF APPROPRIATIONS. 
(a) IN GENERAL.—There are authorized to be appro-
priated to the President to carry out this Act— 
(1) $10,000,000 for fiscal year 2013; and 
(2) $180,000,000 for the period of fiscal years 
2014 through 2022. 
(b) AVAILABILITY.—Amounts appropriated pursuant 
to the authorization of appropriations under subsection (a) 
are authorized to remain available until expended. 
Æ 
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