I 
111TH CONGRESS 
1ST SESSION H. R. 1410 
To provide assistance to improve the health of newborns, children, and 
mothers in developing countries, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 10, 2009 
Ms. MCCOLLUM (for herself, Mr. REICHERT, Mrs. CAPPS, Mr. PAYNE, Mr. 
BLUMENAUER, Mr. SCHIFF, Mr. MOORE of Kansas, Mr. GRIJALVA, Ms. 
MOORE of Wisconsin, Ms. JACKSON-LEE of Texas, Mrs. TAUSCHER, Mr. 
MCDERMOTT, Mr. MCGOVERN, Mr. WALZ, Mr. MORAN of Virginia, Ms. 
WATSON, Ms. WOOLSEY, Ms. DELAURO, Mr. HINCHEY, Mr. CARSON of 
Indiana, Mr. YOUNG of Alaska, Ms. LEE of California, Mr. OBERSTAR, 
Mr. MURPHY of Connecticut, Mrs. CHRISTENSEN, Ms. EDDIE BERNICE 
JOHNSON of Texas, Ms. HIRONO, Mr. SERRANO, Ms. SLAUGHTER, Mr. 
FILNER, Ms. DEGETTE, Mr. CROWLEY, Mr. HONDA, Mr. OLVER, Mr. 
SNYDER, Mr. SHIMKUS, Mr. JACKSON of Illinois, and Mrs. MALONEY) in-
troduced the following bill; which was referred to the Committee on For-
eign Affairs 
A BILL 
To provide assistance to improve the health of newborns, 
children, and mothers in developing countries, 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 ‘‘Newborn, Child, and 
Mother Survival Act of 2009’’. 
VerDate Nov 24 2008 
23:39 Mar 10, 2009
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H1410.IH
H1410
rfrederick on PROD1PC67 with BILLS
SEC. 2. FINDINGS AND PURPOSES. 
(a) FINDINGS.—Congress finds the following: 
(1) At least 9,200,000 children under the age 
of 5 die each year, more than 25,000 children per 
day, mostly from preventable and treatable causes 
according to the United Nations Children’s Fund 
(UNICEF). 
(2) In poor countries, an estimated 3,700,000 
newborns die in the first 4 weeks of life according 
to the World Health Organization (WHO). 
(3) Approximately 536,000 women die every 
year in developing countries from causes related to 
pregnancy and childbirth, the equivalent of 1 woman 
per minute, according to WHO. 
(4) For every maternal death some 20 
women—or 10 million women per year—suffer com-
plications with severe consequences, including preg-
nancy-related injuries, infections, diseases, and dis-
abilities. 
(5) Worldwide, 68 countries account for 97 per-
cent of all maternal and under-5 child deaths. 
(6) Nearly 1 of every 5 children die before the 
age of 5, more than 2,000,000 child deaths per year, 
in the ten countries with the highest child mortality 
rates in the world: Sierra Leone, Afghanistan, Chad, 
VerDate Nov 24 2008 
23:39 Mar 10, 2009
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H1410.IH
H1410
rfrederick on PROD1PC67 with BILLS
Equatorial Guinea, Guinea-Bissau, Mali, Burkina 
Faso, Nigeria, Rwanda, and Burundi. 
(7) Nine out of 10 women in sub-Saharan Afri-
ca will lose a child during their lifetimes. 
(8) In sub-Saharan Africa, a woman’s lifetime 
risk of maternal death is a staggering 1 in 22, com-
pared with 1 in 8,000 in industrialized countries, ac-
cording to UNICEF. 
(9) Pneumonia, diarrhea, low birth weight, sep-
sis, birth trauma, and malaria, all preventable and 
treatable, are the top contributors of deaths of chil-
dren under the age of 5. 
(10) Poor nutrition is a major factor in 20 per-
cent of maternal deaths, up to one-third of under- 
5 child deaths, and 60 to 80 percent of newborn 
deaths. 
(11) Risk factors for maternal death in devel-
oping countries include pregnancy and childbirth at 
an early age, closely-spaced births, infectious dis-
eases, malnutrition, and complications during child-
birth. 
(12) In Mozambique, the ratio of nongovern-
mental organizations engaged in HIV/AIDS preven-
tion efforts compared to nongovernmental organiza-
tions engaged in maternal and child health efforts is 
VerDate Nov 24 2008 
23:39 Mar 10, 2009
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H1410.IH
H1410
rfrederick on PROD1PC67 with BILLS
100 to 1, according to Mozambique’s Minister of 
Health, yet in that country 168 out of every 1,000 
children die before the age of 5 and one in every 45 
mothers are at risk of death. 
(13) Antenatal care coverage for pregnant 
mothers in developing countries is often low. For ex-
ample, in sub-Saharan Africa antenatal care cov-
erage is 69 percent yet programs for prevention of 
maternal to child transmission of HIV reach an av-
erage of only 11 percent of those who need them, ac-
cording to UNICEF. 
(14) In many poor countries, a lack of access, 
including transportation to quality health care facili-
ties, results in deaths for newborns, children, and 
mothers. 
(15) No skilled birth attendant is present at 34 
percent 
of 
deliveries 
worldwide 
which 
means 
45,000,000 births each year are occurring at home 
without skilled health personnel, according to WHO. 
(16) Due to an estimated 50 percent shortfall 
in skilled birth attendants, 700,000 skilled and 
trained birth attendants are needed worldwide to en-
sure universal coverage to maternity care, while an 
additional 47,000 doctors with emergency obstetric 
VerDate Nov 24 2008 
23:39 Mar 10, 2009
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H1410.IH
H1410
rfrederick on PROD1PC67 with BILLS
skills are required, particularly in rural areas, ac-
cording to WHO. 
(17) Expansion of clinical care for newborns 
and mothers, such as clean delivery by skilled birth 
attendants, emergency obstetric care, and neonatal 
resuscitation can save the lives of mothers, and can 
also avert 50 percent of newborn deaths. 
(18) Maternal, newborn, and child health serv-
ices should include interventions along the con-
tinuum of care from before pre-pregnancy to early 
childhood period and should be provided at home, 
community, and clinics. 
(19) An effective household to hospital con-
tinuum of care is especially important for maternal 
survival, since timely linkage to referral-level obstet-
ric care is necessary to reduce maternal mortality. 
(20) A package of 32 affordable interventions, 
including skilled care at birth, emergency obstetric 
care, breastfeeding, vaccinations, antibiotics, and 
micro-nutrients, could save 6,000,000 children per 
year at a cost of only $25 per child or $1.62 per 
person in 60 priority countries. 
(21) Millions of children’s lives can be saved by 
high-impact, low-cost, feasible interventions like oral 
rehydration therapy (ORT) for diarrhea ($0.07 per 
VerDate Nov 24 2008 
23:39 Mar 10, 2009
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H1410.IH
H1410
rfrederick on PROD1PC67 with BILLS
treatment), antibiotics to treat respiratory infections 
($0.25 per treatment), and anti-malaria tablets 
($0.29 per treatment). 
(22) 
Exclusive 
breastfeeding—giving 
only 
breast milk for the first 6 months of life—could help 
prevent an estimated 1,400,000 newborn and infant 
deaths each year, primarily by protecting again diar-
rhea and pneumonia. 
(23) Three million children die each year due to 
lack of access to low-cost antibiotics and anti-malar-
ial drugs. 
(24) Two million children die from diarrheal 
diseases unnecessarily due to lack of access to ORT 
prepared with clean water. 
(25) Between 1999 and 2004, distribution of 
low-cost vitamin A supplements saved an estimated 
2,300,000 lives, yet the unmet need for vitamin A 
supplements results in an estimated 250,000 to 
500,000 children becoming blind each year, with 70 
percent of such children dying within 12 months of 
losing their sight. 
(26) Studies suggest that high coverage and 
quality of proven health interventions could avert 
about 67 percent of neonatal and child deaths in 60 
priority countries worldwide. 
VerDate Nov 24 2008 
23:39 Mar 10, 2009
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H1410.IH
H1410
rfrederick on PROD1PC67 with BILLS
(27) Maternal and child mortality rates are an 
important indicator of a government’s commitment 
to women and children, as well as a barometer of a 
country’s healthcare system and overall development 
performance. 
(28) It is estimated that an additional 
$850,000,000 invested in newborn and child health 
could save the lives of nearly 1,000,000 children 
every year. 
(29) Investments in child survival have contrib-
uted to a major decline in the rate of child mor-
tality, even in poor countries such as Indonesia, 
Nepal, Laos, Bangladesh, and Bolivia, which have 
all reduced their under-5 child mortality by more 
than one-half since 1990. 
(30) Under-five child mortality has decreased 
by 20 to 50 percent in 15 United States Agency for 
International Development-assisted countries over 
the past ten years. 
(31) In 2000, the United States joined 188 
other countries in supporting eight United Nations 
Millennium Development Goals to reduce the mor-
tality rate of children under the age of 5 by two- 
thirds (goal 4) and to reduce maternal deaths by 
three-quarters (goal 5). 
VerDate Nov 24 2008 
23:39 Mar 10, 2009
Jkt 079200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H1410.IH
H1410
rfrederick on PROD1PC67 with BILLS
(32) In 2008, of the 68 priority countries rep-
resenting 97 percent of newborn and child mortality, 
only 16 of these countries are on track to achieve 
Millennium Development Goal (MDG) 4 of reducing 
child mortality by two-thirds. 
(b) PURPOSES.—The purposes of this Act are to— 
(1) authorize assistance to reduce mortality and 
improve the health of newborns, children, and moth-
ers in developing countries, including strengthening 
the capacity of health systems and health workers; 
(2) develop and implement a strategy based on 
a continuum of care to reduce mortality and improve 
the health of newborns, children, and mothers in de-
veloping countries; and 
(3) assess, monitor, and evaluate the progress 
and contributions of relevant departments and agen-
cies of the Government of the United States in 
achieving reductions of newborn, child, and maternal 
mortality in developing counties as well as contribu-
tions in achieving the United Nations Millennium 
Development Goals through the establishment of an 
interagency task force. 
VerDate Nov 24 2008 
23:39 Mar 10, 2009
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H1410.IH
H1410
rfrederick on PROD1PC67 with BILLS
SEC. 3. ASSISTANCE TO REDUCE MORTALITY AND IMPROVE 
THE HEALTH OF NEWBORNS, CHILDREN, AND 
MOTHERS IN DEVELOPING COUNTRIES. 
(a) IN GENERAL.—Chapter 1 of part I of the Foreign 
Assistance Act of 1961 (22 U.S.C. 2151 et seq.) is amend-
ed— 
(1) in section 101(a)(1), by inserting at the end 
before the semicolon the following: ‘‘, with particular 
focus on children and mothers’’; 
(2) in section 102(b)(4)(B), by striking ‘‘reduc-
tion of infant mortality’’ and inserting ‘‘reduction of 
newborn, child, and maternal mortality’’; 
(3) in section 104(c)— 
(A) by striking paragraphs (2) and (3); 
and 
(B) by redesignating paragraph (4) as 
paragraph (2); 
(4) by redesignating sections 104A, 104B, and 
104C as sections 104B, 104C, and 104D, respec-
tively; and 
(5) by inserting after section 104 the following 
new section: 
VerDate Nov 24 2008 
23:39 Mar 10, 2009
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H1410.IH
H1410
rfrederick on PROD1PC67 with BILLS
‘‘SEC. 104A. ASSISTANCE TO REDUCE MORTALITY AND IM-
PROVE THE HEALTH OF NEWBORNS, CHIL-
DREN, AND MOTHERS. 
‘‘(a) 
AUTHORIZATION.—Consistent 
with 
section 
104(c), the President is authorized to furnish assistance, 
on such terms and conditions as the President may deter-
mine, to reduce mortality and improve the health of 
newborns, children, and mothers in developing countries. 
‘‘(b) ACTIVITIES TO PREVENT MORTALITY AND IM-
PROVE NEWBORN AND CHILD HEALTH.—Assistance pro-
vided under subsection (a) shall, to the maximum extent 
practicable, be used to— 
‘‘(1) improve newborn care and treatment, in-
cluding educating families about proper antenatal 
and skilled delivery care, drying and warming with 
the mother, immediate and exclusive breastfeeding, 
handwashing, clean cord care, prompt recognition 
and care seeking for danger signs, and treatment of 
neonatal infections; and 
‘‘(2) increase access to and utilization of appro-
priate interventions to treat life-threatening child-
hood illnesses, including— 
‘‘(A) to prevent and mitigate the severity 
of and treat diarrhea, including point of use 
water treatment, improvements in hygienic be-
havior, oral rehydration therapy (ORT), zinc, 
VerDate Nov 24 2008 
23:39 Mar 10, 2009
Jkt 079200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H1410.IH
H1410
rfrederick on PROD1PC67 with BILLS
exclusive breastfeeding in the first six months 
of life, and adequate and young child feeding 
during the first 6 to 24 month period; 
‘‘(B) to prevent deaths due to pneumonia 
with a focus on community-based treatments 
using antibiotics and effective recognition of se-
vere illness with appropriate referral; 
‘‘(C) to achieve the delivery of full immuni-
zation services, including efforts to eliminate 
polio and introduce new vaccines as available; 
and 
‘‘(D) to prevent and treat malaria through 
increased use of insecticide-treated nets, indoor 
residual spraying, and timely and appropriate 
treatment of malaria. 
‘‘(c) ACTIVITIES TO PREVENT MORTALITY AND IM-
PROVE MATERNAL HEALTH.—Assistance provided under 
subsection (a) shall, to the maximum extent practicable, 
be used to— 
‘‘(1) improve birth preparedness, including 
quality antenatal care throughout pregnancy; and 
‘‘(2) expand access and improve quality of ma-
ternity services, including— 
‘‘(A) skilled birth attendants; 
VerDate Nov 24 2008 
00:48 Mar 11, 2009
Jkt 079200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H1410.IH
H1410
rfrederick on PROD1PC67 with BILLS
‘‘(B) recognition and treatment of obstetric 
complications and disabilities, such as post- 
partum hemorrhage; 
‘‘(C) quality emergency obstetric care; 
‘‘(D) activities to treat and repair injuries 
resulting from pregnancy and childbirth; and 
‘‘(E) activities to lower or remove financial 
barriers to maternal healthcare services. 
‘‘(d) 
ACTIVITIES
TO
PROMOTE
HEALTHY 
NEWBORNS, CHILDREN, AND MOTHERS.—Assistance pro-
vided under subsection (a) shall, to the maximum extent 
practicable, be used to— 
‘‘(1) improve child and maternal nutrition, in-
cluding the delivery of iron, folic acid, zinc, vitamin 
A, iodine, and other key micronutrients; 
‘‘(2) promote breastfeeding, appropriate com-
plementary feeding, and the management of acute 
severe malnutrition, including the use of ready to 
use therapeutic food; 
‘‘(3) improve access to clean water and im-
proved sanitation through community-based hygiene 
education programs, the use of personal water puri-
fication tools and devices, and latrine construction; 
‘‘(4) reduce exposure to environmental toxins 
and indoor smoke from cooking fires; 
VerDate Nov 24 2008 
23:39 Mar 10, 2009
Jkt 079200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H1410.IH
H1410
rfrederick on PROD1PC67 with BILLS
‘‘(5) address antimicrobial resistance in chil-
dren and mothers; 
‘‘(6) ensure access to transportation for 
newborns, children, and mothers in need of emer-
gency clinical care; 
‘‘(7) ensure access to comprehensive post-natal 
newborn and maternal care, including services dur-
ing the immediate post-partum period; and 
‘‘(8) increase access to low- or no-cost 
deworming products. 
‘‘(e) ACTIVITIES TO STRENGTHEN COMMUNITIES 
AND HEALTH SYSTEMS.—Assistance provided under sub-
section (a) shall, to the maximum extent practicable, be 
used to— 
‘‘(1) improve capacity for health governance, fi-
nance and workforce, including support for the 
training and supervision of clinicians, nurses, mid-
wives, skilled birth attendants, nutritionists, techni-
cians, sanitation and public health workers, commu-
nity-based health workers, peer educators, volun-
teers, and private sector enterprises; 
‘‘(2) recruit, train, and supervise providers of 
comprehensive emergency obstetric and newborn 
care services; 
VerDate Nov 24 2008 
23:39 Mar 10, 2009
Jkt 079200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H1410.IH
H1410
rfrederick on PROD1PC67 with BILLS
‘‘(3) establish and support management infor-
mation systems in host country institutions and the 
development and use of tools and models to collect, 
analyze, and disseminate information relating to 
newborn, child, and maternal health, including reg-
istration of all births and deaths, along with cause 
of death, at district and country levels; 
‘‘(4) develop and conduct needs assessments, 
baseline studies, targeted evaluations, and other in-
formation-gathering efforts for the design, moni-
toring, and evaluation of newborn, child, and mater-
nal health programs; and 
‘‘(5) implement tailored programs in priority 
countries in political transition or post conflict set-
tings to extend newborn, child, and maternal serv-
ices as quickly as possible to assist in rebuilding of 
fragile health systems. 
‘‘(f) ACTIVITIES TO PROMOTE INTEGRATION, CO-
ORDINATION, AND MAXIMUM UTILIZATION OF HEALTH 
AND DEVELOPMENT RESOURCE ASSISTANCE.—Assistance 
provided under subsection (a) shall, to the maximum ex-
tent practicable, be used to— 
‘‘(1) carry out activities in host countries, in-
cluding— 
VerDate Nov 24 2008 
23:39 Mar 10, 2009
Jkt 079200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H1410.IH
H1410
rfrederick on PROD1PC67 with BILLS