Title: Physician Education for Fistula Treatment Act
Policy area: International Affairs

Summary:
Physician Education for Fistula Treatment Act
This bill authorizes the John E. Fogarty International Center for Advanced Study in the Health Sciences, which is part of the National Institutes of Health, to support training programs for obstetrician-gynecologists and sub-specialists in urogynecology in least developed countries; the center must also develop a strategy to address physician shortages in such countries.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7301 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 7301

To authorize assistance to train and retain obstetrician-gynecologists 
and sub-specialists in urogynecology and to help improve the quality of 
    care to meet the health care needs of women in least developed 
                   countries, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           December 13, 2018

 Ms. DeLauro (for herself, Ms. Norton, Mr. Grijalva, Ms. Jackson Lee, 
 Mr. McGovern, Ms. McCollum, and Ms. Lofgren) introduced the following 
      bill; which was referred to the Committee on Foreign Affairs

_______________________________________________________________________

                                 A BILL


 
To authorize assistance to train and retain obstetrician-gynecologists 
and sub-specialists in urogynecology and to help improve the quality of 
    care to meet the health care needs of women in least developed 
                   countries, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Physician Education for Fistula 
Treatment Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Historically, obstetric fistulas 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.
            (2) Each year between 50,000 to 100,000 women worldwide are 
        affected by obstetric fistulas, an abnormal opening between a 
        woman's genital tract and her urinary tract or rectum.
            (3) Women who experience an obstetric fistula suffer 
        constant incontinence, shame, and social segregation and health 
        problems. It is estimated that 2 to 3 million women live with 
        untreated obstetric fistulas, a scourge of epidemic 
        proportions.
            (4) A lack of available resources and training programs to 
        develop expertise in comprehensive advanced pelvic 
        reconstructive surgery continues to pose a challenge for the 
        health care workforce in least developed countries.
            (5) Retention rates of OB-GYNs and sub-specialists in 
        urogynecology have seen improvement with fellowships, 
        residencies, and programs that provide resources and training.
            (6) Today, obstetric fistula primarily affects the poorest 
        women in the poorest parts of the world. Obstetric fistulas 
        typically occur because women do not have timely access to 
        emergency obstetric care during obstructed labor, and continue 
        to have fistulas due to lack of access to adequate surgical 
        services once they sustain the injury.
            (7) Left untreated, an obstetric fistula afflicts a woman 
        with devastating physical conditions: incontinence, painful 
        ulcers, and constant and uncontrollable emission of offensive 
        odors. These symptoms leave a woman indelibly and perpetually 
        stigmatized by her condition.
            (8) Because obstetric fistulas are not themselves fatal, 
        millions of women live with this horrific condition and have 
        been overlooked by the international medical community. At 
        present, humanitarian aid and nongovernmental programs treat 
        fistula cases on a small scale and are not equipped to 
        systematically prevent, treat, and eradicate obstetric fistula.
            (9) Obstetric fistula can be prevented when women and their 
        families are educated about the birthing process and are 
        provided timely access to emergency obstetric care. Basic 
        interventions to identify and repair obstetric fistula have 
        achieved meaningful and cost-effective results. The impact of 
        an obstetric fistula-repair surgery is immediate and women can 
        be reintegrated into society. However, access to prevention, 
        effective midwifery services, and OB-GYN care can significantly 
        decrease childbirth-related injuries.

SEC. 3. INTERNATIONAL OB/GYN AND UROGYNECOLOGY PROMOTION PROGRAM.

    (a) Purpose.--The purpose of assistance under this section is to 
train and retain obstetrician-gynecologists (OB-GYNs) and sub-
specialists in urogynecology and to help improve the quality of care to 
meet the health care needs of women in least developed countries.
    (b) Authorization.--
            (1) In general.--To carry out the purpose of subsection 
        (a), the President, acting through the Director of the John E. 
        Fogarty International Center for Advanced Study in the Health 
        Sciences, is authorized to provide assistance for least 
        developed countries to support the activities described in 
        subsection (c).
            (2) Reference.--Assistance authorized under this section 
        may be referred to as the ``International OB/GYN and 
        Urogynecology Promotion Program''.
    (c) Activities Supported.--Activities that may be supported by 
assistance under subsection (b) include the following:
            (1) Fellowship and residency programs.--Establishment of 
        fellowship and residency programs to be carried out in 
        coordination with institutions of higher education (as such 
        term is defined in section 101 of the Higher Education Act of 
        1965 (20 U.S.C. 1001)), institutions of higher learning, 
        midwifery programs, and existing clinical centers in least 
        developed countries--
                    (A) to support existing academic curricula for 
                education training for midwifery students;
                    (B) to develop and help sustain existing 
                specialized curriculum training for medical students 
                and residents to become knowledgeable and proficient in 
                women's health care; and
                    (C) to allow medical students, residents, and 
                midwifery students to practice and develop expertise in 
                geographical areas in which childbirth-related injuries 
                are most prevalent.
            (2) Training centers.--Establishment of training centers--
                    (A) to address the shortage of OB-GYNs and sub-
                specialists in the urogynecology profession; and
                    (B) to carry out specialized programs that are 
                located at health care institutions that provide 
                exceptionally high concentrations of expertise and 
                related resources related to these medical professions 
                and are delivered in a comprehensive and 
                interdisciplinary fashion.

SEC. 4. COMPREHENSIVE 10-YEAR STRATEGY TO ADDRESS THE SHORTAGE OF 
              PHYSICIANS IN LEAST DEVELOPED COUNTRIES.

    (a) In General.--The President, acting through the Director of the 
John E. Fogarty International Center for Advanced Study in the Health 
Sciences, shall establish a comprehensive, integrated, 10-year strategy 
to address the shortage of physicians in least developed countries.
    (b) Elements.--Such strategy shall maintain sufficient flexibility 
and remain responsive to the needs of women afflicted with childbirth-
related injuries and shall include the following:
            (1) A plan for implementation and coordination of programs 
        and activities under this Act, including grants and contracts 
        for prevention, treatment, and monitoring of childbirth-related 
        injuries.
            (2) Specific objectives, multi-sector approaches, and 
        specific strategies to treat women who suffer from childbirth-
        related injuries and to prevent further occurrences of 
        childbirth-related injuries.
            (3) Assignment of priorities for relevant executive branch 
        agencies.
            (4) Public health and health care delivery system research 
        on the prevention, repair, and rehabilitation of childbirth-
        related injuries.
            (5) Social science research in fields such as anthropology, 
        sociology, and related fields to monitor and evaluate the 
        underlying social and economic factors that contribute to 
        childbirth-related injuries.
            (6) Development, implementation, and evaluation of 
        evidence-based systems of care connecting maternity care 
        facilities with local care delivery and community education 
        programs. Such systems of care should promote rapid and long-
        term prevention of childbirth-related injuries, including--
                    (A) culturally appropriate childbirth education, 
                preparation, and planning; and
                    (B) access to obstetrician-gynecologists (OB-GYNs), 
                urogynecology care, or midwifery care.
            (7) Expansion of training centers and partnerships with 
        institutions of higher learning for medical students and 
        residents.
            (8) Priorities for the distribution of resources based on 
        factors such as the size and demographics of the population 
        suffering from childbirth-related injuries, the needs of that 
        population, and the existing infrastructure or funding levels 
        that may exist to treat and prevent childbirth-related 
        injuries, including obstetric fistula.
            (9) A plan for institutional capacity-building of 
        partnerships to strengthen universities, research centers, 
        health-profession training programs, and government institutes 
        to build the in-country capacity needed to eradicate 
        childbirth-related injuries in least developed countries.
    (c) Report.--Not later than 2 years 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. REPORT.

    (a) In General.--The President, acting through the Director of the 
John E. Fogarty International Center for Advanced Study in the Health 
Sciences, shall submit to Congress, on an annual basis, a report on the 
implementation of this Act for the preceding year.
    (b) Matters To Be Included.--The report required under subsection 
(a) shall include an evaluation of the effectiveness and performance of 
the International OB/GYN and Urogynecology Promotion Program 
established under section 3 and all related community outreach and 
medical programs.

SEC. 6. DEFINITIONS.

    In this Act:
            (1) Childbirth-related injuries.--The term ``childbirth-
        related injuries'' means injuries associated with obstructed 
        labor, including--
                    (A) pelvic organ prolapse;
                    (B) a displacement of pelvic organs such as the 
                uterus, bladder, or bowel; and
                    (C) obstetric fistula.
            (2) Low-income country.--The term ``low-income country'' 
        means a country with a per capita gross national income of 
        $1,035 or less.
            (3) Least developed country.--The term ``least developed 
        country'' means a country that--
                    (A) is a low-income country; and
                    (B) according to the United Nations Economic 
                Analysis and Policy Division, is confronting severe 
                structural impediments to sustainable development.
            (4) Relevant executive branch agencies.--The term 
        ``relevant executive branch agencies'' 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 humanitarian 
        activities pursuant to the authorities of such department or 
        agency or the Foreign Assistance Act of 1961.
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