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SECTION 1. SHORT TITLE.

This Act may be cited as the ''Obstetric Fistula Surgical Repair,
Assistance, and Prevention Act of 2004''.

SEC. 2. FINDINGS AND PURPOSE.

(a) Findings.--Congress finds the following:
(1) Obstetric fistula is a devastating condition that
occurs during childbirth when prolonged pressure of the baby's
head against the mother's pelvis can lead to the child's death
as well as cut off the blood supply of the tissues surrounding
the woman's vagina, bladder, or rectum, causing those tissues
to deteriorate, and thus leaving an open hole, or fistula.
(2) Obstetric fistula can be excruciatingly painful and
often causes a woman to lose control of her bowel movements.
(3) To date, an estimated 2,000,000 cases of obstetric
fistula have been reported worldwide--mostly in Africa among
women who are very young, delivering their first child, lacking
proper nutrition and maternity care, and living in rural areas.
(4) The actual number of women who have obstetric fistula
may actually be much higher due to a lack of adequate
reporting. For example, an additional estimate contends that in
Nigeria alone, approximately 1,000,000 women suffer from
obstetric fistula.
(5) It is estimated that 50,000 to 100,000 new cases of
obstetric fistula occur each year, mostly involving women under
the age of 20.
(6) Women who suffer from obstetric fistula may also suffer
from social isolation because they are often abandoned by their
husbands, families, and employers.
(7) Women who suffer from obstetric fistula may also suffer
severe emotional stress from their condition and social
isolation that is often magnified by the death of their child
during labor.
(8) Obstetric fistula can be prevented through increased
access by women to emergency obstetrical care, a postponement
of sexual activity and childbearing past the teenage years, and
increased training for birth attendants in local communities.
(9) Obstetric fistula can also be treated through a
relatively minor surgical procedure that is 90 percent
effective and which can cost as little as $150.
(10) A large percentage of women who suffer from obstetric
fistula are unaware that treatment exists and may spend their
entire lives suffering from this condition needlessly.
(11) Unfortunately, there are few treatment centers or
hospitals with the capacity to treat obstetric fistula in
developing countries, particularly countries in Africa, and
demand for services and surgery far exceed the supply.
(12) Currently the United States Agency for International
Development provides assistance for programs that target
prevention of obstetric fistula but not programs that target
treatment of obstetric fistula.
(13) Tens of thousands of women in developing countries
suffering from obstetric fistula could be successfully treated
if adequate resources were devoted to this objective.
(b) Purpose.--The purpose of this Act is to ensure that, in
addition to the prevention of obstetric fistula, treatment of obstetric
fistula is an important priority of United States bilateral foreign
assistance programs, including through--
(1) the establishment and expansion of the capacity to
treat obstetric fistula in developing countries, including
through the provision of surgery and post-surgery care; and
(2) the reduction of the incidence of obstetric fistula in
developing countries, including through the conduct of
appropriate seminars and the dissemination of appropriate
educational materials, such as brochures, pamphlets, and
posters.

SEC. 3. DEFINITION.

In this Act, the term ''obstetric fistula'' means a rupture or hole
in tissues surround a woman's vagina, bladder, or rectum that occurs
when the woman is in obstructed childbirth for a prolonged period of
time without adequate medical attention.

SEC. 4. AMENDMENTS TO THE FOREIGN ASSISTANCE ACT OF 1961.

Section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C.
2151b(c)) is amended--
(1) by redesignating paragraph (4) as paragraph (5); and
(2) by inserting after paragraph (3) the following new
paragraph:
''(4)(A) In carrying out the purposes of this subsection, the
President is authorized to furnish assistance, on such terms and
conditions as the President may determine, for the establishment and
operation of not less than twelve centers for the treatment of
obstetric fistula at appropriate sites in developing countries.
''(B) In selecting sites for the establishment of centers pursuant
to subparagraph (A), the President should seek the consultation and
advice of United States embassy officials, appropriate nongovernmental
organizations, and local government officials in developing countries
with high rates of obstetric fistula, with particular emphasis on
countries in Africa.
''(C) Each center established pursuant to subparagraph (A) shall,
to the maximum extent practicable, carry out the following activities:
''(i) The provision of surgery to repair obstetric fistula
in women who do not otherwise have the resources to pay for
such surgery and the provision of necessary post-surgery care
and support for such women.
''(ii) Assistance related to surgery and post-surgery care
and support described in clause (i), including the provision of
transportation to and from the center for women in need of such
transportation and the provision of necessary temporary shelter
and food assistance to women in need of such shelter and food
assistance.
''(iii) Activities to reduce the incidence of obstetric
fistula, including the conduct of appropriate seminars and the
dissemination of appropriate educational materials, such as
brochures, pamphlets, and posters.
''(D) Not later than January 31 of each year, the President shall
prepare and transmit to Congress a report on the implementation of this
paragraph for the prior fiscal year.
''(E) In addition to amounts otherwise available for such purpose,
there are authorized to be appropriated to the President $35,000,000
for each of the fiscal years 2005 and 2006 to carry out this paragraph.
Amounts appropriated under this clause are authorized to remain
available until expended.
''(F) In this paragraph, the term 'obstetric fistula' means a
rupture or hole in tissues surrounding a woman's vagina, bladder, or
rectum that occurs when the woman is in obstructed childbirth for a
prolonged period of time without adequate medical attention.''.
Obstetric Fistula Surgical Repair, Assistance, and Prevention Act of 2004 - Amends the Foreign Assistance Act of 1961 to authorize the President to provide assistance for the establishment in developing countries of at least twelve obstetric fistula treatment centers. States that in selecting sites the President should consult with U.S. embassy officials, nongovernmental organizations, and local government officials in developing countries with high rates of obstetric fistula, with particular emphasis on countries in Africa.