Physician Education for Fistula Treatment Act

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9015 Introduced in House (IH)]

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119th CONGRESS
  2d Session
                                H. R. 9015

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

                              May 22, 2026

 Ms. DeLauro 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) Obstetric fistula, an abnormal opening between a
        woman's genital tract and her urinary tract or rectum, is a
        devastating childbirth injury caused by prolonged, obstructed
        labor in the absence of timely and quality medical care.
            (2) Worldwide, an estimated 500,000 women and girls live
        with obstetric fistula with thousands more occurring annually.
        It occurs disproportionately among impoverished, vulnerable,
        and marginalized girls and women.
            (3) Women who experience an obstetric fistula suffer life-
        shattering consequences including chronic incontinence, shame,
        social isolation, poverty, and physical, mental, and emotional
        health problems.
            (4) Obstetric fistula is a violation of human rights and an
        indicator of the failure of health systems to deliver
        universally accessible, timely, and quality health care to
        women and girls who need it.
            (5) Obstetric fistula is preventable. Universal health
        coverage and universal access to quality care are essential in
        ending preventable maternal and newborn deaths and
        disabilities, including fistula. Skilled health personnel at
        birth, emergency obstetric and newborn care, and universal
        access to modern contraception are the most effective
        interventions to prevent maternal mortality and fistula.
            (6) Safeguarding the rights and dignity of women and girls
        and addressing underlying gender and socioeconomic inequalities
        and discrimination which drive obstetric fistula are equally
        important to end the condition.
            (7) In 2018 and 2020, the United Nations General Assembly
        resolutions on fistula were adopted, calling for ``Ending
        fistula within a decade''. This represents a turning point in
        the global fight to eliminate fistula, as it brings the global
        objective and timeline for ending fistula into alignment with
        achieving the Sustainable Development Goals (SDGs)/Agenda 2030.
        The resolutions also call for an increased focus on social
        determinants to tackle the root causes of fistula.
            (8) Obstetric fistula can be surgically treated. The impact
        of an obstetric fistula-repair surgery is immediate and women
        can be reintegrated into society. There is however a high unmet
        need for treatment and social reintegration of fistula
        survivors.
            (9) In 90 percent of cases where women develop fistula and
        timely medical care is not available, a stillborn baby is
        tragically delivered.
            (10) The United Nations Population Fund (UNFPA)-led global
        Campaign to End Fistula, is a key contributor to promoting the
        rights, dignity, and well-being of women and girls. The
        Campaign focuses on prevention, treatment, social
        reintegration, and advocacy. Aimed at ``leaving no one behind''
        and ``reaching the furthest behind'', it contributes to
        achieving the SDGs and has also helped restore overall health,
        dignity, hope, and a sense of self-worth and agency to some of
        the poorest, most marginalized women and girls worldwide
        through its holistic, gender-sensitive, and rights-based
        approach to policies and programs for the elimination of
        obstetric fistula and several other maternal morbidities.
            (11) UNFPA has supported over 150,000 surgical repairs over
        the last two decades. The Campaign to End Fistula and its
        partners have made remarkable progress, but the needs remain
        great.
            (12) With 4 years to reach the global goal of ending
        fistula by 2030, significantly intensified investment, efforts,
        and partnerships at the international and national levels are
        required.
            (13) The International Day to End Obstetric Fistula which
        takes place on May 23, 2024, will be commemorated this year
        with the theme: ``Her health, her right: Shaping a future
        without fistula'', emphasizing that every girl and woman has
        the fundamental right to health, including reproductive and
        sexual health, and that the continued existence of obstetric
        fistula is a ``clear violation'' of this right.

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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