H.R. 9015

[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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