"(5) reports will be submitted by such project to the Secretary in such form, at such times, and containing such information as the Secretary may reasonably require, including an annual report, in accordance with uniform criteria, of the number and characteristics of persons served in such project; and

"(6) in the case of a project which serves a population including a substantial proportion of individuals of limited English proficiency, the project has (A) developed a plan and made arrangements responsive to the needs of such population for providing services to the extent practicable in the language and cultural context most appropriate to such individuals, and (B) identified an individual on its staff who is fluent in both such language and in English and whose responsibilities shall include providing guidance to such individuals and to appropriate staff members with respect to cultural sensitivities and bridging linguistic and cultural differences.

For purposes of this subsection, the term 'low-income family' shall be defined by the Secretary in accordance with such criteria as the Secretary may prescribe in regulations so as to insure that economic status shall not be a deterrent to participation in project assisted under this part.

"(d) The Secretary shall seek to make equitable distribution of funds appropriated under this part among the various regions of the country and to ensure that the needs of rural and urban areas are appropriately addressed.

"VOLUNTARY PARTICIPATION

"SEC. 1007. (a) The acceptance by any individual of family planning services or family planning or population growth information or educational materials provided through financial assistance under this part (whether by grant or contract) shall be voluntary and shall not be in prerequisite to eligibility for or receipt of any other service or assistance from, or to participation in, any other program of the entity or individual that provided such service, information, or materials.

(b) In connection with any grant or contract made under this part, the Secretary shall not require any individual employed by a recipient of such grant or contract, nor terminate, suspend, or reduce assistance under this part for such individual's failure, to advise regarding, refer patients for, or provide, abortion or sterilization procedures when such activity would be contrary to the religious beliefs or moral convictions of such individual.

"PROHIBITION OF ABORTION

"SEC. 1008. None of the funds appropriated under this part shall be used in programs where abortion is a method of family planning.

"PLANS AND REPORTS

"SEC. 1009. (a) Not later than four months after the close of each fiscal year, the Secretary shall make a report to the Congress setting forth a plan to be carried out over the next five fiscal years for the

"(1) extension of family planning services to all persons desiring such services, with particular emphasis on those who cannot afford such services, adolescents, and others who lack access to such services and including persons residing in rural and urban areas;

"(2) development of family planning programs and population research activities, including appropriate emphasis on natural family planning methods; "(3) training of necessary personnel for the programs authorized by this part and other Federal laws for which the Secretary has responsibility and which pertain to family planning and population research;

"(4) financing of such services and programs;

"(5) evaluation of the efficiency and effectiveness of such services and programs; and

"(6) carrying out of the other purposes and provisions of this part. "(b) Such a plan shall, at a minimum, indicate on a phased basis

"(1) the number of individuals (especially those who lack access to such services and including persons residing in rural and urban areas) to be served by family planning programs under this part and other Federal laws for which the Secretary has responsibility, as well as the social and demographic characteristics (including age and sex) of these individuals and the locations and types of agencies and projects providing such services; and the means by which such services and programs are to be financed;

"(2) the types of family planning and population growth information and educational materials to be developed under this part and such other laws and how such information and materials will be made available;

"(3) the research goals to be reached under this part and other Federal laws for which the Secretary has responsibility and which pertain to family planning and population research;

"(4) the personnel to be trained under this part and such other laws; "(5) an estimate of the costs and personnel requirements needed to carry out the plan under the provisions of this part and such other laws; and

"(6) the means and criteria by which such services and programs are to be evaluated, and the steps to be taken to maintain a systematic reporting system capable of yielding comparable, comprehensive data (including data on use of natural family planning methods).

"(c) Each report submitted under subsection (a) of this section shall

"(1) compare results estimated to be achieved during the preceding fiscal year and achieved during the year preceding such year (including estimates for services in rural and urban areas) with the objectives established for each such year under the plan contained in the previous such reports;

"(2) indicate steps being and to be taken to achieve the objectives during the fiscal years covered by the plan (including objectives for services in rural and urban areas) contained in such report and any revisions to plans in previous reports necessary to meet such objectives;

"(3) indicate any projected changes in the data gathering system; and "(4) make other recommendations with respect to any additional legislative or administrative action necessary or desirable in order to carry out more effectively the purposes and provisions of this part.

"PART B SUDDEN INFANT DEATH SYNDROME PROGRAMS

"SUDDEN INFANT DEATH SYNDROME COUNSELING, INFORMATION, EDUCATIONAL, AND

STATISTICAL PROGRAMS

"SEC. 1011.(a)(1) The Secretary, through an identifiable administrative unit under the supervision of the Assistant Secretary for Health, shall carry out a program to develop public information and professional educational materials relating to sudden infant death syndrome, and to disseminate such information and materils to persons providing health care, to public safety officials, and tothe general public. The Secretary shall administer, through such unit, the functions assigned in this section and section 1012, and shall provide such unit with such full-time professional and clerical staff and with the services of such consultants and of such management and supporting staff as may be necessary for it to carry out such functions effectively.

"(2) The Secretary shall

"(A) develop and implement a system for the periodic reporting to the Department, and dissemination by the Department, of information collected under grants and contracts made under subsection (b)(1) of this section; and "(B) carry out coordinated clearinghouse activities on sudden infant death syndrome, including the collection and dissemination to the public, health and educational institutions, professional organizations, sudden infant death syndrome parent self-help organizations, and other interested parties of information pertaining to sudden infant death syndrome and related issues such as death investigation systems, personnel training, biomedical research activities, and information on the utilization and availability of treatment or prevention procedures and techniques, such as home monitors.

The Secretary is authorized to enter into contracts with public or private entities to carry out the information and clearinghouse activities under this subsection.

"(b) (1) The Secretary is authorized to make grants to public or nonprofit private entities, and enter into contracts with public or private entities, for projects which include both

"(A) the collection, analysis, and furnishing of information (derived from post mortem examinations and other means) relating to the causes and other appropriate aspects of sudden infant death syndrome; and

(B) the provision of information and counseling to families affected by sudden infant death syndrome.

"(2) No grant may be made or contract entered into under this subsection unless an application therefor has been submitted to and approved by the Secretary. Such application shall be in such form, submitted in such manner, and contain such information as the Secretary shall, by regulation, prescribe. Each application shall—

"(A) provide that the project for which assistance under this subsection is sought will be administered by or under the supervision of the applicant; "(B) provide for appropriate community representation (including appropriate involvement of parent self-help groups) in the development and operation of such project;

"(C) set forth such fiscal controls and fund accounting procedures as may be necessary to assure proper disbursement of and accounting for Federal funds paid to the applicant under this subsection; and

"(D) provide for making such reports in such form, at such times, and containing such information as the Secretary may reasonably require, including such reports as will assist in carrying out the provisions of subsection (a)(2) of this section.

"(3) Payments under grants under this subsection may be made in advance or by way of reimbursement, and at such intervals and on such conditions, as the Secretary finds necessary.

"(4) Čontracts under this subsection may be entered into without regard to sections 3648 through 3709 of the Revised Statutes (31 U.S.C. 529; 41 U.S.C. 5). "(5) The Secretary shall seek to make equitable distribution of funds appropriated under this part among the various regions of the country and to endure that the needs of rural and urban areas are appropriately addressed.

"(6) For the purpose of making grants and contracts under this section, there are authorized to be appropriated $2,000,000 for the fiscal year ending June 30, 1975; $3,000,000 for the fiscal year ending June 30, 1976; $4,000,000 for fiscal year 1977; $3,650,000 for fiscal year 1978; $7,000,000 for fiscal year 1979; $9,000,000 for fiscal year 1980; and $11,000,000 for fiscal year 1981 and each of the two succeeding fiscal years.

"PLANS AND REPORTS

"SEC. 1012. (a) Not later than February 1 of each year after 1978, the Secretary shall submit to the Committee on Human Resources of the Senate and the Committee on Interstate and Foreign Commerce of the House of Representatives a comprehensive report on the administration of this part (including funds and positions allocated for personnel) and the results obtained from activities thereunder, including the extent of allocations made to rural and urban areas, The report submitted on or before February 1, 1979, shall also set forth a plan to"(1) extend counseling and information projects to the fifty States and the District of Columbia by July 1. 1979; and

"(2) extend counseling and information projects to all possessions and territories of the United States by July 1, 1980.

"(b) The Secretary shall conduct or provide for the conduct of a study on State laws, practices, and systems relating to death investigation and their impact on sudden and unexplained infant deaths, and any appropriate means for improving the quality, frequency, and uniformity of the post mortem examinations performed under such laws, practices, and systems in the case of sudden and unexplained infant deaths. Not later than December 31, 1979, the Secretary shall report to the Congress the results of such study, including recommendations as to any appropriate actions by the Department of Health, Education, and Welfare with respect to the conduct cf post mortem investigations in all cases of sudden and unexplained infant death (including the desirability and feasibility of establishing pilot projects for centralized post mortem and specimen examination systems on a statewide or regional basis).

"SUDDEN INFANT DEATH SYNDROME RESEARCH AND RESEARCH REPORTS "Sec. 1013. (a) From the sums appropriated to the National Institute of Child Health and Human Development under section 441, the Secretary shall assure that there are applied to research of the type described in paragraph (1) (A), (B), and (C) of subsection (b) of this section such amounts each year as will be adequate, given the leads and findings then available from such research, in order to make maximum feasible progress toward identification of infants at risk of sudden infant death syndrome and prevention of sudden infant death syndrome.

"(b)(1) Not later than ninety days after the close of fiscal year 1978 and of each fiscal year thereafter, the Secretary shall report to the Committees on Appropriations of the Senate and the House of Representatives, the Committee on Human Resources of the Senate, and the Committee on Interstate and Foreign Commerce of the House of Representatives specific information for such fiscal year on

"(A) the (i) number of applications approved by the Secretary in the fiscal year reported on for grants and contracts under this Act for research which relates specifically to sudden infant death syndrome, (ii) total amount requested under such applications, (iii) number of such applications for which funds were provided in such fiscal year, and (iv) total amount of such funds; "(B) the (i) number of applications approved by the Secretary in such fiscal year for grants and contracts under this Act for research which relates generally to sudden infant death syndrome, (ii) total amount requested under such applications, (iii) number of such applications for which funds were provided in such fiscal year, and (iv) total amount of such funds; and

"(C) the (i) number of applications approved by the Secretary in such fiscal year for grants and contracts under this Act for high-risk pregnancy and highrisk infancy research which relates to sudden infant death syndrome, specifying how these conditions relate to sudden infant death syndrome, (ii) total amount requested under such applications, (iii) number of such application for which funds were provided in such fiscal year, and (iv) total amount of such funds. "(2) Each report submitted under paragraph (1) of this subsection shall

"(A) contain a summary of the findings of intramural and extramural resarch supported by the National Institute of Child Health and Human Development relating to sudden infant death syndrome as described in clauses (A), (B), and (C) of such paragraph (1), and the plan of such Institute for taking maximum advantage of such research leads and findings;

"(B) provide information on activities underway and plans to bring about the appropriate clinical application of current research findings and the cost and implications of such applications; and

"(C) provide an estimate of the need for additional funds over each of the next five fiscal years for grants and contracts under this Act for research activities described in such clauses.

"(c) Within five days after the Budget is transmitted by the President to the Congress for each fiscal year after fiscal year 1979, the Secretary shall transmit to the Committees on Appropriations of the Senate and the House of Representatives, the Committee on Human Resources of the Senate, and the Committee on Interstate and Foreign Commerce of the House of Representatives an estimate of the amounts requested for the National Institute of Child Health and Human Development and any other Institutes of the National Institutes of Health, respectively, for research relating to sudden infant death syndrome as described in paragraph (1) (A), (B), and (C) of subsection (b) of this section, and a comparison of such amounts with the amounts requested for the preceding fiscal year.". SEC. 3. (a) The title of title XI of the Public Health Service Act is amended to read "GENETIC DISEASES AND HEMOPHILIA PROGRAMS".

(b) Part of title XI of such Act and sections 1, 2, 3, and 4 of Public Law 91-572 are repealed and part C of such title XI is redesignated as part B on the effective date of this Act.

SEC. 4. This Act shall take effect on October 1, 1978.

Amend the title so as to read:

A bill to amend title X and part B of title XI of the Public Health Service Act to extend appropriations authorizations for five fiscal years for voluntary family planning and population research programs and for sudden infant death syndrome programs, and to make improvements in the provisions governing such programs and research with respect to such syndrome; and for other purposes.

INTRODUCTION

S. 2522, the proposed "Family Planning Services and Population Research Act Extension of 1978", and S. 2523, legislation to extend

the Sudden Infant Death Syndrome Act of 1974, were introduced on February 9, 1978, by Senator Alan Cranston. Joining as cosponsors of these bills were Senators Harrison A. Williams, Jr., Jacob K. Javits, and Donald W. Riegle, Jr.

The Subcommittee on Child and Human Development held hearings on these bills on February 24 and March 1, 1978.

Voluntary Family Planning and Population Research Programs The Family Planning Services and Population Research Act of 1970 (Public Law 91-572) established an Office of Population Affairs to be directed by a Deputy Assistant Secretary for Population Affairs, and directed the Secretary to utilize that individual to administer and/or coordinate all Departmental and other Federal programs related to family planning programs and population research. That Act also established title X of the Public Health Service Act which authories grants and contracts for the provision of family planning services to all those who want them but cannot afford or gain ready access to them, and authorized grants and contracts for training and information and education programs related to family planning services. Title X also authorized the appropriation of funds for population research carried out by the Center for Population Research at the National Institute of Child Health and Human Development.

On February 24, 1978, testimony was received on S. 2522 from a broad range of witnesses including Department of Health, Education, and Welfare (HEW) witnesses; a panel of researchers in the field of basic biomedical reproductive research, behavioral and social research, and contraceptive development; a panel on family planning services for adolescents, including representatives of professional medical organizations, comprehensive health centers, serving adolescents and individuals and groups who have developed pertinent educational programs for adolescents; a panel of providers of family planning services; a representative of the U.S. Coalition for Life; and representatives of interested organizations such as the American Public Health Association, women's organizations, and religious organizations.

Witnesses urged reestablishment of the position of Deputy Assistant Secretary for Population Affairs, and reassertion of the directive in Public Law 91-572 that that individual be responsible for the administration and/or coordination of all Departmental and Federal programs related to family planning and population research. The Department testified regarding its plans to reestablish that position. All witnesses, with the exception of the U.S. Coalition for Life witness, urged the extension of the family planning and population research programs for a multiyear period at authorizations levels comparable to those included in the committee print, and urged that special emphasis be placed on providing comprehensive family planning services to sexually active adolescents who desire such serv ices in order to avoid unwanted pregnancies. Witnesses testified about the serious health implications to the child and mother and the future adverse social impact on the adolescent mother imposed by the responsibilities of parenthood.

Testimony was received from most witnesses on the need for safer and more effective contraceptives and the importance of encouraging