Throughout a long election campaign, the future of abortion rights and the right to choose has remained a silent concern for many women and men as the higher-profile issues of the economy and the wars in Iraq and Afghanistan dominated debate. But the question on Roe v. Wade put to the presidential candidates at the final debate on Wednesday moved the issue front and center once again. It is an intensely personal and relevant issue for women, and for most of us it is not an abstraction.
It became central to my life a couple of years back, when my primary physician refused my request to prescribe the morning-after-pill, citing medical reasons that made no sense to me. I was in a better position than most women in the United States. I was in a dual-income relationship and had a steady job that serendipitously afforded me all the information I needed to assess my situation.
I knew I had a number of options. I had the resources to seek out another health care provider, and I would be able to afford a safe abortion if it came to that. The only option I had ruled out was to carry a potential pregnancy to term: we simply would not be able to afford childcare and other expenses for a second child.
This, to me, is the real question of choice. As voters in California, Colorado, and South Dakota are asked to decide on proposals that would limit women's access to abortion and contraception, there is precious little public debate on whether actually having a child is necessarily a viable choice, financially and professionally.
For many, it is not. Federal law affords just 12 weeks of unpaid maternity or paternity leave, and only for those who are eligible, which excludes about 40 percent of American workers. There are no allowances for time off to breastfeed. There are few public child care options before primary school, and even private alternatives generally will not take children under 2.
Perhaps most disturbing in terms of lack of support, 8.7 million children in the United States currently have no health insurance. In the eyes of the law, it would seem, physically giving birth is the only consideration: you are afforded a short time to regain your strength after the delivery, but are otherwise on your own.
Some -- even advocates for choice -- would say that if you plan to depend on the government, you shouldn't have a child in the first place. But this argument also presumes that if there were public health care and childcare, and provisions for family support, birth rates would shoot through the roof, draining government coffers. Experience from countries with much better maternity and child protections shows otherwise. In my own country, Denmark, there are provisions that are generous by American standards - 52 weeks of paid parental leave, child care and public health care. But the birth rate also is quite low, 1.74 per woman in her lifetime, compared with 2.1 in the United States.
Support services are not the only factor in making a choice about parenthood, but clearly in the United States, from a purely economic point of view, fertility is not a matter of choice for everyone.
In the United States the lack of support for child care and parental benefits also coexists with serious legal or financial obstacles to accessing safe abortion services and even, at times, contraception. Since 1973, both state and federal legislators have limited access to legal abortion through burdensome regulation. Women with limited economic resources face additional obstacles because abortion services have been subject to a federal funding freeze since 1977 except in cases of rape, or incest or where the mother's life is in danger. Furthermore, the majority of states do not provide health care funding for abortion services that fall outside these exceptions.
In fact, fertility (and, by extension, choice) often comes down to a class issue. While the overall fertility rate has stayed the same, the number of children living in low-income families has steadily increased since 2000. The point is not that poor women shouldn't have children, but that all women should have a real choice - and that means access to information about contraception and abortion, and the support they need to raise children.
In my case, I ended up finding an alternative health care provider, who prescribed me the morning-after-pill.
For me, this is more than a personal issue. I have made a commitment to press for a real opportunity for choice for all women, including access to safe abortion services for poor, adolescent, or otherwise vulnerable women.
But choice also requires science-based sex education, contraception, maternity and paternity benefits, and access to child care and health care. The rationale behind polices such as Denmark's is that rearing a child is a service to all: reproduction, at its most basic, is the reproduction of society. Both the personal and the collective nature of that choice need to be protected by law and defended by the next president.
Marianne Mollmann is the women's rights advocate at Human Rights Watch