01/21/2012 07:21 pm ET Updated Mar 22, 2012

The Overlooked Realities of Reproductive Health

This month marks the 39th anniversary of the passage of Roe v. Wade and an opportunity to resolve to either enhance or repeal the laws that ensure a woman's right to choose, depending on which side of the issue you support. For me, it is a time of reflection, to remember the lives of women in the U.S. and in faraway places, whose courage touched my life when they came to me for help.

I am a nurse practitioner and midwife, and I have had the privilege to meet women all over the world, from San Diego, to rural Tennessee, Guatemala and Ethiopia, whose ability to access a safe abortion and/or reproductive health care changed the course of their lives, and in many cases, saved it. I've spoken with and treated women for whom pregnancy was the most joyous moment in their lives, and others for whom pregnancy was a death sentence.

I recall a female inmate here in San Diego who sobered up and detoxed while in a jail cell -- only to realize she was pregnant. The look in her eyes was desperate. She did not want to bring a child into the world under these circumstances. I recall a woman who already had a young daughter with severe birth defects, unable to eat or breathe on her own. The woman became pregnant again when her birth control failed. Upon learning that she was pregnant, her husband left the family. She came to me with the same desperate look in her eyes, facing an unimaginable dilemma -- to continue to care for the gravely ill child she already had -- or to let her die and have a healthy baby. Having both was not a possibility. Both of these women had a unique set of circumstances -- ones that led to a carefully considered decision not to have a baby. At a different time of their lives, they may have made an entirely different choice. This is an often overlooked reality about what it is to be a woman -- the same woman at age 25 makes different reproductive health and childbearing choices than she does at age 40. And no one should stand in her way when she tries to do so.

I have seen firsthand, too many times, what lack of choice and lack of health care does to women, particularly women in the developing world. I knew women in Guatemala who had such advanced tuberculosis that becoming pregnant was a death sentence for them and their babies. One woman died in the fifth month of her pregnancy. Another woman lived to deliver her baby but she was so weak, she could not breastfeed. Her only option was to give the baby unpurified water and a tiny bit of formula. Both the mother and the baby died within six months. Like many in the developing world, these women had no access to medical care. If they had received timely medical care, they would have received timely treatment. Because they were so weak and the drug regimen for TB is not recommended during pregnancy, they would have been counseled to terminate their pregnancies. What happened to them was a disaster cascade experienced by the poorest of the poor world-wide: no medical care, no contraception availability and no reproductive choices. The inherent risks of pregnancy and childbirth become a matter of life and death.

While Roe v. Wade still protects a woman's ability to access an abortion in the United States, I believe that true choice is about giving all woman access to all options to prevent, delay or terminate a pregnancy, or to have a safe delivery of a wanted baby, no matter where in the world she lives. In my current work with WomanCare Global, I'm able to help women around the world make choices about their reproductive health by providing affordable, quality products for contraception, fertility and pregnancy management. Our primary mission is to get quality products to women in developing countries where products are not always safe, accessible or affordable.

Consider this: Globally, more than 215 million women would like to be using modern methods of birth control but do not have access to those products. Every day, 1,000 women die from pregnancy related complications, and every year, more than a half a million children lose their mothers in childbirth. Access to choice for all women would prevent many of these tragedies -- unintended pregnancies would drop by more than 70 percent, and 150,000 fewer women would die in childbirth. It is heartbreaking to think of a 15-year-old girl in some parts of Africa with restrictive abortion laws who has a 1 in 22 risk that she will die as a result of pregnancy or childbirth in her lifetime. In contrast, a 15-year-old in Sweden has a 1 in 48,000 chance of dying in pregnancy or childbirth in her lifetime.

As we mark the 39th anniversary of Roe let us remember that choice is about all choices -- the choice to have a baby and when to have one, if ever at all. Protecting this choice is what Roe v. Wade is all about. And all women -- no matter where they live -- deserve that right.