Shanti Conly, director of research for Population Action International, a non-profit lobbying group concerned with population and women's reproductive health, recalls her first foray to Bangladesh in 1978, when she arrived there to help manage family planning programs.
She found that women took a fatalistic view of childbearing and all its attendant risks. Asked how many children they wanted, the typical reply would be, "If God gives them to us, we will take them."
Now, with contraceptives more readily available, when the same question is asked in the same villages, women are ready with an emphatic answer: Most of them want three children. Given the possibility of planning and spacing their pregnancies, their fatalistic view of life retreats -- while optimism and productivity increase.
In Bangladesh and other developing countries, it is easy to see the difference a choice can make. A woman of 35 who has used contraceptives and spaced three children at healthy intervals is a stark contrast to a woman of the same age who has given birth six or seven times and looks shriveled and old. Motherhood takes a severe toll when pregnant and nursing women cannot count on an adequate diet or access to health care.
Too many, too early, too late, too close: These are the risk factors that push up mortality rates for mothers and children.
For women, reproductive health care is a major factor in longevity and the ability to participate in family and community life. Contraceptives, access to medical care in pregnancy and childbirth, screenings for cancer, protection against sexually transmitted diseases and, yes, access to medically safe abortions -- all these factors help determine the health of women and children.
Women in developing countries who space their children at least two years apart double the chances of survival for both the newborn and the next oldest child. Researchers also find a poor survival rate for infants whose mothers die giving birth.
Expand choices, and you can change lives. Improve access to contraceptives and health care and you give families an escape from fatalism.
It's too bad "choice" has become a politicized word, assigned to one side of the abortion debate. Choice, especially in reproductive matters, is not a matter of convenience. For most people in the world, it can literally be a matter of life and death.
The days when women faced frightening odds in childbirth may be over in the United States and other developed countries. But for millions of families around the world, the prospect of a new baby also holds the frightful possibility that the family will lose an essential social and economic anchor.
In Nepal, for instance, some 850 women die for every 100,000 births. The reasons range from relatively high birth rates -- fewer than one in four Nepalese women use contraceptives -- to the small percentage of women receiving prenatal care and the fact that only about 9 percent of births in the country are attended by any kind of trained personnel.
In Nepal and elsewhere, the availability of better medical care could make a huge difference. When a woman suffers obstructed labor, a Caesarean section can save two lives. Access to safe abortions -- or at least prompt treatment for women suffering from complications of unsafe abortions -- also would save many thousands of lives. In many parts of sub-Saharan Africa and some Asian countries, high rates of AIDS and HIV infection present another problem.
Ms. Conly's group, Population Action International, released an index ranking 118 countries in the world on the reproductive risks women face. The United States, as expected, ranked among the "very low risk" countries. But 17 countries, including some newly industrializing ones like Taiwan and Singapore, ranked above the U.S. -- in large part because of this country's high rate of teen-age pregnancy and because some 5 percent of pregnant women fail to get pre-natal care. Our relatively low ranking for such a wealthy country should serve as a warning to Congress not to cut aid for domestic family planning programs.
And those who are eager to cut funding for international family planning programs need to know that U.S. aid directly benefits some 50 million couples and their families in developing countries and prevents thousands of deaths each year among mothers, infants and young children.
OC Safe motherhood -- here and abroad -- should be above politics.
Sara Engram is editorial-page director of The Evening Sun.