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"It is best to only have enough children that you can give your best to."

This obviously simple, yet often unattainable ideal was shared with me when I was participating in a global health learning abroad trip as a first year medical student. This young Ghanaian woman from a small rural village in West Africa, who I will call Ophelia, shared her story with me on a hot July afternoon. Her story, like many women in Ghana, is terrible, desperate and unnecessary.

Our project's purpose in Ghana was to administer pregnancy tests to women visiting a local clinic, and then regularly provide supplements to those testing positive in order to prevent adverse outcomes. However, the consequences of informing women of their pregnancy status early enough that they were not visibly pregnant were alarming. Women came to follow-up appointments, inexplicably no longer pregnant.

Elective abortion is illegal in Ghana, and rural nurses, resigned to the realities, admitted "once they [pregnant women] have made up their mind and decided to abort the baby, they do it no matter what. It's the only choice they see."

Afraid that we were the impetus for this increase in unsafe abortions, we stopped our existing project and it became an investigation into contraceptive knowledge and attitudes regarding abortion.

Ophelia, a tired mother of five, agreed to tell me her terrible story. Ophelia knew she did not make enough money to support the children she already had, and a new baby would only make things worse. She wouldn't be able to survive. She considered her limited options — attempt to abort the fetus by inflicting enough internal damage to necessitate a legal D&C for maternal indication, and be shunned by her family and community, or see the pregnancy through with little chance of financial survival afterward.

"It's really quite easy to find a local with the herbs or knowledge of how to do it," she told me. "The concoction is made of glass shards that are strained and inserted in the vagina to destroy the baby in the uterus. I know five women that have bled by trying to abort the baby too late, so I made sure that I would try early."

Her vaginal canal and cervix were so damaged that Ophelia would later learn from the physicians at the district hospital who stopped her bleeding that she could not have any more children. In Ophelia's eyes, this was possibly a contraceptive blessing.

Because of abortion's illegality and the culturally-ingrained skepticism surrounding hormonal and other contraceptive devices, Ghanaian women typically rely on the rhythm method for family planning, with little success. If the circumstances are dire enough, these women subject themselves to similar trauma, but others have not been as lucky as Ophelia. Twenty-one million women experience an unsafe abortion worldwide each year and eighteen million of these occur in developing countries. The death toll from these completely preventable complications of unsafe abortions reaches 47,000 women each year.

Despite a steep decline in unintended pregnancy in the United States between 2011 and 2014 due to more and better contraceptive use in light of a steady abortion rate, states are continuing to restrict access to contraception and safe abortions with TRAP legislation, limits on sexual education, and family planning funding restrictions.

Abroad, we undermine reproductive health programs as the Helms Amendment of 1973 restricts U.S. foreign aid from going to any program associated with abortion-related activities. The hypocrisy is that the amendment places U.S. restrictions on both recipient governments and individuals, thereby limiting those individuals' free choice regarding fertility control — fertility choices that are legal in the U.S., but might not be for much longer.

We are a global community, and if we think American women are immune to the circumstances playing out in Ghana, we are fools. Why, as the self-declared world leader in health and wealth, do we choose to go backwards, ignoring both the evidence-based medicine we preach and the tragic realities of women in countries with even less access and greater restrictions to the medical care we take for granted?

Instead, state legislatures across the country are passing a slew of abortion restrictions, creating environments perfectly suitable for desperate, unsafe abortion. Are abortions the best family planning solution to unintended pregnancies? Certainly not. Nobody wants more abortion, but some abortion is required. When will we accept the evidence that restricting funding and training for, and access to safe, legal abortions results in nothing less than disability, death, and despair?

Tenley Rawlings Klc is an MD/MPH candidate at the University of Utah and a resident of Millcreek.

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