Defining pro-choice as an issue of abortion rights limits it as a political statement. There are two aspects of PRO-CHOICE which I will suggest should be integrated into this powerful concept in order to change the way women approach issues which affect their total health care - body, mind, and soul. First, the classical concept of pro-choice addresses only the legality and safety of abortion. "Safe and Legal" means that you could get an abortion and you would be safe but you might have to travel 300 miles, pay around $500, and get little or no counseling about the procedure or follow-up care. And what if you want to birth your baby but you have no health insurance and cannot figure out how you will work your minimum wage job and raise an infant at the same time? Clearly, with this limited idea about "pro-choice," realistic choices are very limited . Sisters, this is not enough; safe and legal just is not going to do it. We need this PRO-CHOICE: Safe and Legal + Available + Affordable + Educated. When a woman is educated, has accessibility to a care provider and financial support, she can then make a real choice - one that suits her - whether to have an abortion or to carry her child to term. Second, I think we can make a leap and apply the political concept of PRO-CHOICE to the entirety of women's health care. For years, we have applied pro-choice to abortion, but let's apply the concept of PRO-CHOICE to all of reproductive health care. Think of that first gynecological visit, or of the first time you wanted contraception. Did anyone go over all of your choices - or did they say "You want the Pill!" (Or the shot, these days.) Welcome to women's health care: your provider knows best. HA!

And, consider childbearing : an issue few women confront until it confronts them. How do women have babies? Common knowledge is that the only safe place to have a baby is in the hospital. Saying that is like saying the best and only birth control method is the Pill. Challenging societal norms challenges our own fundamental beliefs in many ways. So, I ask that you step outside for a minute and take a deep breath for the following: there are choices available for childbearing which involve who might be your care providers, the sites for birth, and even the locus of power (i.e. whether it stays with you or your doctor or whomever). To be brief, a woman may choose a nurse-midwife, licensed midwife, general practitioner of MD variety, Ob-Gyn, etc. Which is best? I argue that it is up to the woman to decide but a woman who does not know that midwives have better outcomes for both mothers and babies than most MD's may not have the information she needs to make an informed choice.

Furthermore, birth outside a hospital setting is an option many women do not know is available. Those who question safety can look at the article "Outcomes of Care in Birth Centers: The National Birth Center Study" which appeared in the New England Journal of Medicine on December 28, 1989. The study compared birth center outcomes for mothers and babies to those at a hospital and found freestanding birth centers (clarification: some hospitals claim that they have birth centers; these are generally labor and delivery units with nice curtains, bed throws, and hidden equipment for the hospital tours. Other than that, you are in the hospital) had outcomes for mothers and babies that were the same as if not better than hospitals, i.e. infant mortality and maternal mortalities were lowest for the freestanding birth centers. The availability of this information increases knowledge for women and expands the realm of "choice."

There is another place mothers may birth their babies: at home. HEAVENS! How can you assert such a thing, you may say. All right, let's look at statistics kept by the Farm, a commune and freestanding birth center located in Summertown, TN. Midwife Ina May Gaskin reported in Spiritual Midwifery statistics she recorded from 1970 to 1979. For the births which she and the other midwives attended homes and at the Farm Maternity Center, the perinatal death rate the number of babies that died close to the time of birth was 8.6/1000 for all of their deliveries. The rate in the state of TN in 1977 was 26/1000. There are many other facts and figures I could spout, but one fact that is perhaps especially meaningful to women who have had children is that the Farm reported that 54% of their women had no tears or episiotomies (a deliberate cut made in the skin between the vagina and the rectum) during childbirth.

Lastly, not only can women choose their care provider and their place of labor and birth, I argue they should be able to choose the type of birth they want. How many women know that birth can be an extremely powerful experience? Watch TV: birth is seen as demeaning to women; they shriek and cry. Nurses yell at them and tell them to push and the doctor is the hero when he or she delivers the baby. Perhaps we as feminists have discounted for too long the power our own bodies hold because it ties us to what we struggle to fight against our whole lives - that who we are is somehow tied to our ability to have children. CHOOSE another view: I have seen women labor hard and beautifully without MD's, medicines, or the trappings of the hospital. These women find inner strength they never knew they had and find they can do anything: SHE gives birth to her own child. My own mother says this, "When I gave birth, I knew I could do anything. I could run a marathon." CHOICE: Birth as empowerment.

But women's health care is more than reproductive care. We require health care throughout our lives. To be PRO-CHOICE about our health means to explore beyond the obvious and to search for options we should have in choosing our care providers, the sites for care, and the type of care. These are concepts which have been discussed in regard to reproduction but also can apply to all of our health care. We can choose to have an MD, an Osteopathic Doctor (DO), a Nurse Practitioner (NP) or a Physicians Assistant (PA) to provide primary care for us. We can choose an office, a home, a hospital, or a sweat lodge for our healthcare. We can choose allopathic medicine, naturapathic medicine, eastern medicine, midwifery, or any health care system that meets our needs.

But to choose, we need to educate ourselves about our own healthcare needs. We need to learn how to ask the right questions of our care providers. A good example of knowing what to ask and the answers you want involves the issue of heart disease. The biggest cause of death for women is not breast cancer; it is heart disease. Women experience different signs and symptoms for heart attacks and may go undiagnosed and untreated because the health care provider has not been trained to recognize the signs of heart disease in women. So, women should not be viewed by care providers as a subgender, no different than men except for the existence of a uterus. We need to find out if our care provider recognizes the unique needs of women and men and the fact that gender impacts health in all of its aspects, not just reproduction.

By applying these components of PRO-CHOICE to the issue of health care in its entirety, instead of limiting it to abortion, we begin to have a framework to develop a feminist view of health care. Turning the politic to education regarding health care options and lobbying for affordability and availability, we can not only call ourselves pro-choice, but we can ensure that options, which were once only safe and legal, are actual choices which a woman can make within her own town and her own community.