It's been thirty-five years since the Supreme Court put the jewel in the crown of reproductive rights and civil liberties in America by affirming in Roe v. Wade a woman's constitutional right to choose abortion. Immediately, the government authorized the use of Medicaid funds for poor women who choose abortion and the United States became a world leader in supporting reproductive health services.

Opposition to abortion, however, rapidly became the galvanizing issue in the emerging culture wars. Right-wing leaders from Senator Paul Laxalt to Paul Weyrich seized on abortion as a wedge issue to engage fundamentalist Christians in supporting the full agenda of the then-new right. Women are still paying the price for the success of this campaign. While Roe was not overturned, it was systematically eviscerated, and long-accepted reproductive health services such as birth control became controversial. These days the United States has one of the most punitive and regressive policies on reproductive health in the developed world. To reverse this turn to the far right, women's health advocates must seek not only to protect abortion rights but to restore the whole range of reproductive health services, pushing for this broader agenda to be at the center of any progressive platform.

Looking at Europe, we can see how things would be different if reproductive health policy attended to women's needs rather than the demands of a fundamentalist Christian right. Almost without exception, in Western European countries where abortions are legal, they are included in national healthcare plans. They do not require parental consent or notice for adolescents seeking abortion; contraceptives are reasonably priced, covered by health insurance and often available without prescription; teens and adults have access to emergency contraception in hospitals or over the counter at pharmacies; and abstinence-only sex education is rare.

When European women choose to have babies, they generally get free prenatal care and excellent midwifery services and birthing options. They receive paid medical and family leave. Those who are unemployed, disabled or ill are not penalized for having children but receive adequate resources to care for their family. Single mothers who work have access to professional daycare.

And the countries with these policies have lower unintended pregnancy rates and thus lower abortion rates.

The major European development agencies do not seek to control social values in the countries that receive their aid, nor do they deny funding to agencies or countries where abstinence is not put forward as the only option for preventing either pregnancy or disease. Family-planning funds are not withheld if local agencies provide access to or support safe and legal abortion.

While prochoice and antiabortion groups in the United States have argued about the minutiae of abortion practice, women's economic security and reproductive health have been severely undermined by far-reaching changes in public policy. Given this broad assault on women, it is no longer ethically sound or politically wise to see abortion as the centerpiece of women's struggle for freedom and equality. In the "change" election of 2008, it is critical that all candidates who claim to be prochoice define choice more broadly. They must make a commitment to fully restoring reproductive health and dignity to all American women regardless of their economic status. Likewise, a commitment should be made to a foreign policy that supports these services and rights for women in the developing world.

The sorry state of US reproductive health policy also requires serious shifts within the women's and the abortion-rights movements, where we were privileged to serve as leaders for many years. So-called inside-the-Beltway strategies need to adopt a comprehensive progressive agenda that makes abortion rights and access part of the pursuit of justice for working and low-income women. Should the 2008 election result in a Democratic President and Congress, advocates need to insist on much more than we asked of the Clinton Administration. "Change" needs to go beyond the expansion of unpaid family and medical leave and the provision of emergency contraception to women who have been raped. Certain bottom-line commitments must be made not only by presidential candidates but by Congressional ones. These include commitments to paid family and medical leave; revocation of those aspects of welfare reform that penalize women with children and those who become pregnant while on public assistance; nationwide inclusion of abortion, family planning and emergency contraception for women in all national healthcare plans; and comprehensive, high-quality sex education and confidential reproductive healthcare for adolescents.

Having learned the hard way that Supreme Court decisions can fail us, we need to frame our case in the court of public opinion, and listen more attentively and respond more fully to the public's concern about men's as well as women's responsibilities to prevent unwanted pregnancies and to parent wisely and lovingly. Roe v. Wade was a socially transforming decision that in many ways was ahead of its time. For women much of the task of social transformation is still before us. And it will be achieved only when we truly engage the public on the many issues that will ensure women's equality and security.

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