Since last spring I’ve been talking to audiences around the United States at screenings of Not Yet Rain, a film that Ipas produced about abortion in Ethiopia. The film follows two young women who have been raped as they attempt to terminate unwanted pregnancies safely. Neither woman has received much education, neither knew they could become pregnant as a result of these encounters, and by the time they learned they qualified for abortion, they had to go to a local hospital for care.

In discussions following the film, I have come to anticipate certain questions, like whether the perpetrators of rape will be prosecuted, what we are doing to increase access to contraception, community education and so forth. But this past week I’ve been thinking particularly about this one:

“Who paid for their abortions?”

In most countries, it is inconceivable that the government health plan would not pay for a legal health-care procedure. When I explain this to audiences here in the United States, they have a hard time wrapping their head around it. Our government is the health care provider of last resort, and in fact has gone out of its way to ensure that poor women do not have access to the same health care as middle-class or wealthy women. What’s more, insurance companies regularly make decisions about what procedures or medications they’ll cover. Americans are used to arbitrary medical rules.

Ethiopia, a large, poor country in East Africa, stands in stark contrast. Ethiopia enacted a new abortion law in 2006, one of the most progressive in Africa. It allows abortion for a range of circumstances, including cases where a woman’s life or health are threatened, for minors or when a woman has been raped. The law was one of a number that the government supported to bring Ethiopia’s laws into alignment with the international agreements it had signed on women’s health and rights.

Let me repeat that: Ethiopia specifically sought to change their laws to bring them in line with women’s rights agreements, not to defy them. This included raising the legal marriage age to 18, imposing harsher penalties on people who commit sexual violence and passing a law that would reduce the excessively high rate of deaths from unsafe abortion. Since then, the government has been educating women, law enforcement agencies, community leaders and health-care providers about the new law. They knew that unless the government made sure that the services were available, the law may as well not exist.

I keep harking back to this as I listen to members of Congress and pundits justify allowing anti-choice members to hold health-care reform hostage to the beliefs of a few, at the expense of many. And I think about the women around the world who pay with much more than money to end an unwanted pregnancy; they knowingly put their lives on the line to terminate an unwanted pregnancy. Their injuries make such an impact on health care systems that in the past decade, more than a dozen have liberalized their abortion laws.

These governments know firsthand that safe abortion care is much more cost-efficient than paying to care for women suffering from the complications of unsafe abortion – just as they know that it is worth the investment to pay for contraception, for prenatal care and well-baby check-ups. They know that if they don’t pay for safe abortion care, women will pay with their lives.

So if governments that are committed to improving women’s health are willing to pay for safe abortion care, what does that say about the United States?