In 2015, I moved from North Carolina to Guatemala, where I opened an English school and built an orphanage and a shelter for survivors of domestic violence and sex trafficking. In early 2016, I fell in love, and by late February I was pregnant. Life always moves fast for me, but this was completely unexpected.

Pregnancy was dangerous for me and impossible for a fetus because I was still in the healing phase after several surgeries and remission from pancreatic cancer, with other comorbid health issues. I was using an intrauterine device (IUD). My boyfriend at the time had cryptorchidism (an undescended testicle). And at 38, he was childless after two failed marriages, so I believed pregnancy was impossible.

I was in class on a Saturday night when my phone rang. I don’t normally interrupt my classes, but I was waiting on lab results and the caller ID said it was my doctor. At that hour, I thought he’d tell me that the cancer was back, that my liver was failing again, or that my multiple sclerosis was relapsing. But instead he said, “Congratulations! Why didn’t you tell me you’re pregnant?”

I’d left my boyfriend that very day because the relationship had become a distraction from my long-term goals. My Guatemalan doctor was unfamiliar with the details of my medical history, simply because I hadn’t taken time to explain, and he didn’t know the news would be a death sentence to me. My stateside doctors had assured me that I’d likely die and the fetus would decline slowly before a second-trimester miscarriage because of my severe nutritional issues.

I ended the class early and found an obstetrician I knew; she confirmed the pregnancy (twins, in fact) after a brief examination, during which she removed my IUD. Although IUDs are extremely effective at preventing pregnancies, in very rare cases it can happen. It just so happens I was one of those rare cases, possibly because of extreme weight loss (over 100 pounds) during and after my illness.

In Guatemala an abortion carries a four-to-eight-year prison sentence for both recipient and practitioner, but if two doctors confirm that the pregnant person’s life is in danger, it’s permitted. I had no problem finding two doctors—I found 13—but every one of them shied away from my case, likely because they feared repercussions for performing an abortion on an American.

Interestingly, nearly all were comfortable with abortion care generally, and had referrals prepared for both illegal and medical providers. During my search for a provider, I met even more people who were willing to perform illegal abortions; some were nurses, paramedics, midwives, and retired doctors. The only reasonable rate came from a butcher, who wanted to perform the procedure in my kitchen. He showed me his tools, still dirty and stored in a faded, tattered, pink floral-print Jansport backpack. Needless to say, I turned down his offer.

Everyone I had talked to in Guatemala—medical professionals, friends, family, people with a religious affiliation—supported my exploration of options and told me stories of women who’d obtained abortion care and people who offered the service. For a country without legal access, I was amazed at their neutrality. As an organizer in the United States, I had grown accustomed to anti-choice legislators and protesters who refused to see the truth, and a public that often expressed disapproval of women’s choices.

Several nurses would do a medical abortion with misoprostol but for double the price of what I would pay on my own and without a prescription in the pharmacy. The price was also ten times what I’d purchased it for at the United States-Mexico border to help women back home. However, with my health history, misoprostol wasn’t an option—complications were guaranteed for me, whether I chose a safe clinic route or a clandestine surgical option.

I looked into flying to the United States, but financially it was impossible and I couldn’t cancel any of my 100-hour workweeks without jeopardizing my entire business. So I planned for Mexico City, the closest place to Guatemala, more than a 24-hour trip from my town on the border.

In my arsenal of tools were my training and contacts as a community organizer, and my friends helped me raise the funds. I needed enough money for the procedure and travel for two; I needed a companion and felt better with the native Spanish of my ex-boyfriend. Guatemalans don’t usually have passports and when they do, Mexican visas aren’t easy to obtain. I paid for his passport and rushed visa, which felt like signing my life away in blood, while promising Mexican authorities we’d be back in a few days, that I’d keep him in my sight, and that I wasn’t planning to smuggle him into the United States. I bought our bus tickets and covered his days missed at work because he lives paycheck to paycheck. Only because his employer is one of my best friends and he looked the other way was my ex able to get the time off at all.

A $250 procedure turned into $1,500, and that doesn’t include my lost wages or what the pregnancy was already doing to my body, which more than doubled the overall debt.

By mid-April I was mostly bedridden and paying mounting medical bills. That I was carrying twins made it emotionally harder on both my ex and me, and physically for me. My doctors in the United States urged me to find a solution and terminate my pregnancy immediately. Two even reversed the flow of money and donated to the cause. The day I finally had enough I celebrated through tears; we left a day later.

The personal difficulty didn’t just end at my medical history, though. Even as a years-long reproductive rights activist, I was immeasurably sad about actually terminating my pregnancy. I’m a fierce, outspoken advocate for abortion access, and have been known to shout “on demand, without apology” at anyone who equivocates when it’s permissible, but I honestly never thought about the reality of having one myself. I’ve always wanted many children and previously had the economic and health security to not be concerned about needing an abortion, and I have a large family of biological, step-, and honorary children. Add to this that I still loved my ex, who wanted children but thought he couldn’t have them; the fact he supported my every step while it broke his heart; AND my superstitious beliefs around how I could possibly be pregnant with twins by a man with a low sperm count while using an IUD without it being some sort of miracle. This became the most difficult decision of my life.

I almost didn’t want to, but I had to.

By the time I could actually pay for the abortion, I was so sick and in so much pain that I was starting to feel suicidal and I intentionally overdosed on painkillers—not enough to kill myself but enough to make me sleep through the pain all day. I simply couldn’t do it anymore and I had to move on, for the kids I wouldn’t have and myself, and to accomplish my goals.

The procedure itself was uneventful, not remarkably unlike what would’ve occurred in the United States, though I lied about my medical history because I feared the doctor would decline to perform the procedure and refer me to a hospital. I worried as a foreigner I’d be refused there.

Back in Guatemala, my illness continued. After a month, I attempted to return to Mexico City for routine follow-up care but never made it. The journey was too difficult in my condition and I found the nearest emergency room soon after the Mexican border. The 11-week pregnancy had caused severe malnutrition and with all of the medications I had been taking, I had ulcers, pancreatitis, and acute liver failure. I spent more than a month in a Mexican hospital.

While there, I met several women hospitalized with illegal abortion complications, and more than one died. In Mexico, one-third of clandestine abortions require medical treatment, but in Mexico City, where first-trimester abortion is legal, there are almost no complications.

Esperanza was from the same state in Guatemala, but she lived in Mexico with her three children and a loving husband. She’d paid someone to perform an abortion and came to the hospital some days later with a massive infection and internal bleeding. For a while she was mobile and talkative, and we talked and laughed through our time together. But in her last two days she declined rapidly, and I held her in my arms during her last breaths.

It had been four months since the phone call informing me of my own pregnancy, and snowballing thoughts were now an avalanche. I’d previously stayed out of organizing for reproductive rights in Guatemala—while all communities need allies, there are lines outsider organizers shouldn’t cross. It wasn’t my place. But here I was, experiencing firsthand what women without access can suffer, and a young mother and wife I had grown to love had just died.

The only thing separating me from many of these women was resources—a passport and access to money. Resources saved my life; they left me here while a lack of access took Esperanza from her family. Her children deserve their mother; her husband deserves his wife; and she deserved her future.

I can no longer allow my own silence when these laws are destroying women and families.

If my suffering had to be what it took for me to realize the work left to do around increasing access to abortion care, I’m ultimately thankful it happened. But comprehensive reproductive health care shouldn’t come at such a high price—the cost of women’s lives.