Getting Abortion Pills Into Women's Hands
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I'm Ayesha Roscoe, and this is The Sunday Story, where we go beyond the news to bring you one big story. Three years ago this week, the Supreme Court issued a historic ruling overturning Roe v. Wade, the case that gave women a constitutional right to abortion. The biggest change to abortion rights in the United States in nearly half a century is here. The Supreme Court upended nearly a half century of legal precedent.

Since that decision, nearly 40% of states have passed laws either banning or further restricting abortion. But even with these new restrictions, abortion rates across the country have actually been rising. Women are still finding ways to have abortions, and one of the main ways is taking abortion pills.

In fact, pills account for about two-thirds of abortions in the U.S. healthcare system. There's a surprising history to one of those abortion pills, and that's the focus of a three-part series, The Network, produced by Futuro Media and our colleagues over at Embedded.

The network traces how for decades, a loosely connected network of women across the Americas have helped people access abortions despite restrictions and bans. They've done this by providing each other with pills and support outside the formal health care system. The series also explores the pushback that these women have faced from abortion opponents.

When we come back, I sit down with the host of the series, Marta Martinez and Victoria Estrada. They traveled to Brazil, Argentina, and eventually to the U.S. to tell the story of abortion access, regardless of legal restrictions.

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We're back with The Sunday Story. I'm here with Marta Martinez and Victoria Estrada, hosts of the network. Marta and Victoria, welcome to The Sunday Story. Thank you for having us. Thanks for having us.

Your series follows women all over the Americas as they support each other in accessing safe abortions in countries that partially or entirely restrict access to abortion. You start that story in Brazil. Why does the series begin there? So we started in Brazil because that's where a very important discovery happened in the mid-1980s.

In the mid-1980s, abortion in Brazil was pretty much illegal, and it still is today, actually. And women were still having abortions, but they were using very unsafe methods. Especially among poor women, maternal mortality rates in Brazil were among the highest in the world, and abortion complications was one of the main causes.

And yeah, while we were there, we talked with an OBGYN, Rivaldo Albuquerque, and he told us that so many women came into his hospital with severe complications from botched abortions. I lived through a time when women got sick and died, died of infection, died of bleeding. Young women, extremely young women.

And then he noticed that something changed. Women were coming in with different symptoms, and the symptoms were way less severe.

We had a downward curve in mortality, a downward curve in abortion complications. And then there was a moment when you almost didn't see any complications of abortion at all. Women stopped dying. So did he have any idea, like, what was happening?

Yeah, women had figured something out. There was a stomach ulcer medication called Cytotec. That's the commercial name for misoprostol. And Cytotec had recently come on the market in Brazil. And it had a clear warning. Pregnant women shouldn't take it because it could cause a miscarriage. And so women who didn't want to be pregnant realized they could take advantage of this side effect. They could take the pills to have an abortion.

And actually, the pills are very easy to access because it wasn't supposed to be used for an abortion. It's just this side effect that happened to women. But Cytotec, pretty much like you could just go to the pharmacy and buy it. And what these women were doing is called self-managed abortion with pills. That means that they were getting these pills without a doctor prescribing them or supervising.

Do we know who figured out that this stomach ulcer medication could be used for abortions? We actually don't. There's not one person who came up with this idea. And that's what's actually fascinating about this story. Through our reporting, we found out that across Brazil, which is a huge country, women were using this pill and they were just selling each other. So there was this whole...

whisper network that was growing. Certainly, we know that some pharmacists were involved, but the people we spoke with, they all said that it really was the women. It was the women themselves. And we also spoke to someone who took Cytotec. The first year it came on the market in Brazil. It was spreading by word of mouth. In the story, we call her by her initial R because what she did was illegal.

R had actually two abortions in the 1980s. The first one was years before cytotec was even available. She was in her early teens at the time, and she was really scared of her father, who she says had a gun. And her father had actually threatened her sister when he found that she had lost her virginity.

So it was a real threat for R. She knew she couldn't keep the child for fear of what her father might do to her. So she ended up turning to a midwife who gave her an abortion that landed her in the hospital because she was bleeding so much. And doctors there told her that she had nearly perforated her uterus. My goodness.

That was in the early 80s. This was before Cytotec came into the picture. And a few years later, R got pregnant again. And this time she heard about Cytotec. She was able to get the pills from the pharmacy. It was for gastritis. So they sold it at the pharmacy like water. You just go in and say, hey, give me a box of Cytotec. Anyone could buy it.

And the pharmacist gave her six pills and R took them. And R told us that she started bleeding and she went to the hospital because that's actually what the pharmacist had told her. If you start bleeding, go to the hospital. But when she got to the hospital, a doctor confirmed that she wasn't pregnant anymore.

And between these two abortions, R saw a clear difference. The one through the midwife versus the one when she took the pills, side attack on her own. The second time, I didn't have a lot of side effects. I didn't have a lot of bleeding. So it was safer for me. I felt more comfortable.

So the first one almost killed her. The second one, she had a lot less complications. But was what she was doing, was that actually safe with the cytotec? Today, we know that taking this pill to have an abortion is safe. It's been confirmed by institutions like the World Health Organization. But at the time, like these early years are and the other women who took the pill didn't know that.

And what's also very interesting is that women were figuring out how to use this pill, cytotec, very safely and effectively, very quickly.

And we spoke to a researcher who was studying abortion in Brazil in the early 90s. And she said that she was talking to women who were coming into the hospital who were bleeding, and it looked like they had done something to have an abortion. And the majority of them told her that they had used Cytotec, which is the commercial name of misoprostol. And this researcher, in a matter of months, she saw how women had figured out how to take

Cytotec, how many pills and what the right dose was and when to take it. Well, what was the impact of this discovery in Brazil?

Well, in a five-year span, the maternal mortality rates fell by 21%, according to the World Health Organization. And something we found through our reporting is that some feminists and doctors even had a nickname for cytotec. They called it saintotec because it was really saving so many lives.

Rivaldo, the OBGYN that we mentioned earlier, told us that this was really an incredible change. Severe cases of infection, severe cases of hemorrhage, they disappeared. It seemed like magic, or a better word, a miracle. So birth rates in Brazil also fell during this time, but the impact went far beyond Brazil.

Because news about the pill really spread across Latin America. Because at the time, abortion was very heavily restricted across the board.

And women who heard about this pill began to organize. In countries with abortion bans, these women created their own alternative health care systems, so to say. They created groups that helped get the pills into women's hands. They set up hotlines so that they could tell them about step by step how to take the pills. And they also published manuals.

Some women took on support roles, and they were on call as the women were going through their abortion at any time of the day or night. And this is a method that's called acompañamiento or accompaniment. And the effect of all this organizing was huge. And experts believe misoprostol is now the most commonly used abortion pill in the world.

And in the last few years, in part because of how women organized around the pills and abortion access more generally, there's been a wave of political change in countries like Mexico, Colombia, and Argentina, which we talk about in the podcast. Absolutely.

As an American, I mean, it's hard not to make connections with this story and this history. Brazilian women who came up with this method, they were living under abortion bans, and

A lot of women in the U.S. today are also living under abortion bans. That's right, Aisha. And actually, since Roe was overturned in 2022, self-managed abortions with bills, this method that Brazilian women invented pretty much 40 years ago, has gotten way bigger in the U.S.,

When we come back, we'll talk about how this discovery from Brazilian women decades ago is affecting women in the U.S. today. Stay with us.

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Thanks to a tiny pill. That pill spawned a global movement, helping millions of women have safe abortions, regardless of the law. Hear that story on the network, from NPR's Embedded and Futuro Media, wherever you get your podcasts.

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We're back with the Sunday story, and I'm talking to Marta Martinez and Victoria Estrada. They are the host of the new series, The Network, from Embedded and Futuro Media. Before the break, we were talking about how self-managed abortion with pills became popular in a country with abortion restrictions. And now the U.S. is one of those places. So what is that pill's history here in the U.S.?

Actually, we have heard stories that women were taking these pills as early as in the 90s and they were self-managing their abortions in the 90s. We actually talked to a doctor in the Bronx who saw patients come in in a very similar situation like in Brazil in the 80s, which is women were coming in bleeding and they told the doctor that they had taken this pill. It was mostly immigrants and people who

coming from Latin American communities. But in the United States, it wasn't widely popular. Activists who had seen self-managed abortion and how safe it was to take these pills in Latin America or in other parts of the world, they were trying to tell the Americans about it, but they often met resistance.

A lot of people didn't think that it was relevant for a country that did have a legal right to abortion, right? Roe v. Wade was the law of the land. Also, some thought that it was just dangerous, kind of like, you know, taking a step backwards into this back alley abortion idea. Right. But then state law started to chip away at Roe. And eventually in 2022, we know that Roe was overturned.

So women no longer had a federal right to abortion. And we reported how there was a huge demand for abortion in states where it was banned or very restricted.

So the network, this group of women helping support women have abortions with pills, it's really started to grow here in the U.S. And it actually looks quite a bit like it had in Latin America. Today in the U.S., there's hotlines, there's organizations that mail people pills, and there's even accompaniment networks. Although here, a lot of people who do acompañamiento call themselves abortion doulas.

So here in America, people who want abortions typically go to a doctor, you know, the trained professional who can oversee the process. So what did doctors think about people self-managing with a pill instead of going to them? A lot of doctors who heard about self-managing also thought that it was very dangerous. And one doctor we spoke to is Maya Bass. I didn't think it was safe, you know, as doctors were risk adverse.

And we like control. Maya had been prescribing abortion pills for years, but part of that process included ultrasounds, blood tests, you know, a whole protocol which she believed was in place to keep her patients safe.

But eventually she changed her mind about self-managed abortion because she learned about decades worth of research showing that it was safe and that it worked. Research that had been conducted in many parts of Latin America, in Africa, and in many parts of Southeast Asia as well. And that challenged her to reconsider what safety really meant. Realizing that I was unnecessarily putting people through hoops, that's hard.

And then I felt also excited slash maybe relieved. Like, this means that I can be less scared for people who are doing this. Maya even ended up helping people self-manage their abortions. She volunteered on a hotline that is run by doctors. And in our reporting, we found that lots of other doctors have changed their mind in the last few years, too.

Major medical institutions have put out statements in support of self-managed abortion with pills. This is taking pills without a doctor's oversight. And one of those institutions is the World Health Organization and also the American College of Obstetricians and Gynecologists. Some doctors also took really active steps to support patients getting access to the pills. They started prescribing them from states where abortion was legal to patients in states where it's banned.

I have to imagine that for those who oppose abortion, that they are not happy about these kind of loopholes or workarounds that people are finding to these bans. What kind of pushback is this network in the U.S. seeing right now?

Yeah, we found that state lawmakers have been proposing and sometimes passing laws that restrict access to the pills. And they make it a crime to give the pills to other people if you aren't a doctor. Something a lot of people don't realize is that it's not illegal to self-manage your abortion with pills. That's in every state except one, Nevada, which only explicitly bans it after 24 weeks.

Yeah, I mean, I don't know that I knew that. I thought if they said it was illegal, it was illegal. That an abortion ban is a ban on having an abortion. It's not? Right. It's actually not. It's actually a ban on doctors to perform abortions. And that's changing now.

We talked to a lawyer that told us that prosecutors have realized that these bans won't stop people from having abortions. So abortion opponents have broadened their legal strategy, meaning that, for instance, states have passed laws that make it harder to get the pills and also laws that go after people who support anyone having an abortion. And those tend to be also not specific at all about what it entails.

And one of the big changes that advocates are tracking is that some women are being criminally charged for having abortions or suspected abortions. A couple have even gone to jail. And the restrictions are making it more risky to self-manage or help someone through it. Activists are doing what they can to minimize the risk.

We also found that within the network, within this loosely connected group of people, some people are teaching women what not to do to incriminate themselves. Sometimes this means communicating about pills over encrypted apps.

But it also can mean role-playing. In the event that women taking pills have complications, which are very rare, though they can happen, activists coach them on how to talk to medical staff so that the police don't get involved, especially in states where abortions are banned.

Right. And this is part of the reason why we decided to call the series The Network and not The Pill, because it's really about all the connections women formed among each other that, despite restrictions and bans, has helped them access medically and legally safe abortions.

So let's be clear. These pills we're talking about play an integral role in maternal health care. By some estimates, as many as 20% of known pregnancies end in miscarriage.

And many of these miscarriages are treated with these pills. That's exactly right, Aisha. Yeah. Misoprostol has a lot of medical uses. Of course, it's used for helping after a miscarriage, but it's also used for inducing labor and preventing hemorrhaging. And in Louisiana, we've seen some new restrictions on this drug. And doctors there are really opposed to that because it makes it harder for them to take care of their patients.

So based on all of your reporting, what do you think the impact of the network that helps women self-manage abortions? What will the impact be in the U.S., especially if anti-abortion groups are trying to make access to these pills more difficult?

So in the U.S., the idea that you could have an abortion without doctors is new for a lot of people. And so, of course, there are situations where self-managing an abortion is not an option and you need medical supervision or intervention. But our reporting has shown that in the vast majority of cases, it is safe for women to self-manage their abortions with pills.

And something else we found is that when people learn about self-managing, it also becomes not just the last resort, but some people may even choose it, even if they live in a state where abortion is legal and they have access to a clinic.

We saw this in Argentina, for example. Even though abortion is now legal there, tens of thousands of people have self-managed with the support of an accompaniment network rather than go through the public health system.

We spoke to the former vice president of Planned Parenthood Global. Her name is Dee Redwine, and she's an American, but she worked for 30 years in Latin America and saw how self-managed abortion with miso spread around the region. And she sees parallels to what's happening in the U.S. since Dobbs, the Supreme Court case that overturned Roe. The irony of this post-Dobbs world is that if it goes the way that I think it will, which is what I saw in Latin America,

In some ways, abortion, ironically, will become more accessible, but less legal. I mean, that's quite a statement, especially in the U.S., where the fight over abortion has really taken place in the court so much. The idea that abortion opponents might have won the legal battle, but access could still expand across the country.

And that's what happened in Latin America as well. So we do have a history that we can learn from and that could also tell us a little bit more about what can happen in the United States.

That's Marta Martinez and Victoria Estrada. They are the host of a new series, The Network. The whole series is out now. You can find it in the Embedded Podcast feed. Marta, Victoria, thank you so much for sharing your reporting. Thanks so much for having us, Aisha. Thank you, Aisha. Thank you.

If you want to hear more of NPR's coverage of abortion this week, our friends over at NPR's ThruLine have the story of abortion in America before Roe v. Wade. And It's Been a Minute is running a series this week looking at the cultural, legal, and ideological frameworks shaping reproductive health in America and what it means for the future of our families.

The network is a joint production between Embedded and Futuro Media. This episode of The Sunday Story was produced by Andrew Mambo and Ariana Garib Lee. It was edited by Liana Simstrom and Raina Cohen. It was engineered by Maggie Luthar. The Sunday Story team also includes Justine Yan and Jenny Schmidt.

Our fellow is Andrew Cerulnik. Our executive producer is Irene Noguchi. I'm Ayesha Roscoe. Up First is back tomorrow with all the news you need to start your week. Until then, have a great rest of your weekend. Want to hear this podcast without sponsor breaks? Amazon Prime members can listen to Up First sponsor-free through Amazon Music. Or you can also support NPR's vital journalism and get Up First Plus at plus.npr.org. That's plus.npr.org.

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