KELLY MCEVERS, HOST:
Hey, I'm Kelly McEvers, and this is EMBEDDED from NPR. We've got a new series. It's about one of the biggest political and social issues in the United States right now - abortion. But this isn't a story about the abortion debate, whether abortion is right or wrong, whether it should be legal or illegal. It's about a set of people on one side of the issue who are operating regardless of what the law says about abortion. These people are part of a global movement that's had a major impact on how women have abortions. And the hosts, Victoria Estrada and Marta Martinez, are going to take us all over the Americas to follow this movement. They're journalists for Latino USA. That's a public radio show produced by Futuro Media, and we partnered with them to make this series. OK, here's Victoria and Marta.
MARTA MARTINEZ, BYLINE: It was one of those moments when people understand they're witnessing history. They remember where they were.
KELLY BLANCHARD: I was standing at my standing desk in my house, waiting. And...
DINA ORTEGA: I just started crying at my desk.
MAUREEN PAUL: It was totally surreal.
VICTORIA ESTRADA, BYLINE: They remember where they were when Roe v. Wade fell.
(SOUNDBITE OF ARCHIVED NPR BROADCAST)
AILSA CHANG: The biggest change to abortion rights in the United States in nearly half a century is here.
ESTRADA: The Supreme Court had made its decision.
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CHANG: A ruling that ends the constitutional right to an abortion.
MARTINEZ: While abortion rights opponents celebrated the news that Roe had been overturned...
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UNIDENTIFIED PROTESTERS #1: (Chanting) We will abolish abortion.
MARTINEZ: ...Many abortion rights supporters feared the U.S. was going backwards.
ORTEGA: Back to, like, the 1900s. Like, what are they going to take from us next?
ESTRADA: Back to a more dangerous time.
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PRAMILA JAYAPAL: This is an emergency. This is an extreme crisis. People will die across the country.
ESTRADA: Protesters gathered on the steps of the Supreme Court in Washington, D.C....
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UNIDENTIFIED PROTESTER #1: (Chanting) Abortion saves lives.
ESTRADA: ...Holding images of coat hangers over their heads.
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UNIDENTIFIED PROTESTERS #2: (Chanting) My choice.
UNIDENTIFIED PROTESTERS #3: (Chanting) My Body.
UNIDENTIFIED PROTESTERS #2: (Chanting) My choice.
MARTINEZ: The day after the fall of Roe, 13 states immediately banned or severely limited abortion. Eventually, nearly half of all states did. And within a month of the ruling, dozens of clinics stopped performing abortions, forcing many Americans to travel hundreds of miles to get one. Other laws targeted abortion providers.
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UNIDENTIFIED JOURNALIST #1: Are you scared?
UNIDENTIFIED DOCTOR: I am scared, and I think a lot of us are because there's nowhere else in medicine that is policed and regulated and now criminalized to such a degree.
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UNIDENTIFIED PROTESTERS #4: (Chanting) You don't care if people die.
UNIDENTIFIED PROTESTER #2: (Chanting) Pro-life is a lie.
UNIDENTIFIED PROTESTERS #4: (Chanting) You don't care if people die.
ESTRADA: But not all abortion rights supporters felt this way.
H: Everybody was so calm in the network.
ESTRADA: The Network. It's what we're calling the diffuse set of people who are expanding abortion access in an unconventional way. They were not panicking.
H: Everybody was like, we've been doing this work. We're going to continue doing this work. Nothing is changing. Who cares?
LOURDES RIVERA: I'm actually energized.
(SOUNDBITE OF ALEXANDER HITCHENS' "SNEAKY LOVE")
MARTINEZ: This network, it's hard to even describe because it's not formal or centralized. There's no CEO, no headquarters.
ESTRADA: Some people work together, but plenty don't know each other. They're midwives and nurses, grandmothers and friends.
MARTINEZ: This network crosses borders and reaches people throughout the world, from South Africa to Myanmar to Mexico, and all over the United States. What unites the network is how they are expanding abortion access by helping women have safe abortions on their own, without a doctor involved.
ESTRADA: Their method grew out of a very small thing. It actually fits in the palm of your hand.
MARTINEZ: But despite being physically tiny, when it comes to reproductive health, doctors, researchers and people working in this field say it's been...
ABIGAIL AIKEN: Monumental.
BLANCHARD: Extraordinarily important.
JEFFERSON DREZETT: Fundamental.
DEE REDWINE: It's a lifesaver in so many ways.
GISELLE CARINO: It's the equivalent to the discovery of penicillin because it's a before and after.
ESTRADA: But unlike penicillin, this discovery has not been universally embraced. Instead, it's the latest target of abortion restrictions that continue to make the news.
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VLADIMIR DUTHIERS: The future of abortion access could be impacted by a new lawsuit just filed by the attorney general of Texas.
UNIDENTIFIED JOURNALIST #2: A long-dormant federal law prohibits the mailing of any supplies used for abortions.
UNIDENTIFIED JOURNALIST #3: Possession could be punishable by up to five years in prison.
(SOUNDBITE OF ALEXANDER HITCHENS' "SNEAKY LOVE")
MARTINEZ: From NPR's EMBEDDED and Futuro Media's Latino USA, this is The Network.
ESTRADA: A series about the DIY method that took safe abortions out of the clinic, and the women who made it happen.
MARTINEZ: Episode 1 - St. Saint-o-tec.
(SOUNDBITE OF ALEXANDER HITCHENS' "SNEAKY LOVE")
MARTINEZ: We'll be right back.
ESTRADA: I'm Victoria Estrada.
MARTINEZ: And I'm Marta Martinez. We're both producers at the public radio show Latino USA. We've been covering reproductive rights in the Americas for years now.
ESTRADA: And when we started to see more and more challenges to abortion access in the U.S., we immediately thought about Latin America because historically, Latin America has had strict abortion bans, not so different from what we're seeing now in parts of the U.S.
MARTINEZ: But as research from around the world shows, bans don't stop people from getting abortions. They just lead them to take more risks to end their pregnancies. That's where the phrase back-alley abortion comes from, and where we get the image of a woman using a coat hanger, self-managing her abortion.
ESTRADA: But nearly 40 years ago, in Latin America, women developed an abortion method that was medically safe and effective. No doctor needed. And this new type of self-managed abortion transformed how abortions happen across the world today.
MARTINEZ: It all started in Brazil, where this method was born in the late 1980s. Victoria and I took a trip there last year in 2024, and one of the people we interviewed was Jacqueline Pitanguy.
Hi, Jacqueline.
Jacqueline is a longtime feminist advocate.
How was your day?
And she lived through Brazil's military dictatorship, which lasted for more than two decades. When the dictatorship fell in 1985, she fought to get women's rights into Brazil's new Constitution because women at the time had so little say in their workplaces, marriages or over their bodies.
JACQUELINE PITANGUY: So, here in front, you have the Christ.
MARTINEZ: Oh, it's right here.
PITANGUY: Right here, but there is...
MARTINEZ: From Jacqueline's balcony in Rio de Janeiro, we could see what's probably the most iconic image of Brazil - the statue of Christ the Redeemer.
So you see it every day in the morning when you wake up?
PITANGUY: I see it right every day when I wake up.
ESTRADA: Say hello (laughter).
PITANGUY: Yeah. I say hello, Christ. How are you? Be good. Be good, Jesus Christ.
MARTINEZ: Maybe you've seen it in a movie or photos. It's this huge sculpture overlooking the whole city of Rio de Janeiro on top of this spectacular cliff.
It's interesting 'cause I was actually talking about this with Victoria this morning, that religion is very present in this city in a very visual way.
PITANGUY: Yeah.
MARTINEZ: 'Cause you have the Christ...
PITANGUY: The Christ.
MARTINEZ: ...Up there on the mountain looking at you...
PITANGUY: Yeah, all the time.
MARTINEZ: ...From everywhere.
PITANGUY: (Laughter) Yeah. Everywhere. Everywhere.
(SOUNDBITE OF BLUE DOT SESSIONS' "COLLAGEN AND BONE")
MARTINEZ: It's this constant reminder of the influence Catholicism has had on Brazil for much of its history.
PITANGUY: For the Catholic Church, contraception has always been a key issue.
MARTINEZ: Until the '80s, many Brazilian women didn't have great access to birth control. Before then, in the poorest region of the country, women had, on average, almost six children.
ESTRADA: We heard that some women just didn't know much about their own bodies. For example, some women were afraid of using tampons because they thought they might get lost inside of their vaginas. We also heard that some women thought that their vagina was connected to their mouth.
MARTINEZ: This lack of knowledge had serious consequences.
PITANGUY: The significant - let's call it - punishment, it was on women's bodies, death or morbidity...
ESTRADA: I'm going to start recording.
RIVALDO ALBUQUERQUE: OK.
ESTRADA: Could you just count to 10?
ALBUQUERQUE: Um, dois, tres...
MARTINEZ: In the 1980s, Brazil's maternal mortality rate was higher than most of the rest of the world.
ALBUQUERQUE: (Through interpreter) I lived through a time when women got sick and died, died of infection, died of bleeding, young women, extremely young women.
ESTRADA: This is Dr. Rivaldo Albuquerque.
ALBUQUERQUE: (Through interpreter) I am a gynecologist. I am a practicing Catholic, and I have been working with women's health since I was a medical student.
ESTRADA: We visited Rivaldo in the coastal city of Recife, in northeast Brazil. It's the poorest region in the country. When he started working in a public hospital in 1985, the state that Recife's in had the highest maternal mortality rate in all of Brazil. Rivaldo saw it every day in the emergency room - a lot of pregnant women coming into his ER with complications from a lack of prenatal care, like chronically high blood pressure, and also complications from abortion.
MARTINEZ: Abortion was and still is illegal in most cases in Brazil, and it was often seen as a sin, but that doesn't mean women were not getting abortions. Research from that time estimated there were between 1 and 4 million abortions happening in the country every year.
ALBUQUERQUE: (Through interpreter) People who had the money could look for doctors who did abortions in clinics, in hospitals with every safety precaution, using sterilized material.
ESTRADA: In other words, people who had the money could go see a doctor who was willing to break the law for the right price. Those were not the women who ended up in the emergency room where Rivaldo worked. His patients had often gone to places that were less reputable and unsafe.
MARTINEZ: Others just tried to self-manage their abortion. We heard about lots of ways.
DEBORA DINIZ: Herbs.
MARTINEZ: Teas or drinks.
DREZETT: Chas, bebidas.
SARA COSTA: Insertion of foreign objects.
ALBUQUERQUE: (Speaking Portuguese).
ESTRADA: "The rods of an umbrella."
DREZETT: (Speaking Portuguese).
PITANGUY: Needles.
MARTINEZ: And whatever medicines they could buy at the pharmacy.
COSTA: You know, all those horror stories that you read about.
MARTINEZ: By the time women got to Rivaldo, they often had perforations in their uterus, hemorrhages and serious infections.
ESTRADA: Rivaldo told us about a specific case that has stayed with him. It was a patient who was only a few years younger than he was at the time.
ALBUQUERQUE: (Through interpreter) She was a 19-year-old woman who had already had two children. She came in with a generalized infection. It was a desperate condition, and we didn't have any background information about this woman. She wouldn't speak. She was in no position to explain what had happened to her, and the person who brought her in didn't want to talk either.
ESTRADA: Rivaldo and the other doctors suspected she'd had an unsafe abortion, and so they decided to do an exploratory operation.
ALBUQUERQUE: (Through interpreter) So that we could evaluate the abdomen, what was happening with this infection. And when we opened the abdominal cavity, we found the uterus that smelled - pardon the word - rotten.
ESTRADA: Rivaldo still remembers it.
ALBUQUERQUE: (Through interpreter) A terrible smell, with several perforations. It was a classic picture of an unsafe abortion. Since it's an illegal procedure, this woman must have stayed home for a few days or didn't receive proper medication.
ESTRADA: Who knows how long she waited to go to the hospital after signs that something was wrong? And now, there was nothing the doctors could do.
ALBUQUERQUE: (Through interpreter) Why did this woman die? I can tell you without hesitation because she was Black and because she was poor.
ESTRADA: Rivaldo told us he really felt for these women.
ALBUQUERQUE: (Through interpreter) They are in a situation of suffering, of vulnerability. Their health and their life are at risk. I know these women. Many are Christians, evangelical, Catholic. But they're going through a specific moment in their life. They are in need.
MARTINEZ: But Rivaldo was an exception. Many doctors did not treat these patients well.
ALBUQUERQUE: (Through interpreter) Women who had tried to have an abortion were the last ones to be treated during our shift.
MARTINEZ: So these women, they would be in the emergency room all day long, without food or anything to drink.
ALBUQUERQUE: (Through interpreter) They spent the whole day fasting, waiting for their procedure on an empty stomach, and they were being punished because they were the last ones to be taken care of.
MARTINEZ: He remembers that some doctors wouldn't give the women enough anesthesia before their dilation and curettage, or D&C. So the women would feel the pain of their cervix being dilated and the walls of their uterus being scraped.
ALBUQUERQUE: (Through interpreter) And the women cried out because of the pain, of their suffering. Unfortunately, I heard medical staff say, when you did it, it was a lot of joy, a lot of pleasure, and now you're crying. You don't know what you did. You killed a baby.
(SOUNDBITE OF MUSIC)
ESTRADA: One doctor told researchers at the time that his hospital was doing two hysterectomies a week because of so many botched abortions. Another doctor called working with these patients a, quote, "revolting process because she was presenting us with a disgusting mess," unquote.
MARTINEZ: Some doctors went even further than insulting the women. In some cases, they called the police.
ALBUQUERQUE: (Through interpreter) And the police would come all the way to the hospital and handcuff the women. They would chain them to the bed. Women were arrested.
MARTINEZ: Rivaldo says his hospital never let this happen, but he knew it happened elsewhere.
ALBUQUERQUE: (Through interpreter) That was the standard for these women, so these are things that I will never forget.
ESTRADA: At the end of his shift, Rivaldo would make notes about his patients - who lived, who died.
ALBUQUERQUE: (Through interpreter) How many births, how many C-sections, how many surgeries, how many abortions, how many infected abortions.
ESTRADA: And around the year 1987, he noticed a change.
MARTINEZ: A big change.
ALBUQUERQUE: (Through interpreter) Severe cases of infection, severe cases of hemorrhage - they disappeared.
MARTINEZ: Women were still coming into the ER, but they were showing up with new symptoms, much less serious ones.
ALBUQUERQUE: (Through interpreter) Like an increasing body temperature - hyperthermia. And it didn't make sense because you couldn't find an infectious condition. Some women also had gastrointestinal symptoms. We realized that there was something different, and this made us a little confused.
ESTRADA: Around the same time, a researcher named Sara Costa was working for Brazil's School of Public Health in Rio de Janeiro, more than a thousand miles south from Recife, and she noticed another big change.
COSTA: We were seeing this incredible decline in fertility.
MARTINEZ: Suddenly, women were having fewer children. But why?
ESTRADA: It was strange because there were no big policy changes to account for it.
COSTA: The government wasn't providing much information about how to control fertility.
MARTINEZ: And abortion was still illegal, so something just wasn't adding up.
COSTA: Was it spontaneous use of oral contraception? How were they getting it?
MARTINEZ: So in the early '90s, Sara began talking directly to the women.
COSTA: And we conducted those interviews over a period of several months and analyzed the results.
MARTINEZ: She and her team interviewed more than 800 pregnant women in seven hospitals in Rio de Janeiro. Many of those women had come into the hospital bleeding. Hospitals in Rio and in other parts of the country had been seeing more cases like this in the past few years, of women who seemed like they had attempted an abortion.
COSTA: We thought we would actually discover a lot more complications - serious complications. But most of the women went into hospital with bleeding, had a curettage and left.
MARTINEZ: Left.
(SOUNDBITE OF MUSIC)
MARTINEZ: They didn't get stuck in the hospital with infections or other complications.
COSTA: It was a bit of a surprise.
ESTRADA: In Recife, Rivaldo had noticed a similar pattern.
ALBUQUERQUE: (Through interpreter) 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.
(SOUNDBITE OF MUSIC)
ESTRADA: Fewer complications from abortion meant one thing...
ALBUQUERQUE: (Through interpreter) Women stopped dying.
(SOUNDBITE OF MUSIC)
MARTINEZ: Or at least far fewer were dying. From 1986 to 1991 - the time Sara and Rivaldo were observing - the World Health Organization recorded a 21% drop in Brazil's maternal mortality rate.
ALBUQUERQUE: (Through interpreter) It seemed like magic or - a better word - a miracle.
(SOUNDBITE OF MUSIC)
ESTRADA: The cause of what Rivaldo calls a miracle after the break.
MARTINEZ: In 1973, the same year that Roe v. Wade was decided in the United States, something else happened that transformed reproductive health care, but in a much more roundabout way. An American pharmaceutical company called Searle developed a new drug to treat gastric ulcers, kind of like Tums or Pepto Bismol or milk of magnesia. It was a small, white, hexagon-shaped pill with a tiny figure of a stomach etched on one side.
ESTRADA: Not a belly - the actual organ.
MARTINEZ: It's actually the stomach that makes me remember this pill.
ESTRADA: It's called Cytotec.
MARTINEZ: And even though it was created by an American pharmaceutical company, the Food and Drug Administration was slow to approve it. Several years before being available in the U.S., Cytotec first made its way to Europe, and then Brazil in 1986.
(SOUNDBITE OF MUSIC)
ESTRADA: And here's where it's hard to know what is fact and what is part of the myth of Cytotec, because in Brazil, this ulcer pill took on a new life. For starters, we know that the original Cytotec box came with a warning, but because it's been 40 years, people remember that warning differently.
MARTINEZ: Jacqueline Pitanguy, the sociologist who says hello to the Christ statue every morning in Rio de Janeiro, remembers that the warning was written out.
PITANGUY: It's that little paper that comes with the medicine that says you should avoid to take it if you were pregnant because it could cause contractions.
ESTRADA: Dr. Rivaldo Albuquerque remembers the fine print more specifically.
ALBUQUERQUE: (Through interpreter) There was a very clear paragraph that said that it should not be used in pregnant women because it could cause uterine contractions and lead to miscarriage.
MARTINEZ: Debora Diniz, a Brazilian anthropologist and law professor who grew up in the '80s, remembers the warning as an image on the box.
DINIZ: It was a profile of a pregnant woman - big belly - and a warning crossing the belly. And also a skull.
MARTINEZ: There was a skull?
DINIZ: There was a skull.
MARTINEZ: Wow.
DINIZ: I'm 100% sure of that.
(SOUNDBITE OF MUSIC)
MARTINEZ: We haven't been able to confirm the skull, but we have seen the image of a pregnant woman in a circle with a slash through it.
ESTRADA: When the pharma company developed Cytotec, it discovered that the drug had this significant side effect on women - a serious side effect. It caused bleeding and contractions that could induce a miscarriage.
MARTINEZ: So for people who were pregnant and wanted to stay that way, it was a very dangerous pill to take.
ESTRADA: But for people who were pregnant and did not want to be, Cytotec's side effect wasn't a problem. It was a solution, a new tool to self-manage an abortion. But unlike the teas and crochet needles women had been using, Cytotec was overwhelmingly safe and effective.
MARTINEZ: And somebody, somewhere, somehow, figured that out.
(SOUNDBITE OF ALEXANDER HITCHENS' "SNEAKY LOVE")
COSTA: I don't think we ever identified where it started.
PITANGUY: No, it's impossible to know this.
COSTA: Don't forget we didn't have social media then.
PITANGUY: There's no records.
ESTRADA: It wasn't like there was a lot of incentive to take credit. Whoever did this was likely breaking the law.
PITANGUY: They wouldn't give their name - I am Mary Smith (ph), and listen, you can use this to induce an abortion.
MARTINEZ: Some speculate that it was a pharmacist or a midwife.
COSTA: We certainly knew that pharmacists were involved.
PITANGUY: I went to the pharmacy and I bought this.
ESTRADA: But even if we can't know the original source, we do know how the knowledge spread far and wide.
COSTA: The women themselves.
PITANGUY: Women said, ha (ph).
DINIZ: I have no question of saying that it was from women.
PITANGUY: Brazilian women.
DINIZ: Women continued taking it 'cause it was another woman from her family who shared with her.
COSTA: It certainly wasn't advertised.
PITANGUY: It was in the air. I can tell you when something is in the air among women's talks. I mean, it was in the air.
(SOUNDBITE OF ALEXANDER HITCHENS' "SNEAKY LOVE")
R: (Through interpreter) It was spreading by word of mouth.
MARTINEZ: This is a woman we're calling by her initial - R - to protect her safety because what she did was and still is illegal in Brazil.
R: (Through interpreter) A woman who went through the process would tell another, hey, buy that, buy that.
MARTINEZ: The whispers about Cytotec reached R in 1986, the same year it came on the market in Brazil, and she thought it sounded a lot better than the first abortion she had been through - the type of dangerous abortion Rivaldo had seen time and time again in the emergency room in the early '80s.
ESTRADA: The first time R needed an abortion she was a minor, 13 or 14 years old, living in Recife. She was dating someone a lot older than her, and R says even though she was in a relationship, she understood almost nothing about sex or her body because of how she grew up.
R: (Through interpreter) Oh, my mother raised us like potatoes in the ground.
ESTRADA: R was one of 12 kids.
R: (Through interpreter) We didn't have the talk about what sex was. I just knew that I was going to get kissed. I didn't know that thing was going to create a child, so I didn't know that a partner shouldn't cross certain boundaries.
ESTRADA: When R started feeling funny and her period stopped, she confided in her older sister.
R: (Through interpreter) She sat me down and said, look, you are pregnant. There's going to be a baby, and we have to find a solution because Dad is going to kick you out of the house, or he's going to kill you.
ESTRADA: Her sister didn't mean it as an exaggeration. She thought her dad would literally kill R if he found out she was pregnant. He'd nearly done just that a few years earlier to R's sister.
R: (Through interpreter) He once took out his gun and tried to kill my sister - the same sister who helped me - because my sister lost her virginity.
ESTRADA: So it was dangerous for R to stay pregnant, but it was also risky to get an abortion, both physically and legally. R's sister took her to a midwife, and R remembers the midwife inserted a catheter into her cervix to induce an abortion. When she returned to her parents' house, she had very heavy bleeding and then passed out.
R: (Through interpreter) I actually fell on the bathroom floor. My sister picked me up, showered me and told my mother, I'm going to take her because she's having her period. It's very strong and she's weak. She didn't tell my father.
ESTRADA: R's sister took her to the hospital. While she was there, doctors questioned her. They wanted to know if she'd done anything to cause an abortion. R kept denying she had, even when they threatened her with jail.
R: (Through interpreter) I said no, of course. I had to deny it. I was told to deny it. It was a crime that involved a lot of people, right?
ESTRADA: R was given a D&C to complete her abortion. The doctors told her she'd nearly perforated her uterus and had been at risk of losing it. R stayed in the hospital for several days to recover, in a maternity room with other women who had attempted an abortion.
R: (Through interpreter) All of them had done something, and the one next to me, she died.
ESTRADA: Died? I asked.
R: (Through interpreter) Yes. I had a curettage - right? - then I was fine. But the one next to me, she never came back.
(SOUNDBITE OF MUSIC)
MARTINEZ: A few years later, when R was 19 years old, she got pregnant a second time. She says a guy she had seen just a couple of times forced himself on her. R decided to have another abortion, but this time it was a very different experience because of Cytotec.
R: (Through interpreter) It was for gastritis, so they sold it at the pharmacy like water. You would just go in and say, hey, give me a box of Cytotec. Anyone could buy it.
MARTINEZ: The pharmacy she bought it from told her to swallow two pills, wait a couple of hours, then take two more pills until she finished six pills. He also gave her an instruction that was very common at the time.
R: (Through interpreter) Look, you are going to expel. When you expel and you're bleeding a lot, go to the hospital.
MARTINEZ: R went home and took the pills.
R: (Through interpreter) The contractions started, and I had some bleeding.
MARTINEZ: She says the pain was strong, but not like with the first abortion. She was bleeding, but she didn't faint. She didn't have her sister by her side, but she was able to get herself to the emergency room. One thing was the same - the doctors, again, questioned her, and again, R denied that she had done anything to cause an abortion. And this time, R says she didn't have to stay in the hospital. She had a D&C and left.
(SOUNDBITE OF MUSIC)
MARTINEZ: Her parents never found out about it. R went on with her life. She moved in with her sister, who supported her going to school.
R: (Through interpreter) I graduated as a social worker.
MARTINEZ: The two experiences were very difficult for R, but one thing was clear.
R: (Through interpreter) 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.
(SOUNDBITE OF MUSIC)
ESTRADA: Still, she wishes she'd had more support because R and women like her, who took Cytotec to cause an abortion in those early years, they were experimenting on themselves. It's not like the pills came with a slip of paper explaining how to have an abortion.
MARTINEZ: In fact, if you remember, the instructions said, don't take this pill if you're pregnant.
ESTRADA: In 1993, researchers from a public university in the country published a study called "Cytotec In Brazil: At Least It Doesn't Kill." In it, most women reported taking between four and 16 pills, but some reported taking dozens. It's likely that R didn't take the right dose to have a complete abortion.
MARTINEZ: But over time, Brazilian women again figured out something by themselves.
COSTA: One of the interesting things that I noted in my research is that women got much better at using Cytotec.
MARTINEZ: This is Sara Costa again, the researcher in Rio de Janeiro. While she conducted the study in the early '90s, several years after Cytotec became available, she heard about how women were taking the pills.
COSTA: Put them under your tongue or insert them in your vagina.
MARTINEZ: Eventually, they started getting better results.
COSTA: At the beginning, I would say that a lot of women needed curettage, but it turned out once they got better at using it, they were actually having complete abortions.
MARTINEZ: In other words, they no longer needed a D&C.
How long was your data collection period?
COSTA: I think it was about six to nine months.
ESTRADA: Fast. That's fast.
COSTA: Yeah. So, you know, we were able to observe change.
ESTRADA: Of the women who went to a hospital after having an abortion, Sara found that nearly 60% reported using Cytotec to self-manage it. She wrote that this represented, quote, "only the tip of the iceberg," because many more women could have taken Cytotec and not needed medical help.
According to our research, the median dose the women were taking was 800 micrograms - four pills - which is the same dose the World Health Organization now recommends for pregnancies up to 12 weeks.
MARTINEZ: And how were they getting this information? Sara found that the overwhelming majority of women who used Cytotec - 84% - had learned about it from friends, relatives or colleagues. It was the network starting to form - women loosely connected by whispers. Just by sharing their experiences, what worked and what didn't work, they began to build knowledge.
DINIZ: Women know how to be scientists at home when science is not offering what they need.
ESTRADA: This is Debora Diniz again, the Brazilian anthropologist and law professor who remembers the skull on the Cytotec box.
DINIZ: So basically, it's about observation. It's about taking experiments in our own bodies, and it's about sharing with others.
ESTRADA: She calls it domestic science, and she saw the results of this domestic science for herself. By the time she learned about Cytotec, it was no big deal.
DINIZ: So I was at school in the '80s when I saw for the first time a classmate with the pills telling us, I'm going to take them today.
ESTRADA: Her classmate got the pills through a family member, and they worked.
DINIZ: Can you believe that the day after, she was in school?
(SOUNDBITE OF MUSIC)
MARTINEZ: I'm wondering why you think Cytotec became so popular so quickly.
DINIZ: Let me try five reasons. One, it was discovered by women. It was shared from woman to woman. It proved to work and to be safe. It was used for an essential need to women's lives. And it was available at the community level.
MARTINEZ: And it was cheap.
DINIZ: Very cheap.
MARTINEZ: Pharmacists in Brazil told us they sold it for about five bucks in the early '90s, compared to $500 for an abortion at a private clinic. At the time, Cytotec sales exploded. Researchers track that in the late '80s and early '90s, more than 50,000 boxes of the pill were being sold in Brazil every month.
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ESTRADA: Actually, there are more reasons women chose Cytotec. In that same report from 1993, "Cytotec In Brazil: At Least It Doesn't Kill," the researchers interviewed women who had used it. In their testimonies, they described lots of reasons for liking it. We had voice actors read some of their quotes aloud.
MARTINEZ: Since it wasn't a procedure requiring a doctor's expertise, it didn't exactly feel like an abortion to some of these women.
UNIDENTIFIED PERSON #1: (Through voice actor) It's less traumatic, a lot less. You know what the sensation is? The sensation is that your period is late, and so you take medicine for it to come.
ESTRADA: As a result, some women describe feeling less guilty taking the pill.
UNIDENTIFIED PERSON #2: (Through voice actor) If I had gone to a clinic, I would never have forgiven myself.
MARTINEZ: And women felt it put them - not their partners or doctors - in control.
UNIDENTIFIED PERSON #3: (Through voice actor) Using Cytotec is something that is yours. Nobody has to know what you did or you didn't do. No one invades your privacy. Even the gynecologist I went to later didn't know that I had had an abortion.
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ESTRADA: Women who wanted abortions weren't the only ones who appreciated Cytotec. Many doctors did, too, because they didn't have to deal with so many gruesome cases or do such serious procedures, like having to remove a uterus. One doctor in Sao Paolo told the researchers that he'd seen hysterectomies drop from to a week to one every six months.
MARTINEZ: When we asked Rivaldo - the OBGYN in Recife - how he remembers feeling at the time, he used one word.
ALBUQUERQUE: (Speaking Portuguese).
MARTINEZ: "Relief."
ALBUQUERQUE: (Speaking Portuguese).
MARTINEZ: "Relief of mind and of conscience."
ALBUQUERQUE: (Through interpreter) I was happy because I saw that what we couldn't do, which was to help women, the network was doing it, and that's what I wanted. I wanted women to be healthy. So if I couldn't do it effectively, the network was doing it.
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ESTRADA: Rivaldo told us that feminists and health providers coined the nickname for Cytotec.
ALBUQUERQUE: (Speaking Portuguese).
ESTRADA: They called it Saint-o-tec.
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MARTINEZ: Cytotec, Saint-o-tec, it has many names. You might know it as misoprostol, aka, miso, like the soup.
ESTRADA: Or miso. There's no agreement on how to pronounce it. Experts believe it's now the most commonly used abortion pill in the world. And the World Health Organization says it's safe to self-manage with pills through 12 weeks of pregnancy.
MARTINEZ: Later in the series, we follow the network as it spreads this bill across Latin America.
VERONICA: (Speaking Spanish).
ESTRADA: "I was like, what? No way."
And into the U.S.
H: Oh, there's a whole group of you, and you're all, like, underground and secret squirrel and using different names. It was just mind-blowing.
MARTINEZ: Up next, women create an entirely new support system around miso...
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UNIDENTIFIED PROTESTER #3: (Chanting in non-English language).
UNIDENTIFIED PROTESTERS #5: (Chanting in non-English language).
MARTINEZ: ...That challenges the medical establishment and the law.
GABRIELA: (Through interpreter) Someone was going to do what we didn't dare to because we had a license and we were afraid of the law.
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UNIDENTIFIED PROTESTER #3: (Chanting in non-English language).
UNIDENTIFIED PROTESTERS #5: (Chanting in non-English language).
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ESTRADA: If you want to hear the rest of the series right now, before everyone else, go sign up for EMBEDDED+. EMBEDDED is the home for ambitious storytelling at NPR, and signing up for EMBEDDED+ is a great way to support that work. You'll get early access to every EMBEDDED series and sponsor-free listening. Go to plus.npr.org/embedded to find out more.
MARTINEZ: The Network from EMBEDDED is a collaboration with Latino USA, a production of Futuro Media. This episode was produced by Monica Morales-Garcia and Abby Wendle. Rhaina Cohen edited the series. Additional reporting by Abby Wendle. Fact-checking by Zazil Davis-Vazquez, Nicolette Khan and Giovana Romano Sanchez. Robert Rodriguez mastered the episode.
ESTRADA: Voiceovers by Mariana Della Barba, Julia Carneiro, Marcelo Starobinas and Susie Valerio. Liana Simstrom is our supervising senior producer. Katie Simon is our supervising senior editor. Irene Noguchi is our executive producer, and Collin Campbell is the senior vice president for podcasting at NPR. The EMBEDDED team also includes Luis Trelles, Dan Girma, Adelina Lancianese and Ariana Gharib Lee. From Latino USA, our executive producers are Marlon Bishop and Peniley Ramirez, and our production managers are Jessica Ellis and Nancy Trujillo.
MARTINEZ: Thanks to our managing editor of standards and practices, Tony Cavin, and to Johannes Doerge and Micah Ratner for legal support, and Tommy Evans, NPR's managing editor, editorial review. Our visuals editor is Emily Bogle. Original tile art by Luke Medina.
ESTRADA: Special thanks to Elissa Nadworny, Selena Simmons-Duffin, Mariana Della Barba, Maria Martha Bruno, Julia Carneiro, Roberta Fortuna, Dina Ortega, Kelly Blanchard, Maureen Paul, Lourdes Rivera, Abigail Aiken, Giselle Carino, Dee Redwine and Jefferson Drezett. And a big thanks to our EMBEDDED+ supporters.
MARTINEZ: Funding for this series provided in part by the Levi Strauss Foundation, outfitting movements and leaders fighting for a more just and abundant world, and the International Women's Media Foundation as part of its reproductive health, rights and justice in the Americas Initiative. I'm Marta Martinez.
ESTRADA: I'm Victoria Estrada.
MARTINEZ: This is EMBEDDED from NPR.
ESTRADA: Thanks for listening.
MARTINEZ: (Speaking Spanish).
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