--:-- Aisha Roscoe: I'm Aisha Roscoe, and this is The Sunday Story, where we go beyond the news to bring you one big story.
--:-- Aisha Roscoe: 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.
--:-- Aisha Roscoe: The biggest change to abortion rights in the United States in nearly half a century is here.
--:-- Aisha Roscoe: The Supreme Court upended nearly a half century of legal precedent.
--:-- Aisha Roscoe: Since that decision, nearly 40% of states have passed laws either banning or further restricting abortion.
--:-- Aisha Roscoe: But even with these new restrictions, abortion rates across the country have actually been rising.
--:-- Aisha Roscoe: Women are still finding ways to have abortions.
--:-- Aisha Roscoe: And one of the main ways is taking abortion pills.
--:-- Aisha Roscoe: In fact, pills account for about two-thirds of abortions in the U.S. health care system.
--:-- Aisha Roscoe: 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.
--:-- Aisha Roscoe: The Network traces how, for decades, a loosely connected network of women across the Americas have helped people access abortions despite restrictions and bans.
--:-- Aisha Roscoe: They've done this by providing each other with pills and support outside the formal health care system.
--:-- Aisha Roscoe: The series also explores the pushback that these women have faced from abortion opponents.
--:-- Aisha Roscoe: When we come back, I sit down with the host of the series, Marta Martinez and Victoria Estrada.
--:-- Aisha Roscoe: They travel to Brazil, Argentina, and eventually to the U.S. to tell this story of abortion access, regardless of legal restrictions.
--:-- Aisha Roscoe: This message comes from BetterHelp.
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--:-- Aisha Roscoe: We're back with The Sunday Story.
--:-- Aisha Roscoe: I'm here with Marta Martinez and Victoria Estrada, hosts of the network.
--:-- Marta Martinez: Thanks for having us.
--:-- Victoria Estrada: Thanks for having us.
--:-- Marta Martinez: 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.
--:-- Victoria Estrada: You start that story in Brazil. Why does the series begin there?
--:-- Marta Martinez: So we started in Brazil because that's where a very important discovery happened in the mid-1980s.
--:-- Marta Martinez: In the mid-1980s, abortion in Brazil was pretty much illegal, and it still is today, actually.
--:-- Marta Martinez: And women were still having abortions, but they were using very unsafe methods, especially among poor women.
--:-- Marta Martinez: And maternal mortality rates in Brazil were among the highest in the world.
--:-- Marta Martinez: And abortion complications was one of the main causes.
--:-- Victoria Estrada: And yeah, while we were there, we talked with an OBGYN, Rivaldo Albuquerque.
--:-- Victoria Estrada: And he told us that so many women came into his hospital with severe complications from botched abortions.
--:-- Rivaldo Albuquerque: I lived through a time when women got sick and died, died of infection, died of bleeding.
--:-- Rivaldo Albuquerque: Young women, extremely young women.
--:-- Marta Martinez: And then he noticed that something changed.
--:-- Marta Martinez: Women were coming in with different symptoms, and the symptoms were way less severe.
--:-- Marta Martinez: We had a downward curve in mortality, a downward curve in abortion complications.
--:-- Marta Martinez: And then there was a moment when you almost didn't see any complications of abortion at all.
--:-- Marta Martinez: Women stopped dying.
--:-- Victoria Estrada: So, did he have any idea, like, what was happening?
--:-- Marta Martinez: Yeah, women had figured something out.
--:-- Marta Martinez: There was a stomach ulcer medication called Cytotec.
--:-- Marta Martinez: That's the commercial name for mesoprostol.
--:-- Marta Martinez: And Cytotec had recently come on the market in Brazil.
--:-- Marta Martinez: And it had a clear warning.
--:-- Marta Martinez: Pregnant women shouldn't take it because it could cause a miscarriage.
--:-- Victoria Estrada: And so women who didn't want to be pregnant realized they could take advantage of this side effect.
--:-- Victoria Estrada: They could take the pills to have an abortion.
--:-- Marta Martinez: And actually, the pills are very easy to access because it wasn't supposed to be used for an abortion.
--:-- Marta Martinez: It's just this side effect that happened to women.
--:-- Victoria Estrada: But Cytotech, pretty much like you could just go to the pharmacy and buy it.
--:-- Victoria Estrada: And what these women were doing is called self-managed abortion with pills.
--:-- Marta Martinez: That means that they were getting these pills without a doctor prescribing them or supervising.
--:-- Victoria Estrada: Do we know like who figured out that this stomach ulcer medication could be used for abortions?
--:-- Marta Martinez: We actually don't know one person who came up with this idea.
--:-- Victoria Estrada: And that what actually fascinating about this story.
--:-- Victoria Estrada: Through our reporting we found out that across Brazil, which is a huge country, women were using this bill and they were just selling each other.
--:-- Victoria Estrada: So there was this whole whisper network that was growing.
--:-- Victoria Estrada: Certainly, we know that some pharmacists were involved, but the people we spoke with, they all said that it really was the women.
--:-- Victoria Estrada: It was the women themselves.
--:-- Marta Martinez: And we also spoke to someone who took Cytotec the first year it came on the market in Brazil.
--:-- Marta Martinez: It was spreading by word of mouth.
--:-- Victoria Estrada: In the story, we call her by her initial, R, because what she did was illegal.
--:-- Victoria Estrada: R had actually two abortions in the 1980s.
--:-- Victoria Estrada: The first one was years before Cite to Tech was even available.
--:-- Victoria Estrada: She was in her early teens at the time, and she was really scared of her father, who she says had a gun.
--:-- Victoria Estrada: And her father had actually threatened her sister when he found that she had lost her virginity.
--:-- Victoria Estrada: So it was a real threat for R.
--:-- Victoria Estrada: She knows she couldn't keep the child for fear of what her father might do to her.
--:-- Victoria Estrada: 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.
--:-- Victoria Estrada: And doctors there told her that she had nearly perforated her uterus.
--:-- Marta Martinez: My goodness.
--:-- Victoria Estrada: That was in the early 80s.
--:-- Victoria Estrada: This was before Cytotec came into the picture.
--:-- Victoria Estrada: And a few years later, R got pregnant again.
--:-- Victoria Estrada: And this time she heard about Cytotec.
--:-- Victoria Estrada: She was able to get the pills from the pharmacy.
--:-- Victoria Estrada: It was for gastritis, so they sold it at the pharmacy like water.
--:-- Victoria Estrada: You just go in and say, hey, give me a box of Citotec.
--:-- Victoria Estrada: Anyone could buy it.
--:-- Victoria Estrada: And the pharmacist gave her six pills, and R took them.
--:-- Victoria Estrada: And R told us that she started bleeding, and she went to the hospital, because that's actually what the pharmacist had told her.
--:-- Victoria Estrada: If you start bleeding, go to the hospital.
--:-- Victoria Estrada: But when she got to the hospital, a doctor confirmed that she wasn't pregnant anymore.
--:-- Victoria Estrada: And between these two abortions, R saw a clear difference.
--:-- Victoria Estrada: The one through the midwife versus the one when she took the pills, side attack on her own.
--:-- Victoria Estrada: The second time, I didn't have a lot of side effects.
--:-- Victoria Estrada: I didn't have a lot of bleeding.
--:-- Victoria Estrada: So it was safer for me.
--:-- Victoria Estrada: I felt more comfortable.
--:-- Victoria Estrada: So the first one almost killed her.
--:-- Victoria Estrada: The second one, she had a lot less complications.
--:-- Marta Martinez: But was what she was doing, was that actually safe with the cytotec?
--:-- Victoria Estrada: Today, we know that taking this pill to have an abortion is safe.
--:-- Victoria Estrada: It's been confirmed by institutions like the World Health Organization.
--:-- Victoria Estrada: But at the time, like these early years, our and the other women who took the pill didn't know that.
--:-- Victoria Estrada: And what's also very interesting is that women were figuring out how to use this pill, Cytotec, very safely and effectively, very quickly.
--:-- Victoria Estrada: And we spoke to a researcher who was studying abortion in Brazil in the early 90s.
--:-- Victoria Estrada: And she said that she was talking to women who were coming into the hospital who were bleeding.
--:-- Victoria Estrada: And it looked like they had done something to have an abortion.
--:-- Victoria Estrada: And the majority of them told her that they had used Cytotec, which is the commercial name of misoprostol.
--:-- Victoria Estrada: 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.
--:-- Marta Martinez: Well, what was the impact of this discovery in Brazil?
--:-- Victoria Estrada: Well, in a five-year span, the maternal mortality rates fell by 21%, according to the World Health Organization.
--:-- Victoria Estrada: And something we found through our reporting is that some feminists and doctors even had a nickname for cytotec.
--:-- Victoria Estrada: They called it Saintotec because it was really saving so many lives.
--:-- Rivaldo Albuquerque: Rivaldo, the OBGYN that we mentioned earlier, told us that this was really an incredible change.
--:-- Rivaldo Albuquerque: Severe cases of infection, severe cases of hemorrhage, they disappeared.
--:-- Rivaldo Albuquerque: It seemed like magic, or a better word, a miracle.
--:-- Victoria Estrada: So birth rates in Brazil also fell during this time, but the impact went far beyond Brazil.
--:-- Victoria Estrada: Because news about the pill really spread across Latin America.
--:-- Victoria Estrada: Because at the time, abortion was very heavily restricted across the board.
--:-- Victoria Estrada: And women who heard about this pill began to organize.
--:-- Victoria Estrada: In countries with abortion bans, these women created their own alternative healthcare systems, so to say.
--:-- Victoria Estrada: They created groups that helped get the pills into women's hands.
--:-- Victoria Estrada: They set up hotlines so that they could tell them about step-by-step how to take the pills.
--:-- Victoria Estrada: And they also published manuals.
--:-- Victoria Estrada: Some women took on support roles.
--:-- Victoria Estrada: And they were on call as the women were going through their abortion at any time of the day or night.
--:-- Victoria Estrada: And this is a method that's called acompañamiento or accompaniment.
--:-- Victoria Estrada: And the effect of all this organizing was huge.
--:-- Victoria Estrada: And experts believe misoprostol is now the most commonly used abortion pill in the world.
--:-- Victoria Estrada: 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.
--:-- Aisha Roscoe: As an American, I mean, it's hard not to make connections with this story and this history.
--:-- Aisha Roscoe: Brazilian women who came up with this method, they were living under abortion bans.
--:-- Aisha Roscoe: And a lot of women in the U.S. today are also living under abortion bans.
--:-- Victoria Estrada: That right Aisha.
--:-- Aisha Roscoe: And actually since Roe was overturned in 2022 self abortions with pills this method that Brazilian women invented pretty much 40 years ago has gotten way bigger in the U.S.
--:-- Aisha Roscoe: When we come back we talk about how this discovery from Brazilian women decades ago is affecting women in the U.S. today.
--:-- Aisha Roscoe: Stay with us.
--:-- Aisha Roscoe: We're back with a Sunday story, and I'm talking to Marta Martinez and Victoria Estrada.
--:-- Aisha Roscoe: They are the host of the new series, The Network, from Embedded and Futuro Media.
--:-- Marta Martinez: 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.
--:-- Victoria Estrada: 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.
--:-- Victoria Estrada: It was mostly immigrants and people coming from Latin American communities.
--:-- Marta Martinez: But in the United States, it wasn't widely popular.
--:-- Marta Martinez: 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.
--:-- Marta Martinez: A lot of people didn't think that it was relevant for a country that did have a legal right to abortion, right?
--:-- Marta Martinez: Roe v. Wade was the law of the land.
--:-- Marta Martinez: Also, some thought that it was just dangerous, kind of like, you know, taking a step backwards into this back alley abortion idea.
--:-- Victoria Estrada: Right.
--:-- Marta Martinez: But then state law started to chip away at Roe.
--:-- Marta Martinez: And eventually in 2022, we know that Roe was overturned.
--:-- Victoria Estrada: So women no longer had a federal right to abortion.
--:-- Marta Martinez: And we reported how there was a huge demand for abortion in states where it was banned or very restricted.
--:-- Victoria Estrada: 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.
--:-- Victoria Estrada: And it actually looks quite a bit like it had in Latin America.
--:-- Marta Martinez: Today in the U.S., there's hotlines, there's organizations that mail people pills, and there's even accompaniment networks.
--:-- Victoria Estrada: Although here, a lot of people who do acompañamiento call themselves abortion doulas.
--:-- Marta Martinez: So here in America, people who want abortions typically go to a doctor, you know, the trained professional who can oversee the process.
--:-- Victoria Estrada: So what did doctors think about people self-managing with a pill instead of going to them?
--:-- Marta Martinez: A lot of doctors who heard about self-managing also thought that it was very dangerous.
--:-- Victoria Estrada: And one doctor we spoke to is Maya Bass.
--:-- Maya Bass: I didn't think it was safe.
--:-- Maya Bass: You know, as doctors, we're risk-averse, and we like control.
--:-- Maya Bass: 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.
--:-- Maya Bass: 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.
--:-- Maya Bass: Research that had been conducted in many parts of Latin America, in Africa, and in many parts of Southeast Asia as well.
--:-- Maya Bass: And that challenged her to reconsider what safety really meant.
--:-- Maya Bass: Realizing that I was unnecessarily putting people through hoops, that's hard.
--:-- Maya Bass: And then I felt also excited slash maybe relieved.
--:-- Maya Bass: Like, this means that I can be less scared for people who are doing this.
--:-- Marta Martinez: Maya even ended up helping people self-manage their abortions.
--:-- Marta Martinez: She volunteered on a hotline that is run by doctors.
--:-- Victoria Estrada: And in our reporting, we found that lots of other doctors have changed their mind in the last few years too.
--:-- Victoria Estrada: Major medical institutions have put out statements in support of self-managed abortion with pills.
--:-- Victoria Estrada: And one of those institutions is the World Health Organization and also the American College of Obstetricians and Gynecologists.
--:-- Victoria Estrada: Some doctors also took really active steps to support patients getting access to the pills.
--:-- Victoria Estrada: They started prescribing them from states where abortion was legal to patients in states where it's banned.
--:-- Aisha Roscoe: 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.
--:-- Victoria Estrada: 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.
--:-- Victoria Estrada: Something a lot of people don't realize, it's that it's not illegal to self-manage your abortion with pills.
--:-- Victoria Estrada: That's in every state except one, Nevada, which only explicitly bans it after 24 weeks.
--:-- Victoria Estrada: Yeah, I mean, I don't know that I knew that.
--:-- Victoria Estrada: I thought if they said it was illegal, it was illegal that an abortion ban is a ban on having an abortion.
--:-- Victoria Estrada: It's not?
--:-- Marta Martinez: Right.
--:-- Victoria Estrada: It's actually not.
--:-- Victoria Estrada: It's actually a ban on doctors to perform abortions.
--:-- Victoria Estrada: And that's changing now.
--:-- Victoria Estrada: We talked to a lawyer that told us that prosecutors have realized that these bans won't stop people from having abortions.
--:-- Victoria Estrada: 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.
--:-- Victoria Estrada: And those tend to be also not specific at all about what it entails.
--:-- Victoria Estrada: And one of the big changes that advocates are tracking is that some women are being criminally charged for having abortions or suspected abortions.
--:-- Victoria Estrada: A couple have even gone to jail.
--:-- Victoria Estrada: And the restrictions are making it more risky to self or help someone through it.
--:-- Victoria Estrada: Activists are doing what they can to minimize the risk.
--:-- Victoria Estrada: 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.
--:-- Victoria Estrada: Sometimes this means communicating about pills over encrypted apps, but it also can mean role-playing.
--:-- Victoria Estrada: 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.
--:-- Aisha Roscoe: 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.
--:-- Victoria Estrada: So let's be clear.
--:-- Victoria Estrada: These pills we're talking about play an integral role in maternal health care.
--:-- Victoria Estrada: By some estimates, as many as 20 percent of known pregnancies end in miscarriage.
--:-- Victoria Estrada: And many of these miscarriages are treated with these pills.
--:-- Victoria Estrada: That's exactly right, Ayesha.
--:-- Aisha Roscoe: Yeah.
--:-- Victoria Estrada: Mesoprostol has a lot of medical uses.
--:-- Victoria Estrada: Of course, it's used for helping after a miscarriage, but it's also used for inducing labor and preventing hemorrhaging.
--:-- Victoria Estrada: And in Louisiana, we've seen some new restrictions on this drug.
--:-- Victoria Estrada: And doctors there are really opposed to that because it makes it harder for them to take care of their patients.
--:-- Marta Martinez: 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?
--:-- Victoria Estrada: So in the U.S., the idea that you could have an abortion without doctors is new for a lot of people.
--:-- Victoria Estrada: And so, of course, there are situations where self-managing an abortion is not an option and you need medical supervision or intervention.
--:-- Victoria Estrada: But our reporting has shown that in the vast majority of cases, it is safe for women to self-manage their abortions with pills.
--:-- Victoria Estrada: 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.
--:-- Victoria Estrada: We saw this in Argentina, for example.
--:-- Victoria Estrada: 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.
--:-- Victoria Estrada: We spoke to the former vice president of Planned Parenthood Global.
--:-- Victoria Estrada: 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.
--:-- Victoria Estrada: And she sees parallels to what's happening in the U.S. since Dobbs, the Supreme Court case that overturned Roe.
--:-- Victoria Estrada: 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.
--:-- Victoria Estrada: But less legal.
--:-- Aisha Roscoe: 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.
--:-- Victoria Estrada: The idea that abortion opponents might have won the legal battle, but access could still expand across the country.
--:-- Victoria Estrada: And that's what happened in Latin America as well.
--:-- Victoria Estrada: 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.
--:-- Aisha Roscoe: That's Marta Martinez and Victoria Estrada.
--:-- Aisha Roscoe: They are the host of a new series, The Network.
--:-- Aisha Roscoe: The whole series is out now.
--:-- Aisha Roscoe: You can find it in the embedded podcast feed.
--:-- Marta Martinez: Thanks so much for sharing your reporting.
--:-- Victoria Estrada: Thanks so much for having us, Aisha.
--:-- Aisha Roscoe: Thanks, Aisha.
--:-- Aisha Roscoe: 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.
--:-- Aisha Roscoe: 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.
--:-- Aisha Roscoe: The Network is a joint production between Embedded and Futuro Media.
--:-- Aisha Roscoe: This episode of The Sunday Story was produced by Andrew Mambo and Ariana Garib-Lee.
--:-- Aisha Roscoe: It was edited by Liana Simstrom and Raina Cohen.
--:-- Aisha Roscoe: It was engineered by Maggie Luthor.
--:-- Aisha Roscoe: The Sunday Story team also includes Justine Yan and Jenny Schmidt.
--:-- Aisha Roscoe: Our fellow is Andrew Cerulnik.
--:-- Aisha Roscoe: Our executive producer is Irene Noguchi.
--:-- Aisha Roscoe: I'm Aisha Roscoe.
--:-- Aisha Roscoe: Up First is back tomorrow with all the news you need to start your week.
--:-- Aisha Roscoe: Until then, have a great rest of your weekend.
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