How a community of ladies in Latin America remodeled protected, self-managed abortions

In November 1990, greater than 3,000 ladies descended on the sleepy seaside city of San Bernardo del Tuyú, Argentina, for what was changing into a legendary occasion.

Activists, docs, teachers, social employees and attorneys from throughout the Americas traveled all the way in which to attend a feminist gathering referred to as an Encuentro.

Whereas they publicly debated their political calls for, the piece of data that made the most important impression on the way forward for abortion was exchanged in personal, in whispers.

Alicia Cacopardo, an OB-GYN from Buenos Aires, was a part of these whispers. In between periods, she fell into dialog with a bunch of Brazilian ladies within the hallway, who talked a couple of capsule she had by no means heard of earlier than: Cytotec, the industrial title of misoprostol. The drug was designed to deal with abdomen ulcers, however ladies in Brazil have been utilizing it for protected, at-home abortions.

Although Cacopardo was an skilled in reproductive well being, she was shocked — you may have an abortion by yourself, simply by taking a capsule?

“It’s a huge change. It’s brilliant,” she remembers pondering on the time.

Within the years to come back, different abortion-rights activists throughout the area have been thrilled once they realized about misoprostol, and, like Cacopardo did, wished to unfold the phrase to different ladies.

Activists linked the dots: If ladies may get their fingers on misoprostol, they may finish their pregnancies regardless of the extreme authorized restrictions on abortion most Latin American nations had. With this new capsule, they would not have to attend for the regulation to alter.

Phrase spreads 

When Cacopardo returned to Buenos Aires after the Encuentro, she wished to get her sufferers Cytotec. If she succeeded, ladies may finish their pregnancies regardless of authorized restrictions on abortion. On the time, Argentina solely allowed abortion in instances of rape or when the mom’s life was in danger.

However Cacopardo bumped into an issue: Cytotec wasn’t obtainable in Argentina.

She flipped by a pharmaceutical listing and appeared for any medicine that contained misoprostol, the generic title of Cytotec. She solely discovered one remedy in Argentina: Oxaprost. However Oxaprost included a second substance, referred to as diclofenac, an anti-inflammatory drug usually used to deal with arthritis and different issues.

So Cacopardo got here up with an answer — one which required her sufferers to do a makeshift science challenge at house. Cacopardo informed them to purchase Oxaprost on the pharmacy after which crush the tablets to separate the outer layer of misoprostol from diclofenac, which was contained in an internal layer. Cacopardo wished her sufferers to keep away from any potential negative effects from taking an excessive amount of diclofenac, resembling heartburn and different abdomen points.

It was troublesome to crush the tablets, so some ladies simply took the entire thing — a sign of simply how DIY it was at first to self-manage an abortion with tablets. Cacopardo says that none of her sufferers reported any critical negative effects and most of them had full abortions.

A scientific stamp of approval

Kelly Blanchard, the president of the analysis and advocacy group Ibis Reproductive Well being, says that experiments with misoprostol within the Nineteen Nineties represented activists doing “research in real time.”

“In the clinic setting, those innovations often come from health care providers,” she explains. “The activists are doing exactly the same thing: thinking about and working with people who need the care and seeing what works and what doesn’t.”

Researchers like Blanchard finally ran research on ladies utilizing misoprostol to finish pregnancies, gathering proof from all around the globe — from Peru to India to South Africa. Time and again, the researchers discovered the identical factor: Misoprostol was a protected and efficient approach to have an abortion exterior the formal well being care setting.

The research performed by these researchers additionally persuaded main public well being establishments just like the World Well being Group (WHO). As early as 2003, the WHO included misoprostol as a protected abortion technique within the first trimester (together with one other capsule referred to as mifepristone).

The WHO’s stamp of approval did not change the truth that abortion was unlawful in lots of components of the world. So activists had an issue: They knew of an efficient technique to have abortions exterior of the medical system, however how may they get extra ladies entry to one thing that was unlawful?

Hotlines in Ecuador and Argentina

The statue of a virgin, la Virgen del Panecillo, looms over town of Quito, the capital of Ecuador. She has wings, like an angel.

Sooner or later in 2008, Ecuadorian activists and a bunch of European activists from the abortion entry group Girls on Waves hung a giant white banner on the balcony of the virgin statue.

The banner learn “SAFE ABORTION” in Spanish, with a telephone quantity. That quantity was for the primary abortion hotline in Latin America.

Later that day, that cellphone quantity blew up with dozens of textual content messages and calls.

The thought for a hotline — and the stunt selling it — threw these abortion activists into a brand new, extra public period. They reached 1000’s of ladies this manner with work that was daring, organized and replicable.

In 2009, a yr after the Ecuador hotline launched, Argentina obtained its personal.

The collective Lesbianas y Feministas por la Descriminalización del Aborto (Lesbians and Feminists for Abortion Decriminalization) began the hotline with a dozen volunteers.

“In the beginning, the hotline was so bare bones,” says Ana Mines, one of many first hotline volunteers. The group boasted a backpack they handed round to 1 one other, with a Nokia 1100, a pocket book and flash playing cards.

They have been brief on sources, however they have been decided to provide rigorous info on tips on how to use misoprostol to have protected abortions. And so they marketed the helpline all over the place they may, placing up posters throughout Buenos Aires with their telephone quantity and speaking about it on TV and the radio.

The helpline volunteers referred to the rules developed by international and regional scientific our bodies, such because the WHO. This analysis gave the activists credibility. They thought it additionally gave them a authorized protection: They have been simply sharing publicly obtainable info.

The volunteers delivered this disclaimer to callers — that they weren’t docs however have been offering public info — earlier than providing step-by-step directions on tips on how to use misoprostol. They answered the callers’ questions, resembling: If I am obese, will the tablets work? Can the tablets fall out of my vagina? Will hospital employees have the ability to inform that I took misoprostol?

In Argentina, nobody had ever finished what this collective was doing — talking so overtly about abortions and tips on how to have one by yourself. Mines says a lot of the volunteers like her have been fearful of getting arrested. And the Argentine authorities had a document of going after abortion instances. Between 1990 and 2008, practically 450 abortion instances have been prosecuted in Argentina.

Not all feminists have been completely happy about what the collective was doing. Mariana Romero, a outstanding reproductive well being researcher and advocate for abortion rights in Argentina, anxious that the helpline may inadvertently scale back entry to misoprostol.

“I said, do we have to do this so public? You’re nuts,” Romero recollects. “You are going to make the pharmaceutical company that produced misoprostol take it out of the market.” Regardless of the publicity across the hotline, in the long run, no volunteers have been arrested. And misoprostol remained obtainable.

Barbie will get abortions 

In 2010, a yr after the hotline began, Lesbianas y Feministas obtained extra provocative with the way in which they talked about abortion. They printed a handbook on tips on how to self-manage an abortion with misoprostol and with out a physician.

It didn’t appear to be a traditional medical textual content. The quilt was pink with two huge rainbows and illustrations of tablets with smiley faces. On the again, there was an image of Barbie in a pink convertible, with sun shades and a glamorous scarf over her head, together with the phrases “Barbie, how’d it go?”

“It was awesome,” Barbie replies. The implication was that any girl can have an abortion — even Barbie.

The handbook was thorough — greater than 100 pages lengthy — and it went into vivid element, together with drawings of tips on how to insert the tablets into the vagina.

“It was a bestseller,” says Mines, the hotline volunteer. “It had two printings of 10,000 copies each.”

Different helplines and feminist teams in Latin America began utilizing the handbook to assist extra ladies. Mines herself was capable of assist 1000’s of ladies by the helpline.

However some abortion activists believed sharing info on the telephone and thru written manuals wasn’t sufficient.

Mexico: The beginning of “accompaniment”

In 2010, the activist Veronica Cruz met volunteers from the Argentine helpline at a convention about protected abortions. Cruz is the founding father of a feminist collective referred to as Las Libres (The Free) in Mexico. She recollects a variety of hype round abortion helplines on the gathering, however she was skeptical.

“How do you know for sure that those women are not at risk?” she requested the volunteers. “You gave them information and then what? Did she get the pills? Did she follow the instructions correctly? Did she end up in the hospital? You actually don’t know anything.”

Cruz, then again, did know the way the ladies she helped in Mexico fared as a result of she used a special technique: “acompañamiento.”

In Spanish, acompañamiento means being with somebody, supporting them, or simply conserving them firm. When serving to a girl looking for an abortion, acompañamiento has come to imply being there for somebody all through the entire means of an abortion, from starting to finish, whatever the authorized dangers.

Cruz began doing acompañamiento in 2000 — the identical yr she based Las Libres, and practically a decade earlier than any of the helplines began in Latin America. On the time, abortion in Mexico was primarily banned. Within the state the place Cruz lives, the one exception was for girls who have been raped. However even in these instances, hospitals usually denied ladies their proper to the process.

To start with, Cruz targeted her work on these ladies. Via Las Libres, she labored with a gynecologist to assist ladies who had been raped get protected, authorized abortions. Sooner or later, she noticed the physician use a brand new technique: misoprostol, the ulcer remedy that girls in Brazil first began utilizing for abortions within the late Eighties.

As she watched the physician administer the tablets, Cruz had a realization.

“I can just buy the pills, tell the woman how to use them? That was an incredible discovery for me.”

Not lengthy after, one other girl got here to Las Libres who wished an abortion however wasn’t a rape survivor — which meant that she did not qualify for a authorized abortion. The place they lived, ending a being pregnant that wasn’t a results of rape, by any technique, carried a jail sentence for the girl and anybody who helped her.

Cruz determined to accompany the girl, regardless of the dangers. She informed the girl to purchase the tablets on the pharmacy. In Mexico, although misoprostol technically required a prescription, you would usually get it over-the-counter. Then Cruz gave the girl the identical directions she had seen the OB-GYN give.

Despite the fact that Cruz had seen how the tablets work and the way easy it was to make use of them, she says it was nerve-wracking to help somebody by an abortion with out a physician. Cruz was on standby the entire time. It was late at night time when the girl took the tablets.

“So I slept with my cellphone on my chest,” Cruz recollects. “All the time … in case it rang or something.”

The subsequent day, the girl went to a health care provider, who confirmed that the being pregnant had ended and that there hadn’t been any problems. It was Cruz’s first time doing accompaniment. And in her eyes, it had gone easily.

After that, when somebody contacted Las Libres for an abortion and so they weren’t rape survivors, Las Libres did not go to the gynecologist for assist. They dealt with it themselves.

“We promised ourselves that we were never going to leave anyone without access,” Cruz says. “Whatever we had to do.”

If a girl could not afford to purchase misoprostol, which was costly in Mexico, Las Libres would give her the tablets free.

Typically ladies had leftover tablets and provided to provide them to Las Libres. Cruz informed them to pay it ahead.

“The next woman who comes, you are going to give her the pills as a gift and you’re going to tell her about your experience,” Cruz mentioned. 

Cruz would arrange a gathering between the 2 ladies, in a park or at a mall. The girl who’d had an abortion would share her further tablets and her story. By connecting ladies straight — one after the other — Las Libres was recruiting volunteers and constructing a community.

Las Libres helped create accompaniment networks that, at the moment, attain each state in Mexico.

However over time, some activists criticized Cruz’s strategy. At that convention in 2010, Cruz recollects activists telling her that “what we were doing — of personally accompanying the women and giving them the pills — was risky for us. For us and for the whole movement.”

These activists, who have been preventing to legalize abortion, did not need the motion for abortion rights to be related to individuals who have been breaking the regulation.

Many abortion-rights activists throughout Latin America discovered themselves on reverse sides: Some have been preventing to legalize abortion — these ladies have been taking part in the lengthy sport. Others, like Cruz, have been actively breaking the regulation, as a result of ladies who wanted abortions instantly could not wait till the regulation modified.

One group realized that they did not have to decide on between the 2 sides.

Argentina: From an artwork to a science 

Almost 35 years after that Encuentro in San Bernardo, within the fall of 2024, one other Encuentro kicked off in Argentina. This time, the annual gathering introduced 50,000 ladies to a small metropolis referred to as San Salvador de Jujuy, proper by the Andes Mountains.

They flowed by the downtown streets in a giant demonstration, like a river of ladies.

In Jujuy, Ruth Zurbriggen was onerous to overlook. She was often the particular person with the megaphone and seemingly limitless vitality.

Zurbriggen is among the founders of an Argentine accompaniment community: Socorristas en Crimson (First Responders Community). It is now the most important abortion accompaniment community on the earth. And to make that occur, she and the Socorristas determined to construct techniques, turning acompañamiento right into a science.

Whereas Cruz, the founding father of Las Libres, thought that girls may determine accompaniment on their very own, the Socorristas constructed a complete accompaniment technique and also have a faculty to coach volunteers — La Escuela Socorrista (the Socorrista faculty).

At school, trainees be taught the Socorristas’ technique, which incorporates holding an in-person workshop for girls who’re focused on having an abortion and administering a survey. That survey is exhaustive. It asks easy questions, such because the particular person’s age and the way far alongside they’re of their being pregnant. Different questions are extra private, resembling why the girl wished to have an abortion, whether or not her associate supported her alternative and whether or not she expelled the embryo. They tracked the solutions in spreadsheets, rigorously documenting traits in ladies’s experiences self-managing abortions with misoprostol.

One query on the survey inadvertently helped the Socorristas strengthen their relationships with docs. They requested: How did you discover out about us?

“Thirty percent had come to us recommended by health care professionals,” Zurbriggen recollects. “And that’s when we said, ‘What’s happening? Who are they?'”

Zurbriggen was stunned by that prime quantity. Most docs in Argentina didn’t help abortion at the moment. The Socorristas wished to know why medical employees have been referring sufferers to them, so that they began scheduling appointments with these well being care suppliers, as in the event that they have been private appointments. That allowed the activists to speak to the clinicians in personal.

“We started creating a bond with professional medical staff. And then we started asking them ‘what’s the problem if you write two prescriptions a month for us? Nothing, right?’ And they’d write us two or three prescriptions for us with different dates. And we’d get male names from friends or sons, and the prescriptions would be under male names,” Zurbriggen says. She describes the method as “very DIY.” It was additionally unlawful — and the Socorristas do not do it anymore.

Medical doctors and nurses have been usually prepared to assist although they risked dropping their license by doing so. One OB-GYN named Gabriela Luchetti, who labored within the public well being system for 30 years, says she felt “relief” sending individuals who wanted an abortion to the Socorristas.

Luchetti mentioned, “Someone was going to do what we didn’t dare to because we had a license, and we were afraid of the law.”

The combat to legalize 

Many feminists who had targeted their combat on getting a regulation to guard abortion weren’t comfy with Zurbriggen and the Socorristas’ work. Simply as activists criticized Cruz’s accompaniment work in Mexico, they believed Socorristas would harm their nation’s motion for abortion rights as a result of it could be related to prison exercise.

However the Socorristas’ accompaniment work all the time went hand-in-hand with the combat to legalize abortion. In 2018, when the Argentine Congress first debated passing an abortion regulation, Zurbriggen and different Socorristas have been there, talking to representatives, together with different abortion-rights teams.

They shared knowledge that they had been rigorously monitoring for six years. In that point, they’d accompanied practically 20,000 abortions. Their knowledge challenged stereotypes Argentinians had about abortion. They confirmed that the ladies who’re most definitely to have abortions are already moms, and that a lot of them are non secular.

A few of the different feminists who testified in entrance of Congress, just like the researcher Mariana Romero, had been essential of the Socorristas. However she, and different skeptics, got here round. “They were radical, but, if they weren’t, I don’t know if things would have happened the way they happened,” Romero says.

In December 2020 the senate voted to legalize abortion in Argentina and in January 2021 it was formally signed into regulation. Now any girl can go to a hospital or a neighborhood clinic and ask for an abortion as much as 14 weeks, no rationalization wanted.

The marketing campaign in Argentina impressed feminists throughout Latin America. Argentinians made the inexperienced bandana the image for his or her motion and the combat to legalize abortion throughout the area grew to become referred to as the Inexperienced Wave. Inside a few years, Colombia and Mexico additionally decriminalized abortion.

One may suppose that after abortion was legalized in Argentina, the work of Socorristas would not be vital anymore. Girls may go straight to docs for the process. And but, Socorristas are simply as busy as they have been earlier than abortion was legalized.

The yr after abortion grew to become authorized in Argentina, greater than 13,000 reached out to the Socorristas. Of these, greater than three-quarters selected to have a self-managed abortion with the collective’s help. In different phrases, the overwhelming majority of those ladies most well-liked to self-manage their abortions with acompañamiento over going to a health care provider.

Some OB-GYNs like Luchetti, who signed prescriptions for the Socorristas each every so often, perceive why so many ladies are making this alternative. She says, “The Socorristas method is far superior to medical care and is different and better. It’s warm, friendly, committed.”

One other physician, Nadya Scherbovsky, talked about that Socorristas make themselves obtainable 24/7, whereas the general public well being system has strict schedules.

Individuals who want an abortion aren’t the one ones who’re reaching out to Socorristas. Zurbriggen says she typically will get calls from OB-GYNs who ask her about tips on how to use abortion tablets, as a result of she has extra expertise with remedy abortion than many docs in Argentina.

The Socorristas have change into worldwide consultants on self-managed abortion with tablets. A 2022 examine printed in The Lancet World Well being checked out their accompaniment technique for pregnancies underneath 9 weeks, and it discovered that it was simply as efficient and protected as a drugs abortion managed in a clinic.

“Misoprostol is a technological revolution that when you put it in the hands of women and those who need an abortion, it generates another revolution,” Zurbriggen says. “It’s a cultural, social, political, medical revolution.”

Reporter Victoria Estrada and editor Rhaina Cohen contributed to this text. This reporting was supported by the Worldwide Girls’s Media
Basis’s Reproductive Well being, Rights, and Justice within the Americas Initiative.