AYESHA RASCOE, HOST:
This month marked three years since the U.S. Supreme Court overturned Roe v. Wade, the case that had given Americans legal access to abortions for 50 years. Today, we have the backstory of a drug that is at the center of disputes over the ongoing fight over abortion rights - misoprostol. The drug's intended use is pretty innocuous until a group of Brazilian women figured something out in the '80s.
VICTORIA ESTRADA, BYLINE: There was a stomach ulcer medication called Cytotec - that's the commercial name for misoprostol. 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 the pills to have an abortion.
MARTA MARTINEZ, BYLINE: It wasn't supposed to be used for an abortion. It's just this side effect that happened to women. Cytotec is pretty much like Tums or milk of magnesia.
RASCOE: That's reporters Marta Martinez and Victoria Estrada. They worked on a series called The Network in partnership with NPR's Embedded and Futuro Media's Latino USA, looking at how that drug has made abortion safe and accessible for millions of women around the world. I asked them if we know who figured out a secondary use for misoprostol.
MARTINEZ: We actually don't. There's not one person who came up with this idea. Through our reporting, we found out that across Brazil, women were using this pill, and they were just telling 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.
RASCOE: Was that actually safe?
ESTRADA: Today, we know that taking this pill to have an abortion is safe. It's been confirmed by institutions like the World Health Organization. In those early days, women in Brazil were still figuring out how many pills to take to have an abortion. So they were experimenting on themselves, on their bodies.
RASCOE: Well, what was the impact of this discovery in Brazil?
MARTINEZ: Well, in a five-year span, the maternal mortality rates fell by 21%, according to the World Health Organization. The impact went far beyond Brazil because news about the pill really spread across Latin America. These women created their own alternative health care systems. They set up hotlines. 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 acompanamiento, or accompaniment.
RASCOE: As an American, I mean, it's hard not to make connections with this story and this history.
MARTINEZ: That's right, Ayesha. And actually, since Roe was overturned in 2022, self-managed abortions with pills - this method that Brazilian women invented pretty much 40 years ago - has gotten way bigger in the U.S.
RASCOE: So what is that pill's history here in the U.S.?
MARTINEZ: Actually, we have heard stories that women were taking these pills as early as in the '90s. It was mostly immigrants and people coming from Latin American communities. But in the United States, it wasn't widely popular. A lot of people didn't think that it was relevant for a country that did have a legal right to abortion.
ESTRADA: 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 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.
RASCOE: What kind of pushback is this network in the U.S. seeing right now?
ESTRADA: 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. But 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.
RASCOE: I thought an abortion ban is a ban on having an abortion. It's not?
MARTINEZ: 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.
RASCOE: These pills we're talking about playing 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.
ESTRADA: That's exactly right, Ayesha, 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 we've seen some new restrictions on this drug, and doctors are really opposed to that because it makes it harder for them to take care of their patients.
RASCOE: 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 antiabortion groups are trying to make access to these pills more difficult?
MARTINEZ: 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 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 she sees parallels to what's happening in the U.S. since Dobbs, the Supreme Court case that overturned Roe.
DEE REDWINE: 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.
RASCOE: I mean, that's quite a statement, especially in the U.S - the idea that abortion opponents might have won the legal battle, but access could still expand across the country.
MARTINEZ: And that's what happened in Latin America.
RASCOE: That's Marta Martinez and Victoria Estrada. Thank you so much for sharing your reporting.
MARTINEZ: Thanks so much for having us, Ayesha.
ESTRADA: Thank you, Ayesha. Transcript provided by NPR, Copyright NPR.
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