Embedded: The Network

In the mid-1980s, an OBGYN in Brazil noticed that far fewer pregnant women at his hospital were dying from abortion complications. It wasn't a coincidence. Brazilian women had made a discovery that allowed them to safely have abortions at home, despite the country's abortion restrictions. That discovery eventually spread across the globe. See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  This message comes from NPR sponsor Viore with the Halo Essential Wide-Like Pant. Receive 20% off your first purchase at viore.com/NPR on any US orders over $75 and free returns. Exclusions apply. Visit the website for full terms and conditions.

• 0:17Rund Abdelfatah?

  I'm Rande Abdur-Rahim.

• 0:18Speaker 02

  And I'm Ramtin Arablouei.

• 0:20Rund Abdelfatah?

  Three years ago, when the Supreme Court overturned Roe v. Wade, abortion opponents celebrated. But many abortion rights supporters feared that American women were now in danger. They thought, without access to legal abortions, women would resort to unsafe methods.

• 0:38Speaker 02

  Yet, a sprawling set of people have been expanding abortion access in unconventional ways since the 1980s. They'd been prepared for this moment, a network of activists and midwives, grandmothers and friends.

• 0:52Rund Abdelfatah?

  Today on the show, we bring you episode one of The Network, a three-part series from NPR's Embedded podcast and Futuro Media. Hosts Victoria Estrada and Marta Martinez go inside the global movement that's helped millions of women have abortions at home.

• 1:10Speaker 02

  The story begins decades ago, when Brazilian women found a way to have safe abortions without a doctor, and how their method is shaping the future of abortion in the US today.

• 1:23Rund Abdelfatah?

  Here's Marta.

• 1:29Speaker 03

  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.

• 1:50Speaker 04

  Are you scared? 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.

• 2:10Speaker 05

  But not all abortion rights supporters felt this way.

• 2:14Speaker 06

  Everybody was so calm in the network.

• 2:17Speaker 05

  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.

• 2:27Speaker 06

  Everybody was like, we've been doing this work. We're going to continue doing this work. Nothing is changing. Who cares?

• 2:33Speaker 05

  I'm actually energized.

• 2:38Speaker 03

  This network, it's hard to even describe because it's not formal or centralized. There's no CEO, no headquarters.

• 2:48Speaker 05

  Some people work together, but plenty don't know each other. They're midwives and nurses, grandmothers and friends.

• 2:56Speaker 03

  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.

• 3:17Speaker 05

  Their method grew out of a very small thing. It actually fits in the palm of your hand.

• 3:23Speaker 03

  But despite being physically tiny, when it comes to reproductive health, doctors, researchers, and people working in this field say it's been... Monumental.

• 3:32Speaker 06

  Extraordinarily important.

• 3:36Speaker 03

  It's a lifesaver in so many ways. It's the equivalent to the discovery of penicillin because it's a before and after.

• 3:44Speaker 05

  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.

• 3:54Speaker 07

  The future of abortion access could be impacted by a new lawsuit just filed by the Attorney General of Texas.

• 4:00Speaker 08

  A long dormant federal law prohibits the mailing of any supplies used for abortions. Possession could be punishable by up to five years in prison.

• 4:14Speaker 03

  From NPR's Embedded and Futuro Media's Latino USA, this is The Network.

• 4:20Speaker 05

  A series about the DIY method that took safe abortions out of the clinic and the women who made it happen.

• 4:27Speaker 03

  Episode one, Santotech.

• 4:36Speaker 00

  We'll be right back. Stay tuned for the following announcements and messages from our sponsors. This message comes from the Carter Center. Since 1982, the Carter Center has gone where the need is greatest, waging peace, fighting disease, and building hope. Far Away Up Close: Global Stories from the Carter Center is a new documentary-style podcast about the people who do this difficult, often dangerous, work and what drew them to it, told in their own words. Follow Far Away Up Close: Global Stories from the Carter Center wherever you listen. This message comes from Abrams Books. Take a revelatory journey through Bob Dylan's early life and meteoric rise in the new book, Bob Dylan: Through the Open Window, featuring 100 rare images, an essential gift for Dylan fans.

• 5:21Speaker 00

  Available now wherever books are sold.

• 5:24Speaker 07

  This message comes from BetterHelp. Your brain has limited storage, so why is it still holding on to that embarrassing moment from years ago? BetterHelp is an online therapy platform that gives you space to talk about what's taking up too much of yours. BetterHelp is now in-network with more than 125 health plans, with mini co-pays as low as $15 for eligible members. And if you don't have eligible insurance, you can still get 20% off your first month. Visit betterhelp.com/NPR. Cost and coverage may vary. Discount cannot be combined with insurance.

• 5:59Speaker 05

  I'm Victoria Estrada.

• 6:01Speaker 03

  And I'm Marta Martínez. We're both producers at the public radio show Latino USA. We've been covering reproductive rights in the Americas for years now.

• 6:11Speaker 05

  And when we started to see more and more challenges to abortion access in the US, 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 US.

• 6:26Speaker 03

  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 "bacali abortion" comes from and where we get the image of a woman using a coat hanger, self-managing her abortion.

• 6:45Speaker 05

  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.

• 7:00Speaker 03

  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 Pitangki. 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.

• 7:41Speaker 09

  So here in front, you have the Christ.

• 7:44Speaker 03

  Oh, it's right here.

• 7:45Speaker 09

  Right here.

• 7:46Speaker 03

  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?

• 7:58Speaker 09

  I see it right every day when I wake up.

• 8:01Speaker 03

  Say hello.

• 8:02Speaker 09

  Yeah, I say hello, Christ. How are you? Be good, be good, Jesus Christ.

• 8:08Speaker 03

  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, because I was actually talking about this with Victoria this morning, that religion is very present in this city in a very visual way. Because you have the Christ up there in the mountain looking at you. From everywhere.

• 8:32Speaker 09

  Yeah, everywhere, everywhere.

• 8:39Speaker 03

  It's this constant reminder of the influence Catholicism has had on Brazil for much of its history.

• 8:45Speaker 09

  For the Catholic Church, contraception has always been a key issue.

• 8:52Speaker 03

  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.

• 9:04Speaker 05

  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.

• 9:19Speaker 03

  This lack of knowledge had serious consequences.

• 9:23Speaker 09

  The significant, let's call punishment, it was on women's bodies. Death or morbidity.

• 9:38Speaker 05

  Start recording.

• 9:39Speaker 10

  Okay.

• 9:40Speaker 05

  Could you just count to ten?

• 9:42Speaker 10

  Um, dois, três.

• 9:46Speaker 03

  In the 1980s, Brazil's maternal mortality rate was higher than most of the rest of the world.

• 9:52Speaker 10

  Eu vivi uma época que as mulheres adoeciam e morriam.

• 9:57Speaker 11

  I lived through a time when women got sick and died. Died of infection, died of bleeding. Young women, extremely young women.

• 10:07Speaker 05

  This is Dr. Rivaldo Albuquerqui.

• 10:10Speaker 10

  Sou médico ginecopshtetra.

• 10:14Speaker 11

  I am a gynecologist. I am a practicing Catholic. And I have been working with women's health since I was a medical student.

• 10:24Speaker 05

  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 is 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.

• 10:53Speaker 03

  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.

• 11:11Speaker 11

  People who had the money could look for doctors who did abortions in clinics, in hospitals, with every safety precaution, using sterilized material.

• 11:25Speaker 05

  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.

• 11:42Speaker 03

  Others just tried to self-manage their abortion. We heard about lots of ways. Herbs. Teas or drinks. Chás, bebidas. Incession of foreign objects. Astis de guarda chuva.

• 11:56Speaker 05

  The rods of an umbrella.

• 11:58Speaker 03

  Agulha de crochete. Needles. And whatever medicines they could buy at the pharmacy.

• 12:04Speaker 12

  You know, all those horror stories that you read about.

• 12:08Speaker 03

  By the time women got to Rivaldo, they often had perforations in their uterus, hemorrhages, and serious infections.

• 12:17Speaker 05

  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.

• 12:25Speaker 10

  Era uma mulher de 19 anos que já tinha dois filhos.

• 12:29Speaker 11

  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.

• 12:55Speaker 05

  Rivaldo and the other doctors suspected she'd had an unsafe abortion, and so they decided to do an exploratory operation.

• 13:02Speaker 11

  So that we could evaluate the abdomen, what was happening with this infection. And when we opened the abdominal cavity, we found a uterus that smelled, pardon the word, rotten.

• 13:16Speaker 05

  Rivaldo still remembers it.

• 13:18Speaker 11

  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.

• 13:38Speaker 03

  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.

• 13:46Speaker 11

  Why did this woman die? I can tell you without hesitation, because she was black and because she was poor.

• 13:59Speaker 03

  Rivaldo told us he really felt for these women.

• 14:02Speaker 11

  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 are going through a specific moment in their life. They are in need.

• 14:25Speaker 03

  But Rivaldo was an exception. Many doctors did not treat these patients well.

• 14:30Speaker 11

  Women who had tried to have an abortion were the last ones to be treated during our shift.

• 14:37Speaker 03

  So these women, they would be in the emergency room all day long, without food or anything to drink.

• 14:45Speaker 11

  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.

• 14:57Speaker 03

  He remembers that some doctors wouldn't give the women enough anesthesia before their dilation and curettage, or DNC. So the women would feel the pain of their cervix being dilated and the walls of their uterus being scraped.

• 15:14Speaker 11

  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 the baby."

• 15:39Speaker 05

  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.

• 15:59Speaker 03

  Some doctors went even further than insulting the women. In some cases, they called the police.

• 16:06Speaker 11

  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.

• 16:16Speaker 03

  Rivaldo says his hospital never let this happen, but he knew it happened elsewhere.

• 16:23Speaker 11

  That was the standard for these women. So these are things that I will never forget.

• 16:33Speaker 05

  At the end of his shift, Rivaldo would make notes about his patients, who lived, who died.

• 16:39Speaker 11

  How many births, how many C-sections, how many surgeries, how many abortions, how many infected abortions.

• 16:48Speaker 05

  And around the year 1987, he noticed a change.

• 16:53Speaker 03

  A big change.

• 16:54Speaker 11

  Severe cases of infections, severe cases of hemorrhage, they disappeared.

• 17:01Speaker 03

  Women were still coming into the ER, but they were showing up with new symptoms, much less serious ones.

• 17:08Speaker 11

  Like an increase in body temperature, hyperthermia. And it didn't make sense because you couldn't find an infections condition. Some women also had gastrointestinal symptoms. We realized that there was something different, and this made us a little confused.

• 17:30Speaker 05

  Around the same time, a researcher named Sara Costa was working for Brazil's School of Public Health in Rio de Janeiro, more than 1,000 miles south from Recife. And she noticed another big change.

• 17:42Speaker 03

  We were seeing this incredible decline in fertility. Suddenly, women were having fewer children. But why?

• 17:52Speaker 05

  It was strange because there were no big policy changes to account for it.

• 17:57Speaker 12

  The government wasn't providing much information about how to control fertility.

• 18:04Speaker 03

  And abortion was still illegal, so something just wasn't adding up.

• 18:10Speaker 12

  Was it spontaneous use of oral contraception? How were they getting it?

• 18:14Speaker 03

  So in the early 90s, Sarah began talking directly to the women.

• 18:18Speaker 12

  And we conducted those interviews over a period of several months and analyzed the results.

• 18:26Speaker 03

  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.

• 18:46Speaker 12

  We thought we would actually discover a lot more complications, serious complications. But most of the women went into hospital with bleeding, had a curatage, and left.

• 18:59Speaker 03

  Left.

• 19:03Speaker 03

  They didn't get stuck in the hospital with infections or other complications.

• 19:07Speaker 12

  It was a bit of a surprise.

• 19:12Speaker 05

  In Recife, Rivaldo had noticed a similar pattern.

• 19:15Speaker 11

  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.

• 19:35Speaker 05

  Fewer complications from abortion meant one thing.

• 19:40Speaker 11

  Women stopped dying.

• 19:46Speaker 03

  Or at least far fewer were dying. From 1986 to 1991, the time Sarah and Rivaldo were observing, the World Health Organization recorded a 21% drop in Brazil's maternal mortality rate.

• 20:03Speaker 11

  It seemed like magic, or a better word... A miracle.

• 20:15Speaker 05

  The cause of what Rivaldo calls a miracle after the break.

• 20:20Speaker 00

  Stay tuned for the following announcements and messages from our sponsors. This message comes from the Carter Center. Since 1982, the Carter Center has gone where the need is greatest, waging peace, fighting disease, and building hope. Far Away Up Close: Global Stories from the Carter Center is a new documentary-style podcast about the people who do this difficult, often dangerous, work and what drew them to it, told in their own words. Follow Far Away Up Close: Global Stories from the Carter Center wherever you listen.

• 20:50Speaker 07

  This message comes from Live Right, publisher of John U. Bacon's New York Times bestseller, The Gales of November, a chronicle of the S.S. Edmund Fitzgerald's 1975 shipwreck. "Never has it been told better than by Mr. Bacon in this colorful book," writes John J. Miller of The Wall Street Journal, while author Hampton Sides proclaims it's destined to be a classic. The Gales of November, now in paperback. Support for this podcast and the following message come from the Southern Environmental Law Center. No one voted for a dirty air. No one voted for polluted water. That's why SELC is fighting back to defend the healthy environment everyone depends on, just as they've done for 40 years.

• 21:32Speaker 07

  Because clean air, clean water, and a healthy climate aren't political, they're fundamental. Learn more at SELC.org.

• 21:41Speaker 03

  In 1973, the same year that Roe v. Wade was decided in the United States, something else happened that transformed reproductive healthcare, but in a much more roundabout way. An American pharmaceutical company called Searl developed a new drug to treat gastric ulcers, kind of like Tums or Pepto Bismol or Milcof Magnesia. It was a small, white, hexagon-shaped pill with a tiny figure of a stomach etched on one side.

• 22:12Speaker 05

  Not a belly, the actual organ.

• 22:14Speaker 03

  It's actually the stomach that makes me remember this pill.

• 22:18Speaker 05

  It's called CytoTech.

• 22:20Speaker 03

  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 US, CytoTech first made its way to Europe and then Brazil in 1986.

• 22:39Speaker 05

  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.

• 22:58Speaker 03

  Jacqueline Pitangui, the sociologist who says hello to the Christ statue every morning in Rio de Janeiro, remembers that the warning was written out.

• 23:07Speaker 09

  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.

• 23:18Speaker 05

  Dr. Rivaldo Albuquerque remembers the fine print more specifically.

• 23:23Speaker 11

  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.

• 23:34Speaker 03

  Deborah Diniz, a Brazilian anthropologist and law professor who grew up in the 80s, remembers the warning as an image on the box.

• 23:43Speaker 13

  It was a profile of a pregnant woman, a big belly and a warning crossing the belly. And also a skull.

• 23:53Speaker 03

  There was a skull?

• 23:54Speaker 13

  There was a skull.

• 23:56Speaker 03

  Wow.

• 23:57Speaker 13

  I'm 100% sure of that.

• 24:02Speaker 03

  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.

• 24:12Speaker 05

  When the pharma company developed Cytotec, it discovered that the drug had the significant side effect on women, a serious side effect. It caused bleeding and contractions that could induce a miscarriage.

• 24:24Speaker 03

  So for people who were pregnant and wanted to stay that way, it was a very dangerous pill to take.

• 24:30Speaker 05

  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 tees and crochet needles women had been using, Cytotec was overwhelmingly safe and effective.

• 24:49Speaker 03

  And somebody, somewhere, somehow, figured that out.

• 24:57Speaker 09

  I don't think we ever identified where it started. No, it's impossible to know this. Don't forget, we didn't have social media then. There's no records.

• 25:08Speaker 05

  It wasn't like there was a lot of incentive to take credit. Whoever did this was likely breaking the law.

• 25:14Speaker 09

  They wouldn't give their name. "I am Mary Smith, and listen, you can use this to induce an abortion."

• 25:22Speaker 03

  Some speculate that it was a pharmacist or a midwife.

• 25:27Speaker 09

  We certainly knew that pharmacists were involved. I went to the pharmacy and I bought this.

• 25:34Speaker 05

  But even if we can't know the original source, we do know how the knowledge spread far and wide.

• 25:41Speaker 13

  The women themselves.

• 25:42Speaker 09

  Women said, "Huh."

• 25:43Speaker 13

  I have no question of saying that it was from women.

• 25:46Speaker 09

  Brazilian women.

• 25:48Speaker 13

  Women continued taking it, because it was another woman from her family who shared with her. It certainly wasn't advertised.

• 25:57Speaker 09

  It was in the air. I can't tell you when something is in the air among women's talks. I mean, it was in the air.

• 26:12Speaker 14

  It was spreading by word of mouth.

• 26:15Speaker 03

  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.

• 26:27Speaker 14

  A woman who went through the process would tell another, "Hey, buy that, buy that."

• 26:32Speaker 03

  The whispers about side attack 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.

• 26:50Speaker 05

  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.

• 27:08Speaker 14

  Oh, my mother raised us like potatoes in the ground.

• 27:11Speaker 05

  R was one of 12 kids.

• 27:14Speaker 14

  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 the thing was going to create a child. So I didn't know that a partner shouldn't cross certain boundaries.

• 27:31Speaker 05

  When R started feeling funny and her period stopped, she confided in her older sister.

• 27:38Speaker 14

  She sat me down and said, "Look, you're 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."

• 27:49Speaker 05

  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 nearly done just that a few years earlier to our sister.

• 28:02Speaker 14

  He once took out his gun and tried to kill my sister, the same sister who helped me because my sister lost her virginity.

• 28:11Speaker 05

  So it was dangerous for R to stay pregnant. But it was also risky to get an abortion, both physically and legally.

• 28:20Speaker 05

  Our 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.

• 28:35Speaker 14

  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.

• 28:50Speaker 05

  Our 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.

• 29:03Speaker 14

  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?

• 29:11Speaker 05

  Ar was given a DNC to complete her abortion. The doctors told her she'd nearly perforated her uterus and had been at risk of losing it. Ar stayed in the hospital for several days to recover, in a maternity room with other women who'd attempted an abortion.

• 29:26Speaker 14

  All of them had done something. And the one next to me, she died.

• 29:32Speaker 05

  Died? I asked.

• 29:34Speaker 14

  Why? Yes. I had a curatage, right? Then I was fine. But the one next to me, she never came back.

• 29:48Speaker 03

  A few years later, when Ar 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. Ar decided to have another abortion, but this time, it was a very different experience because of Cytotec.

• 30:05Speaker 14

  It was for gastritis. So they sold it at the pharmacy like water. You'd just go in and say, "Hey, give me a box of Cytotec." Anyone could buy it.

• 30:17Speaker 03

  The pharmacist 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.

• 30:29Speaker 14

  Look, you're going to expel. When you expel and you're bleeding a lot, go to the hospital.

• 30:38Speaker 03

  Ar went home and took the pills.

• 30:40Speaker 14

  The contractions started, and I had some bleeding.

• 30:45Speaker 03

  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, Ar denied that she had done anything to cause an abortion. And this time, Ar says she didn't have to stay in the hospital. She had a DNC and left.

• 31:17Speaker 03

  Her parents never found out about it. Ar went on with her life. She moved in with her sister, who supported her going to school. Me formei assistente social.

• 31:27Speaker 12

  I graduated as a social worker.

• 31:30Speaker 03

  The two experiences were very difficult for Ar, but one thing was clear.

• 31:34Speaker 12

  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.

• 31:56Speaker 05

  Still, she wishes she'd had more support. Because Ar and women like her, who took CytoTech 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.

• 32:13Speaker 03

  In fact, if you remember, the instructions said, "Don't take this pill if you're pregnant."

• 32:18Speaker 05

  In 1993, researchers from a public university in the country published a study called "CytoTech 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 Ar didn't take the right dose to have a complete abortion.

• 32:38Speaker 03

  But over time, Brazilian women again figured out something by themselves.

• 32:44Speaker 12

  One of the interesting things that I noted in my research is that women got much better at using CytoTech.

• 32:51Speaker 03

  This is Sarah Costa again, the researcher in Rio de Janeiro. While she conducted the study in the early 90s, several years after CytoTech became available, she heard about how women were taking the pills.

• 33:04Speaker 12

  Put them under your tongue or insert them in your vagina.

• 33:08Speaker 03

  Eventually, they started getting better results.

• 33:10Speaker 12

  At the beginning, I would say that a lot of women needed curatage, but it turned out, once they got better at using it, they were actually having complete abortions.

• 33:22Speaker 03

  In other words, they no longer needed a DNC. How long was your data collection period?

• 33:29Speaker 12

  I think it was about six to nine months.

• 33:31Speaker 05

  Fast, it's fast.

• 33:33Speaker 12

  Yeah. So, you know, we were able to observe change.

• 33:38Speaker 05

  Of the women who went to a hospital after having an abortion, Sarah found that nearly 60% reported using CytoTech to self-manage it. She wrote that this represented, quote, "only the tip of the iceberg." Because many more women could have taken CytoTech and not needed medical help.

• 33:57Speaker 05

  According to her 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.

• 34:09Speaker 03

  And how were they getting this information? Sarah found that the overwhelming majority of women who used CytoTech, 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.

• 34:33Speaker 13

  Women know how to be scientists at home when science is not offering what they need.

• 34:41Speaker 05

  This is Devra Denise again, the Brazilian anthropologist and law professor, who remembers the skull on the CytoTech box.

• 34:48Speaker 13

  So basically, it's about observation. It's about taking experiments in our own bodies. And it's about sharing with others.

• 34:58Speaker 05

  She calls it domestic science. And she saw the results of this domestic science for herself. By the time she learned about CytoTech, it was no big deal.

• 35:08Speaker 13

  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."

• 35:20Speaker 05

  Her classmate got the pills through a family member. And they worked.

• 35:24Speaker 13

  Can you believe that the day after she was in school?

• 35:30Speaker 03

  I'm wondering why you think CytoTech became so popular so quickly?

• 35:36Speaker 13

  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.

• 35:57Speaker 03

  And it was cheap.

• 35:59Speaker 13

  Very cheap.

• 36:01Speaker 03

  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, CytoTech sales exploded. Researchers tracked that in the late 80s and early 90s, more than 50,000 boxes of the pill were being sold in Brazil every month.

• 36:28Speaker 05

  Actually, there are more reasons women chose CytoTech. In that same report from 1993, "CytoTech 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.

• 36:47Speaker 03

  Since it wasn't a procedure requiring a doctor's expertise, it didn't exactly feel like an abortion to some of these women.

• 36:54Speaker 14

  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.

• 37:04Speaker 05

  As a result, some women described feeling less guilty taking the pill.

• 37:09Speaker 03

  If I had gone to a clinic, I would never have forgiven myself. And women felt it put them, not their partners or doctors, in control.

• 37:20Speaker 15

  Using CytoTech 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.

• 37:36Speaker 05

  Women who wanted abortions weren't the only ones who appreciated CytoTech. 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 Paulo told the researchers that he'd seen hysterectomies drop from two a week to one every six months.

• 37:58Speaker 03

  When we asked Rivaldo, the OB-GYN in Recife, how he remembers feeling at the time, he used one word.

• 38:06Speaker 10

  Alivio.

• 38:07Speaker 03

  Relief.

• 38:08Speaker 10

  Alivio de cabeza, de consciencia.

• 38:10Speaker 03

  Relief of mind and of conscience.

• 38:14Speaker 10

  Sempre fiquei muito feliz.

• 38:15Speaker 11

  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.

• 38:40Speaker 05

  Rivaldo told us that feminists and health providers coined a nickname for CytoTech.

• 38:45Speaker 10

  A gente chamava de São Toteque. São de santo. São Toteque.

• 38:52Speaker 05

  They called it SaintoTech.

• 39:05Speaker 03

  CytoTech, SaintoTech, it has many names. You might know it as misoprostol, aka miso, like the soup.

• 39:14Speaker 05

  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.

• 39:31Speaker 03

  Later in the series, we follow the network as it spreads this pill across Latin America.

• 39:38Speaker 05

  I was like, what? No way. And into the US.

• 39:43Speaker 06

  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.

• 39:52Speaker 03

  Up next, women create an entirely new support system around miso.

• 40:02Speaker 03

  That challenges the medical establishment and the law.

• 40:05Speaker 09

  Alguien iba a hacer. Someone was going to do what we didn't dare to because we had a license and we were afraid of the law. Miedo a la ley.

• 40:29Speaker 05

  If you want to hear the rest of the series right now, before everyone else, go sign up for Embedded Plus. Embedded is the home for ambitious storytelling at NPR, and signing up for Embedded Plus 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.

• 40:52Speaker 03

  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 Wendell. Reina Cohen edited the series. Additional reporting by Abby Wendell. Fact checking by Cecile Davis-Vasquez, Nicolette Kahn, and Giovanna Romano-Sánchez. Robert Rodriguez mastered the episode.

• 41:18Speaker 05

  Voiceovers by Mariana de la Barba, Julia Carneiro, Marcelo Storobinas, and Susie Valerio. Leanna Simstrom is our supervising senior producer. Katie Simon is our supervising senior editor. Irene Noguchi is our executive producer. And Colin Campbell is the senior vice president for podcasting at NPR. The Embedded team also includes Luis Strelles, Dan Germa, Adelina Lencienis, and Ariana Garibli. From Latino USA, our executive producers are Marlon Bishop and Penilei Ramirez. And our production managers are Jessica Ellis and Nancy Trujillo.

• 41:57Speaker 03

  Thanks to our managing editor of standards and practices, Tony Kevin, and to Johannes Dergi and Micah Ratner for legal support, and Tommy Evans, NPR's managing editor, editorial review. Our visuals editor is Emily Bogel. Original tile art by Luke Medina.

• 42:14Speaker 05

  Special thanks to Alyssa Natworny, Selena Simmons-Duffin, Mariana de la Barba, Maria Mapta Bruno, Julia Carneiro, Roberta Fortuna, Dina Ortega, Kelly Blanchard, Maureen Paul, Lourdes Rivera, Abigail Aiken, Giselle Carino, Dee Redwine, and Jefferson Trezett. And a big thanks to our Embedded Plus supporters.

• 42:39Speaker 03

  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.

• 42:57Speaker 05

  I'm Victoria Estrada.

• 42:58Speaker 03

  This is Embedded from NPR.

• 43:00Speaker 05

  Thanks for listening.

• 43:01Speaker 03

  Muchas gracias por escuchar.

• 43:09Speaker 00

  Stay tuned for the following announcements and messages from our sponsors.