The Network: Saint-o-tec

Summary

Embedded: The Network – Saint-o-tec

Release Date: June 5, 2025
Host/Author: NPR
Description: NPR's home for audio documentaries brings untold stories to light through deeply reported narrative series. This episode explores the global movement supporting self-managed abortions, focusing on the development and dissemination of the abortion pill Cytotec.

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1. The Fall of Roe v. Wade and Immediate Aftermath

The episode begins with the historic overturning of Roe v. Wade, marking the most significant change to abortion rights in the United States in nearly half a century. Hosts Victoria Estrada and Marta Martinez describe the emotional and societal impact of this decision.

Victoria Estrada (01:13): "It was one of those moments when people understand they're witnessing history. They remember where they were."

Marta Martinez (01:33): "They remember where they were when Roe v. Wade fell."

Following the Supreme Court's decision, 13 states swiftly enacted bans or severe restrictions on abortion, eventually affecting nearly half of all states. This led to the closure of numerous clinics and forced many women to travel long distances to obtain abortions.

Victoria Estrada (02:28): "The day after the fall of ROE, 13 states immediately banned or severely limited abortion."

Opposition to the ruling led to widespread anxiety among abortion rights supporters, who feared a regression to the early 1900s in terms of women's reproductive rights.

Victoria Estrada (02:10): "This is an emergency. This is an extreme crisis. People will die."

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2. Introduction to The Network: Saint-o-tec

Amidst the chaos, not all were panicking. A decentralized group, referred to as "The Network," emerged, dedicated to expanding abortion access through unconventional means. This network operates without formal organization, spanning across borders and connecting diverse individuals—from midwives and nurses to grandmothers and friends.

Victoria Estrada (03:37): "This network, it's hard to even describe because it's not formal or centralized."

Marta Martinez (03:32): "I'm actually energized."

The Network's primary method involves empowering women to self-manage their abortions safely, without the direct involvement of medical professionals.

3. The Birth of Cytotec: A Safe Abortion Pill

The narrative shifts to Brazil in the late 1980s, where Cytotec (misoprostol), initially developed to treat gastric ulcers, inadvertently became a revolutionary tool for safe abortions. Despite the FDA's slow approval, Cytotec was available in Europe and Brazil by 1986.

Victoria Estrada (22:22): "In 1973, the same year that Roe v. Wade was decided in the United States, something else happened that transformed reproductive healthcare..."

Cytotec's side effects—inducing contractions and causing miscarriages—made it a viable option for women seeking to terminate pregnancies discreetly and safely.

Dr. Rivaldo Albuquerque (03:02): "It was a lifesaver. In so many ways, it's the equivalent to the discovery of penicillin because it's a before and after."

4. Personal Stories: Women Navigating Abortion Access

The episode shares the poignant story of a woman referred to as R., who navigated two abortions under vastly different circumstances. Her first abortion in her early teens involved unsafe methods, leading to severe health complications and the loss of a fellow patient.

Dr. Rivaldo Albuquerque (14:16): "They are in a situation of suffering, of vulnerability. Their health and their life are at risk."

Her second abortion, facilitated by Cytotec, was markedly safer and more controlled, highlighting the transformative impact of the pill.

Unnamed Woman (25:28): "The Second time I didn't have a lot of side effects. I felt more comfortable."

5. Medical Community's Response and Transformation

Dr. Rivaldo Albuquerque, an obstetrician-gynecologist in Recife, recounts the drastic reduction in maternal mortality and abortion-related complications following the introduction of Cytotec. Initially skeptical, he observed a significant decline in severe cases as women became more adept at using the pill.

Dr. Rivaldo Albuquerque (21:01): "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."

The medical community's reception was mixed; while some doctors witnessed the positive outcomes, others remained hostile, even involving law enforcement to punish women seeking abortions.

Dr. Rivaldo Albuquerque (16:38): "Women who had tried to have an abortion were the last ones to be treated during our shift."

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6. The Spread of Cytotec and Formation of a Support Network

As knowledge of Cytotec spread through word-of-mouth among women, a robust support network formed. Women shared information on how to use the pill effectively, transforming self-managed abortion from a risky endeavor into a safer, more reliable option.

Deborah Diniz (35:12): "Women know how to be scientists at home, when science is not offering what they need."

Sales of Cytotec skyrocketed, with over 50,000 boxes sold monthly in Brazil during the late 80s and early 90s. Its affordability and accessibility made it a preferred choice over traditional clinic-based abortions.

Deborah Diniz (36:15): "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."

7. The Legacy and Global Impact of Saint-o-tec

Cytotec, known by various names such as Saintotec, has become the most commonly used abortion pill globally. The World Health Organization endorses its safety for self-managed abortions up to 12 weeks of pregnancy. The Network continues to expand, spreading knowledge and support across Latin America and into the United States, despite legal challenges.

Victoria Estrada (39:44): "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."

The episode concludes by highlighting the ongoing efforts of The Network to support women, challenge medical and legal barriers, and ensure safe reproductive healthcare worldwide.

Jacqueline Pitangui (40:46): "Someone was going to do what we didn't dare to because we had a license and we were afraid of the law."

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8. Production and Acknowledgments

The episode was produced in collaboration with Latino USA and supported by various foundations and contributors dedicated to reproductive health and justice in the Americas.

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Conclusion:
"The Network: Saint-o-tec" delves deep into the grassroots movement that transformed abortion access through the dissemination of Cytotec. By sharing personal stories and expert insights, the episode underscores the resilience and ingenuity of women navigating restrictive reproductive laws, highlighting the critical role of community-driven solutions in safeguarding reproductive rights.

Transcript

[Kelly McEvers]

Support for this podcast and the following message come from Allianz Travel Insurance. You're so excited to finally make it to Ireland, but the stomach bug you caught in Dublin wasn't exactly on your bucket list. Benefits like emergency medical coverage can have your back. Learn [e-mail] hey, I'm Kelly McEvers, and.

[Unnamed NPR Host]

This is embedded from NPR. We've got a new series. It's about one of the biggest political and social issues in the United States right now, abortion. But this isn't a story about the abortion debate, whether abortion is right or wrong, whether it should be legal or illegal. It's about a set of people on one side of the issue who are operating regardless of what the law says about abortion. These people are part of a global movement that's had a major impact on how women have abortions. And the hosts, Victoria Estrada and Marta Martinez are going to take us all over the Americas to follow this movement. They're journalists for Latino usa. That's a public radio show produced by Futuro Media, and we partnered with them to make this series. Okay, here's Victoria and Marta.

[Victoria Estrada]

It was one of those moments when people understand they're witnessing history. They remember where they were. I was standing at my standing desk in my house waiting, and I just started crying at my desk. It was totally surreal.

[Marta Martinez]

They remember where they were when Roe v. Wade fell.

[Victoria Estrada]

The biggest change to abortion rights in the United States in nearly half a century is here.

[Marta Martinez]

The Supreme Court had made its decision.

[Victoria Estrada]

A ruling that ends the constitutional right to an abortion. While abortion rights opponents celebrated the news that Roe had been overturned. We will abolish abortion. Many abortion rights supporters feared the US was going backwards. Back to, like, the 1900s. Like, what are they going to take from us next?

[Marta Martinez]

Back to a more dangerous time.

[Victoria Estrada]

This is an emergency. This is an extreme crisis. People will die.

[Marta Martinez]

Across the country, protesters gathered on the steps of the supreme court in Washington, D.C. abortion saves lives, holding images of coat hangers over their heads.

[Victoria Estrada]

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. 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. You don't care if people die. You don't care if people die.

[Marta Martinez]

But not all abortion rights supporters felt this way.

[Kelly McEvers]

Everybody was so calm and in the network.

[Marta Martinez]

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. Everybody was like, we've been doing this work.

[Kelly McEvers]

We're going to continue doing this work.

[Victoria Estrada]

Nothing is changing.

[Kelly McEvers]

Who cares?

[Marta Martinez]

I'm actually energized.

[Victoria Estrada]

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

[Marta Martinez]

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

[Victoria Estrada]

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.

[Marta Martinez]

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

[Victoria Estrada]

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

[Kelly McEvers]

Been monumental, extraordinarily important.

[Victoria Estrada]

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

[Marta Martinez]

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.

[Unnamed NPR Sponsor Voice]

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

[Victoria Estrada]

A long dormant federal law prohibits the mailing of any supplies used for abortions.

[Kelly McEvers]

Possession could be punishable by up to five years in prison.

[Victoria Estrada]

From NPR's Embedded and Futuro Media's Latino USA, this is the Network, a series.

[Marta Martinez]

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

[Victoria Estrada]

Episode 1 Saintotech we'll be right back.

[Unnamed NPR Sponsor Voice]

This message comes from NPR sponsor Rocket Money. Those daily coffee habits and streaming subscriptions can add up fast. Rocket Money helps you spot spending patterns so you can do something about them and keep more money in your pocket. Rocket Money is a personal finance app that helps find and cancel your unwanted subscriptions, monitors your spending, and helps lower your bills so you can grow your savings money, cancel your unwanted subscriptions and reach your financial goals faster with Rocket Money. Go to RocketMoney.com embedded today. This message comes from Redfin. With the Redfin app, you'll know the moment your next place hits the market. Whether you're looking to buy your dream home or rent a sweet apartment. Give Redfin your gotta have it wish list of property features and you'll receive real time notifications tailored just for you. Ready to see it up close and personal. Scheduling a tour is just a tap away. Don't wait to find your perfect match. Download the Redfin app and start searching today.

[Kelly McEvers]

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[Marta Martinez]

Victoria I'm Victoria Estrada.

[Victoria Estrada]

And I'm Marta Martinez. We're both producers at the public radio show Latino usa. We've been covering reproductive rights in the Americas for years now and when we.

[Marta Martinez]

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 but.

[Victoria Estrada]

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.

[Marta Martinez]

But nearly 40 years ago in Latin America, women developed an abortion method that was medically safe and and effective. No doctor needed. And this new type of self managed abortion transformed how abortions happen across the world today.

[Victoria Estrada]

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 Pitangui. Hi Jacqueline. Jacqueline is a longtime feminist advocate. How was your day? And she lived through Brazil's military dictatorship, which lasted for more than two decades. When the dictatorship fell in 1985, she fought to get women's rights into Brazil's new constitution because women at the time had so little say in their workplaces, marriages or over their bodies.

[Jacqueline Pitangui]

So here in front you have the Christmas.

[Victoria Estrada]

Oh, it's right here.

[Jacqueline Pitangui]

Right here.

[Victoria Estrada]

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.

[Marta Martinez]

Say hello.

[Jacqueline Pitangui]

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

[Victoria Estrada]

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.

[Jacqueline Pitangui]

Yeah, everywhere.

[Victoria Estrada]

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

[Jacqueline Pitangui]

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

[Victoria Estrada]

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.

[Marta Martinez]

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.

[Victoria Estrada]

This lack of knowledge had serious consequences.

[Jacqueline Pitangui]

The significant, let's call punishment. It was on women's bodies, death or morbidity.

[Marta Martinez]

Okay, could you just count to 10?

[Victoria Estrada]

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

[Dr. Rivaldo Albuquerque]

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

[Marta Martinez]

This is Dr. Rivaldo Albuquerque.

[Dr. Rivaldo Albuquerque]

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

[Marta Martinez]

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.

[Victoria Estrada]

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.

[Dr. Rivaldo Albuquerque]

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

[Marta Martinez]

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.

[Victoria Estrada]

Others just tried to self manage their abortion. We heard about lots of ways. Herbs, teas or drinks.

[Unnamed Woman (R)]

Concession of foreign objects.

[Marta Martinez]

The rods of an umbrella, needles.

[Victoria Estrada]

And whatever medicines they could buy at the pharmacy.

[Unnamed Woman (R)]

You know all those horror stories that you read about.

[Victoria Estrada]

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

[Marta Martinez]

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.

[Dr. Rivaldo Albuquerque]

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.

[Marta Martinez]

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

[Dr. Rivaldo Albuquerque]

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

[Marta Martinez]

Rivaldo still remembers it.

[Dr. Rivaldo Albuquerque]

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.

[Marta Martinez]

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.

[Dr. Rivaldo Albuquerque]

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

[Victoria Estrada]

Pu quiera negra y pu?

[Unnamed Woman (R)]

Quiera pobre.

[Marta Martinez]

Rivaldo told us he really felt for these women.

[Dr. Rivaldo Albuquerque]

They are in a situation of suffering, of vulnerability. Their health and their life are at risk. I know these women, many are Christians, evangelical, Catholic, but they're going through a specific moment in their life. They're in need.

[Victoria Estrada]

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

[Dr. Rivaldo Albuquerque]

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

[Victoria Estrada]

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

[Dr. Rivaldo Albuquerque]

They spend 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.

[Victoria Estrada]

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.

[Dr. Rivaldo Albuquerque]

And the women cried out because of the pain of their suffering. Unfortunately, I heard medical staff say, when you did 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.

[Marta Martinez]

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.

[Victoria Estrada]

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

[Dr. Rivaldo Albuquerque]

And the police would come all the way to the hospital and handcuff the women. They would chain them to the beds. Women were arrested.

[Victoria Estrada]

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

[Dr. Rivaldo Albuquerque]

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

[Marta Martinez]

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

[Dr. Rivaldo Albuquerque]

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

[Marta Martinez]

And around the year 1987, he noticed.

[Victoria Estrada]

A change, a big change.

[Dr. Rivaldo Albuquerque]

Severe cases of infection, severe cases of hemorrhage. They disappeared.

[Victoria Estrada]

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

[Dr. Rivaldo Albuquerque]

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

[Marta Martinez]

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

[Unnamed Woman (R)]

We were seeing this incredible decline in fertility.

[Victoria Estrada]

Suddenly, women were having fewer children. But why?

[Marta Martinez]

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

[Unnamed Woman (R)]

The government wasn't providing much information about.

[Victoria Estrada]

How to control fertility, and abortion was still illegal. So something just wasn't adding up.

[Unnamed Woman (R)]

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

[Victoria Estrada]

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

[Unnamed Woman (R)]

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

[Victoria Estrada]

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.

[Unnamed Woman (R)]

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

[Victoria Estrada]

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

[Unnamed Woman (R)]

It was a bit of a surprise.

[Marta Martinez]

In Recife, Rivaldo had noticed a similar pattern.

[Dr. Rivaldo Albuquerque]

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.

[Marta Martinez]

Fewer complications from abortion meant one thing.

[Dr. Rivaldo Albuquerque]

Women stopped dying.

[Victoria Estrada]

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.

[Dr. Rivaldo Albuquerque]

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

[Marta Martinez]

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

[Kelly McEvers]

Support for NPR's Climate Solutions Week Rethinking Home comes from the Nature Conservancy. People from all walks of life depend on nature for the food they eat, the water they drink and the air they breathe for strengthening their communities, powering their livelihoods and safeguarding their health. Nature is common ground for everyone, and uniting to protect nature can help solve today's challenges and create a thriving tomorrow for future generations. Discover [e-mail] NPR support for this podcast and the following message come from Made in Cookware President and co founder Jake Kalik shares a tool that's useful for both master and newbie griller.

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[Kelly McEvers]

Learn more about Made in Cookware at M a d e I-ncookware.com In 1973.

[Victoria Estrada]

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 Serle developed a new drug to treat gastric ulcers. Kinda like Tums or Pepto Bismol or Milk of Magnesia. It was a small white hexagon shaped pill with a tiny figure of a stomach etched on one side, not a belly. The actual organization, it's actually the stomach that makes me remember this pill.

[Marta Martinez]

It's called Cytotec, and even though it.

[Victoria Estrada]

Was created by an American pharmaceutical company, the Food and Drug Administration was slow to approve it Several years before being available in the U.S. cytotec first made its way to Europe and then Brazil in 1986.

[Marta Martinez]

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.

[Victoria Estrada]

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

[Jacqueline Pitangui]

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.

[Marta Martinez]

Dr. Rivaldo Albuquerque remembers the fine print.

[Dr. Rivaldo Albuquerque]

More specifically, 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.

[Victoria Estrada]

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

[Deborah Diniz]

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

[Victoria Estrada]

There was a skull.

[Deborah Diniz]

There was a skull.

[Victoria Estrada]

Wow.

[Deborah Diniz]

I'm hundred percent sure of that.

[Victoria Estrada]

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.

[Marta Martinez]

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

[Victoria Estrada]

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

[Marta Martinez]

But for people who were pregnant and did not want to be, Cytotec's side effect wasn't a problem, it was a solution. A new tool to self manage an abortion. But unlike the teas and crochet needles women had been using, Cytotec was overwhelmingly safe and effective.

[Victoria Estrada]

And somebody somewhere, somehow figured that out.

[Unnamed Woman (R)]

I don't think we ever identified where it started.

[Jacqueline Pitangui]

No, it's impossible to know this.

[Unnamed Woman (R)]

Don't forget we didn't have social media then.

[Jacqueline Pitangui]

There's no records.

[Marta Martinez]

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

[Jacqueline Pitangui]

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

[Victoria Estrada]

Some speculate that it was a pharmacist or a midwife.

[Unnamed Woman (R)]

We certainly knew that pharmacies were involved.

[Jacqueline Pitangui]

I went to the pharmacy and I bought this.

[Marta Martinez]

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

[Unnamed Woman (R)]

The women themselves, women said, ha.

[Deborah Diniz]

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

[Jacqueline Pitangui]

Brazilian women.

[Deborah Diniz]

Women continued taking it because it was another woman from her family who shared with her.

[Unnamed Woman (R)]

It certainly wasn't advertised, was in the air.

[Jacqueline Pitangui]

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

[Unnamed Woman (R)]

Was spreading by word of mouth.

[Victoria Estrada]

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.

[Unnamed Woman (R)]

A woman who went through the process would tell another, hey, buy dad, buy that.

[Victoria Estrada]

The whispers about Cytotec reached R in 1986, the same year it came on the market in Brazil. And she thought it sounded a lot better than the first abortion she had been through. The type of dangerous abortion Rivaldo had seen time and time again in the emergency room in the early 80s.

[Marta Martinez]

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.

[Unnamed Woman (R)]

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

[Marta Martinez]

R was one of 12 kids.

[Unnamed Woman (R)]

We didn't have the talk about what sex was. I just knew that I was going to get kissed. I didn't know that thing was going to create a child. So I didn't know that a partner shouldn't cross certain boundaries.

[Marta Martinez]

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

[Unnamed Woman (R)]

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.

[Marta Martinez]

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.

[Unnamed Woman (R)]

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

[Marta Martinez]

So it was dangerous for R to stay pregnant. But it was also risky to get an abortion, both physically and legally. R's sister took her to a midwife and R remembers the midwife inserted a catheter into her cervix to induce an abortion. When she returned to her parents house, she had very heavy bleeding and then passed out.

[Unnamed Woman (R)]

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.

[Marta Martinez]

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.

[Unnamed Woman (R)]

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?

[Marta Martinez]

R. 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. R stayed in the hospital for several days to recover in a maternity room with other women who'd attempted an abortion.

[Unnamed Woman (R)]

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

[Marta Martinez]

Died. I asked why.

[Unnamed Woman (R)]

Yes, I had a coretage right then. I was fine. But the one next to me, she never came back.

[Victoria Estrada]

A few years later, when R. Was 19 years old, she got pregnant a second time. She says a guy she had seen just a couple of times forced himself on her. R Decided to have another abortion, but this time it was a very different experience. Because of Cytotecastritni.

[Unnamed Woman (R)]

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

[Victoria Estrada]

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.

[Unnamed Woman (R)]

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

[Victoria Estrada]

I went home and took the pills.

[Unnamed Woman (R)]

The contraction started and I had some bleeding.

[Victoria Estrada]

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 the doctors again questioned her. And again R denied that she had done anything to cause an abortion. And this time, R Says she didn't have to stay in the hospital. She had a DNC and left. Her parents never found out about it. R Went on with her life. She moved in with her sister, who supported her going to school.

[Unnamed Woman (R)]

I graduated as a social worker.

[Victoria Estrada]

The two experiences were very difficult for R. But one thing was clear.

[Unnamed Woman (R)]

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.

[Marta Martinez]

Still, she wishes she'd had more support because R and women like her who took Side Attack 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.

[Victoria Estrada]

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

[Marta Martinez]

In 1993, researchers from a public university in the country published a study called Side Attack in Brazil. At least it doesn't kill in it. Most women reported taking between four and 16 pills, but some reported taking dozens of. It's likely that R didn't take the right dose to have a complete abortion.

[Victoria Estrada]

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

[Unnamed Woman (R)]

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

[Victoria Estrada]

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

[Unnamed Woman (R)]

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

[Victoria Estrada]

Eventually they started getting better results.

[Unnamed Woman (R)]

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

[Victoria Estrada]

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

[Unnamed Woman (R)]

I think it was about six to nine months.

[Marta Martinez]

Fast.

[Unnamed Woman (R)]

It's fast, yeah. So you know, we were able to observe change.

[Marta Martinez]

Of the women who went to a hospital after having an abortion, Sarah found that nearly 60% reported using Cytotec to self manage it. She wrote that this represented, quote, only the tip of the iceberg because many more women could have taken Cytotec and not needed medical help. According to our research, the median dose the women were taking was 800 micrograms, four pills, which is the same dose the World Health Organization now recommends for pregnancies up to 12 weeks.

[Victoria Estrada]

And how were they getting this information? Sarah found that the overwhelming majority of women who used Cytotec, 84% had learned about it from friends, relatives or colleagues. It was the network starting to form. Women loosely connected by whispers. Just by sharing their experiences. What worked and what didn't work, they began to build knowledge.

[Deborah Diniz]

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

[Marta Martinez]

This is Deborah Deniseigen, the Brazilian anthropologist and law professor who remembers the skull on the cytotac box.

[Deborah Diniz]

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

[Marta Martinez]

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

[Deborah Diniz]

So I was at school in the 80s when I saw for the first time a classmate with the pills telling us, I'm going to take them today.

[Marta Martinez]

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

[Deborah Diniz]

Can you believe that? The day after she was in school.

[Victoria Estrada]

I'm wondering why you think Citotek became so popular so quickly.

[Deborah Diniz]

Let me try. Five reasons. One, it was discovered by women. It was shared from woman to woman. It proved to work and to be safe. It was used for an essential need to women's lives. And it was available at the community level.

[Victoria Estrada]

And it was cheap, very cheap. Pharmacists in Brazil told us they sold it for about five bucks in the early 90s, compared to $500 for an abortion at a private clinic at the time Cytotec sales exploded. Researchers track that in the late 80s and early 90s, more than 50,000 boxes of the pill were being sold in Brazil every month.

[Marta Martinez]

Actually, there are more reasons women chose Cytotec. In that Same report from 1993, Cytotec in Brazil, at least it doesn't kill. The researchers interviewed women who had used it. In their testimonies, they described lots of reasons for liking it. We had voice actors read some of their quotes aloud.

[Victoria Estrada]

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

[Unnamed Woman (R)]

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.

[Marta Martinez]

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

[Victoria Estrada]

If I have gone to a clinic, I would never have forgiven myself. And women felt it put them, not their partners or doctors, in control. Using Cytotec is something that is yours. Nobody has to know what you did.

[Kelly McEvers]

Or you didn't do.

[Victoria Estrada]

No one invades your privacy. Even the gynecologists I went to later didn't know that I had had an abortion.

[Marta Martinez]

Women who wanted abortions weren't the only ones who appreciated side attack. 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 from two a week to one every six months.

[Victoria Estrada]

When we asked Rivaldo the obgyn Recife how he remembers feeling at the time he used one I leave you relief, relief of mind and of conscience.

[Dr. Rivaldo Albuquerque]

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.

[Marta Martinez]

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

[Victoria Estrada]

Santotechi San di Santo Santo Techi.

[Marta Martinez]

They called it Saintotec.

[Victoria Estrada]

Cytotec Saintotech. It has many names. You might know it as misoprosto, AKA miso, like the soup or maiso.

[Marta Martinez]

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.

[Victoria Estrada]

Later in the series we follow the network as it spreads this pill across Latin America. I was like, what? No way.

[Marta Martinez]

And into the U.S. 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 up.

[Victoria Estrada]

Next, women create an entirely new support system around Miso Holer Feminita Holer feminita that challenges the medical establishment and the law.

[Jacqueline Pitangui]

Someone was going to do what we didn't dare to because we had a license and we were afraid of the law.

[Marta Martinez]

If you want to hear the rest of the series right now, before 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.

[Victoria Estrada]

The network from Embedded is a collaboration with Latinousa, a production of Futuro Media. This episode was produced by Monica Morales Garcia and Abby Wendell. Raina Cohen edited the series. Additional reporting by Abby Wendell. Fact checking by Cecile Davis Vasquez, Nicolette Kahn and Giovanna Romano Sanchez. Robert Rodriguez mastered the episode voiceovers by.

[Marta Martinez]

Mariana de la Varva, Julia Carneiro, Marcelo Starobinas and and Susi Valerio. Liana 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 Treyes, Dan Girma, Adelina Lanciannis and Ariana Garab Lee from Latino usa. Our executive producers are Marlon Bishop and Peniley Ramirez and our production managers are Jessica Ellis and Nancy Trujillo.

[Victoria Estrada]

Thanks to our Managing Editor of Standards and Practices, Toni Kevin, and to Johannes Durgi and Micah Radner for legal support and Tommy Evans, NPR's managing editor. Editorial Review Our Visuals Editor is Emily Bogle. Original tile art by Luke Medina.

[Marta Martinez]

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 Drezt. And a big thanks to our Embedded plus supporters.

[Victoria Estrada]

Funding for this series provided in part by the Levi Strauss foundation, outfitting movements and leaders fighting for a more just and abandoned 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.

[Marta Martinez]

I'm Victoria Estrada.

[Victoria Estrada]

This is Embedded from npr.

[Marta Martinez]

Thanks for listening.

[Victoria Estrada]

Muchas gracias for Es Cuchar.

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