Embedded: The Network

Summary

Throughline Podcast Summary: "Embedded: The Network"

Podcast Information

• Title: Throughline
• Host/Author: NPR
• Episode: Embedded: The Network
• Release Date: July 29, 2025
• Description: Throughline serves as a time machine, delving beyond current events to explore historical moments that have shaped our world. Hosted by Rund Abdelfattah and Ramtin Arablouei, the podcast weaves stories and sound to transport listeners to pivotal times in history.

---

Introduction: The Ripple Effect of Roe v. Wade Overturn

[00:21] Rund Abdelfattah:
Three years ago, when the Supreme Court overturned Roe v. Wade, it sparked widespread celebration among abortion opponents. However, for abortion rights supporters, this decision signaled a looming threat to women’s health and autonomy, raising fears that the lack of legal access would drive women towards unsafe abortion methods.

[00:39] Ramtin Arablouei:
Despite the restrictive ruling, a diverse and resilient network—including activists, midwives, grandmothers, and friends—had been expanding abortion access through unconventional means since the 1980s. This network was poised to respond effectively to the changing legal landscape.

The Birth of the Network: Lessons from Brazil

[01:11] Ramtin Arablouei:
The episode traces its origins to Brazil in the late 1980s, where women developed a safe, self-managed abortion method without the need for a doctor. This innovation has significantly influenced abortion access both in Latin America and the United States.

[01:23] Rund Abdelfattah:
Today’s episode, the first in a three-part series titled "The Network," is a collaboration between NPR's Embedded podcast and Futuro Media. Hosts Victoria Estrada and Marta Martinez explore the global movement that has enabled millions of women to safely self-manage abortions at home.

Challenges Post-Roe and Initial Responses

[01:29] Marta Martinez:
Following the fall of Roe v. Wade, 13 states swiftly imposed bans or severe restrictions on abortion. Within a month, nearly half of all states had enacted such measures, leading to the closure of numerous clinics. This forced many American women to travel extensive distances for abortion services.

[07:11] Victoria Estrada:
Victoria Estrada and Marta Martinez, producers at Latino USA, highlight that abortion bans do not eliminate abortions but instead push women towards more dangerous methods. This historical context set the stage for the emergence of safer, self-managed abortion practices.

Cytotec: A Game-Changer in Reproductive Health

[22:40] Marta Martinez:
In 1973, the American pharmaceutical company Serle developed Cytotec (misoprostol), initially intended to treat gastric ulcers. Although delayed in US approval, Cytotec found its way to Europe and then Brazil by 1986.

[24:05] Deborah Deniz:
Deborah Deniz, a Brazilian anthropologist, recalls that Cytotec came with warnings against use during pregnancy due to its ability to induce contractions and cause miscarriage. However, this very property made it a potent tool for self-managed abortions.

[25:29] Victoria Estrada:
Cytotec offered a safer alternative to the risky and often fatal abortion methods previously used. Unlike traditional methods involving herbs or foreign objects, Cytotec was medically effective and became widely adopted despite its illegal status.

Personal Stories: R’s Journey Through Abortion

[27:13] Marta Martinez:
The episode delves into R’s personal experiences with abortion in Recife, Brazil. As a minor facing unwanted pregnancy, R initially underwent a dangerous procedure with a midwife that resulted in severe complications.

[30:09] Victoria Estrada:
R’s second abortion experience was dramatically different thanks to Cytotec. Accessible through pharmacies, the process was more controlled and less traumatic, allowing her to maintain her privacy and avoid legal repercussions.

[32:55] Victoria Estrada:
R emphasizes the importance of community support and the lack thereof during her first abortion, highlighting the risks women faced when navigating these procedures alone.

The Impact of Cytotec on Maternal Health

[20:11] Marta Martinez:
From 1986 to 1991, Brazil saw a 21% drop in maternal mortality rates, as tracked by the World Health Organization. Dr. Rivaldo Albuquerque attributes this decline to the widespread use of Cytotec and the subsequent decrease in unsafe abortions.

[34:36] Victoria Estrada:
Sara Costa’s research in the early 90s revealed that approximately 60% of women presenting with abortion-related issues had used Cytotec. The median dose was 800 micrograms, aligning with the World Health Organization’s recommendations for safe abortion up to 12 weeks of pregnancy.

[35:32] Jacqueline Pitangui:
Jacqueline Pitangui, a feminist advocate, points out that Cytotec’s success was due to five key factors: discovery and dissemination by women, proven effectiveness and safety, essential necessity, community-level availability, and affordability.

The Spread and Evolution of the Network

[36:34] Jacqueline Pitangui:
Jacqueline identifies five reasons for Cytotec’s rapid adoption: it was a women-driven discovery, shared through personal networks, safety and efficacy, essential need for women, and its affordability compared to traditional clinic abortions.

[40:14] Marta Martinez:
Cytotec, also known as misoprostol or Santotec, has become the most widely used abortion pill globally. The World Health Organization endorses its safety for self-managed abortions within the first 12 weeks of pregnancy.

[39:13] Dr. Rivaldo Albuquerque:
Dr. Rivaldo expresses relief and happiness at seeing fewer women suffer from unsafe abortions, acknowledging that the network effectively stepped in where medical institutions struggled to provide safe options.

Conclusion: Building a Global Movement

[40:30] Marta Martinez:
The series continues to explore how the network expanded beyond Brazil, influencing reproductive health practices across Latin America and into the United States. Women developed new support systems around Cytotec, challenging existing medical and legal frameworks.

[40:51] Marta Martinez:
The narrative underscores the resilience and ingenuity of women in creating safe, accessible abortion methods, fostering a global movement that continues to adapt and thrive despite legal challenges.

---

Notable Quotes

• Marta Martinez [01:51]: "Are you scared?"
• Dr. Rivaldo Albuquerque [14:20]: "Why did this woman die? I can tell you without hesitation, because she was black and because she was poor."
• Jacqueline Pitangui [35:46]: "Women know how to be scientists at home when science is not offering what they need."
• Anonymous Woman [37:52]: "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."

Key Takeaways

• Adaptation and Resilience: In response to restrictive abortion laws, networks of women innovatively developed safe, self-managed abortion methods, significantly reducing maternal mortality.

• Cytotec’s Role: The introduction and dissemination of Cytotec (misoprostol) revolutionized abortion access by providing a safe, effective, and affordable option that could be self-administered.

• Global Influence: The Brazilian model of self-managed abortion has influenced global practices, particularly in regions with stringent abortion laws, including parts of the United States.

• Community Support: The success of the network relied heavily on word-of-mouth dissemination, communal support, and the collective resilience of women facing reproductive challenges.

Conclusion

"Embedded: The Network" offers a compelling exploration of how a grassroots movement in Brazil pioneered self-managed abortion methods, reshaping reproductive health access worldwide. Through personal narratives, expert insights, and historical analysis, the episode underscores the enduring impact of women's solidarity and innovation in the face of legal and societal constraints.

Transcript

[Amazon One Medical]

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[Rund Abdelfattah]

I'm Rund Abdelfattah.

[Ramtin Arablouei]

And I'm Ramtin Arablouei.

[Rund Abdelfattah]

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.

[Ramtin Arablouei]

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.

[Rund Abdelfattah]

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.

[Ramtin Arablouei]

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.

[Rund Abdelfattah]

Here's Marta.

[Marta Martinez]

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?

[Amazon One Medical]

I am scared, and I think a.

[Marta Martinez]

Lot of us are, because there's nowhere else in medicine that is policed and regulated and now criminalized to such a.

[Amazon One Medical]

Degree you don't care if people die.

[Dr. Rivaldo Albuquerque]

You don't care if people die.

[Victoria Estrada]

But not all abortion rights supporters felt this way.

[Amazon One Medical]

Everybody was so calm in the network.

[Victoria Estrada]

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.

[Amazon One Medical]

Everybody was like, we've been doing this work. We're going to continue doing this work.

[Victoria Estrada]

Nothing is changing.

[Amazon One Medical]

Who cares?

[Victoria Estrada]

I'm actually energized.

[Marta Martinez]

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

[Victoria Estrada]

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

[Marta Martinez]

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.

[Victoria Estrada]

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

[Marta Martinez]

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

[Amazon One Medical]

Been monumental, extraordinarily important.

[Marta Martinez]

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

[Victoria Estrada]

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.

[Ramtin Arablouei]

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

[Rund Abdelfattah]

Federal law prohibits the mailing of any supplies used for abortions.

[Jacqueline Pitangui]

Possession could be punishable by up to.

[Amazon One Medical]

Five years in prison.

[Marta Martinez]

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

[Victoria Estrada]

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

[Marta Martinez]

Episode 1 Saintotech we'll be right back.

[Ramtin Arablouei]

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[Marta Martinez]

Victoria.

[Victoria Estrada]

I'm Victoria Estrada.

[Marta Martinez]

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.

[Victoria Estrada]

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 but.

[Marta Martinez]

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.

[Victoria Estrada]

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.

[Marta Martinez]

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.

[Deborah Deniz]

So here in front, you have the Christmas. Oh, it's right here, right here.

[Marta Martinez]

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.

[Victoria Estrada]

Say hello.

[Deborah Deniz]

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

[Marta Martinez]

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.

[Deborah Deniz]

Yeah, everywhere, everywhere.

[Marta Martinez]

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

[Deborah Deniz]

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

[Marta Martinez]

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.

[Victoria Estrada]

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.

[Marta Martinez]

This lack of knowledge had serious consequences.

[Deborah Deniz]

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

[Victoria Estrada]

Okay, could you just count to 10?

[Marta Martinez]

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.

[Victoria Estrada]

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.

[Victoria Estrada]

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.

[Marta Martinez]

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 using sterilized material.

[Victoria Estrada]

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.

[Marta Martinez]

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

[Sara Costa]

Incessant of foreign objects.

[Victoria Estrada]

The rods of an umbrella, needles.

[Marta Martinez]

And whatever medicines they could buy at the pharmacy.

[Sara Costa]

You know all those horror stories that you read about?

[Marta Martinez]

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

[Victoria Estrada]

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.

[Victoria Estrada]

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 open the abdominal cavity, we. We found a uterus that smelled, pardon the word, rotten.

[Victoria Estrada]

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.

[Victoria Estrada]

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.

[Anonymous Woman]

Pu quiera negra y pu quiera pobre.

[Victoria Estrada]

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

[Marta Martinez]

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.

[Marta Martinez]

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 are being punished because they were the last ones to be taken care of.

[Marta Martinez]

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 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.

[Victoria Estrada]

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.

[Marta Martinez]

Some doctors went even further than insulting the women. In some cases, they called 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 bed. Women were arrested.

[Marta Martinez]

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.

[Victoria Estrada]

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.

[Victoria Estrada]

And around the year 1987, he noticed.

[Marta Martinez]

A change, a big change.

[Dr. Rivaldo Albuquerque]

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

[Marta Martinez]

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.

[Victoria Estrada]

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.

[Sara Costa]

We were seeing this incredible decline in fertility.

[Marta Martinez]

Suddenly, women were having fewer children. But why?

[Victoria Estrada]

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

[Sara Costa]

The government wasn't providing much information about.

[Marta Martinez]

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

[Sara Costa]

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

[Marta Martinez]

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

[Sara Costa]

Conducted those interviews over a period of several months and analyzed the results.

[Marta Martinez]

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.

[Sara Costa]

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.

[Marta Martinez]

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

[Sara Costa]

It was a bit of a surprise.

[Victoria Estrada]

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.

[Victoria Estrada]

Fewer complications from abortion meant one thing.

[Dr. Rivaldo Albuquerque]

Women stopped dying.

[Marta Martinez]

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.

[Victoria Estrada]

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

[Ramtin Arablouei]

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[Amazon One Medical]

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[Marta Martinez]

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 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.

[Victoria Estrada]

Not a belly. The actual organ.

[Marta Martinez]

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

[Victoria Estrada]

It's called Cytotec.

[Marta Martinez]

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 U.S. cytotec first made its way to Europe and then Brazil in 1986.

[Victoria Estrada]

And here is 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.

[Marta Martinez]

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

[Deborah Deniz]

It's that little paper that comes with the medicine that says you should avoid to take it if you are pregnant because it could cause contractions.

[Victoria Estrada]

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.

[Marta Martinez]

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

[Jacqueline Pitangui]

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

[Marta Martinez]

There was a skull.

[Jacqueline Pitangui]

There was a skull.

[Marta Martinez]

Wow.

[Jacqueline Pitangui]

I'm 100% sure of that.

[Marta Martinez]

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.

[Victoria Estrada]

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.

[Marta Martinez]

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

[Victoria Estrada]

But for people who were pregnant and did not want to be, cytotic'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, Cettitec was overwhelmingly safe and effective.

[Marta Martinez]

And somebody somewhere, somehow figured that out.

[Sara Costa]

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

[Deborah Deniz]

No, it's impossible to know this.

[Sara Costa]

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

[Deborah Deniz]

There's no records.

[Victoria Estrada]

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

[Deborah Deniz]

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

[Marta Martinez]

Some speculate that it was A pharmacist or a midwife.

[Sara Costa]

We certainly knew that pharmacies were involved.

[Deborah Deniz]

I went to the pharmacy and I bought this.

[Victoria Estrada]

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

[Sara Costa]

The women themselves, women said, ha.

[Jacqueline Pitangui]

I have no question of saying that.

[Deborah Deniz]

It was from women, Brazilian women.

[Jacqueline Pitangui]

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

[Sara Costa]

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

[Deborah Deniz]

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

[Anonymous Woman]

Spreading by word of mouth.

[Marta Martinez]

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.

[Anonymous Woman]

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

[Marta Martinez]

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.

[Victoria Estrada]

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.

[Anonymous Woman]

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

[Victoria Estrada]

R was one of 12 kids.

[Anonymous Woman]

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.

[Victoria Estrada]

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

[Anonymous Woman]

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.

[Victoria Estrada]

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'd nearly done just that a few years earlier to R's sister.

[Anonymous Woman]

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

[Victoria Estrada]

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

[Anonymous Woman]

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.

[Victoria Estrada]

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.

[Anonymous Woman]

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?

[Victoria Estrada]

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.

[Anonymous Woman]

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

[Victoria Estrada]

Died. I asked why.

[Anonymous Woman]

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

[Marta Martinez]

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 Cytotec, Era Prada Gastriti.

[Anonymous Woman]

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

[Marta Martinez]

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.

[Anonymous Woman]

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

[Marta Martinez]

I went home and took the pills.

[Anonymous Woman]

The contraction started and I had some bleeding.

[Marta Martinez]

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 Art denied that you had done anything to cause an abortion. And this time, Art 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.

[Anonymous Woman]

I graduated as a social worker.

[Marta Martinez]

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

[Anonymous Woman]

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.

[Victoria Estrada]

Still, she wishes she'd had more support because R 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.

[Marta Martinez]

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

[Victoria Estrada]

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

[Marta Martinez]

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

[Sara Costa]

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

[Marta Martinez]

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

[Sara Costa]

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

[Marta Martinez]

Eventually they started getting better results.

[Sara Costa]

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

[Marta Martinez]

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

[Sara Costa]

I think it was about six to nine months.

[Victoria Estrada]

Fast. It's fast, yeah.

[Sara Costa]

So you know, we were able to observe change.

[Victoria Estrada]

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 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.

[Marta Martinez]

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.

[Jacqueline Pitangui]

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

[Victoria Estrada]

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

[Jacqueline Pitangui]

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

[Victoria Estrada]

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.

[Jacqueline Pitangui]

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.

[Victoria Estrada]

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

[Jacqueline Pitangui]

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

[Marta Martinez]

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

[Jacqueline Pitangui]

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.

[Marta Martinez]

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.

[Victoria Estrada]

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.

[Marta Martinez]

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

[Anonymous Woman]

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.

[Victoria Estrada]

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

[Marta Martinez]

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. Using Cytotec 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.

[Victoria Estrada]

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 so Paulo told the researchers that he'd seen hysterectomies drop from two a week to one every six months.

[Marta Martinez]

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

[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.

[Victoria Estrada]

Rivaldo told us that feminists and health providers coined a nickname for side attack. They called it Santotec.

[Marta Martinez]

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

[Victoria Estrada]

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.

[Marta Martinez]

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

[Victoria Estrada]

And into the U.S. oh, there's a.

[Marta Martinez]

Whole group of you and you're all.

[Victoria Estrada]

Like underground and Secret Squirrel and using different names. It was just mind blowing up.

[Marta Martinez]

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

[Anonymous Woman]

Someone was going to do what we.

[Victoria Estrada]

Didn'T dare to because we had a license and we were afraid of the 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 to find out more.

[Marta Martinez]

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. Raina Cohen edited the series. Additional reporting by Abby Wendle Fact checking by Cecile Davis Vasquez, Nicolette Khan and Joanna Romano Sanchez. Robert Rodriguez mastered the episode voiceovers by.

[Victoria Estrada]

Mariana de la Varva, Julia Carneiro, Marcelo Starobinas 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 to Dan Girma, Adelina Lancianis and Ariana Garib Lee from Latino usa. Our executive producers are Marlon Bishop and Peniley Ramirez, and our production managers are Jessica Ellis and Nancy Trujillo.

[Marta Martinez]

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

[Victoria Estrada]

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

[Marta Martinez]

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.

[Victoria Estrada]

I'm Victoria Estrada.

[Marta Martinez]

This is Embedded from npr.

[Victoria Estrada]

Thanks for listening.

[Marta Martinez]

Muchas gracias for Escutar Foreign.

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