Summary of NPR's "Up First" Episode: Getting Abortion Pills Into Women's Hands

Release Date: June 22, 2025

In the June 22, 2025 episode of NPR's "Up First," titled Getting Abortion Pills Into Women's Hands, hosts Aisha Rascoe, along with Marta Martinez and Victoria Estrada, delve deep into the intricate network that facilitates access to abortion pills amid changing legal landscapes in the United States and across the Americas. This comprehensive exploration unpacks the historical roots, current dynamics, and future implications of self-managed abortions using medication, particularly focusing on the drug misoprostol (commercially known as Cytotec).

1. Overturning Roe v. Wade and Its Immediate Aftermath ([00:00] - [03:38])

Aisha Rascoe opens the discussion by marking the three-year anniversary of the Supreme Court's pivotal decision to overturn Roe v. Wade, a landmark case that had previously guaranteed women the constitutional right to abortion. This ruling has led to nearly 40% of U.S. states enacting laws that either ban or further restrict abortion access. Contrary to expectations, abortion rates have risen, with a significant shift towards the use of abortion pills, which now account for approximately two-thirds of all abortions in the U.S. healthcare system.

Notable Quote:

• Aisha Rascoe ([00:26]): "Since that decision, nearly 40% of states have passed laws either banning or further restricting abortion."

2. The Genesis of Self-Managed Abortion with Pills in Brazil ([03:48] - [12:30])

Martinez and Estrada recount their investigative journey beginning in Brazil during the mid-1980s, a period when abortion was largely illegal and maternal mortality rates were alarmingly high due to unsafe abortion practices. They highlight the serendipitous discovery that the stomach ulcer medication Cytotec could induce miscarriages. Women in Brazil, particularly those from impoverished backgrounds, began self-managing their abortions using Cytotec, leading to a dramatic decrease in abortion-related complications and maternal deaths.

Notable Quotes:

• Marta Martinez ([04:11]): "Abortion in Brazil was pretty much illegal, and women were using very unsafe methods."
• R ([08:11]): "The second time, I didn't have a lot of side effects... I felt more comfortable. So the first one almost killed her. The second one, she had a lot less complications."

This grassroots movement, driven by women supporting women, created a "whisper network" that disseminated information and access to Cytotec, drastically improving women's health outcomes in Brazil.

3. Spread Across Latin America and Formation of Support Networks ([12:38] - [14:00])

The success of Cytotec in Brazil catalyzed its adoption across Latin America, where restrictive abortion laws prevailed. Women organized into networks that provided pills, established hotlines for guidance, and offered real-time support during the abortion process. This method, known as acompañamento or accompaniment, not only facilitated safer abortions but also empowered women to take control of their reproductive health despite legal barriers.

Notable Quote:

• Marta Martinez ([12:38]): "Abortion ironically will become more accessible but less legal."

These networks have become the backbone of abortion access in regions where legal avenues are severely limited, demonstrating the resilience and ingenuity of women in safeguarding their health and autonomy.

4. Transition to the United States: Mirroring Brazil’s Approach ([14:51] - [25:27])

With the overturning of Roe v. Wade, the United States began witnessing a surge in self-managed abortions using pills, inspired by the Brazilian model. Martinez and Estrada discuss how, initially, self-managed abortions were rare in the U.S., predominantly among immigrant communities. However, post-Dobbs (the Supreme Court case that overturned Roe), there has been a notable increase in such practices, supported by burgeoning networks offering pills, hotlines, and accompaniment services.

Notable Quotes:

• Marta Martinez ([15:22]): "Activists who had seen self managed abortion and how safe it was... they were trying to tell the Americans about it."
• Aisha Rascoe ([24:22]): "Abortion will become more accessible but less legal."

The hosts highlight how these networks are adapting to the U.S. legal environment, facing both logistical challenges and significant opposition from anti-abortion groups.

5. Medical Community’s Evolving Perspectives ([17:15] - [19:20])

Initially, many U.S. medical professionals were skeptical or outright opposed to self-managed abortions, viewing them as risky compared to clinic-based procedures. However, as evidence from Latin America and other regions demonstrated the safety and efficacy of misoprostol, perspectives began to shift. Notably, some doctors have started to support and even facilitate self-managed abortions, aligning with endorsements from major medical institutions like the World Health Organization and the American College of Obstetricians and Gynecologists.

Notable Quotes:

• Dr. Maya Bass ([17:39]): "I didn't think it was safe. You know, as doctors we're risk averse and we like control."
• Maya Bass ([18:36]): "This means that I can be less scared for people who are doing [self-managed abortions]."

This evolving stance within the medical community underscores a broader recognition of women's autonomy and the practicalities of ensuring safe abortion access under restrictive laws.

6. Legal Challenges and Pushback ([19:40] - [22:06])

Despite the rise in self-managed abortions, anti-abortion legislators have sought to curtail access to abortion pills by criminalizing the distribution and support of these medications. While self-managed abortions themselves remain legal in most states, providing pills or assistance outside a medical framework has increasingly become a target of legal action. Activists within the network employ various strategies to mitigate legal risks, such as using encrypted communication channels and training participants on how to avoid incriminating themselves during medical emergencies.

Notable Quotes:

• Marta Martinez ([19:40]): "State lawmakers have been proposing and sometimes passing laws that restrict access to the pills."
• Marta Martinez ([20:17]): "It's actually a ban on doctors to perform abortions. And that's changing now."

This legal tightening not only disrupts the flow of support but also instills fear among those who facilitate access, complicating the network's efforts to sustain their initiatives.

7. Future Implications and Conclusion ([22:27] - [25:27])

Martinez and Estrada reflect on the broader implications of their findings, drawing parallels between the historical context of Latin America and the contemporary U.S. scenario. They suggest that despite legal restrictions, the ingenuity and solidarity within the network may lead to an increase in accessible, albeit less legally protected, abortion services. This paradoxical outcome—where restrictions inadvertently foster greater access through unregulated channels—poses significant questions about the future landscape of reproductive rights in the U.S.

Notable Quotes:

• Aisha Rascoe ([24:22]): "The irony of this post Dobbs world is that if it goes the way that I think it will... abortion ironically will become more accessible but less legal."
• Dee Redwine: "We saw how self managed abortion with miso spread around the region. And she sees parallels to what's happening in the U.S."

The episode concludes by emphasizing the resilience of women in navigating and overcoming legal and societal barriers, ensuring access to essential reproductive health services through community-driven networks.

Conclusion

"Getting Abortion Pills Into Women's Hands" provides a nuanced and comprehensive examination of how women across the Americas have historically and continue to navigate restrictive abortion laws through self-managed methods. By tracing the origins in Brazil to the current dynamics in the United States, Marta Martinez and Victoria Estrada shed light on the profound impact of grassroots networks in safeguarding reproductive rights. This episode not only highlights the challenges posed by legal restrictions but also celebrates the ingenuity and solidarity that empower women to maintain control over their reproductive health despite adversity.

For those interested in exploring this topic further, the series "The Network" by Futuro Media and Embedded is available on the Embedded podcast feed.