The pill of choice by Letícia Bahia

misoprostolThe positive result of her pregnancy test fell heavy on Ana’s shoulders, a 28 year old Brazilian woman. Her job as a maid could barely feed her 3 children. Her husband was unemployed and had been coping with alcohol. Desperate, she seeked help from her neighbour, Maria. Years before Ana learned that Maria had also been pregnant, and ironically, Ana participated in the gossip of those who judged Maria by the mysterious disappearance of her pregnancy. Maria smiled at her semi-condescendingly; she had lived this same experience before. “There’s a way,” she said, “and you don’t need a doctor”. She told Ana what some other Maria had told her two years ago: she just had to buy some pills at the drugstore – “6 or 8 will do” – to settle the stomach. “It will hurt a bit”, she warned, “but it will work.”

This is one possible scene among the many that must have taken place in Brazil in the late 80’s. Thanks to the country’s Anas’ and Marias’, safer abortion during this time (and until the medical community caught on to what was happening) was widespread due these pills. By word of mouth, common Brazilian women with no medical degree and who would probably refute the “feminist” identity, discovered the safest method to terminate a pregnancy at home.

The story begins in 1986 when Brazil approved the marketing of a drug for ulcers commonly known as Misoprostol or Cytotec (Cytotec is the more common name in Brazil). On the label it read that the drug should not be used by pregnant women as it could cause miscarriages. Nevertheless – or precisely because of this detail – the Anas’ and Marias’ of Brazil desperately seeking to end an unwanted pregnancies began using the drug, and it worked. The rumours about the drug spread at light speed. It was not social media or the medical community, but rather the intelligence of Brazilian women and their need for safe abortion that was responsible for the rapid growth in sales of the Pfizer drug until the first half of 1991, when the Ministry of Health imposed drastic restrictions on its sales.

The use of Cytotec as an abortion drug was so widespread such that in 1990 about 70% of women hospitalized for abortion had reported using the drug (due to the nonexistent knowledge on how to properly use Cytotec to induce a safe abortion, most women would take the drug and automatically go to the hospital). After seeing many of these cases, the medical community finally caught on to what was happening in Brazil and began studying Cytotec’s properties. Today, Cytotec is on the World Health Organization’s Essential Medicines List as a safe abortion drug. Abortion with pills has very low risks and mortality rates are lower than that of live births. It’s also very effective, especially when combined with Mifepristone, another abortion drug that is on the WHO’s Essential Medicine List as well.

With the restrictions imposed by the Brazilian government, a black market was born. Although illegal, the demand for abortion did not disappear. A survey conducted by Dr. Mario Monteiro, a specialist in Public Health, had shown that in 2013 about 700,000 women had abortions in Brazil.

With the clandestine sale of Cytotec, Brazilian women who need abortion pills are forced to find them in the black market. Abortion pills are out there, but there is no way to know if they are reliable, placebos, the right amount, quality, etc. The other options are doctors who perform the procedure, usually by (D&C) curettage, an outdated abortion method, and charge a fortune due to the legal risks and having to bribe police. These abortions are not always safe and sometimes women looking for doctors can end up finding a police officer instead.

Concerned about the alarming numbers of unsafe abortions that take place each year  and injuries and mortality rates because of them, some international organizations work to make sure Cytotec gets into the hands of those in need. One of them, safe2choose, operates in countries such as Africa and Latin America, including Brazil. Through the safe2choose website, women can do an online consultation to determine whether they are candidates to use the abortion pills. If so, the woman receives the pills through the mail and can have a safe abortion in the privacy of their own home.

Brazilian women were directly responsible for discovering that Cytotec could be used to provoke a safe abortion. When the State failed to recognize their reproductive rights, they took matters into their own hands. They took a risk, kept having abortions, and disseminated information about these pills to women all over Brazil. These women, from the ground up, paved the way for so many women all around the world to have control over their reproductive health, especially those living in countries where their reproductive rights are not respected or protected. They are proof that when women face an unwanted pregnancy they will find a way to have an abortion, even if that means risking their health and their lives. The real question is how much longer will this safe option be illegal in Brazil, and other parts of the world as well.

*This piece was first published here.