In Brazil, it’s the ‘loneliest feeling’
After abortion ban, women sought pills from drug traffickers
RIO DE JANEIRO — Last November, Xaiana, a 23-year-old college student in northern Brazil, began exchanging text messages with a drug dealer in the south of the country. Following the dealer’s instructions, she transferred $285, her living expenses for several months. Then, she waited three agonizing weeks for the arrival in the mail of a blister pack of eight unmarked white pills.
When she took them, they had the effect she was hoping for: She underwent a medication abortion at home with her boyfriend, ending an eight-week pregnancy.
But Xaiana kept bleeding for weeks, an unusual but not rare complication. “It was like a murder scene every time I had a shower,” she said.
She was afraid to get help because it is illegal for a woman in Brazil to use the drug, misoprostol, to trigger an abortion. If she went to a clinic, she feared, the staff might figure out she had induced the abortion and report her. The penalty for having an abortion in Brazil is up to three years in jail.
“It’s the loneliest feeling I’ve ever felt in my life,” she said, asking to be identified only by her first name out of fear of prosecution.
After seven weeks, she went to a women’s clinic and admitted to having terminated a pregnancy. She was given a simple cauterization, and no one reported her.
Proponents of abortion rights in the United States have suggested that a postRoe America would differ in a key way from the era before abortion was legalized nationally. Women seeking abortions today have the option of a medical termination, using hormone pills to trigger the body to expel the fetus in private, a practice approved by the Food and Drug Administration.
But the wave of state trigger laws that have begun to take effect after the Supreme Court’s ruling overturning Roe last month bars all abortion, including medication abortions. To get the pills legally, women will have to travel to states where it is allowed for a medical consultation, even if it is by video or phone, as required by the FDA.
The trajectory of access to abortion pills in Brazil may offer insight into how medication abortion can become out of reach and what can happen when it does.
While surgical abortion was the original target of Brazil’s abortion ban, the proscription expanded after medication abortion became more common, leading to the situation today in which drug traffickers control most access to the pills. Women who procure them have no guarantee of the safety or authenticity of what they are taking, and if they have complications, they fear seeking help.
Today, black market misoprostol, brought in from India, Mexico and Argentina, is sold for anywhere from about $200 to $400 for the eight tablets recommended for an abortion, compared with less than $15 for a 60-pill bottle in the United States.
“You buy it from a dealer. You don’t know what it is. The whole process is made frightening. It’s secret. It’s not a medicine anymore,” said Maira Marques, who is the director of campaigns for an abortion access advocacy organization called Milhas pelas Vidas das Mulheres. “This is supposed to be the straightforward, less complicated way to have an abortion, but now, instead, it’s buying contraband.”
The drug was sold in pharmacies without a prescription until 1991, and then it was regulated to require a prescription, although the rules were lax.
The availability of the pills sharply reduced the number of women turning up in hospitals with the life-threatening infections or hemorrhages from abortions they had tried to induce with castor root or bleach or coat hangers, said Dr. Ana Teresa Derraik, an OB-GYN in Rio.
But misoprostol was becoming a focus of attention for anti-abortion campaigners in Brazil and beyond.
In 1998, Brazil’s health regulatory agency, ANVISA, included misoprostol on the list of controlled drugs, alongside opiates, which meant a prison sentence of up to 15 years for anyone caught importing or buying it. International pharmaceutical companies that made misoprostol were hit with boycotts and stopped producing it; a small domestic company took over manufacturing a generic version of the drug to sell only to the Ministry of Health for hospital use.
In 2006, the law prohibiting misoprostol distribution was strengthened to ban selling or publishing information about the drug on the internet.
When Jair Bolsonaro was elected Brazil’s president in 2018, with the enthusiastic support of Brazil’s fast-growing evangelical Christian community, access to abortion pills became even more scarce.
New guidelines issued by the Ministry of Health last month include the assertion that “inducing abortion by telemedicine, using drugs from the special control list, can cause irreversible damage to the woman.”
Dr. Helena Paro, a gynecologist in the city of Uberlandia who introduced telemedicine consultations for legal abortion patients during the COVID-19 pandemic, called the guideline “completely ideological and contrary to the scientific evidence.” The World Health Organization considers the practice safe.