Erika Sandoval, who said she had an abortion at home using pills and instructions from Las Libres, in Mexico, Dec. 9, 2021. (Marian Carrasquero/The New York Times ©️ 2021 The New York Times). Photograph:( The New York Times )
Abortion restrictions have been multiplying across the United States for years, including just over Mexico’s border in Texas
Verónica Cruz spent years defying the law in Mexico, helping thousands of women get abortions. Now that Mexico has declared that abortion is no longer a crime, Cruz and activists like her are planning to bring their mission to a country moving in the opposite direction: the United States.
Abortion restrictions have been multiplying across the United States for years, including just over Mexico’s border in Texas. Now the Supreme Court is considering a case that could diminish or completely overrule Roe v. Wade, the 1973 ruling that established a constitutional right to abortion. That would likely set off new restrictions in at least 20 states.
But in much of Latin America, where access to abortion has long been severely limited, highly organized feminist groups have distributed abortion-inducing drugs for years, making it harder for governments to enforce bans on the procedure.
Cruz and other activists are planning to help shuttle Texans and other Americans seeking abortions into Mexico, and to build networks to ferry the abortion pills north of the border or send them by mail — something they’ve already started doing and now plan to expand.
“We aren’t afraid,” Cruz said. “We are willing to face criminalization, because women’s lives matter more than their law.”
The strategy is highly contentious, because it involves foreign activists working directly to undermine U.S. law. It also illustrates what activists on both sides of the abortion debate see as a new frontier of the battle: the government’s ability to control abortion when women can perform them in the privacy of their homes, with pills that are becoming more widely available than ever.
On Thursday, the Food and Drug Administration said that abortion drugs can be delivered by mail, making permanent a measure enacted because of the pandemic and broadening access for women who find it difficult to travel to a provider to end their pregnancies.
But several states ban the delivery of these pills by mail, or still require that the drugs be dispensed by providers in person, on top of other restrictions on their use.
In Texas, a new law bars doctors from providing pills to induce abortions after seven weeks of pregnancy, and adds penalties of jail time and a fine of up to $10,000 for anyone who mails or delivers the medication.
Legal experts say such laws may be challenged after the FDA decision, but for now, these state measures could discourage U.S. doctors from sending pills to parts of the country with restrictive regulations.
“For the first time, Texas does have a way to protect women, through our criminal law, from people bringing dangerous abortion pills,” said Joe Pojman, executive director of the Texas Alliance for Life, an organization that helped craft the measure. “We’ll have to wait to see how well it is enforced in the coming months.”
Anti-abortion groups acknowledge that criminally punishing activists who distribute the pills, especially if they are from Mexico, may prove difficult. They would have to be caught and arrested in Texas, or extradited, experts say.
“This is a really terrible, lawless attack on life,” John Seago, the legislative director for Texas Right to Life, said of the Mexican activists’ plan to help women in Texas get abortions, adding that such efforts would “make it absolutely more difficult to do it, to enforce these laws.”
Dr. Rebecca Gomperts, the leader of Aid Access, an Austria-based group that provides abortion pills to women across the world, confirmed she has been prescribing the medication to women in Texas — who then receive the drugs by mail from a pharmacy in India — even after the state’s law went into effect this month.
The drug misoprostol, originally created to treat stomach ulcers, but which also induces abortions, has upended access to the procedure around the globe by giving women a safe, effective and often cheap method of ending their pregnancies in private.
Taking the drug, either alone or in combination with another called mifepristone, causes what is called a “medication abortion.”
Across Latin America, networks of activists who work on the margins of the legal system deliver the pills to women and walk them through using the medication to end pregnancies.
The groups, often in coordination with allies in the medical community, use a model now known as “accompaniment,” in which they disseminate pills and also provide medical counseling and psychological support to women in a deeply Catholic region where abortions are often shunned and outlawed.
The arrival of misoprostol and mifepristone was “revolutionary,” said Giselle Carino, CEO of Fòs Feminista, an international alliance of health groups. “But it wouldn’t have been so effective in saving women’s lives without the feminist networks of accompaniment and health professionals willing to engage in civil disobedience.”
Cruz, the Mexican activist, helped found an organization called Las Libres, which means “the free ones,” in 2000. She began knocking on gynecologists’ doors in her conservative state of Guanajuato, asking them to provide free abortions to rape victims.
A few years later, one of the doctors she had been working with came back from a conference with some news: There was a pill that could safely cause abortions at home. Misoprostol can be obtained without a prescription in Mexico, and the World Health Organization has a protocol for administering it to perform abortions in the first 12 weeks of pregnancy.
“That’s when I knew we had a solution,” Cruz said. “We didn’t need doctors anymore.”
At the time, the pills were prohibitively expensive. So, Cruz said, she came up with a strategy: A woman who could afford to buy the medication would keep the pills left over after her procedure, then pass the box on to the next woman who needed it, while coaching her through the process.
“And that’s how the first networks were formed, organically,” Cruz said. The goal, she says, was never to just provide abortions. It was to turn every Mexican woman into someone who could help someone else get an abortion.
The handful of employees who work with Las Libres have boxes of the drugs, which they buy or receive as donations, strewn everywhere — in their cars, their homes, even their pockets. Each woman who reaches out to the group is assigned a “companion” to bring her pills and then follow her, through video calls, phone calls or WhatsApp messages, through every step of the abortion.
A recent study of more than 900 people in Nigeria and Argentina, published in The Lancet medical journal, found that accompanying patients as they manage their own abortions is “highly effective and safe.” It led to complete abortions — not requiring follow-up surgical intervention to finish — for 97% of those surveyed. For women living under strict abortion bans, it is also difficult to detect.
Erika Sandoval, 23, said she had an abortion at home this month in Mexico after texting an activist with Cruz’s group. She got the medication from the activist’s brother, followed instructions delivered in a voice memo and finished the process two days later.
“All this from a voice memo,” she said two days after she took her last pill.
Sofía, also 23, said she took the medicine in the house she shares with her parents in Mexico, closing the door of her room while she texted with a woman from Cruz’s group. When she finished, she said, she told her parents she had been feeling ill after eating tacos.
“They made me chicken soup,” she said. Her parents never realized what had happened, and Sofía asked to only be identified by her first name so they wouldn’t find out.
In September, days after Texas began enacting a new ban on abortions after six weeks of pregnancy, Mexico’s Supreme Court ruled that abortion could no longer be treated as a crime. Cruz and her colleagues soon hatched a plan to work with Texas reproductive groups on making it easier for women in the state to end their pregnancies at home.
Dozens of activists are meeting in January to work out the strategy. One of them, Crystal P. Lira, said she has already brought pills from Tijuana to California, and then shipped them to Georgia, Indiana, Massachusetts and Texas.
Cruz said the new Texas laws would not stop them from crossing the border with abortion drugs — even if it means risking jail time.
“If that’s the only way that people will become conscious that what the government is doing is a major violation of human rights,” she said, “then yes.”