The Network: Saint-o-tec

Dear listener, It's Maria no Josa and before we start, I want to give you a heads up because this is not a regular Latino USA episode. Today representing the first episode of the network, which is a new series that let You Know USA co produced with NPR's Embedded podcast.

Now.

This series is about something that is really relevant in the United States right now, and that is abortion. But it's not the story you might be expecting. Our series follows women across the Americas who discovered a method to have safe abortions without doctors in countries where abortion was pretty much banned, and these women changed how people access abortion not only in their countries but around the world,

It was one of those moments when people understand their witnessing history, they remember where they were.

I was standing at my standing desk in my house, waiting and.

I just started crying at my desk.

It was totally surreal.

They remember where they were when Roe versus Wade fell.

The biggest change to abortion rights in the United States and nearly half a century is here.

The Supreme Court had made its decision.

Ruling that ends the constitutional right to an abortion. While abortion rights opponents celebrated the news that Rowe had been overturned, many abortion rights supporters feared the US was going backwards, back to the nineteen hundred.

It's like, what are they going to take from us next?

Back to a more dangerous time.

This is an emergency, This is an extreme crisis.

People will die across the country.

Protesters gathered on the steps of the Supreme Court in Washington, d c. Holding images of code hangers over their heads right by by.

The day after the fall of Row, thirteen states immediately banned or severely limited abortion. Eventually nearly half of old states did, and within a month of the ruling, dozens of clinics stopped performing abortions, forcing many Americans to trouble hundreds of miles to get one. Other laws targeted abortion providers.

Are you scared?

I am scared, and I think a lot of us are because there's nowhere else in medicine that is policed and regulated and now criminalized to such a degree.

But not all abortion rights supporters felt this way.

Everybody was so calm in the network.

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.

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

Nothing is changing. Who cares.

I'm actually energized.

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

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

This network cross borders and reaches people throughout the world, from South Africa to Mian March 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.

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

But despite being physically tiny, when it comes to reproactive health, doctors researchers and people working in this field say it's been monumental, extraordinarily important.

It's a lifesaver in so many ways.

Is the equivalent to the discovery of penicillin, because it's a before and.

After, 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.

The future of abortion access could be impacted by a new lawsuit just filed by the Attorney General of Texas. Long dormant federal law prohibits the nailing of any supplies used for abortions.

Possession could be punishable by up to five years in prison.

From NPR's Embedded and Futuro Media's Latino Usa, This Is the Network.

A series about the DIY method that tooks safe abortions out of the clinic and the women who made it happen.

Episode one, Santo Tech.

I'm Victoria Estrada.

And I'm Marta Martine. We're both producers at the public radio show Latino USA. We've been covering reproductive rights in the Americas for years now.

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 bands, not so different from what we're seeing now in parts of the US.

But as research from around the world shows, bands 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 code hanger self managing her abortion.

But nearly forty 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 happened across the world today.

It all started in Brazil, where this method was born in the late nineteen eighties. Victoria and I took a trip there last year in twenty twenty four, and one of the people we interviewed was Jacqueline pe Tanki 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 nineteen eighty five, she thought 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.

So here in front.

You have the Christ.

Oh, it's here, right here.

From Jacqueline's falcony 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, like hello and yeah, I say hello, Christ, how are you be good?

Be good, Jesus Christ.

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 resent in this city in a very visual way, because you have the Christ up there in the mountain looking at you all from everywhere.

Yeah, everywhere, everywhere.

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

For the careful of church contraception has always been a key issue.

Until the eighties, many Brazilian women didn't have great access to birth control before then. In the Burhish region of the country, women had an average almost six children.

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.

This lack of knowledge had serious consequences.

Significant let's call punishment. It was on women's bodies, death or morbidity.

Okay, could you just count to ten whom doyce.

In the nineteen eighties, Brazil's maternal mortality rate was higher than most of the rest of the world.

UVV my, do we see you in Mohel?

I lived through a time when women got sick and died, died of infection, died of bleeding, young women, extremely young women.

This is doctor Rivaldo Albuquerque so medicotetra.

I am a gynecologist, I am a practicing Catholic and I have been working with women's health since I was a medical student.

I 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 nineteen eighty five, 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 a r with complications from a lack of prenatal care, like chronically high blood pressure, and also complications from abortion.

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 one and four million abortions happening in the country every year.

I spasushkity on.

People who had the money could look for doctors who did abortions in clinics in hospitals with every safety precaution, using sterilized materials.

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.

Others just tried to self manage their abortion.

We heard about lots of ways, herbs, teas or drinks, shahs beb in, session of foreign objects, the rods of an umbrella, needles, and whatever medicines they could buy at the pharmacy.

You know all the horror stories that you read about.

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

Rivaldo told us about a specific case that has stayed with him. It was a patient who was only a few years younger, and he was at the time.

Romomili Diziandois Feelius.

She was a nineteen 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.

Rivaldo and the other doctors suspected she had an unsafe abortion, and so they decided to do an exploratory operation.

So that we could evaluate the abdomen what was happening with this infection. And when we opened the abdominal cavity, we found the uterus that smelled part of the word rotten.

Rivaldo still remembers it.

A terrible smell with several perforations. It was a classic picture of an unsafe abortion. Since it's an illegal procedure. The women must have stayed home for a few days or didn't receive proper medication.

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.

Why did this woman die? I can't tell you without hesitation. Because she was black and because she was poor.

Poqueraigre Rivaldo told us he really felt for these women.

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.

But Rivaldo was an exception. Many doctors did not treat these patients well.

Women who had tried to have an abortion were the last ones to be treated during our shifts.

So these women they would be in the emergency room all day long without food or anything to drink.

They spent 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.

He remembers that some doctors wouldn't give the women enough anesthesia before their diletion and curtash or DNC, so the women would feel the pain of their cervix being dilated and the walls of their urs being scraped.

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.

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.

Some doctors went even further than insulting the women. In some cases they called the police.

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.

Rivaldo says his hospital never let this happen, but he knew it happened elsewhere.

The standard for these women.

So these are things that I will never forget some causes.

At the end of the shift, Rivaldo would make notes about his patients, who lived, who died.

How many birds, how many sea sections, how many surgeries, how many abortions, how many infected abortions.

And around the year nineteen eighty seven, he noticed a change, a big change.

Severe cases of infections, severe cases of hemorrhage.

They disappeared.

Women were still coming into the er, but they were showing up with new symptoms, much less serious, ones.

Like an increasing body temperature hyperthermia. And it didn't make sense because you couldn't find an infections condition. Some women also had astro intestinal symptoms. We realized that there was something different, and this made us a little confused.

So the show took Kofuzu.

Around the same time, a researcher named Sara Costa was working for Brazil's School of Public Health in Rio de Janeiro, more than a thousand miles south from Recife, and she noticed another big change.

We were seeing this incredible decline in fertility.

Suddenly women were having fewer children but.

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

The government wasn't providing much information about how to control fertility, and the borshin was still illegal. So something just wasn't adding up. Was its spontaneous use of oral contraception. How were they getting it?

So in the early nineties, Sarah began talking directly to the women and we conducted.

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

She and her team interviewed more than eight hundred 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.

We thought we would actually discover a lot more complications, serious complications, but most of the women went into hospital with bleeding, had a cure tage and left left.

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

It was a bit of a surprise.

In Recife, Rivaldo had noticed a similar pattern.

We had a downward curve.

Downward curve in abortion completion, and then there was a moment when you almost didn't see any complications of abortion at all.

Praticamuniting now via complicate.

Fewer complications from abortion meant one thing.

Women stopped dying.

Or at least far fewer were dying. From nineteen eighty six to nineteen ninety one, the time Sarah and Rivaldo were observing, the World Health Organization recorded a twenty one percent drop in Brazil's maternal mortality rate.

It seemed like magic, or a better word, familiari.

A miracle, the cause of what Rivaldo calls a miracle. After the break.

In nineteen seventy three, the same year that Wade was decided in the United States, something else happened that transformed reproactive healthcare, but in a much more roundabout way. An American pharmaceutical company called CERL developed a new drug to gastric ulcers, kind of like TOMS or pepto bismo or milk of magnesia. It was a small, white hexagon shaped bill with a tiny figure of a stomach edged on one side.

Not a belly, the actual organ.

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

It's called Cytotech 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 US. Cideattech first made its way to Europe and then Brazil in nineteen eighty six.

And here's where it's hard to know what is fact and what is part of the myth of side attech, because in Brazil this ulcer pill took on a new life for starters. We know that the original side attack box came with a warning, but because it's been forty years, people remember that warning differently.

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

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

Doctor Rivaldo Albuquerque remembers the fine priner more specifically, there was.

A very clear paragraph that said that it should not be usually in pregnant women because it could cause uterinin contractions and lead to miscarriage.

Debra Denis, a Brazilian anthropologist and law professor who grew up in the eighties remembers the warning as an image on the box.

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

With call there was a skull.

There was his call.

Wow.

I'm one hundred percent sure of that.

We haven't been able to confirm this call, but we have seen the image of a pregnant woman in a circle with a slash through it.

When the pharma company developed Cida Tech, it discovered that the drug had the significant side effect on women, a serious side effect. It caused bleeding and contractions that could induce a miscarriage.

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

But for people who were pregnant and did not want to be SATEA Tech'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, set Attack was overwhelmingly safe and effective.

And somebody somewhere, somehow figured that out.

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

No, it's impossible to know this. Don't forget. We didn't have social media. Then there's no records.

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

They wouldn't give their name.

I am Mary Smith, and listen, you can use this to induce an abortion.

Some speculate that it was a pharmacist or a midwife.

We certainly knew that pharmacists were involved.

I went to the pharmacy and I bought this.

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

The women themselves.

Women said hah, I have no question and of saying that it was from women, Brazilian women. Women continue taking it because it was another woman from her family.

Who shared with her. It certainly wasn't advertised.

Was in the air.

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

I mean it was in the air.

Sayra was spreading by word of mouth.

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. Process.

A woman who went through the process would tell another hey by that by that.

The whispers about side attack reached Dart in nineteen eighty six, 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 eighties.

The first time ar needed an abortion, she was a minor, thirteen or fourteen years old, living in Pacific. She was dating someone a lot older than her and ars even though she was in a relationship, she understood almost nothing about sex or her body because of how she grew up.

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

Our was one of twelve kids.

What did you cons I had us on sex so well.

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 the thing was going to create a child, so I didn't know that a partner shouldn't cross certain boundaries.

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

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.

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 nearly done just that a few years earlier.

To our sister, Eileen Lavish, he once took out his gun and tried to kill my sister, the same sister who helped me. Because my sister lost her virginity.

So it was dangerous for ar to stay pregnant, but it was also risky to get an abortion, both physically and legally. Our sister took her to a midwife, and our 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.

Okay, Daddy, 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.

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. Ar kept denying she had, even when they threatened her with jail.

Is he no? 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 Ur was given a DNC to complete her abortion. The doctors told her she 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.

All of them had done something, and the one next to me.

She died, died. I asked why, Yes.

I had a curatage right then I was fine, but the one next to me, she never came back.

A few years later, when I was nineteen years old, she got pregnant a second time.

She says.

The guy she had seen just a couple of times forced himself on her. I decided to have another abortion, but this time it was a very different experience because of cytotech aparash trity.

It was for gastritis. So they sold it at the pharmacy. Like water, you just go in and say, hey, give me a box of cyitotech. Anyone could buy it.

The pharmacy 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.

Oh, look, you were going to expel. When you expel, when you're bleeding a lot, go to the hospital.

I went home and took the pills.

So the contraction started and I had some leading, 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 same. The doctors again questioned her and again are denied that she had done anything to cause an abortion, and this time arsas she didn't have to stay in the hospital. She had a DNC and left. Her parents never found

To school in form so I graduated as a social worker.

The two experiences were very difficult for r but one thing was clear.

The second time, 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 Festal.

Still, she wishes she'd had more support because r and women like her who took side attech 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.

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

In nineteen ninety three, researchers from a public university in the country published a study called side Attack in Brazil at Least it doesn't kill. In it, most women reported taking between four and sixteen pills, but some reported taking dozens. It's likely that ar didn't take the right dose to have a complete abortion.

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

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

This is Sarah Costa again, the researcher in Rio de Janeiro. While she conducted the study in the early nineties, several years after cytotech became available, she heard about how women were taking the bills, put.

The manto your tongue or in set the menual vagina.

Eventually they started getting better results.

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

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

I think it was about.

Six to nine months.

First it's fast.

Yeah, so you know, we were able to observe change.

Of the women who went to a hospital after having an abortion, Sarah found that nearly sixty percent reported using Sida tech to self manage it. She wrote that this represented quote only the tip of the iceberg, because many more women could have taken side attech and not needed

And how are they getting this information? Sarah found that the overwhelming majority of women who used Sido tech eighty four percent 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.

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

This is Devorah Denis Agan, the Brazilian anthropologist law professor who remembers the skull on the side attack box.

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

She calls it domestic science, and she saw the results of this domestic science for herself. By the time she learned about side attack, it was no good deal.

So I was at school in the eighties when I saw for the first time a classmate with the pills, telling us I'm going to take them today.

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

Can you believe that the day after she was in school.

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

Let me try five reasons. One, it was discovered by women, It was shared from women to women. It proved to walk and to be safe. It was used for an essential need to women's lives, and it was available at the community level, and it was cheap, very cheap.

Pharmacists in Brazil told us they sold it for about five bucks in the early nineties, compared to five hundred dollars for an abortion at a private clinic. At the time, cide Attech sales exploded. Researchers tracked that in the late eighties and early nineties, more than fifty thousand boxes of the pill were being sold in Brazil every month.

Actually, there are more reasons women chose cide attack. In that same report from nineteen ninety three, CEDA Tech 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.

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

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.

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

If I have gone to a clinic, I would never have forgiven myself, and women felt it put them, not their partners or doctors in control.

Using side attack is something that is yours. Nobody has to know what you did or you didn't do. No one invades your privacy. Even the gynecologists that I went to later didn't know that I had had an abortion.

Women who wanted abortions weren't the only ones who appreciated side attack. 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 sel Paulo told the researchers that he seemed hasterectomsdropped from two a week to one every six months.

When we asked Rivaldo the Ovigian receive how he remembers feeling at the time, he used one word.

I'll leave you relief. I leave the.

Relief of mind and of conscience, simpme.

We to peel it.

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.

Rivaldo told us that feminists and health providers coined the nickname.

For some attack ashin Shamavady, Santo Techi, Sondy, Santo Santo Techi.

They called it Santo.

Tech, cyto tech, Santa tech. It has many names. You might know it as miso prosto aka miso like the soup or misto.

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 twelve weeks of pregnancy.

Later in the series, we follow the network as it spreads this pill across Latin America.

I was like, what, no way, and into the US. Oh, there's a whole of you, and you're all like underground and secret squirrel and using different names.

It was just mind blowing.

Up.

Next, women create an entirely new support system around me. So that challenges the medical establishment and the law al e sib.

Someone was going to do what we didn't dare to because we had a license and we were afraid of the law.

If you want to hear the rest of the series right now before everyone else, go sign up for Embedded Plus. Embedded is a home for ambitious storytelling at MPR, 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 dot NPR dot org slash embedded to find out more.

The network from Embedded is a collaboration with Latino Usa, a production of Futuro Media. This episode was produced by Monica Moreles Garcia and Abby Wendel. Re Rena Cohen edited the series. Additional reporting by Abby Wendel, fact checking by Cecil Davis Basquez, nicolet Kahn, and Johanna Romano Sanchez. Robert Rodriguez mastered the episode.

Voice overs by Mariana de la Varva, Julia Carneo, Marcellos Darobinaz, and Susi Valerio. Leanna Simpstrom is our supervising Senior producer, Katie Simon is our supervising senior editor, Irena Gucci is our executive producer, and Colin Campbell is the Senior Vice President for Podcasting at MPR. The Embedded team also includes Luis Trejes, Dan Germa, Adelina Lancianie and Ariana Garablee from

Thanks to our managing editor of Standards and Practices, Tony Kevin, and Tojohannes Urghi and Michael Ratner for legal support and Tommy Evans, MPR's managing editor Editorial Review. Our visuals editor is Emily Bogol. Original tail art by Luke Medina.

Special thanks to Alissa nat Warney, Selina Simons, Steffen, Mariana de la Barba, Maria Matta Bruno, Julia Carno, Roberta Fortuna, Dina Ortega, Kelly Blanchard, Maureen Paul Lure, Rivera, Abigail Aiken, Gisell, carinod red Wine and Jefferson Drest And a big thanks to our embedded plus supporters.

I'm Marta MARTINEV.

I'm Victoria Strada.

This is embedded from MPR.

Thanks for listening.

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