FILES-US-VOTE-JUSTICE-HEALTH-ABORTION-FLORIDA

Contributor

The Washington Post

States where abortion is legal, banned or under threat

Florida abortion clinic

Trump Polish President Andrzej Duda

Florida Abortion Election 2024

For The Washington Post

Speaker of the Arizona state House Ben Toma speaks to the news media after Republicans blocked the procedural vote to fast-track a repeal of the 1864 abortion ban

The U.S. Supreme Court Hears Arguments in Case Over Emergency Abortion Care in Washington, DC


Pregnant women visit doctor as Arizona eyes enforcing 1864 abortion law, Phoenix, USA - 12 Apr 2024

US-VOTE-POLITICS-KENNEDY JR.

Kari Lake in West Palm Beach supporting former president Donald Trump.

a Phoenix abortion clinic responds to the abortion ban the state's supreme court reinstated

for The Washington Post

Abortion-Iowa

Oklahoma Abortion Pills 

ABORTIONPILLS

Follow section front redirects in Spectrum

Enable NLP source in PCS for load testing

Switch off the News Alerts Survey Widget when we have enough responses

Poll to determine if new LUF updates are available

Allows the winning A/B test variant to be turned on without Spectrum deployment

Show infinite scrolling sections in Assembler MultiView

Show option for NLP article summaries in Action Bar

A general feature flag for Recipe Features that aren't yet released

Feature flag for media team features that aren't yet released

Use new Orca video player for preroll plugin in Spectrum

Show the snow tracker (instead of the heat tracker) on Spectrum

See more coverage in your recommendations

Get the weekly Campaign Moment newsletter

Set alerts for major election developments

Election 2024

The Campaign Moment newsletter

Politics alerts

Monica had never used Reddit before. But sitting at her desk one afternoon in July — at least 10 weeks into an unwanted pregnancy in a state that had banned <a href="https://www.washingtonpost.com/abortion/" target="_blank" class="contextual_link">abortion</a> — she didn’t know where else to turn.

“I need advice I am not prepared to have a child,” the 25-year-old wrote from her office, once everyone else had left for the day. She titled her post, “PLEASE HELP!!!!!!!!”

Within hours, she got a private message from an anonymous Reddit user. If Monica sent her address, the person promised, they would mail abortion pills “asap for free.”

Monica didn’t know it at the time, but her Reddit post connected her to a new facet of the battle for abortion access: the rise of a covert, international network delivering tens of thousands of abortion pills in the wake of the Supreme Court ruling in June that struck down Roe v. Wade.

Obtained by The Washington Post

The emerging network — fueled by the widespread availability of medication abortion — has made the illegal abortions of today simpler and safer than those of the pre-Roe era, remembered for its back alleys and coat hangers. Distinct from services that sell pills to patients on the internet, a growing army of community-based distributors is reaching pregnant women through word of mouth or social media to supply pills for free — though typically without the safeguards of medical oversight.

“You’re truly [an] angel,” Monica wrote in a string of messages reviewed by The Washington Post. “I think tonight will be the first night i will actually be able to sleep.”

This account of the illegal abortion movement that has grown quickly since the Supreme Court ruling is based on interviews with 16 people with firsthand knowledge of the operation, and includes on-the-ground reporting in four U.S. cities and Mexico. Many who spoke to The Post did so on the condition of anonymity to discuss activity that potentially breaks multiple laws, such as practicing medicine without a license and providing abortions in states where the procedure is banned. The Post was permitted to observe distributors handling pills in antiabortion states on the added condition that their locations not be identified.

Abortion is now banned in these states. See where laws have changed.

Those interviewed described a pipeline that typically begins in Mexico, where activist suppliers funded largely by private donors secure pills for free as in-kind donations or from international pharmacies for as little as $1.50 a dose. U.S. volunteers then receive the pills through the mail — often relying on legal experts to help minimize their risk — before distributing them to pregnant women in need.

The system could upend Republican plans for a post-Roe America. Despite the strict abortion bans that have taken effect in over a dozen states, some antiabortion leaders fear that the flow of abortion pills could help make abortion more accessible than it was before Roe fell. Las Libres, one of several Mexican groups at the center of the network, says its organization alone is on track to help terminate approximately 20,000 pregnancies this year in the United States. That amounts to about 20 percent of all legal abortions that took place in 2019 in the 13 states where abortion is now almost <a href="https://www.kff.org/womens-health-policy/state-indicator/number-of-abortions/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D" target=_blank>entirely banned</a>.

“Soon there will come a moment when we won’t be able to count any of this,” said Verónica Cruz Sánchez, the director of Las Libres, adding that the group works with a U.S.-based volunteer network that numbers about 250 and is “growing, growing, growing.”

The leader of another Mexico-based group that supplies pills, Red Necesito Abortar, said the elaborate volunteer structure was “like a spiderweb.”

“Once we get the pills into the U.S., they can distribute them across the whole country,” said Sandra Cardona Alanís, the group’s co-founder.

Lisette Poole

Most people interviewed for this story acknowledged that the network they are building is far from ideal, with participants taking legal and medical risks they would not face if abortion was still permitted nationwide.

The medication — a two-step regimen of mifepristone and misoprostol — was approved by the U.S. Food and Drug Administration in 2000 with a prescription, for use during the first seven weeks of pregnancy, a limit that was then extended to 10 weeks in 2016. But people involved in the network described a process that goes beyond what the FDA has endorsed. Organizations like Las Libres offer abortion pills without a prescription and, typically, without access to a medical professional — occasionally providing medication to those who say they’re at or beyond the FDA’s 10-week limit. To avoid detection in antiabortion states, the group also mails pills unmarked and unsealed, often in old bottles used previously for other medicines.

Some experts worry that as demand soars and cross-border networks expand to include less credible suppliers, women could start to receive illegitimate pills that are ineffective or, worse, dangerous. Fake abortion pills have been circulating in other countries with strict antiabortion laws, said Guillermo Ortiz, an OB/GYN and senior medical adviser with Ipas, an international abortion rights nonprofit.

“It’s scary,” he said. If women don’t know how to recognize real abortion pills, “it could cause huge harm.”

Other experts are less skeptical. Kristyn Brandi, a doctor and spokesperson for the American College of Obstetricians and Gynecologists, the leading professional organization for OB/GYNs, said she feels confident that patients can carry out abortions safely without medical supervision — as long as the pills they receive are clearly labeled.

“Medication abortion is one of the safest processes that you can go through,” she said. “Regardless of where you get that medication, based on the science … what’s happening in your body shouldn’t be any different.”

Monica’s abortion pills arrived in the mail on a Friday afternoon, hidden inside a  cat flea medication box. While the pills themselves were sealed and labeled, Monica’s boyfriend said he wasn’t sure if she should take them.

“What if they’re fake?” he recalled asking. He’d recently read news reports of other drugs that had been laced with fentanyl.

“What if they’re sending you something that isn’t even the abortion pill?”

By that point, Monica — who relayed her experience to The Post in real-time texts and calls, and then later in a lengthy interview at her home — had known about her pregnancy for over a month. She knew she wanted to have kids one day, but  she and her boyfriend lived paycheck to paycheck, without health insurance. At the end of the month, they’d sometimes get down to their last $40 — and have to decide between groceries and gas.

Without the money or time to get an abortion out of state, Monica had tried to give herself a miscarriage — first with mugwort tea, an herbal remedy she read about online, then with a heavy night of drinking. When none of that worked, she turned to Reddit.

“I’m scared, too,” she said she told  her boyfriend.

Photo for The Washington Post

Two weeks earlier, on the day Roe fell, a nurse in a different city rushed from room to room at the abortion clinic where she worked — frantically telling patients where they could order illegal pills now that their state had banned abortion.

“Do you have Insta?” she asked at least 20 patients that day, waiting as they pulled up their Instagram accounts.

She instructed each patient to follow an online resource called Plan C, which compiles a list of sources where patients can buy abortion pills on the internet. The nurse reviewed various options, including Aid Access, the prominent online service run by Dutch physician Rebecca Gomperts, as well as various online pharmacies that sell abortion pills illegally to people in antiabortion states.

‘We’re done’: Chaos and tears as an abortion clinic abruptly shuts down

The next day, one of those patients found the nurse in the grocery store.

“I have the money,” the woman said, her eyes desperate. “Will you buy the pills for me?”

The nurse couldn’t remember the patient’s name, but she remembered other details the woman had shared about her life — pleading in Spanish in the clinic hallway five hours after the Supreme Court overturned Roe. A mother of four, the woman was an undocumented immigrant from Mexico with a history of severe pregnancy complications and a Catholic husband who did not believe in abortion.

She couldn’t order the pills herself, she explained, because she didn’t speak English and had no reliable access to the internet. If the pills came to her home, she also worried her husband would find them.

Hyper-aware of the other grocery carts moving around her, the nurse considered all she might lose if she helped the woman and got caught. Where she lived — a Republican-led state in the South — she knew she could be stripped of her nursing license for distributing abortion pills. Maybe even go to jail.

The nurse promised herself she would do it just this once.

“I’ll tell you when I have them,” she said to the woman.

Securing the pills was easier than the nurse ever imagined: She called a friend, who sent her the number for Las Libres. The organization, she learned, had been working with many volunteers like her — helping patients who, for one reason or another, couldn’t buy pills on their own.

Many patients had never heard of Plan C or Aid Access. Some couldn’t afford the advertised price tag of $100 or more. Then there were patients like the woman in the grocery store, desperate for pills but without a safe place to receive  them.

On the phone with Las Libres, the nurse had requested just one set of abortion pills — enough to help her former patient. But, she said, the package arrived three days later with the means to end five pregnancies.

Las Libres soon followed up with the address for a woman in a different city.

“Can you help her?” a Las Libres activist asked over text.

The nurse, in her late 20s, thought about the lawmakers who had ushered in these laws — and those who had implemented similar restrictions years ago in Mexico, where she’d had to secure her own illegal abortion at age 16. She still remembered her feet in the stirrups in an empty apartment building. The unsure medical student who performed the abortion. The speculum and dilator boiling in a pot of water on the stove.

“I want those politicians to feel powerless,” the nurse said of her decision to join the ranks of the illegal abortion movement. “I want them to feel the same way my patients feel.”

She mailed her second set of pills the next day.

Before the pills arrived in the nurse’s mailbox, they occupied a corner of Cruz Sánchez’s closet — tucked away in the central Mexico headquarters that has housed Las Libres for almost two decades.

The pill supplier and her team of seven employees work from a mountainside home in Guanajuato, hidden from the road by an eight-foot electric gate and a tangle of red trumpet vines. Inside, the Las Libres office hums with the rhythms of a family: Cruz Sánchez’s nephew brews a pot of coffee while her sister fries up leftover chilaquiles, chatting about everybody’s weekend plans before they all have to get to work.

When Cruz Sánchez, 51, started Las Libres in 2000, she envisioned a feminist activist organization that would help Mexican women in desperate situations. In its early years, the group provided legal counsel for victims of domestic violence and demanded freedom for women whose abortions had landed them in jail. They’ve long provided free abortion pills without facing any legal trouble, despite recent laws in Mexico that criminalized abortion.

It wasn’t until Texas banned most abortions in the fall of 2021 — one week before Mexico’s Supreme Court decriminalized the practice across that country — that Las Libres began to consider an international expansion. Suddenly, Cruz Sánchez was getting calls from women across the border, begging for pills.

“We wanted to help the women in Texas because we understood their situation,” Cruz Sánchez said. “We’d experienced it.”

Demand skyrocketed as soon as Roe was overturned in June, Cruz Sánchez said. Las Libres went from sending 10 sets of pills to the U.S. every day to sending over 100 — all at no cost to the patient.

The rapid expansion has only been possible, Cruz Sánchez said, with the help of U.S. volunteers who find some of the patients and shepherd the pills along to their final destinations. Since the Supreme Court decision, she said, she has been inundated with messages from Americans eager to take a stand against the ruling. In one state, she says, she is working with a group of registered nurses. Elsewhere, 50 pastors and priests.

Some of the volunteers work with U.S.-based abortion funds and other abortion rights groups, connecting with pregnant patients through established pipelines that existed long before Roe fell. Others are doing this work for the first time, Cruz Sánchez said.

“They just show up and say ‘I want to organize my community, my neighbors, my friends — and I’m going to make a network,’” she said.

These days, the women of Las Libres spend much of their time fielding calls and texts from Americans, hunched over laptops at a table strewn with sticky notes and boxes of mifepristone. Cruz Sánchez regularly logs five or six Zoom calls a day — fundraising with American donors, or teaching volunteers how to safely join her efforts.

Until recently, Cruz Sánchez said, Las Libres received all its pills as in-kind donations. International advocacy organizations mail large shipments of pills to their office, she said. Individuals come by with donations of misoprostol, widely available at Mexican pharmacies to treat stomach ulcers. Sometimes Mexican pill distribution companies send over a batch of pills that is about to expire, free of charge, Cruz Sánchez said.

When American demand started outpacing the stash in her closet, Cruz Sánchez said, she called her contacts around the world, searching for the cheapest supplier. Las Libres had roughly $15,000 to spend, she said, from mostly American donors — the product of fundraising efforts they’d stepped up since June. On one recent Zoom call, a leader of a U.S.-based abortion rights group pledged $4,000, adding that she hoped to make the same payment quarterly.

Cruz Sánchez declined to disclose her group’s donors and said she has not been keeping detailed records of the money she has received from donors in the United States. Between 2009 and 2018, Las Libres received at least $193,000 in public grants from the Mexican government, according to government records.

On its search for cheap pills, Las Libres determined that Mexico-based suppliers were too expensive. One set of mifepristone and misoprostol costs about 26 U.S. dollars in Mexico, Cruz Sánchez said. But in South Asia, pills are a fraction of that price, according to Chris Purdy, chairman of the board of DKT International, one of the largest organizations that registers, imports and distributes abortion pills around the world. In India, where many of the largest abortion-pill manufacturers are based, combo-packs of mifepristone and misoprostol are widely available at pharmacies for as little as $1.50, Purdy said.

In mid-September, Cruz Sánchez boarded an overseas flight from Guanajuato, returning four days later with thousands of abortion pills. From there, Cruz Sánchez began sending the pills to towns along the U.S.-Mexico border, where volunteers were waiting to carry them into the United States.

When selling directly to patients, suppliers typically offer pills at a significant markup. Europe-based Aid Access prescribes and sells pills for just over $100 per dose, sometimes offering discounts or free pills for low-income customers. Other online pharmacies charge hundreds of dollars. A medication abortion at a licensed U.S. clinic typically costs between $500 and $600, on top of the price of transportation and accommodations for those who have to travel out of state.

A post-Roe surge could reshape this Illinois steel mill town

Cruz Sánchez says she will never charge patients for abortion pills, which she believes should be widely accessible to all. She is critical of organizations that sell pills to patients for more than they bought them for, accusing these groups  of engaging in the “corporatization” of illegal abortions.

The Aid Access website invites people who can’t afford to pay for the pills to “tell us,” so the organization can help.

“Aid Access believes that a just and equal system means that women with the financial means can pay this way and also support the service for women who cannot afford to pay,” Gomperts said.

While Gomperts and other Aid Access-affiliated physicians write prescriptions for abortion pills — and provide medical consultations to anyone who asks for assistance up to 12 weeks of pregnancy — Cruz Sánchez and her network of volunteers offer their own, more informal support services to women who need guidance while taking the pills. Cruz Sánchez has been expanding these connections, connecting with U.S.-based hotline services and medical professionals.

As far as she knows, Cruz Sánchez said, no one in the U.S. has had severe medical complications after receiving pills from Las Libres.

For most Americans working with Las Libres, Cruz Sánchez said, the more pressing concern is a legal one. Many of her U.S.-based volunteers are terrified of the prison sentence they could face if they get caught, adopting  aliases and avoiding police.

“If they stop you, just point at your stomach and try to look old,” she advised one 80-year-old who picked up 500 pills en route home from her Mexican vacation.

“What’s the government going to do? Open every package in the mail? Conduct an inspection inside every woman’s home?”

“They don’t have a way to do it,” she’ll say with a smile. “There’s no way.”

One thousand miles north, in Dallas, Tex., nearly 100 abortion rights advocates squeezed into a hotel conference room in late August to learn about the illegal abortion movement — and the risks of signing up.

The lawyer at the front of the room did not explicitly mention the abortion pills flowing into the U.S. from Mexico. But she singled out a group she calls “the helpers”: people who are helping American women secure pills in antiabortion states.

This group was particularly vulnerable to legal risk, she said.

At a conference led by SisterSong, a national reproductive justice group, attendees flocked to this particular session, “Self-Managed Abortion in the US After Roe.” Many in the room worked for abortion funds and other abortion rights groups, eager to bring what they learned back to their communities.

“Let’s say this one together,” the lawyer told the audience, gesturing to the all-caps message on the projector: “Don’t talk to cops.”

Post Grad: Five Women and Their First Year Out of College 

Princeton University, BA in History 

Caroline Kitchener is a reporter covering abortion at The Washington Post. She won the 2023 Pulitzer Prize for National Reporting. 

Caroline Kitchener

The covert abortion network that could upend GOP plans for a post-Roe America

the-washington-post

Jonathan Newton

A covert network that delivers tens of thousands of abortion pills is on the rise

Covert network provides pills for thousands of abortions in U.S. post Roe

Amid legal and medical risks, a growing army of activists is funneling pills from Mexico into states that have banned abortion

U.S. abortion access, reproductive rights