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When Abortion Pills Were Banned in Brazil, Women Turned to Drug Traffickers

Women’s reliance on the black market for access to medication abortions means they may not be following the best medical practice. When C., a 24-year-old teacher in Recife, bought misoprostol from a drug dealer last year, she googled how to take it. “Because it was illegal, there was no information on how to take it or what to take,” she said.

Her search found recommendations for inserting the tablets into her vagina, as a doctor would if she were in a clinic, but warned that marks would be left behind and given her away if she ended up in the hospital; instead she dissolved them under her tongue, a method that also works, but less quickly.

C., who wanted to identify only her middle initial for fear of prosecution, bled weeks afterward and wanted to ask her mother, a gynecologist, for advice. But her mother is an anti-abortion activist. Finally, C. said she thought she had had a miscarriage and her mother took her to a colleague who performed a dilation and curettage under anesthesia.

“When I got the curettage, I had to keep saying to myself, ‘Don’t say anything, you can’t say anything’ — it was torture,” she said. “Although I was absolutely sure I wanted an abortion, I had no doubts. You still feel like you did something wrong because you can’t talk about it.”

The restriction on misoprostol has complicated mainstream obstetric care, where the drug is used to induce labor, said Dr. Derraik. At the Rio public maternity hospital, where she is the medical director, a doctor must complete an application for the drug in triplicate and have it signed by Dr. Derraik, to the pharmacy where the supervisor also has to sign before taking it out of a locked cabinet, and then the doctor has to administer the drug with a witness, to make sure it’s not diverted for sale on the black market.

“Not all of these steps are officially required,” said Dr. Derraik. “But hospitals do them because of the intense paranoia surrounding the drug.”

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