The Mexican Model of Abortion Rights

From The New York Times, I’m Michael Barbaro. This is The Daily.

Today: When the Supreme Court decriminalized abortion with Roe v. Wade in 1973, it instantly established the United States as a global leader on abortion rights, decades ahead of many other countries. But in recent years, there’s been a dramatic reversal. The country that for so long was a beacon to abortion rights activists worldwide has been restricting access, just as many other countries have finally begun to expand it. My colleague Natalie Kitroeff has been reporting on how with Roe itself now likely to be overturned, Mexico could suddenly be a model to abortion activists in the U.S. It’s Tuesday, May 17.

So, Natalie, tell us about the reporting that you have been doing in Mexico in the lead-up to this leak of the Supreme Court draft opinion showing that the U.S. is headed toward Roe versus Wade being overturned. Why Mexico in this moment?

Yeah, so I’ve been especially interested in what was going on in Mexico because, of course, well in advance of the leak, the U.S. had been passing increasingly restrictive abortion laws all across the country. And in Mexico, you have this example just across the border of this place where, for years, abortion had been illegal in the vast majority of states in all but the rarest of cases. But many women were still getting abortions there. So I wanted to understand how that worked. And so a few months ago, I traveled to one of the country’s most conservative states, Guanajuato —

— to meet a woman named Verónica Cruz.

And who is Verónica Cruz?

She runs an activist organization called Las Libres, which translates to, “the free ones.”

She’s 51 years old. She’s maybe 5’2. And she’s just a ball of wound up energy. Everything about Verónica just feels like a woman of action. She talks really fast. Her limbs are in constant motion. And she’s one of those people who just kind of seems like they’re doing three things at once all the time.

And on the day we meet up, she has a super full schedule, as usual. So we end up chatting in the car on the way to a meeting. And that’s when she tells me how she started doing this work.

And what does she tell you?

Well, back in the mid-90s, when Verónica is in her 20s, she gets involved with the feminist movement in Mexico. And at the time, she’s primarily focused on fighting violence against women and promoting women’s health in rural areas.

But through that work, she starts to see, really, the impact of Mexico’s conservative Catholic culture on areas of women’s health that we don’t even usually think of as controversial.

What do you mean?

Well, she’s seeing women dying of high rates of breast and cervical cancer.

And part of the reason, she says, is that their husbands wouldn’t even let doctors look at these parts of their body. So they’re going undiagnosed and untreated.

Wow.

And so you can imagine, in this context, just how off limits any discussion of abortion is and how unsafe the situation is in general, as a result of that.

Because you’re saying it’s just totally taboo.

Exactly. Nobody’s talking about that topic. But —

— as she’s spending more and more time with women in these rural areas, they start coming to her, asking for help in getting illegal abortions. And so, Verónica thinks, wait a minute. We, as feminists, need to start talking about this. This thing that these women keep bringing up, this needs to become a focus for us.

And so, as a starting point, she decides to survey dozens of her colleagues in the feminist movement, people she’s working with, to try to understand how they’re thinking about this issue.

And what does she learn from this survey?

It’s interesting.

She finds that nearly all of the women in the movement report having had an abortion.

But even these women, these feminists, report being very uncomfortable talking about the issue.

And interestingly, the women who had gotten abortions were actually the ones who were most uncomfortable talking about it. They reported feeling extremely guilty about their decision.

I mean, Verónica says she’s truly shocked by these responses. And it makes you think, wait a minute. How are we as feminists going to get anywhere on this issue when we ourselves feel such deep shame around it?

For Verónica, as she’s building her approach to abortion in Mexico, this really shapes her thinking around how to deal with this issue in this country.

She, like so many women in so many countries at this time, is looking to the United States as an inspiration. She says what the U.S. has achieved through the courts, the protection of abortion as a guaranteed right, it’s the gold standard she’s working toward.

But in Mexico, Verónica is seeing that she really has to fight another fight first. Before she can even get to legalization, there’s this deeper, more fundamental fight that she’s waging. It’s a cultural battle. And it’s about destigmatizing the issue. She sees it as winning over hearts and minds.

Right.

And she puts that approach into action in the year 2000, which is when Mexico elects a conservative president. And that emboldens these local officials in Guanajuato, where she lives, to try to make their already strict abortion laws even stricter. They pass a bill banning the procedure, even for women who have been victims of rape.

And Verónica is determined to get rid of this bill. So she goes looking for women who have been victims of rape and persuades them to tell their stories publicly, everywhere she can.

She’s leading these massive protests. They’re taking over buildings. And she figures that once people hear these stories, they’re going to be so horrified at the prospect of forcing these women to carry out their pregnancies that the law just can’t go through. People will be so opposed to it that the government is going to have to let it go.

And it actually works. The government backtracks and vetoes the bill. So she actually helps block this law from ever going into place.

But almost immediately, it becomes clear to Verónica just how powerful the cultural resistance in Guanajuato can actually be at a practical level, because even though it’s now legal to provide an abortion like this, Verónica is finding that the vast majority of doctors in the state are still refusing to actually carry them out.

She starts approaching gynecologists —

— and puts together a small group of doctors who are willing to provide these abortions. And now the word is starting to get out about what she’s doing. And women who aren’t victims of rape are coming to Las Libres, her organization, asking for help getting abortions.

So she and this group are increasingly becoming known in this country through a kind of word-of-mouth sharing of information and resources, it sounds like.

Yes, but she’s kind of stuck. Most doctors are still unwilling to provide abortions, legal or illegal. And there is no hope, really, at this point of the Mexican courts going the way of the U.S. and having their own Roe versus Wade anytime soon.

And then, in 2002, this gynecologist she works with comes back from a conference abroad, and Verónica is really excited about something this doctor’s heard.

Which is what?

There is a medicine for abortions.

It’s called misoprostol.

So, for years, women in Latin America had been secretly using this pill, misoprostol, to cause abortions. It’s actually an ulcer medication that often, through word of mouth, women came to realize could also function as an abortion pill. And as time goes on, the medical community gets wind that it’s being used in this way. And they look into it, and they realize, actually, this is really safe. And so, eventually, the World Health Organization recommends it formally, says it’s OK to use this. It’s safe to use this for abortions up to 12 weeks of pregnancy. And Verónica’s hearing about it and realizing, wow. Because this is an ulcer medicine —

— it’s sold in Mexico. And you can get it without a prescription.

Huh.

And she says at this point, when she learns this, her eyes lit up and she said —

— this means we don’t need doctors to be on board with this. Women can give themselves abortions.

Wow.

And so, to start, Verónica sets out to learn all about this medicine. She draws in this existing network of doctors she’s been working with, doctors who were willing to provide legal abortions to victims of rape. And she starts bringing this other group of women, women who weren’t victims of rape, to these doctors. And what she tells me is that a kind of “don’t ask, don’t tell” approach emerges where the doctors aren’t asking whether the women were raped, and she’s not really saying it. And these doctors are still helping these women through abortions that happen with these pills.

Huh, so that feels like a change. These doctors who had been largely unwilling to provide abortions to women who aren’t victims of rape now seem to be kind of willing to look the other way.

Yeah, I think that’s right. And I think it really has to do with this shift from surgical abortions to pills. It’s a lot different to perform a surgery on a woman than it is to supervise her as she takes a pill, right? There’s something about that that has the potential to transform how you think about an abortion.

And Verónica gets this. She sees the pills are probably the most important tool that she will have to advance her strategy on this issue.

And after she’s observed hundreds of these procedures with the help of these doctors, who may or may not know that the women are not victims of rape, right?

And she learns all the best practices for administering these pills, all the questions that women might have as they’re taking them. She takes it one step further.

She cuts the doctor out of the picture altogether. She starts doing what she calls accompanying women as they induce their own abortions at home with these pills.

And the idea is that once one woman has an abortion this way, she’ll become someone who helps the next woman have an abortion. And she’ll help the next woman and so on, until Verónica has formed a network, a kind of underground network for abortion pills. And it grows and grows over the years. Verónica estimates that she’s now helped around 20,000 women in Mexico have this kind of abortion with pills.

Wow, 20,000. Most of them technically illegal, I assume.

Yes, yes. I mean, really, there is no overstating the influence that she has had on the abortion landscape in this country. She becomes an absolutely key figure. And in that role, she starts getting invited to conferences around the world and talking with abortion rights activists from other countries, including the U.S. And she says it’s at this point that she starts to question that U.S. model that has been so inspiring to her all these years.

Why?

Well, all this time, it seemed like the ideal, right? That because of Roe v. Wade, this constitutional protection that was established, you have these clinics. They’re all across the country. And women can just go in and get abortions, she says, abortions that they have the right to receive. I mean, this is the dream for her. And when medical abortions start to become more common, the clinics start providing those, too. They build those into their system, and now women can just walk into these clinics and get pills if they want to.

But as Verónica is meeting and hearing from American activists, she starts to realize, wait. They’re not really talking about a backup plan. This hearts and minds stuff, they’re not really doing much of it. Because the U.S. has had this legal protection in place for so many years, this whole system has been built up around it, and it’s all resting on this one Supreme Court decision — this one Supreme Court decision that, as remote a possibility as it seems at the time, could be overturned. And she starts to think the American activists might be making a mistake.

We’ll be right back.

So, Natalie, Verónica is building up this network of women in Mexico. And as she’s doing that, she’s looking over at the U.S. and starting to question its model. So what happens next?

Well, so last September, the work Verónica has been doing for all these years, it pays off. Mexico’s Supreme Court unanimously rules that criminalizing abortion, as so many states in the country have done, is unconstitutional, paving the way for abortion to be legalized across the country.

And immediately, a lot of the credit is given to groups like Las Libres and other feminist organizations who’ve been fighting out in the streets, demanding these rights for years. And obviously, Verónica is overjoyed, but the timing is really kind of extraordinary because within days of that ruling, lawmakers in Texas pass the most restrictive abortion law in the U.S., banning abortions after six weeks.

Right.

And remember, this was seen as a clear indication that Roe might be in serious trouble.

So the same week that Mexico gets its version of Roe, there’s this huge blow to Roe back in the United States.

Exactly. And this fear that’s been nagging at Verónica about how vulnerable the U.S. might be without any other system in place, it’s coming true. And what it signals to her is that here in Mexico, regardless of this legal victory, she can’t stop doing what she’s been doing. And to show me what she means by that, she offers to introduce me to someone. So the same day I meet with Verónica, I drive across the state to meet this young woman.

And she agrees to go by her first name, Sofía.

And tell me about Sofía.

So Sofía is 23. When I spoke to her, she was just finishing up college online while working at a law firm. And she’s fluent in English. And so when I realized that, we switched over.

She’s this very put together person. She’s dressed professionally. She just exudes confidence, like she knows exactly what she wants.

So when she finds out that she’s accidentally gotten pregnant, she knows what she wants to do. She lives at home with her parents who are conservative, and so she doesn’t feel like she can talk to them about it. But because of the work that activists like Verónica have done, she has a good sense of what her options are.

She knows that one of the most common methods women pursue are these over-the-counter ulcer pills. And so, within hours of finding out that she’s pregnant, Sofía goes with a friend to try this.

And now, just to be clear, even after Mexico has decriminalized abortion, many women are still turning to this informal system of ulcer pills that Verónica has helped establish.

Right, the Supreme Court in Mexico has decriminalized abortion, but Mexican states still need to change their own laws to make this a reality for women in practice, right? So the old system, the informal networks, that’s also really important. Women are still getting abortions at home with pills, just as they were before the Supreme Court ruled. So Sofía goes to the pharmacy and gets this ulcer medication. And the next morning, she wakes up, takes the first round of pills and logs on for work from her bedroom.

But —

— it doesn’t work.

She can tell by the way her body reacts.

And Sofía has heard that sometimes, when the medication doesn’t work, it can be a sign of an ectopic pregnancy, which can be dangerous. So she decides to go see a doctor to get an ultrasound. And here, she’s coming face to face with the kind of medical institution of Mexico.

And what is her experience there?

Well, it’s not great.

The people there keep calling her, “señora.”

Which, in Mexico, is a term that is usually reserved for married women or mothers.

And she doesn’t want to be a mother. She wants to get an abortion eventually, right? So she’s not liking the way this makes her feel. But she gets the ultrasound.

And what she learns is that she doesn’t have an ectopic pregnancy. The medication didn’t work because she was too early in her pregnancy. She was only four or five weeks along. So Sofía and her boyfriend begin to consider what her other options are. And the next day, her friend connects her to a doctor acquaintance in Mexico City.

And she’s talking to this doctor because she wants to know whether she needs to consider a surgical abortion in a place like Mexico City, which is one of the few places where abortion has been legal in Mexico, or whether she should pursue this other option that she’s heard about — which is a two-pill regimen that combines misoprostol, the ulcer medication, with another drug, called mifepristone, a drug that’s designed specifically to cause abortions. But of course, because of that, it’s highly regulated in Mexico, this drug. And so, Sofía wants to talk to the doctor to get some advice. But instead of making her feel better —

— she says the conversation actually makes her feel worse.

How so?

She says the doctor’s telling her, you can’t treat this just like a small thing, this medication. There are real risks.

And on the one hand, of course, Sofía takes that seriously. It actually scares her. But it’s also bugging her because from her own research, she understands that medical abortions are extremely low risk.

This is really pretty telling. It might be hard to imagine ignoring the advice of a doctor who is telling her that taking matters into her own hands could be really dangerous. But Sofía is not convinced that the doctor actually knows as much as she could about this medication. And that instinct really speaks to the cultural landscape that Verónica has helped create in Mexico. But Sofía feels empowered enough to keep going to pursue this on her own.

And pretty quickly, she comes across Las Libres.

So the next day, she drives over to their office.

And they give her the two-pill regimen, misoprostol, the ulcer medication and mifepristone, the medication made specifically for abortion.

She goes back to her parents’ house. And the next morning, Sofía once again locks herself in her room —

— and takes the first pill. This was actually just the day before I met her.

Wow.

And from the beginning, there is a woman from Las Libres that is in constant touch with her, following up, messaging her —

— making sure that everything is going OK, answering any questions she has. And after she’s done her first dose, 24 hours later — one week from the day she found out that she was pregnant — she takes the second dose, with her family just feet away in the other room.

And as the afternoon goes on, Sofía can tell it’s working. She’s feeling a lot of stomach pain.

And then it’s done.

And when it’s over, she takes a shower, goes downstairs to have lunch with her family and decides to run some errands.

And as I was saying goodbye to Sofía —

— she was giving Verónica her contact information so she could join Las Libres’s network.

And this, what happened here, this is the backup plan that Verónica thinks the U.S. should have been building all along. And that was before the leak.

So a few days after the leak of the draft Supreme Court opinion overturning Roe versus Wade, I called Verónica back.

And what was her reaction to this news?

She says she’s both shocked and not shocked. She saw this coming, right? But she says it’s one thing to anticipate it.

But to actually see it happening, the collapse of this bedrock upon which so much of the abortion rights fight has been built, it takes her breath away.

And it feels like the big question for Verónica, now that it’s actually happening, is: Does she think it’s too late? She wanted the U.S. to be building this backup plan, like the model she created in Mexico for letting women give themselves abortions to get around courts and laws that are on their side. That hasn’t happened. Now that the U.S. is on the verge of striking down Roe and moving, in a lot of ways, closer to what Mexico was like when she helped found Las Libres, does she think that there’s still the opportunity, and now, really, the necessity for activists in the U.S. to do this?

Yeah, so I asked her pretty much this exact question.

And it’s just in her nature. It’s really sort of her job to be optimistic about this fight. So she says, yes, she definitely does think the U.S. can do this, and that they have a real advantage that Mexico didn’t, which is that the U.S. has the road map that she and other feminists in Mexico and across Latin America have already laid out. The U.S. doesn’t have to start from scratch.

And in fact, she’s already starting to work with feminist organizations in Texas and across the United States to try to bring these networks to the U.S., to try to get pills in the hands of women and accompany them through their abortions, just the way she did in Guanajuato.

But she also acknowledges that there are real challenges here. She thinks the movement in the U.S. is divided around their ideas of what the next steps really should be. From her conversations with American activists, she says they seem to be split in two.

There are activists, activists she says she’s hearing from, who are saying this is absolutely what we need to do. Mexico got it right. We need to get radicalized, and the future has to be built around these pills and getting them to women in states where abortion is illegal.

But then there are the activists who are resistant to that, who don’t want the solution to be illegal, who want to keep fighting in the courts, in the statehouses, in Washington, to secure, once again, a woman’s legal right to choose.

And I think this comes down to something really important. All along, Verónica has been fighting this cultural battle, right? But it’s a cultural battle specific to Mexico. It was built inside this largely socially conservative Catholic country. It was tailored for Mexico to deal with the stigma and the system that exists in Mexico. And it was also built in a country that didn’t have any other options at the time. For the vast majority of women to get an abortion, they had to break the law.

And the notion of breaking the law, that notion, which is baked into Verónica’s model in Mexico, the notion of doing something outside the walls of your doctor’s office, it’s just not what Americans are used to. It’s completely unfamiliar for a lot of people. And to suddenly ask people to break the law, in many cases, to give each other pills and get abortions at home, even if that’s illegal, that requires some serious risk taking that Americans haven’t necessarily had to do until now.

And so that raises real questions about whether this cultural fight that Verónica has been waging in Mexico, whether it’s going to translate to the U.S. I mean, what happens when you take away a right that has been guaranteed for almost 50 years? Does that create the conditions in America where, suddenly, people are ready to take risks, like Verónica and so many other Mexican women have? We just really don’t know yet. I mean, for all her energy and optimism, I think Verónica herself has real questions about whether American feminists and American women are willing to take that leap and fight that fight.

Natalie, thank you very much. We appreciate it.

Thanks, Michael.

We’ll be right back.

Here’s what else you need to know today. On Monday, police in Buffalo, New York said that the racist gunman who killed 10 people at a grocery store over the weekend had planned an even deadlier massacre. The suspect, they said, wanted to strike multiple stores, potentially including a nearby Walmart, before he was stopped by police.

Meanwhile, fallout from the shooting reached Washington, where Congresswoman Liz Cheney accused fellow Republicans of promoting the hateful ideas embraced by the gunman. In a tweet, Cheney wrote, quote, “The House G.O.P. leadership has enabled white nationalism, white supremacy and anti-Semitism,” adding, quote, “History has taught us that what begins with words ends in far worse.” Finally —

— relatives of the victims began to speak out about their pain, including Garnell Whitfield, whose 86-year-old mother, Ruth Whitfield, was killed during the rampage.

Today’s episode was produced by Clare Toeniskoetter, Rob Szypko and Asthaa Chaturvedi, with help from Chelsea Daniel and Kaitlin Roberts. It was edited by Lisa Tobin; contains original music by Marion Lozano, Elisheba Ittoop, Dan Powell and Rowan Niemisto; and was engineered by Chris Wood. Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly.

That’s it for The Daily. I’m Michael Barbaro. See you tomorrow.