In November 1990, more than 3,000 women descended on the sleepy beach town of San Bernardo del Tuyú, Argentina, for what was becoming a legendary event.
Activists, doctors, academics, social workers and lawyers from across the Americas traveled all the way to attend a feminist gathering known as an Encuentro.
While they publicly debated their political demands, the piece of information that made the biggest impact on the future of abortion was exchanged in private, in whispers.
Alicia Cacopardo, an OB-GYN from Buenos Aires, was part of those whispers. In between sessions, she fell into conversation with a group of Brazilian women in the hallway, who talked about a pill she had never heard of before: Cytotec, the commercial name of misoprostol. The drug was designed to treat stomach ulcers, but women in Brazil were using it for safe, at-home abortions.
Though Cacopardo was an expert in reproductive health, she was stunned — you can have an abortion on your own, just by taking a pill?
"It's a huge change. It's brilliant," she remembers thinking at the time.
In the years to come, other abortion-rights activists across the region were thrilled when they learned about misoprostol, and, like Cacopardo did, wanted to spread the word to other women.
Activists connected the dots: If women could get their hands on misoprostol, they could end their pregnancies despite the severe legal restrictions on abortion most Latin American countries had. With this new pill, they wouldn't have to wait for the law to change.
Word spreads
When Cacopardo returned to Buenos Aires after the Encuentro, she wanted to get her patients Cytotec. If she succeeded, women could end their pregnancies despite legal restrictions on abortion. At the time, Argentina only allowed abortion in cases of rape or when the mother's life was at risk.
But Cacopardo ran into a problem: Cytotec wasn't available in Argentina.
She flipped through a pharmaceutical directory and looked for any drugs that contained misoprostol, the generic name of Cytotec. She only found one medication in Argentina: Oxaprost. But Oxaprost included a second substance, called diclofenac, an anti-inflammatory drug typically used to treat arthritis and other problems.
So Cacopardo came up with a solution — one that required her patients to do a makeshift science project at home. Cacopardo told them to buy Oxaprost at the pharmacy and then crush the pills to separate the outer layer of misoprostol from diclofenac, which was contained in an inner layer. Cacopardo wanted her patients to avoid any potential side effects from taking too much diclofenac, such as heartburn and other stomach issues.
It was difficult to crush the pills, so some women just took the whole thing — an indication of just how DIY it was at first to self-manage an abortion with pills. Cacopardo says that none of her patients reported any serious side effects and most of them had complete abortions.
A scientific stamp of approval
Kelly Blanchard, the president of the research and advocacy organization Ibis Reproductive Health, says that experiments with misoprostol in the 1990s represented activists doing "research in real time."
"In the clinic setting, those innovations often come from health care providers," she explains. "The activists are doing exactly the same thing: thinking about and working with people who need the care and seeing what works and what doesn't."
Researchers like Blanchard eventually ran studies on women using misoprostol to end pregnancies, gathering evidence from all around the world — from Peru to India to South Africa. Again and again, the researchers found the same thing: Misoprostol was a safe and effective way to have an abortion outside the formal health care setting.
The studies conducted by these researchers also persuaded major public health institutions like the World Health Organization (WHO). As early as 2003, the WHO included misoprostol as a safe abortion method in the first trimester (in combination with another pill called mifepristone).
The WHO's stamp of approval didn't change the fact that abortion was illegal in many parts of the world. So activists had a problem: They knew of an effective method to have abortions outside of the medical system, but how could they get more women access to something that was illegal?
Hotlines in Ecuador and Argentina
The statue of a virgin, la Virgen del Panecillo, looms over the city of Quito, the capital of Ecuador. She has wings, like an angel.
One day in 2008, Ecuadorian activists and a group of European activists from the abortion access organization Women on Waves hung a big white banner on the balcony of the virgin statue.
The banner read "SAFE ABORTION" in Spanish, with a phone number. That number was for the first abortion hotline in Latin America.
Later that day, that cellphone number blew up with dozens of text messages and calls.
The idea for a hotline — and the stunt promoting it — threw these abortion activists into a new, more public era. They reached thousands of women this way with work that was bold, organized and replicable.
In 2009, a year after the Ecuador hotline launched, Argentina got its own.
The collective Lesbianas y Feministas por la Descriminalización del Aborto (Lesbians and Feminists for Abortion Decriminalization) started the hotline with a dozen volunteers.
"In the beginning, the hotline was so bare bones," says Ana Mines, one of the first hotline volunteers. The group boasted a backpack they passed around to one another, with a Nokia 1100, a notebook and flash cards.
They were short on resources, but they were determined to give rigorous information on how to use misoprostol to have safe abortions. And they advertised the helpline everywhere they could, putting up posters all over Buenos Aires with their phone number and talking about it on TV and the radio.
The helpline volunteers referred to the guidelines developed by global and regional scientific bodies, such as the WHO. This research gave the activists credibility. They thought it also gave them a legal defense: They were just sharing publicly available information.
The volunteers delivered this disclaimer to callers — that they were not doctors but were providing public information — before offering step-by-step instructions on how to use misoprostol. They answered the callers' questions, such as: If I'm overweight, will the pills work? Can the pills fall out of my vagina? Will hospital staff be able to tell that I took misoprostol?
In Argentina, no one had ever done what this collective was doing — speaking so openly about abortions and how to have one on your own. Mines says most of the volunteers like her were scared of getting arrested. And the Argentine government had a record of going after abortion cases. Between 1990 and 2008, nearly 450 abortion cases were prosecuted in Argentina.
Not all feminists were happy about what the collective was doing. Mariana Romero, a prominent reproductive health researcher and advocate for abortion rights in Argentina, worried that the helpline could inadvertently reduce access to misoprostol.
"I said, do we have to do this so public? You're nuts," Romero recalls. "You are going to make the pharmaceutical company that produced misoprostol take it out of the market." Despite the publicity around the hotline, in the end, no volunteers were arrested. And misoprostol remained available.
Barbie gets abortions
In 2010, a year after the hotline started, Lesbianas y Feministas got more provocative with the way they talked about abortion. They published a manual on how to self-manage an abortion with misoprostol and without a doctor.
It did not look like a conventional medical text. The cover was pink with two big rainbows and illustrations of pills with smiley faces. On the back, there was a picture of Barbie in a pink convertible, with sunglasses and a glamorous scarf over her head, along with the words "Barbie, how'd it go?"
"It was awesome," Barbie replies. The implication was that any woman can have an abortion — even Barbie.
The manual was thorough — more than 100 pages long — and it went into vivid detail, including drawings of how to insert the pills into the vagina.
"It was a bestseller," says Mines, the hotline volunteer. "It had two printings of 10,000 copies each."
Other helplines and feminist groups in Latin America started using the manual to help more women. Mines herself was able to help thousands of women through the helpline.
But some abortion activists believed sharing information on the phone and through written manuals wasn't enough.
Mexico: The birth of "accompaniment"
In 2010, the activist Veronica Cruz met volunteers from the Argentine helpline at a conference about safe abortions. Cruz is the founder of a feminist collective called Las Libres (The Free) in Mexico. She recalls a lot of hype around abortion helplines at the gathering, but she was skeptical.
"How do you know for sure that those women are not at risk?" she asked the volunteers. "You gave them information and then what? Did she get the pills? Did she follow the instructions correctly? Did she end up in the hospital? You actually don't know anything."
Cruz, on the other hand, did know how the women she helped in Mexico fared because she used a different method: "acompañamiento."
In Spanish, acompañamiento means being with someone, supporting them, or just keeping them company. When helping a woman seeking an abortion, acompañamiento has come to mean being there for someone throughout the whole process of an abortion, from beginning to end, regardless of the legal risks.
Cruz started doing acompañamiento in 2000 — the same year she founded Las Libres, and nearly a decade before any of the helplines started in Latin America. At the time, abortion in Mexico was essentially banned. In the state where Cruz lives, the only exception was for women who were raped. But even in those cases, hospitals often denied women their right to the procedure.
In the beginning, Cruz focused her work on these women. Through Las Libres, she worked with a gynecologist to help women who had been raped get safe, legal abortions. One day, she saw the doctor use a new method: misoprostol, the ulcer medication that women in Brazil first started using for abortions in the late 1980s.
As she watched the doctor administer the pills, Cruz had a realization.
"I can just buy the pills, tell the woman how to use them? That was an incredible discovery for me."
Not long after, another woman came to Las Libres who wanted an abortion but wasn't a rape survivor — which meant that she didn't qualify for a legal abortion. Where they lived, ending a pregnancy that wasn't a result of rape, through any method, carried a prison sentence for the woman and anyone who helped her.
Cruz decided to accompany the woman, despite the risks. She told the woman to buy the pills at the pharmacy. In Mexico, even though misoprostol technically required a prescription, you could often get it over the counter. Then Cruz gave the woman the same instructions she had seen the OB-GYN give.
Even though Cruz had seen how the pills work and how simple it was to use them, she says it was nerve-wracking to support someone through an abortion without a doctor. Cruz was on standby the whole time. It was late at night when the woman took the pills.
"So I slept with my cellphone on my chest," Cruz recalls. "All the time … in case it rang or something."
The next day, the woman went to a doctor, who confirmed that the pregnancy had ended and that there hadn't been any complications. It was Cruz's first time doing accompaniment. And in her eyes, it had gone smoothly.
After that, when someone contacted Las Libres for an abortion and they were not rape survivors, Las Libres didn't go to the gynecologist for help. They handled it themselves.
"We promised ourselves that we were never going to leave anyone without access," Cruz says. "Whatever we had to do."
If a woman couldn't afford to buy misoprostol, which was expensive in Mexico, Las Libres would give her the pills free.
Sometimes women had leftover pills and offered to give them to Las Libres. Cruz told them to pay it forward.
"The next woman who comes, you are going to give her the pills as a gift and you're going to tell her about your experience," Cruz said.
Cruz would set up a meeting between the two women, in a park or at a mall. The woman who'd had an abortion would share her extra pills and her story. By connecting women directly — one by one — Las Libres was recruiting volunteers and building a network.
Las Libres helped create accompaniment networks that, today, reach every state in Mexico.
But over the years, some activists criticized Cruz's approach. At that conference in 2010, Cruz recalls activists telling her that "what we were doing — of personally accompanying the women and giving them the pills — was risky for us. For us and for the whole movement."
These activists, who were fighting to legalize abortion, didn't want the movement for abortion rights to be associated with people who were breaking the law.
Many abortion-rights activists across Latin America found themselves on opposite sides: Some were fighting to legalize abortion — those women were playing the long game. Others, like Cruz, were actively breaking the law, because women who needed abortions immediately couldn't wait until the law changed.
One group realized that they didn't have to choose between the two sides.
Argentina: From an art to a science
Nearly 35 years after that Encuentro in San Bernardo, in the fall of 2024, another Encuentro kicked off in Argentina. This time, the annual gathering brought 50,000 women to a small city called San Salvador de Jujuy, right by the Andes Mountains.
They flowed through the downtown streets in a big demonstration, like a river of women.
In Jujuy, Ruth Zurbriggen was hard to miss. She was usually the person with the megaphone and seemingly endless energy.
Zurbriggen is one of the founders of an Argentine accompaniment network: Socorristas en Red (First Responders Network). It's now the biggest abortion accompaniment network in the world. And to make that happen, she and the Socorristas decided to build systems, turning acompañamiento into a science.
Whereas Cruz, the founder of Las Libres, thought that women could figure out accompaniment on their own, the Socorristas built a whole accompaniment method and even have a school to train volunteers — La Escuela Socorrista (the Socorrista school).
In school, trainees learn the Socorristas' method, which includes holding an in-person workshop for women who are interested in having an abortion and administering a survey. That survey is exhaustive. It asks straightforward questions, such as the person's age and how far along they are in their pregnancy. Other questions are more personal, such as why the woman wanted to have an abortion, whether her partner supported her choice and whether she expelled the embryo. They tracked the answers in spreadsheets, carefully documenting trends in women's experiences self-managing abortions with misoprostol.
One question on the survey inadvertently helped the Socorristas strengthen their relationships with doctors. They asked: How did you find out about us?
"Thirty percent had come to us recommended by health care professionals," Zurbriggen recalls. "And that's when we said, 'What's happening? Who are they?'"
Zurbriggen was surprised by that high number. Most doctors in Argentina did not support abortion at that time. The Socorristas wanted to understand why medical staff were referring patients to them, so they started scheduling appointments with these health care providers, as if they were personal appointments. That allowed the activists to talk to the clinicians in private.
"We started creating a bond with professional medical staff. And then we started asking them 'what's the problem if you write two prescriptions a month for us? Nothing, right?' And they'd write us two or three prescriptions for us with different dates. And we'd get male names from friends or sons, and the prescriptions would be under male names," Zurbriggen says. She describes the process as "very DIY." It was also illegal — and the Socorristas don't do it anymore.
Doctors and nurses were often willing to help even though they risked losing their license by doing so. One OB-GYN named Gabriela Luchetti, who worked in the public health system for 30 years, says she felt "relief" sending people who needed an abortion to the Socorristas.
Luchetti said, "Someone was going to do what we didn't dare to because we had a license, and we were afraid of the law."
The fight to legalize
Many feminists who had focused their fight on getting a law to protect abortion weren't comfortable with Zurbriggen and the Socorristas' work. Just as activists criticized Cruz's accompaniment work in Mexico, they believed Socorristas would damage their country's movement for abortion rights because it would be associated with criminal activity.
But the Socorristas' accompaniment work always went hand-in-hand with the fight to legalize abortion. In 2018, when the Argentine Congress first debated passing an abortion law, Zurbriggen and other Socorristas were there, speaking to representatives, along with other abortion-rights groups.
They shared data they had been rigorously tracking for six years. In that time, they'd accompanied nearly 20,000 abortions. Their data challenged stereotypes Argentinians had about abortion. They showed that the women who are most likely to have abortions are already mothers, and that many of them are religious.
Some of the other feminists who testified in front of Congress, like the researcher Mariana Romero, had been critical of the Socorristas. But she, and other skeptics, came around. "They were radical, but, if they weren't, I don't know if things would have happened the way they happened," Romero says.
In December 2020 the senate voted to legalize abortion in Argentina and in January 2021 it was officially signed into law. Now any woman can go to a hospital or a community clinic and ask for an abortion up to 14 weeks, no explanation needed.
The campaign in Argentina inspired feminists all over Latin America. Argentinians made the green bandana the symbol for their movement and the fight to legalize abortion across the region became known as the Green Wave. Within a couple of years, Colombia and Mexico also decriminalized abortion.
One might think that once abortion was legalized in Argentina, the work of Socorristas wouldn't be necessary anymore. Women could go straight to doctors for the procedure. And yet, Socorristas are just as busy as they were before abortion was legalized.
The year after abortion became legal in Argentina, more than 13,000 reached out to the Socorristas. Of those, more than three-quarters chose to have a self-managed abortion with the collective's support. In other words, the vast majority of these women preferred to self-manage their abortions with acompañamiento over going to a doctor.
Some OB-GYNs like Luchetti, who signed prescriptions for the Socorristas every once in a while, understand why so many women are making this choice. She says, "The Socorristas method is far superior to medical care and is different and better. It's warm, friendly, committed."
Another doctor, Nadya Scherbovsky, mentioned that Socorristas make themselves available 24/7, while the public health system has strict schedules.
People who need an abortion aren't the only ones who are reaching out to Socorristas. Zurbriggen says she sometimes gets calls from OB-GYNs who ask her about how to use abortion pills, because she has more experience with medication abortion than many doctors in Argentina.
The Socorristas have become international experts on self-managed abortion with pills. A 2022 study published in The Lancet Global Health looked at their accompaniment method for pregnancies under 9 weeks, and it found that it was just as effective and safe as a medication abortion managed in a clinic.
"Misoprostol is a technological revolution that when you put it in the hands of women and those who need an abortion, it generates another revolution," Zurbriggen says. "It's a cultural, social, political, medical revolution."
Reporter Victoria Estrada and editor Rhaina Cohen contributed to this article. This reporting was supported by the International Women's Media
Foundation's Reproductive Health, Rights, and Justice in the Americas Initiative.
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