When Camila Sigales found out she was pregnant, she felt like her world was falling apart. At 19, she had plans for the future, and those plans did not yet include motherhood. Unfortunately, in Argentina, that wasn’t sufficient grounds for her to get a legal abortion: Here, women, girls, and trans or nonbinary people can only legally end a pregnancy if they were raped or their health is at risk.
Camila did what almost half a million women do each year in Argentina: She had a clandestine abortion. She did it at home, accompanied by her mother, using some pills her mother and stepfather had gotten ahold of. “It was a question of putting the pills in my vagina, lying down, staying calm, and waiting,” she said. “I was comfortable, but I could feel the contractions that the medication produced.”
She suffered no complications, but it was a difficult topic for a long time. “I didn’t speak about it for a year and a half,” Camila said.
On June 14, Argentine deputies narrowly passed a bill legalizing abortion in the first 14 weeks for any reason. The final count was 129 in favor and 125 against, following a marathon session of around 22 hours. It was the first time an abortion bill had been officially debated in Congress, and many deputies remained undecided until the last minute.
Senators will now debate the bill. Whichever way the final vote goes, the issue has promoted an unprecedented public debate about abortion, with many people throughout Argentina and South America reevaluating what it means when abortion is illegal — and the toll that prohibition has on women, girls, trans men, and nonbinary people.
The statistics paint a bleak picture: More than 3,000 women are known to have died from complications during clandestine abortions since the end of Argentina’s last dictatorship, in 1983. It’s estimated that there are around 450,000 abortions in Argentina each year, which is more than one abortion per two live births. Of those women, around 49,000 end up in hospital. There, patients often experience abuse from hospital staff and the terror that, in violation of professional secrecy, their medics will report them to the authorities and they will leave the hospital in handcuffs.
Camila’s story is similar to those of many of the women, girls, and trans people around Argentina who abort with misoprostol, a drug that causes the uterus to contract and expel its contents. It’s a method recognized by international health authorities such as the World Health Organization. In countries where abortion is not restricted, women often take misoprostol with another drug, mifepristone, but when that isn’t available — as in Argentina — larger doses of misoprostol can be used instead.
It’s impossible to say what proportion of abortions in Argentina are done with misoprostol. Since the vast majority of abortions in the country are underground, there are no reliable statistics, but the short answer is almost certainly thousands. The misoprostol method is increasing in popularity, according to Mabel Bianco, MD, president of the management committee at FEIM, a sexual and reproductive health and rights foundation.
Misoprostol is in many ways preferable to the alternatives—for those who can afford it. Poor women and women living in remote, rural areas are still forced to resort to DIY methods, such as inserting objects into their uterus through the tiny opening of the cervix. Objects of choice used to include knitting needles and stems of parsley, but today catheters have become popular, according to Bianco.
Inserting a catheter damages the placenta, and patients usually start bleeding. Then they rush to the hospital to finish the procedure. “Some women arrive at the hospital with the catheter still in,” Bianco said. Aborting this way is far more likely to lead to problems such as infection and is one reason serious complications and maternal deaths following abortion disproportionately affect poor women.
Misoprostol, on the other hand, can be used in the privacy of one’s own home, without the need for medical attention in a hospital or underground clinic. In the absence of aboveboard medical attention, aid networks run crisis hotlines and provide as much useful information as possible for women who are forced to abort in secret. A collective called Lesbians and Feminists for the Decriminalization of Abortion publishes an illustrated manual on how to abort using pills.
Even illegal abortions done with misoprostol can happen safely, as long as the woman is using the correct quantity of good pills and has all the relevant information. Problems are more likely to occur with pills obtained on the black market, according to Andrés López Cabello, a lawyer working on abortion issues at CELS, an Argentine legal center. Those seeking abortions run a greater risk of buying pills that are massively overpriced, expired, or haven’t been stored properly when they have to buy the medication underground.
Although it’s less dangerous than many of the alternatives, misoprostol is not without complications. These can include heavy bleeding and insufficient doses that lead to incomplete abortions.
Natalia Loyola knows firsthand what it’s like when abortions with misoprostol go wrong. She became pregnant in mid-2016, when the condom came off during sex and she didn’t notice. It was a week until payday, and Natalia couldn’t afford the emergency contraceptive pill. Her boyfriend disapproved of the morning-after pill—and any form of abortion—and wouldn’t lend her the money. Natalia eventually bought it with the help of a friend, but it didn’t work.
To end the pregnancy, Natalia found a nurse who sold her four pills for 4,000 Argentine pesos (around $268 at the time) and told her what to do. But the dose wasn’t enough. She tried again, using a box of 16 pills her friend got her. Over the following days, Natalia experienced some pain and bleeding but was nervous about going to hospital.
In 2013, Natalia had experienced obstetric violence when she miscarried a child she wanted to keep. As she lay in hospital, experiencing contractions every minute, the obstetric staff had repeatedly accused her of aborting on purpose. “What have you done? I wonder what I might find if I examine you,” one of the nurses told her. “You know doing that is illegal. We’d have to report you.” In her head, Natalia nicknamed her “the butcher.”
Nonetheless, when the pain got worse, Natalia went to hospital. “One of the obstetricians was saying, ‘I’m sure this girl had an abortion and doesn’t want to tell us.’ I heard her talking outside, and I started to cry and to shake,” Natalia said. Fortunately, a friendly surgeon examined Natalia and told her colleagues that she had found nothing suspicious. “When I got out, I thought, ‘I’m alive, and I still have my uterus,’” she said
Afterward, Natalia’s boyfriend apologized — but not for his less than supportive behavior during the abortion process. He had known all along that the condom had come off and finished inside her anyway.
In Argentina, misoprostol is sold mixed with diclofenac under the brand name Oxaprost, a product officially prescribed for stomach issues. Although abortion is legal in Argentina in the case of rape or risk to the mother’s health, the authorities have not licensed Oxaprost for use in abortion. In fact, there are no medications officially approved for abortion in Argentina at all. “In a country where there are cases of legal abortion, it is unacceptable that these pills do not exist and a suboptimal option is being used,” López Cabello said.
Laboratorios Beta is the only company in Argentina that produces misoprostol — and it has steadily increased the price. Argentina’s previous government capped the price of Oxaprost because of its importance for obstetric uses; boxes of 16 pills cost 452 pesos ($30.36) in mid-2014. Taking advantage of the fact that the cap applied only to packs of 16, Laboratorios Beta launched a pack of 20 pills for 1,117 pesos — more than twice the price.
When contacted for this piece, Laboratorios Beta responded that it does not give interviews to the media.
Today, a box of 16 Oxaprost pills sells for 3,218.36 pesos ($124), online catalogs and CELS data show. That’s more than a third of the monthly minimum wage of 9,500 pesos. Although abortions generally require fewer than 16 pills, this is the smallest pack available, forcing users to buy more than they need. Much of the surplus ends up on the black market, where prices can spiral out of control. Illicit misoprostol is sometimes smuggled into Argentina from other countries.
Legally, Oxaprost is sold under archived prescription, meaning pharmacists must keep a copy on file and can be audited by the authorities. These strict controls can make doctors edgy about prescribing it, even for legal uses. But some chemists are willing to bend the rules. Natalia’s friends knew of a pharmacist who would sell the drug without a prescription, but they told her to look for one of two staff members at the counter and not to ask for it if anyone else was on shift.
“The underground nature and, often, the lack of accurate information can mean that experiences with abortion that could be very simple can become very complicated,” López Cabello said. He would like to see mifepristone produced in Argentina and characterizes the government’s failure to provide secure access to drugs like mifepristone as a discriminatory practice.
The results of the June 14 vote show that a lot of Argentines would be sympathetic toward women like Natalia. Whatever the nation’s senators decide as the vote moves to the upper house, one thing is clear: For now, for many people, misoprostol is the best available option.
“The first time, I had to lose something I wanted. The second time, I was scared for my life,” Natalia said. “Nobody should have to go through what I went through. Nobody.”