The Post-Roe Abortion Underground
Amid bans from Arkansas to South Dakota, women young and old are taking extraordinary risks to keep abortions accessible.Illustration by Rachel Levit
A multigenerational network of activists is getting abortion pills across the Mexican border to Americans.
The handoff was planned for late afternoon on a weekday, at an underused trailhead in a Texas park. The young woman carrying the pills, whom I’ll call Anna, arrived in advance of the designated time, as was her habit, to throw off anyone who might try to use her license plates to trace her identity. She felt slightly absurd in her disguise—sun hat, oversized sunglasses, plain black mask. But the pills in her pocket were used to induce abortions, and in Texas, her home state, their distribution now required such subterfuge, along with burner phones and the encrypted messaging app Signal. Since late June, when the Supreme Court overturned Roe v. Wade, Texas and thirteen other states had effectively banned abortion, and more were sure to follow. In some of the states, laws that originated as far back as the nineteenth century had been restored. Providing the tools for an abortion in Texas had become a felony that could lead to years in prison, and a fellow-citizen could sue Anna and collect upward of ten thousand dollars for every abortion she was found to abet.
Anna wasn’t a fainthearted woman—someone who had recently approached her for pills noted her “cottage-core vibes” and steely calm—but she wasn’t reckless, either. She and other women defying abortion bans had turned to a model developed by Verónica Cruz, a prominent Mexican activist. Until last year, abortion was considered a crime in most of Mexico, the second-biggest Catholic country in the world, and women there had become adept at providing safe abortions in secrecy. (Given the legal exposure, pseudonyms have been used for Anna and other American women who let me into their underground networks.)
By the time the pregnant woman for whom Anna was waiting walked up, the trailhead was quiet enough to make the chirping of birds seem jarring. As Anna pulled a plastic bag of pills from her pocket and settled across from the pregnant woman at a picnic table, she registered the fear on the woman’s face. Her distress, as Anna understood it, was less about a breach of Texas law than about the possibility that her husband, who was violent, might find out what she was doing. Hands shaking, the woman told Anna that she was already raising three children and had been trying to save enough money to remove them from a dangerous home. The prospect of having another child, she said, was like “getting a death sentence.” She couldn’t vanish from her household for a day without explanation, travel to a state where abortion is legal, and pay seven hundred dollars to a doctor for a prescription. Anna’s pills, which were free, were her best option. Taking the baggie and some instructions on how to take the medication, the woman thanked Anna and fled the park, hoping that her husband would never realize she’d been gone.
The town of San Miguel de Allende, in central Mexico, is known as the birthplace of legendary independence leaders. It is just as famous for its charm: cobblestone streets, Baroque churches, bright houses, and lively cantinas once frequented by Mexican muralists and Beat poets. Some Americans visit for a week and decide to stay. Among those expats is Liz, a retired Southern woman in her seventies. On the morning of June 24th, as she was making coffee in a kitchen where photographs of her great-grandchildren covered the fridge, she heard on the radio that the constitutional right to abortion in the United States had ended. She maneuvered her walker to a nearby chair and sank down. She felt as she had as a child, in a house by the sea where she’d once lived, when a hurricane she’d been dreading made landfall. It was awful, yes, but knowing what was coming had given her a chance to gather her courage and make a plan.
Five years earlier, Liz had met Verónica Cruz, who runs a nonprofit called Las Libres—the Free Ones—out of the city of Guanajuato, some fifty miles west of San Miguel. At the time, Cruz was defying Mexican law by helping women—mostly poor women—abort at home. In part because activists like Cruz successfully reduced the stigma of abortion, the Supreme Court of Mexico decriminalized it in September, 2021. That same month, Texas moved in the opposite direction: a state law known as S.B. 8 banned nearly all abortions past the sixth week. Since then, Cruz had widened her remit, supplying free abortion pills to undocumented women in Texas.
Liz figured that, with Roe overturned and states from Arkansas to South Dakota implementing abortion restrictions, the demand for Mexican abortion pills would soar. If she lacked Cruz’s decades of experience working on the cusp between the lawful and the criminal, she was neither too old nor too diminished to take a risk. She picked up the phone to call Cruz and then some friends, to find out which of them would be game to join an underground network.
Locals called expats like Liz “the Old Hippies,” in English. In early July, weeks after the U.S. Supreme Court’s Dobbs decision negated Roe, six of them joined Liz on her terrace for hibiscus tea and a talk with Cruz. Most of the Americans were over sixty and recalled what life was like before the 1973 Roe ruling. One tactic Liz remembered for ending an unwanted pregnancy was to alternate between a tub of ice-cold water and a tub as scalding as you could bear it. Those who tried this method suffered, then usually had a baby anyway. Liz had a baby, too, as a teen-ager. Although she had cheered when the Roe decision was announced, knowing how many lives it would change, it had come too late to change hers.
Cruz, the fifty-one-year-old daughter of farmers, has appraising dark eyes and a booming voice, and is direct by nature. She asked the Old Hippies if they would raise money and buy pills in Mexico that would be distributed across the border. Cruz paused to let an Old Hippie translate for those whose Spanish was weak.
Medication abortion in the United States is typically a two-day process that involves taking mifepristone, which blocks progesterone, and misoprostol, which causes uterine contractions. The Food and Drug Administration approves the use of this two-pill regimen under a doctor’s supervision up until the tenth week of pregnancy. A prescription, which can be obtained in states where abortion is legal, is required. In Mexico, Cruz explained, misoprostol is sold over the counter. Mifepristone still requires a prescription, but Cruz had found suppliers, and when she ran short she relied solely on misoprostol, which can cause an abortion on its own.
Immediately after Dobbs, Cruz said, her existing crew of volunteers had slipped enough medication across the border to help two thousand American women have abortions. If the Old Hippies agreed to aid distributors in abortion-ban states, Cruz told them, Las Libres could help many more women. Each cell in the supply chain would know little about the other cells—safer for everyone that way.
Several Old Hippies wondered aloud about consequences, as the legal terrain was decidedly unsettled. In Louisiana, anyone who “knowingly performs” a medication abortion is subject to a five-year prison sentence and a fifty-thousand-dollar fine. In Oklahoma, it’s a ten-year sentence and a hundred thousand dollar fine. More such laws were likely to come, although no criminal convictions had yet been reported. If charged, an Old Hippie told Cruz, they might end up at the mercy of a district attorney in, say, Mississippi, facing years of jail time. But Liz was an optimist—“You have to be,” she always said—and by meeting’s end everyone in the room had signed on to her plan.
To avoid what Liz called the “gringo price,” she recruited her housekeeper to call more than two dozen pharmacies in San Miguel and find out what they had in stock, at what cost. Then the Old Hippies tried to buy all the pills they could. One pharmacist agreed to sell more than a hundred boxes but cancelled the order at the last minute without explanation. A second pharmacist demanded a prescription for misoprostol, something not required by Mexican law; an Old Hippie had to persuade her doctor to prescribe it for an ulcer, a condition that she didn’t really have but for which the drug was also used. It was a relief when a third pharmacist agreed to sell more than a hundred and fifty boxes with no questions asked.
Many of the pickups were handled by Diana, another Old Hippie, who at pharmacies gravitated to younger female clerks—less judgmental about her purchases, perhaps, than older men. On the day that she unpacked the last of the hundred and fifty boxes on her kitchen counter, she burst into tears. Every box contained more than enough pills for two abortions, and she saw in the stockpile before her hundreds of younger women who would be helped. “All of a sudden,” Diana said, “I realized what we’re all doing.” Those boxes just needed to get to the States, but that part of the relay would be left to others, as Diana, Liz, and other Old Hippies planned their next buy.
Six weeks later, sitting at a long table in a house on a hill in Guanajuato, Cruz counselled a woman in Georgia by phone while responding to a text from Arkansas: “I would like help with a medication.” A window behind Cruz overlooked a lemon grove, and around the table were colleagues—some social workers, some lawyers, most of them young—fielding questions from pregnant women on both sides of the border. The atmosphere was convivial, and taped on one wall was a phonetic cheat sheet for those with limited English: “Jai, dis is Las Libres. Can ay jelp iu?”
Cruz’s work had long been funded by American nonprofits, and after Dobbs the phone number of her organization was passed around by informal networks of activists. Cruz said that she was now getting fifty requests a day from the U.S. for abortion pills. Some women created fake profiles on Instagram to get in touch with her, or sent messages on WhatsApp or Signal, or called her in the middle of the night.
The evasiveness and fear that she sensed when communicating with Americans reminded her of how Mexican women spoke of abortion when she was growing up. Her mother worked on a farm, harvesting corn, and the only way she and her girlfriends alluded to abortion and miscarriage was with the expression malas camas—“bad beds.” Such euphemisms were necessary in part because women in the state of Guanajuato could face up to three years in prison for ending a pregnancy, and so could the medical personnel who assisted them. Before last year’s Mexican Supreme Court decision, abortion, in all cases except for rape, was deemed a criminal act in Guanajuato, where state law presumed that life began at the moment of conception. There is no reliable estimate of how many women died annually from secret abortions; authorities and family members often blamed the deaths on infection or hemorrhage.
In 1995, Cruz had completed training as a social worker and was helping Indigenous farmers improve their crop yields and distribution when, in a coffee shop, she heard an older woman discussing abortion in a way she hadn’t heard in school. The woman, who had attended a United Nations conference on reproductive rights, was speaking about abortion unapologetically, as a matter of public health that disproportionately affected poor women and curtailed their rights. Cruz was surprised, and energized.
Word had been getting out, first in Brazil and then across Latin America, about an expensive American drug that allowed a person to end a pregnancy at home. Manufactured by Pfizer under the name Cytotec and otherwise known as misoprostol, it was available over the counter in Mexico to treat gastric ulcers—to this day, the only use of the drug that Pfizer supports. (“The industry has never been an ally of women’s struggles,” said Raffaela Schiavon, a respected obstetrician-gynecologist in Mexico City.) Cytotec came in boxes of twenty-eight pills. Pregnant women who could afford it consulted other women who had had abortions and calibrated the dosage that would suit their bodies and stages of pregnancy. Some women took four or eight pills orally, and others inserted pills vaginally. When the abortions were done, Cruz had noticed, they’d typically toss out the remainder of the pills—a small fact that would later change the course of her work.
Mexican supporters of abortion rights were, and remain, up against a coalition of conservative politicians and leaders of the Catholic Church. When, in 2000, Guanajuato state legislators voted to make abortion illegal even for rape victims, subjecting them to years in prison, Cruz joined other activists to protest. But she wanted to do more than march on a statehouse—she wanted to make sure that rape victims could still get abortions. She started Las Libres and began asking those who bought boxes of misoprostol for an abortion to set aside the remainder of the pills for women who had been raped. Cruz recalled, “We said, ‘Keep them, and next time someone comes to us you’ll give them the pills and talk about your experience.’ ” The idea was to make abortion not just more accessible but less frightening. A pregnant woman could meet someone who had survived an abortion and gone on with her life. Cruz called the woman who shared her pills and her experience an acompañante—a person who accompanies another.
Eventually, opposition to the new state law became so great that the governor vetoed it, at which point Cruz decided to take her activism a step further and help women in Guanajuato who wanted an abortion for any reason at all. The acompañantes she recruited would bring pills and tips about how to use them, providing comfort and answering questions during the abortion process. Because the acompañante figure did not explicitly appear in Mexican criminal codes, Cruz argued that such a person would be immune to prosecution.
According to Georgina Sánchez, an academic at El Colegio de la Frontera Sur who has researched medication abortion in Mexico, some feminists were skeptical about the acompañamiento model. Ordinary citizens would have to shoulder the state’s responsibility to provide health care to women, and acompañantes would become vulnerable to the whims of authorities. They, and Cruz, might end up in jail. “Me being me,” Cruz recalled, “I told them, ‘Well, you’ll have to get me out!’ ” The way Cruz saw it, women had a moral duty to stand up for one another when the state failed to guarantee their rights.
“At first, women would come to us and say, under their breath, ‘I need an abortion,’ ” Cruz told me. But she began convening meetings in bars and cafés, where she spoke emphatically about abortion as a right to be asserted, not a clandestine affair. “It was our way of saying, ‘Don’t be afraid. You have nothing to be ashamed of,’ ” Cruz said, adding, “There were times when the waitresses would come by afterward and say, ‘How did you say one takes the pills?’ ”
The acompañante movement grew, and so did Cruz’s influence. Working with a team of lawyers, she visited ten jails in the state of Guanajuato, in search of women being held for abortion-related crimes. They found nine women charged with infanticide when circumstances suggested miscarriage or other birth complications. Most of the women had been given sentences ranging from twenty-five to thirty years and had already spent more than four years behind bars. Javier Cruz Angulo, a criminal lawyer who worked with Cruz, said that not all of them could read or write, and that “none of them fully understood why they had been prosecuted.” In 2010, Las Libres finally helped secure the release of all nine women, and Cruz went on to investigate similar convictions in other states.
In those states and elsewhere in Mexico, grassroots organizations were also campaigning for the liberalization of abortion laws. The capital, Mexico City, had already decriminalized abortion, in 2007. After sustained campaigns, the state of Oaxaca followed, in 2019, and in 2021 so did Hidalgo and Veracruz—just before the Supreme Court declared the criminalizing of abortion unconstitutional. “We are all pro-life,” the chief justice, Arturo Zaldívar, said, “only some of us are in favor of allowing women to live a life in which their dignity is respected, and they can exercise their rights fully.” The evening of the decision, which was unanimous, a 7.1-magnitude earthquake shook the capital—to some anti-abortionists, a sign of divine wrath.
In the following months, after S.B. 8 took effect in Texas and Cruz began sharing pills with activists there, she came to understand that she and some of her U.S. colleagues differed in their idea of what being an acompañante entailed. The Americans had been driving people to clinics and helping pay for the procedure for years; now they were planning to travel farther, to states with fewer restrictions. The Mexicans’ experience of aiding women had little to do with clinics. Rather, their model was one that Cruz believed her American contacts would need in the years ahead: a process of aborting that, in addition to being medically safe and effective (as a study of the acompañamiento practice in Argentina and Nigeria, published in The Lancet Global Health, had recently found it to be), also minimized the risk of criminal prosecution. If women avoided doctors and medical establishments and followed the blueprint of Las Libres, Cruz said, “there wouldn’t be a single trace. If the woman getting the abortion kept it to herself, no one would ever find out.”
In the Americas, one of the privileges of advanced age is getting the benefit of the doubt at security checkpoints. The first person to run the Old Hippies’ pills over the border was a gray-maned, soft-spoken Social Security recipient named Rosie. She would pave the way for the second border crosser, an octogenarian.