Nos tenemos entre nosotres
Self-Managed Abortion, Ways of Knowing & Legacies of Care
May 31, 2024
For centuries women were doctors without degrees, barred from books and lectures, learning from each other, and passing on experience from neighbor to neighbor and mother to daughter. They were called “wise women” by the people, witches or charlatans by the authorities. Medicine is part of our heritage as women, our history, our birthright.
—Barbara Ehrenreich and Deidre English, Witches, Midwives & Nurses1Barbara Ehrenreich and Deirdre English, Witches, Midwives & Nurses: A History of Women Healers, 2nd ed. (1973; New York: Feminist Press, 2010), 25.
In the nearly two years since our constitutional right to abortion was overturned in the United States, calls have echoed far and wide for underground networks of care à la the Jane Collective, the pre-Roe Chicago group who helped people access abortion by learning to provide it themselves. Just as in the time before Roe v. Wade (which enshrined our right to abortion in the constitution), networks of care are still doing more for people’s access to reproductive health than any government service. Abortion funds are helping people navigate and pay for the still-too-high costs of abortion procedures and related logistics (such as travel, childcare, and hotel stays, particularly when crossing state lines).2See the National Network of Abortion Funds, abortionfunds.org. Mifepristone and misoprostol, also known as the abortion pills, are being distributed and mailed throughout the country, especially to regions with restrictions.3It is worth mentioning that the abortifacient properties of misoprostol, which was originally formulated, used, and marketed in the 1980s to treat gastrointestinal issues like stomach ulcers, were first generalized by Brazilian midwives. Clinics are being defended from the harassment and invasions of emboldened anti-abortion groups, and fake clinics are being exposed as sites of medical misinformation and of emotional and financial coercion.4“What Is Clinic Defense?” NYC for Abortion Rights; Expose Fake Clinics, exposefakeclinics.com.
But this is nothing new. While Dobbs v. Jackson has shifted the terrain for abortion access in the United States, the work of activists in this period is not historically unique. Not only did underground networks never go away after 1973, the year Roe passed, but the frameworks of care, community health, and acompañamiento (accompanying people through their abortions) of many of today’s reproductive justice groups are tied to rich, centuries-old legacies of community health practices and Indigenous ways of knowing.
As Daena Horner, clinical herbalist and creator of Holistic Abortions, reminds us, for most of human history, birth and death took place in the home—and abortion is no exception.5See Holistic Abortions, holisticabortions.com. For centuries, people practiced abortion together, often using plants and the elements around them. These practices, rituals, and knowledge were passed down through families and cultural traditions over generations, and embedded in the social fabric of people’s lives.
In the United States, enslaved Black women used birth control and abortion methods as a form of resistance against slavery—a refusal to bring new life into such oppressive conditions, especially as many pregnancies were the product of rape by white masters. “Plantation owners tried to withhold knowledge of birth control and abortion from both slaves and white women to maintain the caste system of white male supremacy used to justify slavery. Black women’s fertility increased the owners’ labor force and property value,” details Loretta Ross. The midwifery culture among enslaved Black women “maintained centuries-old African folk knowledge about contraceptives (pregnancy preventers) and abortifacients (pregnancy terminators),” while also adapting to their new environment, as evidenced by their discovery and harnessing of the abortifacient properties of cotton root bark.6Loretta J. Ross, “African-American Women and Abortion: A Neglected History,” Journal of Health Care for the Poor and Underserved 3, no. 2 (fall 1992): 276; Jennifer L. Morgan, Laboring Women: Reproduction and Gender in New World Slavery (Philadelphia: University of Pennsylvania Press, 2004).
Colonization, genocide, medicalization, and criminalization have all contributed to both the targeting of and violent attacks on traditional knowledge, practices, lineage holders, and healers. In Europe around the thirteenth century, the rising medical profession, shaped by Catholic doctrine, actively eliminated female healers, whom they deemed witches.7The Malleus Malificarum, the popular fifteenth-century treatise on the “evils of witchcraft,” often associated witches with midwifery, proclaiming that “no one does more harm to the Catholic Church than midwives.” Women were accused of “infect[ing] with witchcraft the venereal act and the conception of the womb” through numerous methods, including by “destroying the generative force in women” and “procuring abortion.” While the newly professionalized European “doctors” had little actual knowledge about the body and its functioning—even using dangerous practices such as bloodletting—community healers and midwives had developed an extensive understanding of bones, muscles, herbs, and more.
This assault on medicine women was then repeated in the context of the white European settlers’ invasion of the Americas. These attacks explicitly targeted Indigenous healing and ways of knowing, as traditional healers, midwives, and medicine women were highly respected and integral to community life. For example, Spain and the Catholic Church identified Nahua women titiçih (healers/physicians/midwives) as a threat to its attempts to convert Indigenous communities to Catholicism, calling them “swindling physicians.”8Edward A. Polanco, “Tiçiyotl and Titiçih: Late Postclassic and Early Colonial Nahua Healing, Diagnosis, and Prognosis,” in Oxford Research Encyclopedia of Latin American History (Oxford: Oxford University Press, 2019); Edward A. Polanco, “‘I Am Just a Tiçitl’: Decolonizing Central Mexican Nahua Female Healers, 1535–1635,” Ethnohistory 65, no. 3 (2018): 441–63.
Over two centuries later, in 1847, the American Medical Association was founded. Up until the mid-1800s, there were no restrictions on abortion before quickening (when the pregnant person began to feel the fetus move, usually between the fourth and sixth month of pregnancy). Pregnancy terms were not dictated by doctors, but by the pregnant person’s relationship to the fetus. Soon after the American Medical Association’s founding, it started simultaneous campaigns to criminalize abortion and to require licensure to practice medicine. Together, these multi-decade campaigns pushed women, Black, and Indigenous practitioners—particularly midwives and other full-spectrum birth workers—out of medicine. These efforts relied on and perpetuated racist, xenophobic, and eugenicist narratives that deem some unfit for reproduction while encouraging others.
It is no surprise then that Roe did not eliminate healthcare inequalities, guarantee universal access to reproductive health services, or extinguish the needs and desires to access abortion care outside professionalized medicine. For many people, while Roe remained legally intact, abortion remained largely out of reach despite the popularly repeated mantle of “choice.” Poor and working-class people still faced exorbitant financial strains, as the Hyde Amendment prohibited the use of federal funds for abortion-related services, banning medicaid recipients from any financial coverage. The dearth of abortion clinics in many states, especially in the South, meant that undocumented people often had to choose between risking a border checkpoint and carrying an unwanted pregnancy.
This assault on medicine women was then repeated in the context of the white European settlers’ invasion of the Americas. These attacks explicitly targeted Indigenous healing and ways of knowing, as traditional healers, midwives, and medicine women were highly respected and integral to community life.
Women’s different capacities to take time off work, to afford childcare, to travel, to get around abusive partners, and on and on—all the realities of making abortion care happen—compounded with other existing inequalities to create a crisis of reproductive healthcare for many, especially people of color and poor, working-class communities. As Lizzie Chadbourne writes, “the anti-abortion right wing strategically chipped away at abortion rights through state and federal legislation that made it difficult if not impossible for clinics to remain open and for patients to access abortion care. Throughout the decades of constitutional protections for abortion, countless pregnant people were forced to remain pregnant against their will as a result of barriers to accessing abortion.”9Lizzie Chadbourne, “History Shows Community Solidarity Is Essential for Making Abortion Accessible,” Truthout, January 2, 2024.
In the nearly fifty years that abortion was constitutionally legal in the United States, people across the country self-managed their abortions outside of medical establishments through methods including medication (pills), manual procedures (such as aspiration procedures), and herbs—just as they did before 1973 and just as they do now. At present, more than half of all abortions in the United States are induced with pills, both in and out of clinics.
As many activists argue, self-managed abortions are overwhelmingly safe (abortion pills are safer than many other popular medications, such as viagra, penicillin, tylenol, and xanax), and reduce barriers to care while increasing reproductive and bodily autonomy. They are one of the easiest ways to safely self-manage abortions in places with bans or where people are unable to go to a clinic to receive abortion care. Even in places where abortion is legal, the self-managed route can be preferable for those who would like to have their abortion at home (or some other place in which they feel safe) and with people they trust. Self-managed abortion also provides alternatives for communities who have often been neglected and harmed by medical institutions, including through experiences of medical racism, forced sterilization, and transphobia. Self-managed abortion helps destigmatize the procedure itself, wresting it from the purview of medical expertise and putting it in the hands of communities. Nos tenemos entre nosotres.
The idea that “our fight for abortion access is most effective when based on values of bodily autonomy and community solidarity, and when carried out by autonomous, grassroots networks of people whose work is informed by lived experience,” as Chadbourne puts it, is neither new nor limited to the United States.10Chadbourne, “History Shows Community Solidarity Is Essential for Making Abortion Accessible.” Groups in Latin America, where abortion is broadly illegal, have been at the forefront of this approach.
In 2000, the Mexican state of Guanajuato outlawed abortion in cases of rape, resulting in a coordinated wave of protests by feminists that created enough political pressure to overturn the bill—a victory that marked the beginning of the feminist collective Las Libres. For over two decades, Las Libres has fought on every front—from the streets and the courts to hospitals and rural communities—for women’s self-determination and agency over their own bodies, lives, and futures. Not only does the group accompany people through the process of abortion at home, but it has also built defense strategies for people facing abortion-related legal charges; developed educational materials for rural, Indigenous, and poor people on sexual health, violence, birth control, and abortion; advocated for legislation against gendered violence and femicide; carried out research projects on abortion access; coordinated protests and media campaigns; and translated their resources into at least six languages. The group’s founder Verónica Cruz Sánchez explains that they found themselves
specializing in everything relevant to abortion—in law, medicine, and society. We started all of this in Guanajuato, but now we work practically across the entire country.… We adopted a protocol: A woman would receive a single dose of four pills, administered intravaginally, and we would tell any woman who wanted to help others to keep the rest of the pills so that when the next woman came along she could give them to her. Most importantly, she would be able to share her own experience. Imagine a woman who is terrified of what might happen to her who hears that someone who has just gone through it is going to accompany her and support her; it’s like, “Well, if she is okay, then I will be okay too.”
That is what really started generating these networks of solidarity. They were not made up of feminists, they were not collectives, and they were not formed by the kinds of organized groups we know now. The first networks were made up of women who had experienced an accompanied abortion. They returned and said, “I want to give back.”
From there it became obvious that this was a political movement, and that this momentum is what would decriminalize abortion. Rather than waiting around in the hopes that one day lawmakers would decide to do us the favor of legalizing abortion, we knew that women are here and ready to face many problems for which concrete solutions are to be found in solidarity.11 Elizabeth Navarro, “An Abortion Network That Works Mexican Feminists Helped Each Other Get Abortions—Now They’re Helping the U.S.” Lux 5 (summer 2022).
In 2021, relentless feminist resistance to bans in Mexico achieved the impossible: the Supreme Court unanimously voted to legalize abortion, declaring the criminalization of the procedure unconstitutional. To win a demand like the legalization of abortion on such a scale, the state has to feel that it is in its own interest to concede to our demands—that we don’t need anyone but ourselves and that they need to give us what we want in order to remain relevant.
Self-managed abortion helps destigmatize the procedure itself, wresting it from the purview of medical expertise and putting it in the hands of communities.
In Argentina, networks of abortion acompañantes, called socorristas, played a similar role in winning the legalization of abortion in December 2020. Even after abortion was legalized, networks of socorristas remained important groups of support, showing that community health practices can be sites of reciprocal learning and teaching outside of institutionalized medical education and establishments. By moving beyond conventional notions of expertise, knowledge, and professionalism, these networks model alternative dynamics to the unidirectional power imbalances of doctor-patient relationships— especially because doctors, driven by their own interests (such as fear of having their licenses revoked), are often the ones who report patients to legal authorities for illegal abortions (both confirmed and suspected), or even miscarriages.
This re-envisioning of care and education is exemplified by the way that acompañantes and pregnant people in the Argentinian context have learned from and taught each other about the complexities of self-managing abortions in the second trimester. In Argentina, abortion is only legal up until fourteen weeks of pregnancy, or the start of the second trimester. Abortion past the fourteenth week entails physical particularities to be navigated: the different dosages of misoprostol, the concrete materiality of the expelled fetal tissue and placenta, disposing of the expulsion, and sometimes even cutting the umbilical cord. In a socorrista research study about medication-induced abortions in the second trimester, Ruth Zurbriggen, Nayla Vacarezza, Graciela Alonso, Belén Grosso, and María Trpin outline many of the stark contrasts between the experiences of those self-managing at home and those aborting in hospitals.
In cases of second-trimester abortions in hospitals, the interviewed patients tended to recount their experiences using technical medical language and foreground the recommendations, actions, and decisions of the attending medical professionals. When abortions happened at home, people highlighted their protagonism in the decision-making processes. They narrated “the wait, the calls to the socorristas, the decisions about the course of action to follow, and the cooperation of the people accompanying them (their mother, friend, daughter, sister, cousin, partner). The instance of an at-home expulsion requires practical decisions and diligent actions.” One woman talked about her decision to cut the umbilical cord despite the fact that socorristas explicitly do not recommend the practice. “I felt something fall and, when I looked, it was the fetus with the umbilical cord. It was stuck hanging there, right? So I called my cousin, desperate and crying.… Okay, okay, stay calm, calm down… everything’s going to be okay, I’ll come bring you scissors. She went to get the scissors, disinfected them, gave them to me, and I cut the cord.”12Ruth Zurbriggen, Nayla Vacarezza, Graciela Alonso, Belén Grosso, and María Trpinth, El aborto con medicamentos en el segundo trimestre de embarazo: una investigación socorrista feminista (Buenos Aires: La Parte Maldita, 2018), 135–40. Author’s translation. The woman’s testimony showed not only the conditions in which many people self-manage their abortions, but also how they are ultimately the ones who make the decisions about their own bodies and processes. As the researchers illustrate, “They go to socorristas looking for help, but they don’t always follow their instructions. They decide autonomously how to proceed, and make use not only of what the socorristas tell them, but also of other available knowledge and experiences from their social circles. The case of [the woman who cut her own umbilical cord], like other similar cases, affirms that these decisions taken in situations of extreme precarity and subjective demands can be successful. Despite everything, they can do it and, in fact, they do it.”13Zurbriggen, Vacarezza, Alonso, Grosso, and Trpinth, El aborto con medicamentos en el segundo trimestre de embarazo, 140. Author’s translation.
All of these networks of reproductive care and solidarity—US networks and abortion funds, Las Libres, and the Argentinian socorristas—are contemporary iterations of much longer histories of managing our own health with autonomy and in community, of learning from and teaching one another about our bodies and cycles. The anti-abortion right and liberal “pro-choice”-ers alike often invoke the past to misrepresent the history of abortion, framing it as either a modern phenomenon or an act forever looked down on—or, contradictorily, both at once. Supreme Court Justice Samuel Alito, for one, incorrectly argued in the draft majority opinion used to overturn Roe that “an unbroken tradition of prohibiting abortion on pain of criminal punishment persisted from the earliest days of the common law until 1973.”14Leslie J. Reagan, “What Alito Gets Wrong About the History of Abortion in America,” Politico, June 2, 2022; “Read Justice Alito’s initial draft abortion opinion which would overturn Roe v. Wade,” Politico, May 2, 2022. In reality, abortion has been both understood and respected throughout history, across places and cultures. Before abortion could be legalized in the twentieth and twenty-first centuries, it had to be made illegal in preceding centuries. It is as much a mammalian reality as pregnancy itself.
Some have argued that overly focusing on abortion care networks and communities detracts from demanding things from the state (that is, our right to abortion codified into law), but as Latin American activists have shown, we cannot do one without the other. We cannot counterpose the building of mass movements for legalization and the building of independent infrastructures that provide direct material and affective support. The idea that somehow we will be able to do the former without talking about the specificities of abortion and without engaging with and helping people seeking abortions is a failing strategy. People join the movement and their ideas change through personal experience and collective struggle; their horizons about what is possible are raised. Colonialism, white supremacy, gendered violence, medical and criminal institutions, and all systems of oppression have come together to rip the most integral events of life—pregnancy, abortion, death—from our control and our care, and then turned around to convince us that they should be handled by “experts,” by not-us. We’re taking them back. Our ancestral ways of knowing, our legacies of care, our history are the future.15This is a paraphrase and expansion of the title of a book by Nick Estes, Our History Is the Future: Standing Rock Versus the Dakota Access Pipeline, and the Long Tradition of Indigenous Resistance (New York: Verso Books, 2019).
This essay originally appeared in Spanish as “Nos tenemos entre nosotres: aborto autogestionado, formas de saber y legado de cuidados” in Esferas 15 (2024): 71–78.