In too many countries around the world, abortion is criminalized, stigmatized, or otherwise restricted. Although pregnancy termination is one of the most common experiences people have across the globe, reproductive rights are often ignored by local health, community, or legal systems. In response, women have advanced incredibly innovative strategies for challenging the system and meeting their own needs. This women’s history month, it’s time we honor the contributions of the international “sheroes” who have been leaders on spreading information about the use of pills to safely terminate a pregnancy.

The use of misoprostol—a pill available over-the-counter in many countries—as a safe, low-cost, and easy-to-use method to terminate early pregnancies is a shining example, to me, of women “doing it for themselves,” as the Eurthymics once put it. Self-use of misoprostol for abortion began in the 1980s, when women in Brazil living under criminal abortion laws realized they could take advantage of the contraindications of an otherwise readily available drug. The label on Cytotec (the brand name for misoprostol), a medication sold over-the-counter to treat gastric ulcers, included a warning that it might induce abortion in pregnant women. Recognizing that this could serve their needs when faced with an unwanted pregnancy, women began to pass on this knowledge through word of mouth, person-to-person. In later years, they used new technologies—such as hotlines, mobile phone texting, and the Internet—to continue to spread the information. Effectively organizing informal networks, they thus enabled more and more women with the knowledge of how to safely end unintended pregnancies on their own terms.

Even abortion providers in those countries have reported learning about misoprostol’s abortifacient properties from local people, not vice versa. My colleague at Ipas, Virginia Chambers, interviewed more than 25 Latin American providers, researchers, and activists several years ago in an effort to learn more about the history of misoprostol use in Latin America. Chambers found:

Respondents recalled that in the late 1980s medical professionals began observing women coming into the hospitals for treatment of incomplete abortion with abnormal symptoms. In some places, its use seemed to be confined to a geographic region and/or an at-risk population, such as adolescents, commercial sex workers, or women living in poverty … But respondents agreed that women did not learn about misoprostol abortion from doctors or scientific sources; rather that it was the other way around,” she noted.  

In the words of one OB-GYN respondent, “It was as though women started teaching us that there was this way of inducing abortion.”

Because misoprostol’s effects mirror that of spontaneous miscarriage, it isn’t easily detectable. This is an advantage for people in nations where attempting to self-induce an abortion or using misoprostol in this way is against existing laws.

Since the 1980s in Brazil, word has spread widely across borders and continents, and we now have global evidence that women are informing others about how to safely use misoprostol to induce abortion in countries where the procedure is unavailable or restricted. In Ghana, for example, abortion is legally available in only some circumstances, such as to save the life of the woman or to protect her mental or physical health. There, people have begun to take Cytotec to induce abortion and then go to the hospital, where post-abortion care is free. “The word has gotten around and in fact, it has actually saved women’s lives,” said Ipas Ghana Country Director Dr. Koma Jehu-Appiah. 

Around the world, women have continued to promote this and other reproductive health information in a variety of ways, including in the workplace, via mobile health platforms, and on interactive websites. Because safe abortions are restricted, criminalized, or non-accessible for so many people, these grassroots efforts are both lifesaving and life-affirming.  

Now that’s history. That’s woman-to-woman, sisters doing it for themselves. These women, our sheroes, are among the drivers of some of the most innovative approaches to the biggest issues of our time.

We, as advocates and activists, can continue to support women’s rights and our unsung sheroes by: 

• Trusting women to know what is best for them;
• Connecting women to meet their needs through a foundation of networks like Las Libres, Likhaan, and other hotline programs;
• Supporting innovation and making sure individuals have adequate information through hotlines, the Internet, mobile health strategies, and community-based pharmacies;
• Bridging pro-women, pro-choice, and pro-reproductive justice movements across regions and countries, like Inroads and other networks do;
• Helping to expand options: Brazilian groups and activists led to bringing misoprostol into the mainstream, as evidenced when the French government developed RU-486 and when the World Health Organization revisited its definition of abortion safety.

Since last year’s Women’s History Month, thousands of women have died and millions of others have experienced injuries, stigma, and discrimination because their most basic rights to life, to good health, and to self-determination are being undermined. 

That too, unfortunately, is history. Isn’t it time that we build the global political will to really uphold all people’s reproductive rights?