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New Orleans, United States – The half dozen women gathered in the backyard pause for a moment to listen to the television next door. The neighbour is playing a football game at high volume. It’s loud. That’s good – it gives them cover.
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“I couldn’t hear anything from the sidewalk,” says Ana,* referring to the women’s conversation.
“I think we’re OK,” says another. The rest are reassured.
In a green yard ringed by banana trees, on a breezy September afternoon in New Orleans, Louisiana, the women introduce themselves using code names. They’ve left their phones at home so they can’t be recorded or tracked.
This is a clandestine abortion provision group, formed in the wake of Louisiana’s abortion ban to support those who still, inevitably, need abortion care. The fact of the group’s existence was spread by word of mouth, over secure messaging platforms and mentioned to female friends in low voices over drinks. Now, group members sit in a circle around a small wooden table that holds snacks and seltzer water, talking strategy.
“I bet there are tonnes of groups. I’d love to find them,” says Carina*.
The women, who come from a range of professional backgrounds, are all under 40. They discuss an upcoming virtual training with Paula Rivera*, an organiser from Honduras. A couple of the women, children of Central American immigrants, are fluent Spanish speakers, and they volunteer to translate the training so the English speakers can follow along. Rivera will discuss protocols for delivering safe medication abortions according to World Health Organization (WHO) standards, as well as physical and digital security measures.
They set a plan for where to do the training and agree to use a secure video platform, Jitsi. “I’d never heard of it,” shrugs Ana.
The app is the first tool they pick up from Central American organisers, who have been fighting abortion restrictions for years in their own countries. The knowledge and tactics of these organisers, with their decades of experience, are proving invaluable to those in Louisiana who are fresh to the fight.
On June 24, 2022, the United States Supreme Court overturned Roe v Wade, the 1973 ruling that enshrined the right to abortion care. Abortion bans are now in place in a dozen states across the US, including Louisiana and every state bordering it. Abortion is illegal in Louisiana, with no exceptions for rape or incest. All abortion clinics in the state have closed.
While abortion is theoretically permitted for nonviable pregnancies, in practice, terminations on these grounds have already been denied to multiple women.
While the statute criminalising abortion exempts pregnant women from prosecution, legal experts say this does not offer meaningful protection from determined prosecutors. Those who assist a termination, such as the backyard activists or healthcare providers, risk up to 15 years’ imprisonment. Undocumented women suspected of facilitating an abortion risk both criminalisation and deportation. Lawyers with If/When/How, a network of legal professionals supporting reproductive justice, warn of a worst-case scenario in which people facilitating abortion in Louisiana could now technically be charged with the homicide of someone under 12 – a crime that carries the death penalty in Louisiana.
According to their research on criminalised abortions since 2000, published last August, even in states where laws didn’t specifically criminalise abortion, some women have still been charged under statutes related to the mishandling of human remains or practising medicine without a licence.
In the ban’s aftermath, activists are fighting back. As some advocate for change by challenging the law, others have already begun to form whisper networks, scrambling to organise abortion access. A child welfare worker, who asked not to be named, said advocates in Louisiana are helping minors, pregnant from rape, travel elsewhere for abortions. Non-profits are organising abortion access for Louisianans by post, boat, and even private plane.
And in New Orleans, women are drawing from the tactics of organisers like Rivera in Honduras, one of the most abortion-hostile places on the continent, where abortion has been outlawed since 1982. That is in part because New Orleans is home to the largest Honduran-American community in the US, a legacy of successive waves of immigration – most recently following Hurricane Katrina in August 2005, when an estimated 100,000 Hispanics came to rebuild the stricken city. Abortion is illegal in Honduras, without exceptions, even if there is a threat to the woman’s life.
Women’s struggle to circumvent the ban in Honduras, delivering abortion medication and guidance around safe abortion care, offers a model for the American women now organising under the shadow of the law.
The day that Roe v Wade was overturned, hundreds of protesters took to the streets in New Orleans, marching through downtown.
Near the front of the crowd walked 29-year-old Edith Romero, a reproductive healthcare advocate who advises undocumented people and Spanish speakers on abortion and contraception. Romero came to New Orleans from Honduras about 10 years ago. As the sun set, she stood in front of the crowd on the steps of City Hall, carrying a cardboard sign reading “El aborto es un derecho humano” (“Abortion is a human right”), and took the microphone.
“My name is Edith Romero, I’m from Honduras, and I received an abortion last December,” she told the crowd to cheers of support.
Romero was there as part of Unión Migrante, an organisation for immigrants that works particularly with undocumented people in the New Orleans area by assisting with legal and economic support, reproductive healthcare, and rights education.
Soon after, Romero joined up with the newly-founded Louisiana Abortion Rights Action Committee (LARAC), which aims to build a mass movement to re-legalise abortion. She says she’s drawing from the work of Central American organisers such as those in Mexico who, after years of mass protests and civil disobedience, saw abortion decriminalised in 2021. “It was a lot of people in the streets demanding change and being loud and bold. And the government had to respond to that,” she says.
Romero is also doing outreach in the Latina community. She has found that Honduras’s long-standing ban has contributed to stigma around abortion within Louisiana’s Honduran-American community, which means outreach can be a challenge. “In the Latina community, abortion is so taboo,” she says.
The need for clandestine abortions due to stigma within the Hispanic community was something Cristi Fajardo, 44, founder of El Pueblo NOLA, a grassroots organisation run out of her home, was familiar with before the ban came into place.
Fajardo’s organisation helps Hispanics in New Orleans navigate legal, immigration, and medical crises. “We are the 911 of our community,” she says, referring to her being the first person women often turn to in an emergency.
An imposing woman with red braids, she reports with pride that several neighbourhood husbands are afraid of her. Fajardo originally hails from Brazil, where abortion is also a crime, though most of the people she helps are Honduran. These days, to better support her Honduran neighbours, Fajardo is learning Garifuna, an Indigenous language of Honduras.
Fajardo says more than a dozen women have asked for help accessing abortion since she founded El Pueblo NOLA in 2018. “Some just recently had babies and don’t want to have another,” she says. Others were victims of rape or incest.
Vulnerable and undocumented
Fajardo’s neighbourhood is 98 percent people of colour, and 22 percent live in poverty, meaning women there are made particularly vulnerable by the ban. She has already seen what it means for some community members.
In one case, Beverly, a Honduran mother in Fajardo’s community who was barely 20 and financially stressed, discovered that she’d become pregnant by her cousin. Beverly, who only wanted to give her first name, already had a chronically ill infant to care for, and now feared she would be left homeless. She approached Fajardo about terminating her pregnancy and Fajardo helped her make an appointment at the New Orleans clinic. Before Beverly could have the procedure, abortion was criminalised. Facing homelessness, Beverly moved to New York, where she says she is receiving more substantial state support. Beverly ultimately gave up on seeking abortion care. The child she carried in New Orleans was born in New York in January.
Romero is in frequent contact with undocumented and low-income women, who face higher barriers to healthcare access. Reproductive healthcare access “was already pretty horrible, especially for people of colour and undocumented immigrants. And now there’s no options” for legal abortions in Louisiana, explains Romero, a slight woman with a determined set to her jaw.
Abortion care, like healthcare generally, was hard for undocumented people to access before the ban due to costs, language and transportation barriers, and other restrictions. For instance, Louisiana, like most US states, does not allow undocumented people to have driving licences, meaning that using a car carries the risk of arrest and deportation. A lack of health insurance, finances, and discrimination compound the difficulties of accessing help. This increases the health risks women may face, according to Romero.
“If somebody has a self-induced abortion and complications, they’re going to be scared of going to the emergency room,” she says.
Romero was in part drawn to the reproductive health movement because when she was younger, in Honduras, she saw firsthand what a lack of choice and sexual education meant for women’s health and safety. “Coming from Honduras, you don’t get sex education,” she explains. “I definitely saw a lot of teenage pregnancies in Honduras. Very, very high [rates], and of cervical cancer as well.”
Cervical cancer, whose incidence can be reduced via education and screening, is the leading cause of cancer deaths among Honduran women.
But Romero believes there is a lot to glean “from the [abortion organising] efforts that are going on in Honduras, which is an even more hostile environment for organising” than Louisiana.
Learning from a veteran activist
On an October afternoon, the backyard crew arrange themselves on couches and on the floor, phones absent, to hear Rivera give the training for delivering clandestine abortion care based on strategies developed over decades.
The 60-year-old veteran women’s rights activist is speaking over video from her home in Honduras, occasionally cracking jokes from behind large glasses that soften her eyes.
“What we are doing is politically charged,” she begins, pausing so Ana can translate from Spanish. “But it is absolutely legitimate. Men may make the laws, but we know what we need.”
She sits down, lights a cigarette, and launches into the training. It’s thorough and lasts for three hours. She begins by going over the WHO’s definitions of pregnancy, early-term and late-term abortion. Then she reviews the history of the two medications used for abortion – mifepristone and misoprostol – how they work, and how to use them effectively.
“Mifepristone is not available in Honduras,” Rivera says. When possible, activists acquire it from Mexico, where it is legal. “Mexico is the salvation of Central American countries,” Rivera adds before sharing contact information for her own sources in Mexico who can help secure low-cost, legitimate abortion pills. Carina writes them down on a slip of paper.
The women in the room say that they, too, have an easier time acquiring misoprostol.
“Bien (good),” says Rivera, “Then let’s talk about how to administer an abortion with misoprostol alone.”
Then they cover patient care, contraindications, side effects and follow-up. Next, it’s security protocol: use secure messaging platforms, burner phones, code names and coded language. Ask the patient if they’ve told anyone else they’re getting an abortion, Rivera says, and if they did, come up with a cover story together to explain the pregnancy loss.
Rivera suggests transporting the abortion medication to patients discretely in a Pringles can: “First the chips,” she says, miming the actions while smiling over video, “Then the medication, and then the chips.”
Rivera says she herself learned much of this from organisers in Costa Rica, where abortion is allowed only if the mother’s life is at risk. Before she hangs up, the dozen women squeeze together on the floor in front of the web camera and wave, grinning, with a chorus of “Thank you!” and “Gracias!” as Rivera, smiling, waves back.
A palpable contentment fills the room. The women make plans for the next meeting, then file out, chatting animatedly. Outside, after a month of drought, sorely-needed rain is beginning to fall.
What a lack of choice means
Rivera knows that the fight for reproductive rights comes with risks. She and her Honduran colleagues have been defamed and threatened by hardline religious groups because of their work. Her office has been searched by state authorities, and religious anti-choice groups have tried to infiltrate her network. Lately, her official work focuses on legal advocacy, fighting the ban’s constitutionality in Honduras’ Supreme Court.
Her work providing abortion care is “constitutionally prohibited … it implicates me in a crime … it could lead to many years in prison,” she explains. This is why she is careful to take precautions.
Despite the risks, Rivera and others in Honduras press on because they are keenly aware of how the lack of choice touches all aspects of women’s rights.
“Forced maternity has huge consequences long term, physically, but also economically and socially,” says Rivera, speaking to Al Jazeera over video one afternoon. “It affects their lives as well as the lives of the children born, who might not be welcomed, and who might never experience security in their lives.”
In places where abortion remains illegal, women can lose access to education and career prospects due to forced pregnancy. Most sexually active 15- to 19-year-olds in Honduras said in a national survey that they did not want to have a child in the next two years; half of them will likely give birth by age 20. “This is a really brutal and terrible life change for many of them,” says Rivera.
Criminalising abortions can push people to seek unsafe options.
Neesa Medina, 35, a campaigner with Somos Muchas, a Honduran umbrella organisation of several reproductive justice groups, says dangerous practices happen particularly in rural areas with less access to information and medication. “What we are seeing is people who are doing very harmful practices, like throwing themselves from trees to have an abortion,” she says.
Others “put sharp objects [inside themselves]” – which can lead to infections or more serious complications – or drink unsafe concoctions containing herbs and clay. They do this out of desperation, Medina says, despite the risks both physical and legal. Honduran law imposes jail sentences of up to six years for those who facilitate an abortion. According to an investigation by Somos Muchas, 47 women faced criminal charges for abortion in Honduras from 2006 to 2018.
Honduras offers a portrait of the structural consequences of forced pregnancy, says Medina, who notes that opportunities there are limited and that women’s financial independence and safety are threatened. “It’s no coincidence that countries where you have total bans on abortion are countries where you have higher rates of sexual violence,” she says.
Abortion restriction “creates a social fabric that is so thin for the dreams of liberty of women and girls”, Medina says.
‘We still find ways’
Many Honduran women, who may not know about abortion networks, are forced to turn to the unregulated supply of medication on the black market. Sellers, typically found on social media, are motivated by money – not women’s health, say activists.
Sellers “don’t do the math correctly to calculate how many weeks they [the women] are pregnant. Because they are looking at it as a transaction, not a [medical] service,” says Rivera.
Misoprostol, which is also prescribed to treat ulcers, costs about $6 legally. But “the people who are trying to make money off of this will sell the misoprostol for $60 a pill,” Rivera says. The WHO “designates that someone should take a round of 12 pills. And they’ll sell just one to someone.”
This can result in unsuccessful terminations, she says. Sometimes, women will believe they’ve had a successful abortion only to discover, weeks or months later, that they’re still pregnant. “It can lead to really dangerous situations.” An incomplete abortion can lead to haemorrhage, infection, and sepsis.
Still, clandestine doesn’t have to mean unsafe, activists say.
Well-managed clandestine support groups in Honduras, Rivera explains, provide legitimate and sufficient doses of misoprostol and mifepristone – and ensure women are informed and supported, so they don’t resort to riskier approaches or self-harm.
Rivera says her group does not administer abortions that require clinical settings, such as vacuum aspiration abortions. But with the medication, they can assist patients who are up to 19 weeks pregnant.
When Romero received abortion care in 2021, she wound up translating for a Honduran woman in her mid-40s, who explained that she had self-administered an abortion the previous year, back in Honduras, with misoprostol from the black market. “It caused her complications,” Romero says. “She told me she’d had to go to the ER.”
Medina believes that the formation of covert abortion provision circles like the one in the Louisiana backyard is both inevitable and necessary.
“Even within very, very restrictive environments like ours, we still find ways” to exercise the right to choose, she says, referring to underground networks in Honduras. “Everyone in the [United] States that are seeing their rights being cut back: people there will find a way, too.”
Getting the protocol down
A month after Rivera delivered the training, the backyard crew meets again, at a different home – never the same meeting place twice – to go over what they have learned.
Outside, rain is hammering the papaya trees, but it’s cozy indoors. The women have brought each other food – black-eyed peas and sweet potato fries – and once they’ve settled in, they start to outline a health and security protocol based on Rivera’s guidance, writing in black marker on the back of a paper grocery bag.
Since they’re anxious about putting any information online, it’s all handwritten or passed along orally. Repeating it over and over, they agree, helps them to remember.
Ana reads through her own takeaways from Rivera’s training. “The first thing to say,” she reminds the others, “is to tell the patient that this is very safe. You’re not going to die. You’re not going to be left infertile.”
Cypress* writes it on the paper bag, which the women will later finalise into a protocol. Rivera also told the backyard crew that her group uses a small, portable ultrasound with patients. These are used to check for ectopic pregnancies – a potentially life-threatening condition where the fertilised egg implants outside the uterus – but also as a safeguard against anti-abortion rights activists trying to infiltrate the network by posing as some who needs care. During the training, Rivera had warned the Louisiana women that such people sometimes send fake ultrasound photos, pretending to be pregnant, in order to get incriminating evidence on Rivera and her colleagues.
It was a risk the Louisiana women hadn’t thought of. They discuss whether an ultrasound is in the group’s budget. Ana writes a note to herself: Ask Paula what type of ultrasound they use. Then she turns to Maria*, one of the group’s native Spanish speakers, and asks if she’ll help her to translate messages with one of Rivera’s Mexican contacts.
As they finalise protocols, they exchange notes about recent deliveries. Ana, who provided abortion pills to a 17-year-old over the summer, noted she should have better disguised the medication rather than leaving it in its original packaging. Jennifer*, who recently provided pills to a teacher from western Louisiana, discussed the difficulty of providing care instructions when meeting in a public place.
These unforeseen difficulties, the women agree, are why they need firm protocols and an intake process for patients who approach them. As Rivera explained, “It’s not enough to just be a feminist. You also have to be a very responsible person, because we’re dealing with people’s health.”
‘We have to keep fighting’
“When the [Roe v Wade] ruling came through, I felt helpless,” says Jennifer, at a cafe sidewalk table in New Orleans shortly after Rivera’s training. “I was – and still am – very angry. So it felt really good to just be like, ‘F*** all of this. I’m doing something.’”
Jennifer says she appreciated how clear and careful Rivera was in her training. “That gave me great comfort. This person has been doing it for so long.”
Jennifer was also fortified seeing Rivera’s approach, which she described as “DIY” (do it yourself). “The sense I got from her is that she was similar to me. Just a person who was like, ‘F*** this. I’m going to do, going to learn, whatever it takes” to ensure people have access to abortions. That perspective “made me feel stronger,” Jennifer says.
Rivera, for her part, is gratified to see women in the US take up the mantle. “We have to keep fighting,” she says at the end of a video interview, stubbing out a cigarette. “Those of us that were born with that right, we have to make sure we get it again.”
Medina has lived her whole life in Honduras without legal abortion, but says, “I speak to you from a place of hope.” She is strengthened by the work going on around her. “Networks save us. Feminists around the world save us. Women around us save us.”
A representative of Lift Louisiana, a reproductive justice non-profit, said they do not expect abortion to be decriminalised in Louisiana barring action at the federal level. Louisianans can expect abortion to be illegal for years.
Speaking to Rivera, Jennifer felt her years of experience “coming through”.
“It made me realise, in a deep sense: this is not going away. This is going to take a long time,” Jennifer explains. Still, she is optimistic.
“We’re on the very beginning of something,” she says, “and we can really make it work.”
*Name has been changed at the interviewee’s request.
Reporting for this story was supported by the International Women’s Media Foundation’s Reproductive Rights Reporting Fund.