Inside Honduras’s abortion pill black market
Getty ImagesHonduras's first woman president, Xiomara Castro, campaigned on a promise to overhaul the country's super-restrictive policies on female reproductive rights within 100 days in office. A year later it's been announced that the morning-after pill will be legalised - but in cases of rape only.
Laura meets us in the hour after sunset, as the last of the day's light is quickly fading.
She's 25 years old, two months pregnant, and not ready for a child.
"Two months ago, I went out and met someone. I was not careful, I got pregnant," she says, wincing. "It has been hard for me because I live alone. I am my own support."
She stops to watch a stray dog approach the bench we are sitting on in downtown Tegucigalpa, the capital of Honduras, a Central American country with some of the strictest female reproductive rules in the world.
The morning-after pill was banned from 2009 until earlier this week - it is now going to be made available to women who have been raped. Abortion remains punishable by up to six years in prison, even in cases of rape or incest.
But Laura has heard about a prescription drug for stomach cancer that people are taking to end pregnancies. When inserted vaginally, it causes heavy bleeding of the uterine wall, and ultimately an abortion.
She plans to buy these pills through a drug dealer called José, who she says is well-known to people her age in Tegucigalpa.
One evening we accompany José to a pharmacy to pick up the drugs for a client. As the smell of his cologne fills the car, he tells us that an ex-girlfriend who works at a hospital has provided the prescription.
He says he changes his price according to the customer's financial situation. The most he has charged is 7,000 lempira (£230), though he may go as low as 1,500.
He lists his customers on his fingers.
"Students, girls who are just starting their sex life, mature and older mothers, women who became pregnant after an affair... They are mostly women. The men often don't take responsibility."
José says he also sells the morning-after pill but has far fewer clients for it, as there is a pharmacy in Tegucigalpa well-known for selling it illegally. We confirm this by going there and buying it for 230 lempira (£7.50).
A UN working group estimated last year that there are between 51,000 and 82,000 unsafe abortions in Honduras each year, and José says he is always busy.
When challenged, he says he knows what he's doing is illegal and admits he has no medical training. But he says he's providing a service, and names some high-profile clients. His customers trust him, he adds, and sometimes even ask him to insert the pills.
"Since they are inserted two orally and two vaginally, they prefer to have someone who knows how to do it. They ask me for the favour."
He says he also provides rehydration salts to help women recover from the bleeding.
At Honduras's largest public hospital, Hospital Escuela in Tegucigalpa, women often arrive with complications from bleeding caused by the drug that José and other black-market dealers supply.
About 60 women are treated there each week after losing a pregnancy, either because of induced abortion or miscarriage - the hospital doesn't keep separate records.
Staff there also see many 15-to-17-year-olds, who arrive for pregnancy tests. Honduras has the highest rate of teen pregnancies in Central America and more than twice the global average, according to the UN's 2020 World Population report.
Doctors say that it is frustrating that they can do nothing to help when the pregnancy is unwanted - or even when a pregnancy endangers the mother's life.
Jinna Rosales of Accion Joven, a group that supports young people, says it's the poor provision of sex education and the prevalence of gender-based violence that lies behind many of these pregnancies, and the risky abortions that sometimes result.
"If a woman has an abortion in Honduras, it is not her fault, it is the fault of the state because it does not provide the resources to prevent these situations," she says.
She says it's understandable that there is opposition to the legalisation of abortion in a country where 43% identify as evangelical Christian and 38% as Roman Catholic. But the morning-after pill, which is accepted by the World Health Organization as a form of contraception, ought to be less controversial, she argues.
Young activists from an online collective called Generation Celeste - which describes itself as For Life, For Family, For Freedom of Honduras - disagree.
Jorge, whom we meet with fellow activist Alma in a hotel cafe, says the morning-after-pill acts in three ways, one of which prevents a fertilised egg from becoming implanted in the uterine wall.
The way Jorge and Alma see it, this makes the morning-after pill a form of abortion, even though this idea is rejected by medical authorities such as the World Health Organization and the Royal College of Obstetricians and Gynaecologists.
Jorge said he based his view about the way the pill works on information from the US Food and Drug Administration (FDA), but at the end of December the FDA updated its advice to say "evidence does not support that the drug affects implantation".
In the wake of the US Supreme Court's decision to overturn Roe v Wade, BBC Gender and Identity correspondent Megha Mohan meets the women buying black-market abortion pills in Honduras, the men profiteering from them and the doctors dealing with the fallout.
In November 2021, Honduras held its first democratic elections since a military coup in 2009. The winner was Xiomara Castro, who became the country's first woman president on a promise to make abortion legal in some cases - including rape and when a mother's life is at risk - and to make the morning-after pill legally available to all women.
She said she would do this within 100 days of taking office in January this year.
But women's rights groups tell the BBC that while they have been invited to discussions with the president, there have been no signs yet of any change to abortion laws.
The promised change with regard to the morning-after pill has also failed to materialise. On 6 December the Ministry of Health announced that the pill would be made legal again for the first time since the 2009 coup - but only in cases of rape. It must be administered by a doctor at a hospital.
Tess Hewett of Doctors Without Borders in Honduras called the move "a major step in ensuring the availability of vital and urgent care for thousands of women in Honduras", but said it should not be limited to victims of sexual violence.
"The next immediate steps must be to ensure that the emergency contraceptive pill is available to all who need it," she added.
President Xiomara Castro declined an interview with the BBC, but Health Minister Dr José Manuel Matheu agreed to speak to us as the legalisation of the morning-after pill was being prepared.
We asked why he was only making it available for women who had experienced sexual violence.
"We are not going to promote the morning-after pill as contraception, so that there is sexual debauchery," he said. "I use precise words: we are going to use the morning-after pill for rape victims only. For those who have irresponsible sex - let them take the consequences."
Women like Laura, who got pregnant through consensual sex but would struggle to look after a child on her own, would not be eligible.
She says she understands the risks of taking José's pills.
"They say that an [illegal] abortion is three times more painful than a normal birth," she says, shivering.
"I can't be sure that I won't die, but I have no other way out. I know that abortion is illegal, but if I am given the opportunity I'll take it."
Laura and José are pseudonyms
Update 11 January 2023: On 23 December 2022 the FDA changed its position on the morning-after pill. The story has been updated to reflect this.
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