CARACAS, Venezuela — With a flick of the wrist, Beatriz pulled out two strips of birth control pills from her top.
Contraceptives are in short supply in Venezuela, with most pharmacies sold out, so it’s largely up to black marketeers like Beatriz to supply women with them. And despite their exorbitant price tag — on the street, $1 gets you a month’s birth control, but that represents a week’s salary — the pills remain highly sought after.
This black market is soaring in Petare, a sprawling working-class neighborhood in the capital city of Caracas, where all manner of counterfeit goods are for sale. Sitting on the curb, Beatriz, 27, explained how to take the pills, sprinkling the instructions with unsolicited sexual advice.
“Keep your man happy, you know, please him,” she said. Oh, and “just don’t forget to take it every day at the same time, or else you’re in trouble.” The trouble she was referring to — an unwanted pregnancy — is becoming ever more common in Venezuela, where a condom cost two days’ worth of the minimum wage.
The current economic and political crisis in Venezuela, which has seen the embattled president Nicolás Maduro become increasingly authoritarian, is pushing women to make hard decisions about their bodies. With many parents here sending their children to bed hungry or joining a growing exodus across the continent, these decisions can often be life-threatening. Without access to proper health care, women are forced to undertake abortions, which are illegal and punishable with up to two years of jail time in this majority Catholic country. Some women are even doing them at home — often on their own.
A teenage pregnancy crisis had been growing for years, but deteriorating conditions inside the country have turned it into an emergency. Last year Venezuela ranked number one in South America alongside Bolivia, according to the World Health Organization. Infant and maternal mortality rose 30% and 65%, respectively, between 2015 and 2016, according to the latest available data from the Health Ministry.
Anxious about the lack of medical supplies, thousands of pregnant Venezuelans are trekking across the border into Colombia to give birth, overwhelming the hospitals there.
But for the majority, leaving the country is not an option, and often, neither is protecting themselves during sex.
The number of abortions in Venezuela has grown in recent months, according to workers at family planning clinics and women’s rights advocates. It’s impossible to know the true figure, because the constitution forbids abortions, and the government does not keep numbers. But dozens of interviews with doctors, activists, and women revealed a growing abortion crisis, in which women often end up in hospitals with severe complications. And no one knows the number of women who have died from botched abortions.
“Women can no longer control their reproduction,” said Magdymar León, head of the nonprofit Venezuelan Association for Alternative Sexual Education, known as Avesa. “It’s a critical situation.”
Beatriz, who has two daughters, and has been on birth control for years now, knows this well. She had an abortion six years ago, and despite taking all the precautions afterward, found herself pregnant again last November. As soon as she found out, Beatriz worked extra hours to make enough money to buy the pills she would need to carry out an abortion herself.
Two weeks later, she was in the emergency room, fighting for her life.
Beatriz’s two abortions came at very different times in Venezuela’s recent history.
Six years ago, when she got pregnant shortly after having her second daughter, her biggest concern was the stigma of getting an abortion. Back then, Maduro’s predecessor, Hugo Chávez, was still alive, and the socialist revolution he launched — buoyed with oil money — provided the working class with the basics, even allowing a luxury here and there.
Attitudes toward abortion, however, were not as generous. Sitting in a restaurant near where she works earlier this month, Beatriz recalled not wanting to tell anyone at the time, fearing her family’s judgment. If women are held to a sexual double standard the world over, it’s especially so in Venezuela, where girls are often expected to start having sex during puberty but getting pregnant at an early age is considered an embarrassment for the family.
Beatriz, 21 at the time, was three-and-a-half months pregnant from a man she said was a malandro, or a thug, when she found out. Afraid about possible complications, Beatriz went to her mother’s house, but did not tell anyone except a cousin what she was about to do.
Once there, she drank as much chamomile tea as she could — Beatriz had heard that hot liquids would soften the uterus — and inserted several pills in her vagina while lying down in bed.
The pills, called misoprostol, are approved by the FDA to treat gastric ulcers, but many women use them to carry out abortions when they don’t have any other choice. The FDA warns that abortions done with the medication “may be incomplete.”
After drinking the tea, Beatriz waited.
The pain soon became intolerable, forcing Beatriz to suppress her screams as she sat on the toilet, watching the blood accumulate in the bowl. Beatriz’s cousin cut her umbilical cord when the time came.
Back then, it was a gruesome ordeal. Now, years into the economic crisis, such abortions are not only frightening and dangerous, but also so expensive that they often leave the women penniless.
One misoprostol pill cost 20,000 bolivares ($5.70) earlier this month, which is more than the monthly minimum wage. To end a four-week-long pregnancy, women need around five pills, according to Beatriz. Even if they can afford it for now — inflation is expected to hit 10 million percent this year — women must go to extreme lengths to find the medication, with shortages leaving pharmacy shelves empty more often than not.
“The situation in the country doesn’t allow us to support one more child,” said Beatriz, who asked to be known by her middle name because she risked jail for having performed an abortion on herself.
Venezuela has been in a rapidly worsening downward spiral for four years, with the Maduro government stripping the opposition of its powers, stacking state institutions with allies and securing a second term in office amid claims of fraud. After the head of the opposition, National Assembly President Juan Guaidó, proclaimed himself president last month, former government supporters turned on Maduro, confronting him with an unprecedented challenge. Many in the country are now holding their breath to see what happens next.
Women’s rights activists want the law criminalizing abortion to be overturned, but little is getting done amid the ongoing crisis. Attempts to get the bill debated by the National Constituent Assembly have gone nowhere, and abortion remains legal only when the mother’s life is in danger, making it one of the most ironclad restrictions in Latin America.
Yuraima Martinez, who works at a family planning clinic in Caracas called Plafam, said that, despite the ban, they had received a record number of requests for abortions during the last two weeks of January. Thirteen of the 20 women who Martinez said were seeking abortions were motivated by “economic” reasons, because they couldn’t support a child.
“This is not something we had seen before,” Martinez told BuzzFeed News, adding that there is another new trend emerging: childless men asking for vasectomies. She saw 12 cases in her clinic last year, many of whom “said that they did it for economic reasons.”
Despite everything she went through, Beatriz is one of the lucky ones. As she recounted her first abortion, one of her friends, Krisbell, sat quietly listening nearby. Her sister, Krisbell said, was four months pregnant, and wanted to have an abortion. She couldn’t pay for the pills she needed, though, and might end up with a child she can’t afford to raise.
Beatriz did all she could to stop herself getting pregnant again. Last October she bought some medication on the black market that would protect her against pregnancy for the next three months. Carrying the box in her purse, she went to the nearest Plafam clinic to have it injected by a nurse.
Beatriz said she and her partner have sex every day. It’s one of the few remaining pleasures in her life, but she also worried about her boyfriend’s reaction if they didn’t have sex. “El se arrecha” — he gets very angry — she said. The one-room house where they live with her children fits two single mattresses, a tiny table for an old TV, and a couple of gas canisters — making it difficult for the couple to get any privacy.
A month after she had the injection, Beatriz noticed she hadn’t had her period. A pregnancy test soon confirmed her fears. Beatriz believes that the injection she paid for had been switched out by an unscrupulous street vendor for one that would only last a month.
Beatriz immediately started working overtime to save up enough for the misoprostol pills. This time, haunted by flashbacks of her first abortion, she decided to tell her close family members — which was how she found herself, six years on, back in her mother’s bedroom, taking matters into her own hands once more.
The process was much the same. Beatriz started with the pills in the evening and was doubled over in pain by midnight. She bled profusely.
With each passing day, the pain and bleeding worsened. After two weeks of this, Beatriz finally went to a nearby clinic. Immediately, doctors asked her if she had had an abortion. “It’s illegal, but we understand because of the state of the country,” Beatriz recalled one of the doctors telling her.
They told Beatriz there were fetal remains still inside her and that they would have to scrape her uterus to get them out, a procedure known as dilation and curettage, which requires women to be put under general anesthesia.
Beatriz had to buy everything the hospital would need to treat her, including gauze and gloves for the doctors, from the black market. It is now standard for people seeking treatment in the ruined public health care system to bring with them to the hospital all the necessary surgical items. To do so, Beatriz used the money she had been saving to paint her house, high up on the hills of Petare.
She arrived at the hospital at 5 a.m., to avoid having to wait in line for her operation. When she went home that night on a mototaxi, she braced herself before every bump in the road.
Patients like Beatriz have become increasingly common in hospitals across the country. In three hospitals surveyed by Avesa, there was an average of 10 abortion-related entries every day last August. At one of those, the Concepción Palacios Maternity Hospital in Caracas, a doctor said even the most basic medical equipment is often stolen, let alone what is needed to treat a woman who has complications related to an abortion attempt.
The doctor, who requested that their name be withheld because they were not allowed to speak to the press, said there has been a significant increase in patients requiring dilation and curettage during the last year. Many of those patients have either attempted a home abortion that had gone wrong, or had lost their baby due to malnutrition.
At dawn each day, women gather at the entrance to Concepción Palacios hospital, hoping to get inside for treatment. On a recent morning, María sat with her teenage daughter, who was there to register her newborn baby. Underscoring how common abortions have become, María said that one of her neighbors was now running a clandestine clinic in her apartment, where she said she performs abortions by inserting bars of soap into women’s vaginas.
Not far from there, another line of women snaked around a Plafam clinic. A list of prices for different contraceptive methods — including a costly IUD implant — was posted on the wall outside.
A days-old sign was still hanging next to the list. Plafam, it read, would be closed the following Saturday because it had “run out of stock.” ●