TIJUANA, Mexico — Just over a decade ago, when Crystal Pérez Lira needed an abortion, she had to leave Mexico. The procedure was illegal in her home state of Baja California and so deeply stigmatized that even Pérez Lira supported the procedure only for those who were raped. Until she unexpectedly got pregnant.
She traveled to the U.S. for help, walking alone across the border from Tijuana to San Diego, first for a health check and a compulsory ultrasound, and then back for a second appointment, when she was given pills to induce an abortion. She returned to Mexico, where she went through the procedure at a friend’s house.
Today, the cross-border help moves in the opposite direction. Pérez Lira is part of a network of activists across Mexico who provide advice, emotional support, and free medications to those seeking abortion — including, increasingly, people living in U.S. states where abortion is sharply restricted. These volunteer groups, known as “companion networks,” have been quietly sending abortion pills across the border, often to vulnerable people who lack funds or immigration papers, and training volunteers in the U.S. to establish their own companion networks.
These activists operate outside the health care system, working to create abortion access even in places where doctors face prosecution for assisting with the procedure.
“They’re being very underground,” Pérez Lira said, explaining that she couldn’t put a STAT reporter in touch with the U.S.-based networks. “It’s very, very secretive.”
Bloodys Red Tijuana, the group Pérez Lira founded in 2016, a few years after her own abortion, received its first request for abortion pills from someone in the U.S. in the summer of 2019. Three years later, the U.S. Supreme Court’s Dobbs decision eliminated constitutional protections for abortion, just as Mexico’s Supreme Court decriminalized the procedure.
Over the past two years, Pérez Lira said, the group has supported around 60 people living north of the border, distributing not just pills but also information on how to safely manage an abortion. “We’re migrating the way we’re working,” she said. “We’re migrating that mission into the U.S.”
Pérez Lira works out of an office cluttered with paint, posters, and handmade signs championing abortions and the right to choose. “Es nuestro derecho,” (It’s our right), reads one, while another proclaims “Yo aborté” (I aborted). Packets of the abortion pill misoprostol, which is sold over-the-counter at Mexico pharmacies as a treatment for stomach ulcers, are piled in cardboard boxes in the corner, ready to be mailed.
She and her colleague, Minerva Garcia, regularly sit with women going through self-managed abortions. There’s a sofa and blankets, where the women can rest for the hours and sometimes days the process takes, and board games and a movie projector for distraction. The rooms are a refuge for those who don’t have privacy at home; they’re often young, and have parents or partners who don’t approve.
For the most part, though, the group’s headquarters, just off the main drag in Tijuana, is a place for strategic planning, organizing, and volunteer gatherings.
The vast majority of the hundreds of people helped by Bloodys every year don’t need in-person support, because the abortion medication can be sent to them. Anyone going through an abortion can call Bloodys — the name is intended to combat the stigma around menstrual and abortion bleeding — and its volunteers will stay with them on the phone as long as they want.
Along with most other abortion activists in the country, Pérez Lira was trained and supported by Verónica Cruz Sánchez from Las Libres in Guanajuato, the original Mexican companion network, which has spearheaded the growth of this model and spread awareness about self-medication abortions throughout Mexico.
Her focus expanded after the Dobbs decision. Las Libres has trained around 200 volunteers in the U.S. over the past two years, relying on Google Translate to communicate with those who speak only English. Cruz Sánchez started in Texas, but she has since spread far beyond, working with people who have Hispanic roots and ties to Mexico, and others who do not. She has briefed her growing group of U.S. collaborators on World Health Organization protocols on misoprostol and mifepristone — the two pills used to induce abortion — what to expect during a typical abortion, and how to spot and respond to the rare complications.
Volunteers are trained to understand how much pain and blood loss is normal. Pérez Lira said occasionally her clients have decided to go to hospital, but only from anxiety rather than a truly dangerous situation. Excessive bleeding is rare but still possible and, if someone does decide to go to a hospital, Bloodys warns them to describe their experience as a miscarriage, which is indistinguishable from a self-managed abortion and not subject to criminal repercussions.
Part of companion networks’ mission is to combat stigma toward abortion. “We also think that the law changes because the mentality of the society changes, right?,” said Pérez Lira. “And how are you going to change that?” Bloodys Tijuana hands out fliers on abortion in Mexico, and has become more outspoken since the procedure was decriminalized there last year. Political barriers and fear of prosecution, though, have prevented such activities in the U.S.
Still, she said, Bloodys has been quietly building a network of volunteers in Texas, so they can call people in the U.S. who request help with self-managed abortions. Most of those she speaks to north of the border are not citizens. They’re predominantly Hispanic immigrants, perhaps without documentation, and are often domestic workers living in others’ households, without much privacy, and don’t necessarily know if their employers would be supportive.
At Marea Verde Chihuahua, another companion network, Alessa Rey said she also predominantly helps immigrants from Central America living in the U.S. Her organization helps around 20 people in the U.S. every month, roughly quadruple the number from a year ago.
Companion networks are explicitly non-medical, framing abortion as a personal choice, rather than an act that needs to be governed and performed by doctors. “The U.S. is getting late into this type of abortion rights access because they thought they already had it,” said Pérez Lira. “They just had clinics and professionals and prescriptions at the center.”
In Mexico, by contrast, growing support for abortion is buoyed by women who don’t have medical experience but have the knowledge to distribute the pills. And even if they do collaborate with clinics, they are not overseen by them. “If you have a companion network, you’re safe,” said Alfonso Carrera, an OB-GYN and medical director at MSI Mexico, part of an international reproductive health nonprofit. He has trained hundreds of people working in networks, and MSI refers patients to companion networks when necessary.
There will always be abortion for those who can afford to travel, for “certain kinds of women,” said Pérez Lira. She once helped an American woman who just wanted emotional support as she flew to Mexico City to buy and take the pills. MSI Reproductive Choices opened a clinic in Cancun in November partly to help those who can travel on direct flights from U.S. states with abortion restrictions.
The nonprofit is also planning a telehealth service, said Araceli Lopez Nava Vázquez, regional managing director of MSI Reproductive Choices in Latin America, which will deliver abortion medication at any point along the U.S.-Mexico border. The service must operate within Mexico’s borders, meaning it will only be able to serve people with the documentation and freedom to cross over.
Bloodys wants to help those who don’t have means or connections, who can’t take time off work to travel or afford clinics. When Pérez Lira had her 2012 abortion, she didn’t have the money to pay for the pills. She asked an old boyfriend, who told her not to terminate the pregnancy, and started harassing her.
Asking for such payments puts those who need abortion at risk, she said. “They’re going to be asking for the money, they’re going to get harassed, they’re going to delay their decision,” she said. “Even if they go through it, they’re going to always leave with that fear of being harassed. And that’s not fair.”
Eventually, Pérez Lira got the money from a friend who, like her at the time, didn’t support most abortions but, also like her, made an exception.
Today, a box of 28 misoprostol pills, enough for at least two abortions, costs around 280 pesos, or roughly $16. Bloodys provides the medication for free, and although those who are helped can donate if they like, they’re never charged.
Pérez Lira was surprised when the U.S. overturned Roe v. Wade. All her life, she had felt Mexico was lagging the U.S. when it came to abortion rights. Pre-Dobbs, she said, there was a sense people in the U.S. didn’t need companion networks. Now, the reverse is true. So few people in the U.S., she said, even know that self-managed medical abortions are possible. “We’re here to help them,” said her colleague, Garcia.
This Latin American “self-empowerment” model is increasingly important within the U.S., said Elisa Wells, co-founder of Plan C, an online directory of how to access abortion pills in every state, funded by the Washington, D.C., nonprofit National Women’s Health Network. “It’s amazing what these folks in Mexico are doing to help the U.S. with access,” she said. “It shows the solidarity we have around caring for each other in the world. We know this is a basic right and we deserve access to it.”
Plan C highlights Las Libres’ work on its website, but, for the most part, companion networks said they mainly spread awareness through word of mouth. Most women are referred by others who previously used their services.
As the networks expand, said Cruz Sánchez from Las Libres, they discover more complications about operating in the U.S. Although there’s considerable awareness about domestic violence in Mexico, she’s been surprised by how prevalent it is in the U.S., and how often it overlaps with women who need abortions. Low-income people, women of color, and migrants who are isolated or watched in domestic workplaces are most vulnerable.
“We’re learning more about the situation in the U.S. case by case, day by day,” Cruz Sánchez said. Las Libres works with victims of domestic and gender violence in Mexico, but it’s rare for those women to also need abortion assistance. “In the U.S., that’s common,” she said.
Even as Mexico’s abortion networks share their methods with people north of the border, they’re learning lessons from the U.S. The fall of Dobbs was a reminder, said Pérez Lira, that abortion protections can always be rolled back. She wants Bloodys to lay the groundwork so that, even if Mexico reversed the legal right to abortion in 50 years time, everyone in the country would still have access. “We have to be vigilant, and always ahead of them,” she said.
She wants to create enough knowledge about self-managed abortions so that, in the future, everyone would know how to manage abortions themselves, even without companion network support.
Increasingly restrictive abortion laws in the U.S. are no deterrent, she added. After all, the U.S. has signed international human rights treaties, which maintain legal protections for those who need abortion, she noted. “It doesn’t matter if they’re in Florida, California, Texas,” she said. “For us, it doesn’t matter.”
This story is part of ongoing coverage of reproductive health care supported by a grant from the Commonwealth Fund.