Latin American Feminists Train U.S.-Based Doulas on New Mifepristone Protocol for Second-Trimester Abortions

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Latin American Feminists Train U.S.-Based Doulas on New Mifepristone Protocol for Second-Trimester Abortions

PUBLISHED 6/5/2026 by Carrie N. Baker

U.S. abortion doulas are turning to decades of Latin American feminist expertise to make second-trimester medication abortions safer, less painful and more accessible.


Mifepristone works to end a pregnancy by binding to progesterone receptors and blocking progesterone’s effects. Beyond its abortion pill usage, mifepristone has broader medical promise, including potential uses for fibroids, miscarriage care, Cushing syndrome and some cancers. (Anna Moneymaker / Getty Images)

Across the world, women living in countries that ban licensed clinicians from performing abortions have always found ways to access abortion outside of the medical system. Today, abortion pills have made it much safer. When the Supreme Court overturned Roe v. Wade and many states banned abortion, U.S.-based activists turned to Latin American feminists who have run collectives supporting women seeking abortions outside of the medical system for decades. With their guidance, U.S.-based activists have created their own feminist collectives that now serve thousands of women and girls each month in 38 states that ban and restrict abortion access, including the entire Southeast and much of the Midwest of the country. These collectives provide free abortion pills and the doula support to see them through. As Republicans create ever higher barriers to abortion that push abortion seekers later into pregnancy, U.S.-based activists are learning from Latin American feminists who have developed protocols to make second-trimester medication abortion easier and safer. With training and guidance from Latin American feminists, U.S.-based collectives are now using a double-dose mifepristone protocol for pregnancies 17 weeks of gestation and longer.


The protocol works in three steps:

one 200 mg mifepristone tablet taken orally, then waiting 24 hours;
taking another 200 mg mifepristone tablet orally and waiting another 24 hours;
then taking 400 mg of misoprostol (two tablets) under the tongue every three hours until expulsion of the pregnancy is complete.

Mifepristone blocks the absorption of progesterone in the uterus, preparing the uterus to shed the pregnancy. Misoprostol then causes contractions to expel the pregnancy tissue. For second-trimester abortions, taking two mifepristone means needing less misoprostol, which eases painful contractions and shortens the time to uterine expulsion, explained one Latin American expert, Mora, who supports people having abortions, called accompaniers. (Real name withheld to protect privacy.)


The World Health Organization recommends two regimens for medication abortion: misoprostol alone or combined with another medication, mifepristone. (Soumyabrata Roy / NurPhoto via Getty Images)

Describing how mifepristone helps separate a pregnancy from the uterine lining, Mora said: “Mifepristone detaches the gestational sac from the inner side of the uterus, which is less painful than if the detachment comes from contractions caused by misoprostol.” Whereas mifepristone’s side effects are mild—mainly headaches and some nausea that can be treated with medications—misoprostol causes diarrhea, chills and vomiting, which are much harder to experience. “The side effects of the miso are very high in comparison to mife,” said Mora. “After taking mife you can go about life [and normal activities], but starting miso is what gets you home in bed.” Using two mifepristone also significantly reduces the period of painful contractions—from 15 to 18 hours, to often less than six hours, which is critical for women who have to work or care for children or relatives.
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Resources for Abortion Seekers

To learn about these services, people are using the Plan C website. The organization has researched several community networks over the years, and there are now five listed on their website. See INeedAnA.com for more information about second-trimester abortions with medications.
Contact the Miscarriage and Abortion (M+A) Hotline to speak to a volunteer medical provider anonymously and for free for questions during an abortion or miscarriage, including self-managing an abortion in the second trimester. Second-trimester self-managed abortion may increase legal risks https://www.ineedana.com/legal-risks . Repro Legal Helpline https://reprolegalhelpline.org/ offers free legal support.

https://msmagazine.com/2026/06/05/two-mifepristone-home-self-managed-abortion-pills-later-late-term-second-trimester-pregnancy/