In the minds of hard-line Catholics, America and the United Nations are still seen as foreign meddlers spreading their “culture of death” in the Philippines. But they need not fear a new tidal wave of foreign-funded condoms. President Donald Trump’s administration, according to draft documents, hopes to eviscerate USAID’s health care funding for the Philippines by 65 percent.

Government meddling aside, orthodox Catholics also resent American pop culture for normalizing gay love and extramarital hookups across the globe. “This is lamentable,” Dayrit says, “We do know gay partnerships will not bear any children. This is an agenda to depopulate.”

At the moment, however, the church appears to be winning a key part of its long-running crusade. Church-backed lawyers effectively halted a hotly disputed government policy that promised universal access to contraception.

Yet another legal offensive has prodded the Philippine Supreme Court to stop renewing authorization for contraceptive implants and pills. If this course is not reversed, the only contraception available in the Philippines by 2018 will be condoms.

This would be a profound loss for women who rely on pills and IUDs to prevent births that can bankrupt their families.

But it may be celebrated among renegade herbalists.

The Catholic crackdown on birth control has already driven more customers to dealers like Elsa. Dayrit has sympathy for these dealers — they are “victims of poverty,” she says — but she frets over their souls.

“They will have to suffer the consequences of their acts,” Dayrit says. “Maybe they will have to spend some time in purgatory.”

A pharmaceutical solution

Skip the potions. Take the Cytotec.

So says Rebecca Gomperts. Based in the Netherlands, she is among the world’s most vociferous enemies of abortion laws.

Rebecca Gomperts, a reproductive rights activist. Credit: Courtesy of Women on Web

The rogue advocate is best known for chartering boats to Catholic-majority nations, beckoning women aboard and offering to sail them into international waters for free abortions. Her naval activism has been impeded by warships in Portugal and dockside army platoons in Guatemala.

Gomperts — labeled a “pro-choice extremist” by The New York Times — regards laws criminalizing abortions as deeply immoral. She specializes in cleverly subverting these edicts, particularly when they afflict poor women.

“We’re talking social justice here,” Gomperts says. “The wife of some government minister can easily travel to some country where abortion is legal. Or they can pay huge amounts of money to a doctor who’ll do it after office hours.”

As for poor women desperate to void a pregnancy they can’t afford?

In Gomperts’ view, Cytotec is their best salvation. “It has revolutionized women’s access to safe abortions,” she says.

She is unabashed in supporting black-market Cytotec dealers in the Philippines and elsewhere. Her organization, Women on Web, will counsel Filipinas to illegally mail-order the drug — though she concedes that Philippine authorities are now adept at intercepting packages.

An anti-abortion demonstrator holds a banner saying “Woman, you are not alone,” in protest of a boat belonging to the Dutch abortion organization Women on Waves at Spain’s port of Valencia, on Oct. 16, 2008. (Heino Kalis/Reuters)

Cytotec is actually just a Pfizer brand name. Its active ingredient is misoprostol. This drug was synthesized to prevent ulcers but, soon after its mass release in the 1990s, doctors discovered a remarkable side effect: The drug causes uterine contractions that induce miscarriage.

Even the World Health Organization now agrees that abortion through misoprostol pills is indeed safe — and effective in roughly 9 out of 10 attempts.

The WHO publishes usage guidelines for inducing abortion via misoprostol. For pregnancies under 12 weeks, women are instructed to swallow 800 milligrams, wait three hours, take another 800 milligrams, wait three hours and then take a final dose of 800 milligrams.

“It’s quite safe,” Gomperts says. “I really want to put this into perspective. The risk of a fatal event is less than 1 in a half million cases. Yet roughly 1 in 20,000 men have a fatal event from taking Viagra.”

Misoprostol is even used to induce labor in Europe, though not in the US, and to treat post-pregnancy complications in both Europe and the US.

Gomperts urges Filipinas with unwanted pregnancies to acquire Cytotec by any means — including deception. Her organization advises women on faking doctor prescriptions. Get creative, Gomperts says. “It’s used on dogs sometimes. Try getting it from a veterinarian.”

And if that fails? Seek out a dealer, she says.

“I’m so grateful for the underground market,” Gomperts says. “I know how risky it is for them to sell this. But it’s important that the sellers know the proper protocol.”

Unfortunately, they often don’t. Elsa concedes that counterfeit Cytotec is rampant on the black market. She even admits to selling fake pills herself. Her typical advice to pregnant women — just put four pills inside your vagina and wait — is incongruous with the medical guidelines.

Gomperts advises Filipinas to study up on proper usage before they approach criminal herbalists. And never, ever swallow their dubious potions.

“There’s no scientific research showing those herbs are safe or effective,” Gomperts says. “I would never recommend that to anyone.”

(Patrick Winn/GlobalPost Investigations)

Failures of herbs

Foul-tasting roots. Bitter seeds. Cytotec. In the struggle to abort her fourth child, Karen digested them all.

That was more than six years ago. The woman, now 39, had good reasons to wish away that pregnancy.

Then and now, Karen’s most consistent job is selling porridge on the side of the road in a rough part of Manila. That brings in about $5 per day. But a portion of that income is siphoned off by a jobless husband who has fallen under the spell of methamphetamine.

“There’s no feeling of love or partnership between us now,” Karen says. He treats her like a “concubine,” she says, while also demanding that she forego birth control pills. “He thinks they’re unnatural.”

Bringing another kid into this fractured family, she thought, would bring on more chaos and intensified poverty. So back in 2011, she sought the services of an albularyo — a mystic who traffics in herbal concoctions.

Karen is telling me this story in the parking lot of a Roy Roger’s fast-food joint — an inconspicuous spot where she feels safe. I’ve met her through a colleague: Rica Concepcion, a Filipina journalist, who agreed to help me find a women who has actually consumed illegal abortive herbs.

Dressed in an old T-shirt, her hair unkempt, Karen explains that she’s currently living on the run — and that I shouldn’t publish her real name. Karen is a pseudonym.

“I’ve got police trouble,” she says. “I can explain later. It’s a complicated story.”

Better, she says, to begin by recalling her tribulations with the “witch doctor.” That descent into underground health care was marked by fright and humiliation.

Karen was treated by the herbalist in a nondescript house in Quiapo. The home’s interior was lined with sizable Catholic figurines — Jesus as an infant, Mary Magdalene, Jesus as an adult — and an altar wreathed in smoke. Karen was brought to a tiny bedroom, stripped naked and internally probed by the female mystic.

Then she was prescribed the following haphazard recipe: RC Cola, a knobby root called makabuhay, mahogany seeds and the skin of a lanzones, a sour grape-like fruit. She was advised to brew all of this into a tea, drink it regularly and, every so often, insert a single Cytotec pill into her vagina.

Karen followed this errant guidance for months, forcing herself to swallow the bitter potion each morning. “I can’t forget that taste,” she says. “It was extremely bitter.” She would suck on chocolate to rid her mouth of the chalky flavor.

She panicked as her pregnancy persisted through the onslaught of herbs, colas and pills. As her due date neared, she braced herself to give birth to a deformed child. “I thought it might be blind. Or have no teeth. Like all those irregularities you see on television,” Karen says.

To her astonishment, her child was born healthy. Karen gave the baby girl a fitting name: Miracle. She is now a chubby-cheeked 6-year-old who receives good grades in kindergarten.

Naturally, Karen adores Miracle. She attributes the child’s health to the beneficence of God. Yet those worries during pregnancy — that the cost of raising a fourth child would stoke disorder in her home — were quite prescient.

Following Miracle’s birth, Karen found it impossible to nurture her family on her porridge income. To shore up money for her kids, she skipped so many meals that her breasts ran dry. In lieu of milk, she resorted to bottle-feeding Miracle with cheap instant coffee.

In desperation, Karen eventually turned to the underworld. She started buying little sachets of meth and selling them at a markup to neighborhood men who — like her husband — had become transfixed by speed.

Then came the 2016 election of President Duterte. He swept into office vowing to violently purge the Philippines of meth dealers — and swiftly began to honor this grim promise.

The Philippines’ nightmarish drug war has racked up more than 8,000 killings — many of them carried out by plainclothes cops or police-aligned death squads. Men disguising their faces with motorbike helmets began to scope out Karen’s home. Once that began, she started sleeping elsewhere as much as possible.

“Little Miracle is my inspiration,” she says. “She tells me, ‘Mom, one day I’m going to get a good job. I’m even going to pay for you to fly in an airplane.’”

“But honestly,” Karen says, “many of my fears have come true. As a mother, I have nothing to offer her. No rice. No money. No happy place to live.”

Patrick Winn reported in Manila for PRI’s The World. Essential reporting for this story was also provided by Rica Concepcion, a Filipina journalist who has reported throughout Southeast Asia.