Darling was up at 4:30 a.m. on a warm and windy April morning, breastfeeding her 1-year-old baby in the one-bedroom house she shared with her three children and her sick mother, in the El Junquito slum in western Caracas, Venezuela. From the top of her hill, she could see the city sparkling in the distance, its streets deserted since sunset. People rarely dared to venture out into the darkness anymore, in a city that has become notorious for being the most violent capital in the world. Darling dropped her three sleepy children at her father’s house right below hers, climbed the hundreds of steps and steep dirt path leading to the main road, jumped in a bus, rode the subway, and finally, at 7:10 a.m., entered the waiting room of a private clinic in the upscale neighborhood of Sabana Grande, in central Caracas. At 8 a.m., doctors would cut a four-inch incision in her stomach and remove a piece of her fallopian tubes, sterilizing her for life at 21 years old. A 30-minute surgery, which would last forever. But at least Darling knew she wouldn’t end up like her sister Jennifer, just 23 and with five children and no food to feed them.

An increasing number of young Venezuelan women are going to extreme lengths not to give birth to another child. They are in an impossible bind, in a country where abortion is forbidden by law and a box of contraceptive pills costs the equivalent of up to 10 months’ salary at the minimum wage. Their determination illustrates the depth of Venezuela’s economic crisis, the worst in the country’s history, and its disproportionate impact on women.

Photo: Federico Parra/AFP/Getty Images

On May 20, Venezuelan President Nicolás Maduro won a second term in an election that was boycotted by most opposition parties and denounced by a coalition of other Latin American countries. The minimum wage is currently 1 million bolivars per month, or the equivalent of $0.56, and inflation has skyrocketed an estimated 13,779 percent over the last 12 months, according to the opposition-led National Assembly (the government stopped giving an official figure last year). For most Venezuelans, that means contraception — and nearly everything else — has become either unavailable or unaffordable.

Women in Venezuela are in an impossible bind, in a country where abortion is forbidden by law and a box of contraceptive pills costs the equivalent of up to 10 months’ salary at the minimum wage.

“Women’s power to decide whether they become mothers or not is violated,” said Magdymar León, psychologist and coordinator at AVESA, a local NGO focusing on sexual health. “It’s some sort of forced maternity.” There are shortages of between 80 to 95 percent of all medications nationwide, according to local NGO Médicos por la Salud, and contraceptives are especially affected. “Contraceptive methods are not considered essential medicines. So, in the crisis, the ministries and providers favor other kinds of medicines, like antihypertensives or cancer treatment,” León explained. “We consider that contraceptive methods should be included as well, because sexuality is now being pushed to the margins of public policies, which has a direct impact on women’s lives.” So far, Maduro has consistently refused to open a humanitarian aid channel or recognize the depth of the crisis, condemning instead an “economic war” waged by the United States though sanctions. Indeed, President Donald Trump has issued sanctions that ban U.S. entities from buying bonds from the Venezuelan state or its oil company, PDVSA. There are concerns that since oil accounts for 95 percent of Venezuela’s export revenue, which is in turn used to import goods like food and medicine, oil-related sanctions only increase the suffering of the population. The government’s positions on reproductive health are contradictory. On one hand, it offers stipends to pregnant women and for every new child born, even as Venezuela holds the highest rate of teenage pregnancy in Latin America. Inflation has rendered these already small stipends minuscule – 700,000 bolivars ($0.39) per pregnancy and 1 million bolivars ($0.56) per newborn — but León argues that they have contributed to a culture that encourages motherhood at any age. “It’s a cultural thing, more accentuated in lower-income areas: Maternity is not a choice, but part of your fate,” she said. On the other hand, the government also funds periodic national campaigns for free sterilization days in public hospitals. There are no publicly available statistics on these campaigns or on the rates of sterilizations, but all factors indicate a rise in demand. Dr. Wilson Torrealba, surgeon and chief of the obstetrics and gynecology service at Altagracia de Orituco hospital in Guárico state, was supervising the campaign in his hospital when it started in April 2017. ”We knew it was a political move but even so, we participated because we were going to help many patients who had a large amount of children,” he said. “We were solving a social problem.” Before the crisis started, sterilizations in Torreabla’s hospital were only made available for women over 35 with three or more children, or for younger women suffering from an illness that made pregnancy a risk. The sterilization campaigns were supposed to follow those guidelines, but Torrealba said that at his hospital, it quickly spiraled out of his control.

“Some patients got sterilized at 18 or 19 years old with only one child, which shouldn’t have happened.”

“Some patients got sterilized at 18 or 19 years old with only one child, which shouldn’t have happened,” he said. For these reasons, Torrealba said he gave up coordinating the campaign after four months, during which he estimated around 400 to 500 women were sterilized. Catherin, a medical student who interned in a public maternity clinic and the gynecology department of a public hospital for six months in 2017, said that she had to screen girls as young as 14 who were asking for a spot in the free sterilization days. It had become their only solution: “We wouldn’t have 18-year-olds asking to get sterilized if they weren’t desperate,” Catherin said. (She asked that her real name not be used out of concerns it could jeopardize her career.) Doctors in private clinics also noticed an increase in demand. Rhayza Martinez, a gynecologist who worked in four different private clinics all over Caracas, said that five of the 15 patients she received every day asked for sterilization. “I am scared and I think about a lot of things, like the fact that later on, I would like to have another son,” said Krisbell, a 27-year-old mother of two girls who was planning on getting sterilized. (The Intercept is using only the first names of the women who spoke to us about their ordeals for this story, for their privacy and safety.) “But those are decisions that you have to think through, and given the current situation, it’s better to give comfort and security to the kids you already have than to think about having another one that you could be bringing into the world to suffer.”

Still: Daisy Squires and Lou Marillier

Krisbell’s fears are well grounded: a recent government report showed that infant mortality rose by 30 percent in 2016. Natalie, 31, had just been through what the other women were doing all they could to avoid. She lived with her five children in a house on the edge of the “Punta Brava,” or “crazy hill,” a part of the Antímano slum that owed its nickname to regular shootings. Before the crisis, Natalie could feed her five children, but by the time her sixth child was born in the summer 2017, the situation had deteriorated. “CLAP boxes” filled with subsidized food that Maduro introduced in 2016 had started arriving much more sporadically than they used to, and without essentials like milk or beans. Sometimes, Natalie ended up selling some of the sugar in the box to buy cigarettes to sell, and then buy a little more food from that money — often just chicken skin, bones, bananas, and yucca. But it wasn’t enough, and her children often went to bed hungry. In the fall of 2017, her baby got asthma. He started swelling and had a hard time breathing, becoming so weak that he couldn’t even cry. She tried to find medicine, but the treatment was too expensive and too intermittent. Not long after he was hospitalized, Natalie’s baby had two heart attacks and died at 9 months old. “My son died because I didn’t have the money for his medicines,” Natalie said. Beyond the grief, Natalie was scared for two of her other children, who had also developed respiratory infections. Because of equipment shortages, many public hospitals and maternities have also stopped offering sterilization days for now, local sources said. Women who can afford it go through PLAFAM, the country’s main family planning organization, or pricier private clinics. Krisbell and her husband saved up for three months in order to afford the 13 million bolivars (then $19) that the surgery would cost at PLAFAM, the equivalent of more than a year at minimum salary. They work as “bachaqueros,” an often derogatory term that designates people who buy food and medical supplies at the government-controlled price to then sell it at an inflated price on the black market. Like most Venezuelans and even more so because of her occupation, Krisbell spent a big part of her days standing in lines to buy food or medicine. There, she met Darling and other young women who bonded over their fear of getting pregnant and sharing tips on where to get sterilized. On the day of Darling’s sterilization, Krisbell came along, relaxing the atmosphere with her wit and energy. Her own sterilization was meant to take place a week later, but as Darling’s anesthesia started wearing off in the clinic’s windowless room and she vomited on the floor, Krisbell wasn’t so sure anymore. “I’m gonna shit myself,” she said matter-of-factly to Darling’s stepmother Maria. In the corner of the room, the sectioned pieces of Darling’s fallopian tubes had been thrown in a plastic bottle split in half, releasing a pestilential smell. Later, Maria would carry the bottle back home to Darling’s father. Darling’s sterilization at a private clinic cost 78 million bolivars, she said, the equivalent of $118 at the time of the operation, and a fortune for most Venezuelans. She had received the money from family in Peru, and although her and her sister’s children barely had enough to eat, her family considered the operation to be a priority investment. “It’s much better for her. She won’t have the same problems I’m going through with the baby, not having diapers, not having milk or money to buy it,” said her sister Jennifer. She had gotten sterilized as well, right after she gave birth to her fifth child. The newborn was malnourished, as the lack of nutritious food during Jennifer’s pregnancy meant that her breast didn’t produce milk, and she could rarely find baby formula.

Still: Daisy Squires and Lou Marillier

For women who don’t have the kind of support Darling had and can’t afford sterilization, a last, and far more dangerous, option exists: home-induced abortion. Venezuela, where 70 percent of the population identifies as Catholic, has among the strictest abortion laws in Latin America. Abortion is forbidden even in the case of incest or if the fetus displays life-threatening malformations, and punished by six months to two years in prison. (Because of those penalties, The Intercept has changed the names of the women who shared their stories of illegal abortions.)

“There aren’t even diapers or anything. I don’t work. What can I do? If the situation was different, I would have my baby.”