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Inside a little wooden house among the pine and oak forests of western Honduras' coffee-growing mountains, a woman opened a tiny package of pills, delivered to a nearby town. She didn't know it, but the medication had more than likely entered the country hidden in an activist's suitcase, from Mexico.

The woman, 27, was confident in her decision to have an abortion, but in the moment, she panicked. She knew she was breaking national law banning all abortions and could be prosecuted. Even more, she feared medical complications, or her religious family finding out.

Days earlier, an anonymous guide had asked her for an ultrasound; she sent it via encrypted message. Now, in her one-room house, empty and quiet except for the pings of her cellphone with messages from the guide and her closest friend, she studied the instructions on how to take the pills – first the mifepristone, later the misoprostol.

She was ready. She swallowed the first pill.

In remote mountain villages, urban neighborhoods, along the Caribbean coast – despite the national ban against abortions under all circumstances and amid suffocating social and religious opposition, women are terminating pregnancies across Honduras with the help of clandestine networks seeking to make the procedure as safe as possible.

Activists in the networks use code words, aliases, encrypted messages, burner phones. Most don't know one another, or any specifics beyond their role in the chain that ultimately provides information and the abortion pills endorsed by the World Health Organization and used safely and legally in dozens of other countries around the globe.

Honduras has one of the world's strictest abortion bans, with a constitutional prohibition on terminating pregnancy in all cases, even rape. Neighboring El Salvador and Nicaragua have similar total bans. Until March, Honduras was the only country in the region that also banned emergency contraception, the so-called morning-after pill.

Some Latin American countries — Argentina, Colombia, Mexico — are widening access to abortion while manyU.S.states are restricting it. Honduras doesn't enforce its ban as strictly as its neighbors, but the possible punishment of up to six years in prison is a constant threat. Advocacy groups say they believe no Honduran women are currently imprisoned on abortion-related charges, but national data are incomplete.

The Guttmacher Institute, a research group that supports abortion rights, estimates that more than 50,000 abortions occur in Honduras annually. It's unclear how many are medication abortions — in the U.S., they account for over half of all procedures and complications are rare.

Advocates say forcing abortions to take place in secret inherently creates more risk, though that's mitigated when women are provided proper instructions. That's why guides of the networks in Honduras say they're dedicated to helping as many people as possible.

The Associated Press traveled throughout Honduras, interviewed more than a dozen women who have given or received help through activist networks, and documented places where abortions take place amid the ban and societal shame: from rickety bathrooms in crowded houses and sites surrounded by violence and poverty, to comfortable homes and even the occasional hotel.

All the women who had abortions or helped those who did spoke on condition of anonymity over fears they'd be reported or prosecuted. They also worry they'll be stigmatized or shamed, sometimes by those closest to them, because of social pressures and the enormous influence of the Catholic and Protestant churches. Many of these women are vocal activists on other issues – the environment, land rights, social matters – but they feel most afraid of speaking out on abortion. The women also insisted that details of the locations they shared be withheld.

"If something breaks, it blows up the network," said an activist who has been accompanying women getting abortions for 12 years.

This report was produced with the support of the International Women's Media Foundation as part of its Reproductive Health, Reproductive Rights and Justice in the Americas initiative.

To reconstruct how the secretive networks operate, AP drove highways and dirt roads in crowded neighborhoods and indigenous villages, from export-focused assembly-plant regions to banana plantations.

Activists learn tricks of the trade little by little. "Now there is less naiveté and more technology, virtual phone numbers, disappearing messages," said the activist with 12 years of experience.

Allied organizations inside and outside Honduras help them; activists won't name them, to avoid legal issues.

Some women seeking abortions call a hotline publicized on the internet as "La Línea." They're asked questions to try to confirm the request is real and not an attempt to track down activists. Later, calls are triangulated; sometimes phone chips are switched to avoid identifying numbers.

Other women learn about the networks via hushed word of mouth. Either way, women seeking abortion help are ultimately put in touch with the person who will be her guide, introduced via pseudonym.

The guide asks basic health questions, including how far along the pregnancy is, and requests that an ultrasound be sent through a secure application. Then the challenge is obtaining the pills – never referred to as medication abortions, or with their pharmaceutical names, but as ordinary objects, code names that change from group to group.

Misoprostol is sold in Honduras under prescription; it's used for gastrointestinal issues and in hospitals for miscarriages. It can be bought on the black market, but activists warn of misinformation about use. Mifepristone isn't sold at all in Honduras. The networks often sneak both drugs in from Mexico.

Sometimes activists buy them; sometimes they're donated from aid groups. Guides ask for contributions from women who can afford it, about $50 to $60.

Activists take advantage of every trip across the border, hiding the pills in suitcases. Then, packages pass carefully from hand to hand, delivered by taxi or via "drops" with a detailed time, place and description of the contact.

Once a woman has the pills in hand, the guide suggests finding a private place, away from prying eyes. When she's ready to take the medication, the woman is advised to have her cellphone near to ask any questions about bleeding or pain and to let the guide monitor the process through a safe app.

Some women have the support of partners or can afford to escape to a hotel. Others find a private spot in houses with large families or ask for a friend's sofa.

For those with nowhere to go, some groups offer a safehouse in the capital, Tegucigalpa, a city spread over the hills. The grand historic basilica Our Lady of Suyapa stands on one of them. On the steps leading up to church sits a small statue called the Virgin of Life, inaugurated on Christmas Eve 2013 "in memory of unborn babies," according to its plaque.

In a country of 10 million people, sometimes there are surprises.

A young lawyer discovered that her own mother was part of a network when she sought help to get an abortion. She first asked her mother's friend. Her sister eventually encouraged her to approach her mother directly. When she did, her mother assured her there was a solution.

Her mom already was in possession of the pills, as part of her role in the network. Lying on a bed at her sister's apartment in the capital, the woman felt her mother massage her feet to ease pain from the drugs.

Normally, the networks try to avoid having a guide help a relative or friend. But the experience of having an abortion often motivates those involved to help others. The young lawyer later offered her living room to a friend; her own husband didn't know what was happening on the sofa next door.

Other women are conflicted, and their positions on abortion change.

In a small community of unpaved streets in northern Honduras, a woman who ended her pregnancy years ago recently refused to help her daughter get an abortion. She said the girl hadn't been careful with contraception and must deal with the consequences.

"Once the baby is born, she can always give it away if she cannot afford to take care of the child," the mother told AP. "But you can lose your life in an abortion."

She feared for her own life during her abortion, nearly four months into the pregnancy. She said a married man impregnated her and she wanted to take the pills earlier, but it took longer than expected to get them. Now, she said, she supports abortion only in cases of rape or danger to the health of the mother or fetus.

For teens in this largely religious country, pregnancy and reproductive rights pose a particular issue. Honduras has one of the highest rates of teenage pregnancy in Latin America, more than double the world average, according to the U.N. Population Fund.

That's why some activists have specialized in accompanying girls for abortions. The minors, some just 12, are usually with their mothers or grandmothers — who often need more comfort than the girls, the experienced guide said: "The older people, we get more scared."

Guides say they stay glued to their phones for more comprehensive tracking with girls. Minors also undergo more follow-up — including reproductive health tips.

The hardest part, the guide said, "is when I have to give contraceptive counseling, because it's like telling them that it can happen again."

On a March day, two lines of women waited in the gynecological emergency corridor of the country's main public health center, Hospital Escuela. Some were teenagers with fear on their faces.

Dr. Zyanya Cruz consulted with a patient. It was 2 p.m. on a Monday, and eight women whose pregnancies ended had already been seen, two of them minors.

"We don't inquire about what happened, whether it was induced or not," the gynecologist said. "We only evaluate and do an ultrasound."

Problems emerge when pills are found in the vagina, or there are incomplete abortions of women in advanced gestation. That's clear evidence of an abortion, and doctors are obligated by law to report it to authorities.

Honduras' total abortion ban dates to 1985. Previously, abortion was permitted in three instances: rape, risk to the mother or nonviability of the fetus.

After the 2009 coup d'état that removed then-President Manuel Zelaya, husband of current President Xiomara Castro, the emergency contraceptive pill was banned. It marked the start of several administrations linked to ultraconservative churches.

In 2021, an amendment to add the abortion ban directly to the constitution was adopted. The measure also increased the number of lawmakers needed to change that part of the constitution. It cannot be "repealed or modified" by other legal provisions, according to the text.

The constitutional protection is unique in Latin America, according to the International Center for Reproductive Rights. It was appealed twice to the Supreme Court and upheld.

Castro is Honduras' first female president. She's more liberal than predecessors and has integrated well-known feminists into her government. After 14 months in power, on March 8, she ended the ban on the emergency contraceptive pill — just as thousands of women were demanding more rights in demonstrations nationwide.

She pledged to legalize abortion again in the three instances previously allowed. But her administration doesn't have a majority in the legislature, and persistent issues with gang violence and organized crime have diverted much of her attention.

The Honduras Gynecologists Association says the current legislation is inconsistent with science and leaves doctors vulnerable to accusations of violating the constitution every time they save a woman's life.

At Hospital Escuela, Cruz said she recognizes that some health professionals report women to avoid legal problems, but others do so because of religious convictions. Some quietly perform abortions at secretive clinics for those who can pay several hundred dollars.

The Public Prosecutor's Office did not answer AP's request for abortion data. But according to the activist group Somos Muchas, six women were convicted for abortions from 2012 to 2018, the most recent period for which it has figures, and none is in prison. The Center for Reproductive Rights says there may be more but cites the lack of data.

There are criminal consequences outside prison. Some women may be banned from leaving the country or may be unable to obtain the criminal record clearance needed for most employment.

In 2015, raids of clinics resulted in the arrest of several health professionals. More recently, some activists say they received intimidating and threatening messages, sent anonymously to their phones and generally coinciding with political instability. They also say some women have fled the country over harassment and legal complaints.

Other women temporarily disappear from their communities and families while seeking a safe place to have an abortion. Or they land in a private clinic if there's an infection.

A social worker who lives in a violent neighborhood of San Pedro Sula, the country's economic capital, told AP she learned the hard way that the networks aren't infallible.

When a friend fainted and was bleeding heavily after taking the pills, she was gripped with worry — the guide who was supposed to be on the other end of the phone wasn't answering. The social worker found information on the internet and was able to control the situation and help her friend. The episode motivated her to join natural medicine and Indigenous groups to learn about using plants for abortions.

It's a practice used quietly in some remote communities – taking herbs, often in the form of teas, to try to end early pregnancies. But it uses plants that can be toxic in the wrong doses, and some organizations consider it an unsafe method. It's not widely accepted in medical and activist communities.

"Here nobody can know," a woman who provides the teas told AP. "It's very dangerous."

The woman, in her 50s, learned from experienced midwives when unwanted pregnancies among young women increased in her mountain community.

"We're not going to leave them that way, especially the girls who are not ready," the woman said. For her, it's her duty to help, especially young girls and teenagers. She simply doesn't understand villagers who say an abortion "is worse than killing an adult."

For the 27-year-old who took the pills in her home in the mountains, Honduras' clandestine networks helped her successfully terminate her pregnancy. Per the activists' protocol, the guide advised her to have a post-abortion ultrasound.

Like most women, she went to a private clinic far from home. She felt much more relaxed than she did in her first ultrasound, and she was glad to get a healthy report.

Knowing her body was safe, she focused on saving money. She'd been unable to pay for the pills at the time, and she wanted to make up for that. She knew it was the only way for the guides to keep working.

But the secrecy of the networks prevailed.

The woman had no way to send a payment or find the person who'd helped her. Her guide never answered the phone again.

In:
• Health
• World Health Organization
• Abortion