The drug deal takes place in the back of a sedan, parked near one of Manila’s most exalted cathedrals.

The dealer, Elsa — not her real name — has brought her wares in a plastic shopping bag. At my request, she dumps the illicit inventory on the backseat for inspection.

Out pours an astonishing variety of herbs and poultices. There is a gnarled root, the color of merlot and nubby with protrusions. Then a leafy plant that — if alive, Elsa says — would recoil from a human’s touch.

Then she lays out what looks like potpourri and, finally, bits of ginger-colored tree bark. All of it is sold in little baggies, just like heroin or speed.

“Boil all of this stuff in a pot,” Elsa says, “and give the liquid to a woman who has not received her period in up to two months.”

The result?

“Well, these plants are very bitter — so bitter that the body can’t take it. They’ll make her blood come out. And the baby will come out with it.”

For poor women in the Philippines with unwanted pregnancies, this is what health care looks like. In lieu of booking appointments at legit clinics, they are apt to schedule a rendezvous in a parking lot or a secluded corner in some market.

Abortion is among the greatest taboos in the Philippines, the strongest bastion of Catholicism in Asia. Much of the population looks to the Vatican for moral guidance. So do its lawmakers.

In the Philippines, there isn’t much of an “abortion debate” between political camps as in the United States. The matter is settled. By state decree, abortion is murder —  a crime that can bring on up to six years in prison.

Even the constitution vows to protect the “life of the unborn from conception.” An extra dollop of moral censure comes from the penal code, which vows punishment for any woman who undergoes abortion to “conceal her dishonor.”

And yet, according to dealers such as Elsa, the underground abortives business is booming.

For a drug dealer, Elsa is rather conspicuous. She’s loud and hilariously brash with a raspy cackle like Roseanne Barr. Today, she’s dressed in tattered jean shorts and flip-flops, her hair in a bob, looking every bit like an ordinary aunty headed to the market.

Elsa has been selling abortives for more than a decade — long enough to acquire a neighborhood reputation. When local busybodies denounce Elsa to her face, she retorts with black humor.

“Don’t come near me,” she’ll say. “I’m in a bad mood. I haven’t killed anyone today!”

Elsa belongs to a crime network run almost entirely by middle-aged women. They are criminal herbalists, operating in the shadows, dispensing plants grown in the island nation’s provinces.

These dealers aren’t hard to find. Everyone in Manila knows that they congregate around the Minor Basilica of the Black Nazarene — among the most prominent churches in the country. It’s located in a riverside district called Quiapo.

“Even in Filipino radio dramas,” Elsa says, “you’ll hear plot lines like, ‘Oh no, you’re pregnant! Go to Quiapo and find the herbal girls!’”

To a degree, these herbalists operate like any other illegal drug dealers. They use coded language. They bribe police to ward off arrest. They obey a code of silence, never revealing the names of their clientele.

In fact, one of Elsa’s top-selling products is designed for discretion: a pre-mixed herbal abortion elixir — ready to drink on the go, no boiling required. The price: 250 Philippine pesos. That’s roughly $5.

It’s popular among pregnant teenage girls who can’t be seen simmering strange roots in their mothers’ kitchens. “Say your mom sees you boiling something,” Elsa says. “She’ll automatically ask, ‘Are you pregnant?’”

From her bag, Elsa produces a pint-sized whiskey bottle. It’s been emptied out and filled with this dark concoction. She presses it into my hands. The liquid inside is purplish and frothy. Curious, I unscrew the lid, take a tiny sip and wince. My tongue feels like it’s coated in mud and chalk.

Never mind the taste. Does this stuff work?

Yes, Elsa says. But with caveats. Consume it within the first eight weeks of conception and the embryo will be expunged with menstruation. But after that, she says, the elixir can result in the birth of a deformed child.

“It might have defects,” Elsa says, lowering her voice to a conspiratorial whisper. “Like club feet. Or its heart is very weak.”

But Elsa — ever the entrepreneur — promises deliverance for women well into their second trimester. She digs into her shopping bag and retrieves a metallic packet of legitimate-looking medicine.

The foil reads “CYTOTEC” in block letters along with the logo of its manufacturer: Pfizer. I punch through the blister pack to find a hexagonal white pill.

“Ulcer medication. At least that’s what you’re supposed to use it for. But if you take a bunch of these,” Elsa says, “you can definitely end a pregnancy. Even after many months.”

More than 100 million people inhabit the Philippines — a doubling of the island nation’s population since 1980. That’s nearly one-third of the US population crammed into a country the size of Arizona.

There’s no denying it: The Philippines is crowded. In fact, its national birth rate is among the highest outside Africa.

Yet one of its primary institutions —  the church — is determined to eliminate as many contraceptives as possible. For decades, a powerful Catholic lobby in the Philippines has likened IUDs and birth control pills to instruments of murder. They are aghast that roughly half the nation’s couples use contraception.

Their mission: eliminating all government funding for birth control and, if possible, banning contraception outright.

“Truly, there is mass killing with the use of contraception,” says Rita Dayrit, the president of Pro-Life Philippines. Dayrit, though prim and genial, is among the nation’s more prominent voices decrying birth control pills as homicidal.

“We have forgotten what we were taught as young children,” she says. “That life is to be valued. That marriage is between man and woman. That children are gifts from God.”

“We grieve — we lament! — for the women who do not realize their womb is now an unsafe place. This is worse than a terror attack.”

Within the hyper-conservative Catholic lobby, this rhetoric is fairly mild. Some church-aligned senators have argued before the courts that state-backed birth control amounts to “genocide.”

This vehemence has placed Catholic advocacy groups at odds with a Philippine government that, through successive administrations, has pushed for more sex ed, more clinics and more free contraception.

Family planning advocates can point to worrisome stats. Women in the Philippines who have only an elementary school education birth an average of 4.5 children.

Those who earn just $2 a day — that’s 40 percent of the population — are apt to spend their cash on rice, not a $5 packet of birth control pills. What little health care these women receive often comes from free clinics.

Dayrit doesn’t deny that the Philippines is rife with destitute kids. “In Manila, we see children everywhere,” she says. “Dirty, hungry children everywhere.” But she believes that “there is a better way” for impoverished women with more than five children. “We can teach them the Billings method.”

This is better known as the “rhythm method,” the only church-approved family planning technique, apart from abstinence. It requires refraining from sex on fertile days, which are carefully plotted on a calendar.

President Rodrigo Duterte — who wants to advance state-backed birth control programs — has mocked this system in his characteristically gruff manner: “We can’t rely on calendars. Are we playing bingo now? … The urge to have sex is instant.”

To a degree, the US is also entangled in this faith-infused culture war. Over the course of roughly four decades, the US Agency for International Development spent $400 million on contraceptives in the Philippines — a program phased out in 2008.

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.”

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.

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.

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.”

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.

From PRI's The World ©2017 PRI