‘Abortion pills’ (mifepristone and misoprostol) have reshaped the landscape of medication self-managed abortion (SMA), expanding possibilities for feminist accompaniment and redefining what counts as a safe abortion. In contexts marked by criminalisation, abortion pills have enabled SMA to be a safe (even though clandestine) procedure. They have also transformed advocacy narratives, shifting arguments away from preventing death towards affirming sexual and reproductive autonomy. Drawing on narratives produced with eleven feminist collectives in Ecuador and Bolivia, this study follows the trajectories of abortion pills to analyze how these pills both shape—and are shaped by—the abortion landscape and the forms of abortion activism in these countries. We traced how abortion pills changed from being an invisible object crossing borders under the guise of an ulcer medication, to a visible and criminalised substance associated with persecution, to a multiple actor simultaneously embedded in commercial markets and solidarity networks. Within some collectives, the pills were further debated as either reinforcing new normativities, conflicting with ancestral knowledge, or enabling a syncretic articulation of new and ancestral abortion practices. We show that abortion pills gain their most transformative force when integrated into the assemblage of ‘pills + feminist accompaniment’. This assemblage re-signifies the pharmaceuticalisation of abortion. Yet it depends upon the often-exhausting labour of activists, revealing tensions between solidarity and exploitation. We conclude that resistance emerges not from the pills themselves, but from feminist networks that anchor abortion in community, care, and social justice.