This dissertation is about underground markets for misoprostol (“miso” or Cytotec), a drug originally created in the 1980s to treat stomach ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs), but which is frequently used off-label to treat postpartum hemorrhage, induce labor, and induce abortion. In the cross-hairs of some of the most polarizing debates in mainstream U.S. political discourse—immigration, abortion, and the War on Drugs—depictions of off-label miso-use vacillate from hyper-racialized images of flea markets and drug cartels to hope for a future of unconstrained reproductive health options, a vision in which miso symbolizes the cornerstone of medical, technological, and social progress. However, Pfizer—the mega pharmaceutical company that owns, manufactures, and distributes miso under the brand name “Cytotec”—is overtly absent from these discourses. To bring the pharmaceutical machinery that has so successfully eluded these discourses back into the picture, I resituate discourses about underground misoprostol within the neoliberal structures from which it emerged in the post-World War II period, bringing together two key conceptual frameworks: (1) the reproductive justice movement’s long-held emphasis on women of color organizing and intersectional, radically inclusive, community-based, and comprehensive vision of reproductive freedom; and (2) Kaushik Sunder Rajan’s concept of “pharmocracy,” wherein pharmaceutical philanthropy acts as a modern form of extractive capitalism. I argue that the pharmocratic scripts of modernity and cultural backwardness reproduced in discourses about underground misoprostol reflect the dangerous proliferation of an updated version of bootstraps individualism I refer to as “reproductive neoliberalism”: the idea that, in lieu of state-provided equitable and holistic reproductive care, women can still achieve reproductive autonomy through entrepreneurial, legal, and pharmaceutical prowess. The individualist language of reproductive neoliberalism in Pfizer’s annual financial reports, mainstream liberal journalism, and family planning research about underground miso invisibly authorizes the uneven transfer of legal and medical liability away from pharmaceutical corporations, such that individuals are made to bear legal, medical, affective, and cultural liabilities—forms of conscripted labor inherent in the act of transgressing federal licensing and malpractice laws, as well as in the fear of accidental injury (bodily, emotional) to oneself or someone else in the process.