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The Rise of the DIY Abortion in Texas

Customers browse simple items—miracle-diet teas, Barbie dolls, or turquoise jeans stretched over curvy mannequins—but there are also shoppers scanning the market for goods that aren’t displayed in the stalls. Tables lined with bottles of medicine like Tylenol and NyQuil have double meanings to those in the know: The over-the-counter drugs on top provide cover for the prescription drugs smuggled over the border from nearby cities in Mexico. Those, the dealer keeps out of sight.

I’m here to look for a small, white, hexagonal pill called misoprostol. Also known as miso or Cytotec, the drug induces an abortion that appears like a miscarriage during the early stages of a woman’s pregnancy. For women living in Latin America and other countries that have traditionally outlawed abortion, miso has been a lifeline—it’s been called “a noble medication,” “world-shaking,” and “revolutionary.” But now, it’s not just an asset of the developing world.

As policies restricting access to abortion roll out in Texas and elsewhere, the use of miso is quickly becoming a part of this country’s story. It has already made its way into the black market here in Texas’s Rio Grande Valley, where abortion restrictions are tightening, and it is likely to continue its trajectory if anti-abortion legislation does not ease up and clinics continue to be closed.

..  Today, throughout Texas—from the Rio Grande Valley to El Paso—miso’s story is being drafted anew. And in this narrative, it is Latin America that has answers for the United States.

Misoprostol’s role as the world’s revolutionary abortion pill began by accident, and nobody knows for certain where it all began. Early scientific literature traces the drug’s abortion-inducing use to Brazil, but it’s possible that it was also being taken—but not documented—in the Caribbean at the same time.

.. Ironically, misoprostol was never developed to induce abortions: Instead, it was created and marketed as an ulcer medication called Cytotec.

.. In 1986, misoprostol was approved for sale in Brazilian pharmacies as an ulcer medication and was distributed over-the-counter. But its use as an abortion-inducing drug spread rapidly, and slipped below the radar at first. Like many drugs, misoprostol’s label had a simple warning: Do not take if pregnant.

.. But not everyone heeded the warning, including a number of Brazilian women who read the drug’s packaging and decided to try their luck. Or that’s how the story goes.

.. Some believe that certain Brazilian women made this discovery on their own; others say that a select few pharmacists who knew that Cytotec could induce abortions secretly spread the word.

.. That is, until they found the little white pill—that special drug that could, miraculously, “bring the period back.”

.. When women searched for the magic drug, they would shield their intentions with coded language: “I need to bring down my period,” they would say, or “bring it back.”

.. As miso became more popular, Latin American doctors from Peru to Brazil started noticing a trend: They were seeing, it seemed, a dramatic decrease in abortion-related complications. Fewer women were carted through hospital doors with gruesome infections from back-alley botched abortions, and ob-gyns saw a reduction in the grisly abortion complications that had so frequently plagued providers

.. Word of misoprostol spread at the grassroots level, working its way up from Brazil and snaking from one Latin American country to another.

.. In 1991, the company reported that misoprostol’s use as an abortion-inducing drug could reach up to 35 percent of its total usage.

.. Public pressure to regulate the drug in Brazil mounted, and in May 1991, the state of Rio de Janeiro restricted miso’s use to hospitals, while the state of Ceara imposed a total ban on its sales. On July 17, 1991, the Ministry of Health required that the purchase of miso had to be accompanied by a prescription from a physician, and made a deal with Biolab Laboratories to reduce the availability of the drug. In 1992, miso’s public availability in the State of Sao Paulo was restricted to authorize pharmacies registered with local government authorities. Today, it’s difficult—but not impossible—to get the drug in Brazil. Traffickers sell it on the black market and online, but it can be prohibitively expensive (according to a recent Al Jazeera article, one pill can cost up to $60), and when it is sold online, it’s often counterfeit.

.. But miso is still commonly used in Brazil, and it accounts for nearly half of the country’s one million annual abortions. As these numbers reveal, many of the women in Brazil and Latin America had welcomed miso in the absence of safer options. Now, more than three decades later, the secret has made its way to the United States.

..  A study conducted by the University of Texas predicted that the law would bar nearly 23,000 Texas women from getting abortions—or almost one in every three women who seeks an abortion.

.. Many of these women can be found in the Rio Grande Valley, where the admitting privileges provision forced both of the county’s abortion clinics to shut down. Now, the closest clinic for the region’s one-million-plus residents is 150 miles away. For many poor, uninsured South Texas women, that distance is beyond feasible. Few have access to a set of wheels for the long haul, and others lack the right paperwork to cross immigration checkpoints on highways that run through the state.

.. Meanwhile, the flea market is close to most people living in the Valley, and the massive Alamo pulga looks like just the kind of place to pick up miso. According to several of my local sources, the drug is sold here and it’s not difficult to get—you just need to know who to approach and what to ask for.

.. But the “silver standard” is readily available without a prescription. In Mexico, miso is sold over the counter as an ulcer medication (in the U.S., it’s only available with a prescription) creating the perfect conditions for black-market sales in the United States.

.. “When I first found out how many women were asking for it, I couldn’t believe it,” he recalls. “The market had tons of people selling the pill, and I still got asked for it so many times. Almost every time I was here, someone asked me for it.”Lopez’s experience was common. There seemed to be a consensus among nearly everyone I interviewed—from health educators to Valley residents—that if abortion providers remain shut, women will continue to look for miso.

“If a woman wants to abort, she’s going to abort,” says Lucy Felix, a Valley-based promotora, or health educator, at the National Latina Institute for Reproductive Health.

..  “It’s in demand right now. It’s what our patients are doing and they’re going to continue taking it. … The fact of the matter is that women are going to get pills and are going to figure out ways to have an abortion.”

.. “They were so shocked when they found out we weren’t offering abortions anymore. I even have patients that call, and after we tell them that we can’t offer abortions anymore, they’ll just say, ‘That’s fine. I’m going to figure out a way to do this on my own.’ And imagine all the women who don’t call us at all, who are still taking [miso],” she sighs. “We have no idea how many are doing this. We just hope for the best.”

In Latin America, miso was a secretive lifeline for many women without means to have other options. Now that the same is happening in the United States, the phenomenon is even more underground here. The networks are just starting to develop and proper information about dosage is not widely available. Moreover, those in the know appear hesitant to distribute material—much of which is circulated around Latin America—about how to safely take the drug.

.. According to the World Health Organization, more than 21 million women annually have unsafe abortions worldwide, which account for nearly 13 percent of all maternal deaths. Miso is a much safer alternative. If taken in the correct quantities (four to 12 pills over the course of at least nine hours) in a women’s first trimester, the drug is 80 to 85 percent effective.

But miso’s safety is also a function of the information that comes with it. In Texas’s Rio Grande Valley, according to Carreon and others, many women are using the drug improperly because they don’t have access to basic facts about the correct dosage. That ignorance can lead to problems.

.. Instead of ingesting four of the 12 pills every three hours, as is recommended by the World Health Organization, she took two pills under her tongue, then four pills vaginally, then two more under her tongue, then four more vaginally. She began to bleed profusely, doubled over in pain. But because she was undocumented, she was afraid to seek medical help at a nearby hospital or clinic. Instead, she crossed the border to Mexico with her five children—all the while hemorrhaging—in search of medical assistance.

.. Mexican pharmacists can’t provide information about the drug and abortion, since it’s only sold there as an ulcer medication, and many of the vendors selling miso at flea markets know very little about correct dosage.

.. “So I’m curious about how many pills you would sell,” I start. “Because women are supposed to take 12 pills over nine hours if they’re in their first trimester. That’s what most doctors recommend.”I glance at Lopez and ask him if he knew this. His answer is a firm no.

When customers came to Lopez looking for the pills, he says he would sell the number they asked for—which often landed in the three or four range—and would charge around $13 per pill. Commonly, buyers didn’t know how many to purchase, so Lopez says he would defer to odd numbers and sell them three. Once, he sold a woman 20.

“I didn’t know what was right,” he says with a shrug.

.. “But if it isn’t sold in flea markets, more people are just going to end up going to Mexico.”

.. while pharmacists are aware that women are using it for other reasons, they can’t provide information about how to terminate a pregnancy with the pill. After all, abortion is restricted outside of Mexico City.

.. To avoid legal prosecution, hotline volunteers read information about misoprostol abortions that’s publicly available on the WHO (World Health Organization) website.

.. In the United States, laws related to self-abortion vary by state. In some states, women who induce their own abortions, as well as those who assist them, are subject to criminal liability, and in states like Massachusetts, South Carolina, and Idaho, criminal charges have been brought against women who used miso to end their own pregnancies. In 39 states, it is illegal for anyone other than a medical provider to perform an abortion. But there is no consistency among states when it comes to the penalties for women inducing abortion without a physician, or for those who help them get information about the medications necessary to self-induce.

.. Many of the abortion advocates and women’s health organizations I talked to were reluctant to even discuss the topic of phone hotlines, concerned that establishing such networks could have serious legal consequences. After all, self-induced abortion is illegal in dozens of states. One reproductive health expert told me that creating phone hotlines, or handing out flyers with information about miso from the WHO is out of the question.

“Giving general information” about where to get an abortion “is never a problem. Helping a woman who wants to end her own pregnancy is a crime,” she said firmly.

.. Francine Coeytaux, a public health specialist and founder of the Pacific Institute for Women’s Health, says that reproductive health advocates often have a tendency to self-censor because they’ve been playing on the defensive against the pro-life movement for so long, and perhaps are overly cautious.

“I don’t think we should assume that it’s illegal,” she said. “It’s sharing information and we’re not telling them what to do.”

.. “The only website we trust to help women gain access to a safe medical abortion is www.womenonweb.org and we cannot guarantee that any other website is trustworthy,” the organization writes.

.. “It’s incredibly liberating having misoprostol in my bathroom cabinet,” she says. “The idea of a pregnancy scare is … less scary, in a very real way. I wouldn’t need to even tell anyone except me, if I didn’t want to.”

.. Molly says that many of the women who contact her are already mothers who live hours away from the nearest clinic. Often, they don’t have anyone to watch their children while they go in for the procedure, especially if they have to return for more than one visit and can’t afford to take more days off of work.