Southern Border Brings Easy Access to Abortion-Inducing Drug

There is no “abortion clinic” in Brownsville, but women here commonly and quietly undergo the procedure.

In Texas, abortion is legal during the first two trimesters of pregnancy. At the nearest provider in Harlingen, medical and surgical abortions are offered at reduced or no cost to women who cannot afford to pay.

But based on data about the number of self-induced abortions seen by local clinics and social workers, it is likely that many of the abortions undergone by women in this area are done using drugs purchased at Mexican pharmacies, without accurate information about the safest amount or method for inducing miscarriage.

Many Brownsville women and a significant number of men know the vague details of a little white pill called misoprostol, known by its brand name Cytotec and hesitantly referred to as a “wonder drug” by those who study it.

On the bottle a small icon of a pregnant woman encircled and crossed out in red illustrates the product warning: “Cytotec may endanger pregnancy (may cause abortion) and thereby cause harm to the fetus when administered to a pregnant woman.”

Anecdotally, stories of a friend or neighbor who has used it are passed along.

According to Harlingen Reproductive Services, the nearest clinic to offer abortion procedures, about half of the women they see have already attempted to use misoprostol or another prescription drug to attempt abortion. At Women’s Whole Health in McAllen, this comprises 30 to 40 percent of their clients.

If used properly, misoprostol is about 85 percent effective in inducing abortion, and most women will not need to seek medical assistance, according to one of the drug’s pioneering researchers for abortion usage, Dr. John K. Jain.

Misoprostol has been a popular option for women in countries where abortion is either illegal or inaccessible since the late 1980s.

In Texas, abortion is legal in the first 25 weeks of pregnancy. Cameron County is one of the 7 percent of Texas counties with a clinic. Still, for local women the cultural pressure and economic barriers to abortion often outweigh the risks of swallowing an unprescribed pill.

Even a conservative estimate would double and possibly triple the number of abortions occurring in the area.

Unknown Underground

Information on abortion statistics is easy to find, in part because of the stringent surveillance enforced by pro-life lobbying groups. But facts on self-induced abortion require significant investigation, beyond the scope of the average woman in the poorest city of its size in the United States.

Misoprostol hasn’t been extensively tested in this country for use as an independent abortion drug. Even the country’s foremost researcher of sexual and reproductive health, the Guttmacher Institute, has virtually no data on underground usage of the drug for self-induced abortion, because the practice is so secretive.

Research groups like the Population Council, Ibis Reproductive Health, and the National Latina Institute for Reproductive Health have begun gathering data on the accessibility and safety of misoprostol in the past few years.

But there is a reticence to disseminate the information, for fear governments could crack down on the distribution of this relatively safe alternative to informal surgical abortion.

In some countries where abortion is illegal, misoprostol availability has been reduced. Once the drug was widely publicized in Brazil, it became illegal to prescribe outside of a hospital setting.

Dr. Mitchell Creinin, the director of gynecological specialties and family planning at the University of Pittsburgh Medical Center, and one of the drug’s foremost researchers says that there’s no chance this will happen here.

“You have to remember it’s already part of the FDA approved regimen,” he added, referring to the mifepristone-misoprostol regimen available in the first nine weeks of pregnancy, which gives women the option of a medical abortion experienced at home.

The drug also remains useful for its labeled purpose, ulcer treatment, and in the treatment of arthritis and for gynecological purposes, like softening the cervix and inducing labor.

Long Drives, Legal Options

Abortion continues to be one of the most common procedures undergone by women in this country. About 1.5 million American women have clinical abortions every year.

One in three women here will have a clinical abortion before the age of 45 according to the Guttmacher Institute.

Though legal on a national level, the landscape of abortion access continues to be dramatically different from one region to the next.

In South Dakota, there is only one abortion clinic in the state. Medicaid covers the abortion if the woman’s life is in danger. The doctor has to be flown in from Minnesota to perform the procedure.

In Texas, women are required to receive information about abortion 24 hours in advance, a stipulation that some women’s health advocates say represents an economic and social barrier for many women too difficult to traverse.

“If a woman has to drive 30 minutes, turn around and then do it again the next day, that’s two hours of driving, plus the appointment time that she can’t easily hide,” said Jessica Gonzalez-Rojas, the director of policy and advocacy at the National Latina Institute for Reproductive Health.

A clinical abortion can cost anywhere from $400 to $800 depending on how far along the woman is in her pregnancy.

Financial barriers like the Hyde Amendment, which made the use of Medicaid for abortions illegal unless they are the proven product of incest, rape, or in the case of endangerment of the woman’s life, leave low-income women along the border with greater difficulties in obtaining a safe, legal abortion.

Some clinics, like those in Harlingen and McAllen, offer reduced costs to women who can’t afford the prices, but it is unlikely that women would be aware of these unadvertised options.

Challenges and Choices

These obstacles are especially challenging to undocumented women.

The Friendship of Women reports that one in 10 women seeking shelter for domestic abuse has at some time been forced by their partner to self-induce abortion. Eighty-five percent of these women are forced by their partner to have sex without birth control.

“The phrase we hear, ‘he says that I’m his forever. We’re gonna be married ‘til life do us part,’” said Elena Rangel, the Legal Advocate Coordinator for the Friendship of Women. “There are many women who, because of their immigration status, are afraid to reach out for help. They think that if they do they’ll be deported.”

“There are many institutional barriers that exist in this country for women to obtain abortions,” Gonzalez-Rojas said. “A self-induced abortion tends not to be a choice but rather a product of all of these barriers.”

But institutions aside, NLIRH says that culture alone may provide the reason why self-induced abortions are more popular for Latina women. Abortion has historically been illegal in many Latin American countries, (including Mexico where it was legalized in the capital last year) and women are accustomed to living in an environment where it is both technically and culturally illegal.

Among the sparse research that has been conducted on the drug, a survey by a pediatrician and a gynecologist of 610 women in New York City was done in 1999.

Twenty-eight percent of the women were born in the United States, 50 percent had lived in the United States for five or more years, and the rest had lived here for five years or less.

The group was 86 percent Hispanic. Thirty-seven percent of the women were familiar with misoprostol and five percent had used it at some point to self-induce abortion.

Along the border, even for women who have been raised in the United States and don’t face linguistic or legal barriers, an abortion clinic is an intimidating concept.

“Their ideas about an abortion clinic could have nothing to do with the reality of how that clinic works,” said Debbie Billings, a researcher for Ipas, a not-for-profit organization dedicated to improving women’s reproductive health and rights.

“People think of long waiting times, lots of paperwork, and in the end it’s gonna cost an arm and a leg. With misoprostol they think, ‘my sister or my sister’s friends took it, it worked for her, no one will ever know. I can do this totally on my own and very privately.’”

Andrea Ferrigno, Executive Director of Whole Women’s Health of McAllen says that between 30 and 40 percent of the women who come to the clinic have already attempted to self-induce abortion before arriving there.

“We are in a very conservative area, there is so much stigma around the abortion issue,” Ferrigno said.

“Women feel threatened, there’s a fear of exposure of being judged, of being misunderstood. There is a lack of information. They don’t know that it’s safe, that there is funding and abortions can be done without fear of reprimand or counter effect.”

It’s safe. Is it sound?

Those who study the drug say that while it’s far safer than alternative methods of self-inducing abortion, like informal surgery, it still has its hazards.

“It’s counter-intuitive the way this drug works,” Billings said. “Women think if they're further in their pregnancy they should take more, but because of the way the drug interacts with the uterus, when a woman is farther along in her pregnancy her uterus is thinner, and the drug causes it to contract more violently. If your uterus ruptures there’s a good chance you can hemorrhage and die.”

Dr. Daniel Grossman has worked on studies with the Population Council and Ibis Reproductive Health to look at the access and information women have when they use the drug to self-induce abortion.

“The pharmacy people -- I wouldn’t say pharmacists because they’re not trained like the pharmacists here in the United States -- who were giving it to women did not give them good information about how to take it or its side effects,” Grossman said. “It doesn’t seem that pharmacy workers are knowledgeable about how to use it.”

Ultimately, experts say that the use of misoprostol along the border is an indication of the need for continued legal choices for women and easier access to these options.

“You can agree or disagree with abortion, but it happens,” Creinin said. “We can either offer them the safest options, with good counseling on family planning, or we can say ‘I don’t support abortion, it’s horrible, it’s murder,’ and not provide women with options -- but women will continue to find a way to have abortions and a lot of them are gonna die. I don’t think that’s the kind of world we want to live in.”

Pro-life advocates like Dr. Joe Pojman, the director of Texas Alliance for Life say that when women desperately seek to self-induce abortion it’s instead a sign that society should be providing better alternatives for unwanted children.

“I think the answer to all of this is compassionate alternatives to abortion. I believe that a compassionate society can address a child that is the product of rape or incest,” Pojman said. “Many women would seek an alternative to abortion if they knew that one existed.”

Pojman points to legislation that requires teenagers in Texas to get parental consent before getting an abortion as proof that pro-life legislation is effective in reducing abortions. He admits that it’s difficult to tell whether some teens in this area might have simply turned to misoprostol instead.

Pro-choice researchers say that in a utopian society Pojman’s solutions would work, but in today’s world there are still going to be women who choose to have abortions, no matter what.

Creinin says that you don’t have to believe in abortion to be pro-choice.

“At what point do we force individuals to do things with their own body?” Creinin said. “I never argue with people who don’t believe in abortion. But to me, it gets back to the basic question of whether it’s OK for one group of individuals to impinge their beliefs on another group of individuals. There’s no winning because it comes down to the fact that people have different beliefs.”

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