The Alamo flea market sits right off South Texas’s lengthy Highway 83; a sprawling, dusty, labyrinth of a place. Under canopies in the converted parking lot, vendors in dark sunglasses stand behind tables heaped with piles of clothing, barking in Spanish and hawking their wares. The air is hot and muggy, thick with the scent of grilled corn and chili.
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.
Over the past several years, dozens of states have restricted abortions. Since 2011, at least 73 abortion clinics in the nation have shut down or stopped providing services; and more than 200 abortion restrictions were legislated throughout the nation. Despite the passage of Roe v. Wade more than 40 years ago, states with pro-life politicians are still gunning to reverse the ruling—in the words of Rick Perry in 2012, “my goal is to make abortion, at any stage, a thing of the past.”
Yet these myriad restrictions on women and abortion providers have set the stage for women to skirt medical institutions to take charge of their own health. A similar story has already been written in many countries around the world, where pro-life legislation has inspired similarly creative solutions. 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.
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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. The drug, a synthetic prostaglandin E1 analog, has many medical uses: It’s taken to prevent and treat ulcers, induce labor, induce abortions, and treat post-partum hemorrhage. 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. Nobody knows exactly what happened. 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. Regardless of who uncovered its power, the pill was precisely what women needed: a magic personal solution to a dreaded problem that dared not be discussed.
In Brazil, as in many parts of the world, Catholicism dominates the abortion debate. Like adultery and murder, it was a mortal sin, worthy of damnation to hell and, according to the country’s 1940 Penal Code, a crime against life. Despairing Brazilian women with unwanted pregnancies resorted to drastic and dangerous measures. They listened to old wives tails, ramming sharp objects into their uteruses and guzzling drug cocktails, and visiting clandestine, unsafe abortion clinics. But nothing seemed to reliably work, and all were perilous. That is, until they found the little white pill—that special drug that could, miraculously, “bring the period back.”
And so, the whispers circulated and hushed exchanges began. 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.” For many Catholic women, describing miso in those terms felt better. It was different than aborting, and far less cognitively dissonant.
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, including perforated uteruses, heavy bleeding, and fallen intestines, according to a 2012 study by the global health organization Ipas.
The only explanation “was the mass distribution of miso at the community level,” concluded a Colombian ob-gyn in the Ipas study. In the same report, other doctors note that the discovery and circulation all took place outside hospital walls. Word of misoprostol spread at the grassroots level, working its way up from Brazil and snaking from one Latin American country to another.
In Brazil, an analysis of sales by the company Biolab (which began marketing the drug in 1988) shows a sharp increase beginning in 1989, sometimes exceeding more than 50,000 units per month. 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.