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.
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Texas’s Rio Grande Valley—a wide, flat swathe of land straddling the Mexico border—is one of the poorest regions in the country. It’s also ground zero for the state’s bitter abortion battle.
In the summer of 2013, the Texas legislature passed House Bill 2, a controversial set of abortion restrictions that Wendy Davis famously opposed with a marathon filibuster. The bill bans abortion after 20 weeks, adds restrictions to medication abortions, mandates that abortion providers have hospital-admitting privileges at clinics within 30 miles of where they practice, and requires that abortion clinics comply with ambulatory surgical center requirements by September 2014. Some of these provisions sound sensible, but abortion rights activists believe the intended overall effect is to deny abortions.
The law went into effect last October, and the provisions have since shuttered 12 of the state’s 40 abortion providers. Some hospitals refused to grant the privileges because of religious affiliation, while others declined because of the expensive fees associated with the process. Nancy Northrup, the president of the Center for Reproductive Rights, voiced her concerns about the legislation in a statement: “Texas has put the constitutional rights of its women in the hands of biased hospital administrators. As a consequence, the list of high-quality abortion providers forced to turn away patients continues to grow, while reproductive health care options for Texas women continue to shrink.”
Professional organizations, too, including The American Medical Association and the American College of Obstetricians and Gynecologists, openly opposed the restrictions. 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.
In the United States, miso is prescribed and sold legally in combination with another pill called mifepristone (or RU-486) for early nonsurgical abortion. The drug, which is also called Mifeprex, was approved by the U.S. Food and Drug Administration (FDA) in 2000, can only be taken in the early stages of pregnancy (within 49 days of a woman’s last menstrual period).
The miso/mife combination is becoming increasingly popular: In 2011, it accounted for 36 percent of all abortions before nine weeks of gestation, and it’s often considered the gold standard of medication abortion, with an estimated success rate that is nearly 10 percent higher than using miso alone (92 to 95 percent and 80 to 85 percent, respectively). Because of this, the FDA has never approved the use of misoprostol alone. After all, some say, why promote a silver standard when the gold is available?
Since, unlike miso, mifepristone is only used to induce abortions, it’s only available in about 50 countries. In 2007, the Federal District of Mexico City legalized first-trimester abortion, and in 2011 mifepristone was registered in the country. But outside of Mexico City, abortion is only available in the cases of rape or if a woman’s life is in danger—and so, mifepristone access is similarly limited.
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. And while no abortion clinics remain in the Valley, the Mexican town of Reynosa is just across the nearby border. There, miso can be bought in bulk at Mexican pharmacies and snuck back over the border into Texas, where it’s sold undercover at sprawling flea markets like the one I’m searching in today.
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It’s a balmy January morning as I make my way through the aisles of the Valley’s Alamo Flea Market, looking for the magic pill. I find a barrel-chested man in a tattered baseball hat who rests his hands on a table displaying an assortment of medicine: Umcka Cold Care, Posture-D Calcium, Anti-Nausea Liquid, and Valerian Root. He leans forward when customers approach the table, a messy mop of curly black hair peeking out from the bottom of his cap. Local sources have said I’ll be able to find miso here.
I head towards his booth cautiously, and the mop-haired man (who I later find out goes by Jeff Lopez) eyes me equally warily as I approach the table.
“Ummm,” I snatch a bottle of Ibuprofen and squint at the label. “Do you have anything for ulcers?”
Lopez stuffs his hands in his pockets. “We don’t have ulcer medicine,” he says. “Just the stuff on the table.” I’m not surprised he denies it; he may wonder if I’m an undercover agent of the law.
“Ok. Um, do you have something to make your period come back? I need to bring it back,” I trail off, scrutinizing his face for expression. “Cytoteca,” I say firmly, annunciating the teca in the familiar Spanish style. “Do you have it?”
He exhales dramatically.
“Not anymore. I haven’t had it since the police came,” he huffs, referring to a Valley flea market raid last August in Donna, Texas, where sheriffs uncovered a host of counterfeit drugs, including the diet pill Redotex and Viagra.
Shortly after, a woman was arrested for illegally selling thousands of prescription drugs nearby. (The drugs may be over the counter when bought in Mexico, but they are prescription drugs in the U.S. and illegal to distribute.) Though miso wasn’t uncovered in any of the raids, the overall crackdowns—and amped up policing—have made vendors wary of selling the pill. Lopez, who appears to have relaxed his caution, says the market was booming up until those raids.
"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.