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.
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.