“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.
A native of Reynosa, Mexico, Felix has a short brown bob and a bellowing laugh. She wears a thin, gold necklace, a souvenir that a friend brought back from a Catholic trip to Israel. In the middle, a pendant spells out her first name in Hebrew. Blowing on a hot bowl of soup inside a Mexican restaurant in Brownsville, Felix explains the dilemma that many local women face since the crackdown on miso. Now, to get to the nearest abortion providers, they have to pass through la garita, or immigration checkpoints.
“So undocumented women, what can they do?” she asks, flinging her hands in the air. “They put things in their vagina. I've heard that women are using coat hangers or some are going to Mexico and getting clandestine abortions, where it's dirty, unhygienic.” Felix gulps down a spoonful of broth. “Other women go to the flea markets. There are still places where you can get pills.”
McAllen’s Whole Women’s Health stopped providing abortion services after the admitting privileges provision went into effect and shut down entirely in March.
“It’s just the beginning,” the center’s former patient advocate, Luzevlia Carreon, observes. “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.”
HB2 took the community by surprise, Carreon says. Many had relied on the clinic for years.
“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.
One woman I interviewed at a Mexican restaurant in Brownsville told me her good friend nearly died after taking pills that her husband bought in Mexico. 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. She has since recovered but is still in Mexico with her children because she can’t cross the border back into the United States.
Carreon says she sees many patients who have taken improper dosages. “A lot of patients said that they would take the whole bottle and they would tell me they took 28 pills,” she said. “They’re taking maybe four vaginally, two orally. Then an hour later, four more. I hear different ways of using these pills. It’s shocking each time.”
But strict internal clinic protocol bars Carreon and other employees at Whole Women’s Health from answering questions about miso and abortion. And the drug’s other distribution channels are similarly mum. 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.
Lopez is the first to admit that he knew nothing about the pills when he was selling them. “I’m not a doctor. I sell things,” he acknowledges, picking up a medicine bottle. “I don’t know anything else.”
He adjusts his hat and walks around the table. He’s starting to get a little shifty: avoiding eye contact, fidgeting, and giving me short answers. I move a little closer.
“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.
Now that the vendors throughout South Texas operate in the shadow of the police raid, Lopez says he’s not sure if anyone currently sells miso in the pulgas.
“The demand is going to be even higher now that the abortion clinics shut down,” he speculates. “But if it isn’t sold in flea markets, more people are just going to end up going to Mexico.”
* * *
The bridge that connects El Paso, Texas, to Juarez, Mexico is surprisingly short—but the two cities on either side look startlingly different. Halfway through my walk to Mexico, I looked to my right. I could see El Paso, neat and carefully assembled, an American flag in the distance slowly swaying with the breeze. And to my left, there was Juarez, dusty and weathered like an old postcard.
Once I crossed over, I stepped inside a yellow building called Farmacia del Ahorro del Mexico and asked if I could purchase Cytoteca. “No problem,” the pharmacist said, punching a few letters into the keyboard. A couple seconds later, an estimate popped up: $48 U.S. for four pills, or around $150 for the dosage of 12. Down the street, two other pharmacists gave me similar estimates, ranging from $125 to $177, the latter two for a full bottle of 28 pills.