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.
While I didn’t take the pharmacists up on their offer, all three were able to dispense the pills for me immediately, though none of the dosages came with instructions about how to use the pills for an abortion. Misoprostol is only sold in Mexican pharmacies as an ulcer medication, and while pharmacists are aware that women are using it for other reasons, they can’t provide information about how to terminate a pregnancy with the pill. After all, abortion is restricted outside of Mexico City.
A couple hours later, I hiked across the bridge back to El Paso. After waiting in a brief line at the checkpoint, I set my bag on the security belt and looked around the room, wondering how many people were slinking over the border with small white hexagonal pills hidden in their belongings.
* * *
In the late '90s, the Internet spread throughout Latin America, ushering in an era of rapid, real-time communication. Suddenly, information about miso was catapulted onto the web. Websites about the drug—where to purchase it, how to use it, and even businesses offering home delivery—began to pop up, but activists wanted to make sure that the information women were getting was correct. So they thought of a practical solution.