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.
Activists, feminists, and abortion advocates grouped together and began creating volunteer-staffed phone hotlines. These small, often DIY networks promoted miso use and distributed information about the drug, and many of them still exist today. They’re often run by volunteers who give anonymous callers medical information about miso, like how to take the 12-pill regimen and when to be concerned about adverse reactions to the drug. Hotline workers raise awareness about their services through informal, word-of-mouth networks and social media.
The hotlines have made—and continue to make—an impact on women living in countries with some of the world’s strictest abortion legislation. In Chile, where abortion is illegal without exceptions, a hotline called Linea Aborto Libre has had considerable success. It’s staffed by a group of young feminists who take turns passing around a compact cellphone. If they’re not careful, their work could land them behind bars: Getting an abortion in Chile—or telling a woman how to do so—is a crime punishable by three to five years in jail. To avoid legal prosecution, hotline volunteers read information about misoprostol abortions that’s publicly available on the WHO (World Health Organization) website.
Chile’s not the only Latin American country with a hotline; similar ones exist in Argentina, Ecuador, Peru and Venezuela. There are well-known websites like Women on Web, an international collective that provides information about self-induction and sends misoprostol to women in countries with restrictive abortion laws. Women on Waves, a Dutch NGO, performs medical abortions on a ship that sails to countries where abortion is illegal.
In Chile and elsewhere, these phone hotlines and other networks were game-changers, because providing information about miso can make the difference between a successful abortion and a botched one that that lands a woman in a hospital or a jail. But given all of the evidence about improper dosages in Texas, why aren’t there any hotlines in the United States? How is it that women living in the Valley actually have less access to information than women in Chile—a country with some of the most oppressive abortion policies in the world?
When I told Carreon of McAllen’s Whole Women’s Health about the phone hotlines, she immediately perked up. “Wow,” she exclaimed. “That’s so interesting. I think there’s a need for that.”
But that’s where it gets complicated. In the United States, laws related to self-abortion vary by state. In some states, women who induce their own abortions, as well as those who assist them, are subject to criminal liability, and in states like Massachusetts, South Carolina, and Idaho, criminal charges have been brought against women who used miso to end their own pregnancies. In 39 states, it is illegal for anyone other than a medical provider to perform an abortion. But there is no consistency among states when it comes to the penalties for women inducing abortion without a physician, or for those who help them get information about the medications necessary to self-induce.
Many of the abortion advocates and women’s health organizations I talked to were reluctant to even discuss the topic of phone hotlines, concerned that establishing such networks could have serious legal consequences. After all, self-induced abortion is illegal in dozens of states. One reproductive health expert told me that creating phone hotlines, or handing out flyers with information about miso from the WHO is out of the question.
“Giving general information” about where to get an abortion “is never a problem. Helping a woman who wants to end her own pregnancy is a crime,” she said firmly.
But others say that setting up and operating a hotline that comes with a recorded disclaimer that it’s simply providing scientific information that’s already publicly available might be a less risky bet. Francine Coeytaux, a public health specialist and founder of the Pacific Institute for Women's Health, says that reproductive health advocates often have a tendency to self-censor because they’ve been playing on the defensive against the pro-life movement for so long, and perhaps are overly cautious.
“I don’t think we should assume that it’s illegal,” she said. “It’s sharing information and we’re not telling them what to do.”
* * *
While it appeared that the raids earlier this year had ended miso sales at the flea markets, there are other ways to get it besides crossing the border into Mexico.
Buy-pharma.com, for example, sells one 200-mcg pill for $2 (or a package of eight for $16). On the Facebook page “Cytotec misoprostol,” a user can request to buy the pills from the page’s administrator, who sells 12 pills for $950 pesos ($73.05).
But often it’s nearly impossible to verify the reliability of these pills. Surfing the net for miso through search terms like “abortion pills online” yields pages of results from online pharmacies—some of which are carefully constructed to look like the buyer is in good hands.
Advocates don’t promote the use of these sites. A page on the Women on Waves website warns against buying the pills online, and it outlines a long list of doctors and pharmacy websites notorious for selling counterfeit medications.
“The only website we trust to help women gain access to a safe medical abortion is www.womenonweb.org and we cannot guarantee that any other website is trustworthy,” the organization writes.
Despite the cautionary advertising, some still choose to purchase medications advertised as miso online. Molly, a feminist abortion advocate who preferred not to use her real name, buys miso and RU-486 (a.k.a “the gold standard”) in mass quantities from online pharmacies and sends it to women in the United States who want to use the drugs but don’t know how to go about getting them.
“It’s incredibly liberating having misoprostol in my bathroom cabinet,” she says. “The idea of a pregnancy scare is ... less scary, in a very real way. I wouldn't need to even tell anyone except me, if I didn't want to.”