The Rise of the DIY Abortion in Texas

A pill that revolutionized reproductive rights in Latin America is now gaining ground on the black market in South Texas.
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The Alamo flea market sits right off South Texas’s lengthy Highway 83; a sprawling, dusty, labyrinth of a place. Under canopies in the converted parking lot, vendors in dark sunglasses stand behind tables heaped with piles of clothing, barking in Spanish and hawking their wares. The air is hot and muggy, thick with the scent of grilled corn and chili.

Customers browse simple items—miracle-diet teas, Barbie dolls or turquoise jeans stretched over curvy mannequins—but there are also shoppers scanning the market for goods that aren't displayed in the stalls. Tables lined with bottles of medicine like Tylenol and NyQuil have double-meanings to those in the know: The over-the-counter drugs on top provide cover for the prescription drugs smuggled over the border from nearby cities in Mexico. Those, the dealer keeps out of sight.

I’m here to look for a small, white, hexagonal pill called misoprostol. Also known as miso or Cytotec, the drug induces an abortion that appears like a miscarriage during the early stages of a woman’s pregnancy. For women living in Latin America and other countries that have traditionally outlawed abortion, miso has been a lifeline—it’s been called “a noble medication,” “world-shaking” and “revolutionary.” But now, it’s not just an asset of the developing world.

As policies restricting access to abortion roll out in Texas and elsewhere, the use of miso is quickly becoming a part of this country’s story. It has already made its way into the black market here in Texas’s Rio Grande Valley, where abortion restrictions are tightening, and it is likely to continue its trajectory if anti-abortion legislation does not ease up and clinics continue to be closed.

Over the past several years, dozens of states have restricted abortions. Since 2011, at least 73 abortion clinics in the nation have shut down or stopped providing services; and more than 200 abortion restrictions were legislated throughout the nation. Despite the passage of Roe v. Wade more than 40 years ago, states with pro-life politicians are still gunning to reverse the ruling—in the words of Rick Perry in 2012, “my goal is to make abortion, at any stage, a thing of the past.”

Yet these myriad restrictions on women and abortion providers have set the stage for women to skirt medical institutions to take charge of their own health. A similar story has already been written in many countries around the world, where pro-life legislation has inspired similarly creative solutions. Today, throughout Texas—from the Rio Grande Valley to El Paso—miso’s story is being drafted anew. And in this narrative, it is Latin America that has answers for the United States.

* * *

Misoprostol’s role as the world’s revolutionary abortion pill began by accident, and nobody knows for certain where it all began. Early scientific literature traces the drug’s abortion-inducing use to Brazil, but it’s possible that it was also being taken–but not documented—in the Caribbean at the same time.

Ironically, misoprostol was never developed to induce abortions: Instead, it was created and marketed as an ulcer medication called Cytotec. The drug, a synthetic prostaglandin E1 analog, has many medical uses: It’s taken to prevent and treat ulcers, induce labor, induce abortions, and treat post-partum hemorrhage. In 1986, misoprostol was approved for sale in Brazilian pharmacies as an ulcer medication and was distributed over-the-counter. But its use as an abortion-inducing drug spread rapidly, and slipped below the radar at first. Like many drugs, misoprostol’s label had a simple warning: Do not take if pregnant.

But not everyone heeded the warning, including a number of Brazilian women who read the drug’s packaging and decided to try their luck. Or that’s how the story goes. Nobody knows exactly what happened. Some believe that certain Brazilian women made this discovery on their own; others say that a select few pharmacists who knew that Cytotec could induce abortions secretly spread the word. Regardless of who uncovered its power, the pill was precisely what women needed: a magic personal solution to a dreaded problem that dared not be discussed.

In Brazil, as in many parts of the world, Catholicism dominates the abortion debate. Like adultery and murder, it was a mortal sin, worthy of damnation to hell and, according to the country’s 1940 Penal Code, a crime against life. Despairing Brazilian women with unwanted pregnancies resorted to drastic and dangerous measures. They listened to old wives tails, ramming sharp objects into their uteruses and guzzling drug cocktails, and visiting clandestine, unsafe abortion clinics. But nothing seemed to reliably work, and all were perilous. That is, until they found the little white pill—that special drug that could, miraculously, “bring the period back.”

And so, the whispers circulated and hushed exchanges began. When women searched for the magic drug, they would shield their intentions with coded language: “I need to bring down my period,” they would say, or “bring it back.” For many Catholic women, describing miso in those terms felt better. It was different than aborting, and far less cognitively dissonant.

As miso became more popular, Latin American doctors from Peru to Brazil started noticing a trend: They were seeing, it seemed, a dramatic decrease in abortion-related complications. Fewer women were carted through hospital doors with gruesome infections from back-alley botched abortions, and ob-gyns saw a reduction in the grisly abortion complications that had so frequently plagued providers, including perforated uteruses, heavy bleeding, and fallen intestines, according to a 2012 study by the global health organization Ipas.

The only explanation “was the mass distribution of miso at the community level,” concluded a Colombian ob-gyn in the Ipas study. In the same report, other doctors note that the discovery and circulation all took place outside hospital walls. Word of misoprostol spread at the grassroots level, working its way up from Brazil and snaking from one Latin American country to another.

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.

* * *

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.

* * *

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.

“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.

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 ArgentinaEcuadorPeru 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.”

Molly says that many of the women who contact her are already mothers who live hours away from the nearest clinic. Often, they don’t have anyone to watch their children while they go in for the procedure, especially if they have to return for more than one visit and can’t afford to take more days off of work.

“They told me they'd try anything: herbs, soaps,” she writes in a post that went viral online. “One asked if I knew how, exactly, it was that you went about using a wire hanger to abort. Two or three days later, they would receive a small, unmarked envelope. Inside the envelope were doses of two different drugs that, when used together, will abort nearly any first-trimester pregnancy.”

So far, Molly says she has sent the pills out to between 50 and 100 women. Sometimes she receives emails that seem like “suspicious pleas”—messages that sound little too-scripted, like the person behind the keyboard is playing a role to catch Molly at her own game. So now, she’s scaling back on sending the drug packages, instead referring women to international pharmacies to buy the medications themselves.

Sending the pills is a risky endeavor. Legally, the process puts her in harm’s way, but even more worrisome is the possibility that the medications she sends might seriously jeopardize a woman’s health. As many reproductive health experts warn, the pills she buys from the international pharmacies could be counterfeit, or they could be real and still cause complications.

“I know, when I do it, that it could be a devil's bargain,” Molly writes in the post. “This could be the envelope that gets traced back to me. This could be the one that lands me in prison. Or, even worse, it could be the one that kills someone. The abortion drugs rarely cause major complications (less often than birth), but they do happen. I don't know what I would do with that on my conscience. I haven't had to find out yet.”

* * *

Back in Texas, HB2, the state’s strict new abortion law, shows no signs of letting up.

In March, the U.S. 5th Circuit Court ruled unanimously that the admitting privileges provision in HB 2, which led to the closures of clinics in the Valley and elsewhere, “does not impose an undue burden on the life and health of a woman." Since the law went into effect, the state’s number of licensed abortion providers dropped from 40 to 28, and only 24 centers still offer the surgical procedure.

And in September, another portion of HB2 will go into effect, which requires all abortion providers to conform to the same standards as ambulatory surgical centers—a costly upgrade that is expected to shut down the majority of the state's remaining clinics. When this portion of the law goes into effect, the number of abortion facilities in the state is expected to drop to six.

Today in Texas things are starting to look a lot like the early years of miso in places like Brazil and Chile: The simple guidelines about miso haven't yet made it to women in the state. But eventually, in those countries, the Internet and the democratization of information prevailed. Unless, and until, abortion restrictions change again, Latin America’s DIY-abortion culture might be the future of women in South Texas.

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Erica Hellerstein is a freelance writer based in Berkeley, California.

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