Here's reminder No. 4,297 about the gulf between the legal right to abortion and physical/financial access to abortion -- that is, the right to abortion on the long road to the only goddamn provider in your whole entire state. Well, that's Mississippi (oh, and South Dakota); now let's talk about Texas, where 93 percent of counties have no abortion provider. I mean, 80 percent is bad enough -- and that's Rhode Island. Texas, remember, is big.
Which brings us to reminder No. 7,185 -- that many women with limited access to safe, legal abortion will find some other way to get one. An article in the Brownsville Herald (via AlterNet) reports that "based on data about the number of self-induced abortions seen by local clinics and social workers, it is likely that many of the abortions undergone by women in this area are done using drugs purchased at Mexican pharmacies, without accurate information about the safest amount or method for inducing miscarriage."
That drug is a "little white pill" called misoprostol (brand name: Cytotec). In the U.S., misoprostol is used in combination with mifepristone (RU-486) for legal nonsurgical abortion. Misoprostol is also approved by the Food and Drug Administration for use in preventing stomach ulcers. But the bottle also warns: "Cytotec may endanger pregnancy (may cause abortion)." Even in places where abortions may be available, to women who can't afford them, and even -- as the New York Daily News reported over two years ago -- in places where a clinic may be a subway ride away, there exists a black, or at least gray, market in misoprostol.
Still, reproductive rights advocates are not ringing alarm bells -- or at least not the ones you might think. As a matter of public health, misoprostol is not the pill version of a coat hanger; some evidence suggests that it is, at least, not DEFCON 1 unsafe. In fact, the Herald reports, "there is a reticence to disseminate ... information [about misoprostol], for fear governments could crack down on the distribution of this relatively safe alternative to informal surgical abortion."
In terms of safety, though, these pills are not exactly Flintstones chewables. There are serious health risks (uterine rupture, say) -- and there's also a failure rate. As the Herald reports: "According to Harlingen Reproductive Services, the nearest clinic [to Brownsville] to offer abortion procedures, about half of the women they see have already attempted to use misoprostol or another prescription drug to attempt abortion. At Women's Whole Health in McAllen, this comprises 30 to 40 percent of their clients."
Still and all, "for local women the cultural pressure [especially, in this context, for Latina women] and [at least perceived] economic barriers to abortion often outweigh the risks of swallowing an unprescribed pill." (Let's also not forget about Texas' "Are you sure, little lady?" law requiring a 24-hour waiting period after biased counseling.) "If a woman has to drive 30 minutes, turn around and then do it again the next day, that's two hours of driving, plus the appointment time that she can't easily hide," says Jessica Gonzalez-Rojas, the director of policy and advocacy at the National Latina Institute for Reproductive Health.
"There are many institutional barriers that exist in this country for women to obtain abortions," Gonzalez-Rojas says. "A self-induced abortion tends not to be a choice but rather a product of all of these barriers."
So the central concern about misoprostol is really about what it represents: the desperation of women (often themselves desperately misinformed) who need abortion care services -- and, more broadly, a healthcare system that often leaves people to, in effect, pull a tooth by tying a string and slamming a door. Its illegal use will only continue to rise, it seems, as more doors are slammed on reproductive and medical rights.