Monday, August 30, 2010

Crossing the Line
Laura Tillman
The Nation
August 26, 2010

Brownsville, Texas

Diana, a slight, 30-year-old office manager wearing a
smart blouse and pencil skirt, has a tired note in her
voice. In the privacy of her office, she has spent the
afternoon discussing an event in her life that she
previously never recounted to anyone. She is talking
about her abortion. Or maybe her miscarriage. She's glad
she never has to know which.

A single mother of two boys, Diana was unemployed and in
the hospital when she began to suspect she was pregnant.
It was December 2006, and she had missed her period for
two months. Her doctor conducted a urine test, which
came back negative, but when Diana still hadn't gotten
her period in January, she started to panic. She knew it
wasn't the right time for another baby. She wasn't
working and had been suffering severe symptoms of
brittle diabetes, a rare form of diabetes that requires
frequent hospital visits and brings bouts of depression.
She felt unstable and wasn't able to afford her
medications. "I thought, If I am pregnant, I want to
take something to not be pregnant," she says.

For most women in the United States, this would mean a
trip to a doctor or abortion clinic. But where Diana
lives, in Brownsville, Texas, just north of the border,
Mexican pharmacies are only a few miles away. Items said
to be abortifacients-including pills, teas and shots-are
well-known to be cheap and accessible just across the
bridge. Misoprostol, a pill that makes up half of the
two-drug combination prescribed for medical abortions in
the United States, is easy to purchase over the counter
in Mexico because of its effectiveness in treating
ulcers. When used alone and taken correctly, it will
produce a miscarriage between 80 and 85 percent of the

Meanwhile, the closest abortion clinic, in Harlingen, is
some thirty miles away. That might not sound like much,
but without a car it is difficult to make the trip
discreetly. This was one of several reasons Diana didn't
want to go to the clinic. It was also prohibitively
expensive: potentially more than $900, because she was
already a few months into her pregnancy. Also, she was
scared that the doctor wouldn't want to operate because
of her diabetes. Finally, Diana had been there once
before to escort a friend. The whole time she'd felt
like she was being judged by the strangers around her;
she imagined their eyes on her as she sat waiting.

Widespread opposition to abortion in the Rio Grande
Valley may not be obvious at first: it is not discussed
in polite conversation. But spend a little time here and
the bumper stickers that cry out from cars, the messages
that dot billboards on the expressway and the rhetoric
inside many churches resoundingly confirm an
antiabortion message. There are accessible clinics, and
the procedure is legal. But within many women's homes,
their communities, their churches and their minds, a
trip to the abortion clinic amounts to a damnable
transgression. In fact, abortion is so stigmatized, many
women don't even realize it is legal. Terri Lievanos,
who worked for years as an education coordinator for
Planned Parenthood of Brownsville, says that this is
true even among women born in the United States: "They
come in here and say, 'Wait a second, abortion is
legal?' They've only heard it discussed in a negative

For Diana, who was born in Mexico and raised in a deeply
Catholic household, the prospect of being seen at a
clinic was more emotionally taxing than the risk of
taking a mystery drug and enduring the consequences at
home by herself. A friend told her that he knew where to
buy an abortion pill-most likely Misoprostol, although
Diana says she doesn't know its name or what he paid-and
drove across the border to pick it up for her. Diana
took the drugs, two pills over two days, with no medical
guidance. Nothing happened for nearly two weeks. Then
she began to bleed. The intense bleeding lasted four
days, and she had severe cramps. On the fourth day she
began to have painful contractions. A small sac dropped
into her toilet. "It wasn't moving, so I flushed it. I
didn't know what to do. I was scared that if I looked at
it, I'd be traumatized for life." Diana called her
mother and her sister the next day and told them she'd
had a miscarriage. She didn't mention the pills. They
urged her to go to the hospital. "The doctor looked at
me, and I was fine," Diana says. "I told them it was a
miscarriage. I didn't tell [them] about the pills."

She doesn't tell people she had an abortion, she says,
because she never went to a clinic. "When people ask me
if I had a miscarriage, I'll tell them yes," Diana says.
"I didn't actually go get the abortion. I don't know if
it's the pill that actually caused the abortion." As far
as Diana is concerned, it's possible the miscarriage was
caused by the drugs. It's also possible that it wasn't.

Diana is one of many women along the US-Mexico border
who appear to be seeking out drugs like Misoprostol as
an alternative to an abortion clinic. Whether this
represents a broader trend is difficult to say, given
the lack of data and the underground nature of self-
induced abortions. But it is hardly a new phenomenon.
Even before abortion politics roiled the debate over
healthcare reform and the 2009 murder of Dr. George
Tiller, many women in the Rio Grande Valley were looking
to have abortions in private, in order to escape the
scrutiny of their neighbors and the fear of being
attacked publicly. It is far easier to be able to say
"miscarriage" in a city like Brownsville than it is to
admit to an abortion. To protect herself, Diana asked
that only her first name be used in this article.

Dr. Lester Minto works at the abortion clinic in
Harlingen, a nondescript, out-of-the-way building. He
says that some clients first find out about the facility
when they are taken there by church groups to protest.
"I wear a bulletproof vest to work," Minto says. "If the
patient sees me that way, how does the patient feel?"

Minto estimates that some 20 percent of his patients
have tried Misoprostol before coming to him. "That tells
me there are many more who are using it who don't need
to come to me." Finances are a major factor. "It's
something you can try for a small amount of money," he
says. In Texas, abortion care is not covered by Medicaid
except in cases of rape, incest and life endangerment-
and even in those cases the costs are reimbursed less
than half the time. This means that a woman like Diana,
without private insurance, could pay anywhere from $450
to more than $900, compared with $87 to $167 for a
bottle of Misoprostol in a Mexican pharmacy. "But deeper
than that," he adds, echoing Diana's sentiments, "I am
the abortionist. They come to me for an abortion. If I
don't touch them, maybe it wasn't really an abortion."

At Whole Woman's Health, an abortion clinic in nearby
McAllen, executive director Andrea Ferrigno tries to
provide an antidote to the antichoice billboards and
fake cemetery erected by antiabortion activists just
beyond the clinic's property. She papers the walls with
inspirational quotes, displays stacks of pamphlets about
courageous women in history and plays movies on a TV up
front to help clients relax. But she knows that even
with these measures, some women will still be undone by
social pressure. "Women are intimidated; they're
stressed," says Ferrigno. "We need to be protected, but
we also want to be visible. I want women to walk out of
here with their heads held high." This is an uphill
battle. "What we're dealing with now is thirty-five
years of women being very publicly shamed by antichoice
protesters," says Gloria Feldt, former president of
Planned Parenthood. "Underground abortion is one of the

Diana moved to Brownsville at 4, but her parents
maintained strong ties to their home country. They never
discussed sex with her. "It was implied that you
wouldn't have sex until marriage," she says. "It was
still a taboo subject." Jackie Christensen, a
Brownsville teacher who taught high school health
classes for more than two decades, says this is typical.
"I would always start the class by asking if the
students had ever talked with their parents about sex,"
she says. "I'd be lucky if one or two raised their
hands." It wasn't until Planned Parenthood came to
Diana's high school to give a presentation about sex and
contraception that Diana became informed on the subject.
These days, Planned Parenthood is no longer permitted to
make such presentations in the district, and
contraception is prohibited in the classroom.
Christensen says she tried to fill in the gaps for her
students but that many health teachers felt too
uncomfortable. "A lot of health teachers didn't want to
teach that topic," she says. "They wouldn't go into
detail." Stories of underground abortions were so common
that she took to warning against them during health
class. "I'd tell my students, 'If you do things your own
way, there could be damage to the uterus,'" she says.

The familiar history of botched abortions has made
Misoprostol increasingly popular among women seeking out
a less dangerous private alternative to abortion,
particularly in places where abortion is illegal. The
Planned Parenthood in Brownsville reports visits by
women who have used syringes, taken cocktails of
prescription drugs, douched with battery acid and beaten
themselves in the abdomen to attempt abortion. "These
pills are beginning to revolutionize abortion around the
world, especially in poor countries," New York Times
columnist Nicholas Kristof wrote this summer, noting
that the drug would be difficult to ban because of its
other uses, which include stopping postpartum
hemorrhages. Rebecca Gomperts, founder of the
organization Women on Waves, which provides reproductive
health services around the world, agrees. "It creates
autonomy," she says. "The fact that [women] can just
take a medication is huge, because they don't have to
depend on someone else doing something to their bodies."

Gomperts believes that using Misoprostol can actually be
preferable to going to a clinic, particularly if a woman
has access to information on how to use it correctly,
knows how long she has been pregnant and can get medical
help if something goes wrong. Still, there are
significant risks: if used incorrectly, Misoprostol can
cause the uterus to rupture and bring about internal
bleeding. "In one of the most extreme cases, the girl
took over a hundred pills," Dr. Minto, of the Harlingen
clinic, says. "It's amazing that she survived." Diana,
too, was lucky. She now knows that taking the pills that
far into her pregnancy was dangerous. She could have
caused her child to have birth defects, had the drug not
worked and had she carried to term. Or the pills could
have caused her to hemorrhage or prevented her from
having children in the future. That, she says, scares

A number of recent studies looking at self-induced
abortions in the United States suggest that women across
the country continue to seek out alternatives to clinics
that are embattled, increasingly costly and
geographically inaccessible. Dr. Dan Grossman, of Ibis
Reproductive Health, whose research on the topic has
focused on various US cities as well as the Rio Grande
Valley, says the group of women attempting self-induced
abortion is fairly diverse. An ongoing study by the
Guttmacher Institute corroborates this: 79 percent of
women who tried self-induced abortion were from the
United States, and that number was spread across twenty

"I think our findings suggest that there are still
significant barriers to abortion care in the United
States," Grossman says. "Those include the high cost of
abortion care-and in most states Medicaid cannot be used
to cover abortion care." Low-income women feel these
barriers more acutely. Three-fourths of women who have
an abortion say that, like Diana, they cannot afford a
child, according to the Guttmacher Institute. Forty-two
percent of women having abortions are below the federal
poverty line.

Brownsville, located in one of the poorest counties in
the country, illustrates this economic divide. Driving
through one of the new subdivisions, you could easily
assume the city is middle-class. The adobe and brick
homes look alike, with tall palm trees punctuating the
wide lawns. Lakes where ibises, anhingas and ducks dive
for food provide a scenic backdrop for the city's
wealthier families. But Brownsville's poor neighborhoods
resemble those across the snaking Rio Grande and the
eighteen-foot border fence along its northern bank.
Houses here are cobbled together from cheap wood and
scrap metal, dogs run wild and the smell of sewage wafts
through the streets. There is no medical school or law
school for hundreds of miles, and while many soldiers in
the military come from this area, there's no veterans'
hospital either. As in many poor areas in the United
States, health services are often acquired at the
emergency room, with little preventive medicine being
sought. Here, women don't often have a consistent
relationship with a physician they trust. Instead, care
is delivered at times of emergency. In such an
environment, a mission like Ferrigno's at Whole Woman's
Health remains incredibly challenging. Without better
healthcare education, affordable coverage and
information for women about their reproductive rights,
risky, self-induced abortions will continue. A drug like
Misoprostol may be proving to be a safer alternative,
but it is no substitute for reproductive care that
happens out in the open, with the expertise of a medical

For her part, Diana understands this. Now that time has
passed, she has reflected on her experience. She knows
she took a risk and admits she would have had regrets
had things turned out differently. But when asked what
she would tell another woman who is seeking an abortion
and weighing her options, Diana takes a moment to reply.
"Logically, you should go to a clinic," she says. "If
you have the money, you should. It's safer. But the
whole thing of being in a clinic like that is, it
traumatizes people too. Really, the more private thing
and the more convenient thing to do would be to just
take the pill."


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