Crossing the Line
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.
Manipulating information women who are seeking abortion receive is a staple of antichoice politics. A recent episode of Friday Night Lights reveals how damaging that strategy is.
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 time.
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 way."
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 consequences."