Bloomberg News

Legal Abortions Made Harder, Texans Turn to Flea Market Pills

July 11, 2013

Flea-Market Abortions Thrive as Texas Bill Might Close Clinics

Texas pro-choice supporters rally at the state capitol on July 1, 2013 in Austin. Photographer: Erich Schlegel/Getty Images

At an open-air flea market outside McAllen, Texas, near the Mexican border, shoppers can buy a goat and get their car windows tinted. Tables with handwritten signs touting Viagra are stocked with herbal remedies promising to burn fat and boost breast size. You can also find pills to end a pregnancy.

Bazaars like this have become home to a black market where women too poor to afford an abortion at a clinic or deterred by state mandates such as a 24-hour waiting period can buy drugs to induce a miscarriage on their own, a dozen area residents and doctors said in interviews.

Hundreds of miles north in Austin, the capital, lawmakers may inadvertently increase this illegal trade. Rules set to pass as soon as tomorrow might result in the closing of most, if not all, abortion facilities in the state. If the law -- promoted as a way to improve women’s health -- makes legal abortion unavailable in Texas, more women may turn to markets such as the one near McAllen and risk their lives.

“You’d be amazed at how many people, young people, are taking those pills,” said Erlinda Dasquez, a 29-year-old mother of four who has done so herself. “I probably know 12 to 20 people who have done this. My cousin just went to the flea market a few months ago.”

Bleeding Woman

Women in the Lower Rio Grande Valley, along the southeastern border with Mexico, said it’s already harder for them to control their reproductive lives since the state cut funding for birth control in 2011.

In the past few years, health-care providers in the valley, one of the state and nation’s poorest regions, have seen an increasing number of women suffering from incomplete abortions and bleeding after taking drugs unsupervised, they said.

The pills, which are known by the brand name Cytotec and require a prescription in the U.S., are designed to prevent stomach ulcers. They can also induce abortion. Until recently, obtaining them meant a trip across the border to Mexican towns such as Nuevo Progreso, where pharmacies can legally sell them without a prescription.

Underground imports have brought the trade stateside. Whether it’s the actual Pfizer Inc. (PFE:US) medication or a generic, side effects include premature birth and uterine rupture. The drug isn’t typically on display at flea markets. All you need to do is ask, residents said.

Mother Babysat

Pfizer is working with law enforcement to support efforts to prevent illegal sale of the drug, said Chris Loder, a spokesman for the New York-based company.

When Dasquez needed the pills, they weren’t yet available at flea markets. Instead, on a September day in 2010 while her mother babysat, Dasquez got behind the wheel of her gold Chevrolet Malibu to go see a woman who’d smuggled the drugs across the border to sell out of her living room.

The woman handed Dasquez four octagonal pills in a clear plastic bag, she said. They cost $40. At the nearest legal provider, a pharmaceutical abortion costs $550.

Dasquez said she turned down another option: injections that the woman was offering to administer on the spot.

“I was scared, but I thought I didn’t have any other choice -- I had to do it whatever happens,” she said. “I told my mom so, if anything goes wrong, she could bring me to the hospital or get help.”

Ideal World

Texas became a flashpoint last month in the debate over abortion after Republican leaders championed a law to make the state the largest and most populous to mandate that clinics meet structural standards similar to those required of hospitals. It would also ban the procedure past 20 weeks of pregnancy. Abortion-rights advocates say it might force the state’s 42 providers to close by making compliance too expensive or logistically impossible.

Backers of the bill have described the proposal as a way to promote women’s health by improving the safety of clinics, as well as a tipping point in the fight to ensure all pregnancies are carried to term.

“This is a human-rights issue,” Republican Governor Rick Perry said in a June 27 speech to anti-abortion activists. “The ideal world, of course, is a world without abortion.”

There were 72,332 of them performed in Texas in 2011, the latest year for which data is available, according to the Texas Department of State Health Services.

Invented Instructions

A drug called Mifeprex, used in conjunction with Cytotec, is approved by the Food and Drug Administration as an alternative to surgical abortion within the first seven weeks of pregnancy. When taken as directed, it’s effective 92 percent to 95 percent of the time and complications are rare, according to the manufacturer of Mifeprex, Danco Laboratories LLC, based in New York.

That’s not the regimen followed by women getting the drugs on the black market, who can be as ill informed as those selling them. During a recent visit to the Almost Free Pharmacy in the Mexican state of Tamaulipas, a man behind the counter instructed an initial dose of two pills orally and one vaginally, followed by two pills every hour “until something happens.”

William West, a physician at Whole Woman’s Health in McAllen, said he sees patients daily who have taken black-market abortion drugs. Many are bleeding or still pregnant, he said.

Secret Acts

“It’s hard to know how successful it really is -- we just see the failures,” said West, 77, who has been performing abortions for 31 years.

That’s what happened to Dasquez, who took a second dose after the first didn’t work. She bled for at least a month, she said.

Locals have a word to describe abortions like this: “clandestino.” It’s often poor and undocumented immigrants who seek them, unable to afford having more children or legal yet pricier options, said Paula Saldana, a community health instructor who volunteers to educate Hispanics about contraception.

“Only people with money go to clinics,” said Saldana, 36.

Neither of the two abortion clinics serving the Lower Rio Grande Valley meet the bill’s requirements. Their closing would add hundreds of miles to the distance women need to travel to reach the nearest legal provider. Though abortion drugs are easily bought in Mexico, the practice is outlawed everywhere except Mexico City, an 11-hour drive from the border region.

Valley Down

Women in the valley’s four counties are disproportionately poor -- more than a third live in poverty -- while 90 percent are Hispanic or Latino, according to the U.S. Census Bureau. They’re the same women who have been hardest hit by the 2011 state budget, which cut family-planning funds by two-thirds and reduced access to subsidized contraceptives, according to a report from the Texas Policy Evaluation Project led by the University of Texas at Austin.

Last year, Texas’s Health and Human Services Commission estimated that during 2014 and 2015, poor women would give birth to nearly 24,000 more babies as a result of the cuts. Of the state’s 288 clinics offering family-planning before the cuts, 56 have since closed, while others are open as little as one day a week, according to the Evaluation Project report. The state has since restored some funding, though advocates said it falls short.

Alma Saldana, 30, the sister of activist Paula Saldana, stopped taking birth control last year after two nearby clinics closed and the one remaining wanted to charge more than she could afford. She bore her third child, Adrian, last month.

“If I had $100 to pay for birth control or pay the bill for lights, I’d pay the lights,” said Saldana, a Brownsville native and single mother.

Wrenching Choice

Saldana said she considered abortion. Texas Policy Evaluation Project researchers surveyed about 300 pregnant women seeking the procedure after the state cut family-planning funds. Almost half said they were “unable to access the birth control that they wanted to use.”

As her 3-year-old daughter, Ashley, tried to engage her in a game of catch, Saldana questioned whether she should have given up her mobile phone to pay for contraception, then asked how her employer would have maintained contact had she done so.

She said she plans to get sterilized before her Medicaid coverage runs out next month.

To contact the reporter on this story: Esme E. Deprez in McAllen at edeprez@bloomberg.net

To contact the editor responsible for this story: Stephen Merelman at smerelman@bloomberg.net


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