With new laws in Texas, self-induced abortion likely to rise

Texas abortion reform provision set to decrease number of clinics in the state from 40 to five or six

Finding herself with an unplanned pregnancy not long ago, Melissa took a dangerous route to solve her problem. She journeyed 30 miles from her home in Texas’ lower Rio Grande Valley, to the Mexican town of Nuevo Progreso just over the border and walked into a pharmacy. Though she had no prescription, she was able to buy a drug called misoprostal. In the United States, the medicine is normally prescribed to treat gastric ulcers, but Melissa used it to induce a miscarriage.

“Basically, I’m very poor,” said Melissa, 23, who requested "Fault Lines" withhold her last name out of fear that she could be prosecuted for performing her own abortion. Going to Mexico was faster and cheaper on her minimum wage salary as a part-time office worker, than driving several hours north to the closest abortion clinic.

What we’re actually seeing on the ground is the closing of clinics is making things much less safe for women.

Amy Hagstrom Miller

Whole Woman’s Health, CEO

Part of Melissa's problem was that there are no more abortion providers in the impoverished Rio Grande Valley. The final pair of clinics shut down in recent months after state politicians passed one of the most restrictive abortion laws that Texas has ever seen. Proponents assert new stipulations protect women’s health and regulate what they consider a freewheeling “abortion industry.” But doctors say it’s a safe and quick procedure, especially in the first trimester when most abortions take place.

Now, as clinics have shuttered, many experts worry more women will resort to risky ways of ending their pregnancies in Texas, which already has a high rate for self-induced abortions.

Last July, Gov. Rick Perry signed into law Texas Senate Bill 5, sometimes referred to by its sister legislation House Bill 2 or HB-2. The measure banned abortion after 20 weeks and required that physicians administering abortions have admitting privileges at a hospital within 30 miles of their clinic. In Texas, where a number of hospitals have religious affiliations, that’s hard to come by.

“It would be virtually impossible…to get privileges,” said Dr. Lester Minto, who performed abortions in Harlingen, Texas, for more than three decades. “No one wants to be associated with someone like me. As far as doctors go, I’m an outcast.”

7 percent of women reported trying to end their pregnancies on their own before visiting to an abortion clinic, with that figure jumping to about 12 percent for those living near the Mexican border.

Texas Policy Evaluation Project

University of Texas

The new law also requires abortion clinics to meet the same standards as hospital-style ambulatory surgical centers (ASC), which means conducting pricey renovations like widening hallways and changing lighting and ventilation systems.

Amy Hagstrom Miller, the Austin-based CEO of Whole Woman’s Health, a chain of abortion clinics, said the restrictions created a “perfect storm” that will force the majority of the state’s clinics to close. By September, when the ASC provision takes effect, the number of clinics in Texas will decline from 40 statewide to five or six.

In her network, Hagstrom Miller said only one of her five clinics will remain open by the end of this year. “We are truly in survival mode,” she said. “What we’re actually seeing on the ground is the closing of clinics which is making things much less safe for women.”

With fewer clinics, some women will have to travel long distances in a state that can take at least 12 hours to cross by car. That’s already the case in the Rio Grande Valley, where the nearest abortion clinics are in Corpus Christi and San Antonio, a three to five-hours’ drive. It can mean paying big sums to cover gas and hotel costs, and even taking days off work and arranging child care: a struggle for women with low incomes. But that’s not an option for undocumented women. There are internal checkpoints motorists must pass, where federal authorities check their IDs, before leaving the Valley. Texas is the state with the second-largest population of undocumented immigrants, with 1.75 million, according to the Pew Research Center.

Stuck in the Rio Grande Valley, some women are turning to DIY abortions. In a 2012 survey of six cities across Texas, the Texas Policy Evaluation Project at the University of Texas found seven percent of women reported trying to end their pregnancies, with that figure jumping to about 12 percent for those living near the Mexican border.

“I’m worried that this drop [in clinics] is really restricting access to clinic-based services and that more women will attempt self-induction,” said Dr. Daniel Grossman, who led the project’s study. “The Valley is going to be one of the areas that will be hardest hit.”

Among the methods women are employing to induce their own abortions is taking misoprostal. In the Rio Grande Valley, misoprostal used to be found at flea markets. But during a recent visit to one of the largest flea markets in the region, Fault Lines found no sign of the drug, as vendors said there’s been a crackdown on its sale. The drug is still readily available at pharmacies in Mexico, though, sometimes at steep prices.

None of these laws decrease the need for abortions. They only make it harder for girls to get them, do something to decrease demand. I’m against abortion, too.

Dr. Lester Minton

Former abortion doctor

Doctors use misoprostal when performing a medical abortion in combination with another drug called mifepristone, which is more effective than ingesting misoprostal alone. Dr. Grossman said it’s a safe drug when taken before 12 weeks of pregnancy. But he warned of risks for women taking misprostal on their own, such as not knowing if it’s of good quality or the proper dosage to take. There’s also danger of more bleeding and other complications, if taken later in a pregnancy.

Moreover, women could face problems because it is considered illegal in Texas for anyone other than a doctor to perform an abortion.

Despite these concerns, supporters of the new law hope the restrictions will encourage women to seek out options other than abortion, including adoption.

“We want to be compassionate to the mother involved who has limited options…who is often scared. Many times, they haven’t been given the complete information,” said Texas state legislator Bryan Hughes, a co-sponsor of HB-2, who added that the government’s “fundamental role” is to protect “innocent human life.”

Passing the legislation last year “was a victory for women,” according to Carol Everett, a prominent anti-abortion advocate who pushed for the restrictions. Everett said she owned abortion clinics before changing her views because of religious reasons.

“Texas, right now, is a shining star on a hill,” Everett said. But there’s still work to be done to achieve her goal of closing an industry that she says is out to sell abortions to women. There’s also a battle in the courts with abortion rights groups seeking to overturn the law. “We’ve got a wild fight ahead of us, I’m afraid.”

Curbing access to abortion, however, does not diminish the demand for the procedure, abortion providers say.

“None of these laws decrease the need for abortions. They only make it harder for girls to get them,” said Dr. Minto, the former abortion doctor. “Do something to decrease demand. I’m against abortion, too.”

Crystal, a nursing student in her 30s, told Fault Lines she had to drive three hours to the Whole Woman’s Health clinic in Austin to get an abortion. She hadn’t realized the clinic would be closing in a few months. If she ever found herself with another unwanted pregnancy, she said she would do what it takes to find an abortion provider.

“I would drive to wherever I would need to go. That means in state, out of state. It really doesn’t matter to me,” said Crystal, who asked not to print her last name.  

Back in the Rio Grande Valley, Melissa recalled recently taking the misoprostal pills at her boyfriend’s apartment. It was a night full of intense contractions, bleeding, sweating and vomiting.

“Even before I swallowed the pills, while it was under my tongue, I [could] feel the cramps starting,” she said pointing to her abdomen. “Those were the longest three hours of my life.”

“I don’t want people to have to go through this the same way.”

Tune in to Fault Lines, Saturday, April 26, at 7 p.m. ET for the premiere of “Access Restricted: Abortion in Texas” for more. And join the conversation by following the hashtag #accesssretricted on Twitter and by following the episode producers, @LailaAlarian and @NafeesaSyeed.

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