With Roe v. Wade on the line, some Texans look south of the border for abortion drugs

The Texas Tribune’s reporting for this story was supported by the Pulitzer Center.

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NUEVO PROGRESO, Mexico — Maria laid the pregnancy test facedown on the counter in her boyfriend’s bathroom in McAllen and set a timer for the longest three minutes of her life.

She watched the timer tick down, mentally running through her litany of reassurances: They’d used a condom; she’d taken the Plan B pill; maybe her missed period was just an anomaly.

“I was just praying, please don’t let this be the case,” she said. “I had no idea how I’d navigate the situation. But what can I do but flip this test over?”

It was positive.

Maria, who was a 17-year-old high school junior at the time, spoke with The Texas Tribune on the condition of anonymity and is identified in this story with a pseudonym because she fears repercussions from her family for sharing her experience.

Maria came from generations of teenage mothers, and while her Catholic parents didn’t talk with her much about sex, they were clear they had different expectations for her. They wanted her to leave the area for college to pursue her dreams of studying law.

She couldn’t have the baby, she decided.

It was October 2020, a year before Texas would implement the most restrictive abortion law in the country, and 18 months before a draft opinion obtained by Politico revealed that the U.S. Supreme Court plans to overturn Roe v. Wade, the landmark case that established constitutional protections for abortion.

But even before all that, Maria had few options to access legal abortion care. There is only one clinic in the Rio Grande Valley, and she would need to get parental consent or a judicial bypass granted by a court. Even finding the money to pay for a legal abortion seemed impossible.

But living along the border presented another option.

Cheap regulated and unregulated medication is available over the counter at Mexican pharmacies, just a short walk away on the other side of the border. Rio Grande Valley residents and people from all corners of the state often cross into Mexico to get dental work or stock up on anything from daily vitamins and epinephrine to Valium and Xanax.

And then there’s misoprostol, a medication taken orally to prevent stomach ulcers — or terminate pregnancies.

Texas regulates abortion-inducing drugs like misoprostol more strictly than federal regulations require; they can be prescribed and dispensed only in-person by a doctor through the first seven weeks of pregnancy.

Just over the border, though, it’s a different story.

With the constitutional protection for abortion on the line in the U.S., reproductive rights advocates expect to see more Texans traveling to Mexico to get abortion-inducing drugs they can’t obtain legally at home.

But despite the ease of access, abortion is still highly stigmatized in heavily Catholic communities on both sides of the border, representing a risk for patients who may need to seek medical care after a self-managed abortion.

Maria first learned about self-managed abortions online. She knew she could get the pills from a pharmacy over the border much more easily than she could access a legal abortion in Texas.

“I was definitely concerned about the legality of it,” Maria said. “But I also knew, chances are, it will be fine and I had to do it.”

Across the border 

Jesus, Pope John Paul II and the Virgin of Guadalupe look down on customers buying abortion-inducing medication at Uncle Sam Pharmacy in Nuevo Progreso, a Mexican border town along the banks of the Rio Grande about 25 miles away from McAllen.

The portraits hang over the shelves of medication inside the pharmacy, just one reminder of how intertwined religion and everyday life is in the region. But Victor Olvera, the pharmacy’s manager, knows that no matter the religious views of many in the border area, there will always be customers looking to terminate their pregnancies.

Olvera expects that changes to abortion access in the U.S. will mean more business at Uncle Sam Pharmacy.

“The law is going to change and there will be more people coming,” Olvera said.

He doesn’t plan to stock up on more misoprostol just yet — he said he will wait and see. The medication is cheap to buy: Some pharmacies in Nuevo Progreso sell generic misoprostol for as low as $20, while name brands such as Pfizer tend to go for more than $140. Pharmacists at seven different locations said this week they have not received complaints over the years about complications from the medication.

Misoprostol is 80% to 95% effective at terminating early pregnancies by itself. In the United States, it’s approved by the Food and Drug Administration to be used alongside mifepristone to terminate pregnancies up to 10 weeks along.

While U.S. regulators have approved only the two-drug regimen, the American College of Obstetricians and Gynecologists and the World Health Organization both endorse the use of misoprostol alone if a patient can’t access mifepristone. Studies have found misoprostol to be generally safe and effective for terminating early pregnancies.

But that doesn’t mean all pharmacies in Mexico like to stock the drug on their shelves.

“I don’t want to sell this,” said Miguel Hernandez, a pharmacist at Pharmacy Rivera who noted that several customers come to his shop looking for the pills each week. “But if a customer asks if we have the medication, we have to sell it.”

Even before Texas banned abortions after about six weeks of pregnancy last year, people have turned to Mexican pharmacies for years to quietly and discreetly terminate their pregnancies.

Maria and her boyfriend convinced a family member to buy the medication for them at a pharmacy over the border. A few days later, she had it in hand.

Following instructions she found online, she took the medication alone in her bathroom. She experienced terrible cramping, she said, and what felt like a very heavy period for several days. The online guide told her what to do if she had to seek medical care, but she ultimately was able to manage the side effects at home.

“I immediately felt such a sense of relief,” she said. “Being a mother, that wasn’t something I was ready for and it wasn’t something I was willing to do. It was just not an option for me.”

Religion in the region

On Wednesday morning, Valerio García, a 69-year-old car mechanic, stood in front of Whole Woman’s Health, McAllen’s only abortion clinic. He wore black slacks, a beige button-down shirt with a rosary hanging from his neck and a cowboy hat with a Virgin of Guadalupe pin on it.

The clinic, a one-story building with security cameras near the entrance in the city’s downtown, is also the only abortion provider in the U.S. along the 1,200-mile long Texas-Mexico border.

For the past seven years, García said he has joined a group of religious men who show up every Saturday morning near the entrance of the clinic to pray for the women looking to get an abortion. He said the men pray that God can intervene and change the women’s minds about their plans to abort.

“I think there are people who go through this process because it’s been normalized and they lack information,” he said. “But they don’t realize there are repercussions both physically and mentally.”

If the U.S. Supreme Court were to overturn the constitutional protection for abortion rights, he said he would welcome it.

García, who is Catholic, said he opposes the procedure because his first grandson was at risk of being aborted. If his daughter had heeded the doctor’s option to abort, García would have missed out on the love of his grandchild, he said.

He said his daughter was three months pregnant with her first child when a doctor told her the baby’s organs were not developing properly. The doctor presented abortion as an option. García said she turned to him for advice. He prayed for her and she decided to go through with the pregnancy.

The boy is now 13 years old and healthy, he said.

“For me, this story tells me that babies have life in the mother’s womb,” he said, holding his phone up to show a picture of his grandson sitting in front of a piano.

The population in Hidalgo County, where McAllen is located, is mostly Hispanic, and many of its residents identify as Catholic. The Catholic Church has opposed abortion because its doctrine teaches that life starts at the moment of conception.

But south of the border and across Latin America — a region known historically for its Catholic faith and social conservatism — feminist movements have spurred monumental changes for reproductive rights. In recent years, three of the region’s four most populous countries have shifted on the issue: Argentina legalized abortion in 2020, Mexico decriminalized abortion in 2021 and Colombia decriminalized it in February.

Nancy Cárdenas Peña, the Texas director for policy and advocacy at the National Latina Institute for Reproductive Justice, said that regardless of religious influence, reproductive rights advocates have made great strides in helping Valley residents understand that the right to an abortion is a women’s health issue and not a religious and moral issue.

She pointed to Edinburg, a city just north of McAllen where last July advocates stopped the city from adopting an ordinance that would have made it illegal to perform or help someone get an abortion.

“I think at the end of the day, the simple values-based messaging stance is that everyone loves someone who’s had an abortion,” Cárdenas Peña said. “That’s very true and very simple.”

Reproductive rights advocates in the Rio Grande Valley also have different religious values, she said, but they ultimately believe in bodily autonomy.

Barriers to access

The Rio Grande Valley has long struggled with unique challenges to accessing reproductive health care. While some Texans may consider traveling out of state to access legal abortions, that’s not an option for the region’s many undocumented immigrants, Cárdenas Peña said.

There are immigration checkpoints driving out of the Valley to go elsewhere in the state, and it’s common for immigration officers to be at the airport asking for people’s documentation. While some Valley residents can travel to Mexico for misoprostol, undocumented people won’t be able to return legally to the U.S. if they were to go south for the pill.

“Do people attend their abortion appointments? Or do they risk being placed in deportation proceedings?” Cárdenas Peña said.

Noemi Pratt, a board member with South Texans for Reproductive Justice, said the recent case of a 26-year-old woman who was charged with murder after what authorities described as a self-induced abortion in the neighboring Starr County had a chilling effect on the Valley.

Her charge was dropped, but with new limits on abortion seemingly on the horizon, “people can get the wrong idea about what they can and can’t do,” Pratt said.

“We’ve gotten a lot of calls from people asking if they should be going to their abortion appointments,” Pratt said.

Maria, the South Texas woman who terminated her pregnancy a year and a half ago, says she has no regrets. After her abortion, she was accepted to college out of state and though she and her boyfriend broke up, it was on good terms.

She’s never told her parents or any of her friends that she’s had an abortion. She doesn’t think she ever will.

Now, with the Supreme Court’s draft opinion making it clear that abortion access is likely to be eviscerated in Texas and large swaths of the nation, Maria finds herself thinking more and more about how lucky she was to live near the border.

“There’s so many people in the same state that live five hours away from Mexico … and it’s going to be a lot harder” to access abortion care, she said. “They’re probably going to face more detrimental consequences.”

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