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Texas Republicans Can’t Stop All Medical Abortions

The state is trying to regulate something it can’t: the decentralized distribution of pills largely originating in Mexico, where abortion is no longer a crime.

A pharmacist in Mexico, where abortion pills are accessible
Spencer Platt/Getty Images

If you’re seeking an abortion in Texas, despite the state’s recent ban, you still have options. You can go to, where an overseas doctor will prescribe the same medications that you would get in a clinic and have the pills shipped from India in a few weeks. You can buy the pills from online pharmacies. You can have a remote consultation with a legal abortion provider in a less restrictive state, like New Mexico, and get the pills shipped to your Texas address via mail forwarding. Or you can do what countless U.S. residents do to find more affordable medications of all kinds: cross the border into Mexico. There you can buy misoprostol, an ulcer pill used as part of the standard two-drug medication abortion protocol that is about 80 percent effective on its own in the first trimester. You can rest assured that the Mexican Supreme Court last week declared that abortion is no longer a crime in that country. You can take the pills at home, as you would after a clinic visit, and in the rare event that you have a complication, your symptoms will be undetectable as anything other than a miscarriage.

Options like those listed above do bring legal risks, but only a tiny fraction of the tens if not hundreds of thousands of people who have managed their own abortions in the United States have faced criminal consequences. The number of people arrested for ending a pregnancy or helping someone else to do so is in the dozens, according to unpublished data cited by Farah Diaz-Tello, senior counsel for the legal advocacy group If/When/How. (The group’s last published report put the number at 21 since 2000.) Senate Bill 8, the law in Texas that allows any private citizen to sue those who aid or abet in an abortion, does not apply to those who manage their own.

While S.B. 8 has succeeded in shutting down almost all abortions in Texas clinics, it has led to a surge in awareness of strategies for self-managing abortion that are all but imperceptible to anyone trying to enforce the law. Aid Access saw a spike in requests for services for about a week beginning on August 31, the day before the law took effect, a provider told me. Plan C, a group that directs people to information about how to get abortion pills, saw visits to its website increase about 50-fold, from about 500 a day in early August to more than 25,000 on September 1, according to co-founder Elisa Wells. When Instagram shut down Plan C’s account, it only increased the group’s profile.

Now Texas lawmakers are trying to control the uncontrollable by imposing criminal penalties on the transfer of abortion pills. Senate Bill 4, which is awaiting signature by Governor Greg Abbott, would ban medication abortion after 49 days of pregnancy (about three weeks after a missed period). That would cut off access to medication abortion for many in Texas clinics even if the Biden administration succeeds in bringing a halt to the near-total ban that remains in effect right now. Senate Bill 4 makes “any act of giving, selling, dispensing, administering, transferring possession, or otherwise providing” abortion-inducing drugs in violation of the law a felony punishable by up to two years in jail. It is an effort to dismantle something that is beyond the law’s reach—widespread and decentralized distribution of pills largely originating in Mexico, where, as of last week, abortion is no longer a crime. In other words, the law will fail.  

“We have effective pills, we have modern means of ordering them and transporting them that fall entirely outside of the purview of this law,” Wells told me. These options include telemedicine abortion services like Aid Access and online pharmacies that are based in countries and states beyond the legal reach of Texas.  “Access to abortion is necessary, and it’s also inevitable.”

Abortion seekers in Texas have long crossed the border into Mexico, where misoprostol is sold on the street and over the counter in pharmacies for a fraction of what a medication abortion costs in a clinic. Texas-based abortion funds like Frontera Fund that help people pay for abortion in a state where Medicaid doesn’t cover it have always known that their services are far from enough to meet everyone’s needs.

“Even with our help, people were unable to afford an abortion because it’s expensive and it’s much easier to get the medication in Mexico and just do it yourself,” said Zaena Zamora, executive director of Frontera Fund.

Misoprostol’s potential as a self-managed abortion drug was discovered not by doctors, but by women who needed to end pregnancies in countries where abortion was illegal. When it came on the market as an ulcer drug in the 1980s with the warning that it could cause a miscarriage, it didn’t take long for Brazilian women to realize what that meant. Hundreds of thousands of people used the pills to get around Brazil’s abortion ban before the country restricted its sale in 1991. By then, misoprostol’s use had spread around the world.

In Mexico, dozens of accompaniment groups guide people through the process of managing their own abortions with misoprostol, as I wrote for The New Republic last year. The largest and most high-profile of these groups, Las Libres, has helped 20,000 women self-manage abortions since it launched in 2000, about half of them during the pandemic alone, according to founder Verónica Cruz. While Las Libres operates openly, protected by its high profile, more than 3,600 people across Mexico were reported, and 172 people were imprisoned, for the crime of abortion from 2010 to 2020, according to data from the Mexican reproductive rights group GIRE, first cited by Reuters. Many more have been accused of crimes like infanticide or homicide for miscarriages or stillbirths—a possibility that remains, even after the Mexican Supreme Court declared that abortion could no longer be prosecuted as a crime, Cruz said. 

“In those cases, normally what is being criminalized is women’s sexuality or their infidelity, or their lack of knowledge, or their poverty,” Cruz said. “They’re criminalizing the conditions of their lives.”

Or, as Mexican Supreme Court President Arturo Zaldivar put it: “Rich girls have always had abortions and never gone to prison.” 

If Mexico’s history is any indication, lawmakers here will never be able to stop self-managed abortion; its use will only spread as laws became stricter. What state and local authorities will be able to do is ruin the lives of low-income people of color who, as Cruz put it, will be criminalized for the “conditions of their lives,” as much as anything else. S.B. 4 and S.B. 8 will cause enough confusion and fear to prevent many more people from getting care. This confusion is one of the laws’ most dangerous aspects. That’s why activists have turned their energy to distributing information about abortion pills. 

In the days before the near-total abortion ban went into effect in Texas, Plan C drove a billboard truck through the streets with the message: “Missed period? There’s a pill for that.” Last Thursday, outside the Supreme Court in Washington D.C., activists with the group Reproaction gathered to shout the protocol for medication abortion into a bullhorn. About 10 minutes into the event, abortion opponents arrived and began blasting recordings and chanting, “Hey hey, ho ho, the abortion pill has got to go!” The disruption created a certain amount of confusion and chaos. It did not, in the end, stop the activists from making the point that they had intended to make: That you can end a pregnancy at home with pills, and the state will have a hard time stopping you.