Several recent studies suggest that U.S. women are increasingly seeking methods for self-induced abortions instead of visiting legal clinics that have become "embattled, increasingly costly and geographically inaccessible," The Nation reports. The article profiles a woman from Brownsville, Texas, to illustrate a common experience among women in the state's Rio Grande Valley, where women, seeking to avoid social stigma and unable to afford medical care, travel to Mexico for cheap drugs to end their pregnancies. An ongoing Guttmacher Institute study shows that 79% of women who attempt self-induced abortions are from the U.S., with the women spread across 20 states.

Mexican pharmacies -- often located just over the U.S.-Mexico border -- are known for carrying cheap and accessible abortion drugs, such as the ulcer medication misoprostol, which is prescribed with mifepristone for legal medical abortion in the U.S. When taken correctly, misoprostol on its own will produce a miscarriage 80% to 85% of the time.

Dan Grossman of Ibis Reproductive Health, who has studied the topic of self-induced abortion, said, "I think our findings suggest that there are still significant barriers to abortion care in the United States," including the "high cost of abortion care -- and in most states Medicaid cannot be used to cover abortion care." A bottle of misoprostol in a Mexican pharmacy can cost $87 to $167, while an uninsured woman in Texas can pay $450 to more than $900 for an abortion. According to Guttmacher, 75% of women who have an abortion say they cannot afford a child, and 42% of women who obtain the procedure have incomes below the federal poverty level.

According to New York Times columnist Nicholas Kristof, misoprostol is "beginning to revolutionize abortion around the world, especially in poor countries," because of its low cost and widespread availability and because of its use for treating postpartum hemorrhage. Rebecca Gomperts, founder of the global reproductive health services provider Women on Waves, noted that misoprostol can be taken privately in a woman's home, which "creates autonomy." Gomperts added, "The fact that (women) can just take a medication is huge, because they don't have to depend on someone else doing something to their bodies."

In areas like the Rio Grande Valley, such autonomy is necessary to avoid the stigma of visiting an abortion clinic. According to The Nation, for women who choose misoprostol, it is "far easier to be able to say 'miscarriage,'" to explain the end of a pregnancy "than to admit to an abortion." Although there are clinics in the area and the procedure is legal, "a trip to the abortion clinic amounts to a damnable transgression" for many women, who sometimes are unaware that the procedure is legal, The Nation reports. Terri Lievanos, a former education coordinator for Planned Parenthood of Brownsville, Texas, said that U.S.-born women "come in here and say, 'Wait a second, abortion is legal?' They've only heard it discussed in a negative way." Gloria Feldt, former president of the Planned Parenthood Federation of America, said, "What we're dealing with now is 35 years of women being very publicly shamed by anti-choice protestors," adding, "Underground abortion is one of the consequences."

Although the anonymous nature of self-induced abortion makes it difficult to determine exact figures, The Nation reports that it is "hardly a new phenomenon." Lester Minto, who works at an abortion clinic in Harlingen, Texas, said that about 20% of his patients have used misoprostol before coming to him, which "tells me there are many more who are using it who don't need to come to me" (Tillman, The Nation, 8/26).