(Editor's note: This story was produced as part of the Puente News Collaborative, a bi-national partnership of news organizations in Ciudad Juárez and El Paso.)
By Veronica Martinez/La Verdad and Victoria Rossi/El Paso Matters
CIUDAD JUAREZ, Mexico -- Lucero drove across the Bridge of the Americas alone. The cramps the abortion clinic’s staff told her to expect were already creeping into her abdomen.
Behind her was El Paso, where at 23, she’d just received an abortion at the Hill Top Women’s Reproductive Clinic. Ahead was Ciudad Juárez, her home, where in the surrounding state of Chihuahua, abortions are a criminal offense.
Lucero, who has asked to withhold her full name for this story, had considered flying to Mexico City. It was 2017 and abortions had been legal there for 10 years, but she weighed the costs: Two plane tickets, the price of food and lodging — not to mention having to explain her sudden trip to the country’s capital.
Meanwhile, the drive to El Paso could take half an hour. With her tourist visa, she could enter Texas with no issue. She’d be back home the same day without anyone knowing what she had done.
As she crossed the border into Juárez, her fear mounted. “Please, please don’t let this happen,” she remembered telling herself, worried that she might faint or hemorrhage and be forced to go to a hospital in Juárez. She couldn’t count on doctor-patient confidentiality: Anyone who realized she’d had an abortion could report her to the police. “What if I get caught?”
Watch: Abortion access on the Texas-Chihuahua border
While Lucero traveled north for her abortion, many El Pasoans turn south. In Juárez, they find cheap, easy access to misoprostol, an abortion-inducing medication that is sold over the counter as an ulcer treatment at many Mexican pharmacies — a welcome solution for those willing to have abortions outside a health care setting, as tightening legal restrictions make the procedures tougher to come by in Texas clinics.
In the Paso del Norte region, fronterizas on both sides of the Rio Grande have long looked across the border to end their pregnancies on terms they can’t always choose at home.
Now, however, Juarenses must look elsewhere. The U.S. land border remains closed to most Mexican nationals, and in March 2020, El Paso lost all abortion services.
The consequences of El Paso’s barren abortion landscape, along with the pandemic-era closure of the U.S. border, have rippled across the Rio Grande. In the 15 months that El Paso’s Planned Parenthood offered abortion services, about 3% of its patients were from Mexico, according to the clinic. But the Texas city is no longer a legal haven for people like Lucero, who once came to El Paso to have abortions without fear of prosecution.
El Pasoans, meanwhile, could soon rely all the more on Juárez for abortion pills.
On Sept. 1, a new Texas law will effectively ban state clinics from performing abortions roughly six weeks after conception — as soon as cardiac activity can be detected in an embryo, and before many know they are pregnant. With dwindling abortion access, more El Pasoans seeking abortions may choose to cross the border if the law, known as Senate Bill 8, takes effect.
Texas legal restrictions
Over the last two decades, Texas state lawmakers have enacted increasingly strict regulations on abortion providers.
In 2013, after the passage of House Bill 2, which imposed hospital-like standards on abortion facilities, two El Paso clinics temporarily closed and procedures in the county dropped by 40%. Though the Supreme Court struck down the measure in 2016, other restrictions have remained in place. By 2017, about 96% of Texas counties had no abortion clinics.
El Paso was an exception until the pandemic. Then, in March 2020, the Planned Parenthood physicians who’d once flown to El Paso twice a month to perform abortions stopped coming due to COVID safety concerns. That month, El Paso’s last remaining abortion provider — the Hill Top Women’s Reproductive Clinic, where Lucero received her abortion — shuttered without explanation.
The Planned Parenthood clinic remains open in El Paso for other health services and is actively recruiting new physicians to resume abortion procedures. But Texas’ ever-mounting series of restrictions has made physician recruitment all the more difficult, said Xochitl Rodriguez, philanthropy officer for Planned Parenthood of Greater Texas in El Paso. Rodriguez could not say when the clinic would resume offering abortions.
In addition to banning clinical abortions after about six weeks, Senate Bill 8 would empower individuals to sue abortion providers and anyone else who “aids or abets” someone seeking the procedure past this timeframe. In July, dozens of abortion clinics and advocacy groups sued to block the measure before it starts. At a hearing scheduled for Monday, they hoped to convince a federal district judge in Austin to stop the law from taking effect. On Friday, however, the 5th U.S. Circuit Court of Appeals canceled that hearing.
“(W)ithout the courts stepping in, on Wednesday, Texans will be denied their constitutional right to abortion in violation of fifty years of precedent,” Julie Murray, an attorney representing the Planned Parenthood Federation of America in the case, said in a written statement.
At the national level, the Supreme Court has agreed to hear a case where Mississippi’s attorney general has asked to overturn Roe v. Wade and Planned Parenthood v. Casey, the landmark rulings establishing the constitutional right to end a pregnancy.
Abortion opponents hope the court’s conservative majority will soon do just that, among them Texas Gov. Greg Abbott. In July, he joined a coalition of anti-abortion governors to file an amicus brief urging justices to declare abortion unconstitutional. During the spring legislative session, Abbott signed into law a measure that would automatically ban the procedure if Roe v. Wade is struck down.
El Paso → Juárez exchange
Walk across the Downtown Paso del Norte Bridge into Juárez, and “the first thing you see is bar, bar, pharmacy, bar — maybe a good restaurant here and there,” said Lina-Maria Murillo, an assistant professor at the University of Iowa who researches the history of reproductive health care on the border. There, any number of pharmacies sell misoprostol, a medication that induces abortions, in 28-pill boxes that run as low as $20.
“This tells us that for a very long time abortion has been a major part of the health economy of the borderlands,” Murillo said. “(P)eople in border region go to Mexico to get dental work done, checkups — abortion is obviously one part of that health care regime.”
Although it is illegal in Chihuahua to use misoprostol to terminate a pregnancy, the medication is sold over the counter at Mexican pharmacies to treat ulcers.
In Texas border communities, people have long managed their own abortions at higher rates than the rest of the state and country. A statewide survey of abortion clinics found that 12% of patients living along the Texas-Mexico border had at some point attempted to manage their own abortions — compared to 7% of patients throughout Texas, and 2.6% nationwide.
That practice has begun to take hold nationwide. Where abortions outside the clinical setting once conjured images of coat hangers and dangerous folk remedies, the practice has grown safer and more effective with the rising use of abortion pills.
To end pregnancies, U.S. clinics — and now, some telemedicine services — offer a two-drug regimen of mifepristone and misoprostol, which in combination is more effective than misoprostol alone. But with mifepristone hard to come by in Mexico and much of the global south, many rely solely on misoprostol, which is about 85% effective compared to roughly 93% for the two-drug regimen. The World Health Organization has endorsed misoprostol as a safe and effective way to self-manage abortions up to 10 weeks after conception.
As barriers to clinical abortions mount, people are more likely to self-manage their abortions. Abigail Aiken, an associate professor at the University of Texas at Austin, found with her research team that the number of self-managed abortions rises along with each 40-mile increase in distance to the nearest abortion clinic. According to the study, the lower someone’s income, the more likely they are to attempt to end their pregnancy outside a health care setting.
Self-managed abortions increased dramatically during the pandemic, when the U.S. Food and Drug Administration authorized providers to send mifepristone and misoprostol to patients by mail. Nineteen states, including Texas, do not allow in-state providers to mail these medications, but they have little control over organizations that operate outside of the state, or even the country.
Aiken also found that requests to the international group Aid Access, which provides abortion medication and telemedicine consultation, spiked during the pandemic, especially in Texas. When Gov. Abbott imposed a four-week ban on abortion for much of April 2020, citing COVID safety concerns, the study found that Texans’ requests for Aid Access abortion support rose by nearly 94% from the previous year, the highest increase in the country.
Criminalization in Chihuahua
Even after her abortion, Lucero still feared that her family might find out. The fronteriza felt she hadn’t just crossed a geographical line to get an abortion; she’d crossed a moral one as well.
“I knew I was doing something illegal in Mexico and there were a thousand reasons for which I could go to jail,” Lucero said in Spanish.
Since 2013, 10 Juarenses have been charged with illegally terminating a pregnancy, according to data from the Chihuahua State Prosecutor’s Office. Only one, in 2018, resulted in a conviction and a prison sentence of 32 months.
According to information published by the Executive Secretary of the National Security System, nine reports of alleged crimes involving abortion took place in Chihuahua for 2020 and three for 2021, with the latest update released in June.
According to information obtained from the High Court of Justice of the state of Chihuahua through the country’s online National Transparency Platform, there were no registered cases with a pronounced sentence in Chihuahua involving the illegal termination of a pregnancy in 2020 and none so far in 2021.
Though most abortions in Chihuahua are criminalized, the law does grant some exceptions. The criminal code of the state of Chihuahua states that terminating a pregnancy is legal in cases of sexual violence, if the woman’s health is at risk, if the woman has been forcibly inseminated or if the abortion was accidental.
The Mexican Official Norm, NOM-046-SSA2-2005, is the legal framework that lays out the criteria to address and prevent family and sexual violence against women, and the standards for abortion services in the state in cases of rape. Those services include access to syphilis and HIV testing, counseling, pregnancy tests and, in the case of a positive result, emergency contraception pills or the necessary procedures to terminate a pregnancy, if requested.
Medical staff are not required to verify the statements of those who petition for a voluntary abortion in the case of sexual assault. They must take petitioners at their word and act “under the principle of good faith referenced in Article 5 of the Victim’s General Law.”
Though the law also allows medical staff to decline to offer abortion services based on a conscientious objection, the state is still required to provide a physician willing to perform the procedure.
Chihuahua’s state health services fully comply with the standards set forth by the NOM-046, according to Mitzi Alicia Garcia, the Chihuahua Health Department’s coordinator of Reproductive Health in Ciudad Juárez. Garcia affirmed that in cases where abortion is legal under the state’s penal code, all state hospitals can guarantee medical attention from a non-objecting physician.
But Elia Orrantia, the director of the center against family violence SinViolencia, said in her experience, helping women get a legal abortion is still a challenge, as many physicians can still refuse to perform the procedure.
“In Chihuahua, conscientious objection is still very prevalent,” Orrantia explained in Spanish. “It’s really the doctor who decides if there’s going to be a legal termination of the pregnancy.”
Not all state-run hospitals in Ciudad Juárez have the services required to prevent or terminate a pregnancy, Orrantia added. Sometimes people seeking an abortion will have to be referred to other hospitals.
“Best-case scenario, the victim is transferred to another state hospital, but they have to tell their story once again to receive a service that should be guaranteed by the state,” she said.
Even when abortion is legal under state law, Juarenses may shrink from requesting the procedure to avoid judgment and stigma, she noted.
Between restrictions to access and the looming fear of criminalization, some Juarenses may still choose to manage their own abortions after considering that the medication is fairly accessible at pharmacies.
This was the case in 2019, when an acquaintance reached out to Lucero. She asked for her help knowing that she had been very vocal on social media about her position in favor of the legalization of abortion in Mexico. Most importantly, Lucero wouldn't judge her.
After taking misoprostol, she endured an infection for more than a week. Not only that, the medication failed to terminate her pregnancy.
Lucero had taken the day off from work to help her. She took the woman to her own gynecologist — the same doctor who had discreetly handed Lucero a card with contact information for the Hill Top Women’s Reproductive Clinic back in 2017. The doctor recommended a procedure to remove the infected tissue.
Unlike Lucero, the woman didn’t have a visa to easily cross to El Paso. Even if she did, she had no money and no support from her family.
“With her, I saw the counterpart. Those were the two faces of this experience: what I had lived and what she was currently living,” Lucero said.
The two cried in the car on their way to the hospital and practiced what to say to the medical staff once they got there.
Lucero told her there was no way for medical staff to know that she had taken misoprostol. “Deny it completely,” she said. “Tell them that you felt this intense pain and started bleeding this morning and that’s why you’re in urgent care.”
Lucero waited outside of the state Hospital de la Mujer in Ciudad Juárez, while a woman she barely knew had just walked in to get checked. She could only stay outside the hospital with dozens of people who were waiting for their loved ones.
A sheet of paper would be posted on the glass door of the hospital with updates, but every time she checked, there was no news about the girl, who until then was only an acquaintance.
A city police car pulled into the hospital’s entrance. The vehicle parked over the curb, its lights flashing. Lucero’s heart dropped to her feet thinking about the woman inside the hospital.
The woman had no access to her phone; Lucero couldn’t warn her that she may have been reported. She didn’t know what to do, but was convinced that she couldn’t take off and leave her now friend behind.
“I was imagining myself in prison already,” Lucero said. “I thought about how someone had told me that accomplices also go to jail for helping those who want to get abortions.”
Under Article 143 of Chihuahua’s criminal code, anyone who forces or assists a woman obtain an abortion “will be punished with six months to three years of prison, with whichever medium used, as long as this was done with the women’s consent.” Without the woman’s consent, the penalty will go up to three to six years.
Another police vehicle parked by the entrance, and that’s when Lucero saw a pregnant inmate from the federal penal center get off the truck. She wore the center’s uniform and shackles on her ankles and wrists.
Lucero felt relieved, but was still filled with anger.
“Why do we have to go through this? Not only do we not want to be pregnant but we also have to deal with this legal matter and economic struggles just because some people in government get to decide. They get to say ‘No. You don’t get a say over your body.’”
After more than six hours, her friend came out. She’d gotten the care she needed, and no one on the medical staff asked a thing about it.
A privilege or a right?
Lucero’s abortion put a financial burden on her. But unlike her friend, she was able to pay for the procedure. And ultimately, having a car and tourist visa allowed her to get an abortion without legal or health complications.
“I recognize that I was able to do that with all of (my) privileges,” Lucero said, acknowledging that for other fronterizas, access to an abortion is not that simple.
Liz Stunz does not think of abortion access as a privilege. For her, it is a right. Texas’s restrictive abortion landscape, she said, caused her unnecessary fear, isolation and pain. She learned she was pregnant in 2015, just two months after moving to El Paso. The timing couldn’t have been worse.
Then 28, she didn’t have a car and didn’t have friends in the city to confide in. Her new boyfriend had sexually assaulted her, she said — but in El Paso, she had only him to turn to. She knew better than to ask him for too much. A ride to the nearest Planned Parenthood, in Albuquerque at that time, was out of the question.
“I’d never been in such a vulnerable, vulnerable position before,” she said.
Living on a graduate student’s salary, Stunz couldn’t afford the cost of an abortion anyway.
In Texas, the cost of an abortion starts at $450, and depending on the stage of gestation, can run up to $1,500. These are usually paid for out of pocket because Texas prevents health insurance plans from covering most abortion procedures.
She read online about misoprostol and its easy, cheap availability just across the border.
“I wanted to get it over with ASAP and didn’t want to talk to anyone about it,” she said. Her thoughts were blurry, sporadic, constantly turning to her mother — a devout Catholic who would be horrified to hear of her daughter’s plans.
With misoprostol, Stunz wouldn’t have to wait for a clinic appointment and she wouldn’t have to pass a line of protestors outside that clinic. She could end her pregnancy in private, at home.
Stunz’s boyfriend was from Juárez and visited regularly. She told him about misoprostol and asked him to buy it for her. “It was the least he could do,” she said.
For five hours after taking a second round of misoprostol, she huddled at home, her legs curled into her chest, as cramps that felt like a knife twisting within her uterus came and went. Her temperature rose to a fever, then chills. Roiled with nausea, she vomited, then worried she’d thrown up the medication. Finally, she fell asleep.
Fever, abdominal pain and vaginal bleeding are common side effects after taking misoprostol, according to the WHO. The Mayo Clinic states that the medication can also cause nausea and vomiting. In the moment, however, that didn’t make it any less frightening.
Before moving to El Paso, Stunz had lived in Portland, Oregon, where one of her friends was able to get an abortion the day after learning she was pregnant. The procedure was cheap, too, Stunz recalled. Unlike Texas, Oregon allows private insurance to cover abortions, and also has a state insurance program that will fund the procedure. “It's totally opposite sides of the spectrum.”
Had she been pregnant in Portland, she said, she would have gone to one of the city’s many Planned Parenthoods. “If one clinic is a little busy, there's like, four more that would be a 10-minute bus ride away.”
There, she said, she would have felt supported. She wouldn’t have needed her abusive boyfriend’s help. She might even have felt empowered.
“Why (does it) even fucking have to be so much harder than it is in Portland? Like, that makes me fucking angry. That we're still having this debate,” she said. “That women still have to deal with these kinds of regulations on their bodies is fucking crazy.”
In Portland, she said, “no one's standing there trying to make shit harder for you like in El Paso, or just in Texas. I'm glad I could at least get that shit for cheap in Juárez, you know? I’m glad there was at least that.”