Dr. Lester Minto raised four daughters in South Texas, just miles from the Mexican border, where most women are Hispanic and 3 out of 5 girls are pregnant before they reach adulthood.
"My wife died and I raised them on my own," said Minto, 64, who made sure his girls had access to birth control. "Not a single one of mine got pregnant."
For the last three decades, Minto, a family physician and advocate for women, has owned the Reproductive Services clinic in Harlingen, Texas, which performs about 1,500 to 2,000 abortions a year.
But now, with the stringent new anti-abortion law that just passed the Texas legislature, he worries that the women he serves, those from "deep" Texas and Mexico, will turn in greater numbers to do-it-yourself remedy for an unwanted pregnancy -- misoprostol, which goes under the name Cytotec.
The drug, used off-label in medical abortions, is smuggled in by relatives from Mexico to begin a miscarriage -- or what Hispanic women call, "bringing your period down," according to Minto.
"They get things started, then show up in the emergency room and avoid the negative image of having done an abortion," said Minto.
Hispanic women have the highest rate of unwanted pregnancies nationwide -- about 54 percent, according to Jessica Gonzalez-Rojas, executive director of the National Latina Institute for Reproductive Health. Many are uninsured and speak no English.
"With an increase of barriers mounting, what we are hearing is that a lot of women are turning to other folks they know who can smuggle [misoprostol] over the border or are finding it in flea markets," said Gonzalez-Rojas.
"It's the kind of thing -- people know where to get it and are very quiet. While it's not the most dangerous drug, there are a lot of questions about how to take it appropriately. We have tremendous concerns when women take their health into their own hands."
And it's not just women in Texas, according to Gonzalez-Rojas.
"There are lots of cases throughout the country of low-income women, even in New York City, using misoprostol or Cytotec," she said. "I think it's more about the stigma that exists around abortion and they get a lot of mixed messages and turn to underground methods."
Misoprostol, a prostaglandin inhibitor, is usually used as part of a two-part, FDA-approved medical abortion with mifepristone or RU486. Alone, it is routinely used off-label for obstetrical and gynecological procedures such as cervical ripening, labor induction and mid-trimester terminations. It can be used to induce miscarriage, typically up to nine weeks, but can also be safely given in through the second semester.
In combination, the two drugs are 95 to 97 percent effective. Taken alone, misoprostol is only 80 to 85 percent effective, and is suspected of causing birth defects if it fails.
After care is critical to ensure the pregnancy tissue is expelled to prevent infection. In a worst-case scenario, if a woman has placenta previa, (when a baby's placenta partially or totally covers the mother's cervix) she can bleed to death if the drug is used alone.
In 2007, a Massachusetts teenager took misoprostol in an attempt to induce a miscarriage at 25 weeks and the 1-pound baby was delivered prematurely and died. Amber Abreu, who was 18, faced murder charges that were later dismissed.