MEXICO CITY — More than 5.6 million U.S. tourists head to Cancun every year, drawn to the Mexican port’s white sand beaches, all-inclusive resorts, and raucous nightlife. Soon there’s likely to be another reason to visit: MSI Reproductive Choices, an international reproductive health nonprofit, plans to open an abortion clinic in the city, partly designed to cater to travelers from the U.S. who are unable to get an abortion in their home states.
“You have a lot more direct flights to Cancun than to any other city in Mexico,” said Araceli Lopez Nava Vázquez, regional managing director of MSI Reproductive Choices in Latin America. “That was an important thing for us to consider…. We’re aiming to help more American women.”
MSI Mexico has 10 clinics around the country, and opened its Tijuana location close to the border with California just one week after the Supreme Court overturned Roe v. Wade last year. That timing was a coincidence, said Nava Vázquez, but the decision to open a Cancun clinic was more intentional, with an eye to helping not just Mexicans but also U.S. patients denied access to abortion. Many of the direct flights to Cancun come from states with highly restrictive abortion laws, including Texas, Georgia, Louisiana, Indiana, and Missouri.
Several Mexican nongovernmental organizations said they’re increasingly hearing from U.S. patients traveling to Mexico for abortion care after the two countries largely reversed decades-long policies. Last year, Mexico’s Supreme Court found that criminalization of abortion was unconstitutional just three months after its U.S. counterpart overturned a constitutional right to abortion.
Quintana Roo, the state home to Cancun, followed the Supreme Court decision by voting to decriminalize abortion last October; abortions in the state are now legal up to 12 weeks, though those limits don’t apply in cases of rape.
The MSI clinic, which has the capacity to perform up to 15 abortions a day, will be among the first to provide care for locals who previously had to travel for abortion. MSI, which is accredited by the National Abortion Federation, said its clinic has met all the regulatory requirements, and a doctor, nurse and receptionist are fully trained and ready to start work this month, pending approval by Cofepris (the Federal Commission for Protection against Health Risks), Mexico’s health regulatory agency.
The Cancun clinic will hopefully decrease deaths, said Alfonso Carrera, an OB-GYN and medical director at MSI Mexico, citing World Health Organization reports that show up to 13.2% of maternal deaths per year are due to unsafe abortions. “It’s a right. A right for health, for taking their own decisions,” he added.
All the staff at the Cancun clinic will speak both English and Spanish, and MSI plans to reach clients through a social media campaign in the U.S, and the help of “companion networks” that operate throughout Mexico to share information about how to access abortions.
Nava Vázquez estimated around half of all patients at the Tijuana clinic are from the U.S., though it’s hard to know definitively: MSI doesn’t track where its patients come from and populations close to the border often have dual nationality and speak both English and Spanish. Those who do come from the U.S. often cross the border because of lower health care costs in Mexico, she said. A standard surgical abortion, a manual vacuum aspiration (MVA), costs around 3,500 pesos, or $200, at MSI clinics, said Carrera, and the procedure is free for rape victims.
The majority of U.S. abortions are induced with drugs, using a combination of mifepristone and misoprostol, and there are several services that send the medication to those who need abortions, even in states with restricted access. But there are situations where a patient may want or need to have a surgical procedure instead.
Medication abortions can take up to two days, said Carrera, and patients may not have the time or privacy to go through the process, while an MVA takes only a few minutes. Advanced ectopic pregnancies or later-term abortions require surgical treatment. And although drug-induced abortions are safe, there is a small risk of bleeding.
“I worry about the people who take something and go back to their state. Some non-ethical physicians can put them at risk,” said Carrera.
In states where abortion is illegal, patients have been arrested and prosecuted for self-induced abortions, including in instances where medical providers have reported patients to the police.
Clinics in states with less restrictive laws “are overburdened now with people requesting appointments and it creates delays,” said Elisa Wells, co-founder and co-director of Plan C, a U.S. advocacy group that provides information to the public on self-managed abortions. International health care options, whether through drugs or clinics, will help ease the strain, she added: “Every clinic we can offer helps expand the range of options.”
Despite the lower cost for the procedure itself, Americans flying to Cancun for an abortion will have considerable travel and lodging expenses, placing this option out of reach for many. The clinic there will also only be an option for those who have passports and can cross the border. Carrera, who has worked with refugees, worries about those who relocated to the U.S. without documentation, and who would struggle to travel for reproductive health care. Rape is especially common among such vulnerable populations, he said.
While MSI planned the new clinic partly with an eye to helping Americans, there is still limited access to abortion across Mexico following the Supreme Court’s ruling. It takes time to open clinics, train staff, and even publish national guidelines. Even with all the requirements met and the Cancun clinic ready to go, MSI has been waiting for 10 months for approval from Cofepris. Whenever MSI officials ask Cofepris when it will be approved, said Carrera, they’re told “a momentito” — soon. Cofepris did not respond to STAT’s requests for comment.
MSI is working with several universities, said Carrera, encouraging them to start teaching abortion care in medical schools. “Public hospitals are supposed to deliver the service, but they don’t have the supplies, they don’t have the training, they don’t have the medical equipment, they don’t have the willingness,” said Nava Vázquez. “So it’s kind of confusing, because we have the right but at the end, women are not able to get the product.” Even so, with access in Mexico expanding even as it shrinks in the U.S., Cancun is on track to become an international reproductive health care destination.
This story is part of ongoing coverage of reproductive health care supported by a grant from the Commonwealth Fund.