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LITTLE PILL, BIG ISSUES ABORTION DEBATE HEATS UP OVER NEWLY APPROVED DRUG

Pro-life forces consider it an insidious murder weapon, a little pill they label a "chemical bomb" or "the death pill."

Pro-choice activists hail it as a needed option in women's health care, a chance for a woman to terminate a pregnancy earlier, avoid surgery and keep the whole matter private, between herself and her doctor.

Once again, the two sides in the abortion debate are butting heads over the latest development: the arrival in America of RU-486, now known as mifepristone.

Several things already are clear less than 48 hours after the federal government approved the drug:

* Contrary to public belief that the new method will end a pregnancy simply with the taking of a single pill, the new medical abortion involves more doctor visits and more responsibility on the patient's part.

* Not every obstetrician-gynecologist will offer the "medical abortions."

Anywhere from a handful to almost half the Buffalo area's obstetrician-gynecologists will offer the new procedure in their offices, observers suggested.

* The pill won't herald the demise of the Buffalo GYN Womenservices clinic on Main Street, which plans to start offering it within the next six weeks.

Traditional surgical abortions -- at least initially -- are expected to greatly outnumber the medical abortions performed, both here and across the country.

* Preserving the confidentiality of patients going to their private doctors for the procedure will be a priority for the pro-choice side.

Mifepristone may end pregnancies, but it won't quell the ardor of the pro-life forces.

"It won't change what we do as a diocese," said Judith A. Gorman, director of pro-life activities for the Catholic Diocese of Buffalo. "We will continue our prayers and our education. We constantly educate our people in the pew about the pro-life issue, from conception to natural death."

On the other side of the debate, pro-choice activists are preparing for more activism from the pro-life movement in the wake of the FDA approval.

"I don't think the hostile (nature) of the anti-choice movement in Western New York will be changing much," said Dana P. Neitlich, chief executive officer for Planned Parenthood of Buffalo and Erie County. "In fact, I think it initially will increase."

Nothing has changed yet. On Friday morning, a few protesters stood across the street from the Buffalo GYN Womenservices clinic as they usually do, holding signs and saying prayers, without incident.

Activists on both sides of the debate agree on one point: that the public mistakenly believes the new method is a "magic pill" that ends a pregnancy quickly and easily.

The truth is that the medical abortion is a three-step process:

* A woman in the first seven weeks of her pregnancy visits her doctor and, after a full battery of health tests, takes three 200-mg pills of mifepristone. That blocks the hormone essential for maintaining pregnancy.

* Forty-eight hours later, either through a pill or a vaginal insertion, the patient takes a second drug, misoprostol, which induces the womb to contract and expel its contents.

* Within two weeks, the patient returns to her doctor to make sure the abortion is complete. If not, the doctor must be prepared to perform a surgical abortion or refer the patient to someone who can.

"There are three steps to this," Neitlich said. "It doesn't happen quickly. It happens over a number of hours or days. It's clearly not a magic bullet, but it is a very safe and early option for women to choose."

Gorman, from the Catholic Diocese, doesn't think the public understands that the medical abortion involves more trips to the doctor's office and that it's not an easy procedure for women.

"I'm afraid it's a dangerous thing for the woman, with all the cramps and bleeding," she said. "And, of course, it's always dangerous for the baby, who always dies."

Nobody knows how many local obstetrician-gynecologists will offer the medical abortions.

Some are staunchly pro-life.

Like Dr. Richard R. Romanowski, who doesn't care that the medical abortion ends a pregnancy earlier and without surgery.

"You have to look at what you are doing with this prescription," Romanowski said. "You can destroy life with a cyanide pill. Just because it's easy doesn't make it right."

Other doctors, who may believe in a woman's right to choose, will not want to get involved, either because they'd be uncomfortable offering the procedure or because they fear any public exposure or protests.

In a national study of obstetrician-gynecologists who don't perform surgical abortions, nearly 50 percent said they would be willing to provide the new pill once it was approved, according to the Planned Parenthood Federation of America.

Some observers think the percentage might be much lower in Western New York, considered a more conservative community, with its high percentage of Catholics.

Neitlich, from Planned Parenthood, disagreed, citing what she called the local silent majority that's clearly pro-choice and supportive of women's access to quality reproductive health care.

For Neitlich, confidentiality is the key for doctors who might be on the fence.

"I think that, if doctors are comfortable that this will be confidential between them and their patients, then I think that the number here will approach the (50 percent) national figure," she said. "The confidentiality is the caveat."

Romanowski is concerned about the relative ease of the medical procedure. "The fear I have is that because it's a pill -- and not a curette or a suction device -- it will become more widespread."

Nobody sees mifepristone sounding the death knell for clinics like Buffalo GYN Womenservices, which performs the bulk of the abortions in Western New York.

While the number of abortions nationally has declined steadily in the past few years, the number performed at the Main Street clinic has stayed steady and even increased slightly in the two years since abortion provider Dr. Barnett A. Slepian was murdered, said Melinda DuBois, clinic director.

"I believe the need for surgical abortions will remain as long as there is a need for abortion," Neitlich said. "Women, for a lot of reasons, will choose surgical abortion over mifepristone."

DuBois guessed that only about 25 percent of the women coming to the clinic for an abortion in the first seven weeks of pregnancy would opt for the medical abortion.

"It means at least two visits to the clinic," she said. "It means the person is going to have significant bleeding and cramps. We have to prepare the patient for this."

Neitlich agreed that the number choosing a medical abortion would be small, at least in the beginning. But as it's proven to be more successful, she thinks it will be a more popular option.

So who would opt for mifepristone?

* Women who want to terminate their pregnancy at the earliest possible moment.

Buffalo GYN Womenservices now offers surgical abortions for women who are between 4 1/2 and 20 weeks pregnant. The new procedure would be available any time up to seven weeks.

* Women who fear going to an identified abortion clinic.

* Women who feel that the new method gives them more control over their plight.

But it's not for everyone.

Women preferring the surgical method would include those who want the procedure ended in one step and those with medical problems who would have trouble tolerating the two drugs.

And the pro-life side doesn't care how or when an abortion is done. "Obviously, we abhor it on moral grounds," Gorman said. "It's still the taking of a human life, no matter how early it is."

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