Abortion is an emotional issue, an ethical battleground and a Supreme Court-ordered right.
It is also a business.
And in the Buffalo Niagara region, it's a profitable one.
Clinic owners, Planned Parenthood directors and local hospitals won't say for sure.
But new state data shows that in 2000, women in Erie and Niagara counties walked into clinics, doctors' offices and hospital rooms and paid at least $385 each -- the rock-bottom price locally -- for a total of 5,703 abortions.
That means local women spent $2.2 million -- likely much more -- for abortions in just one year, not counting follow-up care and related expenses.
"Everyone knows this clinic is profitable," said Marilynn Buckham, director of GYN Womenservices, the Buffalo area's biggest abortion clinic. "We have made money. It would be foolish of me to say that this clinic isn't profitable."
Thirty years after Roe v. Wade, the Supreme Court decision legalizing abortion in the United States, the business side of abortion is often obscured by the more attention-grabbing aspects of the debate.
But in Buffalo Niagara, the business of abortion looks like:
Abortion clinics, doctors and hospitals making money by performing thousands of abortions each year.
High-tech new drugs that are challenging older abortion methods, but which may well cut into profit margins for providers.
Women paying cash, or using insurance or Medicaid, to cover the cost of their abortions.
Why are abortions so profitable here? One of the reasons is simple: Local women prefer an abortion option that is usually less expensive for providers.
Women in Erie and Niagara counties almost always choose to have surgical abortions in a clinic or other medical setting, rather than swallow the newer technology of the abortion pill, RU-486, according to state data and local providers. RU-486 is available locally for roughly the same cost as a surgical abortion.
With the pill abortion, profit margins are smaller than with surgical abortions, experts said.
That's because mifepristone -- the chemical name for RU-486 -- is an expensive drug, although its price is falling in the United States, said Dr. Eric A. Schaff, a University of Rochester doctor who is participating in clinical trials of the drug.
The recommended dose of mifepristone for a single abortion, three pills, costs $270, Schaff said.
"The profit margin for medical abortions is less than that of surgical abortions," he said.
Abortion providers in Erie and Niagara counties said women aren't familiar with RU-486 yet. They also said that some women don't like certain aspects of the pill -- such as the fact that the abortion takes place at home.
Surgical abortions, on the other hand, have fixed costs, but usually can be done in one office visit, providers said.
"We won't have as many people opting for medical abortions," predicted Shelley D. Stuchell, president of Planned Parenthood in Niagara County, which will begin to offer RU-486 to clients this month.
Buckham, the clinic director, declined to say how many abortions her clinic does each year.
Back in 1983, the year the clinic opened, Buckham charged $140 for a first-trimester abortion. Now she charges $400.
"We're trying to keep it affordable," she said.
Out of that $400, Buckham said, she has to pay certain costs: a doctor's fee, the cost of medical supplies and pharmaceuticals, plus overhead costs and staff salaries. There is also the cost of security measures installed after the murder of Dr. Barnett Slepian, she said.
"Security (costs) used to be just a sliver," Buckham said. "It's no longer a sliver."
The cost of an abortion in Buffalo escalates sharply after the first trimester. For later abortions, fees at Buckham's clinic range up to $1,200.
Health insurance plans in Buffalo generally pay for abortions, although some women choose to pay out of pocket rather than use their insurance plans, abortion providers said.
Officials at several hospitals contacted for this story, including Erie County Medical Center and Millard Fillmore Suburban Hospital, would not return phone calls on the topic of abortion.
The Catholic Health System, which operates five local hospitals, does not permit abortions on moral grounds.
At Children's Hospital, a Kaleida Health spokeswoman said there would be no comment on whether or not Children's -- or any other Kaleida-run hospital -- does abortions.
But Dr. Kenneth Kahn, an obstetrician-gynecologist who practices at Children's as part of the University at Buffalo faculty group, said Children's does abortions up to 19 6/7 weeks of pregnancy.
At Children's, abortion is clearly something that is not desirable as part of the hospital's image, said Kahn, who has practiced since 1973.
"Over here, children are kept alive from as little as 24 weeks on," he said. "They view themselves as the 'children's' hospital. Abortion service isn't something they like to advertise."