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WASHINGTON – Forty years after the U.S. Supreme Court ruled that American women have a right to terminate their pregnancies, abortion is going underground again.

After decades of confrontational politics and the adoption of state laws narrowing the right the Supreme Court granted women on Jan. 22, 1973, women are increasingly taking abortion into their own hands through the use of legally prescribed drugs – or whatever drugs they can buy on the Internet.

Proof of the trend lies in statistics published by the New York State Department of Health.

In 2000, the year that an abortion drug called Mifepristone was approved for use in the U.S., the state reported only 23 “medical” – that is, prescription-induced – abortions in Erie and Niagara counties.

In 2010, the latest year for which the state has statistics, there were 764 such abortions locally – and women’s health care experts say that number may only hint at the number of women who are taking pills to have abortions in their own homes.

That’s because family physicians who prescribe the abortion drug regimen often don’t report it to the state and because no one has any idea how often women are buying abortion drugs on their own through mysterious-looking websites.

Yet the trend toward medical abortions raises troubling questions for people on both sides of the long-standing pro-choice, anti-abortion divide.

Abortion opponents ask: Will this growing trend make abortion seem more convenient, and less of a life-and-death matter, than it really is?

“This is still abortion,” said Randall K. O’Bannon, director of education and research at the National Right to Life Educational Trust Fund. “This is still the taking of the life of an unborn child. This has not made abortion safe or simple or easy.”

Meanwhile, abortion rights supporters wonder: What about the women who are trying to have medically induced abortions without medical supervision?

“There’s a lot of bogus medication being sent out in the Internet, and you’ll never really know what you’re getting,” said Vicki Saporta, president and CEO of the National Abortion Federation.

Still, there are clear and obvious reasons why the medication regimen is the fastest-growing abortion method both in Western New York and around the nation.

“Some women choose it because it’s more private, it’s noninvasive,” said Colleen Schiffhauer, director of patient services at Planned Parenthood of Western New York.

Kenneth R. Kahn, clinical associate professor of gynecology and obstetrics at the University at Buffalo School of Medicine, agreed.

“It gets women away from the politics of abortion, because you don’t have to go to an abortion clinic” and past the protesters that may be outside, Kahn said. “It’s more anonymous.”

After all, it’s pretty much a stay-at-home procedure.

Doctors generally recommend that two drugs be used in combination in the procedure: Mifepristone, formerly known as RU-486, and Misoprostol. A study published in Human Reproduction found the drugs to be 97.5 percent effective, and the National Abortion Federation’s latest guidance shows that the drugs can be used safely and effectively in the first 10 weeks of a pregnancy.

If the drugs are taken early in a pregnancy, they destroy the embryo before it forms into a fetus. Doctors simply prescribe the medication and tell women how to use it, and to report back if there are any complications.

The comparative simplicity of it all, of course, draws widely divergent reviews from the two sides of the abortion debate.

“It has been a wonderful choice for some women,” said Karen Nelson, CEO of Planned Parenthood of Western New York.

In contrast, Cheryl Calire, the director of pro-life activities for the Catholic Diocese of Buffalo, calls medical abortion “the dirty little secret people don’t talk about.”

That’s a deeply troubling fact to the pro-life movement.

For years, pro-life activists have relied on sidewalk counselors to speak with women outside abortion clinics and, in some cases, talk them into having their babies.

Now those activists are often missing that opportunity because in many cases, the abortion drug regimen is prescribed by family physicians rather than abortion clinics or organizations like Planned Parenthood.

“A lot of this work is being done by family practitioners,” Kahn said. “They’re at the forefront of this field.”

To Stasia Zoladz Vogel, president of the Buffalo Regional Right to Life Committee, it’s a dreadfully disturbing trend.

For years, she said her group’s “Abortion-Ask First Hotline” has been able to present alternatives to abortion to women who sometimes chose them. Now Vogel worries that women aren’t even calling the hotline and instead are seeing the abortion drugs as an easy way out of a bad situation.

“It totally abrogates from the parents the recognition that they’re truly dealing with another human being,” Vogel said.

Despite the rapid growth in medical abortions, they still appear to be a relatively small part of the overall abortion picture, accounting for 16.3 percent of all abortions in Erie and Niagara counties in 2010.

But people on both sides of the abortion debate think the official numbers vastly underestimate the real total of medical abortions that occur, for two big reasons.

First of all, while clinics tend to report medical abortions to the state just as they would surgical abortions, family doctors often don’t report prescribing those abortion drugs because they generally don’t have to, Kahn said.

That means it’s likely that plenty of medical abortions are going unreported, which may well mean that the overall drop in the abortion rate – 18 percent in a decade in metro Buffalo – may be misleading.

“I think one of the reasons the abortion rate is down is because women have access to some of these [drugs],” Calire said.

There’s also another, more disturbing reason to suspect that medical abortion is more common than the numbers indicate:

Google “abortion pill,” and you will find numerous websites selling the abortion drugs with all the subtlety of a carnival barker.

“Buy Cytotec (Misoprostol) Online! Lowest Prices Guaranteed!” says a Web ad that steers you to www.meds-discounts.com.

“Early miscarriage can be achieved easily with the aid of a small oral contraceptive pill called Abortion Pill,” www.realpharmacyrx.co tells us.

Of course, there’s no way of knowing how many women are buying abortion drugs from such websites, and therefore no way of knowing how many medical abortions are actually happening, abortion experts said.

Not surprisingly, though, medical professionals and the National Abortion Federation strongly urge women to avoid ordering abortion drugs from such websites.

Tests of such drugs have found some of them to be inauthentic, Saporta said, and that’s just one of the problems they pose.

“The medicine they take may not be effective, or the woman may not know how to deal with the various side effects,” she said.

And of course, there’s nothing stopping a woman from ordering the drugs online and taking them far past the tenth week of pregnancy.

For proof, witness the story of Jenny Linn McCormick of Pocatello, Idaho. Pregnant with her fourth child and in desperate financial straits, McCormick asked her sister to order abortion drugs for her online in late 2010. When the pills arrived, McCormick took them – when she was about five months pregnant.

She delivered a dead fetus that she stored in a box on her back porch, according to an account in the New Republic. She then told a friend about it, and the friend told his sister, who called the police. McCormick is now under arrest, charged with violating Idaho’s state abortion law and facing a possible five-year prison sentence.

Abortion rights activists see the case of a sign of what can happen when the right granted to women in Roe v. Wade is abridged by the states.

Some 92 state laws were passed to restrict abortion in 2011 alone, and seven states, including Idaho, have gone so far as to essentially ban abortion after the 20th week of pregnancy, the New Republic reported.

“When I look back 40 years later, I see that in a lot of states, if there’s one clinic left, that’s a lot,” said Marilynn Buckham, founder of the Buffalo WomenServices clinic. “We’re going back to the days when there were illegal abortions. It seems like there’s been a reversal.”

For many women, then, medical abortions – even those shady online ones – may be the only kind of abortion that’s available, which is why people on both sides of the abortion debate expect abortion-by-pill to be a growing trend.

“Many clinics are offering just that,” Buckham said. ................................

email: jzremski@buffnews.com