Two years after the abortion pill RU-486 hit the market, the drug many hoped or feared would transform abortion into a more accessible and private procedure has barely made a dent.

Meanwhile, drugs called "morning-after pills" have been quietly gaining in popularity since hitting the market four years ago. A recent study suggests they are responsible for nearly half of the 11 percent drop in the U.S. abortion rate from 1994 to 2000.

With Republicans in control of the White House and Congress, as well as the Georgia governor's seat and state Senate, many wonder whether possible new restrictions on abortion -- legalized by the Roe v. Wade decision 30 years ago this Wednesday -- could affect the use of both kinds of pills.

Nationally, several bills previously passed by the House now stand a better chance in the Senate. They include a measure to prevent minors in states with parental consent laws from getting abortions in other states without telling their parents, and one to prohibit governments from discriminating against hospitals that refuse to do abortions.

Another bill, to ban so-called "partial-birth abortions," passed Congress twice but was vetoed by President Clinton. President Bush has said he would sign it.

Georgia probably will see debate on a "woman's right to know" initiative, which would require women seeking an abortion to wait 24 hours after being told of risks and alternatives.

None of the measures is directed specifically at RU-486 or the "morning-after pills," but they could influence their use.

RU-486, known as mifepristone ("mif-eh-PRIS-tone") or by its brand name, Mifeprex, terminates an established pregnancy in a process similar to a miscarriage when combined with another drug taken two days later. Only 6 percent of abortions nationwide have involved the pill method, according to the most recent figures. Few doctors outside of abortion clinics offer it.

The "morning-after pills" -- emergency contraception products marketed under the names Preven and Plan B -- are taken within 72 hours of intercourse. They prevent a fertilized egg from implanting in the uterus. Most medical experts consider that prevention of a pregnancy while some anti-abortion advocates regard it as abortion.

About 200,000 emergency contraception prescriptions were filled in the first nine months of 2002, more than double the orders for all of 2000. Researchers say the drugs averted an estimated 51,000 abortions in 2000, accounting for 43 percent of the abortion rate drop since 1994, according to the Alan Guttmacher Institute, a private abortion rights organization in New York considered reliable on both sides of the issue.

There are several reasons mifepristone, the abortion pill, hasn't caught on. Abortions using it cost about $500, roughly $100 more than surgical abortion, though insurance plans that cover the surgery generally cover the pill. It usually requires three clinic visits over two weeks and can involve several days of cramping and bleeding, while surgery is done in about an hour. Though women can use it in the privacy of their homes, they must view the embryo when it is expelled. It's difficult to predict when that will happen.

"Once you start the process. you have to stick close to home," said Merriam McLendon, administrator at Summit Medical Center in Atlanta, where about 7 percent of women getting abortions used mifepristone.

At Feminist Women's Health Center in Atlanta, mifepristone accounts for about 15 percent of abortions, a figure higher than elsewhere partly because the clinic was a study site for the drug before approval.

Gail Pannachi, a counselor at Feminist Women's Health Center, said most women don't want to endure the cramping associated with mifepristone, which can be much worse than a typical menstrual cycle and last longer than with a surgical abortion.

"It's more time with pain," she said.

Lori Matthews, 33, of Lawrenceville, who had a surgical abortion 15 years ago, said she probably would not have used mifepristone if it had been available then.

"I can't imagine having a miscarriage, much less one that I took medications to have," she said. "With the surgical abortion, I didn't see a whole lot."

Limited acceptance

Abortion rights advocates heralded mifepristone's approval in September 2000 as a way to expand access to abortion beyond clinics, but private physicians haven't warmed up to the pill as anticipated. Just 6 percent of gynecologists and 1 percent of family doctors offered mifepristone in 2001, according to a Kaiser Family Foundation survey. Most of them already did surgical abortions.

To offer mifepristone, physicians must agree to provide surgical abortions, which are necessary in about 5 percent of the cases, in which the drug fails. That has led some doctors who considered using it to back off.

"If you're going to start something like that, you have to be willing to finish it," said Dr. Kelley Dopson of Obstetrics & Gynecology of Atlanta, who said her religious views conflict with performing abortions.

Dr. Luella Klein, director of maternal and infant care at Grady Memorial Hospital and vice president of the American College of Obstetricians and Gynecologists, said many physicians fear being tagged "abortion doctors" even though anti-abortion demonstrations have quieted in recent years.

"There is still a great amount of fear," Klein said.

Dr. James Gay, one of the few private physicians in Georgia who conduct surgical abortions, offered mifepristone for a month then stopped. Liability concerns forced him to charge $900, twice his fee for surgery, he said.

"With RU-486, the patient is in control," said Gay, who is with Northside Women's Clinic in Atlanta. "If she chooses not to come back for the required follow-up visits, and something happens to her, you've got a major malpractice problem."

Despite mifepristone's slow acceptance, backers say the drug eventually will be widely used. "It took Europe 15 years to get where they are now," said Dr. Richard Hausknecht, medical director for Danco Laboratories.

New York-based Danco markets mifepristone, developed in France. Hausknecht said more than 100,000 American women did use the drug in its first two years, and he predicted that in a few years it will make up about a third of abortions, as it does in France, England and Sweden.

New research has shown potential for use of mifepristone -- which blocks the hormones progesterone and cortisol -- to treat some medical conditions, from breast cancer and prostate cancer to uterine fibroids to some types of depression.

Abortion politics

Some say politics could speed up the use of mifepristone for abortion, with possible new restrictions on surgical abortion or a more charged anti-abortion climate, leading women to look more for a private alternative. But others say new laws or regulations could also limit mifepristone use. The Food and Drug Administration is reviewing a petition filed last August by anti-abortion groups to reverse approval of the drug.

"If they overturn Roe vs. Wade, or if the protesters come back, RU-486 pills will be like prenatal vitamins," said Dr. H.M. McFarling of Atlanta Obstetrics & Gynecology. "Everyone will want them."

The use of emergency contraception pills soon after sex also could be affected by changes in abortion law or public sentiment, possibly leading to more promotion campaigns, said Kay Scott, president of Planned Parenthood of Georgia.

But "morning-after pills" -- which are basically high-dose birth control pills -- are already on the rise.

"Many doctors are starting to believe that women should have a kit in their medicine cabinet," said Dr. Michael Randell, a gynecologist at Northside Hospital in Atlanta.

Planned Parenthood of Georgia issued 4,000 prescriptions for emergency contraception in 2002, a fourth through a phone and Internet service that places the order directly to a woman's pharmacy.

Emergency contraception is widely available on college campuses, with student health centers at Georgia Tech, Georgia State University and the University of Georgia offering it. A UGA survey in 2001 said 10.3 percent of sexually active students had used the pills.

Insurance coverage varies for emergency contraception, which costs $25 to $40 for a package of pills taken in two doses 12 hours apart. Blue Cross Blue Shield of Georgia covers neither brand; Aetna and Medicaid cover the one known as Plan B.

Women's Capital Corp., which makes Plan B, is expected to ask the FDA soon for permission to sell it over the counter.

Anti-abortion advocates consider emergency contraception a form of abortion.

"Once the sperm fertilizes the egg, it's a pregnancy," said Melanie Crozier, education director of Georgia Right to Life. "If you're willing to take your child's life at 72 hours, who's to say you're not willing to take your child's life at eight weeks or even 30 weeks? To us, it's all evil."

Abortion rights supporters say mifepristone and emergency contraception are very different.

"The more women who use [emergency contraception], the more pregnancies are prevented and the more abortions are prevented," said Kirsten Moore, president of the Reproductive Health Technologies Project in Washington.

"The problem is that most people still have a lot of confusion between emergency contraception and RU-486. We still have a huge job in getting the word out."

-- Staff writer Charlotte Moore and Cox News Service writer Bob Dart contributed to this article.