Nine years ago, while Michael Cummings was still an obstetrics and gynecology resident at the University of Iowa Medical Center, he invested in equipment for the small-town practice he was about to establish -- a colposcope, which Cummings planned to use for cervical examinations, and a suction machine, which he planned to use for abortions.

"I assumed that was going to be part of my practice," Cummings says. Although his first ob/gyn office was in the heavily French Catholic town of St. Albans, Vt., Cummings says his experience was just the reverse of what many doctors describe -- abortions and all, he says, he thrived. Even after he testified before the state legislature against a parental consent bill, which attracted a flurry of angry telephone calls and demonstrators to his office, Cummings felt so strongly supported by the St. Albans community and local hospital staff that he says his practice continued without difficulty.

But now that he does abortions nearly full-time -- Cummings has moved to New Mexico and begun working in a Santa Fe clinic -- he thinks the women he treated in St. Albans might have been better served by an abortion facility than by a doctor who fit abortion in among all his other procedures. "When I think about the level of knowledge I had of the procedure when I was in private practice, it makes me crawl a little bit, because I'm so much better at it now," he says. "I couldn't be that good if I was doing three or four a month. There's just no way."

Clinics like the one where Cummings works, according to a recently released Alan Guttmacher Institute survey that totaled their numbers at about 400 around the country, now handle almost two thirds of all abortions in the United States. That means most women are going for their abortions to what amounts to a large medical office; a typical abortion clinic has rooms set aside for counseling, recovery and the abortions themselves.

As more physicians and hospitals exclude abortion from the services they will provide, these are the facilities that seem to be taking up the slack -- so that women from northern Iowa who might once have gone to Lee Van Voorhis's ob/gyn office in Sioux City, for example, will now drive the extra hour and a half to reach the abortion clinic in Omaha, Neb., or the Souix Falls office of Buck Williams, the only South Dakota physician who accepts abortion patients. This kind of specialization disturbs Williams, who says a procedure as common and technically simple as early abortion ought not to be restricted to large metropolitan areas as if it required some elaborate and costly equipment. Clinics carry their own sets of problems: They can be impersonal and overworked, are easy targets for picketing or violence by protesters who often describe them as "abortion mills," and standards of care vary widely enough to provide grist for occasional newspaper accounts about scandalous conditions in some shoddy local facility.

But the clinic system has its advantages, too, especially for a woman uncomfortable about having her small-town physician and nursing staff know the details of her abortion. "I think the clinic system offers a better hope for confidentiality than a private doctor's office," Cummings says. "Clinics develop ways of dealing with the telephone public, and people at large, that guarantee anonymity."

Clinic doctors are usually more experienced in abortion techniques than their less specialized colleagues, despite the traditional social disdain that still comes with the "abortionist" label, and well-regarded clinics offer a kind of counseling unavailable from most doctors with a more general practice. The clinics' directors and staff members are often women who believe deeply that abortion should be legal and widely available.

National Abortion Federation director Barbara Radford, whose organization includes in its membership approximately two thirds of the country's nearly full-time abortion providers, says she believes doctors often do patients a service when they refer them away from their offices to reputable abortion clinics nearby. But Radford says she also believes that when a gynecologist or family practitioner knows the nearest abortion facility is several hours' drive away, that doctor should feel responsible for providing the occasional abortion in the office.

"I would argue strongly that it's better for a patient of a doctor like that to be seen by that doctor, for a fairly straight- forward first-trimester or early second- trimester abortion, than to send her 300 miles to a clinic," Radford says. "The risks involved with travel, and the delay of the travel, add to the complications more than {having} a practitioner who may not do as many abortions."