In a move designed to expand access to abortions, the American College of Obstetricians and Gynecologists is endorsing programs that would train non-physicians to perform the procedure.

The decision last month by the executive board of the 34,000-member specialty group, which represents more than 90 percent of the nation's board-certified ob-gyns, comes at a time when abortion is being eschewed by a growing number of doctors. ACOG's endorsement has sharply divided doctors and groups that support abortion rights.

"It is the source of great controversy in our organization," said Ron Fitzsimmons, executive director of the National Coalition of Abortion Providers, an Alexandria-based group that represents half of the nation's 600 independent abortion clinics. "There are doctors who feel that it's an affront to their expertise and their years of training."

Critics of ACOG's move say they fear that physicians, some of whom have been the targets of aggressively personal campaigns by anti-abortion activists who have picketed doctors' homes and confronted their children, are abdicating their responsibilities and succumbing to political pressure. Some doctors whose practices are largely dependent on abortion say they fear encroachment by nurses and physician assistants could endanger both their source of income and the health of women.

But other abortion-rights supporters applaud ACOG's action, saying that expanding the pool of providers beyond the ranks of doctors is an overdue acknowledgment that certain medical procedures can be -- and are -- safely performed by non-physicians. First-trimester abortions are simple procedures routinely performed in outpatient clinics.

"I don't think it's buck-passing," said David A. Grimes, vice chairman of the department of obstetrics and gynecology at the University of California at San Francisco School of Medicine, who has written extensively about the shortage of doctors who perform abortions. "I think it's a modern view of health care, which recognizes that people other than physicians are members of the team. In the past, we've been a bit territorial when it comes to the practice of medicine."

Although abortion is the most common surgical procedure in the United States -- about 1.4 million abortions are performed annually, mostly during the first three months of pregnancy -- the number of doctors able and willing to perform the procedure has steadily eroded in the past decade.

A 1988 survey by the Alan Guttmacher Institute found that 83 percent of counties in the United States have no abortion provider; in some states, such as South Dakota, there is only one doctor willing to perform abortions. A 1991 study found that only 12 percent of American medical schools and residency programs teach abortion, often as an elective that overworked residents avoid.

Although abortion-rights groups have been struggling to replenish the dwindling ranks of abortion providers, Planned Parenthood has so far rejected the concept of using non-physicians. "The debate has been strongly negative," said Jerry Hulka, chairman of Planned Parenthood's national medical committee, who personally favors ACOG's decision. The chief fear, said Hulka, is that someone without medical training might be unable to handle the rare -- but potentially life-threatening -- complications that can occur even during a first-trimester abortion.

That, says Damon Stutes, an obstetrician-gynecologist in Reno whose practice is limited to abortion, is what worries him. "What about women in rural areas or in places where there isn't readily available medical backup?"

"I think the profession has let women down," he added. "Why is it that women would require less medical care than someone who needs an appendectomy?"

ACOG's recommendation, which has no legal standing, is a critical first step in changing state laws that govern who may perform abortions. More than 40 states and the District of Columbia have statutes legalizing only those abortions performed by doctors. Most of them were passed to protect women from the consequences of botched abortions by untrained practitioners, a problem prior to 1973, when the Supreme Court effectively legalized abortion.

But in some rural states, where medical services are scarce, broader latitude has been granted to non-physicians. For more than a decade in Vermont and Montana, physician assistants have been allowed to perform abortions under physician supervision.

Since 1980, physician assistants at the Vermont Women's Health Center, a nonprofit independent clinic in Burlington, have trained residents and medical students to perform abortions. Such training is not provided at the state's only medical school at the University of Vermont, according to clinic director Rachel Atkins.

A 1986 study of nearly 2,500 first-trimester abortions performed at the clinic found no difference in the rate of complications between abortions by physician assistants and those performed by doctors. complications between those performed by physician assistants and those performed by doctors.

Physician assistants "should not be allowed to do a procedure just because doctors don't want to do it, but because it makes good medical sense," Atkins said. At her clinic, the lone physician performs more-complicated procedures such as hysterectomies and oversees the five physician assistants who do abortions.

There are signs that the reluctance of residency directors to teach abortion may be waning.

A committee of the Accrediting Council of Graduate Medical Education, which determines the required curricula for residencies, is recommending a revision that would explicitly require ob-gyns to be trained in abortion techniques; only students with religious or moral objections would be exempt. A spokesman said the Chicago-based accrediting board is scheduled to act on the recommendation this year; the requirement, he said, could be in place by 1995.

Even if residency programs begin teaching methods of abortion, that doesn't guarantee that doctors will perform them.

"What really prompted this {ACOG's vote} was an issue of access," said Richard F. Jones, a Hartford physician who is ACOG's immediate past president. "If doctors won't do it because of the harassment, we should help train non-physicians to do it. My worry is that non-physician providers will face the same problems we have," said Jones, who says he stopped working at an abortion clinic several years ago after he and his children were the targets of harassment by abortion foes.

This may explain the tepid reaction by non-physician groups to ACOG's decision.

"We don't necessarily believe that just because someone is willing to delegate a task means that we would be willing to do it," a spokeswoman for the American College of Nurse Midwives said.

Nancy Hughes, a spokeswoman for the American Academy of Physician Assistants, said that while none of the 58 accredited programs to train physician assistants teaches abortion procedures, physician assistants "should be allowed to perform any medical task, including abortion, delegated by a physician under whose supervision the task will be performed."

Permitting skilled non-physicians to perform procedures traditionally regarded as the exclusive province of doctors is one of the most contentious issues in medicine. The debate is likely to escalate as Congress debates the Clinton administration's health proposal, which would extend the clinical duties of nurses as a cost-efficient way of expanding access to primary care.