Women who come to state Clinic No. 193 for an abortion these days may be offered something extra: anti-abortion lectures and graphic films such as The Silent Scream.

“We’ll work with those who want to help us,’‘ clinic director Irena Tsvetkova says of her decision to let Association Life, the Russian affiliate of the International Right to Life Federation, counsel in the clinic. “We’re not very experienced at this.’‘

Tsvetkova also dispenses contraceptives and family-planning advice – which anti-abortion forces generally oppose.

It is a catch-all approach increasingly common in Russia, where officials without much money or up-to-date training are trying to curb the highest number of abortions in the world.

Progress has been slow.

By the most conservative estimates, Russia had 3 million to 4 million abortions last year – more than double the number of births. The rate is roughly four times higher than in the United States, and the average Russian woman, it is guessed, has three to eight abortions.

“We have had an abortion culture, and it is changing only slowly. In the Soviet Union it was the only method of family planning,’‘ says Yelena Ballayeva, coordinator of the Open Dialogue on Reproductive Rights.

Family-planning groups like hers cite some successes in lowering abortion through public information campaigns and contraceptives, but say that changing social attitudes takes time.

Meanwhile, a small but vocal contingent of anti-abortion activists, many backed by Western religious groups, are increasingly active. They have the support of the Russian Orthodox Church, and, free of the political baggage they carry in the United State, have broad access to schools, clinics and medical institutes.

The new debate over abortion plays on deep fears in Russia since the loss of the Cold War that its soul is sick and even its physical survival is at risk.

“I am thinking of course of the future of the country,’‘ the clinic director, Tsvetkova, answers when asked why the anti-abortion message appeals to her.

Russia’s birth rate and life expectancy have plummeted, and nationalists say abortion is a crime against the nation. Vitaly Savitsky, a parliament member who is drafting a bill aimed at sharply restricting abortion and encouraging birth, says Russia is otherwise “doomed to extinction.’‘

Still, abortion is so ingrained a right that even its fiercest opponents don’t imagine a ban anytime soon.

“This isn’t Poland with the Catholic Church,’‘ sighs Olga Selikhova, director of Association Life. “We are at square one, trying to change the way people think. Here, they were taught that abortion is like having a tooth out.’‘

In Soviet days, contraceptives were scarce and of such poor quality that the dangers of crude, assembly-line abortions seemed the safer bet. The Soviet state needed women in the work force, and few had the time, money or living space to have more than one child.

Now, higher quality Western contraceptives are more available and affordable, but supplies can be unreliable and fears linger. Sex education is virtually nonexistent.

“People my age mostly hope they’ll just be lucky enough not to get in trouble,’‘ says Vika, a 17-year-old who had an abortion this summer in a new St. Petersburg clinic for teens. She said her boyfriend wouldn’t use condoms and she had heard birth control pills were dangerous.

Moreover, economic hard times continue to make babies seem like luxuries.

Women work in Russia’s lowest paying jobs and account for most of the unemployed. Housing remains tight. And state subsidies to mothers are minuscule, between 30,000 and 50,000 rubles a month per child, roughly $6-$11.

“I would be eager to have a baby,’‘ says Vika, “but I just graduated from school and I don’t have a job.’‘

Even abortion itself is becoming more expensive and difficult to obtain, Ballayeva says.

The crumbling of the Soviet health-care system means many women must go to private or regional clinics that set their own rates for a procedure that used to be free. In addition, a medical-insurance law passed in 1994 disqualified from state coverage abortions performed beyond five weeks.

“If it costs money, a lot of women can’t have it. For many Russian women, even abortion is becoming just a dream,’‘ says Ballayeva, who is helping draft a law that would guarantee the right to affordable abortion.

Last year, President Boris Yeltsin signed a law creating a network of family-planning centers that would distribute free contraceptives based on economic need. It also called for an information campaign in print and broadcast.

As for The Silent Scream, aired three times on national television, it may have the opposite effect in Russia than intended. After seeing the film, which shows in detail what happens to a 12-week-old fetus during abortion, some viewers have said they were impressed by Western hygienic standards.

At Clinic No. 193, Tsvetkova says that whatever the counseling, the decision must still be the woman’s.

“And they seem to go ahead and terminate the pregnancy,’‘ she said.

By The Associated Press