The pregnant woman showed up at the medical center in flip-flops and in tears, after walking there to save bus fare.
Her boyfriend had lost his job, she told her doctor in Oakland, Calif., and now — fearing harder times for her family — she wanted to abort what would have been her fourth child.
"This was a desired pregnancy — she'd been getting prenatal care — but they re-evaluated expenses and decided not to continue," said Dr. Pratima Gupta. "When I was doing the options counseling, she interrupted me halfway through, crying, and said, 'Dr. Gupta, I just walked here for an hour. I'm sure of my decision.'"
Other doctors are hearing similarly wrenching tales. For many Americans, the recession is affecting their most intimate decisions about sex and family planning. Doctors and clinics are reporting that many women are choosing abortions and men are having vasectomies because they cannot afford a child.
Planned Parenthood of Illinois clinics performed an all-time high number of abortions in January, many of them motivated by the women's economic worries, said CEO Steve Trombley, who declined to give exact numbers. Abortions at Planned Parenthood's St. Louis-area clinics were up nearly 7 percent in the second half of 2008 from a year earlier — ending a stretch in which the numbers were dwindling.
Planned Parenthood said it has no up-to-date national abortion figures, nor do other private or government agencies. However, Stephanie Poggi of the National Network of Abortion Funds, which helps women in need pay for abortions, said calls to the network's national helpline have nearly quadrupled from a year ago.
"A lot of women who never thought they'd need help are turning to us," Poggi said. "They're telling us, 'I've already put off paying my rent, my electric bill. I'm cutting back on my food.' They've run through all the options."
Vicki Saporta, president of the National Abortion Federation, said her organization's helpline is receiving many calls from women who postponed an abortion while trying to raise money to pay for it. Such delays often mean riskier abortions at even higher cost — the price can double in the second trimester.
Among the women recently obtaining financial aid was Lalita Peterson, 23, of Painesville, Ohio, who in a thank-you note described the partial subsidy of her abortion at Cleveland's Preterm clinic as "probably the only relief I've felt during this very lonely time."
Peterson, who is studying cosmetology and has a 3-year-old daughter, learned in February that she had become pregnant despite using contraception.
"I thought, 'I totally cannot afford another child,'" she said in a telephone interview. "I knew immediately what I had to do."
Peterson said she is a single mother, unable to collect child support from her daughter's absent father and struggling to get by with the help of food stamps. Her financial situation, she said, "is tighter than tight."
Sometimes, the decision goes the other way.
Brooke Holycross, 25, of Port Orange, Fla., was offered financial assistance for an abortion and went to the clinic this month, but changed her mind after seeing a sonogram of the 15-week-old fetus. Holycross already has three daughters, and her common-law husband was laid off.
"We're in a spot where we're scared," she said. "Babies are expensive. ... I'm just praying to God I did the right thing."
In Pittsburgh, newlyweds Mindi and Marc Feldstein are nowhere near that level of desperation — she is a schoolteacher and he owns a cheesesteak restaurant. They hope to have a child soon, but Mindi said recession-related worries have convinced her that she will need to keep working and abandon her long-held dream of stay-at-home motherhood.
If they were younger, they might have delayed having kids to wait out the recession, she said. "But I'm 36, Marc is 39," she said. "At this point we want a family more than we fear what the economy is doing."
Dr. J. Stephen Jones, a urologist at the Cleveland Clinic, said he has seen a surge of men seeking vasectomies, with his monthly caseload rising from about 45 to more than 70 since November. He said most of the men were married, had kids, decided they couldn't afford more and opted to get a vasectomy while they still had job-related health insurance.
"Several articulated very forcefully that the economy was the motive," Jones said. "I have a long discussion with them and ask if there's any chance they still might want kids. They say they know it's time."
Similarly, Jenifer Vick of Planned Parenthood of East Central Iowa said there has been a sharp rise in the number of women who need help paying for birth control because they or their husbands have lost their jobs and their health insurance.
"What they're experiencing is, 'Oh, my gosh, how am I going to pay now that full price for my birth control pills?'" Vick said.
Dr. Anne Davis of New York City, medical director of Physicians for Reproductive Choice and Health, said one of her married patients recently became pregnant with what would have been her third child.
Because the husband was self-employed, the couple could afford only a low-cost family health policy without maternity benefits, Davis said. They estimated the birth would cost at least $30,000 and reluctantly opted for abortion.
"They said that if it had been five years ago, they could have made it, but right now they're barely hanging on," Davis said. "It was a very calculated decision to say 'We can't do this.'"
Paula Gianino, president and CEO of Planned Parenthood of the St. Louis Region, said the recession clearly was a factor behind the rising abortion numbers late last year at the six clinics she oversees.
"Unfortunately we see women who are making decisions about terminating a pregnancy because of the severe economic crisis they're facing," she said. "They simply don't believe they can afford to bring another child into the world."
Some experts believe such concerns over the recession may have an affect on the overall U.S. birth rate, possibly reversing the trends that resulted in last week's government report that a record number of babies were born in the U.S. in 2007.
If there is an upside to the current sobering trends, say family-planning advocates, it may be that federal and state policymakers will boost public funding of contraception.
"We're seeing a receptivity among our legislators to hear about prevention policies," said Lori Lamerand, CEO of Planned Parenthood of Mid and South Michigan. "Folks who wouldn't have opened the doors to a Planned Parenthood representative are now willing to talk to us."