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.' "
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.
"I had a patient last week and I asked her if she was firm and clear in her decision and she said, 'I don't want to bring a child into this world under current economic conditions,' " said Melissa Papania, director of patient services for Planned Parenthood of Southwest and Central Florida.
Planned Parenthood clinics in St. Petersburg and Sarasota observed a 14 percent increase in abortions the first two months of this year compared with the same period last year.
"Many people are choosing to terminate their pregnancies because of the economy," said Barbara Zdravecky, president and CEO of Planned Parenthood of Southwest and Central Florida. "They're forced with making tough decisions because of the situation that the world is in."
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.
Vicki Saporta, president of the National Abortion Federation, said her organization's help line 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.
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. "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 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 has three girls, and her boyfriend 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."
Some urologists are reporting an increase in vasectomies.
Dr. J. Stephen Jones, a urologist at the Cleveland Clinic, said his monthly vasectomy caseload has risen from about 45 to more than 70 since November. He said most of the men are married and have kids. They decided they couldn't afford more and opted to get a vasectomy while they still had job-related health insurance.
At the Pinellas County Health Department, the number of publicly funded vasectomies has increased steadily — from 195 in the fiscal year that ended in 2006 to 305 in 2008. In the 2008-2009 fiscal year, 193 men got vasectomies in just six months.
"I'm hearing a lot of men are losing their jobs or losing hours at their jobs, and this is a very reasonable way to help with their budget crunch," said Flo Concklin, a nurse at the Pinellas County Health Department.
She said one man scheduled a vasectomy only to come back and say he couldn't afford the sliding scale fee of $300 because his hours had been cut.
"In one week, I heard of five men being laid off," she said. "That was a sad week for me."
Dr. Doug Stein, who performs 50 to 70 vasectomies a week at about 20 locations around the state, said he hears all the time from men who want to get sterilized because of finances. But he's not sure a bad economy translates into more business for him.
"Are more people getting vasectomies because children are expensive and they can't afford them? Or are fewer people getting vasectomies because they're losing their jobs and my cost of $490 is less than their health insurance deductible?" Stein said.
Michael Dragoni, 43, got a vasectomy at Stein's Tampa office on Thursday. On Friday, he relaxed at home with his wife and his three kids, ages 4, 2 and 3 months.
"After we had the last child and started seeing what's going on with the economy, we decided, 'You know what, let's make a conscious decision about this,' " said Dragoni, a regional sales director for an information technology organization who lives in Riverview. "And we decided it's not the right environment to bring a child — in light of the things going on — into the world. We decided that three was enough."
Some experts believe concerns over the recession may have an effect on the overall U.S. birth rate, possibly reversing the trends that resulted in this month's government report that a record number of babies were born in the United States in 2007.
Times staff writer Leonora LaPeter Anton and the Associated Press contributed to this report.