The economics of their situation are featuring prominently for American women considering abortion, reports Kimi Yoshino, of the Los Angeles Times.
A rising number of American women, stung by job losses and lapsed insurance cover, are turning to clinics and family-planning agencies for routine gynaecological examinations, contraceptives and abortions.
As the economy worsens, some Planned Parenthood clinics are reporting a record number of abortions. Other women's health agencies say they are experiencing heavier call volumes, more visits and more requests for abortion funding.
In addition, many women are postponing pregnancy and switching to longer-term contraceptives that can last up to five or 10 years, clinic officials report.
"We are seeing poor women get poorer, and we're also seeing low-wage women become poor," said Stephanie Poggi, executive director of the National Network of Abortion Funds.
"The economy is definitely having an impact... We see a greater demand for assistance."
Quantifying the increase is difficult since the most recent statistics are several years old. In California, the most recent data on abortions funded through Medi-Cal, which provides health care for low-income people, is from 2005, when the State paid for an estimated 94,600 abortions.
But those who field phone calls for assistance say many pregnant women tell them they are taking a hard look at the costs of raising a child.
At Oakland-based ACCESS, which helps women who are seeking reproductive health care, about 72% of calls are from women considering abortions, up from 60% in 2008.
"We are seeing women who have children, who in another economy would probably have their second or third child, but now can't because they feel so insecure about maintaining their job or losing a job," said Destiny Lopez, the organisation's executive director.
Lopez said most women recently getting abortions already have families, contrary to the stereotype of the childless abortion-seeker.
"Women are really having to make thoughtful decisions whether now is the right time to get pregnant or not," she said.
In Los Angeles County, Planned Parenthood has 15% more patient cases than this time a year ago. Mary-Jane Wagle, president and chief executive of Planned Parenthood Los Angeles, said more women coming into their 15 clinics are seeking longer-term contraceptives.
In the first three months of 2009, requests for intra-uterine devices - which prevent pregnancies for five to 10 years - were up 83% over the same period in 2008.
A recent Gallup Organisation survey conducted for the American College of Obstetricians and Gynaecologists reported that nearly one in 10 married women indicated that the economy was a factor in their decision to postpone a planned pregnancy.
That same survey found that one in five women is more concerned about having an unintended pregnancy than a year ago and about one in five women is more conscientious about using birth control.
For women struggling to make ends meet, paying for an abortion can be difficult, clinic officials said. As they scramble for money - and week after week passes - the cost of an abortion increases from about $450 for a first-trimester abortion to $1200 in the second trimester.
In some cases, delays in obtaining funding have forced even more difficult choices. Lopez, whose Oakland-based group helps women in Northern and central California, said some women who had decided to terminate early in their pregnancies instead have found themselves choosing between more difficult second-trimester abortions or continuing an unwanted pregnancy.
One woman from Kern County first called ACCESS when she was 11 weeks pregnant. The woman said her insurance wouldn't cover an abortion and she had tried for weeks to enrol in Medi-Cal, the state's health-care system for low-income people.
"She waited five weeks for the Medi-Cal... By that point, she felt it was too late to personally go through with it," Lopez said.
"This is a really good example of the barriers that are put in front of women who are trying to make responsible decisions early on."
ACCESS helped the woman file a complaint about the delay.
"It's not like women are making these decisions at the drop of a hat," Lopez said. "They are considering their life situations."
Although many counties say they are seeing an increase in the number of applicants and processing time, officials in both Kern County and Los Angeles County said pregnant women take precedence over other cases.
The demand for reproductive health care - in particular, Medi-Cal-funded abortions - has pushed some clinics over the edge.
In Oakland, one of the country's oldest health clinics - Women's Choice Clinic - closed its doors in April because it could not cover its bills, the result, its director said, of a growing Medi-Cal patient load, underfunded claims and a decrease in charitable contributions.
"We're just a small little clinic," said Linci Comi, the clinic's director.
"We can't hold up the state. We're always short of cash. Medi-Cal is always slow pay, low pay, no pay. We just got in the squeeze. You reach a point where you can't keep doing it."
