In the US south and beyond, getting an abortion is not only logistically and emotionally difficult – it can push someone over the financial edge

or the third time in a week, LT stood at the reception in the abortion clinic in Shreveport, Louisiana, more than 90 minutes away from her home. She was – again – looking for the right paperwork to show her boss why she had taken time off work from her busy job at a chain restaurant in north-eastern Louisiana.

LT had first showed him a $550 receipt from the clinic. No, he told the 22-year-old single mother, he wanted a doctor’s note from the clinic. So – using the last $25 she had in her bank account – she drove back because, without it, her manager refused to put her back on the schedule.

And LT could not afford to miss any shifts.

Many women did not want to be identified because only a handful of people knew of their situation. They also worried about stigma in their small, southern communities.

But LT’s is a common story and not close to one of the worst. In this poor, rural corner of the American south, the process of getting an abortion is logistically difficult, emotionally fraught and often a battle against poverty.

It is also getting harder. A wave of anti-abortion bills have spread across the US, especially parts of the conservative south. The aim is to make abortion more difficult, with more paperwork, bureaucracy and early deadlines and, perhaps, one day outlaw it. That would force already poor women to travel even longer distances to get abortions and spend even more money – or have them take risks for illegal procedures.

Kathaleen Pittman, director of the Hope Medical Group for Women, said more than 80% of the women who come in to her Shreveport clinic self-identify as living below the poverty line.

LT a week after getting an abortion. Both her mother and her partner pushed her to get one, though she wasn’t sure if she wanted to terminate the pregnancy.
 LT a week after getting an abortion. Both her mother and her partner pushed her to get one, though she wasn’t sure if she wanted to terminate the pregnancy. Photograph: Khushbu Shah/The Guardian

Last week, a counselor at Hope met a woman who drove from New Orleans because the clinic there charged twice as much. A not-for-profit had given her $500 towards the procedure. The woman, who lives in her car and showers at the gym with her $10 membership, knew it wasn’t enough. She called Hope, who gave her the remaining funds, and with those in hand, barely made her appointment before the 16-week cutoff .

The procedure itself equalled two months of LT’s rent for the four-bedroom trailer she lives in with her sister. Her partner paid for half of it. She’s behind in bills by more than $2,500. Her tuition at a community college is $2,000 a semester for her associate degree in Biological Sciences. Her bank account is negative. She has a four-year-old to feed and keep in childcare.

This is life on the financial edge and an abortion can push someone over it. But it’s far less than the cost of an unwanted pregnancy, LT said.

“Neither [my boyfriend] and I are either financially or mentally ready to bring another child into the world. It’s hard for me being a single mom working two jobs and a full-time student with one child alone. So I couldn’t imagine doing it with two,” LT said.

Louisiana has passed a six-week abortion ban and if it goes into effect, LT would have had to rush the decision or drive across state lines to Arkansas or Texas, neither a trip she could afford. Multiple women called the abortion clinic during the days the Guardian visited, asking if they could still get an abortion.

“It’s already a tedious process for a woman to get an abortion in Louisiana,” Pittman said.

A woman must receive state-mandated counseling and wait 24 hours. In recent weeks, after passage of the new law, patients must also be informed, in writing, of the doctors’ credentials at the clinic, their board certifications, if they have medical malpractice insurance and the last 10 years of practice history.

One of the licensed physicians in Shreveport, who also does not want to be identified, comes in to do the the state-mandated counseling sessions. One of the patients he saw that day is Dominique, 34.

Pittman estimated 70% of those who come in are women of color, like Dominique.

“How many kids do you have?” the doctor asked. “Good spacing on those three, girl,” he said after she responded. Immediately, she laughed and relaxed. The abortion will be her first. She can’t go on birth control because her blood pressure is too high, she told him, so most of the time she uses condoms.

The doctor peered at her through his glasses. “That’s the kicker. Most of the time!”

Dominique: ‘You can have all the opinions in the world but your opinions are not going to affect me or my child.’
 Dominique: ‘[Mom] doesn’t believe in abortion. She thinks they’re a sin.’ Photograph: Khushbu Shah/The Guardian

He calculated she’s pregnant in the fourth week of her pregnancy, early enough that even if the state’s six-week abortion ban had been in effect, she would have still been able to get an abortion.

The next day, at her second job in her small town across the state line in Texas, Dominique picks up two extra shifts, a favor from her best friend who is her manager, to pay for her abortion. She has $150 put aside. The clinic is giving her another $100, but they told her she wasn’t the worst off they had seen that day, so they couldn’t give her more. Her boss is giving her the next paycheck a couple days early, even though she doesn’t believe in what her friend is doing. That still leaves her $30 short. The man who got her pregnant hasn’t offered to help her pay.

She can’t ask her mother for the money because she refuses to tell her.

“[Mom] doesn’t believe in abortion. She thinks they’re a sin.”

But she has made her decision.

“At the end of the day, I have to feed the baby. At the end of the day I have to deal with whatever repercussions fall down, not you. So you can have all the opinions in the world but your opinions are not going to affect me or my child,” she said.