This article is published in parternship with The American Independent.

A state law forcing women to receive an ultrasound at least a day before having an abortion has already caused a Northern Virginia health clinic to reduce its non-abortion services in the month since it took effect, according to a clinic official.

Virginia legislators passed House Bill 462 during the 2012 General Assembly. It states that a woman seeking an abortion must receive an abdominal ultrasound and then wait at least 24 hours before terminating her pregnancy. It also requires doctors to offer the woman the opportunity to see the ultrasound image and hear the fetal heart beat.

Virginia is one of a number of states across the country where anti-choice activists have pushed through ultrasound requirements and other “informed consent” regulations.

Rose Codding, director of patient services at Falls Church Healthcare Center in Virginia, said her clinic had performed about 110 abortions since the ultrasound mandate became law. Because of the law, she said, her office had to add appointment times, hire additional staff, and reduce its non-abortion gynecological services.

“Instead of 3,000 appointments handled by our office [each year], we now have 4,000,” Codding said. “Each of our 1,200 abortion care patients now has to come twice.”

Codding said her office performed about 1,200 abortions last year and served 2,000 non-abortion patients, including many uninsured women. The small practice includes a doctor, two nurses, and a support staff of seven employees and provides pregnancy testing, annual well-woman exams, gynecological services, and seasonal flu vaccines.

“We’ve had to cut one of our GYN sessions in order to have enough appointment times for our patients to have their [pre-abortion sonogram appointments],” Codding said. “We’ve cut income, expanded payroll, taken administrative time away, and we get no additional income. It’s an immense challenge to both the business and the practice.”

Codding said that her office performed ultrasounds on many abortion patients before the law passed, but that the 24-hour waiting period complicated the process unnecessarily.

“We have routinely done ultrasounds when medically appropriate,” Codding said. “Sonos were done on the day of the appointment. We could discuss it with the patient, and it flowed very nicely.”

“Sonograms are a strong and positive tool, and I don’t know anyone who doesn’t use them, but the problem is that the state mandating the waiting period is interfering with the doctor-patient relationship,” Codding said. “I haven’t seen any patients that have, after 24 hours, made choices not to continue with the ending of the pregnancy. Our show rate is high. Patients are making the decision to come for the final appointment.”

An ultrasound costs at least $175, Codding said, so some patients have been forced to wait a week or more to gather enough money to pay for it. The Virginia Department of Health provided a list of free ultrasound providers, but most of them are crisis pregnancy centers that encourage women to seek alternatives to abortion.

About 10 percent of women felt emotional distress when asked if they wanted to view the ultrasound image or listen to the fetal heart tones, Codding said, but most women declined both options, and no patient chose to bring a copy of the ultrasound home with her.

“What I hear most is, ‘What, don’t they trust us?’” Codding said. “They are mad at the regulation and really just take it as an insult.”

The law impacted women with insurance less than Codding expected because they could often take extra time off work and pay for the additional procedure.

Still, Codding said she had seen no positive results of the law and while the clinic has not yet been forced to raise prices, she estimated the cost of an abortion would increase $30 per patient by next year.

“The costs are going to be passed along to the patients,” Codding said. “That’s a tragedy because we try very hard to keep costs at right level. I can’t imagine come 2013 that we won’t see a price increase, especially if the [proposed] facility regulations persist.”