The Last of the Late-Term Abortion Providers

After Tiller

At one point early in After Tiller, a new documentary on third-trimester abortion, a counselor at a late-term abortion clinic asks a patient to explain why she wants to terminate her pregnancy just a few months before she gives birth. “My baby’s got a disease, and it’s fatal in a lot of ways,” the woman explains between sobs. The camera zooms in on her hands, clenched around a ball of tissue. “He could be stillborn. He would have a very short life, full of surgeries and seizures until he would pass. He’s not a viable child. The most loving thing I can do is let him go now.”

Stories like this echo throughout After Tiller, directed by Martha Shane and Lana Wilson, which opens today in New York City. The film follows the lives and work of the only four doctors in the country who perform abortions in the last trimester of pregnancy. Three of the doctors portrayed in the film—Stacey Sella, Susan Robinson, and LeRoy Carhart—worked for George Tiller, the late-term abortion provider from Wichita, Kansas, who was gunned down in the foyer of his church by a anti-choice zealot in May 2009.

Pro-choice advocates often defend abortion by saying it’s a decision that should be made by a woman and her doctor. The most powerful moments in After Tiller allow us to eavesdrop on their painful conversations. The women who come to the clinics are tearful but resolute. A rape survivor explains that it took her months to come to terms with her pregnancy and raise the money for an expensive late-term procedure. Another woman chokes out the details of her baby’s illness, which would make it impossible for him to walk or move. Yet another woman thanks her doctor for giving her desperately sick baby a dignified birth. The doctors have weighed the procedure’s ethical implications and still see themselves as duty bound to offer it. In a disarmingly honest moment, Sella, who works alongside Robinson at a clinic in Albuquerque, New Mexico, says, “I think of them as babies. I don’t think of that as a fetus. That would be a way to distance myself from what I do.”

Americans—who, overall, support abortion rights—are deeply ambivalent about third-trimester abortion, which comprises about 1 percent of all abortion procedures. In a recent Gallup poll, only 14 percent of respondents said that abortion should be legal in the last three months of pregnancy. Even in the dire cases that women in the film describe, where a baby is diagnosed with a debilitating mental or physical illness in the fifth or sixth month of pregnancy, less than half of Americans believe third-trimester abortion should be legal.

But poll questions are theoretical, and this film is deeply personal. It’s hard to imagine, watching these parents’ agonized decision, that many Americans would actually condemn them or their choice. The film is strongest when it emphasizes the patients’ and the doctors’ stories—but unfortunately, it’s not structured as a film about why a woman would choose a third-trimester abortion. It takes place in the shadow of Tiller’s murder, and the providers’ physical danger is its central message. This indirectly brings us to the women who seek the procedure; they are, after all, why the four doctors do this difficult work. But the doctors’ courage—which is undeniable—is highlighted at the expense of their patients’ stories. Scene after scene hammers home the peril that faces the doctors. Robinson recalls being told by a federal marshal that her house is “a hard shot even with a sniper rifle.” Carhart remembers the night when anti-choice zealots torched the stable run by his family, burning 21 horses alive. Walter Hern, a third-trimester provider from Boulder, Colorado, reports that he sleeps with a gun next to his bed.

The film’s persistent emphasis on these hazards distracts from the fact that the greatest threats to the legality of third-trimester abortion aren’t anti-choice vigilantes—they’re politicians and voters throughout the country who believe the procedure should be illegal. In the four years since Tiller’s murder, a dozen states have passed laws banning abortion after 20 weeks of pregnancy. Operation Rescue, the militant anti-abortion group that moved to Wichita in 2002 with the explicit goal of shuttering Tiller’s clinic, is now zeroing in on Albuquerque, where Robinson and Sella work. Their “pro-life missionaries” are still using the violent rhetoric that may have inspired Tiller’s killer, but more important, they’re using the political system to their advantage: On November 19, Albuquerque voters will decide whether to pass the first municipal 20-week ban. The political process is less dramatic than a gunman waiting in the shadows, but it poses a greater threat to the doctors’ work.

After Tiller tacitly acknowledges this political reality as it follows Carhart’s struggle to find a stable home for his clinic. He operates out of Bellevue, Nebraska, until state legislators institute the nation’s first 20-week abortion ban in an explicit attempt to close his clinic. He then tries to move across the river to Iowa, only to be thwarted by a city council that refuses to give him a permit. Carhart ends up moving out of the Midwest to suburban Maryland, where the state legislators are less openly hostile. Of course, anti-abortion protesters continue to congregate outside his clinic. But to the women who to travel to his clinic from all parts of the country, the protesters’ presence is a minor nuisance. The expense of a third-trimester abortion, which often costs more than $10,000, is more of a deterrent. “Some women will be able to afford the procedure, but they’ll lose everything they have in order to do it,” he says. “Some women will have a child they know they can’t have because they don’t have the option. And some women may get desperate and do things on their own.”

To their credit, the directors—and some of the doctors—don’t shy away from the fact that in a third-trimester abortion procedure, a potentially viable baby is killed. In one scene, a counselor describes a late-term procedure to a patient over the phone: Over the course of four days, the doctors euthanize the fetus with a shot, induce labor, and assist the woman as she delivers a stillborn baby. “Unless people understand what’s going on for the woman, it’s impossible to support it,” Sella says. “How could you? It sounds barbaric. You have to think about it. What are you doing, and why are you doing it? Well, it's inside the mother, and she can't handle it, for many, many extremely desperate reasons.”

According to the directors, the doctors “thought that if more Americans could meet them, and hear where they were coming from—even if they still disagreed with the work that they did—they at least might not want to kill them.” But that framing limits the scope of their film. By focusing less on Tiller’s death and more on the reasons why third-trimester abortion needs to be legal, this could have been a stronger plea to the well-intentioned Americans who, because they don’t know these women’s stories, might support Albuquerque’s 20-week ban or vote for politicians who want to outlaw the procedure entirely.

It’s awful but true that in the fringes of the anti-choice movement, there are people who want these kindly, funny doctors dead. But those people are not going to see the film, and even if they did, it’s unlikely that any efforts to humanize the doctors enough to absolve them of their sins would be successful. Instead, it’s the people in the middle, the ones who support first-trimester abortion but become more hesitant as the pregnancy progresses, who should see After Tiller. They should see the moment, late in the film, in which Robinson agonizes over whether to give an abortion to an anti-abortion teenager who says that despite her convictions, she wants the procedure. “We’re kind of a court of last resort here,” she says. “If we don’t help somebody, they’re not going to get an abortion.” 

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