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New Film Dramatizes the Severe Threat to Late-Term Abortion Doctors

The new documentary After Tiller, about the only four doctors in America who still openly provide third-trimester abortions, makes sure we know its subjects are living under siege. LeRoy Carhart recounts the night anti-abortion activists set fire to the stable he runs with his wife and daughter, burning 21 of their horses to death. Susan Robinson, standing in her sunlit kitchen, remembers that a federal marshal once tried to comfort her by pronouncing her house “a hard shot even with a sniper rifle.” Directors Martha Shane and Lana Wilson, who are both making their feature-length debut, say the doctors agreed to participate in the film because “they 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.”

That doesn’t seem like so much to ask, but Carhart, Robinson, and their colleagues are also the targets of a broader policy battle—one that has only ramped up since shooting wrapped on After Tiller in 2012. A fresh assault began in 2010 with the passage of the first state law to ban abortion at 20 weeks post-fertilization, which was expressly intended to drive Carhart out of Nebraska. Since then, eleven other states have successfully followed Nebraska’s example, and 20-week bans have become the Achilles heel of the pro-reproductive rights movement. The documentary is not directly involved in this debate. It alludes to the rise of 20-week bans, but its goal is to humanize characters who feel duty bound to a job that others find repugnant, and to illuminate the vice they're in: There are too many needy patients, too few physicians, and (what with the death threats) no one lining up to take their place. "I can't retire," Robinson worries in one scene. In reality, the shortage of willing apprentices may be a less imminent threat to late-term abortion access than the deluge of legislation.

Twenty-week abortion bans openly defy the cutoff for legal abortion established by Roe v. Wade (viability, or roughly 24 weeks), but they are a powerful strategy for the same reason that these four doctors are easy scapegoats for the pro-life movement: the inescapable ugliness of aborting a fetus that looks human. The movie doesn’t shy away from this. Dr. Shelley Sella, who began her career as a midwife, tells us she struggles with her work because “I think of them as babies. I don’t think of them as a fetus. I think of that as a way to distance myself from what it is I do.” But across the country, abortion opponents have capitalized on this moral intuition, selling 20-week bans as a moderate compromise. In July, a Washington Post poll found that 56 percent of Americans (and 51 percent of Democrats) prefer a 20-week cut-off to a 24-week one. As I wrote in August, “even liberals seem to view 20-week bans as a low-cost way of acknowledging abortion’s moral queasiness factor, or of metaphorically ‘splitting the ticket’ on their personal views.”

Perhaps hoping to bridge the political divide, After Tiller includes lots of footage of the doctors questioning the ethics of abortion. “I recognize what I do,” Sella says, “but I always come back to the woman and what she’s growing through, and often to, ‘What kind of life will this baby have?’” Shane and Wilson recorded doctor-patient sessions and the stories of people who find themselves weighing abortion in the final weeks of pregnancy. Mostly, they chose to show families struggling with the news of a pregnancy gone wrong; of a wanted baby who would live for a few days, or maybe a few years, in horrible pain if born. Some of the people they chose are pro-life. In one counseling session, a man with a southwestern accent says shakily, “I prayed, ‘If I’m not supposed to do this, if we’re not supposed to be here, give me a sign right now.’” Fetal anomalies, many of which can’t be discovered until 20 weeks or later, aren't the only reason people have late-term abortions; a professor of obstetrics and gynecology at the University of California has done research, surveying more than 200 women who had abortions after 20 weeks for nonmedical reasons, and she found that “two-thirds of them were delayed while they tried to raise money to pay for a termination. Twelve percent were teenagers, some of whom went months without realizing they were pregnant.” The documentary shows a number of these: a teenage rape victim, a young mother who says she simply couldn’t get the money together to travel to the clinic sooner.

But the doctors in After Tiller, and by extension their patients, are squarely in the path of the anti-abortion movement’s growing head of steam. In Albuquerque, New Mexico, where Sella and Robinson have their clinic, activists got a 20-week ban on a local ballot and are hoping to end late-term abortion within the city limits despite the state’s left-leaning politics. A local paper reports that 54 percent of city residents are for the ban. In the past year, legislators also tried to introduce a 20-week ban in Maryland, where Carhart now works, as well as a broader abortion ban in Hern’s home state of Colorado, according to Elizabeth Nash of the Guttmacher Institute, though neither bill got traction. Meanwhile, a 20-week ban passed the U.S. House of Representatives this spring, though it shows no sign of coming up in the Senate. And some reproductive rights advocates worry the legal challenges they have mounted against these laws—so far, in Arizona, Idaho, and Georgia, and likely soon in Texas—could turn into a threat to Roe if they reach the Supreme Court. 

“If I just give up and don’t do anything after 20 weeks, some women may get desperate and do things on their own,” Carhart says at one point into the camera. He and the other subjects of After Tiller promise they’re not going anywhere, but that choice may be increasingly out of their control.

Nora Caplan-Bricker is an assistant editor at The New Republic. Follow her on Twitter @ncaplanbricker.