Media

Understanding the Doctors Who Perform Late-Term Abortions and the Women who Get Them

The makers of the new documentary “After Tiller” discuss the controversial procedure of late-term abortion and the four doctors in the U.S. who perform it.

Dr. Warren Hern meeting with a patient at his Boulder, Colorado clinic.

In the United States, Americans overwhelmingly disapprove of late-term abortions—abortions after the 25th week of pregnancy. A 2013 Gallup poll found that while 61% of people in the U.S. believe abortion should be legal in the first three months of pregnancy, only 14 percent believe that abortion should be legal in the last three months.

A new documentary that premiered at Sundance is shining a light on late-term abortion, which account for fewer than 1 percent of all abortions in the U.S. Directed by Martha Shane and Lana Wilson, After Tillerfollows the only four doctors in the U.S. who openly provide these third-trimester abortions. The film paints a picture of their daily lives, which often start with walking past anti-abortion protesters to enter their offices and end with the time they spend with their loving families. In between, the documentary shows them interacting with their patients, who come to seek late-term abortions for a variety of reasons, from finding out a child would be born with extreme deficiencies to being in denial about a pregnancy after being raped.

Throughout the documentary, the doctors face a myriad of obstacles, including moral dilemmas at work and danger in their personal lives. One doctor is even forced to move to Maryland after the Nebraska state legislature passes a ban on abortion after 20 weeks.

While Roe v. Wadelegalized abortion in 1973, it allowed states to ban abortions in the third-trimester, with exceptions for the life or health of the woman. Only nine states allow third-trimester abortions without legal constrictions, which continue to grow rapidly nationwide. Over the past three years, nine states have passed a 20-week abortion ban.

Martha Shane and Lana Wilson recently discussed their film with AlterNet.

Alyssa Figueroa: Where did the idea to make a documentary on late-term abortion come from?

Lana Wilson: It came from watching the news coverage of Dr. [George] Tiller’s death in 2009. It was such a shocking event, but I remember being frustrated the way it was covered by the news. I mean they would just say, “A controversial doctor has been killed.” And then they would get a talking point from each side of the issue and that was about it. And there were just all these questions I had that weren’t being answered at all by any of the media. For instance, how crazy was it that this guy was killed in church? He was a religious Christian? That was surprising to me — that the number-one man behind this abortion movement was this religious Christian who had been going to church for almost 30 years with his family.

And then wondering, why would you do a job anyway where people are shooting at you and trying to kill you? I did learn from the news coverage that he had been shot once before in the '90s, and he had gone right back to work the next day, which just seemed insane. So I was wondering why anyone would do that? Why would they put themselves in the line of fire for a job, especially a job that most people don’t understand or support?

And then wondering, why would you get a late-term abortion anyway? I hadn’t any idea why you would before I started this.

And then finally, now that Dr. Tiller is gone, are there any people left that will take his place? Are there other doctors waiting in the wings? Or will they be scared away by this? Or what will happen now?

So it was just curiosity and a series of questions that didn’t come out of ideology really, but all these personal questions, and that’s initially where it came from.

AF: Throughout the film, viewers see patients deeply concerned not only with what they’re going through, but with what others—their families, friends, communities—will think of them. Can you speak about this?

Martha Shane: I think when we realized we would be trying to film with patients, we decided to give them the choice of being completely on camera and showing their faces and being sort of open in a way, or just having their voices and giving little glimpses of them. And for the most part, they chose not to show their faces, and that’s definitely in large part because they were thinking of having to go back to their communities. And with it being still so stigmatized, I think it was just a more realistic approach for them and it gave them a measure of privacy.

And the doctors really do make the point of addressing the fact that people are going to have to go home who have been pregnant and now they aren’t—and how you explain that to the people in your life, and how you explain that without getting into a debate about abortion when you’re still recovering from this, which puts you in a fragile state often times. So Dr. Sella in the film lays out so eloquently how you go about doing that. And it’s a big part of what their responsibility is, preparing them for back home.

LW: You know when Dr. Sella does that scene with the four sentences you need to know—that was something that Dr. Tiller came up with and taught her and Dr. Robinson, so we love that because it’s incredibly powerful to see they have to go back and deal with all these people who knew they were pregnant and talk about this with all of them. But then it’s kind of cool to just see the traces of Dr. Tiller in Dr. Sella’s life everyday at the clinic.

AF: You state that only about 10 percent of Americans support late-term abortions, even among those who are pro-choice. It seems as though people believe society has a moral responsibility to make these decisions for women and/or unborn fetuses/babies. What did you learn from this documentary about who has the moral responsibility to make these decisions?

MS: I think that the doctors in the film, the two female doctors, really struggle and really wrestle with that question of responsibility and making these decisions and how do we take into account the fact that, if we do an abortion for somebody and they later regret it, what does that say. And I think ultimately, they’ve come down on the side on women should be able to make these decisions and that women, like everybody, have a right to regret the decision, that doesn’t mean they didn’t have the right to make that decision. It just means that there are so many complicated, difficult decisions we have to make in life. The most important decisions are like that. And we should have the ability to take them no matter what.

And I think also, in terms of moral responsibility, I think that these doctors feel like they are acting very responsibly toward the mother and toward the fetus. And they really are thinking, not just about the question of life, which is always discussed when it comes to the abortion issue, but really more importantly, is the issue of quality of life and what kind of life, as Dr. Tiller says earlier in the film, is the baby going to have if it's born without a brain or if the parents weren’t able to adequately feed it or care for it.

So they take those questions very seriously and are thinking about them on a regular basis.

AF: None of the patients seemed to have regret after their abortions, though potential regret from the patients was one of the factors the doctors considered before proceeding. Did you find any cases of regret, either from the patients or the doctors, while filming?

LW: We didn’t. But we were seeing women at the end of their abortions in the clinic. We didn’t keep in touch with the patients afterward, so we don’t know what happened. All we know is what the doctors told us, which was no one has ever said I do regret it.

But I love how Dr. Robinson talks about it in the film at the end with the case with the 16-year-old girl. So I think when she talks about the right to regret. I mean, you can regret your decision no matter what. But you could have the child and regret that actually.

Who hasn’t made a decision they haven’t had regret in their lives? Isn’t putting so much pressure on people to say that they have to make this decision, that they have better not regret it. Is that really a realistic thing to ask of them? Instead of just asking them to make the best decision that they can at the time with what they know and how they feel.

And when Dr. Sella talks about, if you do regret it, what do you do? She says think about how you were at the time. Have compassion for yourself about how you were feeling then because people change and things change and your feelings might change. That’s just part of the human condition. And talking about that and accepting that that is part of the complexities in this, is something that we really wanted to address in the film. It’s not realistic to say, “There is no chance that you will ever regret this abortion ever,” to every single woman that comes in there because people are different and this is complicated. And acknowledging that, I felt, was really important.

AF: You document how these doctors really get to know their patients and their stories, and sometimes struggle with performing some abortions themselves. A few women are even turned down. Can you talk about humanizing these doctors? Were you surprised how involved and complex they are?

MS: From the beginning we felt that would inevitably happen was humanizing them because I think outside of this film, there really aren’t a lot of places these doctors have had the opportunity to tell their stories in their own words and allow people to get to know them a little bit. And I think what really humanizes them in the story is just almost less about their work and more about their families. Their families are really important to them. They have this range of interests and in so many ways, their lives are exactly like yours or mine.

And I think you definitely can see how deeply they think about these decisions. The fact that sometimes they have to turn down a patient. The fact that they struggle about whether they should say yes or no to a patient, I think that all is very identifiable for people. I think because audiences see that struggle, they end up putting themselves in the doctor's shoes to think, “Well, what would I decide if I had to make this decision?” And you really think what a difficult and challenging decision it is to make. And also I think they are able to put themselves in the patients’ shoes and realize how complicated their feelings are.

I’m glad this humanizes the doctors, and I feel like we accomplished a large part of what we set out to do.

AF: Although you show these doctors with their families and in their personal lives, it was still difficult to imagine just how these doctors cope with the loneliness their profession brings. What do you think of this?

LW: Yeah, well, one thing they all have in common is incredibly strong and supportive families. They are all in very happy marriages and most of them have kids, and that’s a huge part of their lives. And we think they would all say they couldn’t do it without the support of their families.

And the story of Dr. Hern in the film is him talking about how incredibly difficult it was for him when he was alone. But now his life is much better now that he has this wonderful new family.

So yeah, it’s a huge part of all of their lives. Dr. Carhart is even working with his wife all the time at the clinic. It’s like work and his family are completely interwoven which is more unusual. But in all the cases their families are steadfast, strong supporters, which is really important for all of them.

AF: Were the four doctors who participated in this documentary scared to participate? Are they worried for their safety now that it’s been released?

MS: That’s something that we had so many discussions with them when they all agreed to participate in the film. Security was really key, and we were very careful to respect their requests. In some cases they didn’t want their car or house to be shown. In other cases, it was very obvious that the anti-abortion movement already knew about those things, so it didn’t make sense to hide them. But we were very open to whatever we had to do to make them feel comfortable with participating in the film.

And then we also worked with the National Abortion Federation security just to make sure we weren’t accidently looking over anything that would compromise their security.

And ultimately I think that they actually feel like this film in a way, while it does give them more visibility, it makes them safer in the sense that it’s so easy to vilify someone you don’t know anything about. And by not telling their stories, there was this vacuum of silence that was being filled with mischaracterizations of the work that they’re doing and themselves by the anti-abortion movement. So I think they felt that this is the time to take back the conversation a little bit and tell their own stories in their own words.

AF: What have been the reactions so far to this film? Have you heard of any stories where it has changed people’s minds on the issue?

LW: Yeah, it’s been an incredible response. We have had people from both sides of the issue come up to us and say it’s made them think about it very differently. Even pro-choice people have to think about it differently — thinking about how a part of being pro-choice is accepting that other people might make decisions that you might completely disagree with or that you might not make if you were in their position. So that’s one thing we’ve heard.

We’ve also heard from a lot of people who’ve come up and said, “I’m anti-abortion, but this film made me realize how complicated it is.” “I had no idea how complicated it is” is one thing we hear all the time. And we’ve also had people say, “Well I’m anti-abortion, but I can understand how personal this is. I can understand how people in different circumstances might make these decisions.” And then there are people who come up and say, “I’m anti-abortion, this film didn’t change my mind about that. But I appreciated you making it. I felt like it was fair, and I learned some things I didn’t know before.”

So all of those kinds of responses are good. If you leave the theater, and you’re thinking about this a little bit differently and asking yourself a lot of questions and kind of having an internal debate with yourself and you’re thinking about it for days and days, then we consider that a success.

AF: Did it change your mind about anything? Or at least emphasize something you already knew?

MS: I think it taught us a lot about not passing judgment too quickly. Especially for patients who come in and they don’t have the fetal indications or it’s more that they just had a hard time coming to the clinic to get an abortion, it’s easy on the surface to say, “Well, I just don’t understand. Just get it together faster.”

But when you actually hear all their circumstances and how different their circumstances are from our own—maybe they are low-income and they couldn’t get access to a car to drive to the nearest clinic, or they didn’t have the money to fly, they live in a rural part of America. I mean abortions are so less accessible than we think living here in New York City. And so, it just gave us a lot of more emphasis of the situations that women find themselves in. It’s really difficult, unless you find yourself in someone’s shoes, to make these decisions for them. The only people that can really make these decisions are the women who are in these circumstances themselves.

AF: Can you talk about the future of late-term abortions? There are only four doctors from the start, and it seems like they are all near retirement age.

LW: The doctors themselves, they would say that they aren’t worried so much about the number of doctors who are left because the doctor who is being trained in Albuquerque who is mentioned at the end of the film is in her 30s. And there seem to be a lot of great young medical students who are interested in doing this work. So it’s not so much about the number of doctors, but it is about access. What is the future of access in this country?

And all the doctors are very worried about that. I mean look at the last couple of years, there has been more restrictions against abortion passed than ever since Roe v. Wade. And just women being in a place where they just can’t get to a clinic, having to travel real far, low-income women having to raise the money to travel far and take time off work to get childcare—all this stuff that women have to go through just to get an early abortion, let alone a late abortion.

Even for early abortions, there’s no provider in 90 percent of counties in the U.S. So I think that’s a big concern for the doctors—what’s going to happen with that in the future?

After Tilleropens in New York City this Friday, Sept. 20. Several other cities will also screen the documentary in the following weeks. See thewebsite for more information. Watch the trailer below:   

Alyssa Figueroa is an associate editor at AlterNet. 

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