‘After Tiller’: The Hard Work of Providing Abortions

“We try and put ourselves in her shoes.”

— Shelley Sella

“Of course you don’t want an abortion. Nobody wants an abortion.” Dr. Susan Robinson provides abortions, in particular, for women in their third trimesters who, for any number of reasons, needs to end their pregnancies. One of four such providers in the US who continue to do this work, work they once did with Dr. George Tiller and work they now continue to do, after his 2009 murder in his church in Wichita.

The film After Tiller follows these doctors as they persist and also as they ponder their work, their dedication to their patients, their understanding of their risks. No one wants an abortion, and certainly, no one wants a late term abortion, which is, essentially, a full labor and then delivery of a stillborn baby. As one assistant explains this over the phone in some detail, helping a potential patient to be prepared for what’s coming, you might flinch, but the film does not. After Tiller is clear about what’s at stake for women and for providers, the difficulty of their decisions and also, their sometimes desperate necessity.

The procedure constitutes just 1% of all legal abortions, but it has garnered exceptional media attention, as opponents of abortion have found it to be a useful wedge point, a place to generate outrage and turnout in right-leaning voters and to begin outlawing all abortions. As of 2007, 36 states prohibit late term abortions, as legislators and activists try to roll back Roe v. Wade (1973). Since then, the war over abortion has been waged, notes Dr. LeRoy Carhart, without much of a fight put up by pro-choice advocates. That war has been violent, with assaults on doctors and staffers, their families, and, in the case of Carhart, the barn full of horses he and his wife were raising in Nebraska, killing 21 of 25. “Back in 1997,” he notes, “the Republican Party said I was an abomination and should be driven from the state.” Carhart and his wife moved to Maryland, where they continue to provide abortions out of an office she manages.

In her office in Albuquerque, New Mexico, Robinson explains to filmmakers Martha Shane and Lana Wilson that she was first moved to do this work when she heard about other assaults. “What really got me interested was when they started shooting doctors, you know.” When she saw pro-life activists becoming murderous vigilantes, killing providers in order to scare other doctors from performing the same services, Robinson says she decided to deal with such “terrorists” as such. She took the violence as a call to her own action, and rather than retreating, she took the challenge as a moral one, to do right in the face of wrong.

That’s not to say the definitions of right and wrong are always clearcut, or that Robinson and her professional partner, Shelley Sella, take their daily decisions for granted. Both used to work in Kansas with Tiller, and now they maintain an office together by flying back and forth from their homes in California every other week. Both their spouses, the doctors say, appreciate and worry about the risks they face. “My husband is proud of what I do,” says Robinson as you watch them putter in the kitchen. “He thinks about security, but not in an obsessive way that affects his life at all.” Still, she adds, “My being away from home is trying for him.”

The film makes clear that the doctors’ dedication is complicated, and each has his or her own reasons for what they do. Dr. Warren Hern says that his experience as a Peace Corps physician, Hern says, exposed him to communities ravaged by poverty and violence, rape and patriarchal oppression; “I’ve looked at this from the beginning as a public health issue,” Hern explains. Carhart recalls his personal friendship with Tiller, as well as their shared backgrounds in the military and also their sense of mission regarding their work. In between sessions in their offices, either with patients or in interviews, the film cuts to shots of protestors outside, huddling together in a visceral outrage. After they describe the brutality babies’ deaths, they lower their heads to pray, one man declaring, “This just feels like evil here.”

In some cases, protestors are more aggressive, in others, they listen to speakers with microphones or carry placards that are not so simple as they might seem. They film again looks at the complications of any decision concerning abortion. When one woman holds up a sign reading, “I regret my abortion,” the film raises questions about exactly that possibility. Even if, as Sella reports, none of her patents reports feeling regret when she sees them the day after, she speaks with them about what they might feel, and tries to prepare them. She encourages her patients to remember the moment of the decision, she says, and not rebuke themselves later. “Try to be kind to yourself, and try to remember why you made your decision then,” she tells them, “Because life has changed.”

Life continues to change, as After Tiller shows, as doctors meet with patients before and after their procedures, as they talk with their colleagues about what they do. Robinson articulates yet another context when she wonders out loud about the process for making such a decision. Her focus is less the process for the women seeking abortions than the process — legal and institutional — that positions her as a final arbiter, making decisions as to whether a woman’s story, her account of how she has come to this point now, so late in the pregnancy, warrants the procedure.

It’s a daunting question to consider, and repeated sessions with tearful patients — their babies suffering from terrible medical conditions, their own lives in disarray — hardly make the decisions seem easier. As Robinson puts it, “I hear such hugely sad things,” including the stories of parents who want to hold their dead children, seeking closure or something else. The sadness, the sheer weight of the process, she says, “That’s the thing that makes this work so trying.”

And so After Tiller, for all its admiration for the doctors, takes no joy or celebration in what it shows. The work is hard, and it must be done, for any number of reasons.