If Americans have grown more conservative on abortion, it's a good bet the trucks have something to do with it. If you've seen them you'll never forget them: white vans or delivery vehicles plastered with grisly photos of red, pulpy tissue, clots of dead life distinguished with rough drafts of fists and eyes and a heart-sickening human aspect.
No single image in After Tiller can compete on that gut-punch level. But, as a whole, Martha Shane and Lana Wilson's wrenching, humane film is as convincing a brief as I can imagine in favor of that most controversial of all pregnancy-terminating procedures: third-trimester abortions, which today are performed by only four American doctors.
They're mostly old and tired, especially after the 2009 assassination of Dr. George Tiller in Wichita, Kansas. Tiller's murder inspired them all: "There's two reactions to being bullied," says Susan Robinson, who co-runs a clinic in Albuquerque, New Mexico. "One is to pull your head in. The other is to say, 'Oh, yeah?'" Dr. LeRoy Carhart, formerly of Nebraska, is blunter: "You don't give in to terrorists. It only makes things worse."
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The film is warm and scrupulous, like a sunny women's clinic. It devotes little time to Operation Rescue types, focusing instead on doctors and patients, but we do hear one zealot insist that a great victory was won in Kansas the Sunday morning that Tiller was gunned down at church—that God had wiped abortion from the city with a murder. For all their courageous resilience, the doctors and their staff often seem understandably shaken.
It's not just the dangers and the protestors that drain these doctors, of course. While it never exposes viewers to graphic imagery, the film doesn't stint on the harrowing nature of late-term procedures, which account for less than 1 percent of all abortions in America.
A nurse talks us through it: One four-day outpatient treatment involves euthanizing the fetus with a shot into the heart, and then inducing a full labor and delivery. "Unless people understand what's going on for the woman, it's impossible to support it. How could you? It sounds barbaric," says Dr. Shelley Sella, also at the Albuquerque clinic. "What's difficult about the late-trimester abortion is that the woman delivers the baby, and it's a stillborn. It's a baby." She speaks with the frank, humble compassion she demonstrates in scenes with patients. "You have to think about it," she continues. "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."
Those reasons are too complex and painful for plastering on the side of a truck. With great tact, showing only feet and knees and the backs of heads, the directors introduce us to patients and allow us to eavesdrop on their stories. This is a rare intimacy. Only viewers holding to the ideal that life is absolutely holy, no matter its quality, will not feel moved by what these women and men have endured here in the real world—and respect for their agonized decision.
One set of parents has learned their child is only expected to live three or four years, and that a hug would break his or her bones. Another woman cries while trying to get out the words "vegetative" and "nonviable." Another assures herself and her husband that God understands and that all these babies are up in heaven now. One woman, speaking with relief weeks after her abortion, tells Robinson, "I didn't want him to suffer anymore than he had to," and "it's really important he had somewhat of a dignified birth. The fact that we have the option to spend some time with him afterward was really important."
Speaking to her, Robinson refers to the baby by his name.
Often, we're told, the women want to hold their babies.
After Nebraska has passed a law banning all abortions after 20 weeks, we see Dr. Carhart, in his Omaha–area clinic, explaining how some women can't afford both out-of-state travel and the procedure, which can run up to $10,000. "Some women will have the child that they know they can't have, because they don't have the option," he says. "And some women may get desperate and do things on their own." As he speaks, we're shown a questionnaire filled out by a 14-year-old seeking an abortion. One question asks, "Any thoughts of causing a miscarriage?" Her response: "I used to put the coffee table leg on my belly to try to get rid of it."
The moral issues are muddied by a couple of patients seeking to terminate their pregnancies for practical rather than life-threatening reasons. We see Robinson struggle with this, her face in her hands, after she's told a 19-year-old's hardship is that she'll have to drop out of college if she has a second baby. Later, in an interview, Robinson explains her own decision-making process to us, but she seems to be reminding herself, too. "Why would it be OK for me to say, 'No, you better tell me a better story than that'?" she asks. "What I believe is that women are able to struggle with complex ethical issues and arrive at the right decisions for themselves and their families. They are the world's expert on their own lives."
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