A Film's Simple Question: 'What Makes a Woman Want to Have an Abortion?'

New documentary After Tiller follows the four remaining late-term abortion providers in the U.S., but it spends more time with the women who come to see them.

Oscilloscope Laboratories

Last year, Al-Jazeera English produced a documentary called The Abortion War. One of its interview subjects was Ohio State representative Jim Buchy, who co-sponsored two state anti-abortion bills. In the documentary, he's asked a simple question: What do you think makes a woman want to have an abortion? The Republican legislator grimaces and fidgets in his seat. “Well, there’s probably a lot of reasons.” He lets out a little laugh when admitting, “I’m not a woman,” then continues to think aloud. “So I’m thinking, if I’m a woman, why would I have to… some of it has to with economics. A lot of it has to do with economics. I don’t know, I never—it’s a question I’ve never even thought about.”

Rep. Buchy, then, would learn a lot from Martha Shane and Lana Wilson’s extraordinary new documentary After Tiller. But so would anyone with strong opinions on the question of whether abortion should be legal. The film is a rare consideration of the abortion debate that moves past labels and abstracts and takes a long look at the people involved. It is a showcase for empathy, a quality lacking in many conversations on the subject.

Dr. George Tiller’s Women’s Healthcare Services clinic was the best known of the country’s few providers of late-term (third trimester) abortions, which account for fewer than one percent of all abortions. Tiller was bombed in 1985, shot in 1993, and, finally, murdered in 2009. After his death, only four late-term providers remain: Dr. LeRoy Carhart (located in Bellevue, Nebraska when the film begins, though he is eventually forced to relocate to Maryland), Dr. Warren Hern (in Boulder, Colorado), and Dr. Susan Robinson and Dr. Shelley Sella (who share duties at a clinic in Albuquerque, New Mexico). Directors Shane and Wilson divvy up the film fairly evenly between the three practices, and while they have some understandable interest in the kinds of people who would put themselves in, quite literally, the gun sights of the extreme anti-abortion movement (“When I walk out of the front door of my office, I expect to be assassinated,” Dr. Hern says), they’re more interested in the women who come to see them.

“You’re sad?” Carhart asks a young patient in tears. They embrace. “It’s okay. Take a deep breath and hold it.” Hern sits with a patient who was raped and encourages her, even at this late date, to report the crime (there’s little indication that she will). Robinson and Sella confer with couples whose planned pregnancies are now being terminated due to mental retardation or fetal abnormality—information provided by tests that often cannot be performed until after the 20-week cutoffs in a wave of new bills passed by Republican state legislatures. A young Catholic woman asks, “I’m dealing with God… will he forgive me if I forgive myself?”

After Tiller goes into the rooms where these decisions are weighed and made, and stays there. None of these determinations seem to be made lightly—by the patients or the doctors (who, we see, will occasionally refuse a patient without a compelling story for being “just too far along”). Kleenexes are freely dispensed. “Quality of life” is a phrase that comes up a lot. So do prayers and angels and heaven. In the film’s most heartbreaking sequence, a woman says of her child, who will be born so ill that he’ll die almost immediately, “the most loving thing I could do is just let him go now.” She tells her doctor, “I didn’t want to let him suffer any more than he had to.” A “memory box” is prepared for her son, with a teddy bear and certificate of stillborn birth.

These are tough, gut-wrenching decisions, and watching the film, it seems unthinkable that anyone but these women and their doctors could make them. Dr. Tiller’s credo, it has often been noted, was to “trust women.” In the film’s most direct and astute interview, Dr. Sella expounds on both the complexity and the simplicity of that statement. First-trimester abortion, can be thought of as the removal of tissue, she says, while granting that what they’re dealing with is, save for a few weeks (if that), an unborn baby. “It’s inside the mother,” Sella says, "and she can’t handle it. For many, many desperate reasons.”

“Pro-choice” is a phrase that has been so alternately vaunted and vilified, it’s lost much of its meaning. But it is still the most accurate description for those that favor a woman’s right to this procedure, and in After Tiller, the term seems all the more appropriate. It is a choice—a complex, impossible choice.