Late-Abortion Doctors Carry on “After Tiller”: A Talk with the Filmmakers

By now, we all know the story: While handing out bulletins in May 2009 at the Lutheran church he attended each Sunday, Wichita abortion provider Dr. George Tiller was shot and killed by an anti-abortion extremist.

Known nationally as the “Doctor of Last Resort,” Tiller was one of the few physicians willing to do late abortions in the U.S. The words he placed on the exterior of his embattled clinic have become a pro-choice battle cry: “Trust Women.” As documentary film director Lana Wilson says, “It was never about him—always about the patient.”

When draconian restrictions against abortion action began to hit state after state in 2010, Wilson and fellow filmmaker Martha Shane embedded themselves in the clinics of four doctors continuing Tiller’s legacy: LeRoy Carhart, William Hern, Susan Robinson and Shelley Sella. Through an intimate filmmaking style that captures everything from a damp Kleenex in a woman’s clenched fist to the low buzz of anti-abortion threats, their powerful documentary After Tiller pieces together an emotional portrait of a medical procedure that remains in peril from anti-abortion governors, legislators and, ultimately, judges.

After Tiller, which premiered at this year’s Sundance Film Festival, opens Friday in Los Angeles and Toronto. (The L.A. premiere is hosted by Women’s Reproductive Rights Assistance Project and will include a discussion with the filmmakers.) Ms. spoke with filmmakers Martha Shane and Lana Wilson about late-term abortions and the making of the documentary.

Ms. Blog: These days, abortion is the “scarlet letter” in Hollywood. Why did you decide to take on such a difficult and polarizing topic?

Lana Wilson: The idea came from watching the news coverage of Dr. Tiller’s assassination in 2009. Documentary and narrative films don’t really talk about abortion much. Certainly news does, and the political world does all the time. It’s always covered in the same way: It’s treated as a black-and-white screaming match between two polarized camps. It just seemed like a lot of the debate is about these large philosophical, theoretical ideas and less about the real situations that women are in who are seeking abortions. With Dr. Tiller’s death, the news coverage treated him the same way—just about the controversy and the politics. Nothing was mentioned about who this guy was as a human being. It was surprising to me, not knowing anything about what kind of people were abortion providers. That initially made me very curious, wondering what’s going to happen now that this guy is gone. Who’s going to be left? Who’s going to do his job, anyway, where you go into work having to be afraid of being assassinated every day, and dealing with all these death threats and harassment from protesters and legislators? Who would be willing to do that for a job that is appreciated by so few?

Martha Shane: I’ve generally been drawn to subjects that are more difficult to talk about. Abortion is not easily discussed in a personal, nuanced way. We wanted to take a different approach and change the tone of the conversation. What we found so far with taking the film out into the world is that people do want to talk about abortion in a more complex way, but haven’t had the tools or the opportunity to do so. Hopefully, with the film, it’s not the end of the conversation but the beginning.

The abortion debate leaves very little room for a gray area, yet that gray area is exactly what your film explores. How did you approach the film with this middle ground?

Wilson: What you say is so true—when we started making the film, we realized that a lot of pro-choice people don’t support late-term abortion and are uncomfortable with the gray area you mentioned. We took an approach that was very observational. We felt like if we could capture what it is like to be these doctors in the most honest, intimate way possible, then we succeeded. I think the reason it worked is because the doctors are so intelligent and candid in their own struggles doing this work, whether it’s the impact it has on their families or the moral and ethical issues they deal with every day in their clinics. They’re incredibly open about that.

What was your image of late abortion before you started filming?

Shane: I didn’t have a whole lot of knowledge about late abortion. I had no idea why a women would have a third-trimester abortion. I didn’t realize, for example, that a lot of women who are seeking them have [a fetus with] abnormalities. I would have assumed that if your baby was going to be born without a brain, or without the ability to have any real quality of life, that it would be legal throughout the country to have an abortion under those circumstances. I was surprised to find out that it wasn’t the case, and that that was a reason why women were coming to these doctors. Also, a lot of the women we saw who came into the clinics had been trying to [get an abortion] for a long time, but they had to get their money together, and then the price of the abortion goes up, and then they have to travel. They get just stuck in this sort of cycle. I was really shocked and disturbed by seeing how difficult it is in this country for women to get abortions.

Something your film does really well is highlight how expensive abortions are, and that women now have to travel across state lines for the procedure. 

Wilson: One thing Martha and I both noticed—it was amazing to us how, just anecdotical, women under 30 can be so judgmental about abortion. It’s like, “So-and-so’s pregnant.” “Why wasn’t she using contraceptive? Well, she should have used contraceptive.” Not realizing that lower-income women, or women who don’t have access to a sex education or a proper sex education while growing up, might not know about contraceptive or might not be able to afford it or might not be able to get it where they live. It’s just realizing all those things that I have definitely taken for granted growing up in the post-Roe v. Wade climate, and I think a lot of young women take for granted. But, realizing that in so many parts of the country, it’s not available and sometimes, women can end up needing an abortion because of that. What are the effects down the line of, for instance, of not having sex education?

This isn’t spelled out explicitly in the film, but when you see the 16-year-old girl at the end of the movie, you wonder how did she end up in this situation, and could this have been prevented?

How open were the patients to sharing their stories on film?

Shane: It varied. The doctors and the counselors were close allies, initially explaining [to the patients] that we were there making a film, and if they wanted more information they could come speak to us. Probably 10 percent of the patients decided to do that. In the counseling scenes and the scenes in the medical room, there was so much going on, and the dynamic between [patients] and the counselors and doctors was so intense that they really did, in those moments, forget that we were there.

We had such diverse reactions to the fact that we didn’t show their faces. A lot of people said, “You did that so well. It sort of lets you imagine that those patients become everybody, and it’s easier for you to put yourself in their shoes because you don’t see their faces.” Other people have said: “You know, you should have shown their faces. [Not showing] contributes to the stigma.” But we gave all the patients a choice; the film is about choice. Most of them chose not to [show their faces]. That points to the fact that there is still a stigma attached to abortion, but I think that also gave them a level of comfort. Their privacy was protected and they could forget more easily that the camera was there and be as honest as possible.

These doctors, and many abortion clinic owners, don’t usually do interviews with media outlets, but they gave you unprecedented access. Why?

Wilson: That was Dr. Tiller’s feeling as well [to not give interviews]. The interview at the start of our film is one that PRCH [Physicians for Reproductive Choice and Health] did with him—one of the only interviews he ever did. The doctors didn’t get into this to be political figures; they got into this just to be doctors and to help patients. On the other hand, if you’re vilified by these other people and you don’t tell your story, it makes it easier for them to vilify you because there’s a vacuum of information there.

Dr. Carhart agreed as soon as he met us. You get a sense of it from the film, but he’s very easygoing and open. He’s been trying for years to get Nebraska legislators to come into his clinic and meet his patients, because he believes that hearing their stories could change [the legislators’] thinking. Dr. Hern couldn’t believe the movie’s going to be released in theaters. He was like, ‘This isn’t going to change anything. No one’s going want to see this.’ But as soon as we met him, he agreed to do the film, and now he’s very surprised by how far it’s going. He’s so happy about it.

The two women doctors, they took a year to convince. They said no at first. They’re like Dr. Tiller—it’s not about them, it’s about the patients. But over the course of the year they had more time to think about it, and we were very persistent. They did an interview with Rachel Maddow a year after Tiller’s death, and when they saw there wasn’t too much of a blowback from anti-abortion protesters I think they felt OK.

Shane: I think it was a combination of us being young and independent filmmakers—we weren’t coming in from CNN or anything—so we were pretty un-intimidating and clear from the beginning that we wanted to be collaborative. The patients felt a lot more comfortable with us as women being in the room with them, especially during the surgeries. I think for some patients, it felt like we were their peers, their friends—especially for patients who were there by themselves. They felt more comfortable going through the experience and didn’t feel quite as alone because we were there.

After filming, what did you see are the effects of the increasing number of abortion restrictions?

Shane: The need to travel and how difficult it is to get an abortion is a huge burden. … You see in the film, right after the Nebraska ban was passed, a woman from Nebraska has to travel to Colorado to have a third-trimester abortion because of a fetal abnormality. These doctors will see more and more women in those circumstances. It’s hard to even keep up with the laws because they’re constantly changing. For example, in Albuquerque, they’re trying to get a measure on the ballot that will ban abortions past 20 weeks. Next year, the doctors foresee a lot more states considering these bans. The doctors always hear: ‘There’s only four of you, that must be so hard. Are you worried about there being people who will continue you work after you retire? After you’re gone?’ Most of them say they’re not worried about finding people who are willing to do this work; they’re worried about third-trimester abortions being legal and accessible. They think there will always be somebody to train, [somebody] who cares about these patients.

After Tiller  is now playing in New York City theaters, and will premier Oct. 4 in Los Angeles and Toronto. The documentary is then slated for release in various other U.S. cities through October and November. For info on more screening dates—including screenings in Berkeley and San Francisco that will include Q&As with filmmaker Martha Shane, visit the film’s official website.




Lauren Barbato is a writer who enjoys focusing on the intersection of the arts and social justice. As a journalist, she has contributed to Ms., the Women's Media Center, IndieWire, MovieMaker Magazine and many others. She holds a B.F.A. degree in screenwriting from the University of Southern California. Follow her on Twitter @lauren_barbato.