I visited Columbia during the True/False Film Fest to see the After Tiller documentary. This Sundance Award-winning film follows four physicians who continue to provide third-trimester abortions after the assassination in 2009 of their colleague George Tiller in Wichita, Kan. In the abortion context, the third trimester starts at about 24 weeks of pregnancy.
The film is an insightful look into how these physicians make sense of their decisions to offer this controversial care. It also offers a rare intimate view into the world of patient decision-making. As the filmmakers themselves explain, the take-home message of this film is the issue is more complicated than we think. It isn't black or white; it is gray. The doctors and patients both struggle with complex moral and ethical questions and in the end make the decisions they believe are best for their circumstances.
Currently, Missouri law requires physicians to perform viability testing after 20 weeks. If a fetus is "viable," an abortion is prohibited. Because there is no easy way to interpret the law, most physicians in the state limit their abortion practice to gestations before 22 weeks. As I sat in the room watching the film, I wondered whether people there knew none of the women in the film would be able to get an abortion in Missouri, even if there were a doctor willing to perform this service. Most women in those very circumstances would have to carry an undesired pregnancy to term, the decision stripped from them as a result of a law few people know anything about.
I also wondered whether the people watching this film knew state lawmakers 30 minutes away in Jefferson City were preparing to debate the merits of HB 386, the "Abortion Ban for Sex Selection and Genetic Abnormalities Act of 2013," to prohibit an abortion provided solely because of the sex of the unborn child or for a genetic abnormality diagnosis. For many of the women in the film, no matter when during their pregnancies the genetic abnormalities were diagnosed, they would be prohibited from having an abortion in Missouri.
Abortion rights advocates, especially those who were among the 2,000 people who saw After Tiller at the True/False Film Fest, will be tempted to object loudly to how incredibly cruel such a law would be to families facing the news of a wanted pregnancy diagnosed with a genetic abnormality. But advocates for abortion rights need to be careful not to take the bait. This law is unacceptable not because the banned abortions are more justifiable than other abortions, but rather because it limits women's ability to make decisions about their pregnancies. As advocates fight against these types of laws, they need to be careful not to make disability the villain in the story and abortion the hero.
A diagnosis of a fetal anomaly poses a challenge for anyone facing that information, but different people will come to different conclusions. Central to these decisions will be whether families feel like they can parent the children who would be born. It is exactly the same decision-making process all of us go through when making a decision to terminate a pregnancy.
Abortion is fundamentally a parenting decision: "Is it the right time, are there enough resources, can I be a parent at this time to this child?" The status of the fetus is one factor that goes into people's decisions about parenting, but fundamentally people decide based on what they know they can handle. It is these complex deliberations that the film champions and the law ignores.
It is also critical to remember that while abortion is an important option for people facing a diagnosis of a fetal anomaly, it is not the only option. When I look at Missouri, I'm astounded by how much lawmakers care about restricting one decision, with no attention to the other options. The bill contains no expansion in supports for families who have children with disabilities. It is silent on in-home support services, special education and paid family medical leave. Most egregious, Missouri is poised to make the decision not to expand access to Medicaid under the Affordable Care Act -- the very program necessary to support families the ban affects.
I am struck by how art and politics seem to have traded places in Missouri. After Tiller represents everything that is messy and complicated about the world, while politics here seem to exist in a fantasy world. Lawmakers feel entitled to decide how families are formed while simultaneously denying them the tools necessary to take care of those families. I choose art: Abortion is complicated; people make those decisions because they care about their families and their futures. To support those decisions, a much larger set of resources is needed -- resources that support both the decision not to parent and the decision to parent a child diagnosed with a fetal anomaly.
This piece was first published in the Columbia Daily Tribune