Why It's Important to Talk About Later-Term Abortion

Later-term abortion incites emotion and controversy like few other medical procedures, and the anti-choice movement has not been reluctant to exploit both the passions and misunderstandings surrounding this procedure for their own gain.
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This Friday, the documentary After Tiller opens in New York. The title refers to Dr. George Tiller, a Kansas abortion provider that was murdered in his church in 2009 by an anti-choice extremist. Dr. Tiller was one of the very few physicians in this country that publicly discussed their work doing later-term abortions, and After Tiller focuses on four later-term providers that are currently working in different states.

It's difficult to know just how many physicians perform abortions later in pregnancy, particularly after the 22nd or 24th week, and this is in part because many providers are reluctant to draw attention to their work. Anecdotal evidence indicates that even doctors that perform abortions until the 12th or 14th week are often hesitant to make this information widely known, for fear of the controversy and danger this could mean for themselves, their coworkers, and their patients.

But it is clear that very, very few doctors in this country will perform later-term procedures -- and that makes this documentary all the more extraordinary. These four doctors are all former colleagues of Dr. Tiller, and even before his murder, they were well aware of the risks to their own safety. Yet, in the words of the film's directors, "They thought that if more Americans could meet them, and hear where they were coming from -- even if they still disagreed with the work that they did -- they at least might not want to kill them."

Later-term abortion incites emotion and controversy like few other medical procedures, and the anti-choice movement has not been reluctant to exploit both the passions and misunderstandings surrounding this procedure for their own gain. Even as more and more states move to ban abortions after the 20th week of pregnancy, reputable scientific and medical sources have cast doubt on the main justification for these restrictions: the idea of fetal pain. A number of researchers and physicians have raised doubts that fetuses are able to feel pain at such an early point of gestation, as well as that the ability to feel pain is fully developed before birth. Indeed, this area is so complicated -- as one doctor put it, "There's far more we don't know than we do know" -- that even those physicians whose work is used by anti-choice organizations as evidence for such restrictions stress that their interest is motivated by science, not anti-choice advocacy.

What is clear is that only a small percentage of all abortions occur after the 24th week of pregnancy, and that the vast majority of those terminations happen because of severe health concerns on the part of the woman or fetus. Perhaps After Tiller will help increase awareness of this fact and empathy both for the women that are in these situations and the medical professionals that help them.

And that couldn't happen soon enough, as the case of Dr. Kristin Neuhaus demonstrates. The Kansas abortion provider used to work with Dr. Tiller when he had later-term cases, because state law required that a second medical opinion was required to perform certain later-term procedures. Last year, Dr. Neuhaus lost her medical license after the state medical board accepted a judge's ruling that she kept inadequate records on eleven patients that had abortions in 2003. (The initial complaint against her came from Cheryl Sullenger, an anti-choice extremist who served time in federal prison for conspiring to blow up an abortion clinic.) Dr. Neuhaus has admitted that her records were light on details, but contended that that was to protect the privacy of the patients, who were between 10 and 18 at the time she saw them. And it seems that she had good reason to worry about their privacy; the records were obtained both by the state's anti-choice attorney general, Phil Kline, and by Bill O'Reilly, who included personal details about two of the young women on his show.

The fight to keep her license has brought Dr. Neuhaus close to bankruptcy; the lion's share of the $93,000 that the state charged her in fees came from the testimony of one anti-choice witness. Perhaps not surprisingly, Dr. Neuhaus, who currently works as an instructor at the University of Kansas, is not planning on returning to abortion provision if her license is reinstated in the future.

It's tempting to look at Dr. Neuhaus' story and point fingers at the usual suspects: anti-choice activists, single-minded politicians, and blowhard cable news hosts, just to name a few. It's easy to point out that politics shouldn't interfere with a trained physician providing a legal medical service. And it's even easier to hold up the four doctors in After Tiller, as well as Dr. Neuhaus and other providers, as impossibly brave individuals possessing uncommon amounts of courage and spirit.

None of those conclusions would be incorrect, but they are only half the story. The other half is to wonder why, if millions of people in this country support reproductive rights, abortion providers still have to wear bulletproof vests to work; why women facing severe medical problems have to travel hundreds of miles for help; why doctors have to worry that their patients' most personal information will be aired publicly; and why the entire experience of providing abortion care can best be summarized in the words of the clinic owner that told me, "You know, it's a shame to have to provide medical care in a war zone."

These are big questions with many answers, some of which After Tiller seeks to provide. And some of which can be found in the experience of Dr. Kristin Neuhaus, who recently said: "I feel that people have a responsibility to stand up for their own rights at some point. And if you don't stand up for your rights you will lose them ... We're seeing that everywhere. You can't expect people to keep martyring themselves."

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