BY ERIN ARIZZI     A couple of weeks ago, I attended a screening of the new documentary, After Tiller, at>> Full Frame Documentary Film Festival in downtown Durham.

>>After Tiller is an incredible film about late-term abortion care in the U.S. The film follows the daily routine of the four doctors that continue to perform late-term abortions in the wake of the >>murder of their colleague, Dr. George Tiller. For those who may be unfamiliar with the story, Dr. George Tiller was a life-time advocate for women’s reproductive health care, and ran an abortion care clinic in Wichita, Kansas that performed late-term abortions. After multiple threats on his life by extremists in the so-called “pro-life” movement (in 1986, his clinic was firebombed, and in 1993, he was shot in both arms) he was murdered by anti-abortion activist Scott Roeder at his church on a Sunday morning in May of 2009.

The doctors profiled in the film After Tiller have continued the mission of George Tiller–in spite of constant threats to their own lives–because they feel they have a medical obligation to provide safe health care services to women in desperate situations. Much of the film shows us doctors in consultation with patients. In these conversations, we get to hear women explain why they are seeking a late-term abortion. In many cases, the patients are in great agony, because their pregnancies were very much wanted, but prenatal testing has shown that the fetus is not healthy or viable, and so they have decided to end the pregnancy. Other women have sought a late-term abortion because for a variety of reasons, they could not gather the funds together in time for a first trimester abortion.

I work for NARAL North Carolina, so I spend a lot of time thinking about abortion care and policies that affect women’s access to reproductive health. But in spite of my familiarity with the subject, I found this film incredibly moving. I left feeling even more committed to the idea that structural change must happen if we are to get beyond the kind of divisive arguments that so often occur in the public sphere around abortion access. And my resolve was strengthened again last week, as I watched the >>media run with the Kermit Gosnell story.

There is a scene in After Tiller where a young woman is talking to her doctor, and explains that she already has three children, and she simply cannot afford to have any more. She does not want to give her baby up for adoption; she feels very strongly about her decision to have an abortion. The doctor asks why she did not seek care sooner, if she knew she wasn’t going to continue with her pregnancy. She explains that she could not come earlier, because she did not have the money. One of her children was sick and needed to be hospitalized, and as time passed, the price of the abortion kept increasing, making it more and more difficult for her to come up with the money. She was able to finally seek out care only when she received her tax return.

People often wonder why any one would wait 20 weeks to have an abortion. The people who ask that question are unfamiliar with the harsh economic reality many Americans face.

According to the >>National Women’s Law Center’s (NWLC) analysis of the >>most recent census data: as of 2010, the poverty rate among American women had risen to 14.5%. In >>our state, the rate of poverty among women is even higher, at 16.8 %.  [Note, in 2011, a single mother’s  poverty threshold was an annual income of $17, 916]. >>The Hyde Amendment, which passed in 1976, forbids federal funding for abortion except in cases of rape, incest, or life endangerment. A woman’s “mental health” is not adequate cause for federal funding, nor is fetal impairment. So except in these extreme cases, it is against the law for North Carolina women to receive public assistance to pay for abortion care, leaving low-income women in increasingly desperate positions.


Why would patients seek care at Kermit Gosnell’s horrific clinic? One reason: he was offering care at a deeply discounted price. Abortion care, despite what you may have heard, is not cheap. According to the Guttmacher institute, in 2009, the average price of a first trimester abortion in the US was $470. The price only increases as time progresses. >>According to ThinkProgress, a first trimester abortion at Gosnell’s clinic was $330. A late-term abortion at Gosnell’s clinic was $1,625, about thousand dollars less than what it would cost at one of the legal abortion care clinics that offer late-term services. The difference between $470 and $330 may not seem like much to you, but for a woman living paycheck to paycheck, $140 might pay a month’s rent. The hard reality is that for many women, Gosnell’s clinic may have been the only affordable option available.

No one in the reproductive justice movement condones Gosnell’s actions. Contrary to what our opponents say, we would like women to have access to all of their options, and we would like them to be able to make choices that are not determined by their personal finances. Yes, we want all women to have access to affordable, safe, and legal abortion. But we also want women to have access to the full range of reproductive options.  Whether they choose adoption or motherhood, young women need more than the rhetoric of the anti-choice movement, they need access to pre-natal care, health services, child-care services, and education. We also want all women (and men) to have access to (and education about) contraception, so that unwanted pregnancies can be avoided altogether.  Finally, we want women to be able to have abortions early on, when the health risks are minimal, and the procedure is safest. But this can only be accomplished if state governments work to promote the health of women, families, and children, by giving them access to choice. If state governments continue to shut down clinics by creating unnecessary regulations (as the NCGA’s proposed TRAP law aims to do,) we are creating the conditions for more, not less, Kermit Gosnells.

Erin Arizzi is the Communications Intern at NARAL Pro-Choice North Carolina. She is a PhD student and teaching fellow in Communication Studies at The University of North Carolina at Chapel Hill. She has a Masters Degree in Rhetoric from UNC-CH, and a BA in English from Villanova University in Pennsylvania.

This post was re-posted with permission from the North Carolina Blogs for Choice.