The documentary, Birthright: A War Story, begins with a single, powerful quote: “All wars have collateral damage. This one is no different.”

If you could boil down the premise of the searing and thoroughly researched film by Civia Tamarkin and Luchina Fisher, this is it. In the battle for women’s reproductive health access and bodily autonomy, we have become accustomed to a familiar old paradigm: Choice vs. life. Progressive vs. conservative. Republican vs. Democrat. But as Tamarkin and Fisher would say, the real story is so much bigger than that. It’s about the various ways U.S. women are caught up in an antiabortion fight that stretches back decades, and the systems—judicial, medical, political—that are ensnaring them as the battle rages on.

Telling a story like that presents its own challenges—namely, picking from what seems like an endless possibility of narrative strands to illustrate the state of affairs for American women of reproductive age. The filmmakers were clear on one thing: They had no interest in telling a story about abortion, which they felt had been thoroughly covered. Instead, they wanted to eschew the bilateral pro/antiabortion framing that guides much of women’s health coverage, and focus on the ways the antiabortion movement has mutated to cover ground including sexual education and contraception. Perhaps it is fitting, then, that the filmmakers’ inspiration for the documentary came out of the Supreme Court’s 2014 Hobby Lobby decision, which permitted companies to opt out of providing contraceptive coverage for their employees if they had religious objections.

The outcome left Tamarkin aghast.
“I was outraged and not just outraged but perplexed as to why contraceptive coverage had become part of the war on reproductive rights,” she says. “I set out to connect the dots and began to investigate what is going on.”

To do that, she came out of retirement from filmmaking and enlisted the help of her longtime friend and former colleague Fisher (herself a native Tar Heel and UNC graduate), as well as Ruth Shaber, a Bay Area-based OB-GYN and member of the Medical Advisory Committee for Planned Parenthood Federation of America.

Given the filmmakers’ chosen focus, it’s easier to understand how and why the documentary begins where it does: with the story of a woman, Danielle, who never had an abortion but somehow found herself caught in the crossfire. At about twenty-two weeks pregnant, her water broke prematurely, and she learned that her fetus had nearly no chance of survival. Continuing the pregnancy also posed a risk to her own health, but her doctor was unable to induce labor, thanks to a Nebraska fetal
pain bill that made participating in an abortion after twenty weeks illegal. As a consequence, she was forced to wait ten days, then became sick, before ultimately giving birth to a baby that died shortly after. Next to her sits her husband, shaking with rage at the thought that the law could have resulted in his wife’s death.

The whole thing defies logic. At least, it does if you believe a woman should be able to decide whether, when, and how to give birth.

From there, the documentary details the antiabortion movement’s involvement in politics—galvanized largely by the landmark 1973 Supreme Court decision Roe v. Wade. Led by evangelical leaders like Jerry Falwell, they were strategic, recruiting antiabortion candidates to participate and run at every level of government, from local to federal. It’s especially illuminating for viewers who may not be aware that being antiabortion wasn’t always a prerequisite for the Republican Party: George H.W. Bush’s father, the documentary notes, was the treasurer for Planned Parenthood; and as governor of California, Ronald Reagan signed a bill legalizing abortion in the cases of rape, incest, or when the pregnancy posed a threat to a woman’s life. As president, however, he adopted an antiabortion stance.

All the while, movement leaders pressed forward in an attempt to politicize and undermine abortion. Some abortion foes looked at Roe and saw a done deal, so they focused instead on a strategy known as incrementalism, which consists of chipping away at abortion access at the state, not federal, level, in an attempt to undermine SCOTUS’s ruling. As Carol Tobias, the prim president of the National Right to Life, told the filmmakers: “We want to nibble away at Roe v. Wade.”

Among the conservative movement’s recruits were a younger generation of activists, sent to antiabortion youth camps where they learned to debate some of the finer points of the movement’s rhetoric (some may find this some of the documentary’s stranger footage, kids cheerily splayed out on grassy lawns and eating while being assailed with antiabortion talking points).

Beyond history, the film also touches on the disturbing trend of what can be more or less reduced to the criminalization of pregnancy: women increasingly being prosecuted for crimes ranging from feticide to chemical endangerment of children. It’s something that has not gotten a much attention as, say, the hundreds of abortion restrictions that have been implemented on the state level since the tea party wave of 2010. (In 2016 alone, states passed sixty restrictions on abortion.) But it’s alarming nonetheless.

Some of the most painful-to-watch parts of the documentary are the stories of women who have, unwittingly, been caught up in this battle, particularly the women who found themselves jailed on child-abuse charges after drug tests were administered in the hospital without their knowledge or consent. The filmmakers interviewed one woman who found herself in that predicament after taking half a Valium while pregnant during a panic attack, and another who smoked marijuana to manage her epilepsy.

The takeaway is abundantly clear: this is what happened to women who thought they were safe.

The stories in the film also highlight one of the crueler impacts of the war on abortion. Consider the single mother with several children denied sterilization because of a hospital’s religious beliefs, or the pregnant woman subsisting off just $250 a month who ended up buying pills to induce her own abortion. These women are often—not always, but often—poor. And in the U.S., they are also disproportionately women of color.

There is, sadly, a universality to this. Years ago, I reported for The Atlantic on the abortion ban in Chile—one of just a few countries in the world that, at the time, prohibited abortion under any and all circumstances. There, as in other parts of the world where abortion is criminalized, women found themselves behind bars for doing, or trying to do, what the law prohibited. A human rights lawyer told me that basically all of the women who wound up in jail for getting an abortion were poor. The wealthy women flew to Miami or Cuba for safe and under-the-radar procedures; the poor women were relegated to what some might refer to as “the alleyway”—unsafe situations and procedures that could, and did, land them in jail.

It’s important to understand that this is not just some faraway truth in Latin America. In the U.S., the bundle of restrictions that have been heaped on states as part of the conservative movement’s incrementalist strategy target poor women with cruel precision. The Hyde Amendment bars Medicaid funds from being used to fund abortion, and the procedure is also often excluded from insurance plans. Women who are able to cobble enough money together for an abortion are routinely forced to reckon with additional and unanticipated fees. Legally mandated waiting periods and in-person counseling sessions in some states mean women have to return to clinics more than once—sometimes, those clinics can be hundreds of miles away. Women with children then have to account for fees like gas, childcare, and an overnight stay at a hotel. And if you’re in a low-income job without benefits or sick pay—well, sorry. (It’s also worth mentioning here that women of color account for more than half of women of reproductive age enrolled in Medicaid.)

If you are a well-to-do woman in a blue state, it might be easy to read this and think: I’m safe. But the film has one last twist for you: hospital mergers with Catholic health care systems mean that one in six patients in the U.S. is now cared for at a Catholic hospital; those hospitals are guided by a set of rules written by the U.S. Conference of Catholic Bishops, which prevent doctors from performing reproductive services such as sterilization, in vitro fertilization, and abortion. Many of these hospitals have innocuous-sounding, nonreligious names, so patients don’t necessarily realize they are going to a Catholic institution for care. The hospitals also don’t follow the medical standards for miscarriages by denying women services for miscarriages and pregnancy complications that can put them directly in harm’s way. This can happen even in blue bastions like California, where Catholic health care abounds.

“It’s terrible in northern California,” says Shaber, the Bay Area-based OB/GYN. “And nobody knows. We need to lift up the coverage so people can see what’s happening. It’s a really well-kept secret in California.”

Shaber adds that she found the film’s emphasis on Catholic health care the most directly actionable: “I hope that the rise of Catholic health care is the easiest place where we can really make progress. If you’re not a Catholic or you don’t want that care, you need to know that’s what’s happening when you walk into a Catholic hospital. I think that a large amount of the work we can do is raise awareness.”

Shaber is right that few are aware of this situation, in California and across the country. When I wrote an expose about the quiet expansion of Catholic health care in the U.S., many of the people we heard from were genuinely unaware of the phenomenon, but they were concerned (excluding, of course, the fan from the National Catholic Reporter who wrote an article calling me an anti-Catholic bigot).Still, it’s that narrative thread that helps the film end on a compelling note: any woman could be next. It leaves the audience with a picture that is, well, ominous to say the least. And that’s the point. The filmmakers don’t want you to exit the movie feeling cheery about the state of affairs for women in the U.S. They want you to be moved to action.

“This was intended as a wakeup call, a wakeup call certainly for a younger generation for the most part that did not seem as aware of what was happening,” says Tamarkin. “So what was so important for us was to make people realize, wait a minute, this is something that you must mobilize against and you must begin to change the language, you must begin to see it in the context of the human rights of American women.” Indeed, it’s a battle that is as much about the “womb” as it is about who holds power in this country, and how they maintain it. That’s why those pictures of male politicians signing away women’s reproductive care carry such visceral, symbolic resonance, for so many people. It’s one thing to just limit abortion access. But when you couple that with abstinence-only sexual education, restricted contraceptive access, and the criminalization of pregnant women, too—well, that’s when you begin to get comparisons to The Handmaid’s Tale.

Tamarkin says she always saw the parallels.

“In fact from the very beginning, I always saw the analogy,” she says. “The bottom line is when you have a government that is banning abortion and restricting access to contraceptives, then, in fact, you have a government that is de facto saying women must be breeders. And that’s frightening.”

And life sometimes does imitate art. Yesterday morning, as Tamarkin was preparing to screen the documentary, the GOP announced a hearing on a bill that would ban abortion at six weeks, before many women learn that they are pregnant.

Birthright: A War Story screened last night at the Chelsea Theater in Chapel Hill, and will be playing again tonight at 6:40. The Durham-based global reproductive health organization Ipas helped arrange the screening and moderated a brief Q&A with the filmmakers and a member of the Carolina Abortion Fund after the film.