One of the Last Abortion Doctors in Indiana

Inside a generic government-office conference room in downtown Indianapolis, Caitlin Bernard sat before six members of Indiana’s Medical Licensing Board, whose cases typically involve complaints against physicians who bilked a patient or drove while drunk. But at this hearing the subject was the intricacies of patient-privacy rules. In the aftermath of the Supreme Court’s ruling

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Inside a generic government-office conference room in downtown Indianapolis, Caitlin Bernard sat before six members of Indiana’s Medical Licensing Board, whose cases typically involve complaints against physicians who bilked a patient or drove while drunk. But at this hearing the subject was the intricacies of patient-privacy rules. In the aftermath of the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization, a reporter had overheard Bernard tell a fellow-doctor that a ten-year-old girl from Ohio was coming to Indianapolis for an abortion. This, Indiana’s Republican attorney general claimed, made the girl identifiable and violated her right to confidentiality.

For fourteen hours, as Bernard’s white-coated colleagues sat behind her in solidarity, lawyers tried to prove that Bernard was unfit to practice medicine. Under close questioning, she insisted that she had not violated privacy rules and that the case was designed to intimidate her. Any doubt that the hearing had as much to do with politics as medicine vanished when the deputy attorney general asked, “Do you have a tattoo of a coat hanger that says ‘Trust Women’ on your body?”

Bernard provided a legal medication abortion to the ten-year-old. In the eighteen months since, she has become the most famous obstetrician-gynecologist in the country—equal parts hero and warning to abortion providers in conservative states. Her encounter with the Indiana attorney general made her a target for Fox News pundits and tarnished her professional record. The criticism inspired threats and at times made her question how much longer she can do the work she trained for years to do. As we talked in a clinic between abortion procedures one day, Bernard offered an assessment of the political moment: “It’s just insanity, pure insanity.”

The most senior complex-abortion doctor in a state that recently outlawed almost all abortions, Bernard has struggled to balance her work—which involves delivering babies, as well as ending pregnancies—with the fraught task of supporting her patients through medical decisions that increasingly require the advice of an attorney. “Mostly, it’s just incredibly sad,” she told me. “All of these absolutely brilliant clinicians have just spent their entire lives fighting for one basic human right that is literally the easiest procedure that you’ve ever done in your entire life.”

No one was surprised that it was Bernard who got the call on a June morning in 2src22, three days after the Dobbs ruling. “Caitlin is the person in our state who everybody calls” to handle difficult cases, Tracey Wilkinson, an Indianapolis pediatrician, told me. “Everyone has her cell-phone number.” Bernard was doing paperwork in her office when a child-abuse pediatrician in Ohio contacted her about a ten-year-old girl. The child had been raped and was pregnant. She needed an abortion but was three days past the six-week deadline for termination that had been set by Ohio’s Republican-dominated legislature. Bernard recalled thinking, “Oh, my God, they can’t even take care of this patient?” She agreed to see the girl and later noted that it was not an unusual request. The girl was one of fifty-nine patients younger than sixteen to receive an abortion in Indiana that year, and she was not the youngest patient Bernard had ever treated.

Unlike many other conservative states, Indiana did not have a trigger law that allowed abortion restrictions to take effect immediately after the Court overturned Roe v. Wade. But it was clear in those early days after Dobbs that the Republican governor and legislature would act quickly. On June 29th, several hundred doctors, nurses, and medical assistants, shouting slogans and carrying signs, rallied for abortion access on Indiana University School of Medicine’s campus. Bernard, wearing light-blue surgical scrubs, hollered into a bullhorn: “Abortion is health care!”

At the protest, Bernard, who teaches obstetrics and gynecology and trains new doctors at the medical school, spoke with a resident who was about to start seeing adolescent patients. She warned him to be prepared to see children who were travelling from states where abortion laws had been tightened. For example, she told him, a pregnant ten-year-old from Ohio had been referred to her for care. Shari Rudavsky, an Indianapolis Star reporter, was standing nearby, waiting to interview Bernard. She overheard the conversation and asked if the story was true. Bernard confirmed that it was. The girl and her mother arrived in Indianapolis, and, after a state-mandated waiting period, Bernard provided the girl with mifepristone, to block an essential hormone, followed by a dose of misoprostol, to cause uterine contractions.

On July 1st, the Star published a story about patients travelling for abortions, with an opening anecdote about the child from Ohio. It mentioned the call to Bernard and the fact that the ten-year-old’s pregnancy was a few days beyond Ohio’s new six-week limit. The girl was not further identified, and Rudavsky quoted Bernard only once, when she referred to the prospect that the Indiana legislature might pass a law as restrictive as Ohio’s. “It’s hard to imagine that in just a few short weeks,” Bernard said, in the article, “we will have no ability to provide that care.”

The story spread quickly. Outlets around the world retold the episode, casting it as dramatic evidence of what the fall of Roe v. Wade would mean. President Biden joined in, speaking about Bernard’s patient as he announced an executive order to protect access to medication abortion and contraception. “Ten years old, raped, six weeks pregnant. Already traumatized. And was forced to travel to another state,” he said, wincing. “Imagine being that little girl.”

That was not how everyone saw it. The Wall Street Journal published an editorial under the headline “An Abortion Story Too Good to Confirm,” suggesting that Bernard, “a biased source,” had invented the patient. The Republican congressman Jim Jordan, of Ohio, piled on, tweeting, “Another lie. Anyone surprised?” The Fox News personality Jesse Watters, whose prime-time show typically attracted more than two and a half million viewers, questioned why no rape suspect had been charged. Either “so-called doctors are covering up child rape,” he said, or the story was a liberal “hoax.”

On July 13th, a man in Columbus—the boyfriend of the girl’s mother—was charged with raping a ten-year-old, which allowed reporters to discover her identity and debunked the claim that the story was false. (The man later pleaded guilty and received a life sentence.) A few hours after the suspect’s court appearance, Watters targeted Bernard again, incorrectly stating that she had failed to report the rape. “So, is a criminal charge next? Will she lose her license?” he asked, as he introduced Indiana’s attorney general, Todd Rokita, who spoke by video feed. Rokita called Bernard “an abortion activist acting as a doctor,” and said that the ten-year-old was “politicized for the gain of killing more babies.” Without providing details, he told the Fox News audience that Bernard had a history of failing to report abortions: “We’re gathering evidence as we speak, and we’re going to fight this to the end.”

Even before the Dobbs ruling, Bernard was one of a dwindling number of doctors willing to provide abortions in conservative states. A 2src21 Kaiser Family Foundation study found that ninety-two per cent of ob-gyns in the Midwest did not provide abortions. About a third of ob-gyns who do not provide abortions cited their opposition to the practice, but many expressed concerns about legal regulations and personal safety. For decades, abortion doctors “navigated a never-ending barrage of harmful legislation and interference,” Verda J. Hicks, a Kansas doctor who leads the American College of Obstetricians and Gynecologists, told me. Colleen McNicholas, a St. Louis Planned Parenthood doctor and a mentor of Bernard’s, said, “I can’t even tell you the number of complaints that have been filed to the state licensure board against me by people who I’ve never seen as my patients.” That, combined with attacks from state legislators and ever more stringent regulatory restrictions, means that physicians don’t feel safe.

Bernard was born on a communal farm in upstate New York in 1984. “My parents were hippies,” she said. “This idea of communal living and community, sustainability, and support—everyone has a role in which we’re all helping each other.” She accompanied her father, a carpenter and community organizer, on volunteer trips to Puerto Rico, where he installed septic tanks and built playgrounds and community centers. Back home, Bernard joined her mother, a laboratory researcher, at Take Back the Night marches. Bernard knew from an early age that her mother had had an abortion in college, and that when she became pregnant with Bernard’s older sister, at twenty-one, with a man who wanted no role as a father, she chose to have the baby. Bernard said that her mother was a devoted feminist who taught her “the power of women in their community—that you don’t need anybody, you can make the decisions for your life. And that reproduction is key to that.”

After graduating from Binghamton University, in 2srcsrc6, Bernard interned as a doula and volunteered at Southern Tier Women’s Health Services, the abortion clinic where Randall Terry, the founder of the militant anti-abortion group Operation Rescue, had launched his protests two decades earlier. It was a tumultuous time to be doing this work. Protesters shouted at patients, and the 1998 assassination of Barnett Slepian, an abortion doctor from Buffalo, was still fresh. The clinic’s owners felt traumatized, and Bernard saw how the reproductive-rights community, including her parents, gave them “moral support, more than anything, showing them that they were protected.” After she finished medical school, at SUNY Upstate, she started a fellowship at Washington University in St. Louis, where she learned to perform more complex abortions. Missouri’s legislature was in the midst of passing increasingly strict abortion rules, with measures such as a three-day waiting period, limits on health-insurance coverage, and a requirement to present patients with a sheaf of material designed to persuade them to change their minds. Coached by McNicholas, Bernard donned her white lab coat and testified to the legislature. She did the same later in Indiana, speaking at rallies and becoming a go-to expert witness.

People who work with Bernard talk about her courage. When I asked her where that came from, she laughed and meandered through an unconvincing riff about how anyone would do what she does. Then she said, “Maybe part of it is, if you’re gonna do it, do it—you know, be all in.” To McNicholas, this makes sense. When you see patients who have needed abortions and have struggled to obtain them, she said, “you wake up every day, and you remember those names, and you remember those faces, and you remember those stories of how they were so unnecessarily harmed.”

In 2src19, Indiana’s legislature outlawed dilation and evacuation, or D. & E., a procedure commonly used by doctors in the second trimester, when some major genetic or anatomic anomalies can first be detected and other complications may arise. It is widely acknowledged as the least risky approach to pregnancy termination in the second trimester, and the easiest for the patient, yet the new law made it a felony for a doctor to perform it unless the life or health of the patient is in danger. Bernard, one of the few ob-gyns in Indiana with the skill and experience to perform a D. & E., testified against the bill. She described situations in which a patient might want a second-trimester abortion—after the discovery of a fatal abnormality in the fetus, for example—and argued that doctors must be able to use their best judgment without political interference. When the bill passed, the Indiana chapter of the A.C.L.U. recruited her to help challenge the rule in court. A judge temporarily stopped the law from taking effect, but he dismissed the case when the Dobbs decision came out. “We had an injunction. We had won,” Bernard said. “Dobbs really just, in one fell swoop, took all of that away. That was really, really difficult.”

While that case was in the court system, the F.B.I. relayed word to Bernard of a threat to kidnap her infant daughter. She began travelling with security guards, and she stopped working at a Whole Women’s Health clinic in South Bend after a local anti-abortion group posted her name and work location on its Web site under the heading “Local Abortion Threat.” (That group, Right to Life Michiana, formerly known as St. Joseph County Right to Life, believes that “abortion is unacceptable in all cases” and favors the criminalization of doctors who provide the procedure. In 2srcsrc6, Justice Amy Coney Barrett, then on the faculty at Notre Dame Law School, signed an advertisement sponsored by the group that called for “an end to the barbaric legacy of Roe v. Wade.”) “It was pretty terrifying,” Bernard told me. “In what other specialty would you be, like, ‘I can’t do this area because I might get murdered, or my kids are going to have protesters at their school?’ ” The episode left her wondering whether “doing what I thought was the right thing was actually putting my family at risk.”

In the weeks after the Ohio girl’s abortion, Todd Rokita, Indiana’s attorney general, continued his public attacks on Bernard. He released a letter that he had written to Eric Holcomb, the state’s Republican governor, demanding that officials “immediately” confirm whether Bernard had filed the required Terminated Pregnancy Report and alerted Indiana’s Department of Child Services. The next day, using a simple public-records request, reporters obtained the report, which showed that Bernard had filed the paperwork properly. Indiana University Health also released a statement affirming that she had complied with privacy laws. A friend of Bernard’s published an op-ed in the Times, saying that she was a “target of a national smear campaign.”

Bernard put the attention to use. She said in an MSNBC interview that doctors “need to be able to provide this care for everyone, for every single person that we get a call about, from any state all over the country.” In a column for the Washington Post, she wrote that she felt “anguished, desperate, and angry . . . I don’t want to have to accept that a particular religious ideology eclipses my duty as a physician.” Vice-President Kamala Harris called to thank her for her leadership, and twenty-two doctors launched a GoFundMe for her legal defense, ultimately raising more than seven hundred thousand dollars. “None of this should have happened in a sane world,” she told me. “The problem is that I didn’t realize we weren’t operating in a sane world.”

Five months after the girl returned to Ohio, Rokita filed a five-count administrative complaint against Bernard with the state’s medical-licensing board. He charged that Bernard knowingly violated federal and state privacy laws by revealing the girl’s age and home state. He also said that she failed to report the girl’s rape quickly enough to Indiana child-protection authorities, even though the crime had occurred in Ohio. As Bernard saw it, the most powerful law-enforcement official in Indiana was trying to silence her and send a warning to other providers. “On one hand, it was, like, This is ridiculous. There’s no way he can win this,” she told me. “And then there was the fear of, well, if he does win, am I going to lose my license?”

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