She provided an abortion to a 10-year-old. She's still fighting for her patients.
In the rare moments of quiet, when Caitlin Bernard can pause to think about all that is happening throughout a post-Roe America, everything is distilled to a single image in her mind, the one that matters most to her as a physician. She sees the patient, the person who just found out they are pregnant, or that something has gone terribly wrong in a pregnancy; the person who needs Bernard's care but might not be able to reach her in time, or at all.
In June, that patient was a 10-year-old child, a rape victim who was forced to travel from Ohio to Indiana to receive an abortion from Bernard, a 38-year-old OB/GYN and an assistant professor at the Indiana University School of Medicine. After it was reported in July that Bernard had performed the procedure, she found herself plunged into the center of a furious political clash over reproductive rights. Her name was emblazoned in national headlines, her face flashed across television screens, her reputation assailed by right-wing pundits and politicians. The attorney general of Indiana claimed that Bernard had violated her patient's privacy and failed to properly document the procedure. Bernard and her family, including her two young children, became the targets of harassment and threats.
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The tumult of that episode has since calmed somewhat. But Bernard is still thinking of the faceless patient, the one she knows is always out there somewhere, as she navigates the perpetually shifting legal landscape in her home state. On Sept. 15, one of the most restrictive abortion laws in the country went into effect in Indiana. One week later, the law was blocked by a judge who issued an injunction. The future of the law remains unclear - the Indiana Supreme Court is scheduled to hear oral arguments on the injunction at a hearing in January - and there is no way for Bernard and her colleagues to know what will happen next, or how those developments might affect the people for whom they are trying to provide medical care.
"At the end of the day, I'm a physician," Bernard says, "and I'm just trying to take care of my patients."
She is also a parent, and in that role, "obviously, your family's safety is the most important thing," she says. "I always try to balance protecting my family with the responsibility that I feel to my patients and to other providers to stand up for them, and to publicly say what needs to be said, which is that we are physicians trying to take care of our patients, and that these laws that are hindering our ability to do so are dangerous. And it's always hard to know where that line is."
In the final hours before the new law went into effect, Bernard focused on caring for the nearly two dozen patients who had come to see her that day. One started to cry as she sat with Bernard and explained that she wasn't weeping for herself. "She was saying, 'I know that I'm lucky; I know that there are people who are not going to be able to make it here,' " Bernard says.
The confusion and the trauma of these circumstances have taken a toll on her patients and, in turn, on their doctor.
"It's been emotionally very difficult," Bernard says. "You rise to that occasion ... you find the strength from somewhere to be that person for them, to be present for them. But, you know, there's definitely a certain amount of trying to compartmentalize, so that you don't bring it all home every single night."
But inevitably, she says, "there's so much spillover." Earlier that same morning, she took a call in the car, talking to another physician about a patient in urgent need of care, and she suddenly became aware that her daughter was echoing her mother's words from her car seat: Bleeding, bleeding! The reality outside was there at the periphery of her little girl's awareness, even if she couldn't yet fathom what it meant.
Bernard tries to hold a certain line between her work and the rest of her life, she says, but - especially at moments like this one, when the political has become so deeply and irrevocably personal - "you realize it kind of takes over."
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She was only a child herself when she knew that this was the career she wanted. Before she reached high school, Bernard says, she was sure she wanted to study reproductive medicine.
Bernard grew up in Upstate New York, the younger of two daughters whose perception of the world was shaped by their parents. Her mother, an outspoken feminist who worked for the state health department, took her daughters to Take Back the Night marches, Bernard says, and taught her girls how important it was "to support other women and to not ever feel that there's something that you can't do because you're female."
Her father, a carpenter and a community organizer, took Bernard with him to Guatemala when she was in 10th grade. She worked alongside him as he helped run a medical care clinic. One day a woman came in, bleeding profusely after delivering her newborn, and there was no one present who was equipped to help her. Bernard's father arranged a transfer to a hospital, and they never learned what happened to the woman or her baby after that.
The woman's vulnerability made a lasting impression on Bernard, she says: "It was so obvious ... how important skilled care at that time in a woman's life is."
While in college, Bernard volunteered as a doula and also spent time at an abortion clinic, guiding patients through their options. She felt a deep similarity between those roles, she says: "It was supporting women, being there for them at a time that is critical in their life, being able to have that rapport," she says. "To be able to provide that support in all situations is really an honor."
She attended medical school and completed her residency at State University of New York Upstate Medical University in Syracuse, where her mentor, then in his 80s, had been one of the first physicians to provide abortions in the state after the procedure was legalized.
"He had seen the time in which abortion providers were murdered, where clinics were bombed," she says, and because of this, he had internalized the conviction that it was best not to talk about their work.
"Even in New York, there was such shame around patients seeking abortion and doctors providing abortion," she says, "and this idea that if we just stay quiet, we can protect ourselves, you know, from being murdered."
She deeply admired her mentor, she says, but she couldn't abide this mind-set. "I just thought it was the most insane thing I've ever heard, this idea that we are doing something wrong, that we can't protect our patients and stay true to the values of honesty and transparency," she says. "I just felt that was so wrong."
Bernard would take a different path, choosing to speak openly about the importance of reproductive health care. "I thought my generation could be those people," she says. "For him. That he couldn't, he couldn't -" she pauses, her voice breaking, "but that we would be able to."
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Long before she was nationally known, Bernard was a prominent voice among those who fight for reproductive rights in Indiana, says Tracey Wilkinson, an assistant professor of pediatrics at Indiana University School of Medicine, who has worked alongside Bernard and joined her in testifying against antiabortion legislation introduced in the state.
"She is the most competent, passionate and fierce person that I know," Wilkinson says. "She's the first person I call when I have a patient that I don't know what to do with. She's the first person I call when there is legislation that we have to fight. And she is also one of the first people that I call when I just need support as a professional, or as a mom."
Fighting for abortion access in a state like Indiana is "an uphill battle," Wilkinson says, and now that the fight for reproductive rights has moved to the state level, "having people like Dr. Bernard is incredibly important," she says. "We need 100 Dr. Bernards in every single state."
Bernard says she feels an acute sense of responsibility every time she speaks publicly about her work, an awareness that she is representing so many others in her field. "I don't want people to think that I'm some exception in some way, because I'm not," she says. "This idea that 'Oh, you're so brave' - all abortion providers are brave."
She has always known that her visibility would come with risk. Bernard was in her last year of medical school when George Tiller, a nationally known Kansas physician who had provided abortions for more than three decades, was shot to death in his church. While Bernard completed her fellowship training at Washington University in St. Louis, where she became certified in complex family planning - which includes training in performing second-trimester abortions - swarms of protesters often gathered outside the clinic where she worked. They screamed at her. They took pictures of her face and her car's license plate.
"Even then I felt the fear that, you know, there has been violence toward people like you, and that you are now in their sights," she says. "I knew that that was going to be a part of my life."
When Bernard became a parent, her commitment to her work remained unwavering; being pregnant, she says, "only made me feel closer to my patients." The experience instilled a new empathetic understanding, and it has sometimes meant navigating particularly sensitive circumstances.
"Being visibly pregnant when you have a patient whose baby is going to die and you're providing abortion care for them - that is challenging, that's emotional," she says. "I remember at the end, when I was close to going out [on maternity leave], just trying to wear the biggest scrubs that I could, and my jacket would cover my belly, because I just know how hard it is for them."
Even as the risks of her exposure became more high-stakes with the arrival of her children, she also felt a new awareness of how her efforts might shape the future they would inhabit.
"If I don't do everything that I can now, then I can't guarantee that they will be protected, that they will be safe later. I think that is the responsibility of every generation to make as much positive change as you can during your time," she says, and pauses. "But that was easier to do when it was only my own personal risk that I was taking."
In 2020, she says, the FBI investigated a kidnapping threat against her older daughter. Bernard remembers her toddler curiously touching a GPS tracker in her jacket, mercifully unaware of what it was or why she was wearing it.
"It's just really hard when it becomes so personal, and so involving of your children," Bernard says. But even then, she says, she had no intention to yield to threats: "We are not doing anything wrong, and I am not going to change what I'm doing to give in to them," she says. "That is not going to happen."
She hopes her kids will eventually see that side of her, too. "That their mother can be strong, and outspoken, and help people," she says. "You want them to view those things, view the world in a positive and open and adventurous way." But this also means constantly trying to shield them from the darker truths. "When we had security outside . . . my daughter would be like, 'Who are those people?' And we'd say, 'Well, those are our new friends, and they're sitting on our porch,' " Bernard says. "Trying to protect them at the same time is definitely really hard."
There is a tension in balancing the enormous demands of her work with her family life. "I'm working on creating more boundaries," she says. Bernard sometimes looks at her infant daughter and thinks of all that she has missed these past few months, she says, "because it was just so crazy."
The furor grew all-consuming in early July, after the report about the 10-year-old rape victim was picked up by news media worldwide and President Biden highlighted the story in remarks condemning the Supreme Court's decision to overturn Roe v. Wade: "Ten years old - 10 years old!" he said. "Imagine being that little girl."
Pundits and politicians pounced on the story, many first claiming it couldn't be true. Then, when the report was confirmed, they took aim at Bernard's reputation and motivation for speaking out about the case. Indiana Attorney General Todd Rokita announced an investigation to determine whether Bernard had properly reported the child's abortion to Indiana state officials. Records have shown that Bernard fulfilled this duty as required, and her employer, Indiana University Health, has stated that Bernard has consistently complied with patient privacy laws.
In a statement to The Washington Post, a spokesperson for Rokita's office said, "Our legal review continues."
Kathleen DeLaney, an attorney representing Bernard, said she filed a tort claim notice in July, potentially setting the stage for a defamation suit against Rokita. Bernard has two years to decide whether she will pursue a defamation claim, DeLaney said in a statement, and is still considering her options.
"No matter my client's ultimate decision, we will not let the Attorney General's agenda distract from the important work at hand, which is the care that Dr. Bernard and her fellow physicians provide to patients every day," DeLaney said.
Despite the barrage of criticism and harassment from antiabortion activists, Bernard says, she was overwhelmed by the support she received. Her colleagues sometimes called her at home, she says, holding the phone to the hospital answering machine so she could hear the people who had left messages to thank her. Handwritten notes poured in. Vice President Harris called to express her support and gratitude.
"I'm literally still receiving mail from people thanking me for speaking out for them, for their daughters, for their sisters. ... It definitely gives me a lot of hope for the future," she says, and any measure of hope feels welcome.
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For now, in the state of Indiana, abortion remains legal up to 22 weeks. After the judge blocked the new abortion law on Sept. 22, Bernard could call the people she had turned away only days before and tell them she could see them now after all.
"We don't know how long it's going to last," she says. "It could all be reversed right away." In the meantime, the reality for health-care providers on the ground is still chaotic and confusing. She knows there are patients who won't understand what an injunction is, or how it might impact their specific circumstances. Already, Bernard says, unseen people are falling through the cracks, which makes even an incremental victory seem hollow.
"Because it feels so temporary and uncertain and the long-term impact is still unclear, it doesn't feel better," she says, "It doesn't."
She can't control the legislators or the lawyers, the pundits or the judges. There is a phrase she often repeats - I am a physician - and what she can control is how she responds to the patient in front of her. She recalls the woman who recently came to her office to obtain contraception, and told the doctor: I am literally hanging on by a thread. If I get pregnant, I will fall apart.
"It's those people that I want to be able to reach and say, 'You are not alone,' " Bernard says. "'You do not have to force yourself into something that is going to tear you apart. We will help you. We will get you to where you need to be, however and whatever you need to get there.'"
Faced with the unknown path ahead, she remembers her mentor, who came of age in a time when silence felt safest. She thinks of the society her own children will inherit. And she knows what to say to the medical students and the residents she works with, the ones who are following her into the field and into the fight.
"There's so much in the world that can bog somebody down, to where they think that they can't speak out for fear, or that they aren't powerful enough to make change in a system that seems so powerfully against them," she says. "I try to remind them as much as possible ... that they do have a voice, that they can make a difference. I try to instill in them their power."
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