After four and a half years of fundraising, filming and distribution, “Gosnell: The Trial of America’s Biggest Serial Killer” has finally landed in (a limited number of) theaters.

The title of the conservative-backed dramatization of the story of Dr. Kermit Gosnell, a Philadelphia physician now serving three life sentences, though, is likely confusing for most true-crime aficionados. That’s because, in the film and in real life, Gosnell was tried on eight charges of murder and convicted on three. That’s a large number to be sure, but a small fraction in comparison to, say, Gary Ridgway (pleaded guilty to 48 counts of murder) John Wayne Gacy (convicted of 33 murders), Ted Bundy (confessed to 28 murders, and was convicted of two) or Jeffrey Dahmer (confessed to 17 murders and was convicted on 15 counts).

Dr. Kermit Gosnell is interviewd at his attorney's office in Philadelphia in 2010. Yong Kim / AP file

Since Gosnell was only convicted on three counts of first degree murder, the “America’s Biggest” moniker is a bit of a stretch.

But the filmmakers and the movie’s biggest supporters aren’t really talking about the kinds of crimes most people associate with serial killers. Gosnell operated an abortion clinic, making him, in their eyes, “guilty” of murder for every unwanted pregnancy he terminated in his office in addition to the live children was prosecuted for killing (three babies, believed to be born alive before he took scissors and severed their spinal chords).

There is no defense for Kermit Gosnell’s illegal actions There is no question that he performed even general, legal abortions without the care or training a person should expect from a medical provider when terminating a pregnancy. His clinic was unsanitary and dangerous for patients generally, and he was further known to provide better care and cleaner rooms for his white and higher-income clients than those who were poor, immigrant, or brown or black. He did so apparently under the assumption that his more privileged clients would report him to the health department, whereas those from marginalized communities would either be afraid to do so or — even worse — think that what they were receiving was exactly what they deserved. (Even so, he was reported to authorities, and the governmental agencies that failed to act on the complaints from his patients that would have exposed his crimes far earlier should be held to account for their negligence.)

There is no doubt that Gosnell broke the law, or that he performed some abortions past the legal gestational age in Pennsylvania. It is a fact that — either through lack of training, lack of morality or both — he illegally induced live births in his patients and once those fetuses were delivered, stabbed the fetuses with scissors in the backs of their skulls if they were still showing signs of life.

There is no defense of what Gosnell did, but there is also no comparison between what he did and what a legitimate, trained abortion provider does — and that is where the film becomes purposefully misleading.

The film’s protagonists are mostly based on true characters, although a few were fictionalized for flexibility in promoting anti-abortion talking points (like the lovely female heroine assistant district attorney with five small children at home). But the distinction between babies, the murders of which are prosecutable, and fetuses (which are still in utero and well before the point of viability) grows increasingly fuzzy as the movie progresses. That is, clearly, part of the point of the film in the first place.

Also to the filmmakers' political point is the way in which they seek to present Gosnell and his clinic not as the exception but as the rule. “Is any of this normal?” Detective Wood, played by Dean Cain, asks his partner as he steps over medical debris and even cat feces in one exam room. “I don’t know, I’ve never been in an abortion clinic before,” his partner answers, as though medical offices in which abortions are performed are rare and not held to the same standards as most medical providers.

Needless to say, unsafe and unsanitary conditions in an exam room in which abortions are performed are not normal, but anti-abortion activists are invested in making the public believe they are: That’s the underlying message of their push for so-called “TRAP” laws, which seek to make medical providers meet higher standards for their buildings than other similar medical providers.

The filmmakers repeat that false message again and again, such as when the fictionalized Gosnell practices his testimony with his legal team and argues that he is really no different than the late Dr. George Tiller, one of the few doctors who legally performed third trimester abortions in the U.S. and who was killed by an assassin in his church in 2009.

To compare an experienced doctor who legally performed third trimester abortions, usually for women victimized by sexual assault or who learned that their child had fatal fetal anomalies, to a man who stabbed live babies in the neck to sever their spinal chords isn’t just disingenuous, it’s disrespectful (and potentially slanderous).

But while filmmakers created a revisionist history that puts all the blame for Gosnell’s ability to operate on the “boogey man” of the state health department —– which, again, should have gone after him based on complaints earlier than it did — and the pro-choice governor (who they falsely claim wouldn’t allow abortion clinics to be inspected for decades as a gift to the “abortion industry”), in reality, Gosnell couldn’t have operated except in the landscape created by anti-abortion activists themselves.

Even with abortion legal in his state, Gosnell didn’t bother to operate by the rules; there’s little reason or history to believe that women would have been safer had abortion been illegal. Gosnell’s clinic was where patients went primarily when they thought they had no better options, or couldn’t afford a better clinic. They went there because he didn’t enforce the 24 hour wait mandated by the state. They went there because the anti-abortion protesters surrounding the reputable clinics in the city were so aggressive that they were afraid to enter.

And just as Gosnell gained from the anti-abortion movement, the movement gained from Gosnell. Not long after the gruesome findings from Gosnell’s clinic were discovered by the state health department, Pennsylvania Governor Tom Corbett, a Republican, signed an abortion clinic regulation bill inspired by Gosnell’s rogue clinic, which then closed nearly half the legal abortion clinics in the state.

It was just the first in the wave of ambulatory surgical center requirement bills to sweep the country between 2011 and 2014, the most notable being the Texas bill that eventually turned into the Whole Women’s Health v. Hellerstedt case. In every instance, someone supporting the bill would inevitably mention the decrepit clinic conditions and illegal services of Kermit Gosnell.

Abortion rights activists explained repeatedly throughout the Gosnell trial in 2013 that Kermit Gosnell was exactly what women resort to when abortion becomes too hard to obtain. Now, with the Gosnell movie launching a limited theater release and Brett Kavanaugh now seated as the newest Supreme Court justice, we are at a cross roads in abortion rights -- and the ability to access legal abortion in at least 20 states could come to an end within the next few years.

Blue states, of course, are lucky. They will probably get to keep their safe, legal abortions. And the red states? Well, they are probably going to get a lot more Gosnells. Because when you make abortion completely inaccessible —–- either legally or financially — there will always be someone around to take advantage of the vulnerable women left behind.