The criminalization of abortion care continues - in ND, SC, and MO

As lawmakers and courts revisit abortion restrictions across the country, more states are treating reproductive health care —including both pregnancy outcomes as well as abortion — as a potential criminal offense. Here’s the latest:

• South Carolina advanced a bill (SB 323) that would have sharply expanded felony penalties and criminalized anyone who helped a person seek abortion care. It failed narrowly but signals growing legislative ambition.
• North Dakota reinstated a near-total abortion ban, creating new legal risks for doctors navigating emergency care and pregnancy complications.
• Missouri lawmakers introduced two bills that attempt to classify abortion as murder — despite voters passing a constitutional amendment protecting reproductive rights — a move widely seen as a bid to challenge or narrow those protections.

As of late 2025, about a dozen states have near-total abortion bans, most with criminal penalties for providers.

Why it Matters

Laws like the one proposed in South Carolina show how quickly criminalization can extend beyond clinics to reach everyday people, families, and communities. They affect the care you can safely receive.

If you are pregnant, this might translate to fewer OB-GYNs practicing in your region, longer wait times for appointments, and doctors who might hesitate before giving you clear guidance or emergency treatment out of fear of prosecution.

If you live in a state with a ban, you may need to worry as much about how you’ll be treated during a pregnancy complication as someone seeking an abortion. Three women have already died in Texas as a result of these complications since the abortion ban went into effect.

Background

A growing number of bills are built on some version of fetal personhood, the idea that a fertilized egg, embryo, or fetus should be treated as a separate legal person. When states adopt laws based on that logic — whether directly or indirectly — doctors face real legal risk when treating any pregnancy complication. That fear can lead to delayed care for miscarriage, ectopic pregnancy, or severe pregnancy symptoms, because clinicians worry that acting too soon could be interpreted as harming the fetus.

South Carolina’s SB 323 attempted to widen who could face legal consequences. The bill included severe felony penalties for clinicians and language that could have punished people who helped someone seek out-of-state care, even by just sharing information. South Carolina has a long history of prosecuting pregnant women under drug and fetal-endangerment laws, so the bill’s failure does not close the door on future attempts.

The North Dakota ban's vague exceptions — requiring physicians to determine how “sick” a patient must be — have already prompted hospitals to revise protocols and left providers uncertain about what emergency care they can legally give.

While the Missouri proposals are almost certainly unconstitutional, they reflect a new tactic: using ordinary legislation to provoke court challenges, narrow the meaning of the amendment, or chill providers from offering care, even when the state's constitution protects it.

Quick Explainer

How can Missouri lawmakers introduce bills that conflict with the state's constitution?

A constitutional amendment, like Missouri’s 2024 right-to-reproductive-freedom amendment, is the highest form of state law. Legislatures cannot legally override it with ordinary legislation.

But lawmakers can introduce bills that contradict the constitution to:

• force test cases into the courts
• pressure judges to reinterpret or narrow the amendment
• create confusion or fear among providers
• signal political priorities
• lay groundwork for future ballot measures revisiting the amendment

Sometimes, unconstitutional laws can have a desired chilling effect, which in this case, might cause doctors, hospitals, and insurers to act defensively until courts intervene — which may take years.

In short, these bills cannot override the constitutional right, but they can undermine, confuse, or challenge it.

Resources

Fox Carolina - ‘A very difficult position’: South Carolina abortion bill could criminalize emergency contraception for assault victims
Center for Reproductive Rights - Abortion Illegal Again In North Dakota After Supreme Court Ruling
ProPublica - “Ticking Time Bomb”: A Pregnant Mother Kept Getting Sicker. She Died After She Couldn’t Get an Abortion in Texas.
KFF - Criminal Penalties for Physicians in State Abortion Bans