Republican lawmakers in North Carolina, one of the few Southern states where abortion remains legal and accessible, passed a 12-week abortion ban that could further weaken access in the region. The bill now goes to the governor’s desk.

Party-line approval from the Republican-controlled state Senate came Thursday afternoon, less than 24 hours after Senate Bill 20 passed the House. 

Thursday’s debate spanned hours, including often emotional testimony as Democratic lawmakers shared their own experiences with pregnancy and miscarriage, and discussed concerns from physicians in North Carolina who had condemned the state’s proposed restriction. At times, lawmakers sparred over whether it was appropriate to characterize the legislation — which outlaws abortion after 12 weeks — as a “ban,” with Republicans arguing that the word never appears in legislative text.

North Carolina’s Democratic Gov. Roy Cooper said he would veto the bill, but Republicans can override that veto if they all vote together — which Republican speaker Tim Moore said Thursday morning that he expects to happen. Rep. Tricia Cotham, a former Democrat who recently switched to the Republican Party, and who previously spoke in favor of abortion rights, joined House Republicans to vote for the ban.

The fast-tracked passage of the bill comes a day after Senate President Pro Tempore Phil Berger announced in a Tuesday evening news conference that Republicans, after months of secret negotiations, had “come to an agreement” on what he called a “common sense reasonable approach to restricting second and third-trimester abortions and addressing maternal and infant care” with tens of millions in investments in health care, foster care, adoption services, child care and paid leave.  

The proposed legislation bans most abortions at 12 weeks but allows exceptions for rape and incest through 20 weeks, for fatal fetal abnormalities through 24 weeks and to save the life of the pregnant person throughout pregnancy. 

The legislation would also impose new requirements for people seeking abortions that could make it harder for patients to get in under a 12-week limit — particularly those traveling from out of state to get an abortion, a group that has grown substantially since Roe v. Wade was overturned last summer. Patients in North Carolina would be required to make two in-person visits to an abortion clinic, separated by 72 hours.

Currently, the state enforces a 72-hour waiting period, but patients can complete the first visit over the phone. The bill also would prohibit mailing medication abortion pills, which in 2020 were used for the majority of abortions. It would also ban people from seeking an abortion if they are doing so “in whole or in part” because the fetus appears to have Down syndrome. The bill also would impose new licensing requirements and higher fees for abortion clinics to remain certified in North Carolina. 

“As I listen to the bill summary. I was wondering why you didn’t allocate money for women to hire a lawyer to help navigate through all these new laws y’all put in place,” Democratic Sen. Jay Chaudhuri said in a Wednesday morning hearing. “This bill purports to allow an abortion during the first 12 weeks, but this body has put in place a 46-page bill of government red tape.”

These types of restrictions have long been criticized by physicians, who note that there is no medical reason to ban the procedure at 12 weeks specifically, or to impose a waiting period for abortion. The Food and Drug Administration has also found that medication abortions can be safely performed without any in-person visits to a health care facility. Medical providers have endorsed mailing pills as a mechanism to help people access care if they cannot make the journey to a clinic, and abortion providers seeing an increase in out-of-state patients have relied on medication abortion to expand capacity. 

Democratic Sen. Julie Mayfield called the new regulations and informed consent requirements “an insult” to women in the Wednesday hearing, noting that the majority of women seeking abortions in North Carolina already have children. 

The requirement for an in-person consultation and follow-up, she argued, “effectively bans abortion for most working women, and certainly all of the women who are coming into North Carolina from out of state.”

The legislation is less restrictive and makes more significant investments in state-funded family programs than the six-week or total abortion bans Republican lawmakers in other Southern states have pursued since the fall of Roe v. Wade, including a recently passed six-week ban in Florida. Unlike the Florida bill, the legislation doesn’t require rape and incest survivors to show documentation to receive an abortion past 12 weeks, but instead relies on doctors reporting that information to state health authorities. Still, patients would have to inform their physicians to qualify.

North Carolina, where abortion is currently legal through 20 weeks, is a critical access point for the entire South. Though historically, the vast majority of abortions have occurred in the first trimester, the gestational limits proposed in the bill could have the most impact by limiting the window for patients from other states to receive care in North Carolina. Even now, wait times for an abortion in North Carolina can be four weeks.

If patients as far south as Miami are unable to get an appointment in North Carolina, the next closest options would be the three clinics operating in South Carolina — which provide abortions up to 14 weeks — or providers in Virginia, Washington, D.C., or Illinois. A proposed abortion ban in South Carolina barely failed to pass the state’s Senate, and the state could still pass a six-week ban before its legislative session ends next week.

Currently, 13 clinics provide abortions in North Carolina. In the first six months since Roe was overturned, the state saw an increase of 4,730 abortions compared with April 2022 — an average of 788 more abortions per month.

Jenny Black, CEO of Planned Parenthood South Atlantic, said in April that the state’s network of clinics and providers, already under serious strain by the increased demand, is preparing for another influx of out-of-state patients if and when Florida’s six-week ban takes effect later this year. 

“For us, adding an appointment day doesn’t just mean, ‘Do I have a doctor available?’ It also means, ‘Do I have a nurse for the recovery room?’” she said. “I can’t just add an appointment day tomorrow in North Carolina because all of these patients have to sit through a 72-hour consent period. It just becomes this very complicated algorithm, but we do it on a daily basis.” 

The bill in North Carolina also makes investments toward paid leave and child care. The bill would increase foster care funds, adoption assistance funds and tax credits; increase funds for community health centers to provide contraception; and put funds toward preventing infant mortality and pregnancy-related death. It also increases Medicaid reimbursement rates and matching of federal funds for prenatal care, allocates $32 million in the next fiscal year to increasing child care market rate subsidies and grants $10 million to fund paid parental leave for teachers and other state employees. 

Republican lawmakers framed the legislation as “pro-woman,” arguing that the bill would support families and improve health outcomes for mothers.

“We are pleased that the unborn will be recognized as having a fundamental right to be born and mothers will get our unconditional support,” Rep. Sarah Stevens said in the Tuesday news conference. “It’s time to catch up with the science that affirms parenthood before birth. This is a pro-woman, holistic approach.”

The final product reflects the narrow margins Republicans have in the legislature to overcome a veto from Cooper. 

Republicans are also facing persistent electoral backlash to strict abortion bans, which are highly unpopular with the public. In the past week, Republican lawmakers in neighboring South Carolina and in Nebraska narrowly failed to pass new restrictive abortion bills. Republican donors have criticized Florida Gov. Ron DeSantis — expected to soon declare as a presidential candidate — for his support of the state’s six-week ban.

The legislature’s pursuit of new restrictions means abortion is also likely to be a major issue in North Carolina’s open governor’s race in 2024, the most competitive in the nation. According to a 2022 poll by PRRI, 11 percent of North Carolinians say abortion should be illegal in all cases and 62 percent say it should be legal in most or all cases. It’s unclear how voters will see a 12-week ban with exceptions, but the legislature passing this bill will keep the issue in the public discourse. 

“The electorate has spoken not only across the country, but also in North Carolina, that they don’t tend to like extreme stuff,” Chaz Beasley, a former Democratic state representative said in April. “Our state is a closely-divided state and you can’t get too far ahead of the people in North Carolina, or else they will make you pay a price at the ballot box.”