Lawmakers Look to Redefine Abortion as State Bans Take Hold

State Republican lawmakers are trying to separate miscarriages and ectopic pregnancies from abortion in medical records and elsewhere, spurring outcry from policy watchers who say the measures tarnish reproductive care.

Traditionally, abortion care includes treatment for miscarriages or to save the life of the mother. Lawmakers in a handful of states have put forth measures to distinguish elective abortions from those done for other reasons, an approach whose proponents say spares women from feeling stigmatized, maintains more accurate medical documentation, and ensures proper care is provided.

But critics say that legislation—pushed in states hostile to reproductive rights such as Louisiana, Utah, and South Carolina—would shame people for getting abortions and make it harder for physicians to provide care. The bills, they say, aren’t grounded in medical science, but rather try to characterize some abortions as good and others as bad.

“These bills tie providers’ hands, impacting their ability to provide care,” said Tristan Sullivan-Wilson, Planned Parenthood senior policy counsel. “Instead of adding unnecessary restrictions and fake definitions, lawmakers should focus on making it easier for providers to do their jobs and expanding access to essential health care.”

Since the US Supreme Court’s 2022 Dobbs v. Jackson Women’s Health Organization decision stripping federal abortion rights, conservative states have moved to enact restrictions. As of March 2026, policy group KFF tallied around a dozen states that had banned abortion. Separately, KFF found that as of February 2025, 11 states with bans had criminal penalties for physicians, with violators in Texas and Alabama looking at sentences of up to 99 years or life.

Bills seeking to alter the language around abortions stem from this wave of restrictions, fueled by the “horrific medical outcomes” for and deaths of people denied care, said Kimya Forouzan, principal state policy adviser for Guttmacher Institute.

Post Dobbs, Forouzan said, there have been bills to enumerate the types of definitions that fall under exceptions. With medical records, going beyond standard terminology helps make abortion bans feel more “palatable.”

“They’re trying to push forth the idea that abortion care is not something that’s ever medically indicated,” and that this care is something besides abortion, Forouzan said.

Weighing Terms

Changing the legal definition of what is and isn’t an abortion can also extend beyond medical records.

South Dakota’s HB 1257, signed into law in March, splits treatment for ectopic pregnancies and miscarriages from the definition of abortion. The state bans abortions with limited exceptions, such as to save the mother’s life.

Republican State Rep. Les Heinemann, who sponsored the bill, said there had been allegations from “the pro-abortion side” that “the medical community didn’t have clarity as to what was truly a miscarriage or an ectopic pregnancy, and whether there was the legal authority to be able to treat them.”

State Sen. Tamara Grove (R), who also pushed the legislation, said “‘what this bill does is it says, look, this is not an abortion. If you have an ectopic pregnancy, if you have a miscarriage, you are not having an abortion. Go seek help immediately.”

“It’s more along those lines of how can we come alongside the moms and ensure that in the worst-case scenarios of ectopic or miscarriage that they have the kind of care that they need,” Grove said.

‘Culture of Fear’

Some observers, however, believe altering abortion definitions—particularly in medical records—could discourage people from seeking care.

Louisiana is among the most restrictive states on abortion in the country. Louis Monnig, an OB-GYN in the state and a Physicians for Reproductive Health fellow, has provided care for a patient needing admission to the intensive care unit because they’d delayed too long coming to the hospital for bleeding.

That scenario, Monnig said, could become more commonplace should legislatures begin “dictating and requiring” the type of medical documentation called for in Louisiana’s HB 288. The bill says medical records may add the term “miscarriage” in parentheses after their medical term, “spontaneous abortion.”

The bill has no basis in medicine and seems like “it’s there to create a culture of fear” around abortion, Monnig said.

Meanwhile, a measure was introduced in South Carolina to stop miscarriages from being labeled abortions in patient medical records.

State Rep. Melissa Lackey Oremus (R), who sponsored the bill, said that during testimony on abortion, women said they were surprised to have their medical records state they’d had abortions rather than miscarriages.

“There are women that carry that with them, and they just don’t want that written as such. And it’s just a negative stigma that comes along with that,” Oremus said.

Such medical record legislation contributes to the idea that abortion is “special care that you don’t really need,” said Nourbese Flint, president of All* Above All.

‘False Binary’

Hector Chapa, a Texas OB-GYN and member of the American Association of Pro-Life OBGYNs, said that changes to medical billing language are important for medical accuracy.

“Think about this confusion, both when miscarriage is used and an abortion is used,” Chapa said.

In Utah, where abortion is banned after 18 weeks, the state’s House passed HB480, which would allow for patients to ask that their medical records reflect when a previous abortion wasn’t elective.

Still, Planned Parenthood’s Sullivan-Wilson said medical records legislation “creates a false binary of good and bad abortions,” leaving providers with unclear medical information on a patient, making “every provider after them less able to provide appropriate and fully informed care.”

“Abortion is just the medical term,” and any stigma or fear someone feels from the word is “a direct result of the decades-long anti-abortion playbook,” Sullivan-Wilson said.

Legislatively bifurcating good from bad abortions “can lower the threshold for further bans” and is “laying the groundwork for further restrictions.”