Ohio legislators last month introduced a measure that would, if passed, become the most restrictive abortion law in the country.

The bill creates a new felony called “abortion murder,” making people who have or perform abortions subject to life in prison. It also includes a provision suggesting that doctors should attempt to reimplant an ectopic pregnancy in a patient’s uterus, a procedure medical experts say is not possible with current medical technology.

The legislation has not yet received a vote, but it’s already generated controversy around the world. For its sponsor, Ohio State Rep. Candice Keller, it’s a way to root out abortion in her state once and for all: “The time for regulating evil and compromise is over,” she said in a November statement.

But abortion-rights advocates say the bill puts Ohioans at risk of being jailed over an abortion or even dying as a result of an untreated ectopic pregnancy. “If this bill was to become law, the lives of anyone who can become pregnant would be endangered,” Lauren Blauvelt-Copelin, vice president of government affairs and public advocacy at Planned Parenthood Advocates of Ohio, told Vox.

Ohio has been the source of bills in the past that, initially disregarded as extreme, ended up becoming law: the first so-called “heartbeat” bill, banning abortion around six weeks into pregnancy, was introduced there in 2011. In 2018 and 2019, such laws passed not just in Ohio but in Iowa, Georgia, and elsewhere (though all have for now been blocked by courts).

Now, advocates say Ohio is again at the forefront of a drive to restrict abortion — this time, one that could erode protections for the life and health of pregnant people. Bills like the one in Ohio are meant to give fetuses and even fertilized eggs the same legal rights as pregnant people themselves, Mary Alice Carter, a senior adviser at the reproductive-rights group Equity Forward, told Vox. “When we do that, we create a very dangerous situation for people that are pregnant.”

The Ohio bill includes a provision for reimplanting an ectopic pregnancy, a procedure that doesn’t exist

Ohio House Bill 413, introduced on November 18, is 723 pages long. The bill has gotten attention in part for its striking language — it creates a new felony called “abortion murder.” Under the legislation, people would be guilty of this crime if they purposely “perform or have an abortion,” and could face 15 years to life in prison.

The bill also creates a crime called “aggravated abortion murder,” of which people could be found guilty if they “purposely perform an abortion while committing or attempting to commit kidnapping, rape, aggravated arson, arson, aggravated robbery, robbery, aggravated burglary, burglary,” or other crimes. For aggravated abortion murder, the maximum penalty is death.

The circumstances under which someone could be accused of aggravated abortion murder are somewhat unclear. “Show me the person that can perform an abortion while committing arson, and I’ll show you a person who is remarkably good at multitasking,” Imani Gandy wrote at Rewire.News.

But the new crimes are notable in large part because they would apparently allow patients to be charged with a felony for ending their pregnancies. A spokesperson for Keller told Vox that “the intent of the bill is towards the doctors, it’s not toward punishing the women that are going through these crisis situations.” But as written, the bill would appear to allow Ohioans to be sentenced to life in prison for getting an abortion.

Mainstream anti-abortion groups typically do not support punishments for pregnant people who seek or get abortions. But Ohio isn’t the first state to introduce the possibility of such punishment — a Texas bill introduced earlier this year would make it possible for people who get abortions to be sentenced to death.

Ohio does appear to be first in something else, however. HB 413 includes an exception for doctors who perform an abortion in order to save a patient’s life. In order to be exempt from prosecution, though, the doctor must take “all possible steps to preserve the life of the unborn child, while preserving the life of the woman.”

Such steps, the law states, “include, if applicable, attempting to reimplant an ectopic pregnancy into the woman’s uterus.”

Doctors, however, say no procedure to reimplant an ectopic pregnancy into a woman’s uterus exists. Ectopic pregnancies happen when a fertilized egg attaches, not to the uterine wall, but elsewhere in the reproductive system, usually in a fallopian tube. These pregnancies are not viable, and if left untreated, they can result in a ruptured fallopian tube, hemorrhage, and even death. In most cases, doctors say the only treatment is to terminate the pregnancy with medication or surgery.

However, there’s a growing movement among abortion opponents to argue that ectopic pregnancies can be moved and reimplanted. Earlier this year, writer Georgi Boorman at the conservative website the Federalist mentioned the possibility as part of a larger argument that abortion in the case of ectopic pregnancies was unnecessary. Medical professionals — including some who identify as pro-life — responded that reimplantation is not possible. “To my knowledge we are nowhere near having the technology to do that,” Ingrid Skop, chair of the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG), told Vox at the time.

Boorman ended up issuing a retraction and apology. But she wasn’t the only one talking about the idea of reimplantation. The idea had already made its way into a different Ohio bill, this one restricting insurance coverage for abortion. The bill contained a special provision allowing insurance companies to cover “a procedure for an ectopic pregnancy that is intended to reimplant the fertilized ovum into the pregnant woman’s uterus.”

The sponsor of that bill, Republican Ohio State Rep. John Becker, is a co-sponsor of HB 413 as well.

It could be part of a nationwide trend toward banning abortion with no exceptions — even for a pregnant person’s life

Neither bill has yet passed, and supporters say they’re just looking to the future, when reimplantation could be possible. “If there is a way to save both mother and child, we’d like to see that demonstrated,” the Keller spokesperson told Vox.

But others say the emphasis on a medical procedure that doesn’t exist could set a dangerous precedent. Language about reimplantation — along with the broader argument that abortion is not necessary in cases of ectopic pregnancy — could result in a narrowing of protections for the life and health of pregnant people in abortion law, Carter, the Equity Forward adviser, said.

The current standard of care for ectopic pregnancies in most cases is to treat them with medication or surgery as soon as they are identified, Carter noted. But by introducing the idea that ectopic pregnancies can be saved, abortion opponents could push doctors to wait until a patient is near death before taking action — potentially making serious or even fatal complications more likely.

And ultimately, the focus on ectopic pregnancies may be part of a larger argument that abortion is never necessary, even to save a person’s life. Keller, the sponsor of HB 413, said in November that “the time has come to abolish abortion in its entirety and recognize that each individual has the inviolable and inalienable right to life.”

While the Ohio bills appear to be the first in the country to include language around ectopic pregnancy, the idea could spread, abortion-rights advocates say.

“Ohio has been a breeding ground for very dangerous anti-abortion, anti-reproductive health bans and restrictions” in the past, Blauvelt-Copelin, the Planned Parenthood Advocates of Ohio vice president, said. She noted that the first-ever “heartbeat” bill, banning abortion as soon as a fetal heartbeat can be detected, was introduced in Ohio in 2011. The bill didn’t pass at the time and wasn’t even supported by some anti-abortion groups in the state.

But over time, such legislation, which bans abortion at as early as six weeks’ gestation, before many people know they are pregnant, gained traction around the country, and similar bans have now passed in multiple states.

Something similar happened with the idea of exceptions in abortion law for people who become pregnant as a result of rape or incest. A few years ago, Carter said, most abortion opponents accepted the idea that abortion restrictions should include such exceptions. Now, several laws around the country, including a ban on abortion at all stages of pregnancy in Alabama, have no exception for rape or incest. A similar thing could happen with exceptions for the health and life of the pregnant person, Carter said: “What we’re seeing is an upping of the ante.”

The Alabama law and all of the six-week bans have been blocked by courts, and Blauvelt-Copelin said that if HB 413 were to pass, Planned Parenthood would fight it in court as well. However, she said, “we see that this is the direction that anti-abortion politicians want to move our state and our country in, so we have to take these bills very seriously.”