South Carolina Heartbeat Law: Exceptions, Penalties, and Pending Changes

The South Carolina heartbeat law, formally the Fetal Heartbeat and Protection from Abortion Act, bans most abortions once cardiac activity can be detected on ultrasound, which is often around six weeks of pregnancy. Governor Henry McMaster signed it on May 25, 2023, and the South Carolina Supreme Court has upheld it twice. The law targets providers, not patients, and allows an abortion after heartbeat detection only in three narrow situations: a medical emergency, a pregnancy resulting from rape or incest (up to 12 weeks), or a fatal fetal anomaly.

When the Ban Takes Effect

The law does not name a specific gestational week. Instead, it keys the ban to detection. Section 44-41-610(6) defines “fetal heartbeat” as cardiac activity, meaning the steady and repetitive rhythmic contraction of the fetal heart within the gestational sac.¹ On May 14, 2025, the South Carolina Supreme Court affirmed the Act and held that the ban is triggered when electrical impulses from the developing heart are first detectable as a steady, repetitive rhythmic contraction using diagnostic medical technology such as a transvaginal ultrasound.²

Because transvaginal ultrasounds can pick up cardiac activity earlier than abdominal ones, the practical cutoff varies. Most providers treat six weeks as a rough guideline, but the actual line is whatever the ultrasound shows for a specific pregnancy.

What Must Happen Before Any Abortion

Under Section 44-41-630(A), a provider must perform an ultrasound before any abortion, display the images so the pregnant woman can view them if she chooses, and document a written medical description of the fetal heartbeat if one is present and viewable.¹

Section 44-41-330 layers on informed-consent duties. Before the ultrasound, the physician or an allied health professional must tell the woman she has the right to view the live images and hear the heartbeat, if present. If a heartbeat is detected, the physician must give written notice of that fact and inform the woman of the statistical likelihood of carrying the pregnancy to term based on gestational age.³ No abortion may proceed without voluntary, written, informed consent under Section 44-41-620.¹

The Three Exceptions

Once a heartbeat has been detected, an abortion is only lawful if one of three exceptions applies. Each carries its own documentation rules and its own penalties for providers who invoke the exception incorrectly.

Medical Emergency

Section 44-41-640 allows an abortion after heartbeat detection when a medical emergency threatens the pregnant woman’s life or poses a serious risk of substantial and irreversible impairment of a major bodily function. The statute explicitly excludes psychological and emotional conditions from that definition. The physician must document the nature of the emergency, the medical condition that made the abortion necessary, and the rationale for concluding the procedure was needed to prevent death or serious physical harm.⁴

The physician must also make reasonable medical efforts to preserve the life of the unborn child during the procedure, provided doing so does not increase the risk of death or serious physical harm to the woman. Records must be kept for at least seven years.⁴

Rape or Incest

Section 44-41-650 permits an abortion after heartbeat detection if the pregnancy resulted from rape or incest, but only if the probable gestational age is no more than 12 weeks.⁵ Gestational age is measured from the first day of the last menstrual period, not the date of the assault, so the practical window is often much shorter than it sounds.

The reporting obligation attached to this exception is significant. The physician must report the rape or incest allegation to the sheriff of the county where the abortion was performed within 24 hours, and that report must include the pregnant woman’s name and contact information. Before performing the procedure, the physician must tell the woman that this report will be filed. All of these steps must be noted in her medical records.⁵

Fatal Fetal Anomaly

Section 44-41-660 allows an abortion when the fetus has a fatal anomaly, meaning that even with available treatment, life after birth would be unsustainable. This exception has no gestational time limit. The physician must document the specific anomaly, its nature, and the medical rationale supporting the conclusion that the fetus could not survive, and must maintain those records for at least seven years.⁶

Pregnant Women Cannot Be Prosecuted

Section 44-41-670 bars any criminal prosecution of the pregnant woman. A woman who receives an abortion in violation of the Act cannot be charged with any crime under the Act, cannot be charged with attempting or conspiring to violate it, and cannot face any civil or criminal penalty tied to the procedure.¹ Enforcement runs entirely against providers.

Penalties Providers Face

Performing an abortion in violation of the Heartbeat Act is a felony. It carries a fine of up to $10,000, imprisonment for up to two years, or both. The penalty appears in Section 44-41-630(B) for the core prohibition and is repeated in each exception section for providers who claim an exception but fail to meet its requirements.¹ Penalties for record-keeping failures by medical facilities can reach $50,000.⁶

Section 44-41-690 adds a licensing layer. Any physician or other licensed professional who intentionally, knowingly, or recklessly violates the ban commits unprofessional conduct. The State Board of Medical Examiners must revoke a violating physician’s license after due process, and other licensing boards must do the same for non-physician professionals. Boards can also assess investigation costs and additional fines.¹

Emergency Rooms and Federal Law

The federal Emergency Medical Treatment and Labor Act (EMTALA) requires nearly every hospital to screen and stabilize patients with emergency medical conditions. When the stabilizing treatment for a pregnancy complication would end the pregnancy, EMTALA can collide with state bans.

This area is unsettled. In June 2025, the federal Department of Health and Human Services rescinded earlier guidance that had specifically reinforced EMTALA’s application to pregnancy emergencies in states with abortion bans. HHS Secretary Robert F. Kennedy Jr. stated that EMTALA still ensures pregnant women facing medical emergencies have access to stabilizing care, but the agency did not issue new guidance clarifying how that duty intersects with laws like South Carolina’s. The U.S. Supreme Court declined to resolve the core question in 2024, and the Department of Justice dropped a related suit against Idaho in March 2025. In practice, the Heartbeat Act’s medical emergency exception covers many of the same scenarios EMTALA would require treatment for, but gaps remain where the two standards do not fully overlap.

A Pending Change to the Rape and Incest Exception

In February 2025, South Carolina legislators introduced Senate Bill 323, the “Unborn Child Protection Act,” which would eliminate the rape and incest exceptions from Section 44-41-650 entirely.⁷ If it passed, only the medical emergency and fatal fetal anomaly exceptions would remain. The bill was referred to the Senate Medical Affairs Committee and had not advanced beyond that point as of mid-2025. Anyone counting on the rape or incest exception should know it could be narrowed or removed in a future session.

1
South Carolina Legislature. South Carolina Code Title 44, Chapter 41 – Abortions
2
Justia. Planned Parenthood v South Carolina (2025)
3
South Carolina Legislature. South Carolina Code 44-41-330 – Conditions for Performing Abortion
4
South Carolina Legislature. South Carolina Code 44-41-640 – Exceptions for Medical Emergencies
5
South Carolina Legislature. South Carolina Code 44-41-650 – Exceptions for Rape and Incest
6
South Carolina Legislature. South Carolina Code 44-41-660 – Exception for Fatal Fetal Anomaly
7
South Carolina Legislature. 2025-2026 Bill 323 – Unborn Child Protection Act