The South Carolina miscarriage bill, formally H. 3537 or the Prenatal Equal Protection Act, would define legal personhood as beginning at fertilization and extend the state’s homicide and assault laws to cover embryos and fetuses at every stage of pregnancy. It carries a stated exemption for spontaneous miscarriage, but physicians, legal scholars, and reproductive rights groups warn the exemption is narrow enough that pregnancy losses could still be investigated and prosecuted. As of mid-2026, the bill has had a subcommittee hearing but has not advanced out of committee.
What H. 3537 Would Actually Do
The bill rewrites the definition of “person” in the state criminal code to include “an unborn child at every stage of development from fertilization until birth,” and it defines fertilization as the fusion of a human sperm cell with a human egg. That single change pulls embryos and fetuses inside the existing homicide and assault statutes. Solicitors and the state Attorney General would share authority to bring cases.
Enforcement would run through the same “presumptions, defenses, justifications, laws of parties, immunities, and clemencies” that apply when the victim is a born person. If the mother is the one charged, the bill gives her a narrow affirmative defense: she has to show she “was compelled to do so by the threat of imminent death or great bodily injury.” The bill also says any person can be compelled to testify in these cases in exchange for immunity from prosecution for the acts described, except for perjury.
Because the 2023 predecessor bill drew national attention for exposing women to penalties up to and including the death penalty under existing sentencing law, that structural point has not changed in H. 3537: abortion would be prosecuted as homicide, with all the sentencing consequences homicide already carries in South Carolina.
The Miscarriage Exemption and Why Critics Say It’s Narrower Than It Reads
The bill states that its homicide and assault provisions “shall not apply to the unintentional death of an unborn child” that results from a “spontaneous miscarriage,” which it defines as “the natural or accidental termination of pregnancy and the expulsion of the unborn child.” It also exempts life-saving procedures performed on the mother when accompanied by “reasonable steps, if available, to save the life of her unborn child,” and it shields licensed physicians and healthcare providers from criminal liability for “mistake or unintentional error.”
The Guttmacher Institute warned in a January 2026 analysis that under the bill’s personhood framework, “miscarriages, stillbirths, pregnancy complications, and self-managed abortions could all be questioned by law enforcement,” because any loss authorities deemed potentially intentional or negligent could fall outside “spontaneous.” The exemption only covers unintentional deaths. A prosecutor who suspected a woman’s conduct contributed to a miscarriage could argue the exemption does not apply and file charges.
The affirmative defense is where the practical burden lands. To use it, the mother has to prove she acted under the threat of imminent death or great bodily injury. That flips the usual arrangement in a criminal case, where the state must prove guilt; here the woman is proving her own innocence against a defined and demanding standard.
Women in South Carolina Have Already Been Charged After Miscarriage
The concern that a miscarriage could become a criminal investigation is not theoretical in South Carolina. In March 2023, Amari Marsh, a 22-year-old college student in Orangeburg County, experienced a pregnancy loss at home. She was arrested and charged with homicide by child abuse, a charge that carries 20 years to life in prison. According to her attorneys, the state’s theory rested in part on the allegation that Marsh waited roughly 10 minutes before calling 911. She spent 22 days in jail. An autopsy later confirmed the pregnancy loss resulted from a medical condition. In August 2024, a grand jury declined to indict her and the First Circuit Solicitor agreed with that decision. Marsh told reporters she had not known she was pregnant.
An earlier South Carolina case involved Regina McKnight, who was charged with homicide by child abuse after a stillbirth that prosecutors attributed to cocaine use. Her conviction was reversed after the cause of death was determined to be an infection.
These prosecutions happened under existing law. According to Pregnancy Justice, there were at least 210 pregnancy-related criminal prosecutions in the first year after the Supreme Court’s 2022 Dobbs decision, the highest annual figure recorded since 1973, and 412 across 16 states in the two years after Dobbs. Nearly all cases involved allegations of substance use during pregnancy, and in most, prosecutors did not have to prove the fetus or infant was actually harmed. More than 75 percent of defendants were identified as low-income. Between 2006 and 2022, researchers documented nearly 1,400 cases in which pregnant women faced criminal charges they would not have faced but for their pregnancy. Two-thirds of those arrests happened in just three states: Alabama, Oklahoma, and South Carolina, each of which had already expanded the legal definition of “child” or “person” to include fetuses and embryos.
Where the Bill Stands Now
H. 3537 was introduced in January 2025 by Rep. Rob Harris and members of the South Carolina Freedom Caucus, with cosponsors including Reps. Magnuson, Chumley, Burns, Long, Beach, Huff, Rankin, Sanders, Frank, and Lastinger. It was referred to the House Judiciary Committee. On January 14, 2026, it received a hearing before the House Constitutional Laws Subcommittee. As of mid-2026, it has not advanced.
Its 2023 predecessor, H.B. 3549, was nearly identical and collapsed under public backlash. Nine Republican cosponsors withdrew their names once observers pointed out that classifying abortion as homicide could expose women to the death penalty under existing sentencing law. House Speaker Murrell Smith said “the House has no intentions of taking this bill up” and that the chamber was not “in the business of criminalizing women.” Senate Majority Leader Shane Massey called it a “rogue thing” with “zero chance” of becoming law. It died in committee without a hearing. Many of those same legislators reintroduced substantially the same text as H. 3537.
Related Bills That Could Affect Miscarriage Care
H. 3537 is one of several proposals moving in Columbia. Two others matter directly to how miscarriages are treated, because they touch the medications used to manage them.
H. 4760 would reclassify mifepristone and misoprostol as Schedule IV controlled substances and make it a felony to knowingly deliver, distribute, or possess these drugs for an unlawful abortion, with penalties up to 50 years in prison in cases involving the death of a minor. It exempts the pregnant woman from prosecution for possession for her own use and permits medical professionals to use the drugs in emergencies. The House passed it in February 2026 on 81–31 and 76–28 votes, and the Senate Medical Affairs Committee reported it favorably in May 2026.
S. 1095, introduced by Sen. Richard Cash in April 2026, would impose a near-total abortion ban, classify abortion drugs as Schedule IV controlled substances, remove exceptions for rape and incest, and make it a misdemeanor for a woman who self-induces an abortion, punishable by up to two years in prison. The Senate Medical Affairs Committee voted 8–4 to advance it. Senate Republican leadership signaled it was not a priority, Sen. Tom Davis vowed to block it, and Governor Henry McMaster has expressed opposition, favoring the existing six-week ban. An earlier version, S. 323, was stalled in a November 2025 subcommittee vote of 2–3.
South Carolina currently operates under a six-week abortion ban, the “heartbeat law,” upheld by the state Supreme Court, which prohibits abortions after fetal cardiac activity is detected and allows exceptions for rape and incest up to 12 weeks.
Why the Drug Reclassification Matters for Miscarriage
Mifepristone and misoprostol are not only abortion drugs. The American College of Obstetricians and Gynecologists recommends the combination as the protocol for miscarriage management. According to data analyzed by KFF, roughly half of outpatient misoprostol prescriptions covered by Medicaid in states like Texas and Missouri are for miscarriage management, and 94 percent of non-abortion-related mifepristone claims are for miscarriage care.
Reclassifying these medications as Schedule IV would require special storage, electronic ordering through pharmacy systems, and DEA licensing for prescribers. Patricia Seal, South Carolina’s chair of ACOG, testified that a patient experiencing postpartum hemorrhage could face a 15-to-20-minute delay in receiving misoprostol under the new requirements, compared to immediate administration under current practice. Hemorrhage during labor and delivery accounts for 14 percent of pregnancy-related deaths nationally.
ACOG has stated that personhood measures “can be used to attach criminal liability to the conduct of pregnant individuals regarding their own health, as well as to the conduct of clinicians providing evidence-based care.” Physicians in states with strict abortion restrictions have reported hesitating to provide standard miscarriage care out of fear of prosecution.
The Maternal Health Backdrop
South Carolina ranks eighth-worst in the country for maternal mortality, with a rate of roughly 31.5 maternal deaths per 100,000 live births according to United Health Foundation data covering 2019 to 2023. The South Carolina Department of Public Health puts the 2021 figure at 47.2 per 100,000 using criteria that extend further into the postpartum period. Black women in South Carolina die from pregnancy-related causes at rates two and a half to four times those of white women. The state’s own health department has found that almost 90 percent of pregnancy-related deaths are preventable and that discrimination was a contributing factor in over 25 percent of those deaths between 2018 and 2021.
Fourteen of the state’s 46 counties have no practicing OB-GYN, and rural women travel an average of 26.3 miles to the nearest birthing hospital, with distances exceeding 40 miles in some counties. Dr. Beth Cook, a South Carolina obstetrician-gynecologist, said the repeated introduction of bills like H. 3537 “demonstrates a complete lack of regard for women and their access to health care.” The Center for Reproductive Rights, in a formal letter opposing S. 1095, cited South Carolina’s 29.5-per-100,000 maternal death rate and warned that further restricting abortion access and miscarriage treatment would deepen existing disparities for Black women, immigrants, and low-income residents.