The state Senate approved the bill 22-7 after a brief debate on Tuesday. The state House agreed and passed the bill by a vote of 78-17. The ban will take effect 90 days after it is passed. West Virginia Republicans pushed ahead with the strict ban despite signs elsewhere in the country that many American voters do not support the Supreme Court decision and largely oppose tougher restrictions on abortion. A similar effort to pass a near-total abortion ban in South Carolina failed last week, and voters overwhelmingly rejected a ballot measure in Kansas that would have stripped abortion protections from the state constitution. Abortion has been legal up to 20 weeks in West Virginia since July, when a state judge blocked a preRoe ban dating back to the 19th century. The state borders several anti-abortion strongholds in the Midwest and South, including Ohio and Kentucky. Abortion is legal east of the state line in Virginia, Maryland, and Pennsylvania. In West Virginia, the Republican-controlled legislature reached a compromise on penalties for doctors who perform illegal abortions, a sticking point for some conservative lawmakers. The bill they voted for, which now goes to Republican Gov. Jim Justice’s desk, bans implantation abortion with minor exceptions to save the life of the pregnant woman or in cases of rape or incest, as long as the victim reports the crime. Justice has indicated he will sign a bill tightening state restrictions on abortion. Exceptions for victims of rape or incest limit the procedure to before eight weeks of pregnancy, or 14 weeks for those under 18. Doctors who violate the law may lose their medical license but will not face criminal penalties. Anyone other than a licensed physician with hospital admitting privileges who performs an abortion faces felony charges and up to five years in prison. Those who perform abortions face no penalties. West Virginians support abortion restrictions more than voters in most other states. A 2018 referendum on a constitutional amendment affirming that “nothing in this Constitution guarantees or protects the right to abortion or requires the funding of abortion” passed with the support of about 52 percent of voters. But some lawmakers have raised concerns that tough criminal penalties could drive doctors, especially obstetricians, out of state at a time when some areas are known to be “maternity deserts” already facing physician shortages. “Aren’t you worried we could lose the docs practicing OB because of this?” state Senate Minority Leader Stephen Baldwin (D) asked after the amended version of the bill was introduced, referring to midwifery. He also questioned why the Senate was choosing to vote on the new language without giving doctors a chance to weigh in. “We had a lot of time where we could have involved documents, but now, today, we’re going to vote on this … and they haven’t had time to read it,” Baldwin said. Sen. Tom Takubo (R), who opposed an earlier version of the bill and supported removing criminal penalties for doctors, said he believes the new language addresses doctors’ fears that they could be prosecuted for trying to save lives of a patient suffering from a life-threatening complication of pregnancy. “I think once they read what’s in this amendment, they’ll feel comfortable,” he said. “I feel this protects those doctors who are not trying to break the law.” Some anti-abortion Republican senators opposed the amended bill because they felt it did not go far enough to restrict abortions. “I am confident that this bill closes the abortion clinic,” said state Sen. Eric Tarr (R), who urged his colleagues to vote no on the new language because he said it contained too many exemptions. 1 in 3 American women have already lost access to an abortion. More restrictive laws are coming. “I am also divided and disappointed that my vote now is to decide when you execute an innocent person,” he added. “If life is sacred, when does it become sacred?” About 100 protesters gathered outside the Senate chamber Tuesday to oppose the bill and could be heard inside the state Capitol as senators debated the bill. Some observers in the Senate gallery briefly disrupted the chamber after the amended bill was introduced, shouting their dissent. Although West Virginians widely support some abortion restrictions, abortion access advocates say the bill still goes against the will of the state’s voters. “West Virginia lawmakers are working to ban abortion in our state, taking us back to the 19th century,” said Margaret Chapman Pomponio, executive director of WV Free, the largest abortion rights advocacy organization. “They plow ahead, despite recent polls showing nearly half of West Virginians identify as pro-choice and a strong majority opposes this draconian legislation.” Some state House members have suggested backing off the bill and instead putting the question directly to voters. They cited the ballot measure rejected in Kansas last month and suggested West Virginia voters might surprise lawmakers at the polls. West Virginia’s governor has rejected suggestions that voters should directly decide the state’s abortion laws. “Descending from the U.S. Supreme Court, it’s the responsibility of our legislature and our attorney general,” Justice said in August. Justice called lawmakers back to the West Virginia Capitol for a special session to consider tighter abortion restrictions in July. Days later, the state House approved an initial version of a near-total ban. But the bill stalled when the state Senate deadlocked over criminal penalties for doctors who perform illegal abortions that included fines and jail time. The Senate eventually passed a bill that removed many of the penalties for doctors, but the House refused to agree. State senators and House representatives spent more than a month trying to reach a compromise that could pass the bill in both chambers. Ultimately, the two chambers were able to find common ground and on Tuesday voted to pass the new version of the bill, without criminal penalties for doctors. Earlier this year, Indiana lawmakers passed the first new abortion ban since the fall of Roe.