Lawmakers in Oklahoma have passed a bill that would impose a near-total ban on abortions in the state.
The bill would criminalise performing an abortion in almost all cases, except where it could "save the life of a pregnant woman in a medical emergency".
Medical professionals convicted under the laws face fines of up to $100,000 (£76,505) and 10 years in prison.
It comes as the US Supreme Court weighs a case that could overturn abortion rights across the US later this year.
Oklahoma's House of Representatives, in which Republicans hold a supermajority, voted to send the bill to the governor's office by 70 votes to 14.
The state's Governor Kevin Stitt will be presented with the bill for his approval. The Republican has already committed to signing into law any legislation that restricts abortion rights.
Republican Rep Jim Olsen, who authored the bill, said he was "thrilled" by its passage and said the legislation could see "many lives of babies saved".
But pro-choice groups say the bill is a devastating blow for women, noting it comes after the state became a major destination for women from neighbouring Texas seeking abortions after the passage of extremely restrictive laws in the state last year.
"Nearly half of the patients Oklahoma providers are currently seeing are medical refugees from Texas," a coalition of pro-choice groups said.
"Now, Oklahomans could face a future where they would have no place left in their state to go to seek this basic health care."
Tamya Cox-Toure, director of the American Civil Liberties Union of Oklahoma, said in a statement the bill serves as an "alarming reminder that the days of access to safe and legal abortion may be numbered, and we must continue to fight to guarantee all people have access to the essential health care they need, including abortion".
Republican dominated legislatures have been passing a series of restrictive abortion measures in recent years, designed to set up a showdown in the conservative-leaning Supreme Court.
The court is due to rule by the end of June on a case involving a Republican-backed Mississippi law which could see conservative justices overturn the Roe v Wade decision that legalised abortion under federal law in 1973.
The ruling could cut off abortion services for tens of millions of women and likely see similar laws bar abortion in nearly two dozen states.
A deterrent to medical professionals
By Angelica Casas, BBC News, Texas
The latest tactic in anti-abortion legislation is to target and punish providers.
When Texas last year passed the most restrictive abortion laws in the nation, some abortion providers I spoke to shut their services altogether, fearing reprimand. People seeking abortions were forced to find alternative options, like accessing abortion pills and travelling out of state.
Nearly half of Texans who left the state went to Oklahoma. That may no longer be an option once this law goes into effect there later this year.
"Legislation like SB 612 on its face is very chilling to people's willingness to practise in states that are this hostile to providers," says Zachary Gingrich-Gaylord of Trust Women, one of four abortion clinics in Oklahoma. "That's the point."
Supporters of the law, like State Senator Nathan Dahm, have boasted that the measure is now the "strongest pro-life legislation in the country". And they point out the law does not penalise women but the providers.
Trust Women has long depended on medical professionals from out of state to perform abortions because, they say, it's difficult to find local providers willing to go public about where they work.
"It makes it difficult to bring on even support staff in the clinic at a time that we're seeing an increased volume of patients," says Gingrich-Gaylord told me.
It is a victory for anti-abortion groups who say their priority is to protect the unborn.