Background: In March 2019 the Georgia legislature passed HB 481 described as a “heartbeat bill”, prohibiting abortion at around six weeks gestation. Given the prevalence of anti-abortion legislation and the public health implications of abortion restrictions, we sought to understand how Georgia legislators made decisions on this early abortion ban legislation.

Methods: We conducted in-depth interviews with nine legislators from the Georgia House of Representatives who participated in the 2019 legislative session. In-depth interviews were conducted in-person and over the phone. Interview recordings were transcribed verbatim and inductive codes identified. Codes focused primarily on views of: abortion in general; specific abortion policy; and how information about HB 481 was obtained. A thematic analysis was performed to elucidate legislators’ perspectives.

Results: Legislators had clear considerations that differed by party affiliation. Democrats described concerns with HB 481 grounded in reproductive autonomy and justice. They claimed concern with the lives of pregnant persons citing the physical and emotional harm bills like HB 481 cause. They questioned the medical evidence used to support HB 481 and argued that it violated the freedom to choose when to have children. Republican legislators evoked a similar harm reduction framework, but were concerned with protecting the lives of the unborn, arguing that a fetus should be considered a person once a “heartbeat” is detected and that abortion after this point is equal to killing a person. Republicans also described aligning with their constituents’ values. Despite the arguments and evidence presented during the legislative session, legislators voted according to their previously held beliefs on abortion.

Conclusions: Controversial abortion legislation is commonplace, bringing with it heated debates on when life begins and how to protect it. It is important to understand the underlying motives for legislators’ decisions to enhance communication and improve policy outcomes related to reproductive health and rights.

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