Alabama lawmakers passed a bill on Thursday that would criminalize gender-affirming healthcare for transgender youth, with a threat of 10 years in prison for medical providers.
The legislation, passed 66-28 by the state's House of Representatives on the last day of the legislative session, is the latest in a flurry of measures in Republican-led states dealing with transgender youth.
The American Civil Liberties Union called it the first bill of its kind to make healthcare for transgender youth a felony and said it would challenge the bill in court if Republican Governor Kay Ivey signed it into law.
The bill would make it a felony punishable with up to 10 years in prison to provide medical care including hormone treatment, puberty blockers and gender reassignment surgery to minors.
Democrats in the minority tried to fight the bill in part by arguing it contradicted Republican principles on the role of government.
"This is not small government; this is not a conservative bill," Democratic Representative Neil Rafferty told the chamber.
But Republican Representative Wes Allen likened the initiative to laws that prevent minors from getting tattoos or buying nicotine products.
"We make decisions in this body all the time that are to protect children from making decisions that could permanently harm them," Allen said.
Ivey has not said whether she would sign the bill, but last year she signed one banning transgender athletes from school sports. Ivey's office did not immediately respond to a request for comment.
The bill would also compel school personnel to disclose to the parent or legal guardian that a "minor's perception of his or her gender or sex is inconsistent with the minor's sex."
Last week, Arizona Governor Doug Ducey signed a bill banning irreversible gender reassignment surgery for minors.
Mainstream medical and mental health professionals say gender-affirming care saves lives by reducing the risk of depression and suicide. Gender-reassignment surgery for people under 18 is extremely rare and would take place only after years of treatment in cases where the patient's wishes are unwavering, according to medical experts.
The American Academy of Pediatrics strongly opposed the bill and urged Ivey to veto it.
"This legislation targets vulnerable young people and puts them at great risk of physical and mental harm," Mark Del Monte, the academy's chief executive, said in a statement. "Criminalizing evidence-based, medically necessary services is dangerous."
The Alabama Senate has also passed a bill that would require students in public schools to use bathrooms or changing rooms that match the gender on their original birth certificates. An amendment was attached to the bill, which now has to go back to the House for a vote, prohibiting classroom discussion on sexual orientation or gender identity in certain grades.
Transgender rights have emerged as one of the issues at the forefront in the culture wars ahead of the November mid-term congressional elections. Lawmakers have introduced hundreds of bills across state legislatures, the majority of them dealing with trans youth.
Many Republicans and conservative activists promote the laws as safeguards for children and parental rights. Opponents, including Democrats and LGBTQ+ organizations, say the legislation is harmful, unnecessary and unfairly targeting vulnerable and underrepresented communities.