Recently, the ultra-conservative 8th Circuit Court of Appeals reinstated an involuntary manslaughter charge against a Native woman from Sisseton, South Dakota. That charge is based on allegations that she ingested illegal drugs while pregnant, resulting in the death of her newborn. Jessica Mason Pieklo and Imani Gandy explain why this decision is an alarming escalation of the anti-choice efforts to establish fetal personhood and punish people for their pregnancy outcomes.