North Dakota’s near-total abortion ban is back in force after the state’s highest court reversed a lower-court ruling and made abortion illegal except in narrow circumstances.
The North Dakota Supreme Court reinstated the ban on Friday, making it a felony for doctors to perform abortions except to protect a pregnant patient’s life or health, or in cases of rape or incest within the first six weeks of pregnancy.
The ruling reversed a 2024 judge’s decision that had halted enforcement of the law.
Three of the court’s five justices agreed the statute was unconstitutionally vague regarding when medical exceptions applied. Still, state law requires a supermajority of four justices to strike down the statute. Because the threshold was not met, the ban returned into effect, according to The New York Times.
“This decision is a devastating loss for pregnant North Dakotans,” Meetra Mehdizadeh, senior attorney at the Center for Reproductive Rights, said in a statement reported by The Guardian. The organization represented multiple physicians and the state’s former abortion clinic, which relocated to Minnesota in 2022 after earlier restrictions.
The law now makes it a felony for a doctor to perform an abortion outside the narrow exceptions, with penalties of up to five years in prison and a $10,000 fine.
Patients themselves are shielded from prosecution.
Physicians quoted in reporting described what they characterized as confusing legal terrain. “It is extremely confusing,” Ana Tobiasz, a maternal-fetal medicine specialist in Bismarck and a plaintiff in the case, said per The New York Times. She said fears over legal consequences remained high even while the ban had been temporarily blocked.
Tobiasz pointed to a past case in which a colleague delayed terminating a pregnancy for a patient who was bleeding heavily at sixteen weeks while trying to determine whether the situation legally qualified as a medical exception.
Abortion access in North Dakota has been heavily restricted for years.
The state’s only clinic moved across the border to Moorhead, Minnesota, in 2022, forcing many patients to drive hours for care. The clinic’s director, Tammi Kromenaker, said North Dakota had long been an “abortion desert” and described patients who were reluctant even to use the word “abortion” when seeking help.
The reinstated ban joins similar laws in a dozen other states. Most abortions in Texas also remain illegal under Chapter 170A of the Texas Health & Safety Code, which prohibits nearly all abortions except when a patient faces a life-threatening condition. Under Texas law, a physician could face first- or second-degree felony charges, professional license revocation, and a civil penalty of at least $100,000 if accused of providing a prohibited abortion, according to the Texas State Law Library.
Abortion rights advocates in North Dakota argued the revived law remains too vague for physicians to reliably interpret. “As a majority of the court found, this cruel and confusing ban is incomprehensible to physicians,” Mehdizadeh said. “The ban forces doctors to choose between providing care and going to prison.”