The North Dakota Supreme Court reinstated a near-total abortion ban on Friday, reversing a judge’s earlier decision and making abortion once again illegal in the state.
In North Dakota, it will now be a felony for doctors to perform abortions, except to protect a pregnant woman’s life or health, or in the case of rape or incest in the first six weeks of pregnancy. Patients are protected from prosecution, but doctors who violate the ban could face up to five years in prison and a $10,000 fine.
Twelve other states in the U.S. have similar or more restrictive bans on abortion.
Medical providers in and near North Dakota said the ruling would likely exacerbate fears doctors and patients have around providing and receiving medically necessary abortions, in a state where those fears were already rampant and access was limited.
Ana Tobiasz, a doctor of maternal-fetal medicine in Bismarck, N.D., and a plaintiff in the case, said most medical providers in the state were fearful of repercussions even when the abortion ban had been halted in 2024. She expects to see more effects on care under this ban, which she says makes it hard to interpret when medical exceptions are, and aren’t, permitted.
“It is extremely confusing,” she said. “What I foresee is people going back to being fearful of, ‘Is this actually going to meet the exception?’”
In Friday’s close ruling, three justices agreed the abortion ban was unconstitutionally vague when it came to medical exceptions. But state law requires four of five justices to agree in order for a law to be found unconstitutional.
Abortion in North Dakota has been at the center of a political and legal whiplash since 2022, when the overturning of Roe v. Wade allowed a trigger ban on abortion from the state legislature to take effect. In 2023, after several court rulings, the legislature repealed that ban and passed an identical law which included the exceptions.
A judge overturned the ban in 2024, but the decision was appealed by Attorney General Drew H. Wrigley, a Republican, leading to Friday’s decision that once again made abortion illegal. Mr. Wrigley’s office did not immediately respond to a request for comment.
Dr. Tobiasz said she had already seen this confusing legal battle affect care. She pointed to a colleague who had a patient who was 16 weeks pregnant and bleeding so heavily she needed blood transfusions. Dr. Tobiasz said the colleague delayed terminating the patient’s pregnancy while trying to figure out if it would hold up in court as a medical exception.
Even if a doctor is not convicted of a felony, just being charged could have ramifications for a medical license, on top of legal expenses and the emotional toll, she said.
“I think that subjectivity to interpretation is what is going to end up causing problems for people,” Dr. Tobiasz said.
For people seeking abortions in North Dakota, services have long been limited. The only abortion clinic in the state, the Red River Women’s Clinic, another plaintiff in the case, moved five minutes across state borders to Moorhead, Minn., in 2022.
Tammi Kromenaker, the owner and director of the clinic, called North Dakota an “abortion desert.” Most of her patients, the majority of whom are North Dakotans, drive around four hours each way to and from her clinic, she said. Even when abortion was legal, she said, “there was nobody providing it in that state.”
She already fields calls from patients who are afraid to say the word abortion or who ask her if they could go to jail in the future for terminating a pregnancy.
Just last week, Ms. Kromenaker said, she had a patient in North Dakota who called because she was fearful of visiting a local clinic for a blood test to confirm that a medication abortion had worked.
“There’s already enormous burdens for anybody seeking an abortion,” she said. “It’s going to be even worse now.”
Sonia A. Rao reports on disability issues as a member of the 2025-26 Times Fellowship class, a program for early-career journalists.
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