Abortion is illegal again in North Dakota after the state Supreme Court reversed a decision from a lower court on Friday, allowing a near-total ban to take effect.

The law makes it illegal for anyone to perform an abortion, though it exempts individual patients. Violating the ban is considered a class C felony, so physicians would be subject to a maximum of five years of imprisonment, a fine of $10,000, or both.

The only exceptions are for rape or incest in the first six weeks of pregnancy and to prevent the mother`s death or a "serious health risk."

The North Dakota Constitution requires at least four of the five justices to agree a law is unconstitutional. Three justices ruled that the abortion ban was unconstitutionally vague, but the other two did not.

Justice Daniel Crothers, who was one of the three votes against the ban, said the lower court was correct when it decided the law was unconstitutionally vague because of the law`s exceptions to preserve the life and health of the mother.

"After striking this invalid provision, the remaining portions of the law would be inoperable," Crothers wrote, and the court would not decide any of the other issues presented.

North Dakota joins 12 other states with the most restrictive abortion bans in the country, banning it at almost any stage.

But abortion access in North Dakota has long been a challenge, and there are no abortion clinics in the state. The sole abortion clinic in North Dakota relocated to Minnesota shortly after Roe v. Wade was overturned in June 2022.

The state also explicitly bans the use of telehealth for medication abortion.

The legal status of abortion in North Dakota has been in flux since Roe v. Wade was overturned. That decision allowed a trigger ban on abortion from the state Legislature to take effect. The state Legislature later passed a nearly identical law but included exceptions.

A judge overturned that ban in 2024, but the decision was appealed by state Attorney General Drew Wrigley (R).

According to data from the Guttmacher Institute, a research and policy group focused on reproductive rights, 820 North Dakota residents obtained abortions in Minnesota in 2024.

"As a majority of the Court found, this cruel and confusing ban is incomprehensible to physicians. The ban forces doctors to choose between providing care and going to prison. Abortion is health care, and North Dakotans deserve to be able to access this care without delay caused by confusion about what the law allows," Meetra Mehdizadeh, senior attorney at the Center for Reproductive Rights, said in a statement.