The flag of the U.S. state North Dakota is seen in this illustration taken, August 21, 2024. REUTERS/Dado Ruvic/Illustration

By Diana Novak Jones

(Reuters) -Abortion has again become illegal in North Dakota after the state’s Supreme Court on Friday reversed a lower court’s ruling that its near-total ban on abortion was unconstitutional.

Although a 3-2 majority of the North Dakota Supreme Court’s justices voted to uphold the lower court’s ruling, the state’s constitution requires a minimum of four justices to declare a state law unconstitutional and void, according to the opinion.

As a result, the underlying ruling was reversed, and the 2023 law banning nearly all abortions in the state has been reinstated after over a year.

The law makes it a felony for doctors to perform abortions but allows an exception for saving the life of the mother or in cases where her health is at serious risk.

The ban also makes an exception for rape and incest victims, but only during the first six weeks of pregnancy, which is before many women know they are pregnant.

Attorney Meetra Mehdizadeh of the Center for Reproductive Rights, who represented abortion providers challenging the law, said in a statement the ruling is a "devastating loss."

“As a majority of the Court found, this cruel and confusing ban is incomprehensible to physicians,” Mehdizadeh said.

North Dakota Attorney General Drew Wrigley, whose office defended the law, did not immediately respond to a request for comment.

The providers originally sued North Dakota in 2022 over an earlier, stricter abortion ban, which was to take effect after the U.S. Supreme Court's decision that June allowing states to ban abortion.

North Dakota has not had an abortion clinic for years since Red River Women's Clinic, one of the plaintiffs in the lawsuit, moved to Moorhead, Minnesota, after the 2022 decision by the U.S. Supreme Court, according to its website.

Judge Bruce Romanick in Bismarck blocked the 2022 ban in an order that was upheld by the state's Supreme Court, and the state legislature responded by passing the new law.

Romanick again sided with the providers and blocked the new law in September 2024, holding that the state constitution protects women's right to an abortion before the fetus is viable.

The state appealed, and in its ruling on Friday, the North Dakota Supreme Court majority said the law’s exception covering when an abortion can be performed to protect the life and health of the mother was unconstitutionally vague.

But two of the justices wrote a separate opinion finding that the statute’s guidance for doctors was sufficient.

(Reporting by Diana Novak Jones; Editing by Cynthia Osterman)