The North Dakota abortion ban, codified at Chapter 12.1-19.1 of the Century Code, prohibits nearly all abortions in the state. Only three narrow situations are allowed: a pregnancy that threatens the woman’s life or poses a serious health risk, a pregnancy resulting from rape or incest when the gestational age is six weeks or less, and medical staff who assist a physician without knowing the procedure is unlawful. The North Dakota Supreme Court left the ban in force on November 21, 2025, and it is currently enforceable.1North Dakota Court System. New Opinion: November 21, 2025
What Counts as an Abortion Under the Law
North Dakota defines abortion as using any instrument, medicine, drug, or other means to end a pregnancy when the person performing the act knows it will likely cause the death of the unborn child.2North Dakota Legislative Branch. North Dakota Century Code 14-02.1 – Abortion Control Act Both surgical procedures and medication terminations are covered. Mifepristone and misoprostol used to end a pregnancy fall within the prohibition, and telehealth prescribing or mailing these medications into North Dakota is banned.
Three medical situations are specifically carved out and are not treated as abortions under the statute: removing a deceased unborn child after a miscarriage, treating an ectopic pregnancy, and treating a molar pregnancy.2North Dakota Legislative Branch. North Dakota Century Code 14-02.1 – Abortion Control Act A physician managing any of these conditions is not performing a prohibited procedure, regardless of the technique used. That distinction matters most for ectopic pregnancy, which can be life-threatening and requires prompt intervention.
When an Abortion Is Legally Allowed
Chapter 12.1-19.1 permits abortion in three circumstances. No other basis qualifies. Mental health concerns and socioeconomic hardship are not exceptions.
Life or Serious Health Risk to the Woman
A physician may perform an abortion when, in reasonable medical judgment, it is necessary to prevent the woman’s death or to address a serious health risk to her.3North Dakota Legislative Branch. North Dakota Century Code 12.1-19.1 – Abortion The statute does not spell out which conditions qualify. The standard turns on what a reasonably prudent physician informed about the case would conclude, and the medical reasoning must be documented.
Rape or Incest, Up to Six Weeks
An abortion is permitted when the pregnancy resulted from gross sexual imposition, sexual imposition, sexual abuse of a ward, or incest, but only if the probable gestational age is six weeks or less.3North Dakota Legislative Branch. North Dakota Century Code 12.1-19.1 – Abortion Gestational age is measured from the first day of the last menstrual period, so the window is roughly two weeks after a missed period. Many people do not know they are pregnant by that point. The physician determines gestational age using reasonable medical judgment.
Medical Staff Assisting a Physician
A nurse, technician, or other medical professional who assists a physician is not criminally liable if they acted within the scope of their regulated profession, followed the physician’s direction, and did not know the physician was violating the law.3North Dakota Legislative Branch. North Dakota Century Code 12.1-19.1 – Abortion This shields support staff when the decision to proceed rests with the physician.
Penalties for Performing an Illegal Abortion
Performing an abortion outside these exceptions is a Class C felony.3North Dakota Legislative Branch. North Dakota Century Code 12.1-19.1 – Abortion A Class C felony carries a maximum of five years in prison, a fine of up to $10,000, or both.4North Dakota Legislative Branch. North Dakota Century Code 12.1-32-01 Liability reaches physicians and others who perform or facilitate the procedure.
Professional consequences follow a criminal case. Licensed medical professionals must report any criminal charge or conviction to the Board of Medicine within thirty days.5North Dakota Legislative Branch. North Dakota Code 43-17.1 – Board of Medicine Investigative Panels Any felony conviction is grounds for disciplinary action up to and including permanent revocation of a medical license.6Legal Information Institute. North Dakota Administrative Code 50-03-01-11 – Grounds for Disciplinary Action
The pregnant woman cannot be prosecuted. The statute limits criminal liability to persons “other than the pregnant female upon whom the abortion was performed.”3North Dakota Legislative Branch. North Dakota Century Code 12.1-19.1 – Abortion A woman who seeks, obtains, or self-manages an abortion faces no charges under this chapter. Enforcement is directed at providers and at those who distribute prohibited medications.
Paying for a Legal Abortion
Even when a case falls within an exception, coverage is limited. North Dakota Medicaid pays for abortion only when the procedure is necessary to save the woman’s life, or when the pregnancy resulted from rape or incest. In life-threatening cases, the treating physician must submit a signed statement explaining why continuing the pregnancy would endanger her life. For rape or incest, the crime must be reported to law enforcement, or, for minors who are incest victims, to a child abuse reporting agency. If no report was made, the patient must sign a statement that the pregnancy resulted from rape or incest, and the physician must supply written verification.7North Dakota Health and Human Services. Medicaid Policy – Abortion Claims without the required documentation are denied.
Private health insurance in the state is also barred from covering abortion outside similarly limited circumstances. Anyone paying out of pocket, or traveling to another state, should expect to cover the full cost without insurance reimbursement.
Where North Dakota Residents Go for Care
No abortion providers currently operate in North Dakota. Red River Women’s Clinic, the state’s only provider for more than two decades, relocated to Moorhead, Minnesota, in 2022 after the trigger ban took effect, and its last North Dakota patient was seen on August 3, 2022. The clinic still operates just across the state line from Fargo, and Minnesota allows abortion throughout pregnancy.
For anyone outside the ban’s narrow exceptions, traveling out of state is the only option. Practical costs include transportation, lodging, time off work, and the procedure itself, which for a first-trimester abortion typically runs several hundred dollars. Given North Dakota’s coverage restrictions, those costs fall on the patient. Several nonprofit organizations help fund travel and procedure costs, though availability and wait times vary.
Privacy When You Travel Out of State
A federal HIPAA rule finalized in 2024 bars hospitals, clinics, insurers, and other covered entities from disclosing protected health information for the purpose of investigating or imposing liability on someone who sought, obtained, provided, or helped access reproductive health care that was lawful where it occurred.8Federal Register. HIPAA Privacy Rule To Support Reproductive Health Care Privacy Covered entities had to comply with the core prohibitions by December 23, 2024, and must update their privacy notices by February 16, 2026. The rule presumes the underlying care was lawful unless there is substantial evidence otherwise.
For a North Dakota resident who obtains an abortion in Minnesota, this means a North Dakota provider who later learns about that care cannot hand records over to state investigators seeking to build a case. The protection is tied to the lawfulness of the care where it happened.
HIPAA does not reach every source of health data. Period-tracking apps, fertility monitors, and wearable devices generally sit outside HIPAA because the companies behind them are not covered entities. Data logged in those tools could, in theory, be subpoenaed, and the legal protection is far weaker than in a doctor’s office.