A North Dakota Supreme Court ruling on Tuesday has made drug-induced abortion effectively illegal in the state. The decision reversed a lower court ruling and upheld a 2011 state law banning the off-label use of a drug to terminate pregnancies.

In a decision that was reversed with the latest state Supreme Court ruling, the Cass County District Court held in April 2013 that the ban was unconstitutional. In that case, Judge Wickham Corwin found that the ban placed an undue burden on women, violating women’s rights for abortions under the federal constitution. The state appealed.

The five North Dakota Supreme Court justices were divided on whether the law was legal under federal and state constitutions.

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“Today’s decision directly conflicts with courts across the U.S. that have rejected the idea that politicians have any place in the practice of medicine or in women’s deeply personal decisions about their pregnancies, their health, their families, and their future,” said Nancy Northup, the president and CEO of the Center for Reproductive Rights, which has represented the state’s sole abortion provider in court.

North Dakota’s only abortion clinic is located in Fargo, and approximately 20% of the procedures there involve the use of drugs.

“This decision is good news for the safety of North Dakota women,” said Penny Nance, president and CEO of Concerned Women for America, a pro-life group, in a statement. “And we hope on Nov. 4 that North Dakota voters will decide to affirm life and give clarity to the intentions of the people of the state in protecting the unborn.”

Northup countered that the decision would negatively impact women’s health and safety in the state. “The politicians pushing for these unconstitutional and downright dangerous restrictions have had only one goal in mind: prevent North Dakota women — whom already face incredible obstacles to the severely limited reproductive health care services in their state — from exercising their legal right to abortion,” she said in a statement.