The Nebraska Supreme Court on Friday ruled in favor of the legality of a law that restricts abortion after 12 weeks of pregnancy and prohibits doctors from performing sex-change surgeries on minors, which allows both rules to remain in effect in the state.

Nebraska lawmakers passed the law in 2023, which covers both issues: abortion and sex-change procedures for minors. The American Civil Liberties Union and Planned Parenthood filed a lawsuit that argued that the legislation violated Nebraska’s single subject rule, which states that “no bill shall contain more than one subject.”

The state Supreme Court rejected that argument, noting in the majority opinion that “single subject challenges are rare, and single subject violations even rarer.” According to the ruling, the law addresses the subject of “public health and welfare,” which encompasses both abortion and sex-change procedures. 

“Prior cases have also emphasized that a bill may enact multiple policies, so long as those policies are united under a common purpose or object,” the judges wrote in the ruling.

“We disagree with Planned Parenthood’s contention that it is not possible to identify a single purpose of [the bill] that withstands single subject scrutiny,” the opinion continued. “[The law] does regulate both abortion and gender-altering care, but both abortion and gender-altering care are medical procedures, and [it] prescribes rules that define if and when such procedures can be performed.”

In response to the ruling, Republican Gov. Jim Pillen said he is “grateful for the court’s thorough and well-reasoned opinion upholding these important protections for life and children in Nebraska.”

“There was a dark moment last year when many feared that a victory for unborn babies was impossible and that the pro-life coalition might break apart,” the governor continued. “I was honored to partner with faithful allies and leaders across the state to combine the abortion ban with protections for kids against irreversible sex-change surgeries. We worked overtime to bring that bill to my desk and I give thanks to God that I had the privilege to sign it into law.”

Ruth Richardson, president of Planned Parenthood North Central States, called the decision “heart-wrenching and infuriating” in a statement.

“This ban has already devastated Nebraskans’ lives and will undoubtedly widen dangerous health inequities for people in rural areas, people of color, people with low incomes, and young people,” Richardson said.

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Nebraska law prohibits elective abortions after the 12th week of pregnancy but still allows for abortions in cases of rape, incest, and medical emergencies. Lawmakers failed to pass a law that would prohibit most abortions after six weeks of pregnancy after one Republican abstained from the vote.

The law also prohibits sex-change surgeries for patients younger than 19. However, it still allows doctors to provide sex-change drugs to minors in certain circumstances, such as when the “individual has a long-lasting and intense pattern of gender nonconformity or gender dysphoria.”

Although the law remains in effect, Nebraskans will vote on a referendum on Nov. 5 that would establish a right to abortion in the state constitution. Pro-life activists are trying to get a separate referendum on the ballot, which would restrict abortion after 12 weeks of pregnancy, similar to current law.