Medication abortions have accounted for 20 percent of the procedures in Fargo since the clinic began offering them in 2007 as an alternative to surgical abortions.

The debate over North Dakota's abortion restrictions shifted to the courtroom Tuesday when the medical director of the state's lone abortion clinic testified against a two-year-old bill she said would leave women with "less choice."

Abortion rights supporters have promised that the lawsuit in Cass County District Court won't be the end of legal challenges in North Dakota, after Gov. Jack Dalrymple signed three more abortion bills into law earlier this year. One of those laws bans abortions when a fetal heartbeat is detected, which could be as early as six weeks into a pregnancy and before some women even know they're pregnant.

The Red River Women's Clinic of Fargo is challenging a 2011 law that would ban one of two drugs used to induce medication abortions. Dr. Kathryn Eggleston, medical director of the clinic, testified at the start of Tuesday's civil trial it would leave women without another "safe and effective" option to surgical abortions.

"The primary reason that women have a medication abortion is because it allows them to have the abortion and avoid the surgical process, avoid the instrumentation," Eggleston said. "A lot of women are interested in a more natural process."

East Central District Judge Wickham Corwin, who is presiding over the bench trial, has blocked the legislation. He said during a hearing in January that he saw merits in arguments that the law illegally restricts abortion rights.

Rep. Bette Grande, one of the bill's sponsors, downplayed the lawsuit and said it's not unusual for legislation to wind up in court. She cited recent legal challenges by North Dakota school districts over state funding.

"It's just one of those things," the Fargo Republican said in an interview Tuesday. "You don't need to use the courts to establish public opinion."

Medication abortions, which are done if a woman is pregnant for 63 days or less, involve the use of a combination of two drugs, mifeprex and misoprostol. The law maintains that the use of any drug to cause an abortion must meet "the protocol tested and authorized" by the FDA and outlined on the drug's label. Misoprostol is not labeled as an abortion-inducing drug.

Without misoprostol, Eggleston said the clinic could not continue to perform medication abortions. She said using mifeprex alone is not as effective, especially for women who are more than 50 days pregnant.

"Women would have less choice," Eggleston said.

Medication abortions have accounted for 20 percent of the procedures in Fargo since the clinic began offering them in 2007 as an alternative to surgical abortions.

"The patients, they were interested," Eggleston said of the drugs. "They wanted this. They were asking for this."

Supporters of the bill have for years been asking fellow lawmakers to pass tougher abortions laws, as a challenge to the 1973 U.S. Supreme Court's Roe v. Wade ruling that legalized abortion up until viability, usually at 22 to 24 weeks.

In addition to the fetal heartbeat bill, Dalrymple has signed in this session a measure that bans abortions because a fetus has genetic defects such as Down syndrome, and one requiring a doctor who performs abortions to be a physician with hospital-admitting privileges. Another bill that would outlaw abortions after 20 weeks of pregnancy based on the disputed premise that a fetus can by then feel pain was signed by the governor Tuesday.

Opponents of the legislation believe the laws to be unconstitutional. If that's found to be the case, Senate Minority Leader Mac Schneider said Tuesday, the state "could end up being forced to use taxpayer dollars to pay the attorney's fees of an out of state group like Center for Reproductive rights," which is representing the Fargo clinic.

"That is an outcome that all of us should want to avoid," said Schneider, a Democrat from Grand Forks.

The North Dakota attorney general's office, which is defending the legislation, has paid about $21,000 to Dr. Donna Harrison to act as an expert witness. Harrison, president the American Association of Pro-Life Obstetricians and Gynecologists, will likely testify Thursday.

"What is the price of life?" Grande said when asked about the cost of litigation. "I guess every person has to ask that of themselves."