For the first time since legalizing abortion in 1973, the U.S. Supreme Court approved limits Wednesday on how doctors can terminate pregnancies.
By a 5-4 margin that hinged on the vote of court newcomer Samuel A. Alito Jr., the justices said the 2003 Partial Birth Abortion Ban Act did not violate the constitutional right to abortion that the court found in Roe v. Wade.
"The government may use its voice and its regulatory authority to show its profound respect for the life within the woman," Justice Anthony Kennedy wrote for the majority.
While the controversial "dilation and extraction" method banned by the act is rarely used, experts on both sides of the issue called the high court decision a landmark turning point in the abortion debate.
The decision, they noted, showed Alito's appointment last year -- succeeding then-Justice Sandra Day O'Connor, an abortion rights supporter -- tipped the court's balance against a broad view of abortion rights.
"It means the right to life movement is alive and well, and that the tide has turned," said Stasia Zoladz Vogel, president of the Buffalo Regional Right to Life Committee.
"For the first time, the Supreme Court has said doctors don't get the right to choose a particular medical procedure and legislators do," said Laura Meyers, chief executive officer of Planned Parenthood of Western New York.
While the law provides an exception to save a woman's life, the justices, perhaps most significantly, upheld the measure even though it contains no provision allowing doctors to use the procedure to protect the mother's health.
"The law need not give abortion doctors unfettered choice in the course of their medical practice," Kennedy wrote.
In contrast, in 2000 the high court overturned a similar Nebraska law banning the procedure, saying that law placed an "undue burden" on the right to abortion because it failed to include a health exemption.
Wednesday's ruling did not overturn that earlier decision. The latest ruling said the federal law was narrower in scope than the Nebraska measure.
Kennedy downplayed the risk that the ban poses to women's health.
"There is documented medical disagreement whether the act's prohibition would ever impose significant health risks on women," he wrote.
Chief Justice John G. Roberts Jr. and Justices Antonin Scalia and Clarence Thomas joined Kennedy and Alito in the majority.
In a dissent, Justice Ruth Bader Ginsberg said the court had dramatically narrowed abortion rights.
"Today's decision is alarming," she wrote. "It tolerates, indeed applauds, federal intervention to ban nationwide a procedure found necessary and proper in certain cases by the American College of Obstetricians and Gynecologists."
The court for the first time "blesses a prohibition with no exception safeguarding a woman's health," Ginsburg added.
More than 1 million abortions are performed annually in the United States, but according to the Guttmacher Institute, a nonprofit health research organization, only 2,200 dilation-and-extractions were performed in 2000.
Under the procedure, most often used for late-term abortions, a doctor partially removes the fetus from the woman's uterus and then crushes its skull.
Calling the procedure gruesome, abortion opponents have been fighting for nearly a decade to get state legislatures and Congress to outlaw it before President Bush signed the federal ban into law four years ago.
"I am pleased that the Supreme Court has upheld a law that prohibits the abhorrent procedure of partial-birth abortion," Bush said. "Today's decision affirms that the Constitution does not stand in the way of the people's representatives enacting laws reflecting the compassion and humanity of America."
But abortion rights advocates contended that the high court was, in effect, putting the health of American women at risk.
"Today the Supreme Court effectively stated that politicians, and not doctors, are the ones who will be deciding what is best for women regarding their reproductive health," said Rep. Louise M. Slaughter, D-Fairport. "They decided to take away an essential option for doctors who seek only to provide the best care to their patients."
The decision will have an impact not only in hospitals and clinics but also in legislatures and courtrooms.
"This is a watershed moment for life," said Bishop Edward U. Kmiec of the Catholic Diocese of Buffalo. "It is my hope and my fervent prayer that this is just the first in a series of rulings that will lead our society away from a culture of death and re-establish a culture of life."
Legal experts said state legislatures will try to enact additional abortion limits as a result of the high court decision. Some of those new laws could lead to a legal challenge aimed at overturning Roe v. Wade.
"Roe v. Wade may still be the law of the land, but with this court, the groundwork is being laid to overturn Roe v. Wade soon, with the eventual criminalization of all abortions under the same rationale," said Glenn E. Murray, a pro-choice attorney in Buffalo.
The high court still appears to be at least one justice short of a majority willing to overturn the ruling that established a constitutional right to abortion.
Kennedy has supported Roe in the past, and he did not join Thomas and Scalia in a concurring opinion that said Roe "has no basis in the Constitution."
Neither Roberts nor Alito joined that concurring opinion, which Lucinda M. Finley, vice provost for faculty affairs and a law professor at the University at Buffalo, described as noteworthy.
"They weren't willing to go all the way to saying Roe should go," said Finley, who is pro-choice.
The decision, nevertheless, left Laurence D. Behr, of Western New York Lawyers for Life, feeling hopeful.
"We hope today's Supreme Court decision is just a first step toward halting the insanity and horror of abortion on demand," Behr said.