The North Dakota legislature recently passed the harshest abortion ban in the nation, and is also considering two “personhood” measures that would outlaw abortion altogether. But state lawmakers also want to target abortion by going after Planned Parenthood — even when it comes to the organization’s preventative sexual health resources for youth. Republicans are now attempting to block a comprehensive sex ed program that North Dakota State University (NDSU) was planning to launch in partnership with Planned Parenthood.

NDSU won a three-year federal grant to partner with Planned Parenthood to provide sexual education resources to at-risk youth. The voluntary sex ed program is designed to offer family planning resources and life coaching for teenagers at high risk for unintended pregnancy, and would take place outside of school hours. However, the grant was frozen earlier this year after abortion opponents attempted to derail the initiative because Planned Parenthood was participating — even though the state’s affiliates don’t perform any abortion services. North Dakota’s Attorney General gave NDSU permission to proceed with the sex ed program last month. Unfortunately, the fight over sex ed isn’t over yet.

Now, state legislators are joining the crusade against Planned Parenthood. On Monday, the House Human Services Committee approved an amendment to a Senate bill that would prohibit the use of government funds to “contract with, or provide financial or other support to individuals, organizations, or entities performing, inducing, referring for, or counseling in favor of, abortions.” The amendment notes that this ban would apply to any “institution under the control of the State Board of Higher Education” — and would sure that NDSU’s sex ed grant won’t move forward with Planned Parenthood’s participation.

The president of the Planned Parenthood affiliate for Minnesota, North Dakota, and South Dakota points out that blocking comprehensive sex ed resources actually undermines anti-choice politicians’ goal of preventing abortions. “Politicians in North Dakota who are opposed to abortion are blindly taking aim at the very agencies that can prevent them,” she explained in a statement. “If you want to reduce the number of abortions, the last thing you should do is take away programs that help young people prevent pregnancy before they are ready to have a family.”
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Last week, the North Dakota legislature passed the most stringent abortion ban in the nation, cutting off access to reproductive services after just six weeks of pregnancy — before some women even know they’re pregnant. But Republicans in the state aren’t stopping there. The legislature is also considering even more stringent “personhood” measures, which would endow fertilized eggs with the full rights of U.S. citizens and outlaw absolutely all abortion services.

Two personhood bills — Senate Bill 2303 and Senate Concurrent Resolution 4009 — have already passed the Senate, and the GOP-controlled House is expected to take them up sometime this week. But if North Dakota successfully enacts a total abortion ban, there will be serious consequences for the state that extend even beyond women’s reproductive freedom. Here are five ways the state will suffer under personhood:

1. There will be fewer doctors in the state available to provide medical care. In a historic move for the North Dakota Medical Association, the nonpartisan organization has come out against personhood. The group points out that the anti-abortion measures go too far to “interfere with the physician practice,” and they suspect it will be harder to find qualified medical professionals willing to practice in North Dakota if the state imposes so many complicated restrictions on doctors. Some doctors have already testified before state lawmakers to say they will leave North Dakota if the abortion bans pass.

2. Maternal health care will be compromised. Doctors could be charged with criminal negligence if anything happens to an embryo — which could prevent them from making quick decisions that could help save women’s lives. The tragic case of Savita Halappanavar, a woman who died after being denied an abortion in a Catholic hospital because her doctors were reluctant to provide care that could get them in trouble with the law, highlights the serious consequences of state lawmakers coming between a woman and her doctor.

3. Women could be forced to resort to illegal abortion procedures. Under a personhood law, women will end up resorting to dangerous “backroom” abortions, one former pediatrician warned North Dakota lawmakers last week. That Fargo-area doctor did his medical training before Roe v. Wade, when women were dying of bacterial infections after botched abortion procedures — and he warns that the passage of the proposed personhood measures would pull North Dakota back into “the stone age of medicine.” There’s evidence to back up that claim. According to the Guttmacher Institute, the legality of abortion has absolutely no correlation to abortion rates around the world, because women will continue to seek to terminate pregnancies regardless of the law.

4. Women won’t be able to use in vitro fertilization to try to have a family. Ironically, in addition to compromising medical procedures for the women seeking to terminate a pregnancy, personhood measures also place restrictions on the women who are trying to get pregnant. “These bills will stop the practice of in vitro fertilization in this state,” Dr. Stephanie Dahl, an obstetrician-gynecologist and reproductive medicine specialist in Fargo, explained to lawmakers. Doctors wouldn’t be able to perform any procedure that carries the risk of damaging some embryos, so women would be forced to travel to South Dakota or Minnesota for in vitro treatment, a six-week process that requires multiple sonograms and up to 12 visits to the doctor.

5. The state will become embroiled in expensive lawsuits. North Dakota’s six-week abortion ban already runs afoul of Roe v. Wade, and will certainly invite several costly legal challenges. A total abortion ban would lead to similar consequences. Two personhood bills were recently struck down in Oklahoma, suggesting that the courts won’t take kindly to North Dakota’s push to restrict women’s constitutional rights, either. Nevertheless, even the self-proclaimed “fiscally conservative” Republicans in the state are willing to defend their abortion bans on the state’s dime.

So far this session, Republican majorities in both chambers of the state legislature have successfully advanced a radical anti-abortion agenda in North Dakota — and that’s on top of the existing abortion restrictions. Women already have to undergo a mandatory 24-hour waiting period before having an abortion, and there’s just one last abortion clinic left in the entire state.

Not to be outdone by Arkansas lawmakers — who recently overrode their governor to impose a 12-week abortion ban, the strictest in the country — abortion opponents in North Dakota want to go even further.

So far this year, anti-choice lawmakers in Arkansas and North Dakota have practically tripped over each other to see which state can impose more abortion restrictions. Arkansas initially pulled into the lead by imposing two stringent restrictions, a 20-week abortion ban and, later, a stricter 12-week ban. But North Dakota may be ready to raise the stakes once again. Republican lawmakers are advancing a “fetal heartbeat” measure to outlaw the procedure after just six weeks of pregnancy, before many women even realize they’re pregnant, and they expect to have enough support to push it though:

House Bill 1456 would make it a felony for a doctor to perform a nonemergency abortion after a fetal heartbeat can be detected, which can be as early as five or six weeks. House Bill 1305 would prohibit abortions sought because a fetus has been or could be diagnosed with any genetically inherited defect, disease or disorder.

The Republican-led state Senate will vote today on the measures, said state Representative Bette Grande of Fargo, who co-sponsored the bills in the Republican-controlled House, where both have passed. Grande said she expects the Senate to approve both and the governor, also a party member, to sign them.

“The heartbeat is society’s marker for life,” Grande, a Republican, said by telephone from Fargo.

So-called “fetal heartbeat” bans are blatantly unconstitutional. Even though Roe v. Wade guarantees the right to legal abortion services until the point of viability, typically around 23 or 24 weeks of pregnancy, heartbeat bans narrow that window by as much as 17 weeks. North Dakota’s heartbeat measure will also have the unintended consequence of mandating transvaginal ultrasounds for women seeking abortions, since there’s no other way to detect a fetal heartbeat at such an early stage of pregnancy.

Unfortunately, this isn’t the only egregious affront to reproductive rights that women in North Dakota have to worry about. State lawmakers are also considering an even more radical “personhood” measure that would outlaw abortion altogether, as well as some forms of contraception. And, despite the fact that there’s just one abortion clinic left in the state, anti-choice Republicans are attempting to advance legislation that would force it to close its doors.

Testifying against the mounting abortion restrictions currently moving through the legislature, one Fargo-area doctor warned that North Dakota’s attacks on choice will ultimately force women in the state to resort to dangerous, “backroom” abortion procedures. Unfortunately, even while Roe technically still stands, North Dakota lawmakers could essentially roll back the clock to a time before women had the right to safely determine their own reproductive decisions.

North Dakota lawmakers, who have pushed a stringently anti-choice agenda since the new legislative session began, are set to consider a package of abortion restrictions this week that would tighten the state’s laws even further. But one Fargo-area doctor is warning lawmakers that advancing those measures would have disastrous effects on women’s health — rolling back the clock to a time before Roe v. Wade, when women often resorted to dangerous measures in the absence of safe, legal abortion services.

North Dakota lawmakers are moving closer toward shutting down the state’s last remaining abortion clinic, as well as considering the same two abortion restrictions that Arkansas Republicans recently forced into law — a “fetal pain” ban to outlaw abortion after 20 weeks, and a much more stringent “fetal heartbeat” ban that would outlaw all abortion services just six weeks into pregnancy. Piling on those abortion restrictions would prevent many women in the state from accessing the critical health care they need, retired pediatrician Ted Kleiman explained to lawmakers on Tuesday.

Kleiman has firsthand experience with the consequences of denying women access to reproductive resources. When he was working in a New York hospital before Roe v. Wade legalized abortion services in 1973, he saw at least one woman die from the complications from a botched illegal abortion. “The thought of returning to those days is really beyond imagination,” Kleiman told state senators, urging them not to close North Dakota’s only abortion clinic.

But unfortunately for the women whose state lawmakers are hostile to abortion rights, being forced to return to the days before Roe v. Wade isn’t a distant possibility. It’s dangerously close to becoming their reality. States across the country are successfully chipping away at women’s constitutionally-protected reproductive rights, threatening to return to an era when an estimated 1.2 million women — typically, those who lacked socioeconomic and racial privilege — were forced to resort to illegal, unsafe abortion procedures each year.

Around the world, unsafe abortions contribute to an annual 47,000 preventable deaths. Unlike access to contraception, the legality of abortion has absolutely no correlation to abortion rates around the world, since women seek to terminate pregnancies regardless of the law. If anti-choice lawmakers in states like North Dakota have their way, women in this country could certainly be forced into that type of “backroom” procedure as well — even while Roe v. Wade technically still stands.

The anti-choice community’s crusade against abortion affects much more than women’s ability to legally terminate a pregnancy — it can also threaten women’s financial security, inspire increased levels of violent harassment against health clinics, and even restrict access to critical preventative services like family planning programs or sexual health instruction. On top of that, anti-abortion lawmakers may be contributing to yet another unintended consequence in their states: dissuading medical providers from being willing to practice there.

Harsh restrictions on abortion providers — a double standard leveled against abortion care, which is overregulated in a way that isn’t required of other medicals areas — already limits the number of doctors able to perform abortions in states with laws hostile to reproductive rights. But increasingly stringent state-level abortion laws may discourage other types of medical professionals from settling in those areas, too.

North Dakota, which is quickly earning a reputation as the worst state for women as lawmakers currently advance six different abortion restrictions, could find itself in exactly that situation. The nonpartisan North Dakota Medical Association has come out against a proposed “personhood” bill in the state — a measure that would define zygoytes as U.S. citizens, outlawing all abortions and some forms of contraception — because that type of abortion restriction would interfere too much with their work:

The North Dakota Medical Association, which represents many physicians across the state, rarely takes a public position on divisive issues. The group’s opposition to the “personhood” bills has nothing to do with the abortion issue, NDMA Executive Director Courtney Koebele said, noting that physicians themselves are divided over the issue.

“These bills are interfering with the physician practice to such an extent that we didn’t really have an alternative,” she said. “These are just bad bills.”

Mike Booth, president of the North Dakota Medical Association, said if they become law, the personhood bills could make North Dakota less attractive to professional women.

“I see this as a real swipe at women’s rights,” he said. “I find that very depressing in a state that’s trying very hard to push itself forward. That really upsets me.”

Abortion opponents have a long history of proposing measures to come in between a woman and her doctor. Forced ultrasound bills, mandatory counseling sessions, days-long waiting periods, and restrictions on administering the RU-486 abortion pill all prevent medical professionals from making their own decisions about how best to treat their patients. Doctors who want to practice abortion care, as well as women’s health groups or small business owners who operate their own clinics, are likely to take their skills to places where they don’t have quite as many barriers to overcome.

The routine violence and harassment directed at abortion providers make other medical professionals wary to be associated with that type of reproductive service, which has successfully segregated abortion care from the rest of health care. But ultimately, since abortion is just another aspect of women’s reproductive health, it doesn’t exist in an entirely separate world from the rest of medical community. And if states like North Dakota continue to push for harsher and harsher restrictions for a legal medical procedure, abortion care may not be the only health service that’s placed in jeopardy.

So far this year, GOP lawmakers in Arkansas and North Dakota have practically tripped over each other to see which state can introduce more anti-abortion legislation. Among other abortion restrictions, each state is currently advancing a “fetal pain” measure to outlaw abortion procedures after 20 weeks of pregnancy — based on the scientifically disputed notion that fetuses can feel pain at that point — despite the fact that similar laws have been blocked in court for running afoul of the reproductive rights granted under Roe v. Wade.

On Monday, state senators in both Arkansas and North Dakota approved 20-week abortion bans. Neither measure makes an exception for the health of the woman, despite the fact that women who seek late-term abortions often do so because they discover unexpected health issues or fatal fetal abnormalities. Arkansas’ measure does include narrow exceptions to allow abortion services in the cases of rape, incest, or to save the woman’s life — but North Dakota’s abortion ban doesn’t even make the narrowest exceptions for rape or incest.

Nebraska was the first state to pass a 20-week abortion ban under the specious logic that fetuses can feel pain during the second trimester of pregnancy. Since then, seven other states have passed similar laws, and two fetal pain measures in Georgia and Arizona are currently being blocked from taking effect.

But the possibility of an impending court challenge won’t stop anti-choice lawmakers who are insistent on slowly chipping away at women’s constitutional right to reproductive health services. Both Arkansas and North Dakota have also proposed more extreme abortion measures — a “heartbeat ban” in Arkansas that would outlaw abortion after just 12 weeks, and a “personhood” measure in North Dakota that could ban all abortions and even some forms of contraception — that go even further to circumvent Roe, which guarantees women’s right to a legal abortion until the point of viability, around 24 weeks of pregnancy.

Women’s health is under attack all across the country — in fact, at this point, every single state except for Oregon has enacted at least one abortion restriction to limit access to reproductive services. But some states seem to be competing for the dubious title of the very worst state for women. Right now, North Dakota is pulling into the lead.

North Dakota Republicans have wasted no time so far this year attempting to roll back women’s reproductive rights. Just barely over a month into 2013, North Dakota’s lawmakers are already pushing at least five serious attacks on women’s health:

1. Threatening to close the state’s last abortion clinic. On Thursday, state senators advanced legislation that threatens to close down North Dakota’s only remaining abortion clinic, the Red River Women’s Clinic in Fargo. The legislation would require all doctors who perform abortion services to have hospital-admitting privileges — a complicated and unnecessary step that will likely prevent abortion doctors from continuing to practice in the state. It’s incredibly similar to the GOP-led effort in Mississippi, another state that has just one abortion clinic left, where abortion doctors have been unable to gain hospital privileges and women may soon be left without many options for their reproductive care.

2. Advanced a “personhood” amendment. Republican senators also advanced a personhood measure on Thursday that would amend the state’s constitution to endow zygotes with the full rights of U.S. citizens. If the measure passes, fetuses would be granted all of the legal rights and protections of North Dakota residents — which would ultimately ban abortion, some forms of contraception, and even invitro fertilization. Personhood initiatives are so radical that they haven’t seen much success even within the anti-abortion community.

3. Considering a “fetal heartbeat” bill. Just to hedge their bets in case the extreme personhood amendment doesn’t work out, North Dakota lawmakers are also considering the next best thing: a “heartbeat” ban to outlaw abortion as soon as a fetal heartbeat can be detected, which can occur as early as six weeks of pregnancy. At that point, some women don’t even know they’re pregnant yet — but North Dakota’s heartbeat ban would criminally prosecute them for having an abortion by the time they figured it out.

4. Could mandate transvaginal ultrasounds. The other conservative states that are beginning to propose “heartbeat” bills are quickly learning that this type of legislation may be even more hostile to women’s rights than they first imagined. Because the measures would require doctors to check for a fetal heartbeat before proceeding with an abortion, they would necessitate a transvaginal ultrasound — an unnecessary, invasive procedure — since that’s the only way to detect a fetal heartbeat so early in the pregnancy. The sponsor of Arkansas’ heartbeat bill has amended his legislation to specify that it wouldn’t ban abortion until the fetal heartbeat can be detected with an abdominal ultrasound, but North Dakota’s Republicans haven’t made any similar accommodations to their own measure yet.

5. Blocked sex ed resources for at-risk youth. And on top of legislators’ recent flurry of proposed abortion restrictions, the rest of the anti-choice community in North Dakota is also doing its best to remain hostile to women’s health. Even though North Dakota State University won a three-year federal grant to partner with Planned Parenthood to provide a sex education program for at-risk teenagers in the state, the school may be backing out of it after pressure from anti-abortion activists. The proposed sex ed program would have been voluntary, taken place outside of public school hours, required parental consent, and offered family planning resources. But anti-abortion activists decried the initiative, calling Planned Parenthood “an overt abortion industry that we don’t want to be a part of” — despite the fact that the Planned Parenthood affiliate in North Dakota doesn’t even perform abortion services.

During the height of last year’s outcry over the GOP’s “War on Women,” transvaginal probes became one of the most recognizable symbols of the Republican Party’s overreaching anti-abortion policies. Particularly when Virginia pushed forward with a controversial measure to require all women seeking abortions to undergo a transvaginal ultrasound, women’s health advocates decried the practice as “state-sponsored rape.”

Virginia legislators ultimately changed the language of their ultrasound bill to remove the mention of transvaginal probes. But stringent abortion restrictions don’t necessarily need specific “transvaginal” language to force women to undergo invasive, unnecessary medical procedures against their will. These are just a few examples of carefully-worded abortion bills that would ultimately require transvaginal probes — even though it’s not explicitly stated in the legislation:

– MICHIGAN: Talking Points Memo first reported that Michigan’s proposed ultrasound bill, HB-4187, is a bit more nefarious than it appears to be on the surface. The legislation doesn’t mention trasvaginal probes, but it does stipulate that the mandatory ultrasounds need to use the most modern equipment available, and provide “the most visibly clear image of the gross anatomical development of the fetus and the most audible fetal heartbeat.” Donna Crane, the policy director of NARAL Pro-Choice America, explained that language will require doctors to use transvaginal probes — which provide clearer images than the non-invasive ultrasound procedure.

– KENTUCKY: Women seeking abortions in Kentucky already have to undergo a state-mandated waiting period and a mandatory counseling session intended to talk them out of their decision. But SB-5, which just cleared a Senate committee on Thursday, would also require women to have an ultrasound before terminating a pregnancy. During Thursday’s committee hearing, state Sen. Paul Hornback (R) admitted something that the proponents of similar ultrasound bills in other states haven’t been as forthright about: the legislation would also require a transvaginal ultrasound for early pregnancies, since abdominal ultrasounds don’t work well before 12 weeks of pregnancy. Because the vast majority of abortions are performed during the first trimester, the vast majority of women will be subjected to a transvaginal probe.

– ARKANSAS: Last week, State Sen. Jason Rapert (R) introduced a “fetal heartbeat bill” to outlaw all abortion procedures after a fetal heartbeat can be detected, which can occur as early as six weeks of pregnancy. Women’s health advocates pointed out that, since a transvaginal ultrasound is the only way to detect the fetal heartbeat that early into a pregnancy, Rapert’s bill would also mandate invasive probes for all women seeking abortions. The growing controversy over the unintended consequences of the stringent abortion ban led Rapert to amend his bill earlier this week — updating the legislation’s language to specify it would ban abortions after a fetal heartbeat can be detected by using an abdominal ultrasound, at around 10 weeks of pregnancy.

– NORTH DAKOTA: If Rapert’s heartbeat ban initially had the unintended consequence of mandating transvaginal ultrasounds, then the same holds true for the extreme fetal heartbeat bills that have been proposed in other states. For example, North Dakota’s HB-1456 states that “an individual may not perform an abortion on a pregnant woman before determining, in accordance with standard medical practice, if the unborn child the pregnant woman is carrying has a detectable heartbeat” — and transvaginal ultrasounds are the standard medical practice for determining a fetal heartbeat in early pregnancies.

Even though ultrasounds are not considered medically necessary procedures for first-trimester abortions, 12 states currently require women to undergo one anyway. And according to NARAL Pro-Choice America, 13 new forced ultrasound bills have been introduced in 8 states since the beginning of 2013, a number the group says is all too common for the beginning of a new legislative session.

Donna Crane, NARAL’s policy director, explained to ThinkProgress that Republicans are playing “games of hide and seek” with this type of legislation. But the issue of invasive probes — as well as the fundamental issue at stake, the fact that women are forced to have an unwanted, unnecessary medical procedure simply because a legislator decided they should — has never gone away. “These bills are horrific, but they’re commonplace,” Crane said. “All they’re doing is changing the language. Virginia made a PR error in actually using a searchable word, ‘transvaginal,’ and they’re not likely to do that again. But the bills are still as severe as they ever were.”

2011 and 2012 were both record-breaking years for new abortion restrictions, and abortion opponents are aren’t showing signs of letting up this year. The “personhood” movement to endow zygotes with the full rights of U.S. citizens, effectively outlawing all abortions and even some forms of contraception, has largely been a failure — but that doesn’t mean anti-choice lawmakers are giving up their quest to redefine the medical terms of pregnancy. The push for “fetal heartbeat” bans is the next anti-choice movement to watch.

Fetal heartbeat measures seek to outlaw abortions as soon as a fetal heartbeat can be detected — which can occur as early as six weeks, before many women even know they’re pregnant — in direct contradiction to Roe v. Wade, which guarantees women’s right to an abortion until the point of viability at about 23 or 24 weeks of pregnancy. Despite the fact that heartbeat bills are much more extreme than the 20-week abortion bans that are already floundering in court for running afoul of Roe v. Wade, anti-choice lawmakers in at least five states are flirting with this type of legislation:

– OHIO: Anti-choice lawmakers in Ohio first advanced a heartbeat bill in 2011. After the measure was stalled in the state senate for over a year, abortion opponents pressured the legislature to take up the issue again during their lame duck session after the 2012 elections. But ultimately, the bill didn’t come up for a vote because the state Senate leader, Tom Niehaus (R-OH), acknowledged it was too controversial even among abortion opponents. Niehaus said he wanted to wait until lawmakers anti-choice community reached consensus on the measure — which means it could be back on the agenda sometime this year.

– MISSISSIPPI: About a week into the new year, GOP lawmakers in Mississippi filed a fetal heartbeat bill virtually identical to the one that failed to make it out of committee during the state’s last legislative session. Mississippi Gov. Phil Bryant (R) has already made it clear that he would sign such a bill if it ever reaches his desk. At a private anti-abortion event at the beginning of January, the governor confirmed that he supports banning abortion as soon as a fetal heartbeat can be detected. “It would tell that mother, ‘Your child has a heartbeat,’” Bryant said.

– WYOMING: About two weeks ago, state Rep. Kendell Kroeker (R) introduced a measure to supersede the medical definition of viability. Current state law says abortions are prohibited after a fetus has “reached viability,” and Kroeker sought to replace those words with “a detectable fetal heartbeat.” The Republican lawmaker said the idea for his heartbeat bill just came to him one day because “it became clear that if a baby had a heartbeat, that seemed simple to me that it’s wrong to kill it.” On Monday, a House panel struck down Kroeker’s bill because it was too medically vague. But if Ohio and Mississippi are any indication, this likely won’t be the last time that fetal heartbeat legislation shows up in Wyoming.

– ARKANSAS: Republicans in Arkansas also hopped on the fetal heartbeat train this week, but they went a step further — state Sen. Jason Rapert’s (R) proposed heartbeat bill would prosecute the doctors who perform abortions after the arbitrary cut-off with a Class D felony, punishable by up to six years in prison and up to a $10,000 fine. And thanks to the strong Republican majorities in Arkansas’ legislature, this piece of legislation has a good chance of advancing. It easily passed out of committee on Wednesday and is now headed to the state Senate, where 19 of the chamber’s total 35 members have already signed onto it as co-sponsors.

– NORTH DAKOTA: Like Arkansas, the anti-choice politicians in North Dakota want to prosecute the doctors who perform abortions after a fetal heartbeat can be detected — and their heartbeat ban was part of the “flurry” of anti-abortion bills that lawmakers rushed to introduce around last week’s Roe v. Wade anniversary. A House committee is currently considering the measure, along with an even more radical “personhood” proposal. North Dakota has already imposed some the most restrictive anti-abortion laws in the nation, and women’s health advocates in the state warn that the passage of these new bills “would be tantamount to banning abortion” altogether.

Three of the states on this list — Mississippi, Arkansas, and North Dakota — only have a single surgical abortion clinic left in the entire state, which means women already have to overcome significant geographic barriers to obtain an abortion. If women’s window to access legal reproductive services is narrowed by about 17 weeks, as lawmakers attempt to move the cut-off back from 23 weeks of pregnancy to just 6 weeks, many women may not have enough time to make the trip.

The growth of the oil and gas industries in North Dakota has brought an economic boom to the state in recent years — job growth in the oil and gas industry has tripled since 2007, and North Dakota’s overall population has increased 44,000 since 2008. But, as the New York Times reports, it’s also placed a massive new burden on the state’s health care system.

The new jobs have predictably led to a surge in North Dakota’s population. Combined with the unusually dangerous nature of the oil and gas industries, the explosion of new residents to North Dakota is straining the state’s hospitals to their limits. Mackenzie County in North Dakota has shouldered much of the burden with its single, one-story, sixty-year-old hospital with one emergency room. In the last three years, the hospital’s average monthly emergency room visits ballooned from 100 per month to 400:

Over all, ambulance calls in the region increased by about 59 percent from 2006 to 2011, according to Thomas R. Nehring, the director of emergency medical services for the North Dakota Health Department. The number of traumatic injuries reported in the oil patch increased 200 percent from 2007 through the first half of last year, he said.

The 12 medical facilities in western North Dakota saw their combined debt rise by 46 percent over the course of the 2011 and 2012 fiscal years, according to Darrold Bertsch, the president of the state’s Rural Health Association.

Hospitals cannot simply refuse to treat people or raise their rates. Expenses at those 12 facilities increased by 15 percent, Mr. Bertsch added, and nine of them experienced operating losses.

According to the Times report, many of the new patients for the state’s health care system are transient workers who don’t have permanent addresses or health insurance coverage. One of the biggest drivers of hospital debt there is patients providing inaccurate contact information, and then disappearing when it comes time to collect. Average paychecks in the energy sector are growing faster than elsewhere, so it’s not clear if this is an income problem or just a failure of the state’s housing infrastructure to keep up with the massive influx of new residents. Ad-hoc housing has sprung up in camps and even in Walmart parking lots across the state to compensate.

Those infrastructure problems have also created second-order problems for North Dakota’s health care. Street signs and addresses are often nowhere to be found, and paramedics can have a difficult time locating patients. The cramped housing has brought its own health problems and pests, and — as can happen when lots of human beings are thrown into close quarters — sexually transmitted diseases are also on the rise.

And the problems accompanying North Dakota’s boom are a microcosm for the oil and gas industries as a whole: Their annual fatality rate between 2003 and 2008 was 29.1 deaths per 100,000 workers — seven times the rate for all U.S. workers. A single well can require 1,500 trips by semi-trucks, tankers and standard pickups to move oil, water, sand and chemicals, and a third of the industries’ fatalities are associated with the massive amounts of motor vehicle activity. On top of that, companies often pay out rewards for low injury rates, which encourages under-reporting of workers’ compensation claims. In North Dakota itself, companies are allowed to compensate injured workers directly, prompting one lawyer to describe the situation to Grist as “the wild fucking west.”

In Mackenzie County and elsewhere, there are attempts to convoke the local government to impose a new 1-cent sales tax to finance a $55 million expansion of the hospital facility. Gov. Jack Dalrymple (R) is moving to bulk up medical training in the state with a new $68 million medical school building at the University of North Dakota, and $6 million expansion of the nursing program. But for now, the small-town practitioners are largely on their own.