*132Justice Kennedy

delivered the opinion of the Court.

These cases require us to consider the validity of the Partial-Birth Abortion Ban Act of 2003 (Act), 18 U. S. C. § 1531 (2000 ed., Supp. IV), a federal statute regulating abortion procedures. In recitations preceding its operative provisions the Act refers to the Court’s opinion in Stenberg v. *133 Carhart, 530 U. S. 914 (2000), which also addressed the subject of abortion procedures used in the later stages of pregnancy. Compared to the state statute at issue in Stenberg, the Act is more specific concerning the instances to which it applies and in this respect more precise in its coverage. We conclude the Act should be sustained against the objections lodged by the broad, facial attack brought against it.

In No. 05-380 (Carhart) respondents are LeRoy Carhart, William G. Fitzhugh, William H. Knorr, and Jill L. Vibhakar, doctors who perform second-trimester abortions. These doctors filed their complaint against the Attorney General of the United States in the United States District Court for the District of Nebraska. They challenged the constitutionality of the Act and sought a permanent injunction against its enforcement. Carhart v. Ashcroft, 331 F. Supp. 2d 805 (2004). In 2004, after a 2-week trial, the District Court granted a permanent injunction that prohibited the Attorney General from enforcing the Act in all cases but those in which there was no dispute the fetus was viable. Id., at 1048. The Court of Appeals for the Eighth Circuit affirmed. 413 F. 3d 791 (2005). We granted certiorari. 546 U. S. 1169 (2006).

In No. 05-1382 (Planned Parenthood) respondents are Planned Parenthood Federation of America, Inc., Planned Parenthood Golden Gate, and the City and County of San Francisco. The Planned Parenthood entities sought to enjoin enforcement of the Act in a suit filed in the United States District Court for the Northern District of California. Planned Parenthood Federation of Am. v. Ashcroft, 320 F. Supp. 2d 957 (2004). The City and County of San Francisco intervened as a plaintiff. In 2004, the District Court held a trial spanning a period just short of three weeks, and it, too, enjoined the Attorney General from enforcing the Act. Id., at 1035. The Court of Appeals for the Ninth Circuit affirmed. 435 F. 3d 1163 (2006). We granted certiorari. 547 U. S. 1205 (2006).

*134I

A

The Act proscribes a particular manner of ending fetal life, so it is necessary here, as it was in Stenberg, to discuss abortion procedures in some detail. Three United States District Courts heard extensive evidence describing the procedures. In addition to the two courts involved in the instant cases the District Court for the Southern District of New York also considered the constitutionality of the Act. National Abortion Federation v. Ashcroft, 330 F. Supp. 2d 436 (2004). It found the Act unconstitutional, id., at 493, and the Court of Appeals for the Second Circuit affirmed, National Abortion Federation v. Gonzales, 437 F. 3d 278 (2006). The three District Courts relied on similar medical evidence; indeed, much of the evidence submitted to the Carhart court previously had been submitted to the other two courts. 331 F. Supp. 2d, at 809-810. We refer to the District Courts’ exhaustive opinions in our own discussion of abortion procedures.

Abortion methods vary depending to some extent on the preferences of the physician and, of course, on the term of the pregnancy and the resulting stage of the unborn child’s development. Between 85 and 90 percent of the approximately 1.3 million abortions performed each year in the United States take place in the first three months of pregnancy, which is to say in the first trimester. Planned Parenthood, supra, at 960, and n. 4; App. in No. 05-1382, pp. 45-48. The most common first-trimester abortion method is vacuum aspiration (otherwise known as suction curettage) in which the physician vacuums out the embryonic tissue. Early in this trimester an alternative is to use medication, such as mifepristone (commonly known as RU-486), to terminate the pregnancy. National Abortion Federation, supra, at 464, n. 20. The Act does not regulate these procedures.

*135Of the remaining abortions that take place each year, most occur in the second trimester. The surgical procedure referred to as “dilation and evacuation” or “D&E” is the usual abortion method in this trimester. Planned Parenthood, supra, at 960-961. Although individual techniques for performing D&E differ, the general steps are the same.

A doctor must first dilate the cervix at least to the extent needed to insert surgical instruments into the uterus and to maneuver them to evacuate the fetus. National Abortion Federation, supra, at 465; App. in No. 05-1382, at 61. The steps taken to cause dilation differ by physician and gestational age of the fetus. See, e. g., Carhart, supra, at 852, 856, 859, 862-865, 868, 870, 873-874, 876-877, 880, 883, 886. A doctor often begins the dilation process by inserting osmotic dilators, such as laminaria (sticks of seaweed), into the cervix. The dilators can be used in combination with drugs, such as misoprostol, that increase dilation. The resulting amount of dilation is not uniform, and a doctor does not know in advance how an individual patient will respond. In general the longer dilators remain in the cervix, the more it will dilate. Yet the length of time doctors employ osmotic dilators varies. Some may keep dilators in the cervix for two days, while others use dilators for a day or less. National Abortion Federation, supra, at 464-465; Planned Parenthood, supra, at 961.

After sufficient dilation the surgical operation can commence. The woman is placed under general anesthesia or conscious sedation. The doctor, often guided by ultrasound, inserts grasping forceps through the woman’s cervix and into the uterus to grab the fetus. The doctor grips a fetal part with the forceps and pulls it back through the cervix and vagina, continuing to pull even after meeting resistance from the cervix. The friction causes the fetus to tear apart. For example, a leg might be ripped off the fetus as it is pulled through the cervix and out of the woman. The process of *136evacuating the fetus piece by piece continues until it has been completely removed. A doctor may make 10 to 15 passes with the forceps to evacuate the fetus in its entirety, though sometimes removal is completed with fewer passes. Once the fetus has been evacuated, the placenta and any remaining fetal material are suctioned or scraped out of the uterus. The doctor examines the different parts to ensure the entire fetal body has been removed. See, e. g., National Abortion Federation, supra, at 465; Planned Parenthood, 320 F. Supp. 2d, at 962.

Some doctors, especially later in the second trimester, may kill the fetus a day or two before performing the surgical evacuation. They inject digoxin or potassium chloride into the fetus, the umbilical cord, or the amniotic fluid. Fetal demise may cause contractions and make greater dilation possible. Once dead, moreover, the fetus’ body will soften, and its removal will be easier. Other doctors refrain from injecting chemical agents, believing it adds risk with little or no medical benefit. Carhart, supra, at 907-912; National Abortion Federation, supra, at 474-475.

The abortion procedure that was the impetus for the numerous bans on “partial-birth abortion,” including the Act, is a variation of this standard D&E. See M. Haskell, Dilation and Extraction for Late Second Trimester Abortion (1992), 1 Appellant’s App. in No. 04-3379 (CA8), p. 109 (hereinafter Dilation and Extraction). The medical community has not reached unanimity on the appropriate name for this D&E variation. It has been referred to as “intact D&E,” “dilation and extraction” (D&X), and “intact D&X.” National Abortion Federation, supra, at 440, n. 2; see also F. Cunningham et al., Williams Obstetrics 243 (22d ed. 2005) (identifying the procedure as D&X); Danforth’s Obstetrics and Gynecology 567 (J. Scott, R. Gibbs, B. Karlan, & A. Haney eds. 9th ed. 2003) (identifying the procedure as intact D&X); M. Paul, E. Lichtenberg, L. Borgatta, D. Grimes, & P. Stubblefield, A Clinician’s Guide to Medical and Surgical *137Abortion 136 (1999) (identifying the procedure as intact D&E). For discussion purposes this D&E variation will be referred to as intact D&E. The main difference between the two procedures is that in intact D&E a doctor extracts the fetus intact or largely intact with only a few passes. There are no comprehensive statistics indicating what percentage of all D&Es are performed in this manner.

Intact D&E, like regular D&E, begins with dilation of the cervix. Sufficient dilation is essential for the procedure. To achieve intact extraction some doctors thus may attempt to dilate the cervix to a greater degree. This approach has been called “serial” dilation. Carhart, 331 F. Supp. 2d, at 856, 870, 873; Planned Parenthood, supra, at 965. Doctors who attempt at the outset to perform intact D&E may dilate for two full days or use up to 25 osmotic dilators. See, e. g., Dilation and Extraction 110; Carhart, supra, at 865, 868, 876, 886.

In an intact D&E procedure the doctor extracts the fetus in a way conducive to pulling out its entire body, instead of ripping it apart. One doctor, for example, testified:

“If I know I have good dilation and I reach in and the fetus starts to come out and I think I can accomplish it, the abortion with an intact delivery, then I use my forceps a little bit differently. I don’t close them quite so much, and I just gently draw the tissue out attempting to have an intact delivery, if possible.” App. in No. 05-1382, at 74.

Rotating the fetus as it is being pulled decreases the odds of dismemberment. Carhart, supra, at 868-869; App. in No. 05-380, pp. 40-41; 5 Appellant’s App. in No. 04-3379 (CA8), at 1469. A doctor also “may use forceps to grasp a fetal part, pull it down, and re-grasp the fetus at a higher level — sometimes using both his hand and a forceps — to exert traction to retrieve the fetus intact until the head is lodged in the [cervix].” Carhart, supra, at 886-887.

*138Intact D&E gained public notoriety when, in 1992, Dr. Martin Haskell gave a presentation describing his method of performing the operation. Dilation and Extraction 110-111. In the usual intact D&E the fetus’ head lodges in the cervix, and dilation is insufficient to allow it to pass. See, e. g., ibid,.; App. in No. 05-380, at 577; App. in No. 05-1382, at 74, 282. Haskell explained the next step as follows:

“ At this point, the right-handed surgeon slides the fingers of the left [hand] along the back of the fetus and “hooks” the shoulders of the fetus with the index and ring fingers (palm down).

“ ‘While maintaining this tension, lifting the cervix and applying traction to the shoulders with the fingers of the left hand, the surgeon takes a pair of blunt curved Metzenbaum scissors in the right hand. He carefully advances the tip, curved down, along the spine and under his middle finger until he feels it contact the base of the skull under the tip of his middle finger.

“ ‘[T]he surgeon then forces the scissors into the base of the skull or into the foramen magnum. Having safely entered the skull, he spreads the scissors to enlarge the opening.

“‘The surgeon removes the scissors and introduces a suction catheter into this hole and evacuates the skull contents. With the catheter still in place, he applies traction to the fetus, removing it completely from the patient.’ ” H. R. Rep. No. 108-58, p. 3 (2003).

This is an abortion doctor’s clinical description. Here is another description from a nurse who witnessed the same method performed on a 26-week fetus and who testified before the Senate Judiciary Committee:

“‘Dr. Haskell went in with forceps and grabbed the baby’s legs and pulled them down into the birth canal. Then he delivered the baby’s body and the arms — every*139thing but the head. The doctor kept the head right inside the uterus....

“ ‘The baby’s little fingers were clasping and unclasping, and his little feet were kicking. Then the doctor stuck the scissors in the back of his head, and the baby’s arms jerked out, like a startle reaction, like a flinch, like a baby does when he thinks he is going to fall.

“‘The doctor opened up the scissors, stuck a high-powered suction tube into the opening, and sucked the baby’s brains out. Now the baby went completely limp... .

“ ‘He cut the umbilical cord and delivered the placenta. He threw the baby in a pan, along with the placenta and the instruments he had just used.’” Ibid.

Dr. Haskell's approach is not the only method of killing the fetus once its head lodges in the cervix, and “the process has evolved” since his presentation. Planned Parenthood, 320 F. Supp. 2d, at 965. Another doctor, for example, squeezes the skull after it has been pierced “so that enough brain tissue exudes to allow the head to pass through.” App. in No. 05-380, at 41; see also Carhart, 331 F. Supp. 2d, at 866-867, 874. Still other physicians reach into the cervix with their forceps and crush the fetus’ skull. Id., at 858, 881. Others continue to pull the fetus out of the woman until it disarticulates at the neck, in effect decapitating it. These doctors then grasp the head with forceps, crush it, and remove it. Id., at 864, 878; see also Planned Parenthood, supra, at 965.

Some doctors performing an intact D&E attempt to remove the fetus without collapsing the skull. See Carhart, supra, at 866, 869. Yet one doctor would not allow delivery of a live fetus younger than 24 weeks because “the objective of [his] procedure is to perform an abortion,” not a birth. App. in No. 05-1382, at 408-409. The doctor thus answered in the affirmative when asked whether he would “hold the fetus’ head on the internal side of the [cervix] in order to *140collapse the skull” and kill the fetus before it is born. Id., at 409; see also Carhart, supra, at 862, 878. Another doctor testified he crushes a fetus’ skull not only to reduce its size but also to ensure the fetus is dead before it is removed. For the staff to have to deal with a fetus that has “some viability to it, some movement of limbs,” according to this doctor, “[is] always a difficult situation.” App. in No. 05-380, at 94; see Carhart, supra, at 858.

D&E and intact D&E are not the only second-trimester abortion methods. Doctors also may abort a fetus through medical induction. The doctor medicates the woman to induce labor, and contractions occur to deliver the fetus. Induction, which unlike D&E should occur in a hospital, can last as little as 6 hours but can take longer than 48. It accounts for about 5 percent of second-trimester abortions before 20 weeks of gestation and 15 percent of those after 20 weeks. Doctors turn to two other methods of second-trimester abortion, hysterotomy and hysterectomy, only in emergency situations because they carry increased risk of complications. In a hysterotomy, as in a cesarean section, the doctor removes the fetus by making an incision through the abdomen and uterine wall to gain access to the uterine cavity. A hysterectomy requires the removal of the entire uterus. These two procedures represent about 0.07 percent of second-trimester abortions. National Abortion Federation, 330 F. Supp. 2d, at 467; Planned Parenthood, supra, at 962-963.

B

After Dr. Haskell’s procedure received public attention, with ensuing and increasing public concern, bans on “ ‘partial birth abortion’ ” proliferated. By the time of the Stenberg decision, about 30 States had enacted bans designed to prohibit the procedure. 530 U. S., at 995-996, and nn. 12-13 (Thomas, J., dissenting); see also H. R. Rep. No. 108-58, at 4-5. In 1996, Congress also acted to ban partial-birth abortion. President Clinton vetoed the congressional legis*141lation, and the Senate failed to override the veto. Congress approved another bill banning the procedure in 1997, but President Clinton again vetoed it. In 2003, after this Court’s decision in Stenberg, Congress passed the Act at issue here. H. R. Rep. No. 108-58, at 12-14. On November 5, 2003, President Bush signed the Act into law. It was to take effect the following day. 18 U. S. C. § 1531(a) (2000 ed., Supp. IV).

The Act responded to Stenberg in two ways. First, Congress made factual findings. Congress determined that this Court in Stenberg “was required to accept the very questionable findings issued by the district court judge,” §2(7), 117 Stat. 1202, notes following 18 U. S. C. § 1531 (2000 ed., Supp. IV), p. 768, ¶ (7) (hereinafter Congressional Findings), but that Congress was “not bound to accept the same factual findings,” id., ¶ (8). Congress found, among other things, that “[a] moral, medical, and ethical consensus exists that the practice of performing a partial-birth abortion ... is a gruesome and inhumane procedure that is never medically necessary and should be prohibited.” Id., ¶ (1).

Second, and more relevant here, the Act’s language differs from that of the Nebraska statute struck down in Stenberg. See 530 U. S., at 921-922 (quoting Neb. Rev. Stat. Ann. §§28-328(1), 28-326(9) (Supp. 1999)). The operative provisions of the Act provide in relevant part:

“(a) Any physician who, in or affecting interstate or foreign commerce, knowingly performs a partial-birth abortion and thereby kills a human fetus shall be fined under this title or imprisoned not more than 2 years, or both. This subsection does not apply to a partial-birth abortion that is necessary to save the life of a mother whose life is endangered by a physical disorder, physical illness, or physical injury, including a life-endangering physical condition caused by or arising from the pregnancy itself. This subsection takes effect 1 day after the enactment.

*142“(b) As used in this section—

“(1) the term ‘partial-birth abortion’ means an abortion in which the person performing the abortion—

“(A) deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the body of the mother, or, in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the mother, for the purpose of performing an overt act that the person knows will kill the partially delivered living fetus; and

“(B) performs the overt act, other than completion of delivery, that kills the partially delivered living fetus; and

“(2) the term ‘physician’ means a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which the doctor performs such activity, or any other individual legally authorized by the State to perform abortions: Provided, however, That any individual who is not a physician or not otherwise legally authorized by the State to perform abortions, but who nevertheless directly performs a partial-birth abortion, shall be subject to the provisions of this section.

“(d)(1) A defendant accused of an offense under this section may seek a hearing before the State Medical Board on whether the physician’s conduct was necessary to save the life of the mother whose life was endangered by a physical disorder, physical illness, or physical injury, including a life-endangering physical condition caused by or arising from the pregnancy itself.

“(2) The findings on that issue are admissible on that issue at the trial of the defendant. Upon a motion of the defendant, the court shall delay the beginning of the *143trial for not more than 30 days to permit such a hearing to take place.

“(e) A woman upon whom a partial-birth abortion is performed may not be prosecuted under this section, for a conspiracy to violate this section, or for an offense under section 2, 3, or 4 of this title based on a violation of this section.” 18 U. S. C. § 1531 (2000 ed., Supp. IV).

The Act also includes a provision authorizing civil actions that is not of relevance here. § 1531(c).

C

The District Court in Carhart concluded the Act was unconstitutional for two reasons. First, it determined the Act was unconstitutional because it lacked an exception allowing the procedure where necessary for the health of the mother. 331 F. Supp. 2d, at 1004-1030. Second, the District Court found the Act deficient because it covered not merely intact D&E but also certain other D&Es. Id., at 1030-1037.

The Court of Appeals for the Eighth Circuit addressed only the lack of a health exception. 413 F. 3d, at 803-804. The court began its analysis with what it saw as the appropriate question — “whether ‘substantial medical authority’ supports the medical necessity of the banned procedure.” Id., at 796 (quoting Stenberg, supra, at 938). This was the proper framework, according to the Court of Appeals, because “when a lack of consensus exists in the medical community, the Constitution requires legislatures to err on the side of protecting women’s health by including a health exception.” 413 F. 3d, at 796. The court rejected the Attorney General’s attempt to demonstrate changed evidentiary circumstances since Stenberg and considered itself bound by Stenberg’s conclusion that a health exception was required. 413 F. 3d, at 803 (explaining “[t]he record in [the] case and the record in Stenberg [were] similar in all significant respects”). It invalidated the Act. Ibid.

*144D

The District Court in Planned Parenthood concluded the Act was unconstitutional “because it (1) pose[d] an undue burden on a woman’s ability to choose a second trimester abortion; (2) [was] unconstitutionally vague; and (3) required] a health exception as set forth by . . . Stenberg.” 320 F. Supp. 2d, at 1034-1035.

The Court of Appeals for the Ninth Circuit agreed. Like the Court of Appeals for the Eighth Circuit, it concluded the absence of a health exception rendered the Act unconstitutional. The court interpreted Stenberg to require a health exception unless “there is consensus in the medical community that the banned procedure is never medically necessary to preserve the health of women.” 435 F. 3d, at 1173. Even after applying a deferential standard of review to Congress’ factual findings, the Court of Appeals determined “substantial disagreement exists in the medical community regarding whether” the procedures prohibited by the Act are ever necessary to preserve a woman’s health. Id., at 1175-1176.

The Court of Appeals concluded further that the Act placed an undue burden on a woman’s ability to obtain a second-trimester abortion. The court found the textual differences between the Act and the Nebraska statute struck down in Stenberg insufficient to distinguish D&E and intact D&E. 435 F. 3d, at 1178-1180. As a result, according to the Court of Appeals, the Act imposed an undue burden because it prohibited D&E. Id., at 1180-1181.

Finally, the Court of Appeals found the Act void for vagueness. Id., at 1181. Abortion doctors testified they were uncertain which procedures the Act made criminal. The court thus concluded the Act did not offer physicians clear warning of its regulatory reach. Id., at 1181-1184. Resting on its understanding of the remedial framework established by this Court in Ayotte v. Planned Parenthood of Northern New Eng., 546 U. S. 320, 328-330 (2006), the Court of Appeals held *145the Act was unconstitutional on its face and should be permanently enjoined. 435 F. 3d, at 1184-1191.

II

The principles set forth in the joint opinion in Planned Parenthood of Southeastern Pa. v. Casey, 505 U. S. 833 (1992), did not find support from all those who join the instant opinion. See id., at 979-1002 (Scalia, J., joined by Thomas, J., inter alios, concurring in judgment in part and dissenting in part). Whatever one’s views concerning the Casey joint opinion, it is evident a premise central to its conclusion — that the government has a legitimate and substantial interest in preserving and promoting fetal life — would be repudiated were the Court now to affirm the judgments of the Courts of Appeals.

Casey involved a challenge to Roe v. Wade, 410 U. S. 113 (1973). The opinion contains this summary:

“It must be stated at the outset and with clarity that Roe’s essential holding, the holding we reaffirm, has three parts. First is a recognition of the right of the woman to choose to have an abortion before viability and to obtain it without undue interference from the State. Before viability, the State’s interests are not strong enough to support a prohibition of abortion or the imposition of a substantial obstacle to the woman’s effective right to elect the procedure. Second is a confirmation of the State’s power to restrict abortions after fetal viability, if the law contains exceptions for pregnancies which endanger the woman’s life or health. And third is the principle that the State has legitimate interests from the outset of the pregnancy in protecting the health of the woman and the life of the fetus that may become a child. These principles do not contradict one another; and we adhere to each.” 505 U. S., at 846 (opinion of the Court).

*146Though all three holdings are implicated in the instant cases, it is the third that requires the most extended discussion; for we must determine whether the Act furthers the legitimate interest of the Government in protecting the life of the fetus that may become a child.

To implement its holding, Casey rejected both Roe’s rigid trimester framework and the interpretation of Roe that considered all previability regulations of abortion unwarranted. 505 U. S., at 875-876, 878 (plurality opinion). On this point Casey overruled the holdings in two cases because they undervalued the State’s interest in potential life. See id., at 881-883 (joint opinion) (overruling Thornburgh v. American College of Obstetricians and Gynecologists, 476 U. S. 747 (1986), and Akron v. Akron Center for Reproductive Health, Inc., 462 U. S. 416 (1983)).

We assume the following principles for the purposes of this opinion. Before viability, a State “may not prohibit any woman from making the ultimate decision to terminate her pregnancy.” 505 U. S., at 879 (plurality opinion). It also may not impose upon this right an undue burden, which exists if a regulation’s “purpose or effect is to place a substantial obstacle in the path of a woman seeking an abortion before the fetus attains viability.” Id., at 878. On the other hand, “[regulations which do no more than create a structural mechanism by which the State, or the parent or guardian of a minor, may express profound respect for the life of the unborn are permitted, if they are not a substantial obstacle to the woman’s exercise of the right to choose.” Id., at 877. Casey, in short, struck a balance. The balance was central to its holding. We now apply its standard to the cases at bar.

Ill

We begin with a determination of the Act’s operation and effect. A straightforward reading of the Act’s text demonstrates its purpose and the scope of its provisions: It regu*147lates and proscribes, with exceptions or qualifications to be discussed, performing the intact D&E procedure.

Respondents agree the Act encompasses intact D&E, but they contend its additional reach is both unclear and excessive. . Respondents assert that, at the least, the Act is void for vagueness because its scope is indefinite. In the alternative, respondents argue the Act’s text proscribes all D&Es. Because D&E is the most common second-trimester abortion method, respondents suggest the Act imposes an undue burden. In this litigation the Attorney General does not dispute that the Act would impose an undue burden if it covered standard D&E.

We conclude that the Act is not void for vagueness, does not impose an undue burden from any overbreadth, and is not invalid on its face.

A

The Act punishes “knowingly performing] ” a “partial-birth abortion.” § 1531(a) (2000 ed., Supp. IV). It defines the unlawful abortion in explicit terms. § 1531(b)(1).

First, the person performing the abortion must “vaginally delivejr] a living fetus.” § 1531(b)(1)(A). The Act does not restrict an abortion procedure involving the delivery of an expired fetus. The Act, furthermore, is inapplicable to abortions that do not involve vaginal delivery (for instance, hysterotomy or hysterectomy). The Act does apply both previability and postviability because, by common understanding and scientific terminology, a fetus is a living organism while within the womb, whether or not it is viable outside the womb. See, e. g., Planned Parenthood, 320 F. Supp. 2d, at 971-972. We do not understand this point to be contested by the parties.

Second, the Act’s definition of partial-birth abortion requires the fetus to be delivered “until, in the case of a headfirst presentation, the entire fetal head is outside the body of the mother, or, in the case of breech presentation, any part *148of the fetal trunk past the navel is outside the body of the mother.” § 1531(b)(1)(A). The Attorney General concedes, and we agree, that if an abortion procedure does not involve the delivery of a living fetus to one of these “anatomical ‘landmarks’” — where, depending on the presentation, either the fetal head or the fetal trunk past the navel is outside the body of the mother — the prohibitions of the Act do not apply. Brief for Petitioner in No. 05-380, p. 46.

Third, to fall within the Act, a doctor must perform an “overt act, other than completion of delivery, that kills the partially delivered living fetus.” § 1531(b)(1)(B). For purposes of criminal liability, the overt act causing the fetus’ death must be separate from delivery. And the overt act must occur after the delivery to an anatomical landmark. This is because the Act proscribes killing “the partially delivered” fetus, which, when read in context, refers to a fetus that has been delivered to an anatomical landmark. Ibid.

Fourth, the Act contains scienter requirements concerning all the actions involved in the prohibited abortion. To begin with, the physician must have “deliberately and intentionally” delivered the fetus to one of the Act’s anatomical landmarks. § 1531(b)(1)(A). If a living fetus is delivered past the critical point by accident or inadvertence, the Act is inapplicable. In addition, the fetus must have been delivered “for the purpose of performing an overt act that the [doctor] knows will kill [it].” Ibid. If either intent is absent, no crime has occurred. This follows from the general principle that where scienter is required no crime is committed absent the requisite state of mind. See generally 1 W. LaFave, Substantive Criminal Law § 5.1 (2d ed. 2003) (hereinafter La-Fave); 1 C. Torcía, Wharton’s Criminal Law §27 (15th ed. 1993).

B

Respondents contend the language described above is indeterminate, and they thus argue the Act is unconstitutionally vague on its face. “As generally stated, the void-for-*149vagueness doctrine requires that a penal statute define the criminal offense with sufficient definiteness that ordinary people can understand what conduct is prohibited and in a manner that does not encourage arbitrary and discriminatory enforcement.” Kolender v. Lawson, 461 U. S. 352, 357 (1983); Posters ‘N’ Things, Ltd. v. United States, 511 U. S. 513, 525 (1994). The Act satisfies both requirements.

The Act provides doctors “of ordinary intelligence a reasonable opportunity to know what is prohibited.” Grayned v. City of Rockford, 408 U. S. 104,108 (1972). Indeed, it sets forth “relatively clear guidelines as to prohibited conduct” and provides “objective criteria” to evaluate whether a doctor has performed a prohibited procedure. Posters ‘N’ Things, supra, at 525-526. Unlike the statutory language in Stenberg that prohibited the delivery of a “‘substantial portion’ ” of the fetus — where a doctor might question how much of the fetus is a substantial portion — the Act defines the line between potentially criminal conduct on the one hand and lawful abortion on the other. Stenberg, 530 U. S., at 922 (quoting Neb. Rev. Stat. Ann. §28-326(9) (Supp. 1999)). Doctors performing D&E will know that if they do not deliver a living fetus to an anatomical landmark they will not face criminal liability.

This conclusion is buttressed by the intent that must be proved to impose liability. The Court has made clear that scienter requirements alleviate vagueness concerns. Posters ‘N’ Things, supra, at 526; see also Colautti v. Franklin, 439 U. S. 379, 395 (1979) (“This Court has long recognized that the constitutionality of a vague statutory standard is closely related to whether that standard incorporates a requirement of mens rea”). The Act requires the doctor deliberately to have delivered the fetus to an anatomical landmark. 18 U.S.C. § 1531(b)(1)(A) (2000 ed., Supp. IV). Because a doctor performing a D&E will not face criminal liability if he or she delivers a fetus beyond the prohibited point by mistake, the Act cannot be described as “a trap for *150those who act in good faith.” Colautti, supra, at 395 (internal quotation marks omitted).

Respondents likewise have failed to show that the Act should be invalidated on its face because it encourages arbitrary or discriminatory enforcement. Kolender, supra, at 357. Just as the Act’s anatomical landmarks provide doctors with objective standards, they also “establish minimal guidelines to govern law enforcement.” Smith v. Goguen, 415 U. S. 566, 574 (1974). The scienter requirements narrow the scope of the Act’s prohibition and limit prosecutorial discretion. It cannot be said that the Act “vests virtually complete discretion in the hands of [law enforcement] to determine whether the [doctor] has satisfied [its provisions].” Kolender, supra, at 358 (invalidating a statute regulating loitering). Respondents’ arguments concerning arbitrary enforcement, furthermore, are somewhat speculative. This is a preenforcement challenge, where “no evidence has been, or could be, introduced to indicate whether the [Act] has been enforced in a discriminatory manner or with the aim of inhibiting [constitutionally protected conduct].” Hoffman Estates v. Flipside, Hoffman Estates, Inc., 455 U. S. 489, 503 (1982). The Act is not vague.

C

We next determine whether the Act imposes an undue burden, as a facial matter, because its restrictions on second-trimester abortions are too broad. A review of the statutory text discloses the limits of its reach. The Act prohibits intact D&E; and, notwithstanding respondents’ arguments, it does not prohibit the D&E procedure in which the fetus is removed in parts.

1

The Act prohibits a doctor from intentionally performing an intact D&E. The dual prohibitions of the Act, both of which are necessary for criminal liability, correspond with the steps generally undertaken during this type of proce*151dure. First, a doctor delivers the fetus until its head lodges in the cervix, which is usually past the anatomical landmark for a breech presentation. See 18 U. S. C. § 1531(b)(1)(A) (2000 ed., Supp. IV). Second, the doctor proceeds to pierce the fetal skull with scissors or crush it with forceps. This step satisfies the overt-act requirement because it kills the fetus and is distinct from delivery. See § 1531(b)(1)(B). The Act’s intent requirements, however, limit its reach to those physicians who carry out the intact D&E after intending to undertake both steps at the outset.

The Act excludes most D&Es in which the fetus is removed in pieces, not intact. If the doctor intends to remove the fetus in parts from the outset, the doctor will not have the requisite intent to incur criminal liability. A doctor performing a standard D&E procedure can often “tak[e] about 10-15 ‘passes’ through the uterus to remove the entire fetus.” Planned Parenthood, 320 F. Supp. 2d, at 962. Removing the fetus in this manner does not violate the Act because the doctor will not have delivered the living fetus to one of the anatomical landmarks or committed an additional overt act that kills the fetus after partial delivery. § 1531(b)(1).

A comparison of the Act with the Nebraska statute struck down in Stenberg confirms this point. The statute in Stenberg prohibited “‘deliberately and intentionally delivering into the vagina a living unborn child, or a substantial portion thereof, for the purpose of performing a procedure that the person performing such procedure knows will kill the unborn child and does kill the unborn child.’” 530 U. S., at 922 (quoting Neb. Rev. Stat. Ann. § 28-326(9) (Supp. 1999)). The Court concluded that this statute encompassed D&E because “D&E will often involve a physician pulling a ‘substantial portion’ of a still living fetus, say, an arm or leg, into the vagina prior to the death of the fetus.” 530 U. S., at 939. The Court also rejected the limiting interpretation urged by Nebraska’s Attorney General that the statute’s reference to *152a “procedure” that “ ‘kill[s] the unborn child’ ” was to a distinct procedure, not to the abortion procedure as a whole. Id., at 948.

Congress, it is apparent, responded to these concerns because the Act departs in material ways from the statute in Stenberg. It adopts the phrase “delivers a living fetus,” § 1531(b)(1)(A), instead of “ ‘delivering ... a living unborn child, or a substantial portion thereof,’ ” 530 U. S., at 938 (quoting Neb. Rev. Stat. Ann. § 28-326(9) (Supp. 1999)). The Act’s language, unlike the statute in Stenberg, expresses the usual meaning of “deliver” when used in connection with “fetus,” namely, extraction of an entire fetus rather than removal of fetal pieces. See Stedman’s Medical Dictionary 470 (27th ed. 2000) (defining deliver as “[t]o assist a woman in childbirth” and “[t]o extract from an enclosed place, as the fetus from the womb, an object or foreign body”); see also I. Dox, B. Melloni, G. Eisner, & J. Melloni, The HarperCollins Illustrated Medical Dictionary 160 (4th ed. 2001); Merriam-Webster’s Collegiate Dictionary 306 (10th ed. 1997). The Act thus displaces the interpretation of “delivering” dictated by the Nebraska statute’s reference to a “substantial portion” of the fetus. Stenberg, supra, at 944 (indicating that the Nebraska “statute itself specifies that it applies both to delivering ‘an intact unborn child’ or ‘a substantial portion thereof’”). In interpreting statutory texts courts use the ordinary meaning of terms unless context requires a different result. See, e. g., 2A N. Singer, Sutherland on Statutes and Statutory Construction § 47:28 (rev. 6th ed. 2000). Here, unlike in Stenberg, the language does not require a departure from the ordinary meaning. D&E does not involve the delivery of a fetus because it requires the removal of fetal parts that are ripped from the fetus as they are pulled through the cervix.

The identification of specific anatomical landmarks to which the fetus must be partially delivered also differentiates the Act from the statute at issue in Stenberg. *153§ 1531(b)(1)(A). The Court in Stenberg interpreted “‘substantial portion’ ” of the fetus to include an arm or a leg. 530 U. S., at 939. The Act’s anatomical landmarks, by contrast, clarify that the removal of a small portion of the fetus is not prohibited. The landmarks also require the fetus to be delivered so that it is partially “outside the body of the mother.” § 1531(b)(1)(A). To come within the ambit of the Nebraska statute, on the other hand, a substantial portion of the fetus only had to be delivered into the vagina; no part of the fetus had to be outside the body of the mother before a doctor could face criminal sanctions. Id., at 938-939.

By adding an overt-act requirement Congress sought further to meet the Court’s objections to the state statute considered in Stenberg. Compare 18 U. S. C. § 1531(b)(1) (2000 ed., Supp. IV) with Neb. Rev. Stat. Ann. §28-326(9) (Supp. 1999). The Act makes the distinction the Nebraska statute failed to draw (but the Nebraska Attorney General advanced) by differentiating between the overall partial-birth abortion and the distinct overt act that kills the fetus. See Stenberg, supra, at 943-944. The fatal overt act must occur after delivery to an anatomical landmark, and it must be something “other than [the] completion of delivery.” § 1531(b)(1)(B). This distinction matters because, unlike intact D&E, standard D&E does not involve a delivery followed by a fatal act.

The canon of constitutional avoidance, finally, extinguishes any lingering doubt as to whether the Act covers the prototypical D&E procedure. “‘[T]he elementary rule is that every reasonable construction must be resorted to, in order to save a statute from unconstitutionality.’ ” Edward J. De-Bartolo Corp. v. Florida Gulf Coast Building & Constr. Trades Council, 485 U. S. 568, 575 (1988) (quoting Hooper v. California, 155 U. S. 648, 657 (1895)). It is true this longstanding maxim of statutory interpretation has, in the past, fallen by the wayside when the Court confronted a statute regulating abortion. The Court at times employed an an*154tagonistic “ ‘canon of construction under which in cases involving abortion, a permissible reading of a statute [was] to be avoided at all costs.’” Stenberg, supra, at 977 (Kennedy, J., dissenting) (quoting Thornburgh, 476 U. S., at 829 (O’Connor, J., dissenting); some internal quotation marks omitted). Casey put this novel statutory approach to rest. Stenberg, supra, at 977 (Kennedy, J., dissenting). Stenberg need not be interpreted to have revived it. We read that decision instead to stand for the uncontroversial proposition that the canon of constitutional avoidance does not apply if a statute is not “genuinely susceptible to two constructions.” Almendarez-Torres v. United States, 523 U. S. 224, 238 (1998); see also Clark v. Martinez, 543 U. S. 371, 385 (2005). In Stenberg the Court found the statute covered D&E. 530 U. S., at 938-945. Here, by contrast, interpreting the Act so that it does not prohibit standard D&E is the most reasonable reading and understanding of its terms.

2

Contrary arguments by respondents are unavailing. Respondents look to situations that might arise during D&E, situations not examined in Stenberg. They contend — relying on the testimony of numerous abortion doctors — that D&E may result in the delivery of a living fetus beyond the Act’s anatomical landmarks in a significant fraction of cases. This is so, respondents say, because doctors cannot predict the amount the cervix will dilate before the abortion procedure. It might dilate to a degree that the fetus will be removed largely intact. To complete the abortion, doctors will commit an overt act that kills the partially delivered fetus. Respondents thus posit that any D&E has the potential to violate the Act, and that a physician will not know beforehand whether the abortion will proceed in a prohibited manner. Brief for Respondent Planned Parenthood et al. in No. 05-1382, p. 38.

*155This reasoning, however, does not take account of the Act’s intent requirements, which preclude liability from attaching to an accidental intact D&E. If a doctor’s intent at the outset is to perform a D&E in which the fetus would not be delivered to either of the Act’s anatomical landmarks, but the fetus nonetheless is delivered past one of those points, the requisite and prohibited scienter is not present. 18 U. S. C. § 1531(b)(1)(A) (2000 ed., Supp. IV). When a doctor in that situation completes an abortion by performing an intact D&E, the doctor does not violate the Act. It is true that intent to cause a result may sometimes be inferred if a person “knows that that result is practically certain to follow from his conduct.” 1 LaFave § 5.2(a), at 341. Yet abortion doctors intending at the outset to perform a standard D&E procedure will not know that a prohibited abortion “is practically certain to follow from” their conduct. Ibid. A fetus is only delivered largely intact in a small fraction of the overall number of D&E abortions. Planned Parenthood, 320 F. Supp. 2d, at 965.

The evidence also supports a legislative determination that an intact delivery is almost always a conscious choice rather than a happenstance. Doctors, for example, may remove the fetus in a manner that will increase the chances of an intact delivery. See, e. g., App. in No. 05-1382, at 74, 452. And intact D&E is usually described as involving some manner of serial dilation. See, e. g., Dilation and Extraction 110. Doctors who do not seek to obtain this serial dilation perform an intact D&E on far fewer occasions. See, e. g., Carhart, 331 F. Supp. 2d, at 857-858 (“In order for intact removal to occur on a regular basis, Dr. Fitzhugh would have to dilate his patients with a second round of laminaria”). This evidence belies any claim that a standard D&E cannot be performed without intending or foreseeing an intact D&E.

Many doctors who testified on behalf of respondents, and who objected to the Act, do not perform an intact D&E by accident. On the contrary, they begin every D&E abortion *156with the objective of removing the fetus as intact as possible. See, e.g., id., at 869 (“Since Dr. Chasen believes that the intact D & E is safer than the dismemberment D & E, Dr. Chasen’s goal is to perform an intact D&E every time”); see also id., at 873,886. This does not prove, as respondents suggest, that every D&E might violate the Act and that the Act therefore imposes an undue burden. It demonstrates only that those doctors who intend to perform a D&E that would involve delivery of a living fetus to one of the Act’s anatomical landmarks must adjust their conduct to the law by not attempting to deliver the fetus to either of those points. Respondents have not shown that requiring doctors to intend dismemberment before delivery to an anatomical landmark will prohibit the vast majority of D&E abortions. The Act, then, cannot be held invalid on its face on these grounds.

IV

Under the principles accepted as controlling here, the Act, as we have interpreted it, would be unconstitutional “if its purpose or effect is to place a substantial obstacle in the path of a woman seeking an abortion before the fetus attains viability.” Casey, 505 U. S., at 878 (plurality opinion). The abortions affected by the Act’s regulations take place both previability and postviability; so the quoted language and the undue burden analysis it relies upon are applicable. The question is whether the Act, measured by its text in this facial attack, imposes a substantial obstacle to late-term, but previability, abortions. The Act does not on its face impose a substantial obstacle, and we reject this further facial challenge to its validity.

A

The Act’s purposes are set forth in recitals preceding its operative provisions. A description of the prohibited abortion procedure demonstrates the rationale for the congressional enactment. The Act proscribes a method of abortion *157in which a fetus is killed just inches before completion of the birth process. Congress stated as follows: “Implicitly approving such a brutal and inhumane procedure by choosing not to prohibit it will further coarsen society to the humanity of not only newborns, but all vulnerable and innocent human life, making it increasingly difficult to protect such life.” Congressional Findings ¶ (14)(N). The Act expresses respect for the dignity of human life.

Congress was concerned, furthermore, with the effects on the medical community and on its reputation caused by the practice of partial-birth abortion. The findings in the Act explain:

“Partial-birth abortion . . . confuses the medical, legal, and ethical duties of physicians to preserve and promote life, as the physician acts directly against the physical life of a child, whom he or she had just delivered, all but the head, out of the womb, in order to end that life.” Id., ¶ (14)(J).

There can be no doubt the government “has an interest in protecting the integrity and ethics of the medical profession.” Washington v. Glucksberg, 521 U. S. 702, 731 (1997); see also Barsky v. Board of Regents of Univ. of N. Y, 347 U. S. 442, 451 (1954) (indicating the State has “legitimate concern for maintaining high standards of professional conduct” in the practice of medicine). Under our precedents it is clear the State has a significant role to play in regulating the medical profession.

Casey reaffirmed these governmental objectives. The government may use its voice and its regulatory authority to show its profound respect for the life within the woman. A central premise of the opinion was that the Court’s precedents after Roe had “undervalue^] the State’s interest in potential life.” 505 U. S., at 873 (plurality opinion); see also id., at 871. The plurality opinion indicated “[t]he fact that a law which serves a valid purpose, one not designed to strike *158at the right itself, has the incidental effect of making it more difficult or more expensive to procure an abortion cannot be enough to invalidate it.” Id., at 874. This was not an idle assertion. The three premises of Casey must coexist. See id., at 846 (opinion of the Court). The third premise, that the State, from the inception of the pregnancy, maintains its own regulatory interest in protecting the life of the fetus that may become a child, cannot be set at naught by interpreting Casey’s requirement of a health exception so it becomes tantamount to allowing a doctor to choose the abortion method he or she might prefer. Where it has a rational basis to act, and it does not impose an undue burden, the State may use its regulatory power to bar certain procedures and substitute others, all in furtherance of its legitimate interests in regulating the medical profession in order to promote respect for life, including life of the unborn.

The Act’s ban on abortions that involve partial delivery of a living fetus furthers the Government’s objectives. No one would dispute that, for many, D&E is a procedure itself laden with the power to devalue human life. Congress could nonetheless conclude that the type of abortion proscribed by the Act requires specific regulation because it implicates additional ethical and moral concerns that justify a special prohibition. Congress determined that the abortion methods it proscribed had a “disturbing similarity to the killing of a newborn infant,” Congressional Findings ¶ (14)(L), and thus it was concerned with “draw[ing] a bright line that clearly distinguishes abortion and infanticide,” id., ¶ (14)(G). The Court has in the past confirmed the validity of drawing boundaries to prevent certain practices that extinguish life and are close to actions that are condemned. Glucksberg found reasonable the State’s “fear that permitting assisted suicide will start it down the path to voluntary and perhaps even involuntary euthanasia.” 521 U. S., at 732-735, and n. 23.

*159Respect for human life finds an ultimate expression in the bond of love the mother has for her child. The Act recognizes this reality as well. Whether to have an abortion requires a difficult and painful moral decision. Casey, supra, at 852-853 (opinion of the Court). While we find no reliable data to measure the phenomenon, it seems unexceptionable to conclude some women come to regret their choice to abort the infant life they once created and sustained. See Brief for Sandra Cano et al. as Amici Curiae in No. 05-380, pp. 22-24. Severe depression and loss of esteem can follow. See ibid.

In a decision so fraught with emotional consequence some doctors may prefer not to disclose precise details of the means that will be used, confining themselves to the required statement of risks the procedure entails. From one standpoint this ought not to be surprising. Any number of patients facing imminent surgical procedures would prefer not to hear all details, lest the usual anxiety preceding invasive medical procedures become the more intense. This is likely the case with the abortion procedures here in issue. See, e. g., National Abortion Federation, 330 F. Supp. 2d, at 466, n. 22 (“Most of [the plaintiffs’] experts acknowledged that they do not describe to their patients what [the D&E and intact D&E] procedures entail in clear and precise terms”); see also id., at 479.

It is, however, precisely this lack of information concerning the way in which the fetus will be killed that is of legitimate concern to the State. Casey, supra, at 873 (plurality opinion) (“States are free to enact laws to provide a reasonable framework for a woman to make a decision that has such profound and lasting meaning”). The State has an interest in ensuring so grave a choice is well informed. It is self-evident that a mother who comes to regret her choice to abort must struggle with grief more anguished and sorrow more profound when she learns, only after the event, what *160she once did not know: that she allowed a doctor to pierce the skull and vacuum the fast-developing brain of her unborn child, a child assuming the human form.

It is a reasonable inference that a necessary effect of the regulation and the knowledge it conveys will be to encourage some women to carry the infant to full term, thus reducing the absolute number of late-term abortions. The medical profession, furthermore, may find different and less shocking methods to abort the fetus in the second trimester, thereby accommodating legislative demand. The State’s interest in respect for life is advanced by the dialogue that better informs the political and legal systems, the medical profession, expectant mothers, and society as a whole of the consequences that follow from a decision to elect a late-term abortion.

It is objected that the standard D&E is in some respects as brutal, if not more, than the intact D&E, so that the legislation accomplishes little. What we have already said, however, shows ample justification for the regulation. Partial-birth abortion, as defined by the Act, differs from a standard D&E because the former occurs when the fetus is partially outside the mother to the point of one of the Act’s anatomical landmarks. It was reasonable for Congress to think that partial-birth abortion, more than standard D&E, “undermines the public’s perception of the appropriate role of a physician during the delivery process, and perverts a process during which life is brought into the world.” Congressional Findings ¶ (14)(K). There would be a flaw in this Court’s logic, and an irony in its jurisprudence, were we first to conclude a ban on both D&E and intact D&E was overbroad and then to say it is irrational to ban only intact D&E because that does not proscribe both procedures. In sum, we reject the contention that the congressional purpose of the Act was “to place a substantial obstacle in the path of a woman seeking an abortion.” 505 U. S., at 878 (plurality opinion).

*161B

The Act’s furtherance of legitimate government interests bears upon, but does not resolve, the next question: whether the Act has the effect of imposing an unconstitutional burden on the abortion right because it does not allow use of the barred procedure where “ ‘necessary, in appropriate medical judgment, for the preservation of the . . . health of the mother.’” Ayotte, 546 U. S., at 327-328 (quoting Casey, supra, at 879 (plurality opinion)). The prohibition in the Act would be unconstitutional, under precedents we here assume to be controlling, if it “subject[ed] [women] to significant health risks.” Ayotte, supra, at 328; see also Casey, supra, at 880 (opinion of the Court). In Ayotte the parties agreed a health exception to the challenged parental-involvement statute was necessary ‘‘to avert serious and often irreversible damage to [a pregnant minor’s] health.” 546 U. S., at 328. Here, by contrast, whether the Act creates significant health risks for women has been a contested factual question. The evidence presented in the trial courts and before Congress demonstrates both sides have medical support for their position.

Respondents presented evidence that intact D&E may be the safest method of abortion, for reasons similar to those adduced in Stenberg. See 530 U. S., at 932. Abortion doctors testified, for example, that intact D&E decreases the risk of cervical laceration or uterine perforation because it requires fewer passes into the uterus with surgical instruments and does not require the removal of bony fragments of the dismembered fetus, fragments that may be sharp. Respondents also presented evidence that intact D&E was safer both because it reduces the risks that fetal parts will remain in the uterus and because it takes less time to complete. Respondents, in addition, proffered evidence that intact D&E was safer for women with certain medical conditions or women with fetuses that had certain anomalies. See, e. g., Carhart, 331 F. Supp. 2d, at 923-929; National *162 Abortion Federation, 330 F. Supp. 2d, at 470-474; Planned Parenthood, 320 F. Supp. 2d, at 982-983.

These contentions were contradicted by other doctors who testified in the District Courts and before Congress. They concluded that the alleged health advantages were based on speculation without scientific studies to support them. They considered D&E always to be a safe alternative. See, e. g., Carhart, supra, at 930-940; National Abortion Federation, supra, at 470-474; Planned Parenthood, 320 F. Supp. 2d, at 983.

There is documented medical disagreement whether the Act’s prohibition would ever impose significant health risks on women. See, e. g., id., at 1033 (“[T]here continues to be a division of opinion among highly qualified experts regarding the necessity or safety of intact D & E”); see also National Abortion Federation, supra, at 482. The three District Courts that considered the Act’s constitutionality appeared to be in some disagreement on this central factual question. The District Court for the District of Nebraska concluded “the banned procedure is, sometimes, the safest abortion procedure to preserve the health of women.” Carhart, supra, at 1017. The District Court for the Northern District of California reached a similar conclusion. Planned Parenthood, supra, at 1002 (finding intact D&E was “under certain circumstances... significantly safer than D & E by disarticulation”). The District Court for the Southern District of New York was more skeptical of the purported health benefits of intact D&E. It found the Attorney General’s “expert witnesses reasonably and effectively refuted [the plaintiffs’] proffered bases for the opinion that [intact D&E] has safety advantages over other second-trimester abortion procedures.” National Abortion Federation, 330 F. Supp. 2d, at 479. In addition it did “not believe that many of [the plaintiffs’] purported reasons for why [intact D&E] is medically necessary [were] credible; rather [it found them to be] theoretical or false.” Id., at 480. The court nonetheless in*163validated the Act because it determined “a significant body of medical opinion . . . holds that D & E has safety advantages over induction and that [intact D&E] has some safety advantages (however hypothetical and unsubstantiated by scientific evidence) over D & E for some women in some circumstances.” Ibid.

The question becomes whether the Act can stand when this medical uncertainty persists. The Court’s precedents instruct that the Act can survive this facial attack. The Court has given state and federal legislatures wide discretion to pass legislation in areas where there is medical and scientific uncertainty. See Kansas v. Hendricks, 521 U. S. 346, 360, n. 3 (1997); Jones v. United States, 463 U. S. 354, 364-365, n. 13, 370 (1983); Lambert v. Yellowley, 272 U. S. 581, 597 (1926); Collins v. Texas, 223 U.S. 288, 297-298 (1912); Jacobson v. Massachusetts, 197 U. S. 11, 30-31 (1905); see also Stenberg, supra, at 969-972 (Kennedy, J., dissenting); Marshall v. United States, 414 U. S. 417, 427 (1974) (“When Congress undertakes to act in areas fraught with medical and scientific uncertainties, legislative options must be especially broad”).

This traditional rule is consistent with Casey, which confirms the State’s interest in promoting respect for human life at all stages in the pregnancy. Physicians are not entitled to ignore regulations that direct them to use reasonable alternative procedures. The law need not give abortion doctors unfettered choice in the course of their medical practice, nor should it elevate their status above other physicians in the medical community. In Casey the controlling opinion held an informed-consent requirement in the abortion context was “no different from a requirement that a doctor give certain specific information about any medical procedure.” 505 U. S., at 884 (joint opinion). The opinion stated “the doctor-patient relation here is entitled to the same solicitude it receives in other contexts.” Ibid.; see also Webster v. Reproductive Health Services, 492 U. S. 490, 518-519 (1989) *164(plurality opinion) (criticizing Roe’s trimester framework because, inter alia, it “left this Court to serve as the country’s ex officio medical board with powers to approve or disapprove medical and operative practices and standards throughout the United States” (internal quotation marks omitted)); Mazurek v. Armstrong, 520 U. S. 968, 973 (1997) (per curiam) (upholding a restriction on the performance of abortions to licensed physicians despite the respondents’ contention “all health evidence contradicts the claim that there is any health basis for the law” (internal quotation marks omitted)).

Medical uncertainty does not foreclose the exercise of legislative power in the abortion context any more than it does in other contexts. See Hendricks, supra, at 360, n. 3. The medical uncertainty over whether the Act’s prohibition creates significant health risks provides a sufficient basis to conclude in this facial attack that the Act does not impose an undue burden.

The conclusion that the Act does not impose an undue burden is supported by other considerations. Alternatives are available to the prohibited procedure. As we have noted, the Act does not proscribe D&E. One District Court found D&E to have extremely low rates of medical complications. Planned Parenthood, supra, at 1000. Another indicated D&E was “generally the safest method of abortion during the second trimester.” Carhart, 331 F. Supp. 2d, at 1031; see also National Abortion Federation, supra, at 467-468 (explaining that “[e]xperts testifying for both sides” agreed D&E was safe). In addition the Act’s prohibition only applies to the delivery of “a living fetus.” 18 U. S. C. § 1531(b)(1)(A) (2000 ed., Supp. IV). If the intact D&E procedure is truly necessary in some circumstances, it appears likely an injection that kills the fetus is an alternative under the Act that allows the doctor to perform the procedure.

The instant cases, then, are different from Planned Parenthood of Central Mo. v. Danforth, 428 U. S. 52, 77-79 *165(1976), in which the Court invalidated a ban on saline amniocentesis, the then-dominant second-trimester abortion method. The Court found the ban in Danforth to be “an unreasonable or arbitrary regulation designed to inhibit, and having the effect of inhibiting, the vast majority of abortions after the first 12 weeks.” Id., at 79. Here the Act allows, among other means, a commonly used and generally accepted method, so it does not construct a substantial obstacle to the abortion right.

In reaching the conclusion the Act does not require a health exception we reject certain arguments made by the parties on both sides of these cases. On the one hand, the Attorney General urges us to uphold the Act on the basis of the congressional findings alone. Brief for Petitioner in No. 05-380, at 23. Although we review congressional fact-finding under a deferential standard, we do not in the circumstances here place dispositive weight on Congress’ findings. The Court retains an independent constitutional duty to review factual findings where constitutional rights are at stake. See Crowell v. Benson, 285 U. S. 22, 60 (1932) (“In cases brought to enforce constitutional rights, the judicial power of the United States necessarily extends to the independent determination of all questions, both of fact and law, necessary to the performance of that supreme function”).

As respondents have noted, and the District Courts recognized, some recitations in the Act are factually incorrect. See National Abortion Federation, 330 F. Supp. 2d, at 482, 488-491. Whether or not accurate at the time, some of the important findings have been superseded. Two examples suffice. Congress determined no medical schools provide instruction on the prohibited procedure. Congressional Findings ¶ (14)(B). The testimony in the District Courts, however, demonstrated intact D&E is taught at medical schools. National Abortion Federation, supra, at 490; Planned Parenthood, 320 F. Supp. 2d, at 1029. Congress also found there existed a medical consensus that the prohibited procedure *166is never medically necessary. Congressional Findings ¶ (1). The evidence presented in the District Courts contradicts that conclusion. See, e.g., Carhart, supra, at 1012-1015; National Abortion Federation, supra, at 488-489; Planned Parenthood, supra, at 1025-1026. Uncritical deference to Congress’ factual findings in these cases is inappropriate.

On the other hand, relying on the Court’s opinion in Stenberg, respondents contend that an abortion regulation must contain a health exception “if ‘substantial medical authority supports the proposition that banning a particular procedure could endanger women’s health.’ ” Brief for Respondents in No. 05-380, p. 19 (quoting 530 U. S., at 938); see also Brief for Respondent Planned Parenthood et al. in No. 05-1382, at 12 (same). As illustrated by respondents’ arguments and the decisions of the Courts of Appeals, Stenberg has been interpreted to leave no margin of error for legislatures to act in the face of medical uncertainty. Carhart, 413 F. 3d, at 796; Planned Parenthood, 435 F. 3d, at 1173; see also National Abortion Federation, 437 F. 3d, at 296 (Walker, C. J., concurring) (explaining the standard under Stenberg “is a virtually insurmountable evidentiary hurdle”).

A zero tolerance policy would strike down legitimate abortion regulations, like the present one, if some part of the medical community were disinclined to follow the proscription. This is too exacting a standard to impose on the legislative power, exercised in this instance under the Commerce Clause, to regulate the medical profession. Considerations of marginal safety, including the balance of risks, are within the legislative competence when the regulation is rational and in pursuit of legitimate ends. When standard medical options are available, mere convenience does not suffice to displace them; and if some procedures have different risks than others, it does not follow that the State is altogether barred from imposing reasonable regulations. The Act is not invalid on its face where there is uncertainty over whether the barred procedure is ever necessary to preserve *167a woman’s health, given the availability of other abortion procedures that are considered to be safe alternatives.

V

The considerations we have discussed support our further determination that these facial attacks should not have been entertained in the first instance. In these circumstances the proper means to consider exceptions is by as-applied challenge. The Government has acknowledged that preenforcement, as-applied challenges to the Act can be maintained. Tr. of Oral Arg. in No. 05-380, pp. 21-23. This is the proper manner to protect the health of the woman if it can be shown that in discrete and well-defined instances a particular condition has or is likely to occur in which the procedure prohibited by the Act must be used. In an as-applied challenge the nature of the medical risk can be better quantified and balanced than in a facial attack.

The latitude given facial challenges in the First Amendment context is inapplicable here. Broad challenges of this type impose “a heavy burden” upon the parties maintaining the suit. Rust v. Sullivan, 500 U. S. 173, 183 (1991). What that burden consists of in the specific context of abortion statutes has been a subject of some question. Compare Ohio v. Akron Center for Reproductive Health, 497 U. S. 502, 514 (1990) (“[B]ecause appellees are making a facial challenge to a statute, they must show that no set of circumstances exists under which the Act would be valid” (internal quotation marks omitted)), with Casey, 505 U. S., at 895 (opinion of the Court) (indicating a spousal-notification statute would impose an undue burden “in a large fraction of the eases in which [it] is relevant” and holding the statutory provision facially invalid). See also Janklow v. Planned Parenthood, Sioux Falls Clinic, 517 U. S. 1174 (1996). We need not resolve that debate.

As the previous sections of this opinion explain, respondents have not demonstrated that the Act would be unconsti*168tutional in a large fraction of relevant cases. Casey, supra, at 895 (opinion of the Court). We note that the statute here applies to all instances in which the doctor proposes to use the prohibited procedure, not merely those in which the woman suffers from medical complications. It is neither our obligation nor within our traditional institutional role to resolve questions of constitutionality with respect to each potential situation that might develop. “[I]t would indeed be undesirable for this Court to consider every conceivable situation which might possibly arise in the application of complex and comprehensive legislation.” United States v. Raines, 362 U. S. 17, 21 (1960) (internal quotation marks omitted). For this reason, “[a]s-applied challenges are the basic building blocks of constitutional adjudication.” Fallon, As-Applied and Facial Challenges and Third-Party Standing, 113 Harv. L. Rev. 1321, 1328 (2000).

The Act is open to a proper as-applied challenge in a discrete case. Cf. Wisconsin Right to Life, Inc. v. Federal Election Comm’n, 546 U. S. 410, 412 (2006) (per curiam). No as-applied challenge need be brought if the prohibition in the Act threatens a woman’s life because the Act already contains a life exception. 18 U. S. C. § 1531(a) (2000 ed., Supp. IV).

H= * *

Respondents have not demonstrated that the Act, as a facial matter, is void for vagueness, or that it imposes an undue burden on a woman’s right to abortion based on its over-breadth or lack of a health exception. For these reasons the judgments of the Courts of Appeals for the Eighth and Ninth Circuits are reversed.

It is so ordered.

Justice Thomas,

with whom

Justice Scalia joins, concurring.

I join the Court’s opinion because it accurately applies current jurisprudence, including Planned Parenthood of *169 Southeastern Pa. v. Casey, 505 U. S. 833 (1992). I write separately to reiterate my view that the Court’s abortion jurisprudence, including Casey and Roe v. Wade, 410 U. S. 113 (1973), has no basis in the Constitution. See Casey, supra, at 979 (Scalia, J., concurring in judgment in part and dissenting in part); Stenberg v. Carhart, 530 U. S. 914, 980-983 (2000) (Thomas, J., dissenting). I also note that whether the Partial-Birth Abortion Ban Act of 2003 constitutes a permissible exercise of Congress’ power under the Commerce Clause is not before the Court. The parties did not raise or brief that issue; it is outside the question presented; and the lower courts did not address it. See Cutter v. Wilkinson, 544 U. S. 709, 727, n. 2 (2005) (Thomas, J., concurring).

Justice Ginsburg,

with whom

Justice Stevens, Justice Souter, and Justice Breyer join, dissenting.

In Planned Parenthood of Southeastern Pa. v. Casey, 505 U. S. 833, 844 (1992), the Court declared that “[l]iberty finds no refuge in a jurisprudence of doubt.” There was, the Court said, an “imperative” need to dispel doubt as to “the meaning and reach” of the Court’s 7-to-2 judgment, rendered nearly two decades earlier in Roe v. Wade, 410 U. S. 113 (1973). 505 U. S., at 845. Responsive to that need, the Court endeavored to provide secure guidance to “[sjtate and federal courts as well as legislatures throughout the Union,” by defining “the rights of the woman and the legitimate authority of the State respecting the termination of pregnancies by abortion procedures.” Ibid.

Taking care to speak plainly, the Casey Court restated and reaffirmed Roe’s essential holding. 505 U. S., at 845-846. First, the Court addressed the type of abortion regulation permissible prior to fetal viability. It recognized “the right of the woman to choose to have an abortion before viability and to obtain it without undue interference from the State.” Id., at 846. Second, the Court acknowledged “the State’s power to restrict abortions after fetal viability, if the law *170contains exceptions for pregnancies which endanger the woman’s life or healthIbid, (emphasis added). Third, the Court confirmed that “the State has legitimate interests from the outset of the pregnancy in protecting the health of the woman and the life of the fetus that may become a child.” Ibid, (emphasis added).

In reaffirming Roe, the Casey Court described the centrality of “the decision whether to bear ... a child,” Eisenstadt v. Baird, 405 U. S. 438, 453 (1972), to a woman’s “dignity and autonomy,” her “personhood” and “destiny,” her “conception of... her place in society.” 505 U. S., at 851-852. Of signal importance here, the Casey Court stated with unmistakable clarity that state regulation of access to abortion procedures, even after viability, must protect “the health of the woman.” Id., at 846.

Seven years ago, in Stenberg v. Carhart, 530 U. S. 914 (2000), the Court invalidated a Nebraska statute criminalizing the performance of a medical procedure that, in the political arena, has been dubbed “partial-birth abortion.”1 With fidelity to the Roe-Casey line of precedent, the Court held the Nebraska statute unconstitutional in part because it lacked the requisite protection for the preservation of a woman’s health. Stenberg, 530 U. S., at 930; cf. Ayotte v. Planned Parenthood of Northern New Eng., 546 U. S. 320, 327 (2006).

Today’s decision is alarming. It refuses to take Casey and Stenberg seriously. It tolerates, indeed applauds, federal intervention to ban nationwide a procedure found necessary and proper in certain cases by the American College of Ob*171stetricians and Gynecologists (ACOG). It blurs the line, firmly drawn in Casey, between previability and postviability abortions. And, for the first time since Roe, the Court blesses a prohibition with no exception safeguarding a woman’s health.

I dissent from the Court’s disposition. Retreating from prior rulings that abortion restrictions cannot be imposed absent an exception safeguarding a woman’s health, the Court upholds an Act that surely would not survive under the close scrutiny that previously attended state-decreed limitations on a woman’s reproductive choices.

I

A

As Casey comprehended, at stake in cases challenging abortion restrictions is a woman’s “control over her [own] destiny.” 505 U. S., at 869 (plurality opinion). See also id., at 852 (majority opinion).2 “There was a time, not so long ago,” when women were “regarded as the center of home and family life, with attendant special responsibilities that precluded full and independent legal status under the Constitution.” Id., at 896-897 (quoting Hoyt v. Florida, 368 U. S. 57, 62 (1961)). Those views, this Court made clear in Casey, “are no longer consistent with our understanding of the family, the individual, or the Constitution.” 505 U. S., at 897. Women, it is now acknowledged, have the talent, capacity, and right “to participate equally in the economic and social life of the Nation.” Id., at 856. Their ability to realize their full potential, the Court recognized, is intimately connected to “their ability to control their reproductive lives.” *172 Ibid. Thus, legal challenges to undue restrictions on abortion procedures do not seek to vindicate some generalized notion of privacy; rather, they center on a woman’s autonomy to determine her life’s course, and thus to enjoy equal citizenship stature. See, e. g., Siegel, Reasoning from the Body: A Historical Perspective on Abortion Regulation and Questions of Equal Protection, 44 Stan. L. Rev. 261 (1992); Law, Rethinking Sex and the Constitution, 132 U. Pa. L. Rev. 955, 1002-1028 (1984).

In keeping with this comprehension of the right to reproductive choice, the Court has consistently required that laws regulating abortion, at any stage of pregnancy and in all cases, safeguard a woman's health. See, e. g., Ayotte, 546 U. S., at 327-328 (“[Q]ur precedents hold . . . that a State may not restrict access to abortions that are necessary, in appropriate medical judgment, for the preservation of the life or health of the [woman].” (quoting Casey, 505 U. S., at 879 (plurality opinion))); Stenberg, 530 U. S., at 930 (“Since the law requires a health exception in order to validate even a postviability abortion regulation, it at a minimum requires the same in respect to previability regulation.”). See also Thornburgh v. American College of Obstetricians and Gynecologists, 476 U. S. 747, 768-769 (1986) (invalidating a post-viability abortion regulation for “failure] to require that [a pregnant woman’s] health be the physician’s paramount consideration”).

We have thus ruled that a State must avoid subjecting women to health risks not only where the pregnancy itself creates danger, but also where state regulation forces women to resort to less safe methods of abortion. See Planned Parenthood of Central Mo. v. Danforth, 428 U. S. 52, 79 (1976) (holding unconstitutional a ban on a method of abortion that “force[d] a woman ... to terminate her pregnancy by methods more dangerous to her health”). See also Stenberg, 530 U. S., at 931 (“[Our cases] make clear that a risk to . . . women’s health is the same whether it happens *173to arise from regulating a particular method of abortion, or from barring abortion entirely.”). Indeed, we have applied the rule that abortion regulation must safeguard a woman’s health to the particular procedure at issue here — intact dilation and evacuation (intact D&E).3

In Stenberg, we expressly held that a statute banning intact D&E was unconstitutional in part because it lacked a health exception. 530 U. S., at 930, 937. We noted that there existed a “division of medical opinion” about the rela*174tive safety of intact D&E, id., at 937, but we made clear that as long as “substantial medical authority supports the proposition that banning a particular abortion procedure could endanger women’s health,” a health exception is required, id., at 938. We explained:

“The word ‘necessary’ in Casey’s phrase ‘necessary, in appropriate medical judgment, for the preservation of the life or health of the [pregnant woman],’ cannot refer to an absolute necessity or to absolute proof. Medical treatments and procedures are often considered appropriate (or inappropriate) in light of estimated comparative health risks (and health benefits) in particular cases. Neither can that phrase require unanimity of medical opinion. Doctors often differ in their estimation of comparative health risks and appropriate treatment. And Casey’s words ‘appropriate medical judgment’ must embody the judicial need to tolerate responsible differences of medical opinion . . . .” Id., at 937 (citation omitted).

Thus, we reasoned, division in medical opinion “at most means uncertainty, a factor that signals the presence of risk, not its absence.” Ibid. “[A] statute that altogether forbids [intact D&E]. . . consequently must contain a health exception.” Id., at 938. See also id., at 948 (O’Connor, J., concurring) (“Th[e] lack of a health exception necessarily renders the statute unconstitutional.”).

B

In 2003, a few years after our ruling in Stenberg, Congress passed the Partial-Birth Abortion Ban Act — without an exception for women’s health. See 18 U. S. C. § 1531(a) (2000 ed., Supp. IV).4 The congressional findings on which the *175Partial-Birth Abortion Ban Act rests do not withstand inspection, as the lower courts have determined and this Court is obliged to concede. Ante, at 165-166. See National Abortion Federation v. Ashcroft, 330 F. Supp. 2d 436, 482 (SDNY 2004) (“Congress did not. . . carefully consider the evidence before arriving at its findings.”), aff’d sub nom. National Abortion Federation v. Gonzales, 437 F. 3d 278 (CA2 2006). See also Planned Parenthood Federation of Am. v. Ashcroft, 320 F. Supp. 2d 957, 1019 (ND Cal. 2004) (“[N]one of the six physicians who testified before Congress had ever performed an intact D&E. Several did not provide abortion services at all; and one was not even an obgyn. . . . [T]he oral testimony before Congress was not only unbalanced, but intentionally polemic.”), aff’d, 435 F. 3d 1163 (CA9 2006); Carhart v. Ashcroft, 331 F. Supp. 2d 805, 1011 (Neb. 2004) (“Congress arbitrarily relied upon the opinions of doctors who claimed to have no (or very little) recent and relevant experience with surgical abortions, and disregarded the views of doctors who had significant and relevant experience with those procedures.”), aff’d, 413 F. 3d 791 (CA8 2005).

Many of the Act’s recitations are incorrect. See ante, at 165-166. For example, Congress determined that no medical schools provide instruction on intact D&E. §2(14)(B), 117 Stat. 1204, notes following 18 U. S. C. §1531 (2000 ed., Supp. IV), p. 769, ¶ (14)(B) (Congressional Findings). But in fact, numerous leading medical schools teach the procedure. See Planned Parenthood, 320 F. Supp. 2d, at 1029; National Abortion Federation, 330 F. Supp. 2d, at 479. See also Brief for ACOG as Amicus Curiae 18 (“Among the schools that now teach the intact variant are Columbia, Cornell, Yale, New York University, Northwestern, University of Pitts*176burgh, University of Pennsylvania, University of Rochester, and University of Chicago.”).

More important, Congress claimed there was a medical consensus that the banned procedure is never necessary. Congressional Findings ¶ (1). But the evidence “very clearly demonstrate^] the opposite.” Planned Parenthood, 320 F. Supp. 2d, at 1025. See also Carhart, 331 F. Supp. 2d, at 1008-1009 (“[T]here was no evident consensus in the record that Congress compiled. There was, however, a substantial body of medical opinion presented to Congress in opposition. If anything ... the congressional record establishes that there was a ‘consensus’ in favor of the banned procedure.”); National Abortion Federation, 330 F. Supp. 2d, at 488 (“The congressional record itself undermines [Congress’] finding” that there is a medical consensus that intact D&E “is never medically necessary and should be prohibited.” (internal quotation marks omitted)).

Similarly, Congress found that “[t]here is no credible medical evidence that partial-birth abortions are safe or are safer than other abortion procedures.” Congressional Findings (14)(B), in notes following 18 U. S. C. § 1531 (2000 ed., Supp. IV), p. 769. But the congressional record includes letters from numerous individual physicians stating that pregnant women’s health would be jeopardized under the Act, as well as statements from nine professional associations, including ACOG, the American Public Health Association, and the California Medical Association, attesting that intact D&E carries meaningful safety advantages over other methods. See National Abortion Federation, 330 F. Supp. 2d, at 490. See also Planned Parenthood, 320 F. Supp. 2d, at 1021 (“Congress in its findings ... chose to disregard the statements by ACOG and other medical organizations.”). No comparable medical groups supported the ban. In fact, “all of the government's own witnesses disagreed with many of the specific congressional findings.” Id., at 1024.

*177c

In contrast to Congress, the District Courts made findings after full trials at which all parties had the opportunity to present their best evidence. The courts had the benefit of “much more extensive medical and scientific evidence . . . concerning the safety and necessity of intact D&Es.” Planned Parenthood, 320 F. Supp. 2d, at 1014; cf. National Abortion Federation, 330 F. Supp. 2d, at 482 (District Court “heard more evidence during its trial than Congress heard over the span of eight years.”).

During the District Court trials, “numerous” “extraordinarily accomplished” and “very experienced” medical experts explained that, in certain circumstances and for certain women, intact D&E is safer than alternative procedures and necessary to protect women's health. Carhart, 331 F. Supp. 2d, at 1024-1027; see Planned Parenthood, 320 F. Supp. 2d, at 1001 (“[A]ll of the doctors who actually perform intact D&Es concluded that in their opinion and clinical judgment, intact D&Es remain the safest option for certain individual women under certain individual health circumstances, and are significantly safer for these women than other abortion techniques, and are thus medically necessary.”); cf. ante, at 161 (“Respondents presented evidence that intact D&E may be the safest method of abortion, for reasons similar to those adduced in Stenberg.”).

According to the expert testimony plaintiffs introduced, the safety advantages of intact D&E are marked for women with certain medical conditions, for example, uterine scarring, bleeding disorders, heart disease, or compromised immune systems. See Carhart, 331 F. Supp. 2d, at 924-929, 1026-1027; National Abortion Federation, 330 F. Supp. 2d, at 472-473; Planned Parenthood, 320 F. Supp. 2d, at 992-994, 1001. Further, plaintiffs’ experts testified that intact D&E is significantly safer for women with certain pregnancy-related conditions, such as placenta previa and accreta, and for women carrying fetuses with certain abnormalities, such *178as severe hydrocephalus. See Carhart, 331 F. Supp. 2d, at 924, 1026-1027; National Abortion Federation, 330 F. Supp. 2d, at 473-474; Planned Parenthood, 320 F. Supp. 2d, at 992-994, 1001. See also Stenberg, 530 U. S., at 929; Brief for ACOG as Amicus Curiae 2, 13-16.

Intact D&E, plaintiffs’ experts explained, provides safety benefits over D&E by dismemberment for several reasons: First, intact D&E minimizes the number of times a physician must insert instruments through the cervix and into the uterus, and thereby reduces the risk of trauma to, and perforation of, the cervix and uterus — the most serious complication associated with nonintact D&E. See Carhart, 331 F. Supp. 2d, at 923-928,1025; National Abortion Federation, 330 F. Supp. 2d, at 471; Planned Parenthood, 320 F. Supp. 2d, at 982, 1001. Second, removing the fetus intact, instead of dismembering it in útero, decreases the likelihood that fetal tissue will be retained in the uterus, a condition that can cause infection, hemorrhage, and infertility. See Carhart, 331 F. Supp. 2d, at 923-928, 1025-1026; National Abortion Federation, 330 F. Supp. 2d, at 472; Planned Parenthood, 320 F. Supp. 2d, at 1001. Third, intact D&E diminishes the chances of exposing the patient’s tissues to sharp bony fragments sometimes resulting from dismemberment of the fetus. See Carhart, 331 F. Supp. 2d, at 923-928, 1026; National Abortion Federation, 330 F. Supp. 2d, at 471; Planned Parenthood, 320 F. Supp. 2d, at 1001. Fourth, intact D&E takes less operating time than D&E by dismemberment, and thus may reduce bleeding, the risk of infection, and complications relating to anesthesia. See Carhart, 331 F. Supp. 2d, at 923-928,1026; National Abortion Federation, 330 F. Supp. 2d, at 472; Planned Parenthood, 320 F. Supp. 2d, at 1001. See also Stenberg, 530 U. S., at 928-929, 932; Brief for ACOG as Amicus Curiae 2,11-13.

Based on thoroughgoing review of the trial evidence and the congressional record, each of the District Courts to consider the issue rejected Congress’ findings as unreasonable *179and not supported by the evidence. See Carhart, 331 F. Supp. 2d, at 1008-1027; National Abortion Federation, 330 F. Supp. 2d, at 482, 488-491; Planned Parenthood, 320 F. Supp. 2d, at 1032. The trial courts concluded, in contrast to Congress’ findings, that “significant medical authority supports the proposition that in some circumstances, [intact D&E] is the safest procedure.” Id., at 1033 (quoting Stenberg, 530 U. S., at 932); accord Carhart, 331 F. Supp. 2d, at 1008-1009, 1017-1018; National Abortion Federation, 330 F. Supp. 2d, at 480-482;5 cf. Stenberg, 530 U. S., at 932 (“[T]he record shows that significant medical authority supports the proposition that in some circumstances, [intact D&E] would be the safest procedure.”).

The District Courts’ findings merit this Court’s respect. See, e. g., Fed. Rule Civ. Proc. 52(a); Salve Regina College v. Russell, 499 U. S. 225, 233 (1991). Today’s opinion supplies no reason to reject those findings. Nevertheless, despite the District Courts’ appraisal of the weight of the evidence, and in undisguised conflict with Stenberg, the Court asserts that the Partial-Birth Abortion Ban Act can survive “when . . . medical uncertainty persists.” Ante, at 163. This assertion is bewildering. Not only does it defy the Court’s longstanding precedent affirming the necessity of a health exception, with no carve-out for circumstances of medical uncertainty, see supra, at 172-173; it gives short shrift to the records before us, carefully canvassed by the District Courts. *180Those records indicate that “the majority of highly-qualified experts on the subject believe intact D&E to be the safest, most appropriate procedure under certain circumstances.” Planned Parenthood, 320 F. Supp. 2d, at 1034. See supra, at 177.

The Court acknowledges some of this evidence, ante, at 161, but insists that, because some witnesses disagreed with ACOG and other experts’ assessment of risk, the Act can stand. Ante, at 162,166-167. In this insistence, the Court brushes under the rug the District Courts’ well-supported findings that the physicians who testified that intact D&E is never necessary to preserve the health of a woman had slim authority for their opinions. They had no training for, or personal experience with, the intact D&E procedure, and many performed abortions only on rare occasions. See Planned Parenthood, 320 F. Supp. 2d, at 980; Carhart, 331 F. Supp. 2d, at 1025; cf. National Abortion Federation, 330 F. Supp. 2d, at 462-464. Even indulging the assumption that the Government witnesses were equally qualified to evaluate the relative risks of abortion procedures, their testimony could not erase the “significant medical authority supporting] the proposition that in some circumstances, [intact D&E] would be the safest procedure.” Stenberg, 530 U. S., at 932.6

*181II

A

The Court offers flimsy and transparent justifications for upholding a nationwide ban on intact D&E sans any exception to safeguard a woman’s health. Today’s ruling, the Court declares, advances “a premise central to [Casey’s] conclusion” — i. e., the Government’s “legitimate and substantial interest in preserving and promoting fetal life.” Ante, at 145. See also ante, at 146 (“[W]e must determine whether the Act furthers the legitimate interest of the Government in protecting the life of the fetus that may become a child.”). But the Act scarcely furthers that interest: The law saves not a single fetus from destruction, for it targets only a method of performing abortion. See Stenberg, 530 U. S., at 930. And surely the statute was not designed to protect the lives or health of pregnant women. Id., at 951 (Ginsburg, J., concurring); cf. Casey, 505 U. S., at 846 (recognizing along with the State’s legitimate interest in the life of the fetus, its “legitimate interes[t] ... in protecting the health of the woman” (emphasis added)). In short, the Court upholds a law that, while doing nothing to “preserve] . . . fetal life,” ante, at 145, bars a woman from choosing intact D&E although her doctor “reasonably believes [that procedure] will best protect [her],” Stenberg, 530 U. S., at 946 (Stevens, J., concurring).

As another reason for upholding the ban, the Court emphasizes that the Act does not proscribe the nonintact D&E procedure. See ante, at 164. But why not, one might ask. *182Nonintact D&E could equally be characterized as “brutal,” ante, at 157, involving as it does “tear[ing] [a fetus] apart” and “ripp[ing] off” its limbs, ante, at 135. “[T]he notion that either of these two equally gruesome procedures ... is more akin to infanticide than the other, or that the State furthers any legitimate interest by banning one but not the other, is simply irrational.” Stenberg, 530 U. S., at 946-947 (Stevens, J., concurring).

Delivery of an intact, albeit nonviable, fetus warrants special condemnation, the Court maintains, because a fetus that is not dismembered resembles an infant. Ante, at 158. But so, too, does a fetus delivered intact after it is terminated by injection a day or two before the surgical evacuation, ante, at 136, 164, or a fetus delivered through medical induction or cesarean, ante, at 140. Yet, the availability of those procedures — along with D&E by dismemberment — the Court says, saves the ban on intact D&E from a declaration of unconstitutionality. Ante, at 164-165. Never mind that the procedures deemed acceptable might put a woman’s health at greater risk. See supra, at 180, and n. 6; cf. ante, at 136, 161-162.

Ultimately, the Court admits that “moral concerns” are at work, concerns that could yield prohibitions on any abortion. See ante, at 158 (“Congress could ... conclude that the type of abortion proscribed by the Act requires specific regulation because it implicates additional ethical and moral concerns that justify a special prohibition.”). Notably, the concerns expressed are untethered to any ground genuinely serving the Government’s interest in preserving life. By allowing such concerns to carry the day and case, overriding fundamental rights, the Court dishonors our precedent. See, e. g., Casey, 505 U. S., at 850 (“Some of us as individuals find abortion offensive to our most basic principles of morality, but that cannot control our decision. Our obligation is to define the liberty of all, not to mandate our own moral code.”); Lawrence v. Texas, 539 U. S. 558, 571 (2003) (Though “[f]or many persons [objections to homosexual conduct] are not trivial *183concerns but profound and deep convictions accepted as ethical and moral principles,” the power of the State may not be used “to enforce these views on the whole society through operation of the criminal law.” (citing Casey, 505 U. S., at 850)).

Revealing in this regard, the Court invokes an antiabortion shibboleth for which it concededly has no reliable evidence: Women who have abortions come to regret their choices, and consequently suffer from “[s]evere depression and loss of esteem.” Ante, at 159.7 Because of women’s *184fragile emotional state and because of the “bond of love the mother has for her child,” the Court worries, doctors may withhold information about the nature of the intact D&E procedure. Ante, at 159.8 The solution the Court approves, then, is not to require doctors to inform women, accurately and adequately, of the different procedures and their attendant risks. Cf. Casey, 505 U. S., at 873 (plurality opinion) (“States are free to enact laws to provide a reasonable framework for a woman to make a decision that has such profound and lasting meaning.”). Instead, the Court deprives women of the right to make an autonomous choice, even at the expense of their safety.9

*185This way of thinking reflects ancient notions about women’s place in the family and under the Constitution— ideas that have long since been discredited. Compare, e. g., Muller v. Oregon, 208 U. S. 412, 422-428 (1908) (“protective” legislation imposing hours-of-work limitations on women only held permissible in view of women’s “physical structure and a proper discharge of her maternal functio[n]”); Bradwell v. State, 16 Wall. 130, 141 (1873) (Bradley, J., concurring) (“Man is, or should be, woman’s protector and defender. The natural and proper timidity and delicacy which belongs to the female sex evidently unfits it for many of the occupations of civil life.. .. The paramount destiny and mission of woman are to fulfil[l] the noble and benign offices of wife and mother.”), with United States v. Virginia, 518 U. S. 515, 533, 542, n. 12 (1996) (State may not rely on “overbroad generalizations” about the “talents, capacities, or preferences” of women; “[s]uch judgments have . . . impeded . . . women’s progress toward full citizenship stature throughout our Nation’s history”); Califano v. Goldfarb, 430 U. S. 199, 207 (1977) (gender-based Social Security classification rejected because it rested on “archaic and overbroad generalizations” “such as assumptions as to [women’s] dependency” (internal quotation marks omitted)).

Though today’s majority may regard women’s feelings on the matter as “self-evident,” ante, at 159, this Court has repeatedly confirmed that “[t]he destiny of the woman must be shaped... on her own conception of her spiritual imperatives and her place in society,” Casey, 505 U. S., at 852. See also *186 id., at 877 (plurality opinion) (“[M]eans chosen by the State to further the interest in potential life must be calculated to inform the woman’s free choice, not hinder it.”); supra, at 171-172.

B

In cases on a “woman’s liberty to determine whether to [continue] her pregnancy,” this Court has identified viability as a critical consideration. See Casey, 505 U. S., at 869-870 (plurality opinion). “[T]here is no line [more workable] than viability,” the Court explained in Casey, for viability is “the time at which there is a realistic possibility of maintaining and nourishing a life outside the womb, so that the independent existence of the second life can in reason and all fairness be the object of state protection that now overrides the rights of the woman. ... In some broad sense it might be said that a woman who fails to act before viability has consented to the State’s intervention on behalf of the developing child.” Id., at 870.

Today, the Court blurs that line, maintaining that “[t]he Act [legitimately] applies] both previability and postviability because ... a fetus is a living organism while within the womb, whether or not it is viable outside the womb.” Ante, at 147. Instead of drawing the line at viability, the Court refers to Congress’ purpose to differentiate “abortion and infanticide” based not on whether a fetus can survive outside the womb, but on where a fetus is anatomically located when a particular medical procedure is performed. See ante, at 158 (quoting Congressional Findings ¶ (14)(G)).

One wonders how long a line that saves no fetus from destruction will hold in face of the Court’s “moral concerns.” See supra, at 182; cf. ante, at 147 (noting that “[i]n this litigation” the Attorney General “does not dispute that the Act would impose an undue burden if it covered standard D&E”). The Court’s hostility to the right Roe and Casey secured is not concealed. Throughout, the opinion refers to obstetrician-gynecologists and surgeons who perform abor*187tions not by the titles of their medical specialties, but by the pejorative label “abortion doctor.” Ante, at 144, 154, 155, 161, 163. A fetus is described as an “unborn child,” and as a “baby,” ante, at 134, 138; second-trimester, previability abortions are referred to as “late-term,” ante, at 156; and the reasoned medical judgments of highly trained doctors are dismissed as “preferences” motivated by “mere convenience,” ante, at 134, 166. Instead of the heightened scrutiny we have previously applied, the Court determines that a “rational” ground is enough to uphold the Act, ante, at 158, 166. And, most troubling, Casey’s principles, confirming the continuing vitality of “the essential holding of Roe,” are merely “assumefd]” for the moment, ante, at 146, 161, rather than “retained” or “reaffirmed,” Casey, 505 U. S., at 846.

Ill

A

The Court further confuses our jurisprudence when it declares that “facial attacks” are not permissible in “these circumstances,” i. e., where medical uncertainty exists. Ante, at 167; see ibid. (“In an as-applied challenge the nature of the medical risk can be better quantified and balanced than in a facial attack.”). This holding is perplexing given that, in materially identical circumstances we held that a statute lacking a health exception was unconstitutional on its face. Stenberg, 530 U. S., at 930; see id., at 937 (in facial challenge, law held unconstitutional because “significant body of medical opinion believes [the] procedure may bring with it greater safety for some patients” (emphasis added)). See also Sabri v. United States, 541 U. S. 600, 609-610 (2004) (identifying abortion as one setting in which we have recognized the validity of facial challenges); Fallon, Making Sense of Overbreadth, 100 Yale L. J. 853, 859, n. 29 (1991) (“[Virtually all of the abortion cases reaching the Supreme Court since Roe v. Wade, 410 U. S. 113 (1973), have involved facial attacks on state statutes, and the Court, whether accepting *188or rejecting the challenges on the merits, has typically accepted this framing of the question presented.”). Accord Fallon, As-Applied and Facial Challenges and Third-Party Standing, 113 Harv. L. Rev. 1321, 1356 (2000); Dorf, Facial Challenges to State and Federal Statutes, 46 Stan. L. Rev. 235, 271-276 (1994).

Without attempting to distinguish Stenberg and earlier decisions, the majority asserts that the Act survives review because respondents have not shown that the ban on intact D&E would be unconstitutional “in a large fraction of [relevant] cases.” Ante, at 167 (citing Casey, 505 U. S., at 895). But Casey makes clear that, in determining whether any restriction poses an undue burden on a “large fraction” of women, the relevant class is not “all women,” nor “all pregnant women,” nor even all women “seeking abortions.” Ibid. Rather, a provision restricting access to abortion “must be judged by reference to those [women] for whom it is an actual rather than an irrelevant restriction.” Ibid. Thus the absence of a health exception burdens all women for whom it is relevant — women who, in the judgment of their doctors, require an intact D&E because other procedures would place their health at risk.10 Cf. Stenberg, 530 U. S., at 934 (accepting the “relative rarity” of medically indicated intact D&Es as true but not “highly relevant”— for “the health exception question is whether protecting women’s health requires an exception for those infrequent occasions”); Ayotte, 546 U. S., at 328 (facial challenge entertained where “[i]n some very small percentage of cases . . . women . . . need immediate abortions to avert serious and often irreversible damage to their health”). It makes no sense to conclude that this facial challenge fails because respondents have not shown that a health exception is nec*189essary for a large fraction of second-trimester abortions, including those for which a health exception is unnecessary: The very purpose of a health exception is to protect women in exceptional cases.

B

If there is anything at all redemptive to be said of today’s opinion, it is that the Court is not willing to foreclose entirely a constitutional challenge to the Act. “The Act is open,” the Court states, “to a proper as-applied challenge in a discrete case.” Ante, at 168; see ante, at 167 (“The Government has acknowledged that preenforcement, as-applied challenges to the Act can be maintained.”). But the Court offers no clue on what a “proper” lawsuit might look like. See ante, at 167-168. Nor does the Court explain why the injunctions ordered by the District Courts should not remain in place, trimmed only to exclude instances in which another procedure would safeguard a woman’s health at least equally well. Surely the Court cannot mean that no suit may be brought until a woman’s health is immediately jeopardized by the ban on intact D&E. A woman “suffer[ing] from medical complications,” ante, at 168, needs access to the medical procedure at once and cannot wait for the judicial process to unfold. See Ayotte, 546 U. S., at 328.

The Court appears, then, to contemplate another lawsuit by the initiators of the instant actions. In such a second round, the Court suggests, the challengers could succeed upon demonstrating that “in discrete and well-defined instances a particular condition has or is likely to occur in which the procedure prohibited by the Act must be used.” Ante, at 167. One may anticipate that such a preenforcement challenge will be mounted swiftly, to ward off serious, sometimes irremediable harm, to women whose health would be endangered by the intact D&E prohibition.

The Court envisions that in an as-applied challenge, “the nature of the medical risk can be better quantified and balanced.” Ibid. But it should not escape notice that the rec*190ord already includes hundreds and hundreds of pages of testimony identifying “discrete and well-defined instances” in which recourse to an intact D&E would better protect the health of women with particular conditions. See supra, at 177-179. Record evidence also documents that medical exigencies, unpredictable in advance, may indicate to a well-trained doctor that intact D&E is the safest procedure. See ibid. In light of this evidence, our unanimous decision just one year ago in Ayotte counsels against reversal. See 546 U. S., at 331 (remanding for reconsideration of the remedy for the absence of a health exception, suggesting that an injunction prohibiting unconstitutional applications might suffice).

The Court’s allowance only of an “as-applied challenge in a discrete case,” ante, at 168 — jeopardizes women’s health and places doctors in an untenable position. Even if courts were able to carve out exceptions through piecemeal litigation for “discrete and well-defined instances,” ante, at 167, women whose circumstances have not been anticipated by prior litigation could well be left unprotected. In treating those women, physicians would risk criminal prosecution, conviction, and imprisonment if they exercise their best judgment as to the safest medical procedure for their patients. The Court is thus gravely mistaken to conclude that narrow as-applied challenges are “the proper manner to protect the health of the woman.” Cf. ibid.

IV

As the Court wrote in Casey, “overruling Roe’s central holding would not only reach an unjustifiable result under principles of stare decisis, but would seriously weaken the Court’s capacity to exercise the judicial power and to function as the Supreme Court of a Nation dedicated to the rule of law.” 505 U. S., at 865. “[T]he very concept of the rule of law underlying our own Constitution requires such continuity over time that a respect for precedent is, by definition, *191indispensable.” Id., at 854. See also id., at 867 (“[T]o overrule under fire in the absence of the most compelling reason to reexamine a watershed decision would subvert the Court’s legitimacy beyond any serious question.”).

Though today’s opinion does not go so far as to discard Roe or Casey, the Court, differently composed than it was when we last considered a restrictive abortion regulation, is hardly faithful to our earlier invocations of “the rule of law” and the “principles of stare decisis." Congress imposed a ban despite our clear prior holdings that the State cannot proscribe an abortion procedure when its use is necessary to protect a woman’s health. See supra, at 174-175, n. 4. Although Congress’ findings could not withstand the crucible of trial, the Court defers to the legislative override of our Constitution-based rulings. See supra, at 174-176. A decision so at odds with our jurisprudence should not have staying power.

In sum, the notion that the Partial-Birth Abortion Ban Act furthers any legitimate governmental interest is, quite simply, irrational. The Court’s defense of the statute provides no saving explanation. In candor, the Act, and the Court’s defense of it, cannot be understood as anything other than an effort to chip away at a right declared again and again by this Court — and with increasing comprehension of its centrality to women’s lives. See supra, at 171, n. 2; supra, at 174-175, n. 4. When “a statute burdens constitutional rights and all that can be said on its behalf is that it is the vehicle that legislators have chosen for expressing their hostility to those rights, the burden is undue.” Stenberg, 530 U. S., at 952 (Ginsburg, J., concurring) (quoting Hope Clinic v. Ryan, 195 F. 3d 857, 881 (CA7 1999) (Posner, C. J., dissenting)).

* * *

For the reasons stated, I dissent from the Court’s disposition and would affirm the judgments before us for review.

GRUENDER, Circuit Judge.

The Governor and Attorney General of South Dakota (“the State”), along with two intervening crisis pregnancy centers and two of their personnel (collectively “Intervenors”), appeal the district court’s permanent injunction barring enforcement of a South Dakota statute requiring the disclosure to patients seeking abortions of an “[ijncreased risk of suicide ideation and suicide,” see S.D.C.L. § 34-23A-10.1(l)(e)(ii) (“suicide advisory”), and the underlying grant of summary judgment in favor of Planned Parenthood of Minnesota, North Dakota, South Dakota and its medical director Dr. Carol E. Ball (collectively “Planned Parenthood”) that this advisory would unduly burden abortion rights and would violate physicians’ First Amendment right to be free from compelled speech. For the reasons discussed below, we reverse.

I.

In 2005, South Dakota enacted House Bill 1166 (“the Act”), amending the requirements for obtaining informed consent to an abortion as codified in S.D.C.L. § 34-23A-10.1. Section 7 of the Act requires physicians, in the course of obtaining informed consent, to provide certain information to the patient seeking an abortion. In June 2005, Planned Parenthood sued to prevent the Act from taking effect, contending that several of its provisions constituted an undue burden on abortion rights and facially violated patients’ and physicians’ free speech rights, while other provisions were unconstitutionally vague. After the district court preliminarily enjoined the Act and a divided panel of this court affirmed, this court sitting en banc vacated the preliminary injunction and remanded for further proceedings. See Planned Parenthood Minn., N.D., S.D. v. Rounds, 530 F.3d 724 (8th Cir.2008) (en banc).

On remand, the parties filed cross-motions for summary judgment with respect to the challenged provisions. The district court ruled that a biological disclosure, see §§ 34-23A-10.1(l)(b), 34-23A-R4), and a medical emergency exception, see § 34-23A-10.1, were facially sound with respect to the First Amendment and imposed no undue burden, while disclosures regarding the protected relationship between the patient and the unborn child, see § 34-23A-10.1(l)(c), (d), and the suicide advisory, see § 34-23A-10.1(l)(e)(ii), failed to meet both constitutional requirements. The district court also held that a requirement to disclose “all known medical risks of the procedure,” see § 34-23A-10.1(l)(e), was not *893unconstitutionally vague, but that a requirement to disclose “statistically significant risk factors,” see id,., was.

Planned Parenthood appealed the district court’s decision on the biological disclosure and the “all known medical risks” disclosure, while the State and Intervenors appealed the district court’s decision on the relationship disclosures and the suicide advisory. A panel of this court affirmed unanimously with respect to the biological disclosure and the “all known medical risks” disclosure, reversed unanimously with respect to the relationship disclosures, and affirmed in a divided decision as to the suicide advisory. See Planned Parenthood Minn., N.D., S.D. v. Rounds, 653 F.3d 662 (8th Cir.2011). We granted this rehearing en banc solely on the issue of the suicide advisory.1

II.

We review a grant of summary judgment de novo. Missouri ex rel. Nixon v. Am. Blast Fax, Inc., 323 F.3d 649, 653 (8th Cir.2003). In addition, we review constitutional challenges and questions of statutory interpretation de novo. McDermott v. Royal, 613 F.3d 1192, 1193 (8th Cir.2010) (per curiam).

Planned Parenthood contends that requiring a physician to present the suicide advisory imposes an undue burden on abortion rights and violates the free speech rights of the physician. “[W]hen the government requires [as part of the informed consent process] ... the giving of truthful, nonmisleading information about the nature of the procedure, the attendant health risks and those of childbirth,” and other information broadly relevant to the decision to have an abortion, it does not impose an undue burden on abortion rights, even if the disclosure “might cause the woman to choose childbirth over abortion.” Planned Parenthood of Se. Penn. v. Casey, 505 U.S. 833, 882-83, 112 S.Ct. 2791, 120 L.Ed.2d 674 (1992). Moreover, “the physician’s First Amendment rights not to speak are implicated, but only as part of the practice of medicine, subject to reasonable licensing and regulation by the State.” Id. at 884, 112 S.Ct. 2791 (citations omitted). Thus, with respect to First Amendment concerns, “while the State cannot compel an individual simply to speak the State’s ideological message, it can use its regulatory authority to require a physician to provide truthful, non-misleading information relevant to a patient’s decision to have an abortion, even if that information might also encourage the patient to choose childbirth over abortion.” Rounds, 530 F.3d at 734-35; accord Tex. Med. Providers Performing Abortion Servs. v. Lakey, 667 F.3d 570, 576-77 (5th Cir.2012).

In short, to succeed on either its undue burden or compelled speech claims, Planned Parenthood must show that the disclosure at issue “is either untruthful, misleading or not relevant to the patient’s decision to have an abortion.” Rounds, 530 F.3d at 735. To evaluate the constitutional merits of the suicide advisory, we will examine first what disclosure actually is required, second whether that disclosure is truthful, and third whether it is non-misleading and relevant to the patient’s decision to have an abortion.

III.

Section 34-23A-10.1 requires a physician seeking to perform an abortion to present to the patient:

(1) A statement in writing providing the following information:

*894(e) A description of all known medical risks of the procedure and statistically significant risk factors to which the pregnant woman would be subjected, including:

(i) Depression and related psychological distress;

(ii) Increased risk of suicide ideation and suicide;

Planned Parenthood argues, and the district court agreed, that subsection (ii) must be construed to require a disclosure of a conclusive causal link between abortion and suicide. See Planned Parenthood Minn., N.D., S.D. v. Rounds, 650 F.Supp.2d 972, 982 (D.S.D.2009). However, no language in subsection (ii), or in the heading of section 10.1(l)(e), refers to such a causal link. “The intent of a statute is determined from what the legislature said, rather than what the courts think it should have said, and the court must confíne itself to the language used.” Langdeau v. Langdeau, 751 N.W.2d 722, 727 (S.D.2008) (quoting US W. Commc’ns, Inc. v. Pub. Utils. Comm’n, 505 N.W.2d 115, 123 (S.D.1993)).

Here, the language actually used by the legislature — “medical risks,” “statistically significant risk factors,” “[i]n-creased risk” — denotes risk in a medical context. Moreover, while the heading of subsection (e) refers broadly to “all known medical risks of the [abortion] procedure ... including” those listed in its subsections, the suicide advisory is the only subsection to further incorporate the more precise phrase “[¡Increased risk.” See § 34-23A-10.1(l)(e)(ii). Therefore, we must presume that the term “increased risk” has a more precise meaning than the umbrella term “risk” by itself. See Maynard v. Heeren, 563 N.W.2d 830, 835 (S.D.1997) (“[N]o wordage should be found to be surplus. No provision can be left without meaning. If possible, effect should be given to every part and every word.” (quoting Cummings v. Mickelson, 495 N.W.2d 493, 500 (S.D.1993))); see also FCC v. AT & T Inc., — U.S.-, 131 S.Ct. 1177, 1183, 179 L.Ed.2d 132 (2011) (recognizing that, in construing a statute, “two words together may assume a more particular meaning than those words in isolation”). The term “increased risk” is not defined in the statute, and it has more than one reasonable definition in the medical field. South Dakota law requires that such a term “must be construed according to its accepted usage, and a strained, unpractical or absurd result is to be avoided.” Peters v. Spearfish ETJ Planning Comm’n, 567 N.W.2d 880, 885 (S.D.1997).

As a result, the disclosure actually required by the suicide advisory depends upon the accepted usage of the term “increased risk” in the relevant medical field. We turn to the medical literature and expert evidence in the record to discern the accepted usage of the term “increased risk” in the applicable medical context, with an eye towards whether that accepted usage necessarily implies proof of causation.

The peer-reviewed medical literature in the record on the topic of suicide and abortion consistently uses the term “increased risk” to refer to a relatively higher probability of an adverse outcome in one group compared to other groups — that is, to “relative risk.” See Stedman’s Medical Dictionary 1701 (28th ed. 2006) (defining relative risk as “the ratio of the r[isk] of disease among those exposed to a r[isk] factor to the r[isk] among those not exposed”). For example, one study compared the rate of suicide for women who had received an induced abortion with the rates of suicide for two other groups, women who had given birth and women who had miscarried. See Ex. 60, Mika Gissler *895et al., Suicides After Pregnancy in Finland, 1987-94, 313 Brit. Med. J. 1431, 1432 (1996), ECF No. 172-3.2 That study characterized its finding of a vastly higher suicide rate for women who received an induced abortion as “an increased risk of suicide.” Id. at 1434. Another study compared the rate of, inter alia, suicide ideation in women who had received an induced abortion with the rates for women who had given birth and for women who had not become pregnant. See Ex. 61, David M. Fergusson et al., Abortion in Young Women and Subsequent Mental Health, 47 J. Child Psychol. & Psychiatry 16, 19 (2006), ECF No. 172-4. That study concluded, “Certainly in this study, those young women who had abortions appeared to be at moderately increased risk of both concurrent and subsequent mental health problems when compared with equivalent groups of pregnant or non-pregnant peers.” Id. at 23 (emphasis added).

The discussion of risk in the medical context provided by Intervenors’ expert also supports the conclusion that the term “increased risk” refers to the comparison of two groups, or relative risk:

Assessment of degree of risk is often expressed in terms of absolute risk, which relates to the chance of developing a disease over a time-period (e.g., a 10% lifetime risk of suicide) or in terms of relative risk, which is a comparison of the probability of an adverse outcome in two groups. For example, abortion would be considered an increased risk for suicide if the relative risk is significantly higher for women who abort compared to women who give birth or never have children.

Coleman Decl. ¶ 6, Jul. 6, 2006, ECF No. 189 (emphases added). Based on the “accepted usage” of the term in the relevant field, Peters, 567 N.W.2d at 885, the term “increased risk” in subsection (ii) indicates that the “relative risk” definition is the one intended by the legislature for the suicide advisory.

Noticeably absent from the contextual definition of “increased risk” is a requirement for conclusive proof of causation. This stands to reason, because, as explained by the Intervenors’ expert:

When examining complex human psychological and physical health outcomes, such as depression and suicidal behavior, identification of a single, precise causal mechanism applicable to all situations is not possible----

Given this inherent complexity, sound epidemiological evidence is nevertheless derived by identifying those variables which are most strongly linked with adverse mental or physical health outcomes for large groups of individuals.

Coleman Decl. ¶¶ 5-6, Jul. 6, 2006. While such evidence of relative risk eventually may prove direct causation as further experiments rule out plausible competing explanations, see id. at ¶ 9, conclusive proof of causation is not required in order for the identification of a medical risk.

Even the evidence upon which Planned Parenthood heavily relies is consistent with the “relative risk” definition of “increased risk,” with no requirement for proof of causation. For example, the report of the American Psychological Association’s (“APA”) Task Force on Mental Health and Abortion, Branson Decl. Ex. A, Sept. 8, 2008, ECF Nos. 283-3, 283-4 (hereinafter “APA Report”), decries the “tendency to confuse a risk and a cause” as a “logical fallacy.” APA Report at 31. As another example, Planned Parenthood submitted into the record a letter to a medical *896journal from one of the researchers mentioned above. While the researcher emphasized that his studies linking suicide and abortion did not prove causation, he resolutely reiterated his finding of “increased risk.” Mika Gissler et al., Letter to the Editor: Pregnancy-Related Violent Deaths, 27 Scand. J. Pub. Health 1:54, 55 (1999), ECF No. 206-10. It would be nonsensical for those in the field to distinguish a relationship of “increased risk” from one of causation if the term “risk” itself was equivalent to causation.

In the face of this extensive evidence of the accepted usage of the term “increased risk,” Planned Parenthood makes two arguments as to why the suicide advisory should be read to require a disclosure of proof of causation. First, it argues that the statute refers to the “increased risk of suicide ideation and suicide” as a risk “to which the pregnant woman would be subjected ” by the abortion procedure, see § 34-23A-10.1(l)(e) (emphasis added), implying that the abortion procedure directly subjects the patient to, or causes, the result. A relevant rule of statutory construction, however, holds that “a limiting clause or phrase ... should ordinarily be read as modifying only the noun or phrase that it immediately follows.” Barnhart v. Thomas, 540 U.S. 20, 26, 124 S.Ct. 376, 157 L.Ed.2d 333 (2003). Under that rule, the phrase “to which the pregnant woman would be subjected” modifies only the immediately preceding phrase “statistically significant risk factors” (which is not at issue here), not the phrase “all known medical risks of the procedure” (of which the “increased risk of suicide ideation and suicide” is a listed example). See § 34-23A-10.1(l)(e).

Moreover, even if the phrase “to which the pregnant woman would be subjected” is construed to modify the “increased risk” language, it would not advance Planned Parenthood’s argument because the result to which the pregnant woman would be subjected is the increased risk. In other words, the abortion procedure causes the patient to become a member of a group for which an increased risk is documented relative to other groups. This does not imply proof that the abortion procedure directly causes the adverse outcome in those cases where the risk materializes. There is a very real difference between (1) a statement that an action places an individual at an increased risk for an adverse outcome, and (2) a statement that, if the individual experiences the adverse outcome, the action will have been the direct cause.3

Second, Planned Parenthood relies on the “established principle of statutory construction that, where the wording of an act is changed by amendment, it is evidential of an intent that the words shall have a different construction.” Lewis & Clark Rural Water Sys., Inc. v. Seeba, 709 N.W.2d 824, 831 (S.D.2006) (quoting S.D. Subsequent Injury Fund v. Federated Mut. Ins., Inc., 605 N.W.2d 166, 170 (S.D.2000)). The informed-consent statute in *897effect prior to the Act required the disclosure of “[t]he particular medical risks associated with the particular abortion procedure to be employed including, when medically accurate, the risks of infection, hemorrhage, danger to subsequent pregnancies, and infertility.” S.D.C.L. § 34-23A-10.1(l)(b) (2004) (emphasis added). The Act expanded this subject matter into a new, four-part subsection:

(e) A description of all known medical risks of the procedure and statistically significant risk factors to which the pregnant woman would be subjected, including:

(i) Depression and related psychological distress;

(ii) Increased risk of suicide ideation and suicide;

(in) A statement setting forth an accurate rate of deaths due to abortions, including all deaths in which the abortion procedure was a substantial contributing factor;

(iv) All other known medical risks to the physical health of the woman, including the risk of infection, hemorrhage, danger to subsequent pregnancies, and infertility!)]

§ 34-23A-10.1(l)(e) (2005). Because this provision as amended by the Act no longer includes the word “associated,” Planned Parenthood asks us to conclude that the legislature intended the term “increased risk” to imply proof of causation, rather than that the procedure and the adverse outcome are merely “associated” by a correlative relationship such as relative risk.

We certainly agree that the amendments to the medical-risks provision are “evidential of an intent that the words shall have a different construction,” Lewis & Clark Rural Water Sys., 709 N.W.2d at 831 (quoting S.D. Subsequent Injury Fund, 605 N.W.2d at 170), but in this case that different construction does not hinge on the removal of one word. Instead, the Act effects essentially a complete rewriting of the former § 34-23A-10.1(l)(b) (2004), removing thirteen of the original twenty-eight words and adding seventy new words, including an entirely new introduction requiring a description of “all known medical risks” and a listing of three new specific areas of concern in subsections (i)(iii). Taken as a whole, these sweeping changes to the language of the provision express the legislature’s intent to address a much broader range of specific medical risks in the required disclosure, not to implicitly sever the term “increased risk” from its accepted usage in the medical field. See Lewis & Clark Rural Water Sys., 709 N.W.2d at 830 (“[T]he true intent of the legislature in enacting laws ... is ascertained primarily from the language employed in the statute.” (quoting Sanford v. Sanford, 694 N.W.2d 283, 287 (2005))). Indeed, where only fifteen words of original language remain in an amended provision of eighty-five words, ascribing such an effect to the removal of a single word would go far beyond any use of the cited rule of statutory construction of which we are aware. See, e.g., S.D. Subsequent Injury Fund, 605 N.W.2d at 170-71 (applying the statutory-amendment rule of construction to a seventy-one-word statute to which four new words were added and two were changed).

Finally, even if the language of the suicide advisory also reasonably could be construed to require a disclosure of a causal link, we would be faced with “varying constructions of the South Dakota statute, ‘by [one] of which grave and doubtful constitutional questions arise and by [the other] of which such questions are avoided.’” Rounds, 653 F.3d at 669 (quoting United States v. Adler, 590 F.3d 581, 583 (8th Cir.2009)). In such a situation, our “duty is to adopt the latter,” id. (quoting Adler, 590 F.3d at 583), and “[t]his is *898especially so since ‘[i]n evaluating a facial challenge to a state law, a federal court must ... consider any limiting construction that a, state ... enforcement agency has proffered,’ ” id. (quoting Kolender v. Lawson, 461 U.S. 352, 355, 103 S.Ct. 1855, 75 L.Ed.2d 903 (1983)). As a result, we would be called to apply the “relative risk” construction of increased risk over a construction that required disclosure of a causal link.

To summarize, in subsection (ii), the legislature expressly required the disclosure of an “increased risk,” not a causal link. Based on the accepted usage of the term “increased risk” in the relevant medical field, the usage of that term in the context of § 34 — 23A—10.1(l)(e)(ii) does not imply a disclosure of a causal relationship. Instead, subsection (ii) requires a disclosure simply that the risk of suicide and suicide ideation is higher among women who abort compared to women in other relevant groups, such as women who give birth or do not become pregnant.

IV.

With regard to whether the required disclosure is truthful, see Rounds, 530 F.3d at 735, the State submitted into the record numerous studies published in peer-reviewed medical journals that demonstrate a statistically significant correlation between abortion and suicide. The studies were published in respected, peer-reviewed journals such as the Obstetrical and Gynecological Survey, the British Medical Journal, the Journal of Child Psychology and Psychiatry, the Southern Medical Journal, and the European Journal of Public Health, and there is no indication that the peer-review process was compromised for the studies at issue. See Daubert v. Merrell Dow Pharm., Inc., 509 U.S. 579, 593-94, 113 S.Ct. 2786, 125 L.Ed.2d 469 (1993) (“The fact of publication (or lack thereof) in a peer reviewed journal ... [is] a relevant, though not dis-positive, consideration in assessing the scientific validity of a particular technique or methodology on which an opinion is premised” because “submission to the scrutiny of the scientific community ... increases the likelihood that substantive flaws in methodology will be detected.”).

Planned Parenthood argues that these studies do not examine the correlation between abortion and suicide in sufficient detail to prove a causal link (as discussed in more detail in Part V), but, as we concluded above, the suicide advisory does not require disclosure of a causal link. With regard to the accuracy of the correlation itself, there is nothing in the record to suggest that the underlying data or calculations in any of these studies are flawed. For example, Planned Parenthood’s own expert, Dr. Nada Stotland, admitted that one of the studies, which determined a suicide rate after abortion of 31.9 per 100,-000 as compared to a suicide rate after live birth of 5.0 per 100,000, “indicates an association; not causation, but an association” between abortion and suicide. Stotland Dep. 283:22-284:9, ECF No. 152-12.4 When asked if she had “any quarrel with the validity of that association,” Dr. Stotland replied that she did not. Id. at 284:11-13.

Based on the record, the studies submitted by the State are sufficiently reliable to support the truth of the proposition that the relative risk of suicide and suicide ideation is higher for women who abort *899their pregnancies compared to women who give birth or have not become pregnant. It also is worth noting that Planned Parenthood does not challenge the disclosure that “[depression and related psychological distress” is a “known medical risk[ ] of the [abortion] procedure.” S.D.C.L. § 34-23A-10.1(l)(e)(i); see also Gonzales v. Carhart, 550 U.S. 124, 159, 127 S.Ct. 1610, 167 L.Ed.2d 480 (2007) (noting that “[s]evere depression and loss of esteem can follow” an abortion). As a matter of common sense, the onset of depression and psychological distress also would increase one’s risk of suicide and suicide ideation. See, e.g., Ottar Bjerkeset et al., Gender Differences in the Association of Mixed Anxiety and Depression with Suicide, 192 Brit. J. Psychiatry 474, 474 (2008) (“Depression is thought to be the most important antecedent of suicide.... ”). Thus, there appears to be little dispute about the truthfulness of the required disclosure.

Finally, Planned Parenthood contends that the suicide advisory is not truthful because an increased risk of suicide after abortion is not “known” as required by the statute. See S.D.C.L. § 34-23A-10.1(l)(e) (requiring disclosure of “[a]ll known medical risks of the procedure”); Rounds, 653 F.3d at 673 (“ ‘[K]nown’ means generally recognized, proved, or familiar to all.”). Once again, however, this contention is premised on Planned Parenthood’s argument that the term “increased risk” implies a causal link that is not generally “known.” Because the statute does not require the disclosure of any causal link, Planned Parenthood’s argument on this point is misdirected. The record indicates that the disclosure actually required — that the relative risk of suicide and suicide ideation is higher for women who abort compared to women in other relevant groups — is generally “known.” For example, the ninety-one-page APA Report, on which Planned Parenthood relies extensively, was commissioned for the sole purpose of analyzing that “known” risk in more detail. See APA Report at 5.

As a result, we hold that the disclosure facially mandated by the suicide advisory is truthful.

V.

Despite the extensive evidence in the record of an “increased risk” of suicide, Planned Parenthood contends that disclosure of the increased risk would be misleading and irrelevant to a patient seeking an abortion, see Rounds, 530 F.3d at 735, because some authorities have indicated that there is no direct causal link. In particular, Planned Parenthood argues that it is more plausible that certain underlying factors, such as pre-existing mental health problems, predispose some women both to have unwanted pregnancies and to have suicidal tendencies, resulting in a misleading correlation between abortion and suicide that has no direct causal component. Under this view, the required disclosure would be misleading or irrelevant to the decision to have an abortion because the patient’s decision would not alter the underlying factors that actually cause the observed increased risk of suicide.

As an initial matter, the standard medical practice, as reflected in the record, is to recognize a strongly correlated adverse outcome as a “risk” while further studies are conducted to clarify whether various underlying factors play causal roles. See, e.g., Coleman Decl. ¶¶ 9-11, Jul. 6, 2006. In contravention of that standard practice, Planned Parenthood argues that the mere existence of underlying factors proscribes the disclosure of suicide as a risk related to abortion. However, there is no constitutional requirement to invert the traditional understanding of “risk” by requiring, where abortion is involved, that conclusive understanding of causation be obtained first. Indeed, the Supreme *900Court “has given state and federal legislatures wide discretion to pass legislation in areas where there is medical and scientific uncertainty,” and “[m]edieal uncertainty does not foreclose the exercise of legislative power in the abortion context any more than it does in other contexts.” Gonzales, 550 U.S. at 163-64, 127 S.Ct. 1610. In particular, “a requirement that a doctor give a woman certain information as part of obtaining her consent to an abortion is, for constitutional purposes, no different from a requirement that a doctor give certain specific information about any medical procedure.” Casey, 505 U.S. at 884, 112 S.Ct. 2791. There is no basis in the “non-misleading” and “relevant” requirements of Casey for imposing a new, stricter definition of medical risk — a standard that requires certainty of causation— simply because the medical procedure at issue is abortion.

Thus, the truthful disclosure regarding increased risk cannot be unconstitutionally misleading or irrelevant simply because of some degree of “medical and scientific uncertainty,” Gonzales, 550 U.S. at 163, 127 S.Ct. 1610, as to whether abortion plays a causal role in the observed correlation between abortion and suicide. Instead, Planned Parenthood would have to show that any “medical and scientific uncertainty” has been resolved into a certainty against a causal role for abortion. In other words, in order to render the suicide advisory unconstitutionally misleading or irrelevant, Planned Parenthood would have to show that abortion has been ruled out, to a degree of scientifically accepted certainty, as a statistically significant causal factor in post-abortion suicides. An examination of Planned Parenthood’s evidence reveals that it has not met this burden.

First, Planned Parenthood points out that the label approved by the Food and Drug Administration (“FDA”) for the abortion-inducing drug Mifeprex (mifepristone, also known as RU-486) does not list suicide or suicide ideation as a risk of using the drug, despite FDA labeling regulations requiring the listing of, inter alia, all “clinically significant adverse reactions” and “other potential safety hazards.” See 21 C.F.R. § 201.57(c)(6)(i). However, an FDA-approved label does not represent the definitive or exclusive list of risks associated with a drug. The record before us does not show whether any evidence of the link between abortion and suicide was submitted to the FDA, nor does it provide details of the FDA’s analysis, if any, of the link. Thus, the FDA-approved label for Mifeprex yields no information as to whether abortion has been ruled out as a statistically significant causal factor in post-abortion suicides.

Second, Planned Parenthood argues, and the district court found, that the American College of Obstetricians and Gynecologists (“ACOG”), a well-known professional medical organization, “rejects any suggestion that increased risk of suicide and suicide ideation are known risks of abortion.” See Rounds, 650 F.Supp.2d at 983. Unfortunately, there was no evidence from ACOG in the record for the district court to consider. The only evidence in the record pertaining to ACOG’s position is a second-hand reference in a 2005 report by the State’s expert, Dr. Elizabeth M. Shadigian, that quoted two sentences from a single ACOG Practice Bulletin: “Long-term risks sometimes attributed to surgical abortion include potential effects on ... psychological sequelae. However, the medical literature, when carefully evaluated, clearly demonstrates no significant negative impact on any of these factors with surgical abortion.” Elizabeth M. Shadigian, Report to the S.D. Task Force to Study Abortion 4, Sept. 21, 2005, ECF No. 177-4 (hereinafter “Shadigian Report”); see also Ex. O, Shadigian Dep. 137-38, ECF No. 147-15 (quoting the recitation of those lines in the Shadigian Re*901port). Dr. Shadigian further reported her opinion that ACOG’s statement was erroneous and that “ACOG seems to claim that they have adequately evaluated the medical literature, but they do not consider our study or the many other studies we evaluated.” Shadigian Report at 5. There is no other evidence in the record as to what “medical literature” ACOG considered, in what fashion it was “carefully evaluated,” whether suicide was one of the “psychological sequelae” considered, whether ACOG’s analysis received any independent peer review, or indeed whether a “Practice Bulletin” purports to be grounded in any sort of reliable scientific method at all. The two unsupported sentences from an ACOG Practice Bulletin lend no credence to the argument that abortion has been ruled out as a statistically significant causal factor in post-abortion suicides.

Third, Planned Parenthood cites the previously mentioned APA Report. The six-person Task Force on Mental Health and Abortion that authored the APA Report reviewed “50 papers published in peer-reviewed journals between 1990 and 2007 that analyzed empirical data of a quantitative nature on psychological experiences associated with induced abortion, compared to an alternative.” APA Report at 64. For some of the studies that found increased mental health risks associated with abortion, the APA Report identifies perceived methodological deficiencies, including an inability to limit the comparison group to women who carried unplanned or unwanted pregnancies to term. See id. at 68. Based on one study that attempted to account for that variable, the report states that “the best scientific evidence indicates that the relative risk of mental health problems among adult women who have an unplanned pregnancy is no greater if they have an elective first-trimester abortion than if they deliver that pregnancy.” Id. (emphases in original). In the very same sentence, however, the report states that the published literature could not provide “unequivocal evidence regarding the relative mental health risks associated with abortion per se compared to its alternatives (childbirth of an unplanned pregnancy).” Id.

The State and Intervenors argue that the APA Report is deficient in several respects. While the APA Report alleges methodological flaws in all of the studies that found a strong link between abortion and adverse mental health outcomes, it does not systematically list or analyze those flaws for each study considered. Instead, the report uses a handful of studies as illustrative examples. The State and Intervenors contend that this lack of rigor allowed the APA Report to analyze studies that found abortion to be “a benign experience for most women” less stringently than studies that found abortion to cause adverse effects. Coleman Deck ¶ 14, Sept. 16, 2008, ECF No. 290-3. For example, while the APA Report suggests that the studies showing increased risk did not compare women receiving abortions to women who carried unplanned pregnancies to term, at least three studies purportedly considered by the task force did use such a control group, and each of those studies still “definitively indicated that abortion was associated with more mental health problems.” Id. at ¶ 19. The APA Report also does not acknowledge that some of the studies showing increased risk did statistically control for other potential causal factors such as history of depression, anxiety, suicide ideation, childhood sexual abuse, physical abuse, child neuroticism, and low self-esteem. Id. at ¶ 15(c).5 As another example, although a high rate of attrition (i.e., the loss of subjects from a *902long-term study before the study is complete) is typically regarded as a methodological weakness, the APA Report downplays the significance of attrition, possibly because “the studies with the highest attrition rates ... are also the ones that provide little evidence of negative effects” of abortion. Id. at ¶ 15(d). A number of published authors in the field contacted the APA to point out these problems and ask that the APA Report be retracted. Id. at ¶¶ 28-29.

At a minimum, it appears that many published authors in the field do not accept the opinion of the APA’s six-person task force that the “best evidence” suggests that there is no real significance to the link between abortion and suicide. Even if one accepts the findings in the APA Report at face value, however, the crux of the matter is that while the APA Report states that the evidence available at the time of its review is not “sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion,” id. at 6 (emphasis added), it also concludes that the published literature is inconclusive and more research is needed “to disentangle confounding factors and establish relative risks of abortion compared to its alternatives,” id. at 72; see also id. at 68 (admitting that the published literature could not provide “unequivocal evidence regarding the relative mental health risks associated with abortion per se compared to its alternatives (childbirth of an unplanned pregnancy)”). In other words, while the APA Report finds that studies to date have not established with certainty that abortion is a causal factor in post-abortion suicide, it also acknowledges that abortion has not been ruled out as a causal factor and that currently available studies are inadequate for that purpose.6 Thus, the APA Report provides no support for the proposition that abortion has been ruled out as a statistically significant causal factor in post-abortion suicides.

Finally, the dissent relies on six recent publications submitted to this Court by Planned Parenthood as a supplement to the district court record. While the dissent suggests that these more recent publications have eliminated any uncertainty about the causal role of abortion in the increased risk of suicide, post at 909-10, the publications add little of value to the record. As an initial matter, three of the publications7 are not new analyses of data, *903but rather reviews or surveys of existing studies. As with the APA Report, it is difficult to identify a solid objective basis for the criteria employed in these reviews to identify the “best” studies and discount the others, and in the fine print they sometimes remain equivocal about the role of abortion as a causal factor. See, e.g., Robinson, supra, at 277 (“For women who have more significant [psychological] problems, the causal contribution of the abortion is not clear; a wide range of factors, both internal and external, affect women’s responses — and interact in complex ways.”).

The three remaining supplemental publications actually provide new analysis, but each suffers from apparent weaknesses. One of the publications, Julia R. Steinberg et al., Does the Outcome of a First Pregnancy Predict Depression, Suicidal Ideation, or Lower Self-Esteem? Data from the National Comorbidity Survey, 81 Am. J. Orthopsychiatry 193 (2011) (“Steinberg I”), compared self-reported mental health problems for women who carried their first pregnancy to term with women who aborted their first pregnancy, see id. at 194, while attempting to control for prepregnancy mental health, experience of sexual violence, and age at first pregnancy, see id. at 197. Mental health problems were classified as pre- or post-delivery or abortion of the first pregnancy. Id. at 195. Thus, if a woman delivered a first pregnancy, aborted a subsequent pregnancy, and suffered an adverse mental health outcome after the abortion, her adverse outcome nevertheless was classified by Steinberg I as belonging to the “delivery” comparison group, rather than the “abortion” comparison group. According to data from the Guttmacher Institute, however, approximately 45 to 47 percent of women obtaining their first abortion have previously carried at least one pregnancy to term. See Jones et al., Repeat Abortion in the United States, Guttmacher Institute, 18 (Nov. 2006), http://www. guttmacher.org/pubs/2006/ll/21/or29.pdf (listing number of prior births for women having a first abortion, based on two sets of data collected by the Guttmacher Institute at abortion provider locations). As a result, Steinberg I almost certainly shifts the outcomes for a significant number of women who aborted their second or subsequent pregnancies from the “abortion” comparison group to the “delivery” comparison group, rendering its comparison of mental health outcomes unreliable.

Another study, Julia R. Steinberg & Lawrence B. Finer, Examining the Association of Abortion History and Current Mental Health: A Reanalysis of the National Comorbidity Survey Using a Common-Riskr-Factors Model, 72 Soc. Sci. & Med. 72 (2011) (“Steinberg II”), compared self-reported mental health problems for women who had been pregnant but never aborted with those women who had aborted one or more pregnancies, while attempting to control for pre-pregnancy mental health, experience of violence, and age at first pregnancy. See id. at 77. However, Steinberg II identified post-abortion or post-delivery mental health outcomes only as those problems the participants reported they were experiencing at the time of the survey, rather than considering mental health problems that participants reported as occurring at any time after an abortion or delivery. See id. at 76-77. Therefore, it appears that Stein-berg II addresses only an arbitrarily limit*904ed window of the women’s mental health histories.

Finally, Trine Munk-Olsen et ah, Induced First-Trimester Abortion and Risk of Mental Disorder; 364 New Eng. J. Med. 332 (2011), extracted data from the Danish Civil Registration System and the Danish Psychiatric Central Register. The study considered data only for women who had no history of inpatient treatment for mental illness in their lifetime prior to the nine-month period preceding either a first abortion or a first delivery of a pregnancy. See id. at 334. For that group of women, the study analyzed data regarding inpatient or outpatient mental health contacts during the nine-month period preceding abortion or delivery and the twelve-month period following abortion or delivery. See id. While the study observed a significantly higher number of psychiatric visits after abortion as compared to after delivery, see id. at 335, it “found no significant increase in the incidence rate of psychiatric contact in the 12 months after an induced first-trimester abortion as compared with the 9-month period before the abortion” and concluded that the higher incidence in post-abortive women compared to post-delivery women likely was due solely to higher pre-existing levels of psychiatric problems for the women who sought abortions, see id. at 336. This conclusion apparently begs the question, however, by assuming that any mental distress occurring in the nine-month period prior to an abortion procedure was completely unrelated to the abortion. It seems just as plausible to assume, particularly in a population selected for having no adverse mental health history prior to that time period, that for at least some of the women, psychological distress in that time period arose in part because they had decided, or already were facing pressure from others, to undergo the abortion. Under this interpretation, the study actually tends to confirm the legislative finding that women who seek abortions are “often under stress and pressures from circumstances and from other persons, and that there exists a need for special protection of the rights of such pregnant women.” S.D.C.L. § 34-23A-1.5.

We acknowledge that these studies, like the studies relied upon by the State and Intervenors, have strengths as well as weaknesses. Like all studies on the topic, they must make use of imperfect data that typically was collected for entirely different purposes, and they must attempt to glean some insight through the application of sophisticated statistical techniques and informed assumptions. While the studies all agree that the relative risk of suicide is higher among women who abort compared to women who give birth or do not become pregnant, they diverge as to the extent to which other underlying factors account for that link. We express no opinion as to whether some of the studies are more reliable than others; instead, we hold only that the state legislature, rather than a federal court, is in the best position to weigh the divergent results and come to a conclusion about the best way to protect its populace. So long as the means chosen by the state does not impose an unconstitutional burden on women seeking abortions or their physicians, we have no basis to interfere.

In summary, although the record reflects “medical and scientific uncertainty,” Gonzales, 550 U.S. at 163, 127 S.Ct. 1610, as to whether abortion itself is a causal factor in the observed correlation between abortion and suicide, there is nothing in the record to suggest that abortion as a cause per se has been ruled out with certainty. As a result, the disclosure of the observed correlation as an “increased risk” is not unconstitutionally misleading or irrelevant under Casey and Gonzales. Indeed, physicians who provide abortions *905should be capable of reviewing the research in the field, understanding the difference between relative risk and proof of causation, and explaining it correctly to their patients. Cf. Rounds, 530 F.3d at 736 (holding that the subject matter of the biological disclosure “should be clear in context to a physician”).8 In the end, “[t]he point of informed consent laws is to allow the patient to evaluate her condition and render her best decision under difficult circumstances. Denying her up to date medical information is more of an abuse to her ability to decide than providing the information.” Lakey, 667 F.3d at 579.

Accordingly, we hold that the suicide advisory is non-misleading and relevant to the patient’s decision to have an abortion.

VI.

In conclusion, we hold that the requirements of S.D.C.L. § 34 — 23A—10.1 (1)(e)(ii) are satisfied by a disclosure that the relative risk of suicide and suicide ideation is higher for women who abort compared to women in other relevant groups, as described in the relevant medical research. The statute does not require the physician to disclose that a causal link between abortion and suicide has been proved. The disclosure is truthful, as evidenced by a multitude of studies published in peer-reviewed medical journals that found an increased risk of suicide for women who had received abortions compared to women who gave birth, miscarried, or never became pregnant. Various studies found this correlation to hold even when controlling for the effects of other potential causal factors for suicide, including pre-existing depression, anxiety, suicide ideation, childhood sexual abuse, physical abuse, child neuroticism, and low self-esteem.

Moreover, the suicide advisory is non-misleading and relevant to the patient’s decision to have an abortion, as required by Casey. It is a typical medical practice to inform patients of statistically significant risks that have been associated with a procedure through medical research, even if causation has not been proved definitively.9 While Planned Parenthood points to uncertainty as to whether abortion itself is a causal factor in the observed correlation to suicide, as opposed to other underlying factors that tend to be associated independently with both abortion and suicide, the Supreme Court “has given state and federal legislatures wide *906discretion to pass legislation in areas where there is medical and scientific uncertainty,” including “in the abortion context.” Gonzales, 550 U.S. at 163-64, 127 S.Ct. 1610. Thus, a truthful disclosure cannot be unconstitutionally misleading or irrelevant simply because some degree of medical and scientific uncertainty persists. To be sure, informed consent requirements “must be calculated to inform [a] woman’s free choice, not hinder it,” Casey, 505 U.S. at 877, 112 S.Ct. 2791, but there is no unconstitutional hindrance of the woman’s choice where, as here, the State merely is using “its regulatory authority to require a physician to provide truthful, non-misleading information relevant to a patient’s decision to have an abortion, even if that information might also encourage the patient to choose childbirth over abortion,” Rounds, 530 F.3d at 735.

On its face, the suicide advisory presents neither an undue burden on abortion rights nor a violation of physicians’ free speech rights. Accordingly, we reverse the district court’s grant of summary judgment to Planned Parenthood with respect to S.D.C.L. § 34-23A-10.1 (l)(e)(ii), direct the entry of summary judgment for the State as to that provision, and vacate the permanent injunction against the enforcement of that provision.

LOKEN, Circuit Judge,

concurring.

Though I agree with the dissent that the plain language of S.D.C.L. § 34-23A-10.1(l)(e)(ii) — “known medical risks ... to which the pregnant woman would be subjected” — strongly suggest legislative intent to require that a physician make an untruthful, misleading causation disclosure, the first two sentences of Part VI of the court’s opinion require only a disclosure as to relative risk that the physician can adapt to fit his or her professional opinion of the conflicting medical research on this contentious subject. With the facial constitutionality of the statute limited in this fashion, controlling Supreme Court precedent requires that I concur. See Gonzales v. Carhart, 550 U.S. 124, 163-68, 127 S.Ct. 1610, 167 L.Ed.2d 480 (2007).

COLLOTON, Circuit Judge,

concurring in part and concurring in the judgment.

I concur in Parts I through III of the court’s opinion, except that I find it unnecessary to consider the meaning of the hypothetical phrase “a description of all known risks of the procedure ... to which the pregnant woman would be subjected.” Ante, at 896 & n. 3. The most natural reading of S.D.C.L. § 34-23A-10.1 is that it requires the physician to present “a description of all known medical risks of the procedure,” including “[ijncreased risk of suicide ideation and suicide.” Ante, at 896. For the reasons set forth in Part III, the statutory language thus calls for a description of the relative risks of suicide ideation and suicide that are discussed in the peer-reviewed literature. See ante, at 894-96, 898. The phrase “to which the pregnant woman would be subjected” modifies “statistically significant risk factors.” The district court’s order striking “statistically significant risk factors” did not rewrite the statute to cause the phrase that follows the stricken text to modify antecedent text that was not previously modified.

I concur in Part IV of the court’s opinion concerning why the required disclosure is truthful. I also concur in the portion of Part V that explains why the record before the district court did not establish that the disclosure is misleading. This court took the unusual step of permitting the appellees to supplement the record on appeal, after the completion of briefing, with a 476-page supplemental appendix that includes several studies that were not presented to the district court. Without attempting to engage in a social science *907critique of these studies in the first instance, it is sufficient to observe that the conclusions of these studies do not, on their face, eliminate the medical and scientific uncertainty concerning the relationship between abortion and suicide ideation or suicide. See ante, at 904. I thus concur that the State was permitted to require a description of the relative risks as reflected in the peer-reviewed literature, with the physician free to augment that description based on his or her professional judgment. Ante, at 905 & n. 8.

For these reasons, I concur in the judgment.

MURPHY, Circuit Judge,

with whom WOLLMAN, BYE, and MELLOY, Circuit Judges, join, dissenting.

The record before the district court supported its conclusions that South Dakota’s 2005 suicide advisory is unconstitutional because it will not inform the free choice of a woman and is not consistent with the medical evidence. These conclusions have only been strengthened by the medical evidence received since then. The governing rule of law is that laid down by the Supreme Court in Planned Parenthood of Southeastern Pennsylvania v. Casey, 505 U.S. 833, 112 S.Ct. 2791, 120 L.Ed.2d 674 (1992), which prohibits a state from requiring an advisory which is not “calculated to inform the woman’s free choice” but “hinder[s] it.” Id. at 877, 112 S.Ct. 2791. Gonzales v. Carhart, 550 U.S. 124, 127 S.Ct. 1610, 167 L.Ed.2d 480 (2007), on which the majority relies, did not address that standard.

The most reliable evidence in the record shows that abortion does not have a causal relationship to the risk of suicide and that South Dakota’s mandated advisory is not truthful, but actually misleading. In Casey, the Court recognized both a woman’s right “to decide to terminate a pregnancy free of undue interference by the State” and the state’s “legitimate goal of ... ensuring a decision that is mature and informed” in order to “facilitate[ ] the wise exercise of that right.” 505 U.S. at 883, 887, 112 S.Ct. 2791. Focus on these parallel goals in Casey shows how carefully the Court considered the interests of both the woman and the state in that decision.

In order to be constitutional an informed consent requirement must be truthful, non misleading, and relevant. See Casey 505 U.S. at 882-83, 112 S.Ct. 2791; see also Planned Parenthood Minn., N.D., S.D. v. Rounds, 530 F.3d 724, 735 (8th Cir.2008) (en banc). Requiring physicians to provide their patients with information that does not meet this standard violates the physicians’ First Amendment right against compelled speech. Casey, 505 U.S. at 884, 112 S.Ct. 2791; see also Rounds, 530 F.3d at 734-35.

The content of the 2005 suicide advisory raises constitutional problems which the prior version of the South Dakota statute did not. The previous provision required a physician to advise a patient about the “particular medical risks associated with the particular abortion procedure to be employed, including when medically accurate, the risks of infection, hemorrhage, danger to subsequent pregnancies, and infertility.” S.D.C.L. § 34-23A-10.1(1)(b) (2003) (emphasis added). In contrast, the statute before the court requires doctors to tell a pregnant woman that a greater likelihood of suicide and suicide ideation is a “known medical risk [ ]” to which she “would be subjected” by having an abortion. S.D.C.L. § 34-23A-10.1(l)(e) (2005) (emphasis added).

The record clearly demonstrates, however, that suicide is not a known medical risk of abortion and that suicide is caused instead by factors preexisting an abortion such as a history of mental illness, domestic violence, and young age at the time of *908pregnancy. See, e.g., Julia R. Steinberg, et al., Does the Outcome of a First Pregnancy Predict Depression, Suicidal Ideation, or Lower Self-Esteem? Data from the National Comorbidity Survey, 81 Am. J. Orthopsychiatry 193 (2011); Gail Erlick Robinson, et al., Is There an “Abortion Trauma Syndrome?” Critiquing the Evidence, 17 Harv. Rev. Psychiatry 268 (2009).

As can be seen, the prior version of the South Dakota law did not carry the fatal flaw embodied in the statute now being considered. The wording of the statute under consideration conveys a causal relationship between abortion and the risk of suicide “to which the pregnant woman would be subjected.” The phrase to subject someone to something means “to cause to undergo or submit to.” Webster’s Third New Int’l Dictionary 2275 (2002). In contrast, the wording in the prior state legislation spoke of the “risks associated with ... abortion.” An association is defined as “the relationship of the occurrence of two events, without evidence that the event being investigated actually causes the second condition.” Taber’s Cyclopaedic Med. Dictionary 201 (21st ed. 2009). Legislative findings show that the statutory drafters intended that the advisory under review convey causality, for they stated that women must be informed that “procedures terminating the life of an unborn child impose risks to the life and health of the pregnant woman.” S.D.C.L. § 34-23A-1.4 (emphasis added); Webster’s Third New Int’l Dictionary 1136 (2002) (defining “impose” as “to cause to be burdened”).10

The majority concedes that there is no proof in the medical literature that abortion causes suicide, ante at 895-96, and it recognizes that an advisory telling a woman that abortion causes an increased risk of suicide would be untruthful. Ante at 897-98. It seeks to avoid the constitutional problem created by the current statutory text by suggesting that the legislature’s amendment substituting subjected to for “associated with” should not be understood to mean causality since nearly all of the words in the advisory were changed. The new language is explained as merely informing women that their decision to have an abortion would “cause[ ] [them] to become a member of a group” with a statistically higher rate of suicide. Ante at 896. That is not what the plain language of the statute says, however, and the medical evidence shows that women sharing certain factors may have a higher rate of suicide but not that abortion causes suicide.

The evidence considered by the district court shows that an advisory informing women that abortion causes them to be more likely to commit suicide is untruthful and misleading. That record made clear that abortion does not cause a “known” risk of suicide or suicide ideation. The record included volumes of deposition testimony, published medical research, and legislative reports supporting the district court’s conclusion that the suicide advisory is unconstitutional.

One of the significant reports in the record was the American Psychological Association’s (APA) review of the medical *909literature. That review showed only an association between women who have an abortion and woman who commit suicide. The APA’s review concluded that “the best scientific evidence indicates that the relative risk of mental health problems among adult women who have an unplanned pregnancy is no greater if they have an elective first-trimester abortion than if they deliver that pregnancy.” Brenda Major, et al., American Psychological Association, Report of the APA Task Force on Mental Health and Abortion 68 (2008) (APA Report).

There was also evidence from the “most recent edition of medical opinions” by the American College of Obstetricians and Gynecologists (ACOG) showing that the ACOG shared the APA’s interpretation of the medical literature and informed its members that abortion does not affect women’s subsequent mental health. The record included evidence that the label for the abortion inducing drug mifepristone was never revised to include the risk of suicide or suicide ideation. That was relevant in light of the Food and Drug Administration requirement that drug labeling must “be revised to include a warning as soon as there is reasonable evidence of an association of a serious hazard with a drug; a causal relationship need not have been proved.” 21 C.F.R. § 201.80(e).

In addition the district court was made aware of the fact that the author of two of the studies, on which the state and intervenors rely, has explained that his findings did not “support the hypothesis that abortion itself causes suicide.” Mika Gissler, et al., Letter to the Editor: Pregnancy-Related, Violent Deaths, 27 Scand. J. Pub. Health 54, 55 (1999). Gissler concluded that “[a] more likely explanation is that the excess risk may be due to causes related both to induced abortion and violent death.” Id.

The record included other criticisms of studies presented by the state and the intervenors which had used comparator groups irrelevant to a pregnant woman’s decision to have an abortion. Because pregnant women can no longer choose not to become pregnant, providing them information about the relative risks of suicide for women after abortion compared with women with no pregnancy does nothing to inform their decision on whether to have an elective abortion. See, e.g., Mika Gissler, et al., Injury Deaths, Suicides and Homicides Associated with Pregnancy, Finland 1987-2000, 15 European J. Pub. Health 459, 460 (2005) (comparing women electing abortion with women who are not pregnant); David M. Fergusson, et al., Abortion in Young Women and Subsequent Mental History, 47 J. Child Psychol. & Psychiatry 16, 17 (2006) (same); see also APA Report at 53-54, 71 (discussing this methodological problem).

Since the district court enjoined the suicide advisory and a panel of this court affirmed that decision, the United Kingdom’s Royal College of Obstetricians and Gynaecologists (RCOG) has issued recommendations that women “be informed that the evidence suggests that they are no more or less likely to suffer adverse psychological sequelae whether they have an abortion or continue with the pregnancy and have the baby.” RCOG, The Care of Women Requesting Induced Abortion 45 (Nov. 2011). The United Kingdom’s National Collaborating Centre for Mental Health arrived at the same conclusion in its report to the Academy of Medical Royal Colleges. Induced Abortion and Mental Health: A Systemic Review of the Mental Health Outcomes of Induced Abortion, Including Their Prevalence and Associated Factors 125 (Dec. 2011).

These conclusions are based on numerous studies which strengthen the evidence *910on which the district court relied. The studies establish that post abortion suicide rates are linked to preexisting mental illness and domestic violence, not to the decision to undergo an abortion. See, e.g., Trine Much-Olsen, et al., Induced First-Trimester Abortion and Risk of Mental Disorder, 364 New Eng. J. Med. 332, 338 (2011); Robinson, supra, at 276 (“The most well controlled studies continue to demonstrate that there is no convincing evidence that induced abortion of an unwanted pregnancy is per se a significant risk factor for psychiatric illness.”). If, as the majority points out, “the standard medical practice ... is to recognize a strongly correlated adverse outcome as a ‘risk’ while further studies are conducted to clarify whether various underlying factors play causal roles,” ante at 899 (emphasis omitted), must not research conducted by experts in the field after the district court’s decision be considered as corroboration of its findings and conclusions?

Dr. Priscilla Coleman, an expert witness produced by the state and intervenors in the district court, has recently been criticized for her study methodology and her resulting conclusions that abortion plays a causal role to increase the risk of suicide. In one study researchers used the same data and methodology Coleman had in a 2009 study discussed in one of her declarations to the district court. Guhin Deck, Exh. 87 at 13, ECF No. 290-2. The researchers found that Coleman’s results were not replicable and concluded that “structural, psychological, and sociodemographic risk factors associated with both having an abortion and having poor mental health drive a relationship between abortion and mental health.” Julia R. Stein-berg & Lawrence B. Finer, Examining the Association of Abortion History and Current Mental Health: A Reanalysis of the National Comorbidity Survey Using a Common-Risk-Factors Model, 72 Soc. Sci. & Med. 72, 81 (2011). The editor-in-chief of the Journal of Psychiatric Research subsequently concluded that Coleman’s explanation for her methodology in the 2009 study was “unpersuasive” and that the analysis “does not support [Coleman’s] assertions” that abortions “were associated with increased risk of lifetime mental disorders----” Reply to Letter to the Editor: Commentary on Abortion Studies of Steinberg and Finer (Soc. Sci. & Med. 2011; 72:72-82) and Coleman (J. Psychiatric Res. 2009; 13:770-6 & J. Psychiatric Res. 2011; 15:1133-1), 46 J. Psychiatric Res. 410, 410 (2012).

The quality of the cited studies has been recognized by leading professional associations. This research also formed the basis for the opinions of these bodies that the induced abortion of an unwanted pregnancy does not cause an increased risk of mental health problems. See, e.g., National Collaborating Centre for Mental Health, supra at 125-27. Rather than recognizing this emerging consensus based on the scientific research in the record before the district court and all the subsequently submitted evidence by the parties to this court, the majority theorizes about the nature of an advisory. In the end it arrives at a new test divorced from the standard established in Casey.

The majority posits that the lack of evidence — that the correlation between abortion and suicide is due to a causal relationship — is not fatal to the advisory because the existence of a correlation for any reason makes the advisory truthful. Pointing out that Planned Parenthood does not currently challenge the state’s depression advisory, it asserts that “as a matter of common sense” depression can be a precursor to suicide. Ante at 899. While Planned Parenthood withdrew its challenge to that section of the statute, it never conceded that “depression and related psychological *911distress” are known medical risks of abortion nor does it inform its patients of this. Resp. Pet. for Reh’g n. 8. Even a study submitted by the intervenors admits that data do not support an association between abortion and depression. David M. Fergusson, et al. A Further Meta-Analysis, Br. J. of Psychiatry, Oct. 5, 2011 available at http://bjp.rcpsych.Org/content/199/3/180/ reply#bjprepsych_eL.33839.11

The majority concedes though that if the correlation between abortion and suicide were not due to a causal relationship, then the advisory “would be misleading or irrelevant to the decision to have an abortion because the patient’s decision would not alter the underlying factors that actually cause the observed increased risk of suicide.” Ante at 899. The vast majority of researchers, however, assert that this is precisely the case. Those studies in the record show that other independent factors which co-occur with both abortion and suicide, such as prepregnancy mental health problems, domestic violence, and youth, account for the correlation between abortion and suicide risk.

To overcome this evidentiary problem a new standard for informed consent advisories is offered. Under this proposed test, so long as a causal link between abortion and suicide would be theoretically possible, an advisory is truthful, non misleading, and relevant unless Planned Parenthood can prove the absence of a causal link with “scientifically accepted certainty.” Ante at 900. In support the court turns to Gonzales, 550 U.S. at 163-67, 127 S.Ct. 1610, to rely on its discussion of medical uncertainty. Ante at 899-900, 904-05. The Court there was not considering a Casey issue about informed consent, however, and it was not evaluating the information given to an individual woman to “ensur[e] a decision that is mature and informed.” See Casey, 505 U.S. at 883, 112 S.Ct. 2791. The Court concluded only that Congress, which was fully informed of the contradicting medical opinions, could balance the need to protect the state’s interests in the “ethics of the medical profession” and “respect for dignity of human life” against the uncertain risks to women’s health resulting from the ban. Gonzales, 550 U.S. at 157, 166, 127 S.Ct. 1610 (citation omitted).

The state’s interest in this case is to promote a “wise,” “mature[,] and informed” decision by women considering abortion. Casey, 505 U.S. at 883, 887, 112 S.Ct. 2791. Here, any medical uncertainty as to whether abortion causes an increased risk of suicide undermines the advisory’s constitutionality because a woman’s ability to make a wise, mature, and informed choice is hindered by being told that the increased risk of suicide is a “known medical risk[ ]” “to which ... [she] would be subjected” by having an abortion when the weight of the medical research indicates the opposite and she is not informed of the debate. The state’s interest is thus not furthered by such an advisory.

It is significant that the South Dakota legislature and governor amended certain abortion regulations in March 2012 in order to reflect the more accepted view in the medical community that abortion does not cause mental health problems such as suicidal ideation and suicide. In the new version of the statute, which requires a physician to meet with a pregnant woman before she can schedule an abortion, the *912state legislature eliminated language mandating an assessment “to determine if any of the risk factors associated with abortion are present in her case.” S.D. House Bill 1254 § 2 ¶ 4 (amending S.D.C.L. § 34-23A-56). The state law now requires an assessment “to determine if any of the following preexisting risk factors associated with adverse psychological outcomes following an abortion are present in her case.” Id. Among the listed preexisting risk factors in South Dakota’s revision are coercion, a history of mental illness, and youth. Id. This amendment thus brings the statute in line with the existing medical evidence which shows that an increased risk of suicide is linked not to the decision to undergo an abortion, but to preexisting risk factors that coincide with abortion.

We agree that “[t]he point of informed consent laws is to allow the patient to evaluate her condition and render her best decision under difficult circumstances” and that “[d]enying her up to date medical information is more of an abuse to her ability to decide than providing the information.” See ante at 905 (quoting Tex. Med. Providers Performing Abortion Servs. v. Lakey, 667 F.3d 570, 579 (5th Cir.2012)) (first alteration in original). Yet, instead of recognizing that medical research has shown that South Dakota’s suicide advisory is untruthful, misleading, and irrelevant, the majority tries to shift the responsibility to attending, physicians to “review! ] the research in the field, understand! ] the difference between relative risk and proof of causation, and explain! ] it correctly to their patients.” Ante at 905. The statute provides only for a written transaction between doctor and patient in which explanation and clarification occur if a woman requests it, see S.D.C.L. § 34-23A-10.1 ¶¶ 2, 3, but no judicial attempt to direct the content of the conversation between a patient and her doctor can remedy the advisory’s constitutional shortcomings.

By forcing doctors to inform women that abortion subjects them to a risk which the record medical evidence refutes, the suicide advisory places an undue burden on a pregnant woman’s due process rights and violates a doctor’s First Amendment right against compelled speech. The district court’s order enjoining the suicide advisory should therefore be affirmed.