All eyes are on Texas this week, and not in a good way. Already the nexus of national health news this week due to the ongoing Ebola crisis in Dallas, the state is again a focus of debate, as an appeals court ruled last night that new requirements for Texas abortion clinics could be enforced while the law undergoes a federal appeal.  

The seventeen-page ruling, handed down by the U.S. 5th Circuit Court of Appeals, gave the state the green light to implement the law, which requires that clinics adhere to the same standards as ambulatory surgical centers and that doctors who perform the procedure hold admitting privileges at a hospital within thirty miles of the clinic. According to the three-judge panel, the state’s case is “likely to succeed” on whether the new requirements “have the effect of imposing an undue burden on the women in the Rio Grande Valley.”

Abortion has long been a complex and contentious issue in Texas, and this most recent development only furthers that narrative. The debate here shifted considerably in 2011, when the bill was initially introduced, marking the start of the most anti-abortion, anti-contraception session in state history. Since then, Texas women have had to confront a reality where the right to dictate their health and economic futures has been called into question.

But although Wendy Davis’ eleven-hour filibuster of the bill made Texas the epicenter of the national debate on abortion, this latest ruling is part of a gradual increase on abortion restrictions nationwide. Over the past few years, states across the country have introduced a litany of abortion constraints. According to a report released by NARAL Pro-Choice America, a pro-abortion group headquartered in Washington, DC, identified in its annual report 53 anti-abortion laws passed in 2013 across the U.S., up from 42 the previous year. Oklahoma is grappling with a similar debate—yesterday a doctor who performs almost half of abortions in the state filed a lawsuit to contest the admitting privileges requirement. 

Now, with the ruling effectively shuttering thirteen abortion clinics overnight, leaving just eight clinics operating across five major cities, the future of abortion in Texas remains murky. A long and arduous legal battle over the constitutionality of the law could take months, as the 5th Circuit has yet to set a hearing to evaluate the law’s constitutionality.

Additional questions remain if the law were to eventually come before the U.S. Supreme Court, with justices already weighing in on the case. Last week, Justice Ruth Bader Ginsburg spoke frankly about the implications of overturning Roe v. Wade, saying in an interview with the New Republic that “Women who can’t pay are the only women who would be affected” by abortion bans. Ginsburg’s comments prompted much outcry, with some even arguing that she has in essence disqualified herself from presiding over the case if it came before the court.

In the meantime, there remains the possibility that Texas could revert to the pre-Roe v. Wade era where many women lacked access to proper reproductive health care and sought out abortions at any cost. In June, the Atlantic examined the rise of abortion alternatives in South Texas, including a black market operation of purportedly abortion-inducing pills in the Rio Grande Valley already popular in Latin America. Abortion clinics in surrounding states like New Mexico have already begun preparing to treat an influx of women from Texas. Earlier this month, one Texas company, Whole Women’s Health, opened a new clinic in Las Cruces area, near West Texas. 

As legal costs continue to rise for both the state and abortion clinics, it still remains to be seen exactly how the situation will unfold.

(AP Photo/Tamir Kalifa, File)