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A federal appeals court upheld key parts of Texas's strict anti-abortion law on Tuesday, a decision that could leave as few as seven abortion clinics in the nation's second largest state.

The decision by the 5th U.S. Circuit Court of Appeals upholds requirements that abortion clinics meet hospital-level operating standards, which owners of small clinics say demand millions of dollars in upgrades they can't afford and will leave many women hundreds of miles away from an abortion provider. But the court said abortion clinics failed to prove that the restrictions would unduly burden a "large fraction" of women.

Republican Gov. Greg Abbott and other conservatives say the standards protect women's health. But abortion-rights supports say the law is a thinly veiled attempt to block access to abortions in Texas, and they promised to appeal to the U.S. Supreme Court, which temporarily sidelined the law last year.

"Not since before Roe v. Wade has a law or court decision had the potential to devastate access to reproductive health care on such a sweeping scale," said Nancy Northrop, president and CEO of the Center for Reproductive Rights.

Texas will be able to start enforcing the restrictions in about three weeks unless the Supreme Court steps in and temporarily halts the decision, said Stephanie Toti, an attorney for the center. Only seven abortion facilities in Texas, including four operated by Planned Parenthood, meet the more robust requirements.

The ruling, made by a three-judge panel, is the 5th Circuit's latest decision in a lawsuit challenging some of the toughest abortion restrictions in the country.


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