Starting in September of this year, it will also require all abortion clinics to conform to the standards of ambulatory surgical centers, which include specifications on everything from the spacing of the hand-sanitizer dispensers to the flooring of the janitor’s closet.

In a state where a person can drive for hours without encountering much more than cattle and brush, just 27 percent of Texas’s 630 hospitals are located in rural areas. Of the 34 abortion clinics that were open in the state in October 2013, 12 closed in November because their doctors weren’t able to secure admitting privileges. (Three of them have since reopened to at least partial capacity). Of those 25 clinics, only three are currently licensed surgical centers that are staffed by a doctor with admitting privileges.

Now, women who live in Willacy County must drive 120 miles to Corpus Christi, where the nearest physician with admitting privileges struggles to keep up with a torrent of new patients. Starting in September, they will have to drive 250 miles, to San Antonio, to visit the nearest abortion clinic that’s also a surgical center. And because a 2011 Texas law required women to first get an ultrasound, then wait 24 hours before getting an abortion, they would likely have to stay overnight.

“I know I'm a good mother and I provide for my children, but I see a lot of kids who aren't wanted, and I think it's going to be even worse now with this law,” Susan said. “I remember it cost me $1,000 just to give birth to my last child. And the abortion was $550.”

The new law has been embroiled in a bitter legal war since its passage last summer—a vote that itself was famously filibustered for 13 hours by the pink-sneaker-clad state Senator Wendy Davis. In October, a panel of judges at the Fifth Circuit Court of Appeals in New Orleans said the law requiring doctors to have admitting privileges can take effect while the case works its way through the system. The court acknowledged that the provision “may increase the cost of accessing an abortion provider and decrease the number of physicians available to perform abortions,” but said the state’s goals were ultimately aligned with the public interest.

Last week, a coalition of abortion providers argued before the Fifth Circuit Court of appeals that Texas’ expansive terrain—and the capriciousness of hospitals’ decisions—means not every abortion doctor will be granted admitting privileges, and desperate women will suffer as a result. They say that more than 22,000 women would be left without any meaningful access to abortions.

Throughout the legal back-and-forth, the state has maintained a persuasive counter-argument: Abortions would still be available in the state, after all, and the pro-choice groups so far haven’t been able to offer proof that specific women would be hurt by the new restrictions. “Aggregate information from providers,” they said, doesn’t constitute demonstrating an “undue burden” on women’s abortion rights, as would be required for the law to be unconstitutional.