An Oklahoma County court dealt a blow to abortion rights on Friday, becoming the first in the country to uphold a state ban on a common procedure to terminate pregnancy in the second trimester.

The Oklahoma law, passed in 2015, bans abortion by the dilation and evacuation, or D&E, method. This surgical procedure accounts for around 95% of the 11% of abortions that occur after the first trimester of pregnancy nationwide, according to the Guttmacher Institute. Such a ban disproportionately affects women facing maternal health complications. It forces doctors to choose between using a less safe method of abortion or not providing abortions for women after their first trimester, said Autumn Katz, a staff attorney at the Center for Reproductive Rights and an attorney on this case.

Laws like Oklahoma’s are part of a nationwide push to challenge abortion at the state level. This conservative effort has been met by equally determined progressive lawyers and activists, who aren’t backing down without a fight

“Oklahoma’s law is part of this orchestrated national strategy that we’ve seen where states are passing hundreds of restrictions on abortion ... [including] these kinds of D&E bans and many other restrictions on abortion that are completely politically motivated and designed to push abortion out of reach for women,” Katz told HuffPost.

She said that low-income people, those living in rural areas, and those who face barriers to accessing reproductive health care in general are most impacted by these restrictions. Oklahoma has only four health centers that offer abortions, according to the Center for Reproductive Rights.