On Tuesday, the U.S. Supreme Court refused to take up a Planned Parenthood challenge to an Arkansas law restricting the use of abortion pills. This decision seemingly reversed the Court’s decision to strike down a similar Texas law in 2016.

The Supreme Court allowed Arkansas to enforce a law requiring doctors who provide abortion pills to hold a contract with another physician who has admitting privileges at a hospital, and who would agree to handle and treat complications from the abortion.

Planned Parenthood argued that if the law stands, the state would prevent women from being able to access abortion pills. The “medication abortion” involves two drugs: mifepristone, which softens the uterine wall, making it more difficult for the fetus to implant in the mother’s womb; and misopostol, which sends the body into labor, expelling the baby in a process similar to a miscarriage. While the process is often described as safe, it may lead to excessive bleeding, requiring a blood transfusion.

Planned Parenthood offered these abortion pills at clinics in Fayetteville and Little Rock, but the organization was unable to find obstetricians in the state willing to handle hospital admissions in case the pills caused damaging complications.

The nation’s largest abortion provider argued that the law would constitute an “undue burden” on women’s ability to procure an abortion, echoing the successful argument against a Texas law that required abortion clinics to have admitting privileges at local hospitals. The Supreme Court struck down that law in 2016.

The U.S. Court of Appeals for the Eighth Circuit also upheld the law, but Planned Parenthood succeeded in getting an injunction to prevent the law’s implementation until the Supreme Court issued a ruling. While the legal battle is not over, the Supreme Court’s decision allowed Arkansas to implement the law.

The law imposes criminal penalties on physicians who provide medication-induced abortions unless they have a signed contract with a physician who has “active admitting privileges and gynecological/surgical privileges at a hospital designated to handle any emergencies associated with the use or ingestion of the abortion-inducing drug,” and who agrees to handle complications from medication abortions, The Hill reported.

Prosecuting attorneys in Arkansas argued that their state law differed from the Texas measure, since it does not require abortion providers themselves to have admitting privileges anywhere. The Texas law also required abortion doctors to have admitting privileges at a hospital within 30 miles.

“Arkansas law merely requires medication abortion providers to have a contractual relationship (to ensure follow-up treatment if needed) with a physician that has admitting privileges,” the state attorneys argued.

The Arkansas and Texas laws come in the context of a nation-wide debate about restrictions intended to ensure that abortions are safe for women. Pro-life advocates have argued that tragic deaths of women, as in Kermit Gosnell’s “House of Horrors” abortion clinic, can be prevented by various restrictions to ensure safety. Pro-life activists would not lament the closure of abortion clinics if they cannot meet strict safety standards.

Abortion activists and organizations like Planned Parenthood have denounced the laws as an attempt to shut down abortion clinics in the name of safety. While there may be some truth to this claim, the debate puts abortion activists on the side against protecting women’s health.

Interestingly, Planned Parenthood services outside of abortion declined precipitously in 2017, just as pregnancy resource centers expanded across the U.S. Another current Supreme Court case focuses on laws requiring pro-life pregnancy resource centers to advertise abortion clinics. The abortion debate will continue to take interesting twists and turns. America has not seen the last of these issues.