ST. LOUIS — A St. Louis judge issued another order Monday to keep Missouri's only abortion clinic operating while a fight over the facility's license plays out in court.

Circuit Jude Michael Stelzer granted Planned Parenthood's request for a preliminary injunction, which extends his earlier order to temporarily block the state from allowing the St. Louis facility's license to lapse. The courtroom win for abortion-rights advocates comes after a string of setbacks in legislatures around the U.S.

The state health department in May declined to renew the clinic's license to perform abortion procedures, citing concerns about patient safety, "failed surgical abortions" and legal violations.

Stelzer's ruling on Monday ordered the Missouri Department of Health and Senior Services to decide on Planned Parenthood's application to renew its license by June 21.

Dr. Leana Wen, president and CEO of Planned Parenthood Federation of America, called the ruling "a clear victory for our patients - and for people across Missouri," but said the threat against legal abortion remains.

"We've seen just how closely anti-health politicians came to ending abortion care for an entire state," Wen said in a statement. "We are in a state of emergency for women's health in America."

Phone and email messages seeking comment from Republican Gov. Mike Parson's office and the health department were not immediately returned.

Stelzer's ruling said he wasn't determining whether the license should be approved or denied. But the judge noted that one issue in dispute is whether the health department can simply allow the abortion clinic's license to lapse without taking any action.

"The Court does not believe that an 'official action' can include non-action," Stelzer wrote.

The state issued subpoenas to staff doctors and former medical residents who worked at Planned Parenthood's St. Louis facility, seeking their testimony about what an assistant attorney general called "grave concerns" about patient safety. Clinic leaders said the move is part of an effort by an anti-abortion administration to eliminate the procedure in Missouri.

According to Planned Parenthood, no state has been without a functioning abortion clinic since 1974, the year after the U.S. Supreme Court's Roe v. Wade ruling that legalized abortion nationwide.

The fight over the clinic's license comes as lawmakers in many conservative states, including Missouri, are passing new restrictions that take aim at Roe. Abortion opponents, emboldened by new conservative justices on the Supreme Court, hope federal courts will uphold laws that prohibit abortions before a fetus is viable outside the womb, the dividing line the high court set in Roe.

Missouri Republican Gov. Mike Parson signed legislation on May 24 to ban abortions at or beyond eight weeks of pregnancy, with exceptions for medical emergencies but not for rape or incest.

The number of abortions performed in Missouri has declined every year for the past decade, reaching a low of 2,910 last year. Of those, an estimated 1,210 occurred at eight weeks or less of pregnancy, according to preliminary statistics from the state health department.

Missouri women also seek abortions in other states. In Kansas, about 3,300 of the 7,000 abortions performed in 2018 were for Missouri residents, according to the state's health department. Illinois does not track the home states of women seeking abortions.

An abortion clinic is located just across the Mississippi River in Granite City, Illinois, less than 10 miles (16 kilometers) from the Planned Parenthood facility in St. Louis. Planned Parenthood's abortion clinic in the Kansas City area is in Overland Park, Kansas, just 2 miles (3 kilometers) from the state line. State figures show a handful of Missouri hospitals also perform abortions, but those are relatively rare.