A women’s clinic in Cincinnati, Ohio has lost its bid for a reprieve from new, restrictive anti-choice laws in the state and may be forced to close. According to the Cincinnati Enquirer, this leaves the city one step closer to being the largest in the U.S. without any local abortion provider.

The state moved to revoke Women’s Med Center of Sharonville’s license to practice in the state based on its inability to comply with Republican-sponsored laws aimed at gutting women’s health options in Ohio. State health officials appointed by Gov. John Kasich (R) say that they are acting to protect women’s safety, but Kellie Copeland of the Ohio chapter of the National Abortion Rights Action League (NARAL) told the Enquirer that the state’s motivations are ideological.

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“Governor Kasich and his political appointees at the Ohio Department of Health are abusing their regulatory authority by moving to close an abortion clinic without any medical justification,” charged Copeland.

At issue are so-called transfer agreements with local hospitals. Clinics that provide abortions are required to partner with a local hospital. While most abortions are simple outpatient procedures, sometimes there are complications and a patient must be transferred to a hospital.

Republican lawmakers made it illegal for women’s clinics to partner with hospitals that receive state money. Private hospitals, on the other hand, are reluctant to partner with women’s clinics, creating a Catch-22 in which clinics must meet requirements that they are unable to fulfill. This is one of the many ways in which state-level Republicans are attempting to make abortion illegal in the U.S. by default.

Women’s Med has been operating under a variance request as it searches for a partner hospital. On Friday, Health Department Director Theodore Wymyslo — a Kasich appointee — denied the clinic’s request to renew the variance.

A clinic spokesperson told the Enquirer that Women’s Med intends to appeal the decision by the Feb. 3 deadline. The clinic will stay open in the meantime.

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The only other women’s clinic in Cincinnati, one of the state’s most densely populated areas at 2.1 million citizens, is Planned Parenthood’s Elizabeth Campbell Surgical Center in Mount Auburn. The Planned Parenthood clinic is currently trying to receive a variance ruling of its own after losing its partnership with University of Cincinnati Academic Health System on Oct. 1 under the transfer agreement law.

If Planned Parenthood is also forced to close, it will leave the vast urban area with no abortion provider whatsoever.

Watch video of Gov. John Kasich discussing his views on abortion, embedded below: