A federal appeals court has allowed Arkansas to enforce a ban on most surgical abortions, as part of a state directive aimed at postponing medical procedures not deemed urgent during the coronavirus outbreak.

The ruling from the eighth US circuit court of appeals in St Louis, Missouri, lifted a federal judge’s order which had allowed abortions to continue. The new ruling does not affect abortion induced through medication in the early stages of pregnancy, which is still allowed.

The ruling comes two days after another federal appeals court, the fifth circuit, allowed Texas to enforce curbs on abortions via medication, as part of its response to the pandemic.

“For the health and safety of all Arkansans, state officials need to focus on protecting people from the pandemic, not using the virus as an excuse to advance their own extremist political agendas,” said Holly Dickson, legal director of the American Civil Liberties Union of Arkansas, in a statement.

The decisions are part of an effort by eight states in the south and midwest to restrict abortion, arguing it is an elective procedure and should be delayed during the Covid-19 pandemic. Mainstream doctors’ groups have opposed such restrictions, describing them as exploitative and a “government intrusion into medical care”.

“The question at the center of this is whether abortion providers use [personal protective equipment, or PPE] or hospital beds, which is a factual question,” said Mary Ziegler, a law professor at Florida State University and author of Abortion and the Law in America.

She said the anti-abortion movement had focused on “muddying the facts” and creating “uncertainty about what the reality on the ground is”.

States seeking to restrict abortion argued the need to preserve PPE for healthcare workers fighting the pandemic was paramount to women’s constitutional rights, and abortion clinics should not receive “special treatment”.

A lack of masks and gowns for frontline workers has been a defining feature of the pandemic. However, most states have allowed medical professionals to determine which surgeries and procedures can be delayed.

“It is unfortunate that elected officials in some states are exploiting this moment to ban or dramatically limit women’s reproductive health care,” said Dr Patrice A Harris, president of the American Medical Association, in a statement.

The pandemic has created new challenges for women seeking abortions. When states limit it, women are often forced to travel hundreds of miles for care. Doing so could violate some stay-at-home orders, which urge people not to travel. In other cases, states have banned doctors from providing medication to induce an abortion through online appointments.

In Arkansas, the eighth circuit ruled the lower-court judge “usurped the functions of the state government by second-guessing the state’s policy choices in responding to the Covid-19 pandemic”.

Alabama, Iowa, Louisiana, Ohio, Oklahoma and Tennessee have also worked to enact restrictions, citing the pandemic. Indiana called on clinics to stop performing abortions but did not force clinics to close. Mississippi and Kentucky are considering restrictions.

In a brief arguing against abortion restrictions in Alabama, attorneys representing the National Abortion Federation and 20 other women’s right groups said: “Covid-19 is an emergency that warrants emergency measures.

“It cannot, however, be used as pretext for attacking a constitutional right. Yet, that is exactly what Alabama’s Covid-19 executive order [does].”

Abortion has been considered a constitutional right in the US since 1973, when the supreme court ruled in the Roe v Wade case, overturning abortion bans.

Some states have sought to overturn that ruling, among them Alabama, Iowa and Ohio, which have challenged Roe v Wade by passing unconstitutional abortion bans. Those laws have not gone into effect because they are being challenged in court.

A Louisiana abortion restriction is the current subject of supreme court hearings, with a decision expected in June. If Louisiana prevails, two of its three clinics could shut down. Louisiana’s law is modeled after one passed in Texas, which shut down many of the state’s clinics, though it was later overturned.

“Providers in Alabama have every reason to fear that their reasonable medical judgments will land them in criminal jeopardy,” said the National Abortion Federation’s friend-of-the-court brief.

“For patients, delaying abortion care can have serious health consequences, and often an abortion delayed is an abortion denied.”

Abortion remains legal in all 50 US states up to the point the fetus can survive outside the womb, or roughly 24 weeks. A full-term pregnancy is 39 weeks.