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Medical assistant Nyla Munoz begins a sonogram exam on the Whole Women's Health Clinic's last day of seeing patients, in McAllen, Texas, March 4, 2014. Abortion clinics in McAllen and Beaumont are closing in large part because their doctors could not obtain admission privileges at a hospital within 30 miles as required by regulations passed by the state's Republican-controlled Legislature.

JENNIFER WHITNEY/NYT

In an inconspicuous brown-brick strip mall in northwest San Antonio – neighbouring a hair salon, a bible counselling centre and a parking lot infested with feral cats – sits the Alamo Women's Clinic, one of San Antonio's three abortion clinics.

Last week, the Alamo Women's Clinic was, by virtue of a federal court decision, handed an odd geographical designation. It may soon become the westernmost abortion clinic in Texas – a state that stretches another 800 kilometres past San Antonio toward the Pacific. In one fell swoop, every clinic in between may be forced to close its doors.

A federal court last week upheld parts of a Texas law that imposes some of the most severe restrictions on abortion anywhere in the United States. Among the provisions of the law are requirements for abortion clinics to have many of the same ventilation and infrastructure standards as hospital-grade surgical centres – a burden that many smaller clinics cannot afford to meet.

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As a result, about 13 of the state's remaining abortion clinics are expected to close, leaving Texas (population 27 million) with just six. When the law, known as House Bill 2, first passed in 2013, there were more than 40 clinics in the state.

Using myriad new laws that enshrine restrictions and burdens such as mandatory waiting periods and multiple-visit requirements, legislators in several states are succeeding in slowly regulating abortion out of existence. "Texas is emblematic of what's happening across the country," says Elizabeth Nash, senior state issues associate at the the Guttmacher Institute, which studies and advocates for sexual and reproductive health.

Proponents of the law, including various anti-abortion groups and politicians in the solidly Republican state, have tried to frame the legislation as a measure intended to improve women's health and safety. In addition to making abortion clinics maintain more advanced surgical standards, the law also requires doctors performing abortions at the clinics to have admitting privileges at hospitals no more than 50 kilometres away.

Charmaine Yoest, president of the anti-abortion group Americans United for Life, called the federal court's ruling a victory for women, framing it as part of an effort by like-minded organizations "to ensure that American women are no longer victimized by a profit-centred abortion industry."

However, critics say the argument that the new rules are intended to improve women's safety, rather than subject abortion services to death by a thousand regulatory cuts, is profoundly disingenuous. "It's a complete farce," says Heather Busby, executive director of Pro-Choice Texas. "They made it very clear what their true intent is."

Following the Texas law's initial implementation, Ibis Reproductive Health, a research organization, conducted interviews with some 20 women who had been scheduled or were trying to use services in clinics that were forced to shut down by the law. The survey found that, disproportionately, the closings affected poorer women who were unable to get time off from their jobs or arrange transportation to far-away clinics.

The closings also caused delays for some women, moving their abortions into the second trimester, where there is a relatively higher chance of complications. Some women reported that they were ultimately unable to get an abortion.

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"There is no evidence that [the Texas abortion law] improved the safety of these procedures," says Daniel Grossman, vice-president for research at Ibis. "These procedures are already very, very safe."

Barring a stay, the federal court ruling is expected to take effect in 20 days. However it is almost certain that the issue will be appealed to the Supreme Court. That sets the stage for a landmark decision on the extent to which states such as Texas, Missouri and Virginia, among others, can impose restrictions on abortion without violating fundamental rights.

Much of the federal court's ruling – and the central issue that the Supreme Court will almost certainly have to consider – centres on whether myriad restrictions on abortion constitute an "undue burden" on women trying to receive the services. For example, in its reasoning, the federal court decided that women living in El Paso, on the western edge of Texas, were not subjected to an undue burden by the potential closing of clinics between their city and the clinics in San Antonio, because they can cross state lines and use services in New Mexico to the west.

"The Supreme Court will be the ultimate arbiter of this," says Ms. Nash of the Guttmacher Institute. "We're expecting the court will be hearing these cases very soon."

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