INDIANAPOLIS (AP) — An Indiana county judge ruled Wednesday against abortion providers who are seeking to broaden access to the procedure under the near-total ban state lawmakers passed after the U.S. Supreme Court ended federal protections in 2022.

The providers — including the regional Planned Parenthood affiliate — had sought a permanent injunction to expand the near-total ban’s medical exemptions and to block its requirement that abortions can only be performed at hospitals.

Judge Kelsey Blake Hanlon, who conducted a three-day bench trial in late May in southern Indiana’s Monroe County, denied the providers’ request for the permanent injunction against both elements of the state’s law, known as S.B. 1.

“Significant and compelling evidence regarding the policy implications of S.B. 1 and its effect on medical professionals in particular was presented. However, the Court cannot substitute its own policy preferences for that of the Indiana General Assembly,” wrote Hanlon, an elected Republican from a different county who was appointed as a special judge in the case.

Indiana became the first state to enact tighter restrictions after the U.S. Supreme Court ended federal abortion protections by overturning Roe v. Wade in June 2022. Rare exceptions to the near-total ban include when the health or life of the mother is at risk as well as in cases of rape, incest and lethal fetal anomalies in limited circumstances.

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The Indiana Supreme Court upheld the state’s ban in June 2023, ending a broader legal challenge brought by the same plaintiffs, but said the state’s constitution protects a women’s right to an abortion when her life or health is at risk.

Indiana’s clinics stopped providing abortions ahead of the ban officially taking effect in August 2023.

The providers said that the ban’s exceptions for protecting health are written so narrowly that in practice, many doctors won’t end a pregnancy even when a woman’s condition qualifies under the statute. The state defended the statute and said it sufficiently protects women when health complications arise in pregnancy.

When asked Wednesday if they plan to appeal the ruling, the plaintiffs said they “are still evaluating all options.”

The Planned Parenthood Federation of America said in a joint statement with the ACLU of Indiana and other plaintiffs that the court’s ruling means “lives will continue to be endangered by Indiana’s abortion ban.”

“Already, Hoosiers with serious health complications have been forced to endure unjustifiable suffering due to miscarriages, ectopic pregnancies, and other pregnancy-related issues or leave the state to access appropriate care,” the statement said.

Indiana Attorney General Todd Rokita praised the judge’s ruling Wednesday. “Indiana’s pro-life law is both reasonable and constitutional, and we’re pleased the Monroe County Circuit Court upheld it,” he said in a statement.

Planned Parenthood and the ACLU of Indiana did not immediately respond Wednesday to requests for comment on the ruling.

In a 50-page order, Hanlon said providers gave hypothetical scenarios but did not identify a situation where the health and life exemption or the hospital requirement prevented a woman from obtaining an abortion.

Hanlon agreed with the state’s argument that the health and life exemption constitutionally protects pregnant patients with “serious health risks,” but acknowledged the ill-defined standard has been challenging for physicians in a “politically charged environment” and under the threat of criminal liability. However, Hanlon said physicians do not have to wait until a woman is “clinically unstable to provide care.”

She wrote that some conditions outlined by the providers can be treated with interventions other than abortion depending on the severity of the health risk, such as medication, therapy and nutritional changes. She also rejected the argument from the providers that mental health conditions constitute serious health risks.

In rejecting the providers’ request to strike the hospital requirement, Hanlon said hospitals are better equipped to handle lethal fetal anomaly, rape, incest and serious health risks.

“The evidence demonstrates that many women receiving abortion care when they are seriously ill or at risk of becoming seriously ill will likely be receiving in-hospital care irrespective of the hospital requirement,” she wrote.

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Volmert reported from Lansing, Michigan.