An Indiana judge on Wednesday has ruled against abortion providers seeking to challenge the state’s near-total abortion ban.

The ruling, handed down by Monroe County Circuit Court Judge Kelsey Blake Hanlon, denies efforts by the providers, including Planned Parenthood, who sought a permanent injunction to expand medical exceptions within the ban and remove restrictions limiting abortion procedures to hospitals.

Following the U.S. Supreme Court’s 2022 decision to overturn Roe v. Wade, Indiana outlawed abortions except when the mother’s life or health is in jeopardy, or in instances of rape, incest and deadly fetal anomalies under limited circumstances. The law, enacted in August 2022, makes Indiana one of the most restrictive states in the U.S. regarding access to the women’s health care procedure.

In her decision on Wednesday, Hanlon, who conducted a three-day bench trial in late May, denied the providers’ request for the permanent injunction against both elements of the state law, known as S.B. 1, stating that while the court considered evidence on the impact of the law, it could not substitute the legislature’s decision-making. Hanlon, a Republican appointed to oversee the case, emphasized that the Indiana General Assembly holds the authority to shape policy on the matter.

“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,” Hanlon wrote.

The case comes after the state’s Supreme Court upheld the ban in June 2023, but maintained that the Indiana Constitution still safeguards a woman’s right to terminate a pregnancy if her life or health is at risk.

But abortion providers argue that the language in the law is so vague that many doctors are hesitant to perform abortions, even in cases that technically qualify under the exemptions.

While Hanlon, in her 50-page order, acknowledged the difficulties posed by the law’s language—particularly for doctors operating under the threat of criminal liability—and recognized that the “politically charged environment” creates challenges, she ultimately sided with the state’s argument. She said that providers did not identify a situation where the health and life exemption or the hospital requirement prevented a woman from obtaining an abortion.

Newsweek has reached out to Planned Parenthood Federation of America via email for comment on Wednesday.

The ruling also upheld the requirement that all abortions be performed in hospitals, rejecting the providers’ plea to allow outpatient clinics to offer the procedure, stating that hospitals are better equipped to manage cases involving serious health risks, fetal anomalies and cases of rape or incest.

“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,” Hanlon wrote.

In response to the ruling, Planned Parenthood Federation of America warned 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,” adding that they “are still evaluating all options” on whether or not they will appeal the ruling.

“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 decision, calling the state’s abortion law both “reasonable and constitutional.”

Abortion has been a key issue for the Republican and Democratic campaigns as former President Donald Trump and Vice President Kamala Harris vie for the presidency.

Since the Supreme Court overturned Roe, many Republican-controlled states have enacted abortion restrictions, with 21 states banning or restricting the medical practice at every stage of pregnancy.

This article includes reporting by the Associated Press.