The Iowa Supreme Court ruled Friday to uphold the state’s abortion ban, which prohibits most abortions in the state as early as six weeks into pregnancy.

The ruling will dramatically restrict abortions in Iowa, where women were able to seek the procedure for up to 22 weeks as legal challenges played out against the six-week ban.

The ban will prohibit physicians from providing most abortions after early cardiac activity can be detected in a fetus or embryo, commonly as early as six weeks into pregnancy, before many women know they are pregnant. It includes exceptions for miscarriages, when the life of the pregnant woman is threatened and fetal abnormalities that would result in the infant’s death. Exceptions will also be made for pregnancies resulting from rapes reported within 45 days and incest reported within 140 days.

The case is part of the larger political fallout around the issue of abortion since the US Supreme Court overturned federal abortion rights in June 2022. The high court ruling allowed abortion rights to be determined by state governments. Several bans were quickly met with challenges from abortion rights groups, and many are still being litigated, including in Utah, Ohio and Wyoming. And on Thursday, the Supreme Court blocked the enforcement of Idaho’s strict abortion law.

Iowa Republican Gov. Kim Reynolds celebrated the ruling Friday, saying she is glad the state’s high court “upheld the will of the people.”

“As the heartbeat bill finally becomes law, we are deeply committed to supporting women in planning for motherhood, and promoting fatherhood and its importance in parenting,” Reynolds said in a statement, vowing to protect in vitro fertilization, which has become another flashpoint in the post-Roe abortion landscape.

The Iowa ban was passed in July 2023 during a special legislative session called solely to pass abortion restrictions, after the state Supreme Court declined to lift a block on a similar 2018 bill. The 2023 ban immediately faced challenges from the local Planned Parenthood and American Civil Liberties Union chapters, along with other reproductive rights advocates. A state district court temporarily blocked the measure three days after it went into effect.

Attorneys for the state argued in a brief that Iowa’s constitution “does not recognize a fundamental right to an abortion” and as a result, the abortion ban doesn’t “implicate a fundamental right.” Thus, they claimed that the court must only establish whether the legislation has a “rational basis.”

Reproductive rights advocates said that a law that restricts abortions as early as six weeks into pregnancy will prevent most Iowans from accessing an abortion as many people do not know they are pregnant at that point.

Even if some women determine they are pregnant before six weeks, they will face “substantial logistical and financial obstacles in arranging to have an abortion in Iowa before their time runs out,” attorneys for Planned Parenthood and the ACLU local chapter argued in a brief.

With the ruling, Iowa joins nearly two dozen states that have banned or limited access to abortion. Florida, Georgia and South Carolina have similar six-week restrictions in place.

This story has been updated with additional details.