The US state of Missouri was left on Wednesday with one abortion clinic for its population of six million, after a new state rule effectively barred another clinic from performing the procedure.
The Midwestern state is requiring abortion clinic physicians to have admitting privileges at a hospital. Officials say the rule is aimed at patient safety.
But a Planned Parenthood clinic in the city of Columbia could not meet the requirement and its licence to perform abortions expired, The Kansas City Star reported.
Opponents of hospital affiliation rules say clinics often can't meet such a standard, because abortions are generally safe and their doctors don't hospitalise enough patients to qualify for affiliation, according to Kaiser Health News.
The Columbia clinic has asked a federal judge for a temporary exemption from the Missouri rule, but the judge has not yet ruled, The Star said.
In the meantime, women seeking abortion were being directed to another provider in St Louis, 190km away, or to providers in neighbouring states, US media reported.
The US Supreme Court in 2016 struck down a similar hospital-affiliation rule in Texas, saying in a 5-3 decision that the regulation was too burdensome, and "a substantial obstacle to women seeking abortions".
But a federal appeals court last month allowed Missouri's requirement to take effect.
About two dozen states led by conservative politicians have passed numerous measures to set limits on abortions, according to the pro-abortion rights Guttmacher Institute.
The state of Iowa earlier this year passed the most restrictive abortion limit in the country. The so-called "heartbeat" rule banned abortions if a fetal heartbeat is detected.
A federal judge blocked the law while a lawsuit proceeds.
US President Donald Trump's administration has also proposed cutting federal funding to hundreds of US clinics that offer abortions.
Stipulations approved in Washington in May last year deny US aid to organisations which provide abortion information, referrals, or services – even with their own money.
This includes grants from PEPFAR, the programme set up under former US president George W Bush in 2003 and now a major funder of HIV testing, counselling and treatment worldwide.
- FOLLOW News24 on Twitter