A federal appeals court ruling today effectively closed thirteen abortion clinics in Texas with a ruling Thursday, leaving only five clinics to serve the state's 5 million reproductive-aged women.

A three-judge panel in the Fifth Circuit Court of Appeals voted to uphold a restrictive Texas law that would require abortion clinics to pay for millions of dollars in hospital-style upgrades to remain in operation.

According to the AP, the ruling—which took immediate effect Thursday—will have a major effect on the state.

The impact of the ruling will be most felt along the Texas-Mexico border and in the western half of the state, where access to a legal abortion is especially limited. The only abortion clinic in McAllen, which reopened after the lower court's ruling, now stands to close again. That would leave women in the area facing a 300-mile drive to the next-nearest abortion facility.

The only clinics remaining in Texas are in Houston, Austin, San Antonio and Dallas, according to the AP.

The decision, which could only be temporary, reversed a lower court judge who had ruled that the restrictions were more focused on restricting access to abortions than patient safety.

[image via AP]