An Iowa judge has ruled the state’s strict abortion law will take effect Monday, banning most abortions after about six weeks of pregnancy, before many women know they are pregnant.

The law passed last year, but a judge had blocked it from being enforced. The Iowa Supreme Court reiterated in June that there is no constitutional right to an abortion in the state and ordered the hold to be lifted. That translated into Monday’s district court judge’s decision ordering the law to into effect next Monday at 8 a.m. Central time.

Lawyers representing abortion providers asked Judge Jeffrey Farrell for notice before allowing the law to take hold, saying a buffer period was needed to provide continuity of services. Iowa requires pregnant women to wait 24 hours for an abortion after getting an initial consultation. Abortion had been legal in the state up to 20 weeks of pregnancy.

The high court’s order gave a decisive win to Iowa’s Republican leaders after years of legislative and legal battles.

Iowa will join more than a dozen states where abortion access has been sharply curbed in the two years since the U.S. Supreme Court overturned Roe vs. Wade. Currently, 14 states have near-total bans at all stages of pregnancy and three states — Iowa will make four — ban abortions after about six weeks of pregnancy.

Abortion access stands to be a major issue in the 2024 election, especially as Vice President Kamala Harris aims to lead the Democratic Party. Harris has said “everything is at stake” with reproductive health in November’s election and has traveled across the country to draw attention to the issue, including in Des Moines roughly a year ago after the stricter law was initially passed.

Iowa’s Republican-controlled Legislature passed the law in a special session last July, and a legal challenge was immediately filed by the American Civil Liberties Union of Iowa, Planned Parenthood North Central States and the Emma Goldman Clinic. The law was in effect for just a few days before a district court judge temporarily blocked it.

“Today is a victory for life,” Republican Gov. Kim Reynolds said in a statement Tuesday.

There are limited circumstances under the Iowa law that would allow for abortion after six weeks of pregnancy: rape, if reported to law enforcement or a health provider within 45 days; incest, if reported within 145 days; if the fetus has an abnormality “incompatible with life”; or if the pregnancy endangers the mother’s life.

The state’s medical board defined standards of practice earlier this year, though the rules do not outline how the board would determine noncompliance or what the appropriate disciplinary action might be.

Representatives from Planned Parenthood and the Emma Goldman Clinic have indicated they will continue to provide abortion services in Iowa in compliance with the law when it takes effect.

In June, Ruth Richardson, president and chief executive of Planned Parenthood North Central States, also said the organization has spent the last year making “long-term regional investments” in preparation for this outcome, including expanding facilities in Mankato, Minn., and Omaha — both cities near Iowa.

Planned Parenthood in Iowa has ceased abortion services in two Iowa cities in the last year, including in Des Moines. Two of the state’s five Planned Parenthood clinics offer in-person abortion services, and three offer abortion through medication.

People in and around Des Moines seeking an abortion have been traveling about 35 miles north to Ames.

Alex Sharp, who manages the Ames facility, said conversations with patients will be difficult once the ban lifts and staff will be empathetic. There is “the sensitivity of being told you’re too far along and it’s too late now: ‘You have to, you know, leave and go somewhere else and you have to travel and you’re going to have to miss work again.’”

“A lot of people don’t know this happened,” Sharp said of the stricter law.

The facilities that provide abortions had been offering additional appointments in June ahead of the Iowa Supreme Court’s decision, and appointments throughout July have been completely booked, Sharp said.

“It’s entirely possible that they’re over six weeks, but we’ll scan them,” she said of people that have appointments scheduled for after the block is lifted.

Sarah Traxler, the Planned Parenthood region’s medical director, said a law like Iowa’s prohibiting abortions after cardiac activity can be detected — usually but not always at about six weeks — is “tricky.”

Since six weeks is approximate, Traxler said, “we don’t necessarily have plans to cut people off at a certain gestational age.”

The U.S. Centers for Disease Control and Prevention found that 44% of the 3,761 total abortions in Iowa in 2021 occurred at or before six weeks. Only six abortions were at the 21-week mark or later.

In other states with bans that kick in around six weeks into pregnancy, the number of abortions has fallen by about half.

In its 4-3 opinion last month, Iowa Supreme Court’s majority determined that abortion laws in Iowa are to be judged by whether the government has a legitimate interest in restricting the procedure, rather than whether there is too heavy a burden for people seeking abortion access.

The decision was celebrated by Iowa’s conservative leaders, who have advocated for decades against access to abortion. Chuck Hurley, vice president of the conservative Christian organization Family Leader, said “bad judges for over 51 years” allowed access to abortion in Iowa.

While Hurley celebrated the victory and the “great strides in protecting the most innocent among us,” he alluded to work still to be done.

“Fourteen states now protect babies from the moment of conception,” he said, “and Iowa should be the 15th.”

Fingerhut writes for the Associated Press. AP reporter Geoff Mulvihill in Cherry Hill, N.J., contributed to this report.