The ruling this week by the US 5th Circuit Court of Appeals came down like a ton of bricks onAmerica’s long-running abortion debate: As the court upheld a controversial new Texas law, up to a dozen women’s health care centers immediately began turning away women seeking abortions.

Those optics alone, never mind the underlying legal complexity, instantly cemented Texas as America’s next abortion battlefield, even as four other states in the Midwest and South seek to join the Lone Star State in raising medical standards for abortion providers at least in part to curb abortions.

While those four other states have been told to stay their laws until adjudicated, the decision by the appeals court in New Orleans changes the dynamics of the debate as it allows the Texas law to go into effect despite its immediate impact on abortion availability.

The new law requires that abortion doctors have admitting privileges to local hospitals, and that, starting in the fall of 2014, abortions are done in certified surgical facilities. 

Because of its immediate and widespread impact, reproductive rights experts believe the case is headed straight for the US Supreme Court, which ruled in 1973 that American women have a right to abortions.

That essential right hasn’t stopped state legislatures from tackling the issue from other directions. Many of those efforts over the years have since morphed into the current anti-abortion tack: That states should have the right to regulate the safety of women seeking abortions.

Elizabeth Nash, a policy analyst with the Guttmacher Institute, which advocates for women’s health rights, called the 5th Circuit’s ruling “a huge sea change” because it allows the law to take effect and become entrenched, according to USA Today.

Long part of America’s culture wars, the abortion debate has ratcheted up this decade, with 30 states passing over 200 abortion restrictions in the last three years alone. So far, anti-abortion forces have had the most success with laws like the one in Texas. The US has seen approximately 57 million abortions since the Roe v. Wade decision.

Undercover video investigations of Planned Parenthood by antiabortion amateur journalists have helped shift the debate toward more restrictions, as did the recent guilty verdict in the murder trial of abortion doctor Kermit Gosnell of Philadelphia.

The surprising ruling on the new Texas law, which was announced late Thursday, came after US District Court Judge Lee Yeakel previously ruled that the law serves no medical purpose other than to raise undue obstacles for women.

The 5th Circuit’s rebuff of Judge Yeakel’s ruling “is a vindication of the careful deliberation by theTexas Legislature to craft a law to protect the health and safety of Texas women,” suggested Texas Attorney General Greg Abbott.

Meanwhile, about a third of the state’s 36 clinics began turning women away on Friday. The fear among abortion rights advocates is that especially poorer women in rural areas won’t have the resources to travel and find lodging near still-operating clinics. Some 20,000 women could be affected, abortion rights advocates said.

“This law affects real people, real lives and real families,” said Amy Hagstrom Miller, president of Whole Woman’s Health in McAllen, Fort Worth, and San Antonio, in a statement.

All three of Ms. Hagstrom Miller’s clinics began turning abortion-seekers away on Friday.

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