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Republican leaders in Texas are further exacerbating the harm of the state’s raft of anti-choice regulations by stopping legal abortion amid the COVID-19 pandemic.

Texas Gov. Greg Abbott (R) and Attorney General Ken Paxton (R) ordered a halt to abortion care as part of Texas’ response to the COVID-19 outbreak; on Tuesday, conservative judges on the U.S. Fifth Circuit Court of Appeals, including President Trump appointee Judge Kyle Duncan, upheld the policy. The abortion ban, scheduled to end April 22, will push care out of reach for many, force people to seek abortion later in their pregnancy, and create onerous travel requirements that haven’t existed since before the 1973 U.S. Supreme Court ruling in Roe v. Wade.

In an analysis released this week, the Texas Policy Evaluation Project (TxPEP) said that because of the medically unnecessary 24-hour waiting period in Texas and neighboring states, “many patients seeking care out of state would have to travel 800 round-trip miles or more to attend two separate visits.” TxPEP is a collaborative group of researchers at the University of Texas at Austin who evaluate the impact of reproductive health legislation in the state.

“Some of these patients may be able to stay overnight and reduce their overall travel, but our prior research indicates that fewer than one in five patients do so,” according to the analysis on the potential effects of Abbott’s abortion ban. Lost wages, unemployment, and a lack of childcare during the COVID-19 crisis, and skyrocketing demand for abortion care at clinics in nearby states could also contribute to the myriad complications imposed by the ban.

Even before the Abbott administration banned abortion in its COVID-19 policy, almost half of the state’s 254 counties were more than 100 miles away from the nearest abortion-providing U.S. clinic, according to TxPEP. Under the ban, people in nearly every Texas county will be more than 100 miles away from a U.S. abortion care provider, resulting in many pregnant people in the state being pushed beyond the gestational limit for medication abortion (viable for the first ten weeks of pregnancy), TxPEP researchers wrote.

In a survey conducted by TxPEP, 88 percent of people seeking abortion care “were eligible for medication abortion at the time of their initial consultation and ultrasound visit.” Less than half of those patients would still be able to undergo medication abortion if Texas’ ban lasts until April 22, and hardly any of these patients would still be eligible for medication abortion if clinic wait times increase in the weeks after the abortion ban is lifted.

Alexis McGill Johnson, acting president and CEO of Planned Parenthood Federation of America, emphasized that abortion care is “essential health care, and it is urgent and time-sensitive.”

“How heartless do you have to be to, in a time of crisis, take extraordinary measures to take away people’s health care?” McGill Johnson said in a statement. “While people everywhere are trying to survive the COVID-19 pandemic, politicians like Gov. Abbott continue this perverse obsession with banning abortion. Those who are caring for their families, forced to work essential jobs, and doing what they can to stay healthy need access to health care right now.”

TxPEP researchers wrote that 35 percent of people seeking abortion care in the first trimester “would need second trimester abortion care” after a four-week delay, noting “the risk of complications increases later in pregnancy.” Fewer facilities in Texas offer services for second-trimester abortions, which are usually more expensive than first-trimester abortions.

Texas’ legal arguments for its abortion ban are flimsy in the most generous reading, Imani Gandy, senior legal analyst, wrote for Rewire.News. For weeks, anti-choice activists and lawmakers have looked for ways to restrict or end abortion access by exploiting the COVID-19 outbreak. Anti-choice activists have falsely claimed abortion clinics hoard personal protective equipment needed by hospitals facing an influx of COVID-19 patients, while encouraging lawmakers to deem abortion as a “nonessential” health-care service that should be banned during the COVID-19 response.

“While many physicians and health-care workers are on the front lines in the COVID-19 pandemic, it is unfortunate that elected officials in some states are exploiting this moment to ban or dramatically limit women’s reproductive health care, labeling procedures as ‘non-urgent,'” Dr. Patricia Harris, president of the American Medical Association, said in a statement.

Kamyon Conner, executive director of the Texas Equal Access Fund (TEA Fund), which provides financial assistance to people who need help paying for abortion care in northern Texas, said the organization is “hearing from Texans on our helpline every single day asking how they can access the abortion care they want and need during this time of crisis, meanwhile our shameful state leaders continue to play politics with their lives.”

“The COVID-19 pandemic is compounding the barriers to care that Texans already face,” Conner said in a statement. “During this crisis, our elected officials should be working to expand access to health care by lifting the 24 hour waiting period between abortion appointments and allowing for telemedicine for medication abortion so that people can get the care they need in the safety of their homes. Let’s be clear: all pregnancy-related care is essential and time-sensitive, including abortion care.”