In Louisiana, women seeking abortions must receive an ultrasound. They must visit a clinic at least twice — once for counseling about the abortion, and then again for the procedure itself, which cannot take place until 24 hours have passed since their first visit. And if they wait more than 22 weeks after their last periods before getting their abortions, they can’t get abortions in Louisiana at all.

Louisiana is currently neck-and-neck with Mississippi for the title of being the most restrictive state in the nation when it comes to abortion, according to the Guttmacher Institute, which tracks and supports abortion rights. Now, lawyers are trying to stop the state from adding even more restrictions by putting every single anti-abortion measure passed by Louisiana lawmakers in 2016 on trial.

In an unusual legal maneuver, the lawsuit against Louisiana doesn’t just challenge each measure’s individual impact on women’s ability to access an abortion. Instead, it argues that all seven restrictions “by themselves and together impose unconstitutional restrictions on the right to abortion,” said Zoe Levine, an attorney for the Center for Reproductive Rights, which brought the case on behalf of one of Louisiana’s last three abortion clinics.

No recent lawsuit against abortion restrictions has challenged so many laws in one case, and that cumulative approach more closely mirrors the actual experiences of Louisiana women seeking abortions, who must grapple with all of the restrictions at once.

On Friday, the lawyers went to court to get it started. Overall, the lawsuit — filed on behalf of one of Louisiana’s last three abortion clinics — seeks to roll back seven abortion restrictions, including:

  • Banning “dilation and evacuation” procedures, which are generally seen as the safest way to perform second-trimester abortions
  • Requiring fetal remains from abortions to be given burial rites
  • Criminalizing “knowingly and for money” buying, selling, or transporting fetal tissue from abortions for medical research, even if that tissue is donated
  • Mandating that abortion providers give women seeking abortions an “informational document” about “fetal genetic abnormalities” and “children born with disabilities” — and banning any woman whose fetus has been diagnosed with a potential “genetic abnormality” from getting an abortions 20 weeks after the fetus was fertilized
  • Extending the time between a woman must wait between her first trip to an abortion clinic and her actual abortion from 24 hours to 72 (with some exceptions)
  • Requiring that the only physicians who can provide abortions are trainee residents, OB-GYNs or family medicine doctors
  • Prohibiting all state or local government agencies from contracting with groups that perform abortions, or even any third-party entities that perform abortions, with some exceptions

“If you had to pick a handful of restrictions that have been trends in recent years, these are what you would pick,” explained Elizabeth Nash, a policy analyst for the Guttmacher Institute, adding that the ban on dilation and evacuation abortions and the extending women’s waiting period have been particularly popular. “If these restrictions all get struck down, that could be useful for other states challenging their own restrictions.”

Louisiana officials are arguing the abortion clinic failed to prove sufficient harm would be caused by the laws, and asked U.S. District Judge Brian Watson to dismiss most of the lawsuit’s claims on Friday.

“Louisiana really never gives up, and they’re always sort of among the leaders of the pack in terms of finding ways to restrict women’s access to abortion,” said Zoe Levine, an attorney for the Center for Reproductive Rights, which brought the case on behalf of one of Louisiana’s last three abortion clinics. (A second abortion clinic was also involved in the lawsuit, until it shut down.) “This is not, by any means, the first time that we’ve had to go to court to try to fight back against restrictions that the Louisiana legislature has passed.”

Right now, an agreement between the state and the plaintiffs is keeping the new restrictions from going into effect.

Legislation around the handling of fetal tissue drew national scrutiny after a series of videos purporting to show that Planned Parenthood employees illegally sold fetal remains for profit were leaked in 2015, though later investigations found no evidence to support that claim.

But more than 45 states saw lawmakers introduce bills this session to restrict fetal tissue donation and research, according to the Guttmacher Institute. So far this year, only Wyoming has passed such a measure.

Then there’s Louisiana’s attempt to stop government agencies from contracting with abortion providers, which essentially amounts to “defunding Planned Parenthood,” anti-abortion advocates say. Louisiana’s version of law, however, goes much further than many states’ attempts to strip Planned Parenthood of funds — those merely sought to cut Planned Parenthood out of Medicaid family planning programs.

In court documents, lawyers for the Louisiana abortion clinic argue that this law alone could shut down all abortion providers in Louisiana, since so few businesses would want to risk losing state funds. U.S. District Judge Brian Jackson appeared to acknowledge far-reaching consequences in court on Friday, when he asked an attorney with the Louisiana attorney general’s office if the law could, say, even stop an office supply company from letting an abortion clinic use its copy paper.

When the attorney told Jackson that the state didn’t interpret the law to apply to “basic services,” Jackson pointed out, “That’s not what the statute said.”

But even without considering its larger implications, the case’s stakes are already high for abortion rights advocates: If it fails, it’s unclear what exactly will happen to the agreement not to enforce these seven restrictions — but Louisiana could finally become the state with the most restrictions on abortion.

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