The Texas Supreme Court on Friday rejected a challenge to one of the most restrictive abortion bans in the U.S. following a lawsuit by women who had serious pregnancy complications.

The ruling from the court, whose nine justices are all elected Republicans, is the latest decision to uphold Texas’ abortion ban, which critics say does not offer enough clarity over when exceptions are allowed.

“Texas law permits a life-saving abortion,” the court wrote in the order signed by Republican Justice Jane Bland.

Last summer, state District Judge Jessica Mangrum had granted a temporary injunction preventing Texas from enforcing the ban against doctors who in their “good faith judgment” ended a pregnancy that they determined was unsafe because of complications. But that was immediately blocked by an appeal from the Texas attorney general’s office to the state’s Supreme Court.

The lawsuit filed in March 2023 didn’t seek to repeal Texas’ abortion ban, but instead aimed to force more clarity on when exceptions are allowed.

It argued that exemptions under the law, which allow an abortion to save a mother’s life or prevent the impairment of a major bodily function, are written too vaguely and create confusion among doctors, who were turning away some pregnant women experiencing health complications because they feared repercussions.

The plaintiffs said the abortion ban has made medical professionals wary of facing liability if the state does not consider the situation a medical emergency.

But the Texas Supreme Court also declined to offer clarity on the exemptions late last year after Kate Cox, a mother of two from Dallas, sued the state for the right to obtain an abortion after her fetus developed a fatal condition and she made multiple trips to an emergency room. Cox ended up leaving the state for an abortion before the court ruled that she hadn’t shown her life was in danger. The court called on the state medical board to offer more guidance.

The medical board’s proposed guidelines, unveiled earlier this year, offered little beyond advising doctors to meticulously document their decision-making. And Texas’ Republican-led Legislature is not expected to make any changes to the law’s language.

The lead plaintiff in the case, Amanda Zurawski, had been told that she had a condition that meant her baby would not survive. But the Austin woman was forced to wait until she was diagnosed with a life-threatening case of sepsis before being provided an abortion. Zurawski spent three days in intensive care and was left with a permanently closed fallopian tube from the infection, which affects her ability to have more children.

Under the law in Texas, doctors who perform abortions risk life in prison, fines of up to $100,000 and revocation of their state medical licenses. Opponents say that has left some women with providers who are unwilling to even discuss terminating a pregnancy.

Most Republican-controlled states have started enforcing new bans or restrictions on abortion since the U.S. Supreme Court in 2022 overturned Roe v. Wade, which for nearly 50 years had affirmed the constitutional right to an abortion.