Missouri’s health department has declined to renew the abortion license for the state’s lone clinic, but a court order allows the St. Louis Planned Parenthood affiliate to perform the procedure — for now.

The state notified the clinic of its decision Friday morning before a court hearing. St. Louis Circuit Judge Michael Stelzer said a preliminary injunction he previously issued to allow the clinic to continue perform abortions would remain in place for now.

Stelzer said he would issue a written order outlining next steps, but he was not sure if the order would come on Friday.

Missouri’s health department allowed the clinic’s license to perform abortions to lapse effective June 1. Rulings by Stelzer allowed the clinic to continue to perform abortions temporarily after the clinic took the state to court over the dispute.

Stelzer had told the state it couldn’t simply let the license lapse but had to renew or deny it.

“The Court does not believe that an ‘official action’ can include non-action,” Stelzer wrote in a June 10 ruling granting a preliminary injunction.

He gave the health department until Friday to decide.

According to Planned Parenthood, no state has been without a functioning abortion clinic since 1974, the year after the U.S. Supreme Court’s Roe v. Wade ruling that legalized abortion nationwide.

Health department officials have cited concerns at the clinic, including that three “failed abortions” required additional surgeries and another led to life-threatening complications for the mother, The Associated Press reported Tuesday, citing a now-sealed court filing.

Planned Parenthood leaders say top-level care is provided at the clinic, and the license fight is just part of an effort by an anti-abortion administration to eliminate the procedure in Missouri.

Missouri is among several conservative states, emboldened by new conservative justices on the Supreme Court, to pass new restrictions on abortions. Officials in those states are hopeful that federal courts will uphold laws that prohibit abortions before a fetus is viable outside the womb, the dividing line the high court set in Roe.

Republican Gov. Mike Parson signed legislation on May 24 to ban abortions at or beyond eight weeks of pregnancy, with exceptions for medical emergencies but not for rape or incest.

Planned Parenthood appeared to escalate its fight with Missouri on Thursday when it stopped performing one of two state-mandated pelvic exams for women seeking abortions. The health department requires a pelvic exam during a consultation at least 72 hours before the procedure, and a second exam at the time of the abortion.

Dr. Colleen McNicholas, an abortion provider at the clinic, said the preliminary exam is invasive and unnecessary.

The number of abortions performed in Missouri has declined every year for the past decade, reaching a low of 2,910 last year. Of those, an estimated 1,210 occurred at eight weeks or less of pregnancy, according to health department data.

In fact, more Missouri women are getting abortions in Kansas than in Missouri. Information from the state of Kansas shows that about 3,300 of the 7,000 abortions performed there last year involved Missouri residents.

Kansas has an abortion clinic in Overland Park, a Kansas City suburb just 2 miles (3 kilometers) from the state line.

The nearest clinic to St. Louis is in Granite City, Illinois, less than 10 miles (16 kilometers) away. Illinois does not track the home states of women seeking abortions so it’s unknown how many Missouri residents have been treated there.