Tennesseans will again have to wait 48 hours before getting an abortion. That waiting period had been reinstated in April while a challenge to the law was being appealed. But Thursday, the Sixth Circuit Court ruled the law is constitutional, reversing a district court decision.

In its opinion, the court wrote that it is wise to take time for reflection before making a decision and noted that there has not been a big drop in abortions as predicted when the law passed in 2015.

“For five years, the law remained in force,” the opinion reads. “And for five years, women continued to obtain abortions in Tennessee: Abortion rates remained above 10,000 per year both before and after passage of the law.”

Tennessee Attorney General Herbert Slatery applauded the ruling. He says the waiting period is not a substantial obstacle preventing abortions.

Critics say the law will make abortion harder to access — many patients who seek abortions are considered low income, and face barriers like the cost of travel or finding child care.

Many states have some kind of waiting period before abortions can be performed, though according to the Guttmacher Institute they’re more often 24 hours. But last fall, a federal district court struck down the waiting period, and for several months it could not be enforced. The law was reinstated in April while the case was being appealed.