NASHVILLE (AP) — A federal judge who earlier this year struck down Tennessee's 48-hour waiting period for abortions as unconstitutional has ruled against the state again. U.S. District Judge Bernard Friedman refused on Monday to put his earlier order on hold while the state appeals to the 6th U.S. Circuit Court of Appeals.

Freidman ruled in October that Tennessee's waiting period law serves no legitimate purpose while placing a substantial burden on women who seek abortions in Tennessee. The 2015 law required women to make two trips to an abortion clinic, first for mandatory counseling and then for the abortion at least 48 hours later.

Directors of Tennessee abortion clinics testified during the 2019 trial that the waiting period posed logistical challenges for patients and clinics that could actually delay abortions by weeks. At times, women were no longer eligible for medication abortions because their pregnancies were too far along and they had to get surgical abortions instead, which have greater risks of complications. A few women were pushed beyond the time when they could receive an abortion altogether.

A motion filed last month by state Attorney General Herbert Slatery in the U.S. District Court in Nashville asked Friedman to keep the law in place during the appeal. It argued that Friedman should have weighed the benefits of the restriction against the burdens it places on patients.

In his opinion Monday, Friedman stated that the outcome would have been the same. "With or without such a balancing test, the Tennessee statute constitutes a 'substantial obstacle to a woman seeking an abortion' and, thus, an undue burden," he wrote.

Tennessee also argued that the statute is not a burden for a "large fraction" of the people it affects.

"This is incorrect," Friedman wrote, noting that he found in his October ruling that the restriction "'burdens the majority of abortion patients with significant, and often insurmountable, logistical and financial hurdles.'"

Before the law was struck down, Tennessee was one of 13 states that required in-person counseling and then a waiting period before a woman could get an abortion, necessitating two separate trips to the facility, according to the Guttmacher Institute, a research group that supports abortion rights.