In a stunning move, the U.S. Supreme Court allowed a sweeping law to take effect in Texas last week that eradicates nearly all abortion care in the second-largest state in the country.

Senate Bill 8, signed into law by Republican Gov. Greg Abbott in May, bars abortion once an ultrasound picks up cardiac activity, which is typically around six weeks. This amounts to a near-total ban: Many women are not aware they are pregnant that early.

At least a dozen other states have enacted so-called heartbeat bills that have been halted by the courts, but the Texas version is particularly insidious. It applies not just to abortion providers, but also anyone who “aids or abets” care, which could include rape crisis counselors or a friend who drives a patient to the clinic. And in order to smuggle it past the Supreme Court, it devolves enforcement to private citizens, offering them bounties for successful lawsuits.

This sweeping piece of legislation didn’t come out of nowhere. It is the latest barrier in a dizzying maze of logistical and financial obstacles to women’s health care that cemented Texas as not only one of the most difficult states in which to get an abortion, but also one of the most dangerous in which to carry a child.

For years now, the state has suffered from a maternal mortality crisis. The United States holds the highest maternal death rate in the developed world. But Texas’ maternal mortality rate is above even the U.S. average, at 18.5 deaths per 100,000 live births. Black women in Texas are disproportionately affected, accounting for 11 percent of live births but 31 percent of maternal deaths.

In 2016, a state committee composed of maternal health experts reported that roughly one-third of pregnancy-related deaths in the state occurred 43 days to a year after the end of pregnancy. Nearly 90 percent of such deaths were preventable, the committee found. Its primary recommendation was simple: Extend Medicaid coverage postpartum for low-income mothers to one year; Texas has historically removed them from Medicaid after 60 days.

Given the availability of a concrete and straightforward solution, one might think Texas’ ostensibly pro-life Republicans would have been compelled to act swiftly. But it was not until this May that they took any substantial action. The Texas House passed a Democrat-authored measure that would have extended coverage after childbirth to 12 months. However, the ultraconservative Senate inexplicably amended it to cut coverage to just six months.

Republican lawmakers have also thwarted efforts to expand Medicaid, despite the fact Texas has the highest rate of uninsured residents, along with the highest rate of uninsured women of childbearing age, in the country.

Rather than addressing maternal mortality, Texas lawmakers have instead spent years decimating access to basic preventive health care. Those who suffer most from Texas’ reproductive health policies are its most vulnerable — low-income, rural, undocumented women and women of color, who already face the steepest barriers to health care.