The Nebraska Supreme Court on Friday upheld laws restricting both abortion access after 12 weeks and transgender medicine for minors following a challenge that the measure violated the state’s constitutional obligation that all bills must stick to a single subject.

The state Supreme Court said that abortion and transgender medicine are “distinct types of medical care,” but the law combining regulations on both does not violate the single-subject rule because they both fall under the topic of healthcare.

The measures became entwined after Republican legislators failed to pass two separate bills, one limiting abortion after six weeks of pregnancy and the other restricting transgender hormone therapies for minors. 

The Republican-led legislature added the 12-week abortion provision to the existing transgender medicine bill following the success of a filibuster to block the six-week bill.

After Gov. Jim Pillen signed the combination health bill in May 2023, the American Civil Liberties Union, representing Planned Parenthood of the Heartland, sued on the grounds that the hybrid law violated the state constitutional requirement for single-subject legislation.

The lawsuit was dismissed by a district judge in August 2023, and the ACLU appealed.

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Abortions in the state dropped by 25% in seven months following the passage of the abortion restrictions after 12 weeks gestation. By 12 weeks of pregnancy, a fetus has already grown a four-chambered heart that pumps more than six quarts of blood per day and has already beat over 10 million times.

Prior to the law, abortion was legal in Nebraska up until 22 weeks gestation, the approximate gestational age for fetal viability outside of the womb.