SIOUX FALLS, S.D. (AP) — South Dakota lawmakers on Thursday approved Gov. Kristi Noem’s new rule for medical abortions that make the state one of the hardest places in the U.S. to get abortion pills.

The rule requires women to return to a doctor to receive the second of two drugs used to carry out a medication abortion.Usually women receive both drugs in one visit, taking the second medication at home.

Doctors and abortion rights advocates decried the rule as a dangerous intrusion on the relationship between doctors and patients.

The Republican governor initiated the rules change in September through an executive order, ahead of theFood and Drug Administration’s decision last month to permanently remove a requirement that women seeking abortion pills pick them up in person. The new rules, spurred by the governor’s order, had stalled in a legislative committee last month after Republican Sen. Timothy Johns, said he did not see any evidence that the requirement was really necessary for the abortion-seeker’s safety, as Noem argued.

Johns on Thursday sided with three other Republicans on the committee in approving the rule change, which is expected to take effect later this month.

Currently, women seeking a medical abortion in South Dakota must visit a provider, wait 72 hours, then return to take the first drug, mifepristone. At that time, they also receive a hormone blocker called misoprostol, which is usually taken in subsequent days to end the pregnancy.

Under the new rule, women will have to wait at least a day after receiving the first drug, then return to the receive the second one.

The change comes as the U.S. Supreme Courtis considering a casethat could severely erode abortion rights that have stood for half a century.

Noem’s administration argued the extra visit is necessary to make sure women don’t have complications from the drug.

But doctors warned that making it harder for women to get the second drug is dangerous. Forgoing the second drug creates a greater risk of hemorrhage, according to the South Dakota Section of the American College of Obstetricians and Gynecologists.

“How many women will be unable to comply, unable to return for the third time in about a week and decide they just have to take their chances and skip taking the second drug?” asked Nancy Turbak Berry, a lawyer representing Planned Parenthood, at the committee’s meeting last month. “How many emergency rooms and clinics in the outlying areas of our state are going to be faced with unnecessary medical emergencies?”

One medical trial, which published its findings in the journal Obstetrics and Gynecology, tried to study the effects of women either not taking the second drug or taking the hormone progesterone, which anti-abortion activists claim may stop a medical abortion. But the trial halted at just 12 participants after three were rushed to the hospital due to bleeding. Two of the women had not received any medication the second round; one had received progesterone.

Dr. Erica Schipper, a Sioux Falls obstetrician and gynecologist, noted that studies on halting the medical abortion process have so far been limited, but pointed out that abortion-causing medication has a long track record of safety.

Since 2000, when medication abortion became available in the United States, the FDA has tracked 26 deaths associated with the drug, though not all of those can be directly attributed to the medication due to underlying health conditions and other factors. Schipper said that constitutes a low risk, considering that drugs like acetaminophen — marketed as Tylenol — account for an estimated 150 deaths every year.

“(The rule) will unfortunately increase government interference in the physician-patient relationship and cause far more problems than it will solve,” Schipper said, adding that it could delay treatment for patients who get abortions for medically-necessary reasons and sets a precedent of the state government regulating prescription drugs.

Several physicians opposed to abortions testified to the committee Thursday, asserting that medical abortions do present risks and requiring extra visits helped mitigate it. Dr. Glenn Ridder, who is the medical director at the Alpha Center, a crisis pregnancy center in Sioux Falls, said the third visit was an opportunity to evaluate whether the woman needed to even take the second drug.

In halting Noem’s rule last month, two Democrats argued that it was more akin to a law that should be debated in the full Legislature. Noem said she would support legislation to make the rule into law.

But lawmakers on Thursday washed their hands of the debate over the merits of the rule and instead focused on whether the Department of Health made the steps necessary to enact it.

“I’m troubled by it; I truly am troubled,” Johns said in voting to approve the rule.