The Iowa Board of Medicine has voted to end the largest telemedical abortion program in the country.

On Aug. 30, the Iowa Board of Medicine voted in an 8-2 decision to end the practice of telemedical abortions in their state, which are abortions supervised via video conference with a physician. As of Nov. 6, women can no longer terminate their pregnancies without being in the physical presence of a doctor.

The ruling will end the nation’s largest telemedical abortion program, serving women in rural areas without easy access to a hospital. In 2008, there were only 11 abortion providers in the state of Iowa, according to reproductive health advocacy organization the Guttmacher Institute.

The controversial decision is igniting passion from both pro-life and pro-choice advocates, with many in the former camp fighting for further abortion restrictions and those in the latter advocating for a woman’s right to an abortion—no matter if she is at home or in a doctor’s office.

The new Medical Board ruling is made up of four parts. First, a woman seeking an abortion must be examined in person by a physician. Second, when an abortion-inducing drug is prescribed, the physician must also be present. Third, the patient must receive follow-up care, and lastly, in accordance with Iowa law, a patient under the age of 18 seeking an abortion must notify her parents before the procedure.

It’s the first two clauses that are the source of the most outrage by pro-choice groups, says Mark Bowden, executive director of the Iowa Board of Medicine. Pro-choice advocates do not see the Board’s decision as an effort to protect women’s safety, as proponents of the ruling claim.

“This decision is a political attack aimed at restricting access to abortion in Iowa,” said Planned Parenthood of the Heartland president Jill June in a prepared statement. “Proponents of this rule aren’t against telemedicine technology; they are against safe, legal abortion and are unjustly targeting our system with no scientific information or evidence to back their claims.”

The decision came down to the Iowa Board of Medicine’s 10 members, who all have their own different views regarding abortion. It is comprised of seven physicians and three members of the public: an attorney, a Catholic priest, and a former physician, appointed by the governor of Iowa’s office. The attorney and one surgeon voted against the measure.

The process, legally implemented by Planned Parenthood in 2008, is similar to other wellness checkups that can be done via a webcam. A woman is able to terminate a pregnancy from home, with the guidance of a physician. She receives instructions from her doctor, who authorizes a local clinic to give her abortion-inducing drugs, which she takes in the privacy of her own home.

The system has been in practice successfully for years, with no recorded patient complaints, but opponents of telemedical abortions fear that medical complications can still arise during labor and fetal delivery at home, even with the input of a qualified doctor.

“Women deserve high quality medical care and a standard of care designed to protect their health regardless of the procedure at issue,” said Tim Albrecht, a spokesman for Republican Gov. Terry Branstad, in an emailed statement to the Associated Press. “The board made this decision based on the standard of health care that women deserve.”

The ruling becomes effective 35 days after it is published in the Iowa Administrative Bulletin. A petition or lawsuit opposing the ruling is still possible, however, and resistance to the law will likely continue from pro-choice groups.

While the decision was made publicly, the Board will also be releasing an in-depth statement about the factors it considered in striking down the law.

“At the end of the day, the Board chooses what it deems as relevant,” Bowden said. “The focus is on [whether they] are acting within the lawful processes of the ruling.”

The Iowa Board of Medicine’s decision mirrors a growing trend across the country to limit abortion access. As The Huffington Post reports, more than 50 U.S. abortion clinics have shut down or stopped providing abortions since 2010.