DES MOINES, Iowa (AP) — The Iowa Supreme Court on Friday cleared the way for lawmakers to severely limit or even ban abortion in the state, reversing a decision by the court just four years ago that guaranteed the right to abortion under the Iowa Constitution.

The court, now composed almost entirely of Republican appointees, concluded that a less conservative court wrongly decided that abortion is among the fundamental privacy rights guaranteed by the Iowa Constitution and federal law.

Friday’s ruling comes amid expectations that the U.S. Supreme Court will overturn the landmark Roe v. Wade decision that legalized abortion nationwide. Then Iowa lawmakers could ban abortion in the state without completing the lengthy process of amending the state constitution.

The Iowa decision stemmed from a lawsuit filed by abortion providers who challenged a 2020 law that required a 24-hour waiting period before a woman can get an abortion. A judge who struck down the law cited the state high court’s 2018 ruling. The judge also concluded that the law violated rules prohibiting passage of bills with more than one subject.

The state Supreme Court returned the waiting-period case to district court.

In its 2018 ruling, decided by a 5-2 vote, the court said that “autonomy and dominion over one’s body go to the very heart of what it means to be free.”

The reversal of the decision after just four years reflects a dramatic change in the court’s makeup. Gov. Kim Reynolds has named four justices since 2017, and six of the seven people on the court have been appointed by Republican governors.

Reynolds, an outspoken opponent of abortion rights, and Republicans in the Legislature have repeatedly said they hoped the court would overturn the 2018 ruling. With that in mind, Reynolds and GOP lawmakers gave the governor more control over the panel that chooses which lawyers and judges are nominated for court positions.

The 2018 decision had made Iowa the sixth state — with Alaska, Florida, Kansas, Montana and Minnesota — where a right to abortion was recognized by the state’s high court.

As in Iowa, Republicans control the legislatures and governorships in Florida and Montana, where GOP leaders have been stymied from enacting abortion bans that could take effect if the U.S. Supreme Court overturns its 1973 landmark decision and puts decision-making power in state government hands.

In Montana, a challenge to abortion restrictions that could test that state’s high court opinion is before the Supreme Court.

In Iowa, Reynolds has demurred on questions of what exceptions she would accept. She said last month she is “proud of the legislation she signed in 2018,” including the ban on abortions once cardiac activity is detected, as early as six weeks and often before many women know they are pregnant. The measure included exceptions to protect the life of the mother and in pregnancies that result from incest or rape.

Yet more recently, she stopped short of specifying similar exceptions. “I’m not going to set any parameters,” she told reporters.

Iowa Department of Public Health data shows there were 4,058 abortions in Iowa in 2020 — 835 by surgical procedure and 3,222 by medication. That was an increase over the previous year when 3,566 abortions were reported. Iowa averaged just under 3,500 abortions a year from 2015 to 2019.

Court documents show Planned Parenthood performs about 95% of Iowa abortions. Surgical and medical abortions may be obtained in clinics in Des Moines and Iowa City. Medication abortions are provided in other clinic locations including Ames, Council Bluffs and Sioux City.