Nearly two years after Louisiana launched one of the strictest abortion bans in the nation, legislators have killed an effort to let voters decide whether to do away with the ban and enshrine the right to abortion in the state constitution.

That decision comes on the heels of a report, sponsored by pro-abortion rights groups, which found that fears of criminal penalties for performing abortions are wreaking havoc on the state’s maternal healthcare system, as doctors hesitate to provide miscarriage care for fear of running afoul of the ban.