NASHVILLE, Tenn. — The former medical director of Planned Parenthood of Tennessee and North Mississippi testified on Monday that Tennessee's 48-hour waiting period for abortions actually delays the procedure by up to a month.

Dr. Sarah Wallett was testifying in the federal trial challenging Tennessee's 2015 law. Tennessee is one of 14 states with laws requiring women to make two trips to an abortion clinic, first for mandatory counseling and then for the abortion, according to the Guttmacher Institute, a research group that supports abortion rights.

Alex Rieger of the state attorney general's office said in opening statements that Tennessee's law is similar to laws in other states that have been upheld by the courts. He said the waiting period "offers women a chance to make a different choice." He said the law provides a commonsense approach to promoting the state's legitimate interest in fetal life.

Wallett testified that the two-visit requirement poses logistical challenges for both patients and clinics, delaying abortions far beyond 48 hours. Medical abortions that only require taking pills are not available later in pregnancy, so the law forces some women to have surgical abortions, she said.

There are also a small number of women who can't obtain an abortion at Tennessee Planned Parenthood clinics because the waiting period pushes them past the cutoff for when they will provide abortions. That's despite the agency increasing how late they would perform abortions from just under 15 weeks before May 2016 to just under 20 weeks by December 2017, Wallett testified.

During cross-examination, Rieger presented Planned Parenthood data showing that since the waiting period law took effect, more than 2,000 women have gone to the counseling appointment but not returned for an abortion.

Wallett said there are many reasons women may not return, including miscarriage.

Rieger also suggested that the waiting period law would help prevent women from later regretting their decisions.

"I have not had patients express regret," Wallett testified, noting that she has seen thousands of patients.

Much of Wallett's testimony was echoed by Rebecca Terrell, the executive director of a small independent Memphis clinic called Choices. She said the waiting period delays abortions for about half their patients by only a few days, but about 10 percent of patients are delayed by more than two weeks. Although some women never return for the second appointment, the clinic does not track the reasons.

Both women also testified that the law places a burden on women by increasing the cost and time required for abortions. Some women have challenges with work, travel and childcare, while others are in abusive relationships where it could be dangerous for their partners to find out they have been to a clinic, Wallett and Terrell testified.

Testimony continues on Tuesday, and the trial is scheduled to last a week. Five of the Tennessee's seven abortion clinics are suing over the law, claiming it violates the U.S. Constitution by placing an undue burden on the right to abortion.

Proving that the law poses an undue burden on women is highly dependent on the individual circumstances of the state.

In 1992, the U.S. Supreme Court upheld a 24-hour waiting period in Pennsylvania. But in Iowa last year, the state Supreme Court struck down a 72-hour waiting period there as unconstitutional.

Meanwhile in Florida, state attorneys will get a chance to argue in favor of a 24-hour waiting period after a state appeals court decision last month. It overturned a circuit court judge's 2018 decision to throw out the law as unconstitutional without a trial.