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A U.S. appeals court in San Francisco on Monday upheld a revised rule by President Donald Trump’s administration that bars federally funded family planning clinics from providing abortion referrals.

The decision was made by a 7-4 vote of an 11-judge panel of the 9th U.S. Circuit Court of Appeals. The panel overturned preliminary injunctions issued by federal judges in San Francisco, Oregon and Washington in lawsuits filed by a total of 22 states and several doctors and health organizations.

The revised rule allows doctors in family planning clinics to mention abortion, but it prohibits them from encouraging abortion or providing an abortion referral. Instead, it requires doctors to refer pregnant patients to prenatal services.

The previous version of the rule by the U.S. Department of Health and Human Services allowed doctors to give neutral, “non-directive” counseling and to provide abortion referrals.

Circuit Judge Sandra Ikuta wrote in the majority opinion that the revised rule was “a reasonable interpretation” of the federal law that authorizes family planning grants, known as Title X.

California Attorney GeneraL Xavier Becerra, who led one of the lawsuits, called the rule “reckless” and said it “obstructs access to care by gagging medical professionals from discussing all available options with their patients.”

Another of the lawsuits before the appeals court was filed in federal court in San Francisco by Equal Access Health, California’s largest Title X grantee, which distributes funds to clinics.

Equal Access Health President Julie Rabinovitz said:

“This is a devastating decision for the millions of low-income patients who rely on the Title X program for comprehensive, quality sexual and reproductive health care nationwide.”

Rabinovitz said the organization is reviewing the decision and discussing next steps with its lawyers and litigation partners.

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