SEATTLE — A U.S. appeals court on Monday upheld Trump administration changes that include additional hurdles for those seeking abortions through a federal program that helps low-income women.

The 7-4 ruling by the 9th U.S. Circuit Court of Appeals overturned decisions issued by judges in Washington, Oregon and California. The court had already allowed the administration’s changes to begin taking effect while the government appealed those rulings.

The rules ban taxpayer-funded clinics in the Title X program from making abortion referrals and prohibit clinics that receive federal money from sharing office space with abortion providers — a rule critics said would force many to find new locations, undergo expensive remodels or shut down.

More than 20 states and several civil rights and health organizations challenged the rules in cases filed in Oregon, Washington and California. Judges in all three states blocked the rules from taking effect, with Oregon and Washington courts issuing nationwide injunctions. One called the new policy “madness” and said it was motivated by “an arrogant assumption that the government is better suited to direct women’s health care than their providers.”

Planned Parenthood has already left the Title X program over the new rules, giving up about $60 million a year in federal funding.

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