A U.S. appeals court once again declined to halt new Trump administration rules that bar taxpayer-funded clinics from referring patients for abortions.

The 9th U.S. Circuit Court of Appeals on Friday, Aug. 16 rejected a request from more than 20 states, Planned Parenthood, and the American Medical Association to block the rules from going into effect while the lawsuit proceeds.

Planned Parenthood, which is a major abortion provider, has said it will leave the federal family planning program by Monday unless a court puts a hold on the rules. It said the administration’s new policy is “unethical and dangerous,” amounting to a “gag rule” on clinicians.

About 4 million women are served nationwide under the Title X family planning program, which distributes $260 million in grants to clinics. Planned Parenthood said it serves about 40% of patients.

Religious conservatives see the program as providing an indirect subsidy to Planned Parenthood and the Republican lawmakers opposed using taxpayer funds to pay for abortions.

“Women across America are going to find out for themselves that they don’t need Planned Parenthood after the nation’s largest abortion vendor pulls out of a program that they never should have been in at all,” said Students for Life President Kristan Hawkins in a statement.

This year, four states passed “heartbeat” bills, which outlaw abortion once a doctor can detect embryonic cardiac activity, amounting to 15 states that have introduced six-week bans this year, according to the Guttmacher Institue, an abortion rights group.

Janet Porter, president of Faith2Action, a Christian organization that has successfully promoted “heartbeat” bills told the Reuters, “There’s been a shift. This is the year America went from regulating abortion to ending it.”

Includes reporting of the Associated Press