The Trump administration has upheld one of its gravest attacks on abortion since the election and clinics which offer the procedure could be forced to close, campaigners have warned.

The frontline service providers’ stark warning comes after the US appeals court upheld rules which implement barriers for women who need abortions.

The changes ban taxpayer-funded clinics in the Title X program – the federal grant program that subsidizes affordable birth control, cancer screenings, HIV screening and other medical care for four million low-income patients – from making abortion referrals.

The rules will bar clinics which get federal money from sharing office space with abortion providers from March 4 onwards – with campaigners and service providers saying this will likely force abortion clinics to relocate or shut their doors entirely.

Alice Huling, a lawyer for the Campaign for Accountability, a public interest watchdog based in the US, said the rule change which the US Department of Health and Human Services initially introduced in March last year was “staggering”.

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She told The Independent: “It is one of the Trump administration’s biggest attacks on the right to have an abortion and the provision of comprehensive healthcare. It is part of an effort to wage war on women’s sexual and reproductive freedom.

“It is certainly the biggest effort the Trump administration has made to defund Planned Parenthood and to redirect family planning funding to other organisations – some of which give women dangerous, misleading and incomplete healthcare.”

Ms Huling said the changes had gone into effect last summer and have already had a “detrimental impact” on low-income women who have lost their access to vital healthcare.

“This change means many Americans can’t access birth control or STI treatment, plus it makes it much harder for individuals to access truthful, medically sound options if they are pregnant. But it is also important to note organisations are continuing to provide healthcare through other means via private donations.”

The Trump administration was unsuccessfully sued by Planned Parenthood in March in an attempt to block the rule which makes it illegal for all services in the Title X program to tell people how they can get an abortion. The majority of Title X patients are people of colour, Hispanic, or Latino.

Major medical associations, such as the American Medical Association, the American College of Obstetricians and Gynecologists, the American College of Physicians, have opposed the move.

Alexis McGill Johnson, acting president and CEO of Planned Parenthood Federation of America, said: “Your access to health care should not depend on how much you earn, where you live, or who you are. The Trump administration’s dangerous gag rule is causing immense harm across the country.

“This unethical rule has put up egregious barriers for people with low incomes to get birth control and preventive care like STI testing, education, and cancer screenings. With the court failing to block the rule, congress must take action to reverse this dangerous rule and restore access to care for millions through Title X. Planned Parenthood will never give up on our patients and we will continue to do everything we can to fight this rule.”