WASHINGTON—The State Department on Monday officially announced a broad expansion of the Mexico City Policy, a regulation put in place by every Republican president since Ronald Reagan that prevents foreign non-governmental organizations that perform or promote abortions from receiving American dollars.

Typically, the Mexico City Policy has only impacted funds specifically earmarked for family planning programs. Under the new policy, however, organizations that perform other health-related work and happen to support abortions — for example, a foreign NGO that does sexual health education to prevent the spread of HIV and also informs women that abortion is legal in the country — could see the whole of their US health funding disappear.

The policy the current White House will implement extends to all organizations that perform abortions, promote abortion, or even financially support other NGOs that do so. The restrictions also apply to a vast swath of foreign aid dollars—encompassing malaria prevention, HIV treatment, and maternal health—amounting to $8.8 billion, nearly 15 times more than the amount of restricted money under the policy as enacted under former President George W. Bush.

Foreign non-governmental organizations are already prohibited from receiving money for family planning programs if that organization “performs or actively promotes abortion as a method of family planning,” according to guidance issued by the State Department in March. An organization must “agree in writing” that they will follow this policy in order to receive funds. Federal funds have also long been prohibited from being used on abortions directly, both within the United States and abroad.

Of the $8.8 billion, approximately $6 billion is earmarked for the Presidential Emergency Plan for AIDS Relief, some of which is used to fund the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Much of the money also goes to USAID family planning efforts, maternal health programs, and other public health initiatives.

Administration officials stressed that the amount of global health money distributed by the US would not change, and that the restriction was simply following through on a pledge that “U.S. taxpayer money should not be used to support foreign organizations that perform or actively promote abortion as a method of family planning in other nations.” The policy also does not apply to funds distributed directly to foreign governments.

A number of global health advocacy groups immediately decried the expanded restriction, saying it would jeopardize preventive health and treatment efforts that depend on American money to operate.

PAI, a global advocate for contraceptive and reproductive health, said the new restrictions would “broaden the reach of the policy’s already deadly effects, including increasing unintended pregnancies, unsafe abortions, and maternal and child mortality.”

Earlier in the year, a coalition including Planned Parenthood, Marie Stopes International, a number of AIDS groups, and a variety of religious and labor organizations also released a joint statement opposing the reinstatement of the policy and citing “broad and severe” health consequences worldwide.

Some major international organizations have publicly declared that they will make no such agreement with the US government, even if it means forgoing tens of millions of dollars. The UK-based International Planned Parenthood Federation expects to lose $100 million.

Marie Stopes International, a UK-based organization that provides women with contraception and safe abortion, also pledged not to sign on with the policy. In 2015, they received about 23 million pounds, or about $30 million, from USAID, making up about 9 percent of their budget.

To fill such budgetary gaps, other governments have pledged to pitch in, committing at least $190 million at a conference in Brussels in March. Still, that amount is a fraction of the $8.8 billion at stake.

The Mexico City Policy or “global gag rule,” first implemented in 1984, is usually revoked by Democratic presidents and reinstated by Republicans—with the exception of one year during former President Bill Clinton’s second term when it remained in force by Congressional action.

It’s up to the legions of civil servants who work for the State Department to enforce the policy, however, and they can have some leverage as to how aggressively it’s enforced, said Duff Gillespie, a professor at the Johns Hopkins Bloomberg School of Public Health, during a February panel discussion at his university. He worked for USAID when the policy was previously in place.

During his time at the agency, Gillespie said he did his best to implement the policy “to the letter,” trying “to minimize the damage.” That might be more difficult now, he said.

Republished with permission from STAT. This article originally appeared on May 16, 2017