President Trump on Monday reinstated the “global gag rule,” also known as the “Mexico City Policy,” prohibiting foreign nongovernmental organizations (NGOs) receiving U.S. family planning aid from providing abortion care or information about the medical procedure.

The move will revive the Reagan administration’s anti-choice restriction, which, according to the Guttmacher Institute, has “led to the closing of some of the developing world’s most effective family planning programs” when enforced. Though the Helms Amendment already prohibits the use of U.S. foreign assistance funds “for the performance of abortion as a method of family planning,” the global gag rule goes further by banning NGOs from providing abortion care, counseling, or engaging in advocacy for abortion.

“With this action, Donald Trump has turned his anti-women rhetoric into policy, and made it more difficult for women and families all over the world to access vital reproductive care,” Ilyse Hogue, president of NARAL Pro-Choice America, said in a statement on the announcement. “He really is living up to the lowest of expectations.”

Nancy Northup, president and CEO of the Center for Reproductive Rights, said in a statement that the Trump administration’s move “made clear that women will be the first casualty of his administration.”

“It is appalling to dictate to civil society groups and health care providers how they can spend their own money and force them to withhold from women critical information about and access to the full range of reproductive health care,” Northup said. “Trump’s Global Gag Rule will only lead to increases in unintended pregnancies, unsafe abortions, maternal and newborn deaths. This harmful policy undermines American democratic values of free-speech and imposes an anti-woman agenda.”

The anti-choice restriction was lifted by President Clinton in 1993 and revoked again by President Obama in 2009 after President George W. Bush reinstated it. In a statement on his decision, Obama said that the policy had “undermined efforts to promote safe and effective voluntary family planning in developing countries.”

Senate Republicans failed to reinstate the rule in their fiscal year 2017 State, Foreign Operations, and Related Programs and could try again in the 2018 fiscal budget process.

Sen. Jeanne Shaheen (D-NH) told Foreign Policy last week that she has planned a legislative response in anticipation of Trump’s executive order. She previously attempted to permanently repeal the rule.

The global gag rule has had major global consequences for reproductive health care. The policy has raised abortion rates, interfered with HIV prevention efforts, and “prevented women and girls from accessing contraception and safe abortion consistent with the laws in their Countries,” according to a January fact sheet from the Center for Health and Gender Equity. 

The fact sheet pointed to a 2010 study from Fordham Law School’s Leitner Center for International Law and Justice that found “strict enforcement policy under the Bush administration hampered Ethiopia’s efforts to address high rates of unsafe abortion.”

The World Health Organization estimates that 21.6 million women experience unsafe abortions across the world every year. Unsafe abortions account for 13 percent of all maternal deaths globally.

A 2011 study by Stanford University researchers examining the effect of the global gag rule suggested that “the Mexico City Policy is associated with increases in abortion rates in sub-Saharan African countries” and that “reduced financial support for family planning may have led women to substitute abortion for contraception.”