Just three days after his inauguration, President Donald Trump issued a memorandum to reinstate and expand the “global gag rule,” a Reagan-era, anti-abortion, foreign policy directive, with the backing of Vice President Mike Pence. Because of this policy, any nongovernmental organization (NGO) outside of the United States that provides abortion procedures, participates in pro-choice advocacy, supplies information about abortion, or offers referrals to abortion providers has been forced to choose between forfeiting U.S. foreign assistance funding or ceasing to provide the basic reproductive health services that its patients need.

The global gag rule, also known as the “Mexico City Policy,” goes beyond just blocking U.S. funding for critical reproductive health services. A Center for Health and Gender Equity (CHANGE) research report notes that this policy also restricts what groups receiving U.S. funds can do with money from all other sources; organizations must subject all their funds to the same restrictions or lose U.S. funding.

Previous versions of the policy—enacted by every Republican president since former president Ronald Reagan and then rescinded by every Democratic president—only affected international family planning funds, but Trump’s policy goes further. His global gag rule now formally applies to nearly $9 billion of U.S. global health assistance funds, which reach far and wide to support health and well-being across the globe.

This hazardous policy reminds us that despite the constant deluge of policies endangering reproductive freedom here in the United States, people living in the United States are not the only ones affected by Trump and Pence’s militantly anti-choice, anti-woman agenda. Trump and Pence are also exporting their attacks on basic bodily autonomy to the Global South—namely to sub-Saharan African countries, where adolescent girls and young women are disproportionately affected by the HIV crisis.

The apparent dangers of this policy have produced an ongoing push for more legislators to co-sponsor the Global Health, Empowerment and Rights (HER) Act in both the House and Senate. If passed, the HER Act would nullify Trump’s global gag rule and prevent future presidents from re-enacting a similar policy.

The global gag rule exists in a historical reality in which the United States and its foreign policies have played a significant role in the continuous destabilization of African economies. From loans contingent upon structural adjustments to the support of African dictators to harmful “voluntourism” attempts at development, the United States has had a nearly constant hand in the functionality of African economic systems. Trump’s expanded global gag rule is a further use of U.S. wealth to control African bodies and African money. Placed in the context of this history, it’s nothing short of neocolonialism.

As advocates and researchers have seen, it is African women and girls who suffer because of the United States’ interference with reproductive autonomy globally.

At a recent congressional briefing regarding the early effects of the expanded global gag rule, policy research experts from CHANGE, the International Women’s Health Coalition (IWHC), and Human Rights Watch (HRW) each shared findings from their most recent in-country, qualitative research with African organizations and individuals who were already seeing the affects of Trump and Pence’s anti-choice imperialism. During her presentation of on-the-ground research, IWHC Program Officer Vanessa Rios shared a quote from a research interview with a stakeholder based in Nigeria: “It is not American women dying [as a result of this policy], it is Nigerian women that are dying.”

Research conducted by Marie Stopes International substantiates this, projecting that by 2020, Trump’s renewal and expansion of the policy will result in over 2.1 million unsafe abortions and over 21,700 maternal deaths in affected countries, with the majority of those occurring in sub-Saharan Africa.

According to a policy brief produced by CHANGE, the expansion of the global gag rule also has drastic effects on integrated health services. The same clinics that offer abortion-related services are often the sole community source for contraception counseling, prenatal care, gender-based violence care, vaccinations, cervical cancer screening, HIV testing and treatment, and other critical health services. In a region where AIDS-related illnesses are still a major cause of death and 74 percent of new HIV infections among adolescents occur in girls, this policy is unravelling decades of successful work combating the HIV and AIDS epidemic.

If locally run health-care clinics—those that are uniquely positioned to serve their own communities’ health needs in a way that is both efficient and culturally meaningful—continue to provide abortion-related services, they lose the critical flow of funding that helps to power their HIV prevention and treatment work, among other critical services. This further strains the budget and operating power of these organizations that have invested their own time and resources to improve health outcomes of vulnerable populations, making it incredibly difficult for them to provide abortion-related services even if they choose to relinquish U.S. funding. It’s a lose-lose situation for both providers and patients.

Research conducted by HRW found that Trump’s iteration of the global gag rule has resulted in a great deal of confusion about the legality of abortion in Kenya. This effectively further restricts Kenyan’s access to abortion and affects even Kenyan government-run clinics that don’t receive U.S.-based funding services. Even more concerning, Family Health Options Kenya, a top provider of reproductive services in the country, has reported instances of women contemplating and committing suicide in association with reduced access to contraceptives and abortion and called the rule “a death sentence” for Kenyans.

In Mozambique, Swaziland, and Botswana, International Planned Parenthood Federation-associated clinics have experienced significant cuts to both staff and services provided, and the loss of funding for reproductive services in Madagascar means that programs offering free contraceptives to low-income women have been shut down.

Anti-choice advocates have shouted that the global gag rule protects U.S. taxpayers from funding foreign abortions, but the Helms Amendment has prohibited U.S. aid dollars from financing abortion procedures abroad since 1973. Furthermore, previous variants of the global gag rule actually have been found to increase both unintended pregnancies and abortions in sub-Saharan Africa. Existing historical data tells us that the policy does nothing whatsoever to help Africans or others in the Global South, which is supposedly the very intention of U.S. foreign aid.

What the global gag rule does do is impose U.S. control over African financial resources and exploit the power of United States global health aid to enforce anti-choice restrictions upon African bodies. It superimposes U.S. policy upon African laws—even countries where abortion is legal without restriction are subject to global gag rule stipulations. It undermines the success that African researchers, health-care workers, volunteers, and communities have achieved in building health-care infrastructure and making quality care more accessible for their fellow citizens.

Trump’s expansion of the global gag rule leverages U.S. wealth as a weapon against African health. Make no mistake—this administration has revitalized colonial tactics of power to intrude upon the sexual and reproductive autonomy of African women and girls.