U.S. Secretary of State Mike Pompeo on Tuesday announced another expansion of the administration’s anti-choice “Mexico City Policy,” dubbed the global “gag rule” by abortion rights proponents.

In his remarks, Pompeo said the administration was making “further refinements” on the global gag rule. “As before, we’ll continue to refuse to provide assistance to foreign [nongovernmental organizations (NGOs)] who perform or actively promote abortion as a method of family planning,” he said. “Now, as a result of my decision today, we’re also making clear we will refuse to provide assistance to foreign NGOs that give financial support to other foreign groups in the global abortion industry. We will enforce a strict prohibition on backdoor-funding schemes and end runs around our policy. American taxpayer dollars will not be used to underwrite abortions.”

On day one of his administration, Trump implemented and expanded the global gag rule, which bans U.S. foreign aid from going to organizations that perform or refer patients for abortion care. The rule, which was first put into place by the Reagan administration, has been a political football through successive administrations.

Pompeo on Tuesday also reaffirmed the U.S. State Department’s commitment to enforcing the Siljander Amendment, which prohibits the use of U.S. foreign aid to lobby for or against abortion access. “The American people should rest assured that this administration and this State Department and our USAID will do all we can to safeguard U.S. taxpayer dollars and protect and respect the sanctity of life for people all around the globe,” Pompeo said.

Reproductive health advocates reacted to the announcement with concern. “Further expanding the dangerous global gag rule is yet another step in this administration’s two-year-long crusade against reproductive health and rights both in the United States and globally,” said Heather Boonstra, director of public policy at the Guttmacher Institute, in a statement. “Each iteration of the global gag rule has been blatantly coercive, both in intent and practice, and is moving forward in lock step with the Trump administration’s non-stop assault on reproductive health services. This ideologically driven policy undermines the very goals of U.S. foreign aid programs by harming the health of people in developing countries, violating medical ethics, and trampling on democratic values.”

The rule as initially implemented under Trump affects an estimated $8.8 billion in U.S. global health funding, “up from about $600 million during the administration of President George W. Bush,” according to a 2017 report from the New York Times  According to a 2017 report from the Guttmacher Institute, half of the 1.65 billion women age 15-44 worldwide “live in countries where the gag rule would impede otherwise legal abortion services.”

Planned Parenthood President Dr. Leana Wen in a statement noted that the global gag rule has already cut off access to reproductive health services in underserved localities worldwide, and suggested that further expansion of the policy would hurt those communities even more. “This is unethical, dangerous, and unacceptable,” she said in a statement. “Two years into the sweeping expansion of the global gag rule, there are countless examples around the world of patients losing access to health care, especially in places where maternal deaths, HIV rates, and unmet need for contraception are unacceptably high.”

“Further expansion of the global gag rule will harm millions of people around the world and have consequences for generations to come,” said Wen.

The global gag rule announcement is the administration’s latest move to enact its anti-choice policies on a global scale.

U.S. officials last week failed to undercut support for women’s rights and reproductive health access at the United Nations Commission on the Status of Women conference. Earlier in the month, the State Department again dropped information on critical reproductive health access issues from its global human rights report.

“UPDATE, March 26, 2:15 p.m.: This story has been updated to include response from reproductive health advocates and details about the global gag rule policy.