Xai-Xai, a peaceful coastal town a few hours north of Mozambique’s capital, sits in a province with the highest rate of HIV/AIDS in the country. One-quarter of the population in this region is HIV-positive, a figure which along with tuberculosis contributes significantly to high maternal-mortality rates. Sixteen percent of residents have malaria.

In regions where clinics depend on funding for specific services—say, testing and treatment for HIV/AIDS under the U.S. President’s Emergency Plan for AIDS Relief program, or for malaria under the President’s Malaria Initiative—one-stop shops for medical care aren’t a given. But here in Xai-Xai, residents can go to a clinic run by an NGO called the Mozambican Association for Family Development (AMODEFA) for family planning, tuberculosis testing, information on drug use, HIV prevention, and referrals for treatment in youth clinics. Many young people in Mozambique born with the virus aren’t aware of their status, so AMODEFA began a pilot program encouraging parents to explain HIV to their children.

On January 23, 2017, however, much of AMODEFA’s work came to an abrupt halt. The reason was the Republican U.S. administration’s desire to limit abortions abroad—a reinstatement of what’s known as the “global gag rule.” Since last week, that step has seemed particularly ironic. Last Thursday, peer-reviewed medical journal The Lancet published a study confirming what reproductive health experts have long suspected: Surveying 26 countries in sub-Saharan Africa between 1995 and 2014 (a time period during which the gag rule was reinstated by Republican administrations and rescinded by Democratic ones), the countries relying heavily on U.S. aid saw much higher rates of abortion—40 percent more—when the gag rule was in place. In other words, in addition to the steep costs imposed on other forms of health care when the gag rule is instituted, it has the exact opposite effect of what conservative policymakers say they intend.

Since 1973, the Helms Amendment has prohibited federal dollars from going toward abortions in other countries. In 1984, the Reagan administration intensified that policy with what has since come to be known as the global gag rule, which prevents foreign health nonprofits that receive U.S. funds from even mentioning abortion—even if a patient asks about it, and even if it’s legal.

AMODEFA refused to sign the gag rule—and lost 60 percent of their budget.

In 2017, the Trump administration expanded the rule far beyond any previous iteration. Earlier versions of the gag rule said international family-planning NGOs could not “perform or actively promote abortion as a method of family planning.” The Trump version, officially, and according to experts somewhat misleadingly titled “Protecting Life in Global Health Assistance,” expanded the ban to all foreign health organizations receiving U.S. dollars. Under this new iteration of the ban, it doesn’t matter whether an NGO is preventing and treating HIV/AIDS, malaria, tuberculosis, poor sanitation, or malnutrition; if it “promotes” abortion—i.e. so much as offers a referral to a local abortion provider, according to Secretary of State Mike Pompeo’s clarification earlier this year—U.S. aid is yanked. The U.S. is the largest global health donor in the world, spending $7.4 billion in 2018, often in parts of the world where alternate funding is not available. The effect of such a policy is enormous.