President Trump yesterday signed a presidential memorandum re-instating the Global Gag Rule. For most of the day yesterday the actual text of the memorandum was not released so much of the media coverage — including our own — was based on the understanding that Donald Trump simply re-instated the same policy that existed during the George W. Bush-era administration. In fact, he did not. Rather, after the text became public last night it became clear that Trump dramatically expanded the scope of the Global Gag Rule to include all global health assistance provided by the US government.

Previously, the restrictions embedded in the Global Gag Rule were limited exclusively to NGOs that receive US government assistance for family planning and reproductive health, like contraception. These restrictions include prohibiting that NGO from counseling women that abortion is an option or lobbying foreign governments to liberalize their abortion laws. Even if the funding sources for abortion counseling come from another source, that NGO must cease that counseling or either relinquish its US funding for, say, condom distribution or obstetric surgeries. That’s how it worked in the Bush administration–to disasterous effect.

But the Trump memo takes this a huge step further. Rather than applying the Global Gag Rule exclusively to US assistance for family planning in the developing world, which amounts to about $575 million per year, the Trump memo applies it to “global health assistance furnished by all department or agencies.” In other words, NGOs that distribute bed nets for malaria, provide childhood vaccines, support early childhood nutrition and brain development, run HIV programs, fight ebola or Zika, and much more, must now certify their compliance with the Global Gag Rule or risk losing US funds. According to analysis from PAI, a global health NGO, this impacts over $9 billion of US funds, or about 15 times more than the previous iteration of the Global Gag Rule which only impacted reproductive health assistance.

We already know from research that the Bush-era Global Gag Rule resulted in a sharp decline in the availability of contraceptives in some of the poorest places on earth, which in turn hindered the fight against maternal death and increased abortion raters. Now, this one change may profoundly undermine not only progress on maternal health worldwide but also the US government’s ability to fight HIV/AIDS, big childhood killers like malaria, and prevent infectious diseases like Zika and ebola from reaching US shores.

This is a profound expansion of what was already a harmful policy.