Once Donald Trump claimed he would keep abortion legal if he became president. “I am pro-choice in every respect,” the real-estate developer said in a 1999 NBC interview.

What a difference 20 years makes. With a willing Republican Congress, President Trump has moved to obliterate abortion access at every turn. Last week, the Senate Appropriations Committee approved a funding bill designed to block the District of Columbia from providing monies for abortion for low-income women (Congress has the final word on the District’s budget).

Meanwhile, Planned Parenthood plans to sue the federal Department of Health and Human Services over its regressive efforts to impose an abstinence-only-until-marriage agenda on the Teen Pregnancy Prevention Program (TPPP), an initiative originally designed to use science-backed approaches to prevent teen pregnancy. (Abstinence-only programs do not necessarily succeed in convincing young people not to have sex.)

And on Tuesday, the Supreme Court ruled that “crisis pregnancy centers,” which aim to persuade women to parent or consider adoption, do not have to provide information about the availability of abortion services elsewhere.

Among the most far reaching of Trump's anti-abortion moves is his attempt to implement a domestic version of a global gag rule that bans the use of U.S. foreign aid from abortion-related services. He reinstated and even expanded the Reagan-era policy on his first Monday in office.

With a little help from staunch religious conservatives, Trump is itching to cut Title X funding from clinics that provide abortions or refer patients to other places that offer the procedure. The American version would essentially block patients from receiving comprehensive health care by preventing providers from educating their patients about abortion options, making referrals, or providing abortion care. HHS has already moved to change how it awards family-planning grants based on this new anti-abortion strategy that groups like Planned Parenthood are fighting in federal court.

Title X enables low-income people to access affordable contraception and reproductive health care. More than four million Americans rely on services funded by Title X, which include wellness exams, life-saving cervical and breast cancer screenings, birth control, education about contraception, and STI and HIV/AIDS testing and treatment. About two-thirds of these people are at or below the poverty line.

One service Title X does not fund? Abortion care.

The ongoing debate over abortion means that many American women live in “abortion deserts”—areas that do not offer abortion care. Some people must travel more than 100 miles to reach an abortion facility. In a recent study conducted by the Journal of Medical Internet Research, 27 abortion deserts were identified, most of which are located in the South and Midwest. The state with the largest number of deserts was Texas, known for its breakfast burritos and the DIY abortion.

Indeed, as abortion clinics shut their doors at alarming rates, Texas women have been forced to take extreme measures to access abortion, like hopping the U.S.-Mexican border to buy an over-the-counter drug, that if taken correctly will induce a miscarriage. There is a cruel irony to the fact that women living in a country where abortion is technically legal but extremely hard to access must cross the border into another country where women are frequently prosecuted and convicted for having the procedure or even miscarrying.

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Additionally, many women cannot afford to travel hundreds of miles or cross borders to have an abortion. Transportation access, especially when compounded by poverty, can be a barrier, and delays due to distance or lack of transportation can force women seeking abortions even later in their pregnancies.

That Title X money is already barred from funding abortion care is probably news to Trump, who continually strives to satisfy his core supporters. However, the goals of anti-abortion activists are much more insidious. With Justice Neil Gorsuch ensconced in his Supreme Court seat, the time is ripe for anti-abortion crusaders. By working to defund Planned Parenthood as well as forcing clinics to shut down, and setting up as “crisis pregnancy centers,” pro-life activists are harming the women they piously claim to protect.

While the final form of this this American “gag rule” is not yet clear, it will without question have dire consequences. Lapses in funding will quickly translate into lapses in quality care, especially for low-income women. This means missing months of contraception, delaying cancer and STI screenings, and possibly outright denial of care.

Access to comprehensive reproductive health care is essential for women's economic security. According to the Reproductive Health Technologies Project, the birth control pill is responsible for 31 percent of the narrowing of the gender wage gap in the 1990s. When women can plan their families and delay pregnancy, it is beneficial not only to their own health, but that of their families as well. Improved access to birth control is also directly linked to declines in maternal and infant mortality.

As the politicization of women's reproductive care continues unabated and abortion deserts expand, women will continue to suffer.