The Trump administration instituted an unprecedented expansion of a Reagan-era anti-abortion policy Monday, dramatically cutting U.S. foreign aid access for international healthcare providers that promote abortion rights.

In January, President Donald Trump reinstated the Mexico City policy, known as the “global gag rule” among abortion rights activists, which bars funds for international non-government groups that advocate for abortion rights or even discuss abortion’s role in family planning. The policy, originally penned by Ronald Reagan, has been rolled back by every Democratic president and reimposed by every Republican one since the 1980s.

But abortion rights activists worried that Trump’s version would go even further than past presidents’, cutting off not only groups’ access to family planning funds, but all aid for U.S. global health assistance. And on Monday, their fears came true. The U.S. State Department announced that its new Mexico City policy, rebranded as “Protecting Life in Global Health Assistance Plan,” will for the first time also cut funding to “international health programs, such as those for HIV/AIDS, maternal and child health, malaria, global health security, family planning, and reproductive health.”

The U.S. government is currently the world’s single-largest provider and implementer of global health programs, and while its total amount of available foreign aid will remain the same, groups that promote abortion rights will be ineligible to receive those funds, even if they’re used for other services.

The previous version of the policy cut about $575 million in aid. This new plan will slash about $8.8 billion.

“Votes in America have international consequences,” said Marjorie Dannenfelser, president of the anti-abortion group Susan B. Anthony List, in a statement. “This executive order does not cut a single penny from U.S. aid, rather it simply ensures our hard-earned tax dollars are used by other health care entities that act consistently to save lives, rather than promoting and performing abortion. Abortion is not health care.”

It is already illegal to use taxpayer money to pay for abortion services, with some exceptions, both domestically and abroad.

Critics contend that the new policy will not only cause maternal deaths to skyrocket, but also point out that under past presidents, researchers found the Mexico City policy actually resulted in higher abortion rates in certain countries because people ended up with less access to contraception.

“Trump’s Global Gag Rule impacts about 15 times more U.S. funding and also extends the reach of restrictions beyond NGO grants and cooperative agreements to contracts,” the Population Action International, a global family planning and reproductive health group, said in a statement. “This will also broaden the reach of the policy’s already deadly effects, including increasing unintended pregnancies, unsafe abortions, and maternal and child mortality.”

The largest non-governmental provider of contraception worldwide, the International Planned Parenthood Federation, stands to lose about $100 million in funding. The group announced in January that despite these cuts, it would not abide by Trump’s Mexico City policy and would continue to provide abortion services.