× Expand Doug Strickland/Chattanooga Times Free Press via AP

Largely lost so far in the coverage of Trump's order on Monday reviving the so-called global gag rule is its unprecedented sweep.

Also known as the "Mexico City Policy," after the location of the United Nations population conference where President Reagan first announced it in 1984, the gag rule bans U.S. funding for international groups that provide abortions, advocate politically for abortion rights, or even talk about abortion with patients. Reagan and subsequent GOP presidents have all imposed the gag rule, while Democratic presidents, including Obama, have rescinded it.

But Trump, in re-imposing the funding ban this week-one day after the 44th anniversary of the Supreme Court's Roe v. Wade ruling-went much further than his GOP predecessors. Until now, the gag rule has applied only to U.S. family planning assistance and reproductive health assistance to non-governmental groups overseas. Trump's new gag rule applies to all "global health assistance furnished by all departments or agencies," meaning that it will potentially affect as much as $9 billion in federal aid, according to PAI, an international family planning and reproductive health advocacy group. That's compared with the approximately $600 million in American assistance for family planning that fell under George W. Bush's global gag rule.

The gag rule in its original form was bad enough. When last in effect during the second Bush administration, the global gag rule closed down urgently needed health clinics, and generally hampered the work of international family planning groups, reducing services and driving up fees. Millions of women and girls were denied access to contraception, safe abortions, maternal care, and help in preventing HIV-AIDS, contributing, perversely, to elevated abortion rates and maternal deaths from unsafe illegal abortions. Many women died.

On top of that, health-care providers were required to withhold vital medical information from female patients, violating decency and the basic requirement of informed consent. The cause of democracy and America's credibility were seriously set back by the gag rule's interference with vital political debate on abortion-related issues and apparent abandonment of free-speech principles.

But

Trump's recent action radically expands the gag rule's universe of harm.

His reinstatement of the rule was widely expected, but its cruel scope was not. The rule's tendency to ping-pong back and forth between Democratic and Republican president may tend to make Trump's order strike some as ho-hum. But make no mistake: Trump's gag rule on steroids has already begun to inflict damage around the world.

For example, USAID's two largest family planning providers, International Planned Parenthood and Marie Stopes International, have said they will forfeit U.S. aid rather than agree to Trump's conditions. "Every year, 21.6 million women are so desperate to end their pregnancy they put their lives on the line by risking an unsafe abortion," said Marjorie Newman-Williams, who directs the group's international operations. "Thousands of them die and millions more are left with life altering injuries. Agreeing to the Mexico City Policy would mean accepting their fate and turning our backs on the very women who need us most."

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Serra Sippel, president of another important advocacy group, Center for Health and Gender Equity, offers these grisly details: The Trump gag rule "targets integrated maternal health services; HIV prevention, treatment, and care; services for infections diseases like Zika and Ebola; and services for reproductive cancers, like cervical cancer," says Sippel. Under the Trump gag rule, she elaborates, a non-U.S. organization receiving U.S. global health assistance would be barred from advising a pregnant woman who contracts Zika about her pregnancy options, or referring her to a safe abortion provider if she wants to terminate the pregnancy.

By not only renewing but also expanding this harsh Republican tradition, Trump has accomplished two things, apart from pleasing the nation's anti-abortion rights lobby. He has inflicted immediate harm on vulnerable women and girls all over the world. And, at a moment when access to reproductive health care-including affordable contraception and safe abortion-is at risk in this country, Trump has given American women a window into the future he and congressional Republicans seek for them.