The U.S. has fallen from 43rd to 45th out of 180 countries on the World Press Freedom Index—due in no small part to President Donald Trump and his routine attacks on the press, according to a report released on Wednesday by Reporters Without Borders.

“In 2017, the 45th President of the United States helped sink the country to 45th place by labeling the press an ‘enemy of the American people’ in a series of verbal attacks toward journalists, attempts to block White House access to multiple media outlets, routine use of the term ‘fake news’ in retaliation for critical reporting, and calling for media outlets’ broadcasting licenses to be revoked,” the report from RWB read.

Countries like Germany and South Africa are ranked higher than the U.S., while nations like North Korea, Russia, and Myanmar—whose leaders called the persecution of Rohingya Muslims “fake news”—fall on the bottom half the list. In 2016, the U.S. ranked at number 41 on the press-freedom index.

The new report points out that Trump often singles out journalists and news outlets. Last week, the president attacked Maggie Haberman, a Pulitzer-prize winning journalist at The New York Times, calling her a “third rate reporter and a “Hillary flunky.” Trump also claimed he has never spoken with Haberman, who broke multiple stories based on statements from the president and his associates.

Trump's public disdain for the media has been echoed by his supporters. Last year, Guardian reporter Ben Jacobs was body-slammed by Congressman Greg Gianforte (R-MN) for asking a question about the Republican’s health-care plan. “Get him the hell out of here,” Gianforte reportedly said after lashing out at Jacobs.

In January, the Republican National Committee held the inaugural “fake news awards,” dishing out honors to The Times and CNN, frequent Trump targets. The RNC website crashed when the awards debuted.

“The US’ decline in press freedom is not simply bad news for journalists working inside the country; the downward trend has drastic consequences at the international level,” the RWB report says. “‘Fake news’ is now a trademark excuse for media repression, in both democratic and authoritarian regimes.”