The Trump administration announced a massive expansion Monday of the pro-life Mexico City Policy, issuing guidelines that will strip billions of dollars in aid from international groups that perform or promote abortion.

Originally a ban covering roughly $600 million in family planning money, the Trump policy now applies to all international health care aid doled out by the U.S. government — nearly $9 billion.

The administration said the same amount of money will be paid out but will go only to groups that pledge not to perform or promote abortion as part of their family planning activities.

Secretary of State Rex W. Tillerson on Monday approved the Protecting Life in Global Health Assistance plan, which broadens the scope of the Mexico City Policy.

First announced by President Reagan in Mexico City in 1984, the policy has been in effect during Republican administrations and suspended by Democratic presidents, including Barack Obama. President Trump restored the policy this year, then plowed new ground with Monday’s expansion.

“We applaud the Trump administration for not just stopping the pro-abortion policies of the Obama era, but putting in place policies that will reverse the destructive and immoral trends of the last eight years,” Tony Perkins, president of the pro-life Family Research Council, said in a statement.

The policy now covers money spent on malaria-fighting efforts, maternal health programs and the AIDS-fighting program started by President George W. Bush.

Administration officials said it was too early to determine which international organizations will lose access to the money because they won’t comply with the policy.

“I direct the Secretary of State, in coordination with the Secretary of Health and Human Services, to the extent allowable by law, to implement a plan to extend the requirements of the reinstated Memorandum to global health assistance furnished by all departments or agencies,” the executive memorandum reads.

Critics of the Mexico City Policy have dubbed it the “Global Gag Rule” and argue that it will force organizations to choose between providing health care services and performing abortions.

Sen. Jeanne Shaheen, New Hampshire Democrat, said Mr. Trump’s “dangerous obsession with rolling back reproductive rights” will have “severe consequences for millions of vulnerable women and children.”

“Today, the Trump administration confirmed our worst fears regarding this new, drastically expanded global gag executive order,” Ms. Shaheen said in a statement. “This administration’s pathetic rebranding of this policy is a thinly veiled attempt to hide the tremendous harm it has around the world.”

Ms. Shaheen said the policy’s reinstatement underscores the need to pass her Global Health, Empowerment and Rights Act, which would permanently repeal the rule.

Even during Democratic administrations, American money was not supposed to be used to directly fund abortions — though groups that provided abortions were allowed to collect U.S. funds for other purposes.

Pro-life activists said the money ended up being mixed anyway.

Organizations affected by the policy include Marie Stopes International Uganda, which says 94 percent of its outreach work is funded by the U.S. Agency for International Development, and the International Planned Parenthood Federation, which stands to lose $100 million in annual funding.

Marjorie Dannenfelser, president of the pro-life Susan B. Anthony List, said the policy does not “cut a single penny from U.S. aid” but “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.”

She said this is exactly why “pro-life voters worked to elect Donald Trump to the White House” in November.

“With the implementation of Protecting Life in Global Health Assistance, we have officially ceased exporting abortion to foreign nations,” Ms. Dannenfelser said in a statement. “No longer will we undermine the pro-life laws and cultural commitments of other countries by funding organizations like Marie Stopes International that obsessively promote and perform abortion.”

A Marist poll in January found broad support for the Mexico City Policy, with 83 percent of respondents agreeing that tax dollars should not be used to promote abortion overseas.

The policy is another pro-life victory for Mr. Trump during his first months in office, along with his appointment of pro-life Justice Neil M. Gorsuch to the U.S. Supreme Court.

But the president still has a long way to go toward fulfilling all of his campaign promises.

The effort to defund Planned Parenthood, for instance, has been sidetracked by Republican infighting over the Obamacare repeal bill. In order to avoid a government shutdown, Mr. Trump last month signed a short-term spending bill that will continue to fund the abortion giant through September.

Mr. Trump also has promised to sign into law the Pain-Capable Unborn Child Protection Act and a permanent Hyde Amendment.

Mr. Perkins said he is looking forward “to continuing to work with the Trump administration in bringing about a culture of life in which every child is welcomed into this world and protected under our laws, both here and abroad.”

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