But the State Department’s new initiative, now dubbed “Protecting Life in Global Health Assistance,” expands the amount of funding affected from $600 million to $8.8 billion, $6 billion of which comes from PEPFAR.

In its previous incarnation, the Mexico City Policy seems to have done little to reduce the number of abortions abroad. As I’ve previously written, the policy was actually associated with a reverse effect: an increase in the rate of abortions, including unsafe abortions in the countries it affected. The policy also denied funding to NGOs that provided contraception, which is believed to decrease the abortion rate by lowering the number of pregnancies in the first place.

Now, critics say the revised version of the rule could do significant harm to PEPFAR, which has been called George W. Bush’s greatest legacy.

When the executive order was announced earlier this year, J. Stephen Morrison, the director of the Global Health Policy Center at the Center for Strategic and International Studies, was concerned about the lack of clear information on how the decision to expand the policy to include PEPFAR was made, and how the potential consequences would be dealt with. Since then, he says, his feelings haven’t changed much.

“There is not a very transparent process by which we got to this point,” Morrison says, adding that some terms of the statement are likely only to cause further confusion. Morrison sees the executive order as a move meant to appeal to more conservative evangelicals within Donald Trump’s base, who are in support of curbing abortion both in the U.S. and abroad. “This is political theater,” Morrison contends—a move that he believes dovetails with Trump’s recent executive order promoting “religious freedom” and his commencement address at Liberty University, a conservative-leaning evangelical college.

Elizabeth Radin, an epidemiologist at Columbia University, echoed a common concern among experts that the policy would create a chilling effect: Amidst the confusion about the policy’s particulars, and a fear among local organizations that they may get the facts wrong, NGOs might self-censor and limit the services they provide for fear of losing funding. As the author Jill Fillipovic has written, “what it means to ‘actively promote’ abortion is vexing.”

A senior State Department official, who spoke on the condition of anonymity to offer more transparency about potentially sensitive matters within the department, says that the State Department is aware of the worries of global-health experts like Radin. “I understand that concern,” the official says. “What I can’t tell you is who will sign and who will not sign [and agree to these new terms]. And until that happens, I won’t know if that concern is borne out.”

The official adds that the while the policy will restrict funding to NGOs in the countries the U.S. has partnered with through PEPFAR, it won’t affect funding to these countries’ governments themselves—which means, for instance, a government-run hospital in South Africa, a partner country in which abortion is completely legal, would be unaffected. The policy will also exempt some aid organizations formed between multiple countries, like Gavi (the Global Vaccine Alliance) and the Global Fund, Morrison says. (These exceptions total one-third of PEPFAR funds.)