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resident Trump on Monday reinstated a US policy preventing foreign nonprofit groups that receive federal funds from administering abortions or providing abortion counseling or referrals.

Originally enacted by President Ronald Reagan in 1984, the “Mexico City Policy” was rescinded by Bill Clinton and Barack Obama — and reinstated by George W. Bush and now Donald Trump — in the first days of each new administration.

Known as the “global gag rule” by pro-abortion rights groups, the Mexico City Policy goes a step further than existing legislation, which prevents federal dollars from being used for abortions. Instead, it prevents organizations that receive any federal funds from paying for their own abortion programs.

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Existing legislation known as the Helms Amendment already prevents federal funding of foreign abortions “as a method of family planning,” a restriction abortion rights advocates say has led to excessive interpretation. George W. Bush’s administration clarified that the amendment exempted abortions performed in cases of rape, incest, or when the mother’s life would be endangered by the pregnancy.

Trump’s move forces nonprofit groups to choose between cutting abortion services altogether or looking to fill a major budget gap left by the withholding of federal dollars.

Marie Stopes International, a group that provides contraceptive and abortion services, says it gave 2,843 general and gynecological checkups and performed 586 contraceptive implant insertions in the wake of the 2015 earthquake in Nepal. Those procedures, it says, would not have been possible without US federal aid.

Ipas, an international abortion rights and women’s health NGO, estimates that women in more than 40 countries receive services made possible through US-funded family planning and reproductive health programs.

Other restrictions on US federal funds for organizations that provide abortion, Ipas says, have “led to fragmentation of basic health services.”

The executive order comes as part of a broader salvo on federally funded abortion and contraceptive coverage.

Separately, a bill under consideration by the House rules committee aims to change the Hyde Amendment, a provision in annual appropriations bills that prohibits federally funded abortions, into permanent law. The proposal would also make employers with insurance plans that cover abortion ineligible for tax credits under the Affordable Care Act.

Trump also issued an executive order on Friday that, depending on how the Department of Health and Human Services interprets it, could eliminate the ACA requirement that private insurers include contraception in their coverage.

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An earlier version of this story incorrectly stated that President George H.W. Bush reinstated the “Mexico City Policy” in the first days of his administration. It was standing policy when he succeeded President Ronald Reagan.

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