Women and children will die after the Trump administration instituted a new "global gag rule" that blocks aid groups from providing information about abortions if they receive US funding, it has been claimed.
The restriction now applies to groups receiving US funds to fight HIV/Aids or even malaria and covers nearly $9 billion (£7 billion) in aid, rather than the $600m (£465 million) restricted by the original Mexico City Policy.
The Mexico City rules, brought in by President Ronald Reagan, force NGOs to agree to "neither perform nor actively promote abortion as a method of family planning in other nations" if they want to apply for federal funds.
Suzanne Ehlers, president of the PAI reproductive health NGO, said the move would "cause unspeakable damage to integrated care efforts across all health sectors". She added: "It will cost many around the world their lives, especially women."
PAI said the rules — dubbed the Protecting Life in Global Health Assistance programme — would cause unsafe abortions, unintended pregnancies and child mortality to rise.
Shannon Kowalski, policy director at the International Women's Health Coalition, called the programme "cruel and unusual punishment".
She told The Independent: "Instead of protecting life, it will increase maternal deaths by putting essential sexual and reproductive health care out of reach for far too many women."
The International Planned Parenthood Foundation said it was "set to lose $100m (£776,000)" and that the expansion, called for by Mr Trump in a January executive order, "will have devastating effects on HIV, family planning and maternal health programmes". It claimed 20,000 new mothers could be at risk of dying.
Nisha Varia, women's rights advocacy director at Human Rights Watch, told The Independent Mr Trump's move "hurts the international standing of the US".
She said: "It shows that the US is willing to ignore evidence at the cost of women and girls’ lives, and to exploit its role as an important donor to impede freedom of speech and the private relationship between doctors and their patients.
"This policy undermines the global campaign to end maternal mortality, which is largely preventable. If we look at the effects of previous versions of this policy, we know it meant more unplanned pregnancies, more abortions, and more maternal deaths.
"This time, far more is stake, since the restrictions will affect critical health services on HIV, malaria, and newborn and maternal health. The restrictions will hurt everyone — women, men, girls, and boys."
A State Department official told reporters Mr Trump believed "US taxpayer money should not be used to support foreign organisations that perform or actively promote abortion as a method of family planning in other nations".
Clarifying what constituted "family planning", they added: "Referrals for the termination of a pregnancy in cases of rape, incest, or endangerment of the life of the woman are not prohibited under this policy."
They said: "The United States remains deeply committed to supporting health programmes around the world. This change will have no impact on the total amount of US Government funding for health programmes around the world.
"Departments and agencies will reprogramme to other organisations any funding they would have awarded to NGOs that do not agree to the terms."
Last month, leaked State Department budget documents showed that for 2018 Mr Trump's administration was planning to axe its Office of Global Women's Issues. The office promotes the rights and empowerment of women and girls, and aims to include them in how US diplomacy is conducted.
Charities including Oxfam and the Global Fund for Women reacted with outrage to the news, while Tarah Demant, senior director of Amnesty’s identity and discrimination unit, told The Independent the plan was "a clear middle finger to women globally".
Since it was unveiled by President Reagan in 1984, the Mexico City Policy has been routinely rescinded under Democratic administrations and reinstated under Republican ones, and is used by presidents to signal where they stand on abortion rights.
President Trump, a Republican, reinstated the policy in January, just days after taking office, but he went further and directed government agencies to apply it "to global health assistance furnished by all departments or agencies".
The Trump administration has taken a staunchly anti-abortion stance since its earliest days. In January Vice President Mike Pence addressed the March for Life in Washington, and Mr Trump tweeted his "full support". Mr Pence, a devout Christian, told demonstrators: "Life is winning again in America."
February saw the leak of a draft order that would have enshrined a slew of conservative Christian beliefs, including that life begins at conception, in executive policy. The eventual incarnation of the order did not include that language, however.
However, the "global gag rule doesn't reduce abortion," Ms Demant claimed in an email to The Independent, because "US law already restricts US foreign assistance dollars from paying for abortion as a method of family planning".
She added: "What it does do is threaten the lives and health of countless communities by poisoning the water of US foreign aid.
"Any clinic, any hospital, any nutrition program that receives US foreign assistance dollars will now be required to certify that it doesn’t even give information about safe abortion or tell women where they can find out about abortion."
The expansion "threatens to exclude some of the most effective health organisations in 60 low and middle income countries," she said.
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