At a small health center in Lagos, Nigeria, a nurse advises women on how to have a healthy pregnancy. The center is supported by the U.N. Population Fund. (Ruth McDowall for The Washington Post)

President Trump’s executive order to block U.S. aid to groups abroad that counsel or provide referrals about abortion went into effect Monday and will restrict nearly $9 billion in foreign health assistance.

The rule, which has reproductive-rights advocates reeling, is significantly broader than similar bans in place intermittently since 1984. Those past actions were limited to about $600 million in family planning funding.

Senior administration officials confirmed Monday that Trump’s version will impact $8.8 billion for programs, including those related to AIDS, malaria and child health. About $6 billion of that supports programs for HIV/AIDS services, primarily in Africa, as part of the President’s Emergency Plan for AIDS Relief established in 2003. Another program that could be hit hard is the President’s Malaria Initiative, started under George W. Bush and expanded under Barack Obama. Defense Department grants related to global health security will also be impacted.

The new policy, which is being called “Protecting Life in Global Health Assistance,” affects any organization deemed to promote abortion “as a method of family planning” through abortion counseling, referrals, lobbying or public information campaigns. Trump has said taxpayer dollars should not be used for this purpose.

Women’s rights and family planning groups that oppose the ban have said the result could be catastrophic, resulting in the closure of critical health-care centers around the world. Some health-care providers have expressed concern that without referrals for care, more women could seek dangerous abortions; in some parts of the world, women have been known to drink battery acid and use wire coat hangers.

Women’s health experts also cite a 2011 study by Stanford researchers that shows similar policies may be linked to an increase in abortion rates in sub-Saharan African countries — the exact opposite of the outcome Trump and antiabortion advocates of the rule are seeking.

It is expected to take several months before the new policy’s impact is fully felt on the ground.

Organizations will have to agree to the new rule whenever they receive a new grant or take any extra money for an existing contract, or they will lose the funding. Administration officials, who would only discuss the policy on condition of anonymity, said money could be “redirected” to other organizations offering similar health services. It won’t be known which organizations could benefit, they said, until the groups with existing contracts decide what to do.

The officials said they do not expect any reduction in overall aid for global health programs. The United States is by far the largest funder of such assistance.

The administration policy does not prohibit referrals for terminating a pregnancy caused by rape or incest or for one that endangers the woman’s life. In addition, humanitarian assistance will be exempt, and there will be a mechanism in place for other exemptions on a case-by-case basis.

Originally known as the “Mexico City policy” because it was first introduced by the Reagan administration during a meeting there, some form of the global gag rule, as it’s commonly called, has been in effect for about half of the past 34 years — rescinded by Democratic presidents and reenacted by Republican ones. In the months since Trump announced the rule’s expansion, there had been much speculation and uncertainty about the specifics of what activities would be prohibited and how restrictive they might be.

Among the largest groups to face defunding is the U.N. Population Fund (UNFPA), which operates in more than 150 countries. The administration has cited the fund’s work with the Chinese government, which runs programs involving coerced abortion and forced sterilization, as the reason it would fall under the policy. The U.N. agency has characterized this argument as “erroneous.”

“We prevent unwanted pregnancies, we prevent abortions, and we prevent maternal death,” Eugene Kongnyuy, deputy representative for the U.N. agency in Nigeria, said in an interview earlier this month. “UNFPA has never and does not currently support abortion in any country, including China.”

On Monday, both supporters and critics of the policy came out in full force. Marjorie Dannenfelser, president of the Susan B. Anthony List, which supports politicians who oppose abortion, characterized the policy’s expansion as a way of modernizing it.

“This executive order does not cut a single penny from U.S. aid, rather it 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. Abortion is not health care,” she said in a statement.

Democratic Reps. Nita M. Lowey, Eliot L. Engel and Louise M. Slaughter of New York and Barbara Lee of California marked the rule’s start by calling it “a cruel and unprecedented attack on the world’s most vulnerable women.” They argued that it undermines U.S. “moral leadership abroad” and could end access to critical health-care programs.

Read more:

Trump reverses abortion-related U.S. policy, bans funding to international health groups

Trump’s revival of the antiabortion ‘gag rule’ could have a big impact in Africa