JOHANNESBURG (AP) — President Donald Trump’s dramatic expansion of a ban on U.S. funding to foreign organizations that promote or provide abortions has left impoverished women around the world without treatment for HIV, malaria and other diseases, health groups say, calling it “devastating” because Trump went where no administration had gone before.

Trump in his first working day in office revived the so-called global gag rule. He expanded on previous versions so that for the first time foreign NGOs that even discuss abortion as an option are barred not only from about $575 million in U.S. family planning funds but also an estimated $8.8 billion in U.S. global health aid. And they must certify that none of their non-U.S. funding goes for abortion related activities.

Today marks one year since Trump’s decision, and health organizations are sharing the first effects of the shift by the United States, the world’s largest health donor. The Trump administration, cheered by anti-abortion groups such as the Susan B. Anthony List for no longer “exporting abortion,” is expected to release its own assessment.

Last week, London-based Marie Stopes International announced it faces a funding gap of $80 million in the 37 countries where it works, with more than 2 million women risking the loss of contraception services. About 870,000 risk unsafe abortions.

Africa has been hardest hit. In Zimbabwe, where the health system is in tatters amid a plummeting economy, Marie Stopes has cut in half its outreach sites from 1,200 to 600.

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