Soon after he took office, President Donald Trump reinstated and expanded a policy known by its critics as the “global gag rule,” which bars U.S. funding for organizations abroad that perform abortions – or offer information about them.

On Thursday, a week into his presidency, Joe Biden is expected to issue an executive order rescinding the policy.

The Reagan administration first enacted its version of the rule, often called the Mexico City policy after the place where it was drafted, in 1985. Since then, two Democratic presidents, Bill Clinton and Barack Obama, have rescinded it, arguing that it put millions of women and girls at risk by cutting off access to critical health services. Two Republican presidents, George W. Bush and Donald Trump, have put it back in place, arguing that U.S. money should not go to organizations that promote abortion.

The decades of Washington-imposed whiplash have left sexual and reproductive health and rights programs around the world scrambling to secure funding – or needing to adjust the services they provide.

Here’s what you need to know about President Biden’s move.

– What is the “global gag rule”?

The policy forbids international organizations that receive U.S. health aid from using their own funds or money from another source to provide abortion services or counseling. The measure has become a “political football that is rescinded by Democrats and reinstated by Republicans,” said Bethany Van Kampen, a senior policy adviser at Ipas, an international organization focused on safe abortion and contraception access, during a call with reporters in December.

Trump broadened the funding restrictions to cover all global health aid, rather than just aid aimed at family planning. Under Trump’s expansion, the rule applied to about $12 billion in U.S. aid, said Van Kampen.

The policy is built on an preexisting base of constraints on U.S. aid recipients, such as the 1973 Helms Amendment.

– What is the Helms Amendment?

An addition to the Foreign Assistance Act passed more than a decade earlier, the Helms Amendment requires that U.S. assistance cannot be used by foreign organizations to provide abortions as part of family planning. (The “gag rule” goes further, demanding that organizations do not provide the service at all.) It covers around $40 billion dollars in U.S. aid.

As a law rather than executive order, it does not seesaw with White House turnover.

But critics say it extends in practice beyond its family planning confines.

The amendment has come to be “applied as a total ban on abortion services and information with U.S. funds,” Van Kampen said. Aid recipients may feel forced to cut services for abortions, she said, that do not fall under the category of family planning, such as in cases of rape, incest or a threat to the mother’s life.

“It causes such fear among providers and health system managers who worry that any association with abortion will jeopardize their overall U.S. funding,” she said.

– What else did Trump do to restrict abortion access globally?

In 2017, the Trump administration announced that it would eliminate funding for the United Nations Population Fund, UNFPA, for the coming year, over claims that the reproductive and maternal health agency supported abortion and forced sterilization in China. UNFPA said the charges were erroneous.

“The support we received over the years from the government and people of the United States has saved tens of thousands of mothers from preventable deaths and disabilities, and especially now in the rapidly developing global humanitarian crises,” the U.N. agency said in a statement at the time.

The United States provided $69 million in UNFPA funding in 2016. If reinstated, the money could be used to prevent 1.4 million unintended pregnancies, 32,000 unsafe abortions and provide reproductive and sexual health care to 4.2 million women and girls within a year, according to Eddie Wright, a UNFPA spokesman.

Last year, the Trump administration spearheaded the Geneva Consensus, a nonbinding international antiabortion declaration, which Biden is also reportedly set to disavow Thursday.

– What impact do U.S. funding restrictions have on abortion rates?

Worldwide, around 48 percent of pregnancies are unintended, and of those about 60 percent end in abortions, leading to some 73 million abortions every year, said Zara Ahmed, associate director of federal issues at the Guttmacher Institute, which supports abortion rights, during a call with reporters in December. Around 35 million of those women receive unsafe abortion, according to Ipas.

Studies have shown repeatedly that U.S. restrictions do not lower abortion rates. A recent report published in British medical journal the Lancet found they often led to cuts in health and reproductive services that caused increases in unsafe abortions.

“There is no evidence that abortion rates are lower where it’s restricted,” said Ahmed. “In fact, abortion rates are lowest in high-income countries were abortion is broadly believed to be legal, but almost four times higher in low-income countries where it is heavily restricted.”

– What else are international abortion rights activists pushing Biden to change?

Biden’s election marks an “unprecedented moment” in which to “repeal the multitude of harmful actions that the Trump administration took to attack sexual and reproductive rights around the world,” said Seema Jalan, executive director of the universal access project and policy at the United Nations Foundation, a nongovernmental organization that supports the U.N.

Thursday’s move is a “first step,” said Amanda Ussak, the international program director for Catholics for Choice. But she had hoped he would move even faster. “The fact that he didn’t repeal the global gag rule on day one is problematic,” she said.

Advocates have called on the Biden administration to throw its support behind the Global Health, Empowerment and Rights (Global HER) act, which would prevent future presidents from re-declaring the “gag rule,” and the Health Care Everywhere act, proposed legislation to repeal the Helms Amendment and to issue guidance clarifying that U.S. funding can be used for abortions in the case of rape, incest or a threat to life.

“For better or for worse the actions of the United States have an outsized impact around the world,” said Jalan. “This is why it such a high priority to put a permanent end to these harmful policies so that people’s access to basic health care around the world is not based on the political whims of what’s happening in the United States.”

The Trump administration’s antiabortion policies drew global support from conservative religious groups, especially evangelical Christians. Ussak’s organization, in contrast, works with faith-based groups pushing to expand abortion access, with a focus on heavily Catholic countries like Argentina, Malta and Poland.

Biden, like the majority of U.S. Catholics, according to polls, supports abortion rights, despite the official teachings of the church. Ussak said she considers “access to reproductive rights and women’s health and autonomy . . . part of Catholic social justice teaching.” Biden’s view could “help reshape the narrative” around faith and abortion in some parts of the world, she said.

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