One of Donald Trump’s first acts as President of the United States has had far-reaching consequences, because the executive order he signed on January 23, 2017, explicitly denies aid to any foreign organization that promotes, performs, or offers any information on abortion.

According to the Washington Post, a policy similar to this one has been in effect under multiple Republican presidents. However, Trump’s version opens it up from affecting the $600 million in overseas family planning funds to the entire $8.8 billion in global aid money.

This forces entities which perform vital services for underserved countries to take a vow not to promote or otherwise encourage abortion so that they can continue to receive necessary American aid money. The central issue with this policy is that it is often difficult to untangle abortion-related services from general health care programs in poorer nations.

Aisa Russell, the executive director of Health GAP, a global AIDS and human rights advocacy group based in Uganda, told the Post, “This is now a massive, potentially devastating experiment with people’s lives.”

In Madagascar, a prime example of the problems created by Trump’s policy is rearing its head. That country is especially vulnerable under this policy because they have very few foreign donors. Madagascar’s director of the family health division Marie Georgette Ravoniarisoa told the Washington Post that “there are still many women in Madagascar who want contraception but don’t have it… Marie Stopes was beginning to reach more of them, but it looks like the Trump administration will make things go backwards.” In the city of Betsingilo, Stopes is the only provider of family-planning services and the group works out of a mobile clinic. Last year, a woman identified as Nana traveled 8 miles on foot to a Stopes clinic to become the first woman in the city with long-term contraception, an implant in her arm that can last up to three years.

Anti-abortion activists such as Cardinal Timothy M. Dolan, head of the U.S. Conference of Catholic Bishops’ Committee on Pro-Life Issues, praised Trump signing the executive order, saying “This is a welcome step toward restoring and enforcing important federal policies that respect the most fundamental human right — the right to life.” However, a 2011 Stanford study suggests that the policy was “associated with increases in abortion rates in sub-Saharan African countries.” This may be because when organizations which provided contraceptives lose funding, it leads to more unwanted pregnancies, according to the researchers.

Some groups have refused to sign the agreement because of their own moral obligations. President of Marie Stopes’ U.S. division Majorie Newman-Williams told the Washington Post, “It was painful, but at the end of the day, it was a no-brainer not to sign… The right to safe abortion is core to our mission. To sign it would’ve been walking away from who we are.” But most groups will sign the agreement to claim funds. The administration defended the policy in a statement reading, “when we design programs to end malaria or HIV/AIDS or maternal mortality, we don’t intend to fund the abortion industry.”