The Trump administration has announced it is expanding a ban on US aid to foreign groups that promote or provide abortions overseas.
The expanded rules on the so-called Mexico City policy will now apply to organisations that comply with regulations but give money to others that don't, Secretary of State Mike Pompeo announced on Tuesday.
He also said the US would cut some funding for the Organisation of America States because at least one of its affiliated institutions has lobbied for abortion availability in the Western Hemisphere.
Mr Pompeo said the administration was committed to protecting "the sanctity of life" of the US and abroad and would enforce the policy "to the broadest extent possible" by not allowing foreign non-governmental organisations to skirt the ban.
"We will refuse to provide assistance to foreign NGOs that give financial support to other foreign groups in the global abortion industry," he told reporters at the State Department.
"We will enforce a strict prohibition on backdoor funding schemes and end runs around our policy. American taxpayer dollars will not be used to underwrite abortions."
Abortion rights advocates slammed the decision as dangerous to women's health while abortion opponents welcomed it.
The move is an expansion of the so-called "Mexico City policy", first established under President Ronald Reagan but rescinded by subsequent Democratic administrations.
Just days after taking office in 2017, President Donald Trump reinstated the policy and then expanded it to include all health programs not just reproductive health ones.
Critics of the policy that has been a hallmark of Republican administrations call it the "global gag rule."
They say it hurts reproductive and maternal health care in developing nations by cutting funds to groups that offer critical non-abortion related services to women and children, including birth control and nutritional support for infants and HIV/AIDS treatment.
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Mr Pompeo denied that and said the US would continue to be a leader in such aid. The US spends some $9 billion to support global health programs.
Critics, however, expressed outrage, with Dr Leana Wen, the president of the Planned Parenthood Federation of America, branding the decision "unethical, dangerous and unacceptable".
"This administration's obsession with attacking women's reproductive health is egregious and dangerous," she said.
"Further expanding the global gag rule puts international organisations in an impossible position: provide women the full scope of reproductive health care services or deny critical funding that saves lives."
Brian Dixon of the Population Connection Action Fund said Mr Pompeo's decision was "repulsive."
"The global gag rule has been an unmitigated disaster for people throughout the developing world," he said. "It is undermining progress on maternal and child health. It is leaving millions of people without access to health care."
However, Susan B. Anthony Fund, an anti-abortion group, issued a statement praising the step, saying it was "excited to see Secretary Pompeo taking additional steps to ensure that Americans' hard-earned dollars are actually used for health assistance, not funnelled to groups that push abortion."
Jeanne Mancini, president of March for Life, said Mr Pompeo's "courageous leadership on the implementation of this policy will assure its proper oversight and help advance the protection and empowerment of human persons at all stages in our international global health assistance initiatives."
In addition to the revision of the Mexico City rule, Mr Pompeo said the administration would also start to enforce legislation that bars all US funds from being used to lobby for or against abortion.
As the first step in enforcement, support for the Organization of American States would be reduced by $210,000, State Department spokesman Robert Palladino told reporters later.
Mr Pompeo said the step came as a result of some OAS institutions promoting greater access to abortion in the Americas.
"The institutions of the OAS should be focused on the crises in Cuba, Nicaragua and in Venezuela and not advancing the pro-abortion cause," Mr Pompeo said.
