The Trump administration said just four out of 733 organizations that have received US funding to deliver health services have turned down US grants rather than accept new rules that forbid the US providing aid to promote or perform abortions overseas.
Advocates said that claim drastically downplays the impact of the new rules, which they say will have "far-reaching and deadly" effects, limiting access to health care and HIV/AIDS treatment, among other services, and ultimately contributing to a rise in unsafe abortions.
The so-called "Mexico City Policy," implemented on and off since 1985, has conditioned US funding for global family planning on a commitment from NGOs that they won't promote or perform abortions using funds from any source.
The Trump administration has drastically expanded the rule to apply not just to funding for family planning, but all global health assistance, including funding for HIV/AIDS, maternal and child health, malaria, nutrition and other programs.
State Department officials weren't able to say how much money the four groups would have received, or how much money will go to the groups that agreed to the conditions. The rules haven't yet been applied to another 500 NGOs, but will be before the end of this fiscal year, the officials said.
A report posted on the agency's website said that even if aid groups refused to comply with the policy, the amount of funding directed to recipient countries would remain the same. It is "too early to analyze systematically what effect, if any, this will have on programming," the report said.
But international aid groups disagreed, pointing to reproductive health clinics that have already had to close and outreach teams that have been scaled back, leaving women with no access to health services.
Marie Stopes International, which works in 37 countries to help women "have children by choice, not chance," was one of the groups that declined to accept the new rules.
Their resulting $80 million shortfall in funding will lead to 6,900 avoidable maternal deaths, 870,000 unsafe abortions and 2.5 million unintended pregnancies, the group said. Already, it said, clinics and projects in Madagascar, Uganda and Zimbabwe have been scaled back.
"This will damage not just women's health and their opportunities for the future, but the longer-term economic prospects and stability of the world's poorest countries," said Marjorie Newman-Williams, the group's director of external affairs.
Latanya Mapp Frett, the executive director of Planned Parenthood Global, another group that refused to accept the new rules, said in a statement that the State Department was telling "a misleading story that President [Donald] Trump wants the public to hear.... The Trump-Pence administration has taken unprecedented steps to expand a lethal policy that deprives women around the world of the right to health care and full information to plan their futures."
The State Department did not respond to requests for comment about the criticism.
The newly expanded rule affects assistance totaling more than $8 billion in fiscal year 2017, with family planning assistance accounting for about $600 million of the total, according to the Kaiser Family Foundation.
Where the rule formerly covered programs run by the State Department and the US Agency for International Development, it now also encompasses the Defense Department as well.
State Department officials said an initial six-month review of the policy found that, "prime partners declined to agree to the conditions of the policy in only four instances out of the 733 awards."