Abortions rose by about 40% in aid-reliant African countries when President George W. Bush implemented a global anti-abortion policy, researchers said on Thursday, as U.S. lawmakers battle over a repeal of the controversial rule.

The policy, employed by Republican presidents, bans groups such as health clinics and charities from discussing abortion if they want to receive U.S. aid.

Many have been forced to close because they refuse to accept the restriction, according to reproductive rights experts.

“Our analysis is the first to demonstrate that the … policy is followed by increased abortions – likely unsafe abortions,” said the study by Stanford University researchers in The Lancet Global Health journal, describing the policy results as “undesirable and unintended.”

The U.S. Agency for International Development (USAID), which administers aid, was not immediately available to comment.

A USAID spokeswoman said earlier this month that the government under the policy was making sure it did not fund groups that “perform or actively promote abortion as a method of family planning”.

Used by U.S. presidents since 1984 to signal their stance on abortion rights, the rule has been backed by Republicans – including Bush from 2001 to 2008 – and revoked by Democrats.

President Donald Trump reinstated the rule in 2017.

Democratic lawmakers voted this month to repeal it in a spending bill that is set to be opposed by Republicans, who control the Senate.

When the policy was in place in the Bush era, modern contraception use declined by 14% and pregnancy rates rose 12% in Sub-Saharan countries most reliant on U.S. family planning aid, the study found.

Looking at 26 African countries, the researchers measured the abortion increase in those getting the most U.S. aid for family planning and reproductive health.

When the policy was rescinded by Democratic President Barack Obama, the pattern reversed, with higher contraceptive use and fewer abortions, it said.

Previous studies have said the policy forced the closure of health clinics, outreach programs and refugee services by charities, risking the health of millions of women.

A report by the International Women’s Health Coalition (IWHC) this month said the policy under Trump has led to deaths from botched abortions and cut care to HIV-infected orphans.

“This brings into really sharp focus what we’ve known for some time, which is the policy has the exact opposite of its stated impact,” said Nina Besser Doorley, IWHC senior program officer for U.S. foreign policy.

“Efforts to restrict abortion don’t decrease the incidence of abortion. They just make it harder, they make it more unsafe, they drive it underground.”

REUTERS