According to the report, eight of the 1,340 prime awardees — those with direct agreements with US departments or agencies — opted not to comply with the policy from May 2017 to September 30, 2018. The majority of award recipients did “not experience a disruption in the delivery of health care or significant delays in implementation,” the report added.

In fiscal year 2016, International Planned Parenthood Foundation and Marie Stopes International together represented less than 0.5% of the Department of State’s Global Health Programs implemented by the US Agency for International Development.

Forty-seven sub-awardees — groups that indirectly get funding from US departments or agencies — also declined the conditional funding. Of those 47 groups, all of which received aid through USAID, 12 “reported a gap or disruption in the delivery of health care as a result of a declination,” according to the report.

“USAID found that, in a few cases, the declination resulted in some impact on the delivery of health care, including for HIV/AIDS, voluntary family planning/reproductive health, tuberculosis, and nutrition programming,” the report says of the 12 sub-awards and three prime awards affected, before explaining that health services in entire countries in sub-Saharan Africa were affected.

Nonprofits in sub-Saharan Africa were the most affected, with 32 of the 47 sub-awardees located in the region — more than any other region noted in the report.

Lapses in aid

When USAID was unable to find other partner organizations to continue work done by International Planned Parenthood Foundation and Marie Stopes International — which lost awards dating back to 2014 of more than $145 million — several African countries saw lapses in aid.

“In the Republics of Liberia and Togo, for example, no other partners that operate in country are prepared to implement integrated, voluntary family planning through both mobile outreach and local fixed clinics, as IPPF affiliates had been doing,” the report stated. “In the Federal Republic of Ethiopia; the United Republic of Tanzania; and the Republics of Mali, Madagascar, and Sénégal, Missions needed additional time to identify other organizations to implement voluntary family-planning interventions that MSI had been performing.”

Tuesday’s report — the second such review of the policy, which was ordered “to enable a more thorough examination of the Policy’s benefits and challenges” — joins previous accounts demonstrating the policy’s significant consequences.

David Gootnick, the author of the GAO report, told CNN in March that “according to the State Department, USAID would have had to reprogram the money, but they were unable to tell us exactly where those reprogrammed funds went.”

Gootnick said Wednesday that “we still don’t have any information about the extent to which that 152 million was reprogrammed, and to where it might have gone.”

A State Department spokesperson told CNN on Thursday that the funding “identified in the GAO Report was reprogrammed to other organizations.”

The spokesperson did not specify which organizations when asked where the funds were reprogrammed, asserting that the policy “does not change funding levels for (global health) programs by one dollar.”

Trump’s anti-abortion stance

Reproductive rights groups slammed the policy following the report’s release.

“Study after study has demonstrated that this policy has inflicted a crushing blow to health care access for people around the world, especially those who already face systemic barriers to care,” Monica Kerrigan, executive director of Planned Parenthood Global, said in a statement.

“No matter how much the State Department attempts to minimize the policy’s true impact, its latest report demonstrates what we already knew: the global gag rule is disrupting health care access for communities around the world, which is especially critical now as we face the COVID-19 pandemic,” she added.

Zara Ahmed — associate director for federal issues at the reproductive rights research group the Guttmacher Institute — said Tuesday that “while numerous studies have documented the policy’s harms, there is no evidence — none — that the global gag rule has had any positive impacts. The Trump administration’s own report released today confirms tangible harm around the world.”

But the administration asserted that the report and policy exemplified Trump’s strong anti-abortion stance without limiting access to health care resources.

“Contrary to claims from the left, report shows that the President’s policy has not hindered women’s health programs,” the White House press office said in an email to reporters Tuesday, characterizing the report as “further demonstrating the President’s clear commitment to protecting the sanctity of life.”

In a statement Tuesday, a State Department spokesperson told CNN that the 47 groups that refused US funding rather than comply with the administration’s restrictions were “out of hundreds of sub-awards.”

“This Administration has shown that we can continue to meet our critical global health goals, including providing healthcare for women and addressing such diseases as HIV/AIDS, while ensuring US taxpayer funding does not support foreign non-governmental organizations performing or actively promoting abortion as a method of family planning,” they added.

This story has been updated with comments from a State Department spokesperson.