U.S. aid for international family planning would be eliminated.

Programs to combat HIV/AIDS in the world's poorest countries would be slashed by 17 percent.

Efforts to fight malaria would be chopped by 11 percent.

Those are just some of the cuts to global health spending called for by President Trump in the proposed budget he unveiled this week.

On one level the reductions did not come as a surprise. Trump had already made clear in his "skinny budget" proposal, released in March, that he wanted to lower spending on foreign assistance by more than a third.

Yet advocates for global health programs say they are nonetheless reeling as they pore through this week's more detailed release.

"This is an official act of the executive branch. It's not a press release," says Scott Morris, director of the U.S. Development Policy Initiative at the Center for Global Development, a Washington D.C. think tank.

He adds that the shock is all the greater in light of longstanding bipartisan support for global health spending. Overall, Trump would cut the annual global health budget by about 26 percent, or around $2.2 billion in the 2018 fiscal year that begins October 1, decreasing it from about $8.7 billion in the current fiscal year budget to less than $6.5 billion.

The program that would be hit hardest would be family planning. The U.S. currently spends $607.5 million per year to provide women in poor countries with birth control and reproductive healthcare. Trump appears to want to zero that out entirely. His budget proposal explicitly calls for eliminating the largest source of this funding: $524 million disbursed by USAID, stating that the cut "achieves further savings" to the budget.