The Trump administration is ordering 46 states and territories to eliminate content on gender ideology, including transgender and nonbinary identities, from public school sex education curricula within the next two months.

The Department of Health and Human Services order directs 40 states and six territories, including Washington, D.C., and Maryland, to remove content related to gender ideology as defined in President Donald Trump’s Day One executive order prohibiting federal funding for anything that does not affirm the concept of binary biological sex.

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Together, the states could lose more than $81 million in federal sex education funding under the Personal Responsibility Education Program from the Administration for Children and Families at HHS.

Acting HHS Assistant Secretary Andrew Gradison said in a press release on Tuesday that “accountability is coming” for states that are not in compliance with the Trump executive order on biological sex.

“Federal funds will not be used to poison the minds of the next generation or advance dangerous ideological agendas,” Gradison said. “The Trump Administration will ensure that PREP reflects the intent of Congress, not the priorities of the left.”

In June, the ACF warned California that it had 60 days to remove gender ideology references from its sex education programs, with which Gov. Gavin Newsom (D-CA) did not comply. The ACF terminated funding for California’s PREP last week.

The Education Department also announced last week new measures that place several northern Virginia school districts, including Loudoun, Fairfax, Prince William, Arlington, and Alexandria, under “high risk” of losing federal funding after they defied federal demands to change their bathroom and locker room policies that allow transgender-identifying students to use the facilities of the opposite biological sex.

It is not just Democrat-led states that are poised to lose funds if they do not take action.

Several red-majority states, including but not limited to Alabama, Louisiana, Montana, Nebraska, South Carolina, Utah, and West Virginia, also have PREP curricula that HHS has determined are not in compliance with the Trump gender executive order.

The Washington Examiner obtained copies of the letters sent from HHS to the 46 states and territories. Each letter highlights detailed portions of the state’s curriculum that are not in compliance with the executive order, down to the page and line number.

For example, the Washington, D.C., curriculum includes the goal of being able to identify and define all of the acronymed identities in LGBTQIA+.

One activity in the curriculum instructs educators to mention that there are 20 states that do not have laws prohibiting discrimination against sexual orientation or gender identity, telling teachers to ask students, “Which states do you think they are?”

Other states have comparatively minor infractions, such as Alabama’s instruction to ask and use preferred pronouns, or West Virginia’s distinction between gender identity and gender expression.

Public health experts say these programs are vital for preventing the spread of sexually transmitted infections and curbing teenage pregnancy rates.

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Teenage pregnancy rates in the U.S. have declined by about 77% in the past 30 years.

HHS did not respond to a request for comment on the possible negative public health consequences of withdrawing funding.