The U.S. Department of Health and Human Services on Tuesday asked 46 states and territories to remove all references to gender ideology from a federally funded program that provides sexual health education, or risk losing millions in funding.

The directive, issued through the agency’s Administration for Children and Families (ACF), gives the states and territories 60 days to revise materials used in the Personal Responsibility Education Program (PREP).

The PREP program educates young people on abstinence and contraception to prevent pregnancy and sexually transmitted infections, with particular focus on children who are homeless or living in foster care or in areas with high teen birth rates.

The states and territories include Alabama, Massachusetts, New York, Puerto Rico, Guam and Washington, D.C.

Last week, the HHS terminated California’s federal PREP grant, citing the state’s refusal to remove “radical gender ideology” from its curricula.

The PREP statute “includes no mention of gender ideology, which is … irrelevant to teaching abstinence and contraception,” the ACF said in its letter to California.

Failure to comply with the directive could result in similar enforcement actions, including suspension or termination of federal PREP funding, the HHS said on Tuesday.

Overall, the 46 states and territories have about $81 million in remaining funds.

In a series of executive orders, Republican President Donald Trump has banned transgender people from serving in the military, barred transgender girls and women from competing in female sports and ordered an end to federal funding for school programs that include “gender ideology.”

—

(Reporting by Sneha S K in Bengaluru; Editing by Alan Barona)