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No fewer than 11 states and a pair of regions have complied with a new directive from the Trump administration to remove mentions of gender identity and the presence of trans and non-binary people from a federal sexual health program, officials confirmed.

The administration set a Monday deadline for stripping these mentions, threatening the loss of substantial government funding. Almost every of the agreeing jurisdictions have Republican-controlled state legislatures and predominantly GOP state leaders.

Legal Challenges and Financial Conflicts

An additional sixteen jurisdictions and the nation's capital have filed a lawsuit challenging the administration's demand, claiming it infringes on legislative power, which created the $75m sexual health initiative, known as the PREP initiative.

All jurisdictions involved in the legal challenge are governed by Democratic state executives.

In a recent court order, a U.S. judge blocked the HHS agency, which oversees Prep, from cutting financial support to the suing jurisdictions if they refuse to comply.

“The agency does not demonstrate that the updated requirements are justified, nor does it offer any valid reason, other than an excuse, for its actions,” wrote Ann Aiken, a U.S. district judge in the state. “The department offers no proof that it made factual findings or considered the statutory objectives.”

Initiative Aims and Federal Review

The program aims to educate teenagers on positive interactions and how to avoid unplanned parenthood and the transmission of STIs.

In April, the federal government demanded all states and territories receiving program money to submit a version of their educational materials to HHS and its agency, the ACF office, for a health content assessment.

By late summer, the government dispatched notices to 46 states and territories, informing them that, during the evaluation, it had discovered “material in the curricula that deviate from the purview of the program's legal framework.”

In particular, the administration said it had uncovered evidence of “gender-related concepts,” a term often used by rightwing groups to describe the idea that gender is a fluid social construct and that transgender individuals exist.

Notable Cases of Required Alterations

The government directed one state to remove a lesson that said: “Adolescents may identify in ways that don’t conform with their assigned gender.”

It told another state to eliminate a sentence from a middle school lesson that stated: “People of all sexual orientations and gender identities need to know how to avoid unplanned pregnancy and infections.”

Additionally, sex educators in numerous states could no longer be told to “demonstrate acceptance and respect for all students, regardless of personal characteristics, including ethnicity, heritage, faith, social class, orientation or identity,” according to the letters dispatched to states.

Government Comments and State Responses

“Accountability is coming,” declared a federal official, acting assistant secretary of the ACF office, in a announcement. “Government money will not be used to poison the minds of the next generation or promote dangerous ideological agendas.”

Multiple states and territories stated they would eliminate the content or had already done so. These include Alaska, Georgia, Iowa, Kentucky, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, West Virginia and Wyoming, as well as the U.S. Virgin Islands and the Northern Mariana Islands.

Another pair of jurisdictions, the states, reported their educational programs never contained the terminology referenced in the administration’s letters.

Impact on Youth and Mental Health

Together, these states are inhabited by more than 120k trans people between the ages of 13 and 17, based on estimates from a university department.

“When the aim is to support youth and give them a safe space, I’m not sure why we are targeting the most vulnerable youth in the population,” said an advocate, who heads an organization that provides sex education in one state.

“When the government says that there’s something wrong with you and the educators aren’t allowed to tell you things or they have to disclose your identity to family – when you know that that’s not secure – that’s horrible for mental health.”

Almost 50% of transgender adolescents contemplated self-harm in the past year, according to a recent study from a suicide-prevention group. School support for these youths is linked to lower rates of attempted suicide, the organization discovered.

Earlier Incidents and Continuing Conflicts

Earlier this year, the Trump administration ordered a state to remove mentions to transgender topics from its Prep curriculum.

When the jurisdiction declined, the government withdrew its funding, cutting about $12 million in federal funding and stopping health initiatives in educational institutions, youth centers and care facilities.

The state agency is challenging the withdrawal. To date, it has been unsuccessful in make up for the withdrawn money.

The government has additionally told instructors who obtain funding from two other federal sex education initiatives, the $50m Sexual Risk Avoidance Education (SRAE) and the $101m Teen Pregnancy Prevention Program (TPPP), that they cannot teach about “gender-related concepts.”

An early October court order prevented the administration from altering one program, while the Monday court order stops it from changing the other program in the suing jurisdictions that challenged the initiative.

The Administration for Children and Families did not immediately respond to a request for comment.