A new report reveals students in the nation’s largest school districts are encouraged to change their names and pronouns without parental knowledge, even though those same schools require parental approval for over-the-counter medicine.

The report, released by The Defense of Freedom Institute for Policy Studies (DFI), found that “eight of the nation’s 20 largest school districts allow students to use names and pronouns at school aligned with their gender identity without parental knowledge and consent,” said DFI.

“Yet these same districts, including New York City Department of Education, Los Angeles Unified School District, and Chicago Public Schools, require parental permission to dispense over-the-counter medication to students at school,” added DFI.

The report comes one day after news broke that Saint Paul Public Schools are “explicitly instructing teachers to use students’ preferred names and pronouns with or without parental consent,” according to WZTV Nashville.