Texas tops the nation in teens who give birth multiple times

By Eleanor Klibanoff, The Texas Tribune
FEB. 21, 2022 

High school junior Iryanna Rodriguez, 18, plays with her 9-month-old daughter, Ariyanna Juliett Fuentes, at Lincoln Park High School in Brownsville, Texas. The school enrolls teens who are pregnant or parenting and offers a host of resources, including child care. 

Photo by Verónica G. Cárdenas for The Texas Tribune

LONG READ

Feb. 21 (UPI) -- Like a lot of teenagers, Iryanna Rodriguez's day starts early and ends late, and she's often running behind from the moment she wakes up. The 18-year-old juggles all the normal high school experiences -- classes, a boyfriend, a search for a part-time job -- along with some additional hurdles.

"I'm always in a rush in the morning, getting my son ready and out for school," she said. "And then the baby, I have to get her changed. It doesn't get more real than that, first thing in the morning."

Rodriguez got pregnant for the first time when she was just 13 years old. Her son is now 4, and last year, she had a daughter as well. She says her children are her greatest blessing and have taught her that she's capable of so much more than she realized.

"But, yes, two children is a lot harder than one," she said with a laugh.

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Rodriguez lives with her boyfriend, but has a lot of family support in raising her children. Her mother had her first child when she was around 15, she said, and her grandmother was a young mother, too.

While teenage birth rates have declined significantly across the country in recent decades, Texas remains above the national average, consistently ranking in the top 10 states. Out of all births in Texas, around 6% were teen births in 2019 and 2020.

And a startling proportion of teenagers who gave birth in Texas in 2020 -- more than 1 in 6 -- already had at least one other child. Analysis by The Texas Tribune using data from the Centers for Disease Control and Prevention found that Texas had the highest rate of these so-called "repeat teen births" in the country, along with Alabama. In the last decade, the state has been in the top five states for repeat teen birth rates.

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Rodriguez lives in Brownsville, a city in the poor, predominantly Hispanic Rio Grande Valley on the U.S.-Mexico border. While Texas has seen an overall decline in the repeat teen birth rate, the counties that make up this region have not, with more than one in five teens that give birth already having at least one child almost every year since 2005. This is according to data from the Texas Department of State Health Services.

Cynthia Cardenas sees the impact of this every day. She's the principal at Brownsville's Lincoln Park High School, where all the students, including Rodriguez, are pregnant or parenting. Cardenas said the school has five students with three children.

Other schools in the Brownsville Independent School District have softball teams or drama productions. Lincoln Park has a day care and flexible scheduling. Her students are smart and ambitious, Cardenas said, and they want to be in school -- but they're juggling demands most other high school students couldn't imagine.

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"They're looking at what they need to do to raise their child right now," Cardenas said. "They tell me, 'I can't make it to school tomorrow because I have to work.' I'm like, 'Wait a minute. You have to prioritize your education.'"

Cardenas said Lincoln Park is doing all it can to make sure these students stay on track to graduate. But she wishes there was more attention paid to what happens before the students need to enroll there at all.

"We need to be proactive instead of reactive," she said. "The parents will not talk to their students about safe sex. ... It's just not an open conversation here. These girls need to be educated."

Texas does not require high schools to teach sex education, and the vast majority that do focus on sexual abstinence. The state has a complicated maze of requirements for teenagers seeking birth control and is operating under the strictest abortion laws in the country.

All of this leaves teenagers with insufficient tools to proactively manage their own reproductive health, advocates and teenagers say, with long-lasting consequences for themselves, their children and their communities.

Rodriguez is on track to graduate and wants to become a nurse. She and her boyfriend are planning to have a big family. She said she plans to talk to her children early and often about topics like safe sex, healthy relationships and birth control.

"I want them to have more education on that than I did," she said.

Sex education

A lot of what 18-year-old Jannely Villegas learned about sex came from the TV show 16 and Pregnant.

"I would always watch those and be like, 'How do they do it? They're so young and to be juggling school and having a baby, it must be stressful,'" she said.

No one taught her about birth control before she started having sex with her boyfriend. And even when she started suspecting that she might be pregnant, she dismissed it.

"I wish someone taught me about any of that stuff," she said. "We're not born with the knowledge of, hey, if you're pregnant, this is what it's going to feel like, or this is what it means to miss your period."

She ignored her fluctuating weight and swollen ankles until, one day, she couldn't anymore. In the middle of the night, she went into the bathroom in her mother's house, hunched over in pain.

Two pushes, and she gave birth to her son, all alone, on the floor of the bathroom.

"I didn't feel the pain until after because I guess I was so traumatized," she said. "When I called my mom in, she almost passed out."

Villegas and her now 3-month-old son are both healthy and thriving. But that's an experience she wouldn't wish on anyone else.

"I really do wish I had the knowledge in the beginning so I could have done all the things, like the sonogram, the ultrasound, taking care of myself better," she said.

Villegas grew up in La Feria, a small town west of Harlingen, where she said sex education was limited to one sit-down with sports coaches to go over the basics.

This is pretty common in Texas, which does not require schools to teach sex education. According to the left-leaning Texas Freedom Network, in the 2015-16 school year, 25% of school districts offered no sex education and an additional 58% taught abstinence-only sex ed.

In 2020, the Texas State Board of Education overhauled its sex education standards for the first time in two decades. While schools still must stress abstinence, starting this year, seventh- and eighth-graders will also have to learn about other birth control methods.

The board declined to require districts to teach about sexual orientation, gender identity and consent. And after a change by the Legislature, all sex education in Texas is now "opt-in," meaning parents must proactively enroll their students in these classes.

Texas Values, a right-leaning group that advocates for abstinence-only education, said it heard from more than 22,000 parents concerned that teaching comprehensive sex education would end up encouraging more teens to have sex.

"The pregnancy rates among teens are not ideal right now, but we are seeing that decline," said senior policy adviser Mary Elizabeth Castle. "We believe that we're going to continue to see this decrease as more schools are adopting the sexual risk avoidance model."

Texas Freedom Network political director Carisa Lopez said the recent changes, while progress, are insufficient to meet the needs of teenage Texans.

"Young people spend all of their early life in school. ... We teach them history, we teach them math, but what is more important than teaching them about health and sex ed and their bodies?" she said. "They deserve to be armed with this information to guide them through the rest of their lives."

Access to contraception

Teenage birth rates have declined precipitously in the United States in recent decades to an all-time low in 2019 of 16.7 births per 1,000 girls ages 15-19. But in Texas, there were 24 births per 1,000 girls in the same cohort, according to the CDC.

"Despite all of this tremendous progress, the pace of the decline has been inconsistent," said Jennifer Biundo, director of policy and data at the Texas Campaign to Prevent Teen Pregnancy. "What's really coming to light is increasing disparities and the young women who are left behind."

In Texas, Biundo said, it's Hispanic and Black teenagers who continue to have high rates of teenage pregnancy, as well as teenagers in the foster care system, teens in rural areas and teens with a history of trauma.

Biundo and other advocates say that decades of declining teen pregnancy rates have shown what works, specifically a system that has "no wrong doors" for teens who are looking to access contraception, education and other tools to manage their own reproductive decisions.

But in Texas, teens have to navigate an unstable maze of federal and state programs with varying confidentiality and parental consent requirements.

"Texas has some of the most complex laws in the nation just around teens' access to healthcare in general," said Biundo. "We want parents to be very involved in their child's health ... but we want to make sure that teens aren't being left behind."

Generally, parents have to consent to medical care for their minor children. But many states make an exception for reproductive healthcare: 23 states allow minors to consent to start birth control in all situations, and another 10 states have broad exceptions for minors who are of a certain age, pregnant or parenting.

Texas is in the remaining minority of states that does not allow minors to consent to birth control, except in extremely rare cases, like if the teenager is legally emancipated from their parents.

Texas minors who have given birth and are actively parenting their children still need their parents' permission to get on birth control. Rodriguez was surprised to learn this after she had her first child.

"I wanted to get on birth control and they required my mom's signature to put it in my arm," she said. "Luckily, my mom was like, you need to get on it."

Castle, with Texas Values, said having conversations about birth control can be an opportunity for that teenage parent to develop a closer relationship with their own parents. She acknowledges that some minors may be in situations where their parents aren't involved or it's otherwise difficult to get their consent, but she said that's not justification to loosen the requirements.

Minors who get their health insurance through Medicaid can access birth control without parental consent. But Texas is one of 12 states that chose not to expand Medicaid, leaving many teenagers on the state-run Children's Health Insurance Program.

Texas and North Dakota are the only states that do not cover birth control on CHIP. With or without parental consent, a teenager on CHIP cannot get birth control through their insurance program unless they can prove that it's for a medical need other than pregnancy prevention.

"CHIP covers [teens] up through the month of their 19th birthday," said Biundo. "We're talking about legal adults whose birth control isn't covered by their insurance program. There are very, very few insurance programs in the country that don't cover birth control."

There is a workaround: The state's Family Planning Program provides birth control, with parental consent, at one of roughly 200 clinics funded. But if teens on CHIP get birth control through this program, it comes with a much higher price tag for the state, which covers 100% of the Family Planning Program. The state covers less than 25% of the cost of CHIP claims, with the federal government providing the rest.

"Instead of adding this as a benefit and taking the federal funds for it and allowing these teens to have easy access to contraception, we're going to send them through this convoluted maze of programs, and the state's going to pay for the whole thing," said Biundo.

State Rep. Donna Howard, D-Austin, has repeatedly introduced a bill that would have added coverage for contraception for pregnancy prevention on CHIP. After passing the House and stalling in the Senate in 2019, the bill did not even get a hearing in 2021.

"We have huge challenges with making sure that we are providing the youth in this state with the tools that they need," Howard said. "We know that contraceptives are an important part of that toolbox and to not make it available to some of our youth who are in some of these programs is just irresponsible."

Her bill would still require parental consent to obtain birth control on CHIP, which she says is just a matter of being realistic about what would be seen as acceptable in Texas.

Castle said her group, Texas Values, advocated against adding birth control to CHIP.

"We want to make sure that we don't encourage sexual activity among teens or kids," she said. "I think it would motivate them to not be sexually active if they know that they don't have an alternative that would help them avoid risk.

Research indicates that providing adolescents with low- or no-cost contraception does not increase their number of sexual partners, and in fact leads to a significant decrease in teenage pregnancy rates.

When Myrna Alvarado was growing up in the Dallas area, she said talking about birth control with her parents would have been taboo. By the time she graduated high school, she had received, by her estimation, about 90 minutes of sex education in seventh grade.

"A lot of the information teens have is from Google or rumors that pass round their friends," she said. "We're not getting information from a reliable source."

She knows how difficult it can be for teens to talk to their parents about birth control -- and how that may not be enough to deter them from having sex. She now helps teens in the Dallas area access information and contraception through the North Texas Alliance to Reduce Unintended Pregnancy in Teens.

"We can show them what clinics are near them and which clinics are teen-friendly, where they won't need parental consent to go and their privacy will be respected, and usually low- to no-cost," she said.

Teens in the Dallas area can seek confidential contraception at clinics funded by the federal Title X program.

But the 175 Title X clinics in Texas are distributed unevenly across the state, leaving whole swaths of Texas underserved. And some of the clinics that receive this funding have struggled with inconsistent funding and political pressures in recent years that leave teenagers in limbo.

Clinic closures

By the time teenagers find their way to one of Access Esperanza's clinics in the Rio Grande Valley, they're often already pregnant or parenting. CEO Patricio Gonzales said one of their most important programs is helping teenagers access confidential reproductive healthcare.

"The criticism we always get is, 'Your contraceptives promote promiscuity,'" he said. "My response is, you've got the wrong P. It's not promiscuity, it's prevention. Preventing unwanted diseases, as well as unwanted pregnancies, especially at a young age."

A decade ago, Access Esperanza operated eight clinics, providing sexual and reproductive healthcare to 23,000 people across the Rio Grande Valley. Back then, the group went by a different, more recognizable name: Planned Parenthood of Hidalgo County.

Then, in 2011, Texas passed legislation that blocked public funds from going to Planned Parenthood-affiliated clinics. Almost immediately, Planned Parenthood of Hidalgo County lost millions in state funding, Gonzales said. They had to close five clinics and lost two-thirds of their patients.

All that for a clinic that never provided abortions, which was the target of the cuts.

"We were doing prevention work," said Gonzales. "We're preventing abortions by putting women on contraceptives."

After three years of scaled-back services, the board voted to disaffiliate from Planned Parenthood and changed its name to Access Esperanza. Six months later, Gonzales said, the money started flowing again from the state.

Nearly a decade after the initial cuts, they are finally getting close to serving the same number of clients as before. Gonzales worries most of all about the teenagers the clinics couldn't serve during those years.

"A lot of the young people were blaming us, saying 'What did y'all do wrong?'" he remembers. "They were not realizing the politics behind it with us just being a Planned Parenthood."

A quarter of family planning clinics statewide closed as a result of these funding cuts, according to the Texas Policy Evaluation Project. The fallout continues to this day, said Rosann Mariappuram, executive director of Jane's Due Process, a group that helps teenagers access contraception and abortion care.

"A lot of clients will call us and say, 'I went to my local Planned Parenthood, but they said, there's this law and they can't actually help me,'" she said. "They just end up confused about where they can go and maybe just stop looking."

Abortion access

Mariappuram said this is a common occurrence in Texas, where teens often end up caught in the crossfire of political decisions they have no say in. The best example, she said, is Texas' latest effort to restrict access to abortion.

The controversial law, known as Senate Bill 8, bans abortions after fetal cardiac activity is detected, usually around six weeks of pregnancy.

Many women don't know they're pregnant yet at that point, and that's particularly true for teenagers, who may not yet have a regular period or a full understanding of their reproductive system.

If a minor did detect a pregnancy before that point, Texas requires parental consent to get an abortion. If their parents won't consent, the minor can seek a judicial bypass in which a judge agrees the minor is mature enough to make that decision on their own.

"We always encourage youth to involve their parents if it's safe for them to do so," Mariappuram said. "Our clients tend to be in a more severe or dangerous situation where, especially if they're pregnant, talking to their parents can lead to them getting kicked out of the house or being forced to continue a pregnancy against their will."

Castle, with Texas Values, emphasized the importance of parents being involved in this decision -- hopefully, she said, with the goal of encouraging the child to keep the pregnancy.

"I believe there is adequate support for teens to carry those babies to term," she said. "There are over 200 pregnancy care centers in the state that can help these teen moms with whatever they need ... to take care of that child in the future."

Texas has invested more than $100 million in its "Alternatives to Abortion" program, which funds these pregnancy centers, although there's little data available about how the money is spent.

Since Senate Bill 8 went into effect on Sept. 1, Mariappuram said calls to her organization's hotline have dropped by more than half -- and less than a third of the teens who did call were still in the window of time in which they could access an abortion.

The judicial bypass process can take days or weeks, pushing some teens over the time frame during which they could legally have the procedure. And teenagers are less likely to be able to travel out of state to have an abortion as some adults have been able to do, Mariappuram said.

In the face of all these barriers, a lot more teens are carrying pregnancies to term. In September 2021, the month the law went into effect, only 29 women under the age of 18 had an abortion, according to data from the state Department of Health and Human Services.

That's a nearly 75% decline from the year prior and a 70% decrease from 2019. The number of abortions in 2021 are still subject to change as the state finalizes numbers.

"We've been doing a lot of emotional support around thinking through how to handle being forced to stay pregnant against their will," said Mariappuram.

Disclosure: Planned Parenthood, Texas Campaign to Prevent Teen Pregnancy and Texas Freedom Network have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

This article originally appeared in The Texas Tribune. Read the original here.

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