To understand why teen pregnancy rates are so high in Texas, meet Jessica Chester. When Chester was in high school in Garland, she decided to attend the University of Texas at Dallas. She wanted to become a doctor.
"I was top of the class," she says. "I had a GPA of 4.5, a full-tuition scholarship to UTD. I was not the stereotypical girl someone would look at and say, 'Oh, she's going to get pregnant and drop out of school.' "
But right before her senior year of high school, Chester, then 17, missed her period. She bought a pregnancy test and told her mom to wait outside the bathroom door.
"I saw both lines came up," Chester says. "I had tears and I remember just opening the door and she was standing there with her arms out and she just wrapped me up and hugged me. I just cried and she told me it's going to be OK."
Chester's mother had also been a teen mom, and so had her grandmother.
In Texas every year, about 35,000 teens and young women get pregnant before they turn 20. And while rates of teen pregnancy are on the decline nationwide, in Texas the rate of decline is slower.
Traditionally, the two variables most commonly associated with high teen birth rates are education and poverty, but a new study co-authored by Dr. Julie DeCesare, of the University of Florida's OB-GYN residency program in Pensacola, shows that there's more at play.
"We controlled for poverty as a variable, and we found these 10 centers where their teen birth rates were much higher than would be predicted," she says.
DeCesare, whose research appears in the June issue of the journal Obstetrics & Gynecology, says several of those clusters were in Texas. The Dallas and San Antonio areas, for example, had teen pregnancy rates 50 percent and 40 percent above the national average.
Research shows teens everywhere are having sex, with about half of high school students saying they've had sexual intercourse. Gwen Daverth, CEO of the Texas Campaign to Prevent Teen Pregnancy, says the high numbers in Texas reflect policy, not promiscuity.
"What we see is there are not supports in place," Daverth says. "We're not connecting high-risk youth with contraception services. And we're not supporting youth in making decisions to be abstinent." The state needs to emulate more progressive policies found in other states, she says.
For years, California has invested in comprehensive sex education and access to contraception, Daverth says. There, the teenage birth rate dropped by 74 percent from 1991 to 2012. The teen birth rate in Texas also fell, but only by 56 percent.
In South Carolina, young women on Medicaid who have babies are offered the opportunity to get a long-acting form of birth control right after they give birth. They're also trying that approach in parts of North Carolina. And Colorado subsidizes the cost of long-acting birth control. There, both abortions and teen birth rates are dropping faster than the national average.
Texas makes it hard for teenagers to get reproductive health care, Daverth says.
In Texas, if a 17-year-old mom wants prescription birth control, in most cases she needs her parents' permission. "Only us and Utah have a law that if you're already a parent, you are the legal medical guardian of your baby but you cannot make your own medical decisions without the now-grandma involved," Daverth says.
That's part of the reason, she notes, that Texas has the highest rate of repeat teen pregnancies in the country.
After Skylar was born, Chester wasn't given contraception counseling and still wasn't sure where to go for help. Three months later she was pregnant again. She and her then-boyfriend, now-husband hadn't realized she could get pregnant so soon after having a baby. She was a full-time student at UT-Dallas at that point, double-majoring in molecular biology and business administration. But the education Chester never got, she says, was sex ed.
"In hindsight," she says, "It's like, 'Dude, what were you all thinking? I came in 17, pregnant, why weren't you all lining up the chart and showing me [my] options?' "
Chester's high school taught abstinence-only sex ed, and the majority of schools in Texas, either do that or don't offer any sex education at all. But more districts do seem to be adopting "abstinence plus" — which still encourages abstinence but also includes information on other pregnancy prevention methods and sexually transmitted diseases. Still, abstinence-only education is king, and of course, some parents aren't comfortable discussing sex with teens, much like Chester's mother wasn't.
Nicole Hudgens, a policy analyst with the socially conservative Texas Values public policy group, supports abstinence-only education and says there are plenty of options for young moms who become pregnant.
"There are so many places like crisis pregnancy centers that are able to help these girls that are in need," Hudgens says.
Crisis pregnancy centers provide counseling and support for pregnant teens but don't offer abortions or contraception.
Studies show access to contraception is key to reducing the teen pregnancy rate. And according to the National Campaign to Prevent Teen Pregnancy, teen pregnancies in Texas cost the state $1.1 billion each year. Gwen Daverth says the costs are due to lost wages and an increased reliance on social services.
"One of the things we know is that 60 percent of teen parents will not graduate from high school and only 2 percent will go on to graduate from college," Daverth says.
Jessica Chester did graduate from college. Her mom helped her through it, and she did end up taking out loans for day care, but she got a degree and at age 30 now has a job doing community outreach and family planning.
"I have a lot of support with my mother alone," Chester says. "I had the example in front of me of [that getting pregnant young] doesn't have to derail your plans, it doesn't have to stop you from getting an education and a career."
Chester and Marcus got married in 2010 and in 2014 planned to have another baby — Kameron, now 21 months.
Sitting in the couch at her home in Garland, Chester admits it can be tough watching friends graduate with medical degrees or who are further along in their careers. Sometimes, she says it can feel like she failed.
"Like I gave up on my goals and dreams or messed them up. But when I look at my children I don't regret a thing. I'm not sad," she says through tears. "It's just the reality of knowing my life is completely altered because of decisions I made as a teenager."
Then Chester hears her older boys laughing upstairs, wipes her tears and goes to cheer them on.
That story was part of our reporting partnership with NPR, KERA and Kaiser Health News.
RACHEL MARTIN, HOST:
Today in Your Health, we're going to look at teen pregnancy because nationwide the rates of teen pregnancy have been on the decline. Reporter Lauren Silverman from member station KERA in Dallas has been looking into this, and she joins me now. Hi, Lauren.
LAUREN SILVERMAN, BYLINE: Hey, Rachel.
MARTIN: So this is good news, right?
SILVERMAN: Yeah. So across the country, the number of teenagers who are having babies has hit a record low. It's down to about 1 out of 45 young women, and that's everywhere. But recently, researchers have found there are still these pockets where the teen birth rate is much higher than the national average. And some of these hot spots are in Texas, and to understand why this is happening, I wanted to tell the story of Jessica Chester.
MARTIN: OK. Jessica's story. Let's listen.
SILVERMAN: When Jessica Chester was in high school in north Texas, she wanted to become a doctor.
JESSICA CHESTER: I was that student. I was top of the class - full tuition scholarship to UTD. I was not the stereotypical girl someone would look at and say, oh, she's going to get pregnant and drop out of school, you know, I just wasn't.
SILVERMAN: But right before her senior year, Chester missed her period. She bought a pregnancy test and told her mom to wait outside the bathroom door.
CHESTER: Both lines came up, and I didn't say a word. I just slid the test under the door. I had tears. And I remember just opening the door. She was standing there with her arms, out and she just wrapped me up and hugged me. And I just cried and, you know, she told me it's going to be OK.
SILVERMAN: Chester's mother had also been a teen mom and so had her grandmother. Every year in Texas about 35,000 young women have babies before their 20th birthdays. Teen birth rates are typically highest where education levels are low and poverty is high. But a new study co-authored by Dr. Julie Caesar shows there's more at play.
JULIE DECESARE: We removed poverty as a variable, and we did the same thing for education. And we found these 10 centers where their teen birth rates were much higher than would be predicted.
SILVERMAN: In the clusters that you found, a few were in Texas.
DECESARE: Lots of them were in Texas.
SILVERMAN: The Dallas and San Antonio areas, for example, had teen pregnancy rates 50 and 40 percent above the national average. Here's the thing - teens everywhere are having sex. Gwen Daverth CEO of Texas Campaign to Prevent Teen Pregnancy says the high numbers in Texas reflect policy, not promiscuity.
GWEN DAVERTH: What I mean by that is we're not connecting high-risk youth with contraception services. Our state is the most restrictive state when it comes to accessing health care.
SILVERMAN: For instance, if you're a 17-year-old mom and want prescription birth control, in most cases you need your parents' permission.
SKYLAR: Mommy, do you know the people that talk?
SILVERMAN: Twelve years ago after Skylar was born - that's him playing video games - Chester wasn't given contraception counseling and still wasn't sure where to go for help. She continued dating Skylar's father and three months later was pregnant again. She and her boyfriend hadn't realized, she could get pregnant so soon after having a baby. She was a full-time student at UT, Dallas double majoring in molecular biology and business administration. The education Chester never got, she says, was sex ed.
CHESTER: In hindsight it's like dude, like, what were you all thinking? I was an 18 year old. I came in 17 pregnant, had my baby at 18. Why weren't you all, you know, lining up the chart and showing me these are your options?
SILVERMAN: Chester's high school, like the majority of schools in Texas, teaches abstinence only or doesn't offer sexual education at all. Nicole Hudgens with the socially conservative Texas Values Public Policy Group supports abstinence-only education and says there are plenty of options for young moms who become pregnant.
NICOLE HUDGENS: There are so many places like crisis pregnancy centers that are able to help these girls that are in need.
SILVERMAN: That help generally does not include education about contraception. Most teen parents don't finish high school and just 2 percent go on to graduate from college. Jessica Chester falls into that 2 percent. She graduated and works in community outreach. She admits it's tough.
CHESTER: A lot of my sorority sisters, they've gone through medical school. They're doctors now, and I'm so happy for them. But I can't lie. Sometimes it's hard. You know, every graduation that comes around, I know that that's something I always wanted to do. And it's hard because sometimes I do feel like a failure like I gave up on my goals and dreams or I missed them up. But when I look at my children, I don't regret a thing.
SILVERMAN: Chester hears her boys laughing upstairs, wipes her tears and goes to cheer them on.
MARTIN: And we've got Lauren Silverman back to talk about this. She's a reporter from member station KERA who's been looking into teen pregnancy rates. So, Lauren, it's hard to imagine that in this day and age, teens have so much information online. But there is still such an information gap, it seems, in some communities when it comes to preventing pregnancy.
SILVERMAN: Yeah. And talking about sex can be uncomfortable and even with information, teens sometimes make rash decisions as I'm sure you remember.
SILVERMAN: But the information gap is real in Texas. Here nearly 85 percent of high schools teach abstinence only or don't have any sexual education at all. And there are some districts that seem to be adopting this sort of third-way approach called abstinence plus which still encourages abstinence, but it also includes information on pregnancy, prevention and STDs. But still in Texas, abstinence-only education is king.
MARTIN: What did you find out about school districts, states where things are working well?
SILVERMAN: So in addition to providing sexual education, a lot of these places are focusing on access, making access to contraception easier and literally meeting teen moms in hospitals or doctors offices. In South Carolina, for example, young women who have babies and are on Medicaid, which is health insurance for lower income people, they're offered the opportunity to get a long-acting form of birth control right after they give birth. Colorado also is subsidizing the cost of long-acting birth control. They're both abortions and teen birth rates are dropping faster than the national average.
MARTIN: Finally, Lauren, do we know anything more about Jessica's future plans? She said she wanted to go to med school. Is that still in the cards for her?
SILVERMAN: She is still thinking about it. Right now she's actually working doing some family planning counseling as well, and she's still thinking about medical school.
MARTIN: Lauren Silverman from member station KERA. Her story was part of our reporting partnership with Kaiser Health News. Lauren, thanks so much.
SILVERMAN: Thanks, Rachel. Transcript provided by NPR, Copyright NPR.