Teen birth rates in the U.S. and Texas have been declining for decades.

“From a public health phenomenon, you don’t see that magnitude of change in many fields.”

Jen Biundo, director of policy and data at the Texas Campaign to Prevent Teen Pregnancy

“From a public health phenomenon, you don’t see that magnitude of change in many fields,” said Jen Biundo, the director of policy and data at the Texas Campaign. “It’s really a striking change.” The confluence of factors behind the nationwide drop in teen births is complicated; there isn’t a single answer, according to Biundo. Sexual health advocates like her and Chester are piecing together the data and stories that might explain what Biundo calls the “million-dollar question”: Why teen birth rates have dropped so precipitously in these past few decades.“We tend to look at three big factors,” Biundo said. “One is access to health care. One is access to information. And then one is changing behaviors.” The data reflect cultural shifts in behaviors related to sex and pregnancy.

The overall birth rate in the U.S. has been declining for decades. These days, women wait until they’re older to have their first children. And, fewer teens are having sex. When they do have sex, more teens are using birth control. In 1991, more than half of high school students nationwide reported that they’d already had sex, according to the CDC’s Youth Risk Behavior Survey. By 2019, that number had decreased nearly 16 percentage-points, to 38.4%.

Graph of high school students who’ve had sex

Despite the decline, disparities across place and race still exist

Some states’ teen birth rates have declined more steeply than others. In 2005, Texas and New Mexico were tied for the highest teen birth rates in the country, with nearly 62 births per 1,000 women ages 15-19. By 2019, Texas’ rate had dropped to 24, a more than 60% decrease. In fact, Texas was one of the top 20 states with the biggest declines in that period. Still, Texas’ rate hasn’t dipped below the U.S. teen birth rate, which was 16.7 in 2019, according to the CDC.

“When we look at teen pregnancies and teen births, what we see is that we still have these really tremendous disparities in the teens who are left behind,” Biundo said. Neighboring counties like Dallas and Tarrant, each with vastly different teen birth rates, can provide insight into these disparities, according to Terry Greenberg, the chief executive officer for the North Texas Alliance to Reduce Unintended Pregnancy in Teens, or Ntarupt. Some of the disparities arise from sex education practices at the school district level, which can differ from county to county. The disparities also “coexist” with demographic differences, Greenberg said, which can coincide with access to education and resources. Across the U.S., birth rates were more than twice as high for Black, Hispanic and Indigenous teens in 2019 as they were for white teens. The good news, according to Chester, is that the newly adopted curriculum standards, passed by the State Board of Education in 2020, will streamline sex education across Texas. In doing so, they may help increase access to information across county lines.

Chester was a top student in her school and active in academics and band when she found out she was pregnant. Then, three months after giving birth to her son, she got pregnant again — she didn’t know one pregnancy could happen so soon after another. For her, it was “ignorance.” She wasn’t a “wild child,” she said, and neither are the young people she works with now. “The kids in this community are so smart. They are good, well-behaved kids. They’re absolutely fantastic. They’re creative. They’re amazing,” Chester said. “And yet, they’re not invincible. They’re not special. They can get pregnant, too, or get someone pregnant.” Texas doesn’t require schools to teach sex education; if they do teach sex education, the curriculum must spotlight abstinence as the “preferred choice of behavior” for unmarried young people, according to the Texas Education Code.

However, evidence existed a decade ago that abstinence-only programs don’t prevent teen pregnancy. In fact, it’s the opposite. “The more strongly abstinence is emphasized in state laws and policies, the higher the average teenage pregnancy and birth rate,” according to a 2011 study published by the Public Library of Science. On the other hand, states that taught “abstinence-plus,” a medically accurate curriculum that covers abstinence along with birth control use, had the lowest teen pregnancy rates.

Texas’ steep decline in its teen birth rate mirrors national trends not because of its abstinence-only focus, Greenberg said, but because teens are changing their sexual behavior and are more able to access information and resources like birth control. Most Texas voters want abstinence-plus education, according to a 2020 survey from the Texas Campaign to Prevent Teen Pregnancy. “Although Texas parents want their youth to have (sex education), youth want the information, and they want to connect with each other to get it and share it, it’s not happening that way,” Chester said. “They’re going to social media, they’re going to their friends. They’re going to the internet. So I think we have to do some parenting education.”

That’s why Biundo recommends people visit the website of Texas is Ready, which provides resources to people about sex education. It’s also why Chester works to normalize conversations about sex with her own children. She said she “can turn anything into a sex ed conversation.” “If we’re talking about Texas students, a lot of them have Texas parents who came up in the same abstinence-only education system that their children are now coming in,” she said. Sixteen years after she had her first son as a teenager, her children attend school in the same district she attended when she got pregnant. “They’re in the same school district I grew up in, getting the same abstinence education I received,” she said. “They just are so blessed to have a mother who is a sexual health educator, who doesn’t mind talking about these things all the time.” The teen birth rate in both Dallas and Tarrant counties was declining even before Chester was a teen. Since 1991, both rates have dropped sharply, mirroring state and national trends. Dallas, however, continues to float above the Texas rate which, in turn, is higher than Tarrant County’s rate.

Tarrant County teen birth rate

A high teen birth rate “doesn’t exist in a vacuum,” Greenberg, with Ntarupt, said. She said ZIP codes with high teen birth rates tend to experience other negative health outcomes: “As I always say, the same people have all the problems … because of the lack of resources that have been poured into where they live.” A higher portion of people in Dallas County than in Tarrant County is Black or Hispanic, according to the U.S. Census Bureau. Those communities tend to experience higher teen birth rates, more than double the birth rate of white teens in 2019. Also, the median household income for Dallas County was about $8,000 less than in Tarrant County. Multiple studies link low income or socioeconomic disadvantage with teen births. Demographic differences can be addressed by increasing access to resources and education.

Misty Wilder, who directs Healthy Start, a maternal and infant health program through The University of North Texas Health Science Center, said she thinks Tarrant County’s success has come in part through local partnerships. The Health Equity Alliance, a collaboration of dozens of local organizations — including universities, hospitals and the public health department — convened 20 years ago to address disparities in infant mortality. As the years passed, the group’s focus expanded to include maternal health and mortality. Part of the program’s model, Wilder said, centers a campaign called “one key question”: Would you like to become pregnant in the next year? As chair of the Health Equity Alliance, Wilder encourages providers and patients to discuss that question when patients “touch any kind of medical system,” be it through a dentist appointment or a wellness exam. Those conversations make space for what’s called preconception health, or “the health of the woman before she becomes pregnant,” Wilder said. They also lead to education about options like birth control.

Partnerships between local and federal entities also play their part, according to Roina Baquera, the director of health and physical education at Fort Worth ISD. In 2013, Fort Worth ISD received a grant from the Centers for Disease Control and Prevention to help reduce rates of HIV, STDs and unintended pregnancy. The partnership not only helps the district specifically center sexual health, it expands requirements for students in the district, Baquera said. That means Fort Worth ISD requires students to take a health class in middle school and in high school, whereas Texas only requires students in elementary and middle school to receive health education. “Our curriculum is very much constructed around trying to impact teen pregnancy along with HIV stigma and sexual health,” Baquera said. “So this partnership we have with (the CDC) really helps build a broader education piece for the students.”

New TEKS standards will streamline sex education across counties

After more than two decades passed without an update to school curriculum standards, the state School Board of Education voted to adopt new Texas Essential Knowledge and Skills, or TEKS, standards in late 2020. A key difference is that the new standards, which will go into effect in the 2022-23 school year, mandate sexual health education at the middle school level. Before, the sexual health standards applied only to high school students, who weren’t required to take a health class to graduate, according to Chester. It’s good news, she said. It means “it won’t be a Tarrant County vs. Dallas County thing anymore,” because middle school students in every county will receive sex education.

In the spring legislative session, things changed yet again. When Gov. Greg Abbott signed the school finance bill, HB 1525, into law in June, a last-minute amendment to the law went immediately into effect: Texas parents and guardians must now opt in to sex education for their children, rather than opting out. Fort Worth ISD had already asked parents to do so, according to Marcey Sorensen, assistant superintendent of teaching and learning at Fort Worth ISD. For her, an opt-in policy allows the district to “truly communicate” with parents about sex education and create stronger partnerships between schools and families. Chester isn’t concerned about the statewide opt-in requirement — she’s more worried about the kids who could slip through the cracks as a result.

Anecdotally, she said districts that already require opt-ins receive a high rate of return. But children in nontraditional living environments, like foster homes, or children who live with adults who can’t be fully present, may not have anyone who can opt in for them, Chester said: “So they’re going to miss the email, they’re going to miss the paper in the bottom of the backpack.” The amendment will be up for reassessment in three years. Until then, Chester said, the Texas Campaign will be gathering data to see which kids were left behind as a result. That way, her team can be prepared to advocate for fewer barriers to abstinence-plus sex education. “Let’s do what makes sense,” Chester said. “It’s not about us, it’s about these kids. And I don’t know any parents who don’t want optimal health for their children from head to toe.”

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.