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, about 35,000 teens and young women get pregnant before they turn 20 every year. 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, an OB-GYN at the University of Florida 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 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 al. 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 farther along in their careers. Sometimes, she admits 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.