To understand why teen pregnancy rates are so high in Texas, meet Jessica Chester. When Chester was in high school in Garland, Texas, she decided to attend the University of Texas-Dallas. She wanted to become a doctor.
âI was top of the class,â she said. âI had a GPA of 4.5, a full-tuition scholarship to UTD. I was not the stereotypical girl someone would look at and say, âOh sheâs going to get pregnant and drop out of school.ââ
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.
âI saw both lines came up,â Chester said. âI 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 itâs going to be OK.â
Chesterâs mother had also been a teen mom, and so had her grandmother.
In Texas each year, about 35,000 before they turn 20. 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, shows that thereâs more at play.
âWe controlled for poverty as a variable, and we found these 10 centers where their teen birth rates were much higher than would be predicted,â she said.
DeCesare, whose  appears in the June issue of the journal Obstetrics & Gynecology, said 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  are having sex. Gwen Daverth, CEO of the Texas Campaign To Prevent Teen Pregnancy, said the high numbers in Texas reflect policy, not promiscuity.
âWhat we see is there are not supports in place,â Daverth said. âWeâre not connecting high-risk youth with contraception services. And weâre not supporting youth in making decisions to be abstinent. Weâre just saying that is an approach we want to take as a state â whereas other states have put in more progressive policies.â
Daverth said California invested in comprehensive sex education and access to contraception. There, the teenage birth rate dropped from 1991 to 2015. The teen birth rate in Texas also fell, but only .
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. Theyâre also in parts of North Carolina. And 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 parentsâ permission. âOnly [Texas] and Utah have a law that if youâre 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,â Daverth said.
Thatâs part of the reason, she notes, Texas has the highest rate of repeat teen pregnancies in the country.
After Skylar was born, Chester wasnât given contraception counseling and still wasnât sure where to go for help. Three months later, she was pregnant again. She and her then-boyfriend, now-husband, Marcus Chester, hadnât 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 said, was sex ed.
âIn hindsight,â she said, âitâs like, âDude, what were you all thinking? I came in 17, pregnant, why werenât you all lining up the chart and showing me [my] options?ââ
Chesterâs high school, like , teaches abstinence-only or doesnât offer any sex education at all, though more districts do seem to be adopting âabstinence plusâ â which still encourages abstinence but also includes information on other pregnancy prevention methods and sexually transmitted diseases.
Jessica Chester, then 23, poses with sons Ivory (right) and Skylar (left) on the morning of her graduation from the University of Texas-Dallas. (Courtesy of Jessica Chester)
Still, abstinence-only education is king and, of course, some parents arenât comfortable discussing sex with teens, much like Chesterâs mother wasnât.
Nicole Hudgens, with the socially conservative Texas Values public policy group, supports abstinence-only education and said there are plenty of options for young moms who become pregnant.
âThere are so many places like crisis pregnancy centers that are able to help these girls that are in need,â Hudgens said.
Crisis pregnancy centers provide counseling and support for pregnant teens but donât offer abortions or contraception.
 show access to contraception  to reducing the teen pregnancy rate. And according to the National Campaign to Prevent Teen and Unplanned Pregnancy, teen pregnancies in Texas cost the state $1.1 billion each year. Gwen Daverth said the costs are due to lost wages and an increased reliance on social services.
âOne 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,â Daverth said.
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 now has a job doing community outreach and family planning for a Dallas hospital.
âI have a lot of support with my mother alone,â Chester said. âI had the example in front of me of [getting pregnant young] doesnât have to derail your plans, it doesnât have to stop you from getting an education and a career.â
Jessica and Marcus Chester married in 2010 and have a third son â Kameron, now 21 months old. That pregnancy was planned, she said.
Sitting on the couch at her home in Garland, Chester admitted it can be tough watching friends graduate with medical degrees who are further along in their careers. She has a good job, but itâs not what she was imagining when she graduated at the top of her high school class. Sometimes, she admits, it feels as if she failed.
âLike I gave up on my goals and dreams or messed them up. But when I look at my children, I donât regret a thing. Iâm not sad,â she said, even though her tears were flowing. âItâs just the reality of knowing my life is completely altered because of decisions I made as a teenager.â
Then Chester heard her older boys laughing upstairs, wiped her tears and went to cheer them on.
That story was part of our reporting partnership with NPR, ČčČÔ»ćÌęKaiser Health News.