For teens in Deep East Texas, accessing sex education and contraception is next to impossible

Brittany Henson, 33, right, became pregnant with her daughter Bremyiah, left, when she was a student at Hemphill High School in Sabine County. The county’s teen birth rate in 2020 was three times the statewide average. (Credit: Annie Mulligan for The Texas Tribune)

This reporting was supported by the International Women’s Media Foundation’s Reproductive Rights Reporting Fund.

SABINE COUNTY — When condoms were distributed at a career fair five years ago, West Sabine High School’s seventh and eighth graders took handfuls and tucked them inside their jackets and pants pockets. It set field trip chaperone Carnelius Gilder into a panic.

Gilder had driven the students to a church in the area to attend the career fair. Students had attended it in previous years with no problems; Gilder was taken aback to see a vendor giving away contraception for the first time.

“No, no, no, no, no, no, no, no, no, no, no. We cannot bring these home,” Gilder, now West Sabine school district’s superintendent, recalled thinking. “These are junior high kids. And we’re in a church.”

In rural Sabine County, a part of Deep East Texas near Louisiana’s western border, Gilder knew many parents who would light up his phone if students came home with condoms from a school-sanctioned field trip. So before the students got back on the bus, Gilder told all of them to empty their pockets.

West Sabine High School students haven’t been back to the career fair since. The school district now organizes its own health fair, which parents attend, and school officials can decide whether contraception will be offered to the students.

“East Texans believe in and have a great deal of morality,” said Gilder, who graduated from West Sabine High School in 2002. “And, well, you have to include the parents.”

In Sabine County, pine trees outnumber the people. To commute between Pineland and Hemphill, the two towns that anchor the county, residents drive down a road that winds through a national forest. The towns are dotted with churches that loom large in daily community life. Bible scriptures are printed on plaques in local stores and even in Gilder’s office.

Research has shown access to contraception and comprehensive sex education prevents unplanned pregnancies. But for sexually active teens trying not to get pregnant in Sabine County, it’s hard to access either.

Sex education in Texas is taught amid tight parameters and bureaucratic strings. Texas schools have to offer health class at the middle school level, but parents must opt their children in to any lessons about sexual health. And when teachers do touch on sex education, state law requires them to stress abstinence as the preferred choice before marriage.

Even if teens in this region want contraception, it’s nearly impossible to get without parental consent. In small towns like Hemphill and Pineland, parents have eyes and ears everywhere, making teens reluctant to go to the local Brookshire Brothers or dollar store to purchase condoms. They could go to a family planning clinic, which provides contraception at little to no cost, but only clinics funded through the federal Title X program do not require parental permission — and a federal judge in Texas ruled last month that the program violates parents’ rights and state and federal law.

As Every Body Texas, the nonprofit group that is the state’s Title X administrator, awaits guidance from the U.S. Department of Health and Human Services on how to proceed, it informed Texas providers this week to require parental consent out of precaution.

West Sabine ISD superintendent Carnelius Gilder in his office in Pineland on Dec. 19, 2022. “These people have a high value system and they need to know that their values do stitch into the quilt of education,” Gilder said of involving parents in conversations about sex education. (Credit: Annie Mulligan for The Texas Tribune)

Today, family planning programs are few and far between, thanks to funding cuts by the Texas Legislature in 2011. No family planning clinic exists in Sabine County. To get to the nearest one, teens in the region must travel to an adjacent county.

Meanwhile, Texas has one of the highest teen birth rates in the country. And in 2020, Sabine County’s teen birth rate was three times the statewide average. Nearly 7% of Sabine County teenage girls between the ages of 15 and 19 gave birth that year, compared with about 2% statewide.

Evolving health education standards 

In Texas, abstinence became the cornerstone of sex education in the mid-1990s when conservatives demanded sweeping changes to health textbooks, insisting sex education was an inappropriate topic for teens. Then-Gov. George W. Bush signed a law forcing school districts that offer sexual education to emphasize abstinence until marriage. The law allowed health educators to discuss contraception with students only if they spent more time emphasizing abstinence.

In 2009, the state removed health class as a high school graduation requirement, further minimizing the importance of health education. As a result, less than a third of Texas high school students took a health class between 2016 and 2020, according to an analysis of state course enrollment data by Healthy Futures of Texas, a nonprofit that works to reduce teen pregnancies.

In 2021, state lawmakers made it even harder for students to learn about safe sex. Now, parents must give written permission before their children can learn about “human sexuality,” family violence, child abuse or sex trafficking. Texas is one of only five states in the nation, along with Nevada, Utah, Mississippi and North Carolina, to have such a requirement for sex education and the only state requiring parental permission to teach about child abuse.

Students whose parents allow them to attend sex education classes are still taught that abstinence is the “preferred choice of behavior.” But, for the first time in more than 20 years, the Texas State Board of Education in November 2020 voted to overhaul the middle school health curriculum standards. These students should now learn about contraception and sexually transmitted diseases, conversations previously reserved for high school health classes.

Keven Ellis, the Lufkin-based chair of the State Board of Education, called the new requirements a “good middle ground” between comprehensive sex education — which prioritizes accurate and exhaustive information about contraception, sexual health and sexually transmitted infections — and an abstinence-only class.

Schools were scheduled to adopt these new standards by August of this year. But in Sabine County, as well as many others in East Texas, schools are sticking with an abstinence-based curriculum for middle school students.

Tenaha High School students fill in the blanks of their “Choosing the Best Life” workbooks on Nov. 11, 2022, as an instructor from a nonprofit that provides abstinence-based sex education reads out information on STDs. Tenaha ISD is in Shelby County in Deep East Texas. (Credit: Shelby Tauber for The Texas Tribune)

Every few years, the Texas State Board of Education sets standards about what is to be included in teachers’ lesson plans, whether it’s social studies, math or health. These standards are known as the Texas Essential Knowledge and Skills, or TEKS. But no state agency tracks whether districts employ these standards. Students eventually take annual standardized tests on core subjects like math and science, but there is no such test for health.

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“There’s no guarantee that every single TEK is taught to every single student,” Ellis said. “In the state of Texas, I’m sure some TEKS get skipped over, hopefully inadvertently, but probably in this case a little less inadvertently.”

When new health requirements for schools come from the state capital, districts turn to their school health advisory councils to advise their local school boards about how to implement them. The councils, made up of parents and administrators appointed by the local school boards, are there to ensure that “local community values are reflected” in their school districts’ health education instruction. School boards tend to listen to their suggestions.

Inside a classroom at Hemphill High School this fall, members of the local advisory council struggled to navigate the new state requirements about sex education.

“Have we been able to decipher the bill yet?” Cecily Bridges, a Hemphill school nurse and the council’s chairperson, asked during the meeting. She turned to Stephen English, Hemphill Independent School District’s superintendent, for an assist.

“Not really,” English replied.

“It’s hard to interpret what we’re required to do,” Hemphill Middle School principal Jeremy McDaniel interjected.

At the end of the meeting, Bridges instructed committee members to read through the new laws and the updated curriculum before the next meeting. And she said she’d reach out to the district’s education service center for guidance.

Across the rest of religious and conservative Deep East Texas, some districts are choosing not to offer sex education to middle school students.

Students walk to class in between class periods at Tenaha High School. (Credit: Shelby Tauber for The Texas Tribune)

“I don’t care for the school to be teaching the kid sex ed. That’s my job,” one parent said during the health advisory council meeting for Chester ISD in nearby Tyler County in April. “I’ll do that.”

If a district is not complying with state standards, the only recourse would be for a parent to file a complaint with the school board. But that puts the responsibility of tracking district curriculums on parents who, in Deep East Texas, would often prefer to avoid sex education altogether.

In Hemphill, a town of less than 1,000 people, churches outnumber medical clinics. Wednesday night church services are part of the weekly rhythm. And religion has long been entangled in debates about sex education.

Some parents in this region clam up when the words “sex education” come up, said health educator Ashley Cook. She’s trying to get into the Hemphill schools to teach students about child abuse, teen dating violence and sex trafficking as part of her Lufkin-based nonprofit, Harold’s House.

A homemade billboard along Farm to Market Road 83 outside of Hemphill on Dec. 30, 2022. In this region of the state, religion is entangled in community life and conversations about sex education. (Credit: Annie Mulligan for The Texas Tribune)

But even Cook has to reassure school officials and parents that she will stick to euphemisms like “private parts,” even for middle and high school students.

“I don’t say the biological terms,” Cook said. “The schools are a little concerned about that, so I’m careful about how I use my language.”

Inconsistent sex education 

Because sex education is voluntary, it’s not clear what Texas students know about sex and contraception. According to a 2016 survey, 58% of Texas school districts teach abstinence-only sex education while 17% teach an abstinence-plus curriculum that includes information about contraception. The remaining 25% teach no sex education at all.

Tenaha ISD in Shelby County — about 50 miles north of Hemphill — invited nonprofit Excellent Teen Choice to deliver abstinence-based lessons to students.

On a Friday morning in November, Excellent Teen Choice educator Eric Love, 47, launched into a class about sexually transmitted diseases as he stood before 10th graders at Tenaha High School.

“Did anybody know you could have sex and catch a disease? Isn’t that cool?” Love said sarcastically, his eyes wide and hands gesticulating wildly.

For 45 minutes, the high-energy instructor enthusiastically told students about the signs and symptoms of infections like gonorrhea, HPV and chlamydia. Students followed along in workbooks.

To demonstrate how widely the diseases can spread, students ran around the room collecting as many signatures as they could on index cards. Love then explained that each signature represented someone they had sex with.

Eric Love, who provides abstinence-based sex education through the nonprofit Excellent TEEN Choice, speaks about STDs to students at Tenaha High School on Nov. 11, 2022. The nonprofit is funded by the state’s Abstinence Education Program. (Credit: Shelby Tauber for The Texas Tribune)

Two students, unbeknownst to them, had tiny X’s printed on the corners of their notecards. That X, Love said, meant the student had a sexually transmitted disease.

“It’s living in their body and they’ve been transmitting the STD to other people, and they just don’t know it,” Love said.

He then had the two “infected” students stand at the front of the room and read the names on their cards. Now those students were infected, too, Love explained.

“I need you guys to understand the way this happened,” Love said. “Although this is a game, it’s not a game in real life.”

Love understood this personally. His half-sister became pregnant when she was in high school, an experience that inspired Love to educate young people about the consequences of premarital sex.

As students returned to their desks, Love flashed images on a screen at the front of the room. One showed pus-filled bumps on a male penis that made some students’ jaws drop. Another pictured an infected cervix, the narrow passageway between a woman’s vagina and her uterus. A student cocked his head and remarked that the fallopian tubes resembled frozen Tyson chicken wings.

Tenaha High School ninth-grader Karina Corpus reacts to examination photos of people infected with STDs like gonorrhea, chlamydia, HPV and HIV during a program run by Excellent TEEN Choice. (Credit: Shelby Tauber for The Texas Tribune)

Before students went on to their next classes, Love returned to his main point: abstinence. “It is our hope, our aim that you all will listen to this message: The best decision for your health, for your life, for your children’s lives is to save sex until marriage.”

Ninth grader Jasmine Santos said she was ignorant about STDs before the lesson.

“Now that I understand what can happen, I’ll probably say no [to sex] until marriage,” she said.

Studies show abstinence-only sex education or no sex education at all correlates with high teen birth rates. Medical experts, meanwhile, have championed comprehensive sex education.

When Brittany Henson, 33, attended Hemphill High School, she and her mother never talked about safe sex. The school district wasn’t teaching sex education, either. The gaps in her sex education were a byproduct of how little the town and the community had discussed the subject, Henson said.

“That is the culture of Hemphill. It is ‘Let’s not talk about it. It’s not a problem,’” said Henson, whose family has lived and worked in this town for generations. “People feel like it’s so wrong to talk about it. And like if you talk about it, ‘Oh, let me grab my shirt and button it all the way up to my neck because you shouldn’t be talking about these things.’”

Without formal sex education, Henson turned to other students. Their information was often incorrect.

“So, result? Hey, you got a baby,” she said.

Henson was in her junior year of high school when she got pregnant. She was on birth control but wasn’t taking her pills consistently and didn’t know that would raise her risk of pregnancy. She was, by no means, an anomaly. Five other girls in her high school class also got pregnant before graduation, she said.

Valerie Polk stands in front of a cabinet containing several types of contraception at the clinic for the Jasper Newton County Public Health District. It’s the only clinic in the region that has historically been able to prescribe birth control to minors without obtaining parental consent. (Credit: Annie Mulligan for The Texas Tribune)

Contraception access

Over the years, Valerie Polk has gotten very comfortable with subterfuge. Polk works at the only clinic in the region that has historically been able to prescribe birth control without parental consent, and she’s had to find creative ways to help young people protect themselves.

She’s met students off the highway, at the post office, on the bleachers during a high school football game and in the checkout line at the local Brookshire Brothers.

Once, in 2017, Polk wrapped contraceptive pills inside a Walmart bag and slipped the bag to a teen cashier at the local grocery store. The cashier laughed at Polk’s stagecraft before accepting the bag and putting it out of sight.

Valerie Polk, a public health worker at the Jasper Newton County Public Health District, describes the challenges of getting contraception to patients in a rural area.

“We do what we have to do to get our patients taken care of,” Polk said.

VIDEO: Valerie Polk, a public health worker at the Jasper Newton County Public Health District, describes her long drives and herculean efforts to get contraception to patients in this rural area. (Credit: Jinitzail Hernández / The Texas Tribune)

Polk has worked at the Jasper Newton County Public Health District for more than 25 years, providing health services to residents in Jasper and Newton counties as well as other nearby areas, including Sabine County.

The Jasper Newton County Public Health District is a federal Title X health care provider, one of 156 such clinics in the state. That has allowed Polk to give anyone birth control, free of charge. The Title X program has been one of the only ways minors in Texas can access birth control without parental consent. But last month, a Trump-appointed federal judge in Texas ruled that Title X violates parents’ rights and state and federal law.

Legal proceedings are ongoing, but the state's Title X administrator has instructed Title X clinics to stop giving out birth control to minor patients without proof of consent for now. The ruling has left Polk and her team in a bind. Starting this week, they now began requiring parental consent.

"This isn't somewhere we've been before — where we really can't help someone," Polk said. "This is a new era for us. I just hope the ruling is overturned sooner rather than later."

Already, over the past decade, the number of Title X clinics in the region has fallen, further impeding sexually active teenagers who want to avoid becoming pregnant. In 2011, there were four federally funded clinics in Deep East Texas. That number has been sliced in half, with just two clinics within a 100-mile radius of Sabine County. The Jasper Newton County Public Health District runs both those clinics — with one in Jasper and the other in Newton.

In Lufkin, a health care hub about 50 miles away from Sabine County, the Angelina County and Cities Health District suspended its contract with Title X in 2021, citing onerous requirements and paperwork. While the health district still provides contraception, teens must be 15 or older and have parental consent to receive it.

Polk shows a nondescript package containing 12 free condoms available for anyone at the Jasper Newton County Public Health District clinic. (Credit: Annie Mulligan for The Texas Tribune)

In 2011, in an effort to stop state dollars from flowing to Planned Parenthood’s health care clinics, Texas legislators cut funding for family planning services by two-thirds — from $111 million to $37.9 million for the 2012-13 budget. Within three years, more than 80 clinics across the state shuttered, including those that were never affiliated with Planned Parenthood.

Some of the clinics that closed were also Title X providers. Every Body Texas, which has administered the state’s Title X funds since 2013, has tried to rebuild the network of family planning services. But restarting services brings up a host of challenges.

“It’s a lot easier to close. It’s a lot harder to reopen a clinic,” said Stephanie LeBleu, the group’s acting deputy Title X project director. “We still see the legacy of that choice to cut family planning funding throughout the state.”

The Title X program has faced its own politically motivated attacks in recent years. Under the Trump administration, clinics that provided abortions or made abortion referrals were disqualified from the program.

Adding to the barriers to contraception access, the teens Polk wants to serve don’t even seem to know that Title X exists. Some teens who want birth control don’t know where to go for it. Few have formally been taught about sex. Those who have were instructed to abstain.

“The Bible Belt says, ‘No, we’re not going to talk to our kids about birth control,’” Polk said. “‘We’re not going to talk about premarital sex.’”

English, the Hemphill school superintendent, said contraception was not covered in the district’s sex education curriculum and he doubted students could access it if they wanted to.

Polk and her team have tried to get into the public schools to educate students about their options for contraception. But that’s been nearly impossible, she said.

VIDEO: Polk details some of the obstacles to teaching high school students about contraception. (Credit: Jinitzail Hernández / The Texas Tribune)

“It may not be the superintendent, it could be the school board. It could be some parents that are going, ‘Oh, no, you're going to tell my child about sex,’” Polk said.

What students do learn, Polk said, is often inaccurate information that comes from social media platforms like Snapchat or TikTok.

Brochures sit on a shelf at the clinic for Jasper-Newton County Health District in Jasper on Dec. 19, 2022. (Credit: Annie Mulligan for The Texas Tribune)

So Polk and her team do what they can to make themselves known in their community to address the misinformation. Outside of work, they wear health district T-shirts to raise its visibility. And when teenagers come in for appointments, Polk asks them to tell all their friends about their services.

Some doctors are also filling the gap left in education and access. George Fidone, a Lufkin pediatrician, said he speaks openly about sex with his adolescent patients and prescribes contraception on a weekly basis — but only with parental permission.

“I’ve had too many kids come in with their parents, and the parents think they’re coming in for a sore throat,” Fidone said. “And the kid will give me a look. And I’ll know that look is ‘I’m pregnant, and I need help with this.’”

Another thing that keeps teens from accessing birth control is that Texas is one of just two states that do not cover contraception through the Children’s Health Insurance Program, the insurance plan for low-income families. Also, state-funded family planning clinics require parental consent before minors can get contraception. Even a teenager who has had a baby cannot obtain birth control without parental consent.

Brittany Henson spends time with her son Leo and daughter Bremyiah at their home in Hemphill on Dec. 30, 2022. She’s raising her children in the town where generations of her family have lived and worked. (Credit: Annie Mulligan for The Texas Tribune)

Teen pregnancy

When Henson was a junior in high school, she bought an at-home pregnancy test from the local dollar store and took the test in her parents’ bathroom.

But after the two pink faint lines emerged, signaling she was pregnant, she didn’t call her mother. She didn’t call her older siblings who had already left home.

Instead, she initially kept quiet about her pregnancy. She took herself to and from doctors’ appointments. She continued to make straight A’s and work her job as a cashier at Brookshire Brothers. She said she even competed in the state track meet while five months pregnant.

“I just didn’t want to deal with the disappointment. ... I wasn’t ready for that,” said Henson, who was an all-star athlete and a straight-A student. “I felt like I had the weight of not only my family, but the weight of my community.”

Hemphill and West Sabine school districts work with pregnant students to provide accommodations to get them to graduation, including homebound services late in the pregnancy. But teen moms are less likely to finish high school. Just over half of 20- to 29-year-old women who were teen moms have high school diplomas, according to a 2018 report from Child Trends.

But after Henson gave birth to her daughter, she kept a firm grip on her dreams. She drove straight from the Jasper Memorial Hospital delivery room to the school athletics office to rejoin the school basketball team. She would go on to graduate high school on time and attend Sam Houston State University on a track scholarship.

Henson now lives in Hemphill. She’s worked as a nurse at the Sabine County Hospital. Her daughter, Bremyiah, now 16, attends the same high school she did.

Bremyiah, 16, and her mother, Brittany Henson, in their home in Hemphill on Dec. 30, 2022. Brittany and Bremyiah speak openly about safe sex — conversations Brittany wishes she had when she was her daughter’s age. (Credit: Annie Mulligan for The Texas Tribune)

Bremyiah is dating now, but Henson says she feels OK about it. She fiddles with a silver ring on her finger, emblazoned with the word “Mom” in cursive. She hopes she’s given her daughter the information to make the right decisions.

The mother and daughter talk about safe sex and contraception. Bremyiah doesn’t want to get on birth control, but Henson hopes her daughter can come to her if she changes her mind.

Last year, Henson drove Bremyiah to the gynecologist for the first time, an appointment where her daughter could get basic reproductive information from a doctor.

“What am I going here for?” Bremyiah asked as they were getting ready. “I’m not having a baby.”

“That’s the point. It’s to keep you from having a baby,” Henson said. “We gotta learn, we gotta learn.”

Sixteen-year-old Bremyiah holds a ring she bought for her mother. (Credit: Annie Mulligan for The Texas Tribune)

Reporter Eleanor Klibanoff, video journalist Jinitzail Hernández and data visualization fellow Caroline Covington contributed to this story.

Disclosure: Planned Parenthood, Sam Houston State University and Walmart Stores Inc. 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.