A 16-year-old girl in Texas can legally drive, hold a job, and become a parent — yet she may never be taught how to prevent pregnancy.
Until recently, Texas was one of just five states in the U.S. that required parental permission for students to receive sex education under SB 1525, which passed in 2021. The state officially ended that opt-in policy in August 2024, but the change is largely symbolic.
In updated guidance, the Texas Education Agency (TEA) advised: “Notwithstanding expiration of the statutory opt-in mandate, school systems should continue requiring parental consent prior to offering human sexuality instruction to students, which is fully permitted by the authority granted to local school systems under TEC, §11.151.”
The TEA’s letter encourages school districts to continue requiring parental consent, not only for sex education but also for related topics like abuse prevention. Schools must notify parents about lesson content, schedules, and their rights, including opportunities to give input on the curriculum.
This continued emphasis on parental consent creates real barriers for students seeking essential health information. A study by the University of Texas Health Science Center found that more than 80% of school representatives identified the opt-in rule as a major obstacle to delivering sex education. Consent forms can often be overlooked by busy or disengaged parents or deliberately withheld by abusive guardians, leaving many students with no access to sex education at all.
The result? Texas continues to have one of the highest teen pregnancy rates in the country and the highest rate of repeat teen pregnancies.
The policy may have changed, but the barriers have not. Students today continue to pay the price.
Sex Education in Texas: A System Designed to Fail
Sex education in Texas is failing students. According to CDC data, only 19% of Texas schools offer any form of sex education, and most rely on abstinence-only programs. A survey by Healthy Futures of Texas found that just 7% of young adults felt their sex education had prepared them for real-life decisions about consent, contraception, pregnancy, and sexually transmitted infections.
In 2022, Texas adopted an “abstinence-plus” policy, but key topics like consent, gender identity, and LGBTQ+ issues remain excluded. While health education is required in middle school, there is still no mandate for sex education at either the middle or high school level. This gap leaves students without critical information at the age they need it most.
Texas also receives more federal funding for abstinence-only education than any other state — an incentive that encourages schools to stick with outdated curricula focused on moral instruction rather than medically accurate, evidence-based information. The consequences are clear: in California, where comprehensive sex education is mandated, the teen birth rate is nearly half that of Texas, at 9.8 births per 1,000 girls aged 15 to 19.
The Consequences: Teen Pregnancy and Public Health
The impact of inadequate sex education, combined with the state’s abortion ban, is measurable. Since the ban took effect in 2021, the teen birth rate in Texas increased for the first time in 15 years. Black and Hispanic teens have been most affected. A University of Houston analysis found the sharpest rise among Hispanic teens (1.2%) and Black teens (0.5%), while the rate for white teens declined by 0.5%.
Maternal health outcomes have worsened as well. A recent ProPublica report found a 50% increase in sepsis rates among women who experienced second-trimester miscarriages, a life-threatening, preventable condition affecting multiple organs. Researchers estimated a 5.6% increase in infant deaths in states with abortion bans, with Texas reporting the highest rate.
These challenges are compounded by structural barriers to care. Nearly 47% of Texas counties are considered maternity care deserts, meaning pregnant individuals often lack access to essential health care. Texas also has the highest uninsured rate for women of reproductive age, at 22%.
Despite these worsening trends, Texas has chosen to limit the scope of its Maternal Mortality and Morbidity Committee, which was established to examine maternal death cases and provide recommendations aimed at reducing preventable pregnancy-related deaths in Texas. In its next report, the committee announced it will only analyze data from 2024 onward. The most recent report only covered data through 2020, leaving a large gap from 2021 to 2024. The original statute, which defined the committee’s responsibilities, also prohibits it from reviewing abortion-related deaths, further limiting access to vital public health data.
Legislative Roadblocks and the National Context
Texas continues to push restrictive measures that further limit access to sex education. In the 2025 legislative session, Texas lawmakers have already introduced a wave of bills restricting access to reproductive health education, including SB 12, SB 204, and SB 112. One proposal, SB 371, would reinstate the opt-in requirement, reversing even the limited progress made toward expanding access if implemented.
This trend extends beyond Texas. According to the recent Sexuality Information and Education Council of the United States (SEICUS) report, only five states require comprehensive sex education, while 17 still rely on abstinence-only programs. The SEICUS analysis found that 65% of newly introduced sex education bills were restrictive, particularly in states with abortion bans. These efforts are part of a broader national movement to limit reproductive health education, one that disproportionately harms marginalized communities.
Looking Forward: A Preventative Approach to Reproductive Health
Comprehensive sex education is not a radical idea; it’s a proven public health strategy. Prevention is more effective, less painful, and far less costly than intervention. As a pediatric dentist, I know that we don’t wait for cavities to teach children how to brush their teeth. So, why wait until teens face pregnancy to teach them how to protect themselves?
To address rising teen pregnancy rates and worsening maternal health outcomes, Texas should:
- Mandate comprehensive sex education in middle and high schools. Research from the American Academy of Pediatrics shows that evidence-based programs significantly reduce teen pregnancy, far more effectively than abstinence-only approaches.
- Adopt an opt-out system. Health education should be the default, not the exception. Students should receive this information unless parents actively opt them out.
- Invest in teacher training and resources. Without clear guidance, educators often misinterpret policy or avoid instruction altogether.
- Ensure transparent data reporting. Withholding critical reproductive and maternal health data prevents policymakers from addressing the full scope of the crisis.
The consequences of inadequate sex education extend beyond the classroom. High teen pregnancy rates are linked to increased school dropout rates, higher unemployment, and long-term poverty. These outcomes place a growing burden on Texas’ health care and social service systems. Without action, the state will continue to leave its students unprepared for the realities of adulthood.
Reproductive rights begin with education. Texas teens deserve clear, accurate information about their bodies and their health. It’s time for lawmakers to treat sex education not as a political battleground, but as a public health solution to the teen pregnancy crisis.
About the Author:
Dr. Lakshmi Moorthy is a public health graduate student at the Johns Hopkins Bloomberg School of Public Health, specializing in health systems and policy. She is currently completing her practicum at the Center for HIV and Infectious Disease Policy at the O’Neill Institute for National and Global Health Law. A pediatric and preventive dentist, she is dedicated to advocating for preventive policies that address health disparities and promote long-term well-being for children and young adults.
DISCLAIMER: The views and opinions expressed in this piece are those of the author and do not reflect the views of the O’Neill Institute.
