While studies and statistics have shown that a lack of sex education correlates with higher teen pregnancy rates , some states, like Texas, continue to teach abstinence-only sex education. Texas’ abnormally high teen birth rate could also be affected by the lack of contraception access.

A study by researchers at the University of Florida-Pensacola examined the number of nationwide births by females ages 15 to 19 between 2006 and 2012. Although the nation has seen a decline in teen birth rates, researchers found clusters of elevated teen birth rates in particular areas.

Texas has the fifth-highest teen pregnancy rate in the country, with more than 35,000 teen births recorded in 2014. The Lone Star State also leads the country in repeat teen pregnancies, according to the Center for Disease Control and Prevention.

States that provide inclusive sex education have seen decreases in teen pregnancies overall. In Texas, however, 25 percent of all school districts did not teach sex education in the 2015-2016 school year, and 58 percent of school districts offered abstinence-only education.

Along with the lack of education, inadequate access to contraception may also explain why Texas’ teen pregnancy rates are so high. When state funding was cut to abortion providers in 2011, Texas closed 82 family planning clinics, a third of which were affiliated with Planned Parenthood.

Gwen Daverth, CEO of the Texas Campaign to Prevent Teen Pregnancy, told NPR the high numbers of teen births in Texas reflect policy, not promiscuity.

“What we see is there are not supports in place,” Daverth told NPR. “We’re not connecting high-risk youth with contraception services. And we’re not supporting youth in making decisions to be abstinent.”

Texas began offering free birth control to low-income teens in 2015, but people under the age of 18 need parental permission to access contraception. A teen mother cannot necessarily access prescription birth control without her parents’ permission, which could help explain the state’s high rate of repeat teen pregnancies.