Falling Behind More in this series

“It was a whole gang,” said Carbs, who got pregnant at 17 while attending North Garland High School and is now the 21-year-old mother of Klarissa, 2, and Khloe, 2 months.

In Texas and across the country, the rate of teenage births has declined significantly since its peak in 1991. Birth rates among teenagers in Texas dropped 43 percent between 1991 and 2012. In states like California and Connecticut, the drop was even larger, and nationwide, the rate declined 52 percent in that period.

But despite the improvements in the Lone Star State, it is faring worse than most. Texas has the nation’s fifth-highest birth rate among teenagers, behind Arkansas, Mississippi, Oklahoma and New Mexico. And Texas, where schools are not required to teach sex education, has the highest rate of repeat births among teenagers ages 15 to 19. Teenage birth cost Texas taxpayers $1.1 billion in health care, foster care and lost tax revenue in 2010, according to the National Campaign to Prevent Teen and Unplanned Pregnancy. Teenage mothers often drop out of school, specialists said, and their children are also likely to become teenage parents.

Gov. Rick Perry’s office said a drop in the birth rate among teenagers in the last decade corresponded with the state’s abstinence education program.

“Teen pregnancy is a multifaceted issue with many contributing factors,” a spokesman for Perry, Travis Considine, said. Among those factors, advocates said, are race, ethnicity and economic status.

Dr. Janet Realini, president of Healthy Futures of Texas, a nonprofit that works to prevent teenage and unplanned pregnancy, said that Texas’ often ineffective sex education helped explain the state’s comparatively high teenage birth rate. Other factors, she said, include the limited access to health care and insurance for the poor as well as the high rates of school dropouts and poverty.

“It’s this mentality that we’re Texas, we do it our way, we ignore science and kind of go with our gut,” said David Wiley, a professor of health education at Texas State University in San Marcos. “That Wild West mentality about public policy is not helpful.”

One state with similar demographics to Texas is faring much better: California, which cut its teenage birth rate by 64 percent from 1991 to 2012. Melissa Peskin, an assistant professor at the University of Texas School of Public Health in Houston, said Texas could lower its teenage birth rate by following California’s example in areas like sex education and access to contraception.

Others are not convinced. Jonathan Saenz, president of Texas Values, which promotes family values and abstinence-focused sex education, said California's abortion rate is higher than Texas'.

“In Texas, since when did we think it was a good idea to adopt any policy from California?” Saenz said.

“I don’t think the proper measure is how do we compare to other states,” he added. “It’s undeniable that not only in our state but across the country, teen birth rates are at historic lows.”

The real problem, he said, is the glamorization of sexual activity.

Allison Field, the founder of a Dallas nonprofit called Alley’s House, which provides education and mentoring to teenage mothers, said it was not uncommon in Texas to see 19-year-olds with four children. The organization works to break the cycle of teen parenthood and to pick up slack from health and education systems that Field says are “failing our girls.”

During the 2011 legislative session, lawmakers cut two-thirds of the state’s family planning budget, leading to the closure of dozens of family planning clinics.

Carly Caraway, the nonprofit’s 26-year-old program director, can relate to teenage mothers because she was one. She said teenage mothers often lack a vision for their futures.

“I didn’t even know college was a possibility,” said Caraway, a high school dropout who earned a college degree in social work after receiving assistance at Alley’s House.

Like many teenagers who find their way to Alley’s House, Carbs was not the first teenage mother in her family. She had no intention of following that path.

She and her boyfriend had been together for four years before they decided to have sex, Carbs said.

“I got on the patch and waited two months,” she said of birth control. “I still came up pregnant.”

It was the first time she had sex.

Carbs says she did not remember receiving sex education at school.

Texas allows school districts to decide whether and how to approach sex education, as long as they teach more about abstinence than any other preventive method, like condoms and birth control.

The majority of Texas school districts teach abstinence-only sex education, which Saenz said is clearly working because Texas’ teenage birth rate has declined. A small but growing percentage of districts are adding contraception information to the curriculum — 25.4 percent in the 2010-11 school year, compared with 3.6 percent three years earlier — according to a 2011 report by the Texas Freedom Network, which advocates for sex education that includes medically accurate information about contraception.

“A lot of people in Texas think that if you teach students about sex, they’re going to have more sex,” Field said. “People need to talk about sex and healthy relationships.”

While sex education is not mandatory in California, the state does require schools to teach HIV education, including medically accurate information on abstinence, contraception and condoms.

The two states also differ in access to contraception. California allows minors to get state-funded prescription birth control without parental consent, but Texas requires parental consent unless the minor is married.

A key to changing the situation in Texas is encouraging adults to talk more about teenage pregnancy, said Beth Olson Drew, who until April was executive director of the Texas Campaign to Prevent Teen Pregnancy.

“Teens are not necessarily afraid to talk about sex and pregnancy,” she said. “It’s the adults that are stepping back and afraid.”

Keshawn Johnson of Dallas said she could have used information about sex and pregnancy. Johnson gave birth to two boys while she was still a teenager. She is now the 21-year-old mother of Kenny, 3, and Keenan, 2.

“I didn’t really have nobody to tell me about pregnancy,” said Johnson, who was 6 when her mother died. “The only thing my granny taught me is, ‘Don’t get pregnant.’”

Like Carbs, Johnson is African-American. Across the country, birth rates for black and Hispanic youths are more than twice as high as the rate for white teenagers.

Johnson dropped out of high school when she was pregnant with her first son and ended up in a homeless shelter after having her second. Through Alley’s House, she got her GED. Now living in her own apartment with her children, she works at a call center and hopes to begin community college soon.

She thinks she may not have gotten pregnant if she had more support.

“I guess I didn’t have enough love,” Johnson said.

Disclosure: Texas State University and the University of Texas at Austin are corporate sponsors of The Texas Tribune. A complete list of Texas Tribune donors and sponsors can be viewed here.