By Brittney Martin

Large numbers of poor teenagers will be able for the first time to get free birth control from the state as officials aim to reduce Texas' high teen pregnancy rate, state health agencies announced Wednesday.

By consolidating programs that provide family planning, reproductive health care and cancer screenings, leaders hope to expand low-income teens' access to another 5,000 health providers in the new Healthy Texas Women program, Health and Human Services Commission officials said.

To qualify for enrollment in the new program, the family's combined income must be below 200 percent of the federal poverty level -- about $4,000 per month for a family of four. Teenagers will need parental consent for birth control and any other health service.

"We are hoping [that] by expanding the new Healthy Texas Women's Program to teenagers, we will see a decrease in the number of teen pregnancies," said commission spokesman Bryan Black.

In 2013, nearly 46 percent of Texas high school students reported that they had had sex before they graduated. The teen birth rate is fifth-highest in the country, and Texas leads the nation in repeat teen pregnancies, according to the Centers for Disease Control and Prevention.

Dr. Janet Realini, chairwoman of the Texas Women's Healthcare Coalition, said that the expanded access was a "good start" on the road to reducing teen pregnancy in Texas but that "we have a ways to go." The parental consent policy, she said, could still be a barrier for many teens.

Teenagers enrolled in Medicaid, which is partly federally funded, can get birth control at no cost from any Medicaid-enrolled doctor without parental consent.

"Parents worry that if kids have access, that will be a message that it's OK to have sex, but I don't think there's any evidence that that's really how things operate," Realini said. "I would like for parents to be able to understand what would really protect their children."

Fran Hagerty, chief executive of the Women's Health and Family Planning Association of Texas, said the issue of parental involvement extends to teens from higher-income families as well. Many are afraid to use their parents' health insurance to pay for birth control.

"We've all been adolescents, we all remember," Hagerty said. "Very few could say, 'Oh, yeah, I could just easily talk to my parents about sex and they would be very supportive of me taking responsibility for contraception.'"

Long-acting methods

The decision comes amid a push to get sexually active teenagers to use long-acting reversible contraception known as LARCs, such as intrauterine devices and hormonal implants, above all other birth control methods.

Physician groups recommend them because they are highly effective, can last up to 12 years, and remove the human error that can thwart birth control pills or condoms.

But they are also the most expensive methods. Though some health insurance plans cover the entire cost of the devices, other women pay up to $1,000 out of pocket for LARC methods.

In Texas, 93 federally funded clinics provide free or low-cost birth control to minors without requiring parental consent. Within those clinics, about 1,500, or 8 percent of the minors seen, chose a LARC device in 2013.

Rules for the new program have yet to be established, but it's likely long-lasting devices will be included.

In 2010, the most recent figures available, Texas spent more than any other state to cover the cost of unintended pregnancies, surpassing the next highest spender by more than $1 billion.

"We know that the goal is to have healthier moms and babies in Texas and LARC is one of those ways that we can do that," said Kami Geoffray, a senior policy adviser for Medicaid at the Texas Health and Human Services Commission. "There's no human error."

Despite the higher initial expense, LARCs save money in the long run, Geoffray said.

For the last year, doctors enrolled in the Texas Women's Health Program have been given the option to order the hormonal devices Mirena and Skyla from Medicaid-enrolled pharmacies and have them sent to the clinics for insertion.

Pharmacies update their reimbursement rates more frequently than the state health program, so they can adapt to changing birth control prices, which saves doctors money.

Starting in 2016, Medicaid-enrolled hospitals will be fully reimbursed for LARC devices given to new moms whose deliveries are covered by Medicaid.

Additional barriers

While the state takes steps to remove barriers to access, health experts say Texas is still depriving teens of other tools they need to prevent pregnancy, like informative sex education.

Hagerty said the combination of barriers Texas teens face "tends to isolate adolescents and not encourage them to take care of themselves or take responsibility for their own sexual behavior."

The state used to require a semester of health class for high-school graduation, but no more. Now, individual school districts set their own requirements. And if they teach about human sexuality, the state requires that the lessons encourage abstinence above all. Teachers and materials don't have to mention contraception.

"Young people may not even have the knowledge that they should be going to a clinic or seeking out health care," said Susan Tortolero Emery, director of the Center for Health Promotion and Prevention Research at The University of Texas School of Public Health in Houston.

David Wiley, a professor of health education at Texas State University, said the greatest progress will be made when talking about sex is no longer considered taboo.

"Teenagers don't understand their own bodies," Wiley said. "We're not making contraception illegal, but we're just putting so many speed bumps and barriers in front of people that it makes it difficult for even a responsible young person to take care of his or her health."

That was the case for Shanterrica Piper, who was 14 and nearing the end of her first semester at Duncanville High School when she found out she was pregnant.

She said that for birth control, she had used the "pull-out" method and condoms -- but only when her partner remembered to bring them. She said she didn't know about other options.

"I wish I knew, because when I look back on it, I'm like, I could've gotten more than what I did get," said Piper, who is now 19.

She dropped out of high school in her sophomore year, but later got her GED and enrolled in classes at El Centro Community College in Dallas, pursuing a degree in nursing. She hopes to one day start her own organization to boost girls' self-respect.

"When you want respect, you have to respect others and yourself to get it," Piper said. "I was looking for somebody to give me what I couldn't give myself."

Piper, who was enrolled in Medicaid before, during and after her pregnancy, said she chose to get a hormonal birth control implant in her arm shortly after her daughter was born.

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