“It was a time of a lot of learning, turnaround, and pivoting for me, because we weren’t necessarily expecting that kind of life change,” she said.

Ferrell Ortiz would have liked a little more guidance to navigate the application process for Medicaid. She was inundated with forms. She spent days on end on the phone trying to figure out what was covered and where she could go to get care.

“Sometimes the representative that I would speak to wouldn’t know the answer,” she said. “I would have to wait for a follow-up and hope that they actually did follow up with me. More than are currently navigating that fragmented, bureaucratic system to find care. Medicaid provides coverage for about — but many people lose eligibility not long after giving birth.

Many pregnant people rely on Medicaid coverage to get access to anything from prenatal appointments to prenatal vitamins, and then postpartum follow-up. Pregnancy-related Medicaid in Texas is available to individuals who make under $2,243 a month. But that coverage — and advocates and researchers say that strict cutoff contributes to rates of maternal mortality and morbidity in the state that are higher than the national average.

They support a bill moving through the Texas legislature that would extend pregnancy Medicaid coverage for a full 12 months postpartum.

Texas is one of 11 states that has chosen not to expand Medicaid to its population of uninsured adults — a benefit offered under the Affordable Care Act, with 90% of the cost paid for by the federal government. That leaves more than in a coverage gap — they don’t have job-based insurance nor do they qualify for subsidized coverage on , the federal insurance marketplace. In 2021, 23% of women ages 19-64 in Texas.

Pregnancy Medicaid helps fill the gap, temporarily. Of the nearly half a million Texans currently enrolled in the program, the majority are Hispanic women ages 19-29.

Texans living in the state without legal permission and lawfully present immigrants are not eligible, though they can get different coverage that ends immediately when a pregnancy does. In states where the Medicaid expansion has been adopted, coverage is available to all adults with incomes below 138% of the federal poverty level. For a family of three, that means an income of about $34,300 a year.

In Texas, childless adults don’t qualify for Medicaid at all. Parents can be eligible for Medicaid if they’re taking care of a child who receives Medicaid, but . To qualify, a three-person household with two parents can’t make more than $251 a month.

For Ferrell Ortiz, the hospitals and clinics that accepted Medicaid near her Dallas neighborhood felt “uncomfortable, uninviting,” she said. “A space that wasn’t meant for me” is how she described those facilities.

Later she learned that Medicaid would pay for her to give birth at an enrolled birthing center.

“I went to Lovers Lane Birth Center in Richardson,” she said. “I’m so grateful that I found them because they were able to connect me to other resources that the Medicaid office wasn’t.”

Ferrell Ortiz found a welcoming and supportive birth team, but the Medicaid coverage ended two months after her daughter arrived. She said losing insurance when her baby was so young was stressful. “The two-months window just puts more pressure on women to wrap up things in a messy and not necessarily beneficial way,” she said.

In the 2021 legislative session, Republican Gov. Greg Abbott signed a bill extending pregnancy Medicaid coverage from , pending federal approval.

Last August, that extension request had initially failed to get federal approval, but that the Centers for Medicare & Medicaid Services had followed up the next day with a statement saying the request was still under review. The Tribune reported at the time that some state legislators believed the initial application was not approved “because of language that could be construed to exclude pregnant women who have abortions, including medically necessary abortions.”The state’s application to extend postpartum coverage to a total of six months is still under review.

The state’s is tasked with producing statewide data reports on causes of maternal deaths and intervention strategies. Members of that committee, along with advocates and legislators, are hoping this year’s legislative session extends pregnancy Medicaid to 12 months postpartum.

Kari White, an associate professor at the University of Texas-Austin, said the bureaucratic challenges Ferrell Ortiz experienced are common for pregnant Texans on Medicaid.

“People are either having to wait until their condition gets worse, they forgo care, or they may have to pay out-of-pocket,” White said. “There are people who are dying following their pregnancy for reasons that are related to having been pregnant, and almost all of them are preventable.”

In Texas, maternal health care and Pregnancy Medicaid coverage “is a big patchwork with some big missing holes in the quilt,” White said. She is also lead investigator with the Texas Policy Evaluation Project (TxPEP), a group that evaluates the effects of reproductive health policies in the state. A surveyed close to 1,500 pregnant Texans on public insurance. It found that “insurance churn” — when people lose health insurance in the months after giving birth — led to worse health outcomes and problems accessing postpartum care.

Chronic disease accounted for almost 20% of pregnancy-related deaths in Texas in 2019, according to a partial cohort review from the . Chronic disease includes conditions such as . The report determined at least 52 deaths were related to pregnancy in Texas during 2019. Serious bleeding (obstetric hemorrhage) and mental health issues were leading causes of death.

“This is one of the more extreme consequences of the lack of health care,” White said.

Black Texans, who make up close to 20% of pregnancy Medicaid recipients, are also to die from a pregnancy-related cause than their white counterparts, a statistic that has held true for close to 10 years with little change, according to the MMMRC report.

Stark disparities such as that can be traced to systemic issues, including the in medical providers; for Black women such as cost, transportation, lack of child care and poor communication with providers; and shortcomings in medical education and providers’ implicit biases — which can “impact clinicians’ ability to listen to Black people’s experiences and treat them as equal partners in decision-making about their own care and treatment options,” according to a .

Diana Forester, director of health policy for the statewide organization , said Medicaid coverage for pregnant people is a “golden window” to get care.

“It’s the chance to have access to health care to address issues that maybe have been building for a while, those kinds of things that left unaddressed build into something that would need surgery or more intensive intervention later on,” she said. “It just feels like that should be something that’s accessible to everyone when they need it.”

Extending health coverage for pregnant people, she said, is “the difference between having a chance at a healthy pregnancy versus not.”

As of February, 30 states have adopted a 12-month postpartum coverage extension so far, according to a , with eight states planning to implement an extension.

“We’re behind,” Forester said of Texas. “We’re so behind at this point.”

Many versions of bills that would extend pregnancy Medicaid coverage to 12 months have been filed in the legislature this year, including and . Forester said she feels “cautiously optimistic.”

“I think there’s still going to be a few little legislative issues or land mines that we have to navigate,” she said. “But I feel like the momentum is there.”

Ferrell Ortiz’s daughter turns 5 this year. Amelie is artistic, bright, and vocal in her beliefs. When Ferrell Ortiz thinks back on being pregnant, she remembers how hard a year it was, but also how much she learned about herself.

“Giving birth was the hardest experience that my body has physically ever been through,” she said. “It was a really profound moment in my health history — just knowing that I was able to make it through that time, and that it could even be enjoyable — and so special, obviously, because look what the world has for it.”

She just wishes people, especially people of color giving birth, could get the health support they need during a vulnerable time.

“If I was able to talk to people in the legislature about extending Medicaid coverage, I would say to do that,” she said. “It’s an investment in the people who are raising our future and completely worth it.”

This story is part of a partnership that includes , , and KHN.

This <a target="_blank" href="/health-care-costs/texas-medicaid-coverage-childbirth-postpartum-insurance-legislation/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

“They had a bunch of tennis balls and wrote [the names] of STIs on them,” Cali said. “Then they had a couple of kids come up, put on gloves, and said, ‘If he throws the ball to her and she has a glove on, then she’s protected. But if she doesn’t have a glove on, then she’ll get the disease or something.’ It was really weird.”

Cali said the instructors never explained what the STIs were, just that people should wear condoms to prevent them. “It really was not helpful,” she said.

That presentation was the last time she got any formal sex education in school, she said. Health education is not a mandatory offering .

In 2020, Cali started training to be a peer educator through . “I learned about specific STIs, what they did, viral versus bacterial. I learned different methods of birth control,” Cali said. “It was a lot of catching up.”

After more than two decades, the Texas State Board of Education has updated its health curriculum, including sexual health, for elementary and middle school students. The new curriculum, which will be taught starting in fall 2022, includes detailed information about birth control and STIs for the first time.

But it leaves out key elements sex-ed advocates wanted to see. And despite the state’s high teen birth rate, a recent policy change by Texas leaders rather than opt out of their children’s sex education, which means some kids might not receive any formal school instruction.

Working to Normalize Sexual Health Conversations

The new curriculum comes after years of work from organizations across Texas that are trying to mainstream conversations about sexual health.

“Your reproductive and sexual health is really important for your life,” said Terry Greenberg, founder of the . “Not only does it determine your personal health, it’s the health of your family. If you’re not giving kids that, you’re not equipping them to be adults.”

Teen birth rates across the country , according to the U.S. Department of Health and Human Services. But Texas ranks among the top 10 states for high teen birth rates, with 22.4 teen births per 1,000 females ages 15-19, compared with California’s rate of 11 per 1,000, or Vermont’s at 7 per 1,000, according to 2019 .

Advocates like Greenberg in Texas think better education about contraceptives and pregnancy prevention would improve these statistics. support this idea. Providing students with can reduce unintended consequences like teen pregnancy and STIs.

“I mean, any unintended pregnancy is kind of on us,” Greenberg said. “Why didn’t we supply people with what they needed?”

The new curriculum is still abstinence-first. But including detailed information on contraceptives and STIs is a win for Greenberg and advocates statewide, such as those with the .

“These standards hadn’t been updated since ‘Titanic’ was out in theaters,” said director of policy and data with the organization. “It had been a minute.”

The new curriculum does not include instruction on . Those omissions reflect a larger battle for control over what information kids can access, which has resulted in lawmaker-led , attempts to curb school , and opposition to gender-affirming care for .

Texas and at least four other states have . Students there will not be taught about sexual health, puberty, or reproduction unless parents — or other caregivers — give permission. Texas leaders, including Gov. Greg Abbott, said parents should have control over what their children learn in schools.

Biundo said she’s concerned that one missed piece of paper or email will mean some kids will miss the opportunity.

“When I think about the paperwork that I’ve fished out of my child’s backpack three weeks late, this kind of terrifies me,” she said.

“The big concern with the opt-in policy is that some kids will just slip through the cracks,” Biundo said. “Maybe they’re not living with a parent or guardian, or maybe they don’t have a parent or guardian who’s closely engaged. Those might be the kids that need this information the most.”

Greenberg said an opt-in policy is a “huge logistical barrier for kids.”

“Do you really care about the reproductive health of these kids? You have to give them information,” she said.

Combating Shame and Myths

J.R. Chester has seen all this before. Slow updates and lack of access to information have been a pattern since she started as a community health worker with Parkland Health Hospital System more than 10 years ago.

“I was a repeat teen mom,” Chester said. “Our oldest is 16. He is just a year younger than I was when I got pregnant with him. Then, after I gave birth to him, three months later, we were pregnant with No. 2.”

The Dallas native said she doesn’t remember anyone explaining to her what contraceptives were, or why she menstruated every month.

“No one took the time to tell me, this is why your body is doing this,” Chester said.

Chester said her work is to make sure that kids can ask questions, without shame or guilt.

There are still a lot of that Chester works to debunk, even with adults.

“A lot of my female students had no idea that sexual intercourse didn’t take place in the same hole that they urinated from,” said Chester. “They had this myth in their mind that ‘Oh, well, can’t you just pee it out?’ I hear that a lot as a method of pregnancy prevention.”

At home, she talks with her own kids about health at every stage of their development. For her younger children, that means using the anatomically correct names for body parts. With her teenagers, health conversations include discussions about boundaries and safe sexual encounters.

“A lot of our education in this household has been between parents and children,” Chester said. “That’s because I have the resources and the education to provide it. If I wasn’t in this role, and hadn’t been doing this for 10 years, I don’t know if I would know what to say to them, honestly.”

Biundo, Chester, and high school student Cali Byrd want sex education to be more accessible.

Cali said she wishes decision-makers at the state level would communicate with students like her as they craft the health education plan.

“They need to look at it from the perspective of a child in school,” Cali said. “You can’t make a law concerning how someone lives their life when you don’t understand how they live their life.”

Cali also thinks there’s too much left out of the new curriculum.

“That is honestly the root of all the problems, is if we just teach ‘Don’t have sex,’ you’re not teaching about sex,” Cali said. “I just hope we move past that and, instead, actually teach them what they need to know.”

The health curriculum implementation , but Chester hopes the recent changes will generate open conversations between parents and kids.

“I think people hear ‘sexual health’ and some of them get really squeamish about it,” she said. “But sexual health is your understanding of your body, your basic functioning, how you’re put together, why. That’s really harmful to shame something that is normal.”

Opt-in policies seem to be gaining ground in Texas. A recent change from the state now requires parental permission to teach kids about .

“This really concerns us,” Chester said. “This means that if you have a child who has been abused by their parents, that child would have to get permission from their abusers to learn about child abuse. We think this runs the risk of withholding really crucial information from the kids that need it the most.”

This story is from a partnership that includes , , and .

This <a target="_blank" href="/public-health/texas-sex-education-update-birth-control-sexually-transmitted-infections/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

“It was a time of a lot of learning, turnaround, and pivoting for me, because we weren’t necessarily expecting that kind of life change,” she said.

Ferrell Ortiz would have liked a little more guidance to navigate the application process for Medicaid. She was inundated with forms. She spent days on end on the phone trying to figure out what was covered and where she could go to get care.

“Sometimes the representative that I would speak to wouldn’t know the answer,” she said. “I would have to wait for a follow-up and hope that they actually did follow up with me. More than are currently navigating that fragmented, bureaucratic system to find care. Medicaid provides coverage for about — but many people lose eligibility not long after giving birth.

Many pregnant people rely on Medicaid coverage to get access to anything from prenatal appointments to prenatal vitamins, and then postpartum follow-up. Pregnancy-related Medicaid in Texas is available to individuals who make under $2,243 a month. But that coverage — and advocates and researchers say that strict cutoff contributes to rates of maternal mortality and morbidity in the state that are higher than the national average.

They support a bill moving through the Texas legislature that would extend pregnancy Medicaid coverage for a full 12 months postpartum.

Texas is one of 11 states that has chosen not to expand Medicaid to its population of uninsured adults — a benefit offered under the Affordable Care Act, with 90% of the cost paid for by the federal government. That leaves more than in a coverage gap — they don’t have job-based insurance nor do they qualify for subsidized coverage on , the federal insurance marketplace. In 2021, 23% of women ages 19-64 in Texas.

Pregnancy Medicaid helps fill the gap, temporarily. Of the nearly half a million Texans currently enrolled in the program, the majority are Hispanic women ages 19-29.

Texans living in the state without legal permission and lawfully present immigrants are not eligible, though they can get different coverage that ends immediately when a pregnancy does. In states where the Medicaid expansion has been adopted, coverage is available to all adults with incomes below 138% of the federal poverty level. For a family of three, that means an income of about $34,300 a year.

In Texas, childless adults don’t qualify for Medicaid at all. Parents can be eligible for Medicaid if they’re taking care of a child who receives Medicaid, but . To qualify, a three-person household with two parents can’t make more than $251 a month.

For Ferrell Ortiz, the hospitals and clinics that accepted Medicaid near her Dallas neighborhood felt “uncomfortable, uninviting,” she said. “A space that wasn’t meant for me” is how she described those facilities.

Later she learned that Medicaid would pay for her to give birth at an enrolled birthing center.

“I went to Lovers Lane Birth Center in Richardson,” she said. “I’m so grateful that I found them because they were able to connect me to other resources that the Medicaid office wasn’t.”

Ferrell Ortiz found a welcoming and supportive birth team, but the Medicaid coverage ended two months after her daughter arrived. She said losing insurance when her baby was so young was stressful. “The two-months window just puts more pressure on women to wrap up things in a messy and not necessarily beneficial way,” she said.

In the 2021 legislative session, Republican Gov. Greg Abbott signed a bill extending pregnancy Medicaid coverage from , pending federal approval.

Last August, that extension request had initially failed to get federal approval, but that the Centers for Medicare & Medicaid Services had followed up the next day with a statement saying the request was still under review. The Tribune reported at the time that some state legislators believed the initial application was not approved “because of language that could be construed to exclude pregnant women who have abortions, including medically necessary abortions.”The state’s application to extend postpartum coverage to a total of six months is still under review.

The state’s is tasked with producing statewide data reports on causes of maternal deaths and intervention strategies. Members of that committee, along with advocates and legislators, are hoping this year’s legislative session extends pregnancy Medicaid to 12 months postpartum.

Kari White, an associate professor at the University of Texas-Austin, said the bureaucratic challenges Ferrell Ortiz experienced are common for pregnant Texans on Medicaid.

“People are either having to wait until their condition gets worse, they forgo care, or they may have to pay out-of-pocket,” White said. “There are people who are dying following their pregnancy for reasons that are related to having been pregnant, and almost all of them are preventable.”

In Texas, maternal health care and Pregnancy Medicaid coverage “is a big patchwork with some big missing holes in the quilt,” White said. She is also lead investigator with the Texas Policy Evaluation Project (TxPEP), a group that evaluates the effects of reproductive health policies in the state. A surveyed close to 1,500 pregnant Texans on public insurance. It found that “insurance churn” — when people lose health insurance in the months after giving birth — led to worse health outcomes and problems accessing postpartum care.

Chronic disease accounted for almost 20% of pregnancy-related deaths in Texas in 2019, according to a partial cohort review from the . Chronic disease includes conditions such as . The report determined at least 52 deaths were related to pregnancy in Texas during 2019. Serious bleeding (obstetric hemorrhage) and mental health issues were leading causes of death.

“This is one of the more extreme consequences of the lack of health care,” White said.

Black Texans, who make up close to 20% of pregnancy Medicaid recipients, are also to die from a pregnancy-related cause than their white counterparts, a statistic that has held true for close to 10 years with little change, according to the MMMRC report.

Stark disparities such as that can be traced to systemic issues, including the in medical providers; for Black women such as cost, transportation, lack of child care and poor communication with providers; and shortcomings in medical education and providers’ implicit biases — which can “impact clinicians’ ability to listen to Black people’s experiences and treat them as equal partners in decision-making about their own care and treatment options,” according to a .

Diana Forester, director of health policy for the statewide organization , said Medicaid coverage for pregnant people is a “golden window” to get care.

“It’s the chance to have access to health care to address issues that maybe have been building for a while, those kinds of things that left unaddressed build into something that would need surgery or more intensive intervention later on,” she said. “It just feels like that should be something that’s accessible to everyone when they need it.”

Extending health coverage for pregnant people, she said, is “the difference between having a chance at a healthy pregnancy versus not.”

As of February, 30 states have adopted a 12-month postpartum coverage extension so far, according to a , with eight states planning to implement an extension.

“We’re behind,” Forester said of Texas. “We’re so behind at this point.”

Many versions of bills that would extend pregnancy Medicaid coverage to 12 months have been filed in the legislature this year, including and . Forester said she feels “cautiously optimistic.”

“I think there’s still going to be a few little legislative issues or land mines that we have to navigate,” she said. “But I feel like the momentum is there.”

Ferrell Ortiz’s daughter turns 5 this year. Amelie is artistic, bright, and vocal in her beliefs. When Ferrell Ortiz thinks back on being pregnant, she remembers how hard a year it was, but also how much she learned about herself.

“Giving birth was the hardest experience that my body has physically ever been through,” she said. “It was a really profound moment in my health history — just knowing that I was able to make it through that time, and that it could even be enjoyable — and so special, obviously, because look what the world has for it.”

She just wishes people, especially people of color giving birth, could get the health support they need during a vulnerable time.

“If I was able to talk to people in the legislature about extending Medicaid coverage, I would say to do that,” she said. “It’s an investment in the people who are raising our future and completely worth it.”

This story is part of a partnership that includes , , and KHN.

This <a target="_blank" href="/health-care-costs/texas-medicaid-coverage-childbirth-postpartum-insurance-legislation/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

“They had a bunch of tennis balls and wrote [the names] of STIs on them,” Cali said. “Then they had a couple of kids come up, put on gloves, and said, ‘If he throws the ball to her and she has a glove on, then she’s protected. But if she doesn’t have a glove on, then she’ll get the disease or something.’ It was really weird.”

Cali said the instructors never explained what the STIs were, just that people should wear condoms to prevent them. “It really was not helpful,” she said.

That presentation was the last time she got any formal sex education in school, she said. Health education is not a mandatory offering .

In 2020, Cali started training to be a peer educator through . “I learned about specific STIs, what they did, viral versus bacterial. I learned different methods of birth control,” Cali said. “It was a lot of catching up.”

After more than two decades, the Texas State Board of Education has updated its health curriculum, including sexual health, for elementary and middle school students. The new curriculum, which will be taught starting in fall 2022, includes detailed information about birth control and STIs for the first time.

But it leaves out key elements sex-ed advocates wanted to see. And despite the state’s high teen birth rate, a recent policy change by Texas leaders rather than opt out of their children’s sex education, which means some kids might not receive any formal school instruction.

Working to Normalize Sexual Health Conversations

The new curriculum comes after years of work from organizations across Texas that are trying to mainstream conversations about sexual health.

“Your reproductive and sexual health is really important for your life,” said Terry Greenberg, founder of the . “Not only does it determine your personal health, it’s the health of your family. If you’re not giving kids that, you’re not equipping them to be adults.”

Teen birth rates across the country , according to the U.S. Department of Health and Human Services. But Texas ranks among the top 10 states for high teen birth rates, with 22.4 teen births per 1,000 females ages 15-19, compared with California’s rate of 11 per 1,000, or Vermont’s at 7 per 1,000, according to 2019 .

Advocates like Greenberg in Texas think better education about contraceptives and pregnancy prevention would improve these statistics. support this idea. Providing students with can reduce unintended consequences like teen pregnancy and STIs.

“I mean, any unintended pregnancy is kind of on us,” Greenberg said. “Why didn’t we supply people with what they needed?”

The new curriculum is still abstinence-first. But including detailed information on contraceptives and STIs is a win for Greenberg and advocates statewide, such as those with the .

“These standards hadn’t been updated since ‘Titanic’ was out in theaters,” said director of policy and data with the organization. “It had been a minute.”

The new curriculum does not include instruction on . Those omissions reflect a larger battle for control over what information kids can access, which has resulted in lawmaker-led , attempts to curb school , and opposition to gender-affirming care for .

Texas and at least four other states have . Students there will not be taught about sexual health, puberty, or reproduction unless parents — or other caregivers — give permission. Texas leaders, including Gov. Greg Abbott, said parents should have control over what their children learn in schools.

Biundo said she’s concerned that one missed piece of paper or email will mean some kids will miss the opportunity.

“When I think about the paperwork that I’ve fished out of my child’s backpack three weeks late, this kind of terrifies me,” she said.

“The big concern with the opt-in policy is that some kids will just slip through the cracks,” Biundo said. “Maybe they’re not living with a parent or guardian, or maybe they don’t have a parent or guardian who’s closely engaged. Those might be the kids that need this information the most.”

Greenberg said an opt-in policy is a “huge logistical barrier for kids.”

“Do you really care about the reproductive health of these kids? You have to give them information,” she said.

Combating Shame and Myths

J.R. Chester has seen all this before. Slow updates and lack of access to information have been a pattern since she started as a community health worker with Parkland Health Hospital System more than 10 years ago.

“I was a repeat teen mom,” Chester said. “Our oldest is 16. He is just a year younger than I was when I got pregnant with him. Then, after I gave birth to him, three months later, we were pregnant with No. 2.”

The Dallas native said she doesn’t remember anyone explaining to her what contraceptives were, or why she menstruated every month.

“No one took the time to tell me, this is why your body is doing this,” Chester said.

Chester said her work is to make sure that kids can ask questions, without shame or guilt.

There are still a lot of that Chester works to debunk, even with adults.

“A lot of my female students had no idea that sexual intercourse didn’t take place in the same hole that they urinated from,” said Chester. “They had this myth in their mind that ‘Oh, well, can’t you just pee it out?’ I hear that a lot as a method of pregnancy prevention.”

At home, she talks with her own kids about health at every stage of their development. For her younger children, that means using the anatomically correct names for body parts. With her teenagers, health conversations include discussions about boundaries and safe sexual encounters.

“A lot of our education in this household has been between parents and children,” Chester said. “That’s because I have the resources and the education to provide it. If I wasn’t in this role, and hadn’t been doing this for 10 years, I don’t know if I would know what to say to them, honestly.”

Biundo, Chester, and high school student Cali Byrd want sex education to be more accessible.

Cali said she wishes decision-makers at the state level would communicate with students like her as they craft the health education plan.

“They need to look at it from the perspective of a child in school,” Cali said. “You can’t make a law concerning how someone lives their life when you don’t understand how they live their life.”

Cali also thinks there’s too much left out of the new curriculum.

“That is honestly the root of all the problems, is if we just teach ‘Don’t have sex,’ you’re not teaching about sex,” Cali said. “I just hope we move past that and, instead, actually teach them what they need to know.”

The health curriculum implementation , but Chester hopes the recent changes will generate open conversations between parents and kids.

“I think people hear ‘sexual health’ and some of them get really squeamish about it,” she said. “But sexual health is your understanding of your body, your basic functioning, how you’re put together, why. That’s really harmful to shame something that is normal.”

Opt-in policies seem to be gaining ground in Texas. A recent change from the state now requires parental permission to teach kids about .

“This really concerns us,” Chester said. “This means that if you have a child who has been abused by their parents, that child would have to get permission from their abusers to learn about child abuse. We think this runs the risk of withholding really crucial information from the kids that need it the most.”

This story is from a partnership that includes , , and .

This <a target="_blank" href="/public-health/texas-sex-education-update-birth-control-sexually-transmitted-infections/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">