Cali Byrd is a junior at Booker T. Washington High School in Dallas. She remembers when a group came to talk to her class about sexually transmitted infections in eighth grade.
The talk involved a bunch of tennis balls with the names of STIs written on them.
"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,' " Byrd said. "It was really weird."
Byrd 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 was the last time she got any sex education in school, Byrd said, as it's not mandatory once kids get to high school.
Instead, in 2020, Byrd started training to be a peer educator through Planned Parenthood of Greater Texas, where she learned details about STIs, and different methods of birth control. "It was a lot of catching up," she said.
After more than two decades, the Texas State Board of Education is finally catching up too. It has updated the 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 some key elements advocates wanted to see. And despite the state's high teen birth rate, a recent policy change by Texas leaders made sex education opt-in, rather than opt-out, which means some kids might not get any instruction in schools at all.
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, the founder of North Texas Alliance to Reduce Unintended Pregnancy in Teens. "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 have been declining since 2007, according to the U.S. Department of Health and Human Services. But Texas is routinely in the top ten states with the highest teen birth rate, with 22.4 teen births per 1000 females aged 15-19, compared to California's rate of 11 per 1000, or Vermont's at 7 per 1000, according to 2019 data from the Centers for Disease Control and Prevention.
Advocates like Greenberg in Texas think better education about contraceptives and pregnancy prevention would help some of these statistics. Multiple research studies support this idea. Providing students with medically accurate and inclusive sexual health education 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 statewide advocates at the Texas Campaign to Prevent Teen Pregnancy.
"These standards hadn't been updated since Titanic was out in theaters," said Jen Biundo, director of policy and data with the organization. "It had been a minute."
But the new curriculum still leaves things out. It does not include instruction on consent, gender or LGBTQ+ topics. Those omissions reflect a larger battle for control over what information kids can access, that's seen book bans, pride events and trans youth targeted by lawmakers.
There's also a new policy from the legislature that requires parents and caregivers to opt-in to health education, rather than opt-out. That means the default is that kids don't get taught about sexual health, puberty or reproduction, unless parents give permission. Texas leaders, including Gov. Greg Abbott, said parents should have control over what their children learn in schools.
Texas is now one of less than six states across the country with an opt-in policy.
Biundo said she's concerned that one missed piece of paper or email will mean that some kids won't get this instruction at all.
"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."
Greenbert says 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.
Letting kids ask questions and learn, without shame
J.R. Chester has seen all this before. Slow updates and lack of information access has been a pattern since she started as a community health worker with Parkland Health Hospital System more than ten 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 number two."
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 myths about health and reproduction 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 conversation 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."
Future visions for health education in Texas
Biundo, Chester and high school student Cali Byrd want sex education to be more accessible.
Byrd said she wishes there people from the state deciding on health education would communicate with students like her.
"They need to look at it from the perspective of a child in school," Byrd said. "You can't make a law concerning how someone lives their life when you don't understand how they live their life."
Byrd also thinks there's too much left out.
"That is honestly the root of all the problems, is if we just teach, don't have sex, you're not teaching about sex," Byrd said. "I just hope we move past that and instead, actually teach them what they need to know."
The health curriculum implementation varies across districts and schools, but Chester hopes the recent changes will help more parents and kids have open conversations.
"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."
But the opt-in policy seems to be gaining ground in Texas. A recent change from the state now requires parental permission to teach kids about child abuse, family violence, dating violence and sex trafficking.
"This really concerns us," she 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 part of a partnership between NPR, KERA and Kaiser Health News.