AMARILLO, Texas — On the vast Texas Panhandle, raked by wind and relentless sun, women might drive for hours to reach Haven Health, a clinic in Amarillo.

One of more than 3,200 federal family-planning clinics nationwide, Haven serves both English and Spanish speakers, providing contraception, testing for pregnancy and sexually transmitted infections, and cervical cancer screening, all at low cost or without charge to patients who are anxious, impoverished, or both.

Those patients include teenage girls — under 18 — seeking birth control pills or long-acting contraception.

But under a startling court decision issued in December, a federal judge ruled that such clinics violate Texas state law and federal constitutional rights, effectively cutting off a vital source of health care for young women across Texas.

Permission required

Women's health advocates and health care providers alike have decried the decision by a conservative judge appointed by President Donald Trump who is at the center of other reproductive rights cases. They say it is overly broad and unprecedented. (The ruling applies to the national regulations, but for now is followed only in Texas.)

"We can't even provide contraception for a gynecological issue," said Carolena Cogdill, CEO of Haven Health, adding that the ruling by U.S. District Judge Matthew Kacsmaryk has had a chilling effect on care. "We had a young lady come in who had abnormal bleeding, and we wanted to prescribe contraception to help control that bleeding. And we couldn't do it because she was 16." The patient had said her mother would not understand, believing that her daughter was "going to go out and have sex and she just didn't want to go there," Cogdill said.

Texas law has long required that teenage girls have a parent's permission to get prescription contraception. But under the federal program Title X, certain clinics could provide contraception without parental consent. Established in 1970, Title X evolved out of the "War on Poverty" era and passed with broad bipartisan support. The legislation was signed by then-President Richard Nixon, a Republican, to provide family-planning services to low-income people, including minors, with the goal of reducing teen pregnancy.

But in July 2022, weeks after the Supreme Court rescinded constitutional protection for abortion in Dobbs v. Jackson Women's Health Organization, Alexander R. Deanda, a father of three adolescent daughters who lives in Amarillo, sued the Department of Health and Human Services. He argued that the government had violated his constitutional right to direct the upbringing of his children.

In his suit, Deanda, a Christian, said he was "raising each of [his] daughters in accordance with Christian teaching on matters of sexuality" and that he could have no "assurance that his children will be unable to access prescription contraception" that "facilitate sexual promiscuity and premarital sex."

In his opinion, Kacsmaryk agreed, writing that "the use of contraception (just like abortion) violates traditional tenets of many faiths, including the Christian faith plaintiff practices."

Moreover, Kacsmaryk, who is a Christian, said the existence of federal clinics operating in Texas, where state law otherwise requires parental permission for teenage girls to receive contraception, posed an "immediate, present-day injury."

"Title X clinics are open most days and, therefore, they post an ongoing, continuous, and imminent risk," the judge wrote.

Religious versus legal arguments

The decision, which referenced Catholic catechisms and fourth-century religious text, stunned legal experts like Elizabeth Sepper, a law professor at the University of Texas at Austin, who said it was part of the rising influence of conservative Christian theology in the courts.

"We've seen religious arguments that increasingly come into the courts dressed up as legal arguments," Sepper said. "I think we're seeing a movement that began with a religious exemption, saying 'Let me structure my health care to suit my morals,' and we're moving toward an agenda that says, 'Let me structure all of health care according to my morals.'"

Neither Deanda nor his attorney, Jonathan Mitchell, the architect of Texas' pre-Dobbs abortion ban, responded to requests for comment.

The effects of teenage pregnancy on the arc of a woman's life can be profound. Half of teenage mothers receive a high school diploma by age 22, compared with 90% of young women who do not give birth as teens. Teen births can lead to poor outcomes for the next generation: Children of teenage mothers are more likely to drop out of high school and end up in jail or prison during adolescence.

Dr. Stephen Griffin, an assistant professor at Texas Tech University in Lubbock and a practicing OB-GYN, described access to birth control for young women as a "safety issue," adding that many parents underestimate their teenagers' sexual activity.

"We know that people who identify as regular church attendees are more likely to underestimate their child's risk-taking behavior in terms of sex," Griffin said. "We know that parents who feel they have open lines of communication with their children" also underestimate the risk.

Texas has one of the highest rates of teen pregnancy in the nation and the highest rate of repeat teen pregnancy — more than 1 in 6 teenagers who gave birth in Texas in 2020 already had a child. Health experts say the court decision banning access to contraception is likely to increase those numbers, following on the heels of other restrictions on reproductive health care in the state.

"Abortion is illegal in Texas. Kids aren't getting comprehensive sexual education in schools. A vast [number] of folks in Texas are living without health insurance," said Stephanie LeBleu, acting director of Every Body Texas, which administers the state's more than 150 Title X clinics. "So it does make it very difficult to get sexual health services."

The Biden administration appealed the Texas decision in February. In the meantime, LeBleu said, there is no safety net left here for teens.

"It robs them of their humanity," she said. "It robs them of their future, potentially. And it robs them of their bodily autonomy, and I think young people are more than capable of making decisions about their own health care."

Confidential and controversial

Decades of research shows that teens are more likely to seek sexual health care if they can do so confidentially. But for Texans like Christi Covington, the belief is that the law shouldn't make exceptions even in the hardest cases.

Covington lives in Round Rock, an Austin suburb. She was raised in a large evangelical family and is passing those teachings on to her three children. Leaving aside religious objections to birth control, she said, the family unit should be respected.

"God designed the world for there to be parents and then we have our offspring and that the parents care for those children, and that is design," she said. "And we do see that reflected in nature."

As for birth control, she said, "It feels like a band-aid."

"Let's give them birth control, and then we don't actually have to deal with what's happening in our society where these teens are getting pregnant so quickly and so easily," Covington said.

She added she already is required to give permission for her children's health care, including inoculations. "Honestly, I have to give consent all over the place for my children's other medical care," she said. "Why would we decide that this one area is exempt?"

But Rebecca Gudeman, senior director of health at the National Center for Youth Law, said 60% of teens involve their parents in such decisions.

"They do that not because the law requires them to do that, but because that's what they want to do," Gudeman said.

Some young people, she said, simply can't involve their parents or guardians, including couples like Victoria and Richard Robledo, who began dating — and having sex — when they were both minors. During those early days, Victoria said, she decided to get birth control but couldn't turn to her mother, a devout Catholic, for advice.

"We were a typical Hispanic household," Victoria recalled. "And so usually in households like mine, they don't want to talk about boyfriends or sex or anything like that."

But Victoria found a clinic less than a mile from her high school and was able to obtain birth control free of charge. The couple, now married and living in Clovis, New Mexico, just across the state border, has two children.

Victoria said being able to protect herself from pregnancy as a teenager changed the course of life, allowing her to go to college and her husband to join the military.

"We weren't worried about the fact that we may have a kid," she said. "We both were able to go out and live our own lives."

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation. [Copyright 2023 Kaiser Health News]