Texas Newborn Screening Program’s Benefits Vary for Families

Newborn Screening1 is done through a simple heel prick to get a blood sample followed by a lab analyzing the molecular weights of the newborn’s metabolites. The process is seemingly harmless to newborns, and can reduce disability progression and morbidity of serious diseases. As a resident of Texas, where life expectancy can be predicted from a person’s zip code, one can’t help but wonder if newborn screening provides equal outcomes for every baby screened. 2 

Why is equality of outcomes important? Newborn screening is a public health program aimed at reducing overall disability and morbidity of certain early childhood diseases, which is thought to save money throughout the population on healthcare expenses. If the uninsured and underinsured are not able to appropriately treat diseases found in newborn screening, this public health policy would be increasing inequality in child healthcare. Healthcare equality is important because it lowers the healthcare expenses of citizens that rely on subsidized insurance, increases overall population health, and promotes equitable quality of life. 

One problem faced by families after newborn screening is access to healthcare facilities.3 A newborn who is screened as likely to have a metabolic disease must undergo follow up examinations to actually diagnose them. In such a large state, access to specialty doctors varies greatly. Rural areas struggle to provide families with appropriate follow up care for diagnosis and proper facilities to provide treatment after diagnosis. Rural areas also have a harder time submitting samples due to their distance from testing sites in cities, meaning rural families may get results later than urban families. Rural pharmacies will take longer to get uncommon prescriptions or special formulas, or families may have to travel to a pharmacy which carries what they need. 

Another barrier to healthcare equality for newborn screening lies in the educational materials offered to families.4 Healthcare providers are not always aware of the education materials provided by the health department, and thus may not offer them to families who are confused at the process. The educational materials are offered in English and Spanish, so families who do not know how to read one of these languages will require help with the materials. Doctors may hand the families the reading material instead of sitting down and talking with them. This would also affect parents who struggle with literacy. The educational materials are close to high-school level readings, which many people have not achieved. 

The barriers discussed apply to all areas of healthcare, not just newborn screening. In order for NBS and other healthcare initiatives to reach their full potential, there must be an organized effort to reduce barriers in healthcare equality.  

1. Texas Administrative Code §37.51 requires all babies born in Texas participate in Newborn Screening, with a religious exemption.

2. https://www.texashealthmaps.com/lfex

3. https://www.dshs.state.tx.us/lab/NBSgapsWeaknessSummaryReport.pdf

4. https://www.dshs.state.tx.us/lab/NBSgapsWeaknessSummaryReport.pdf

Anti-Prostitution Laws are Hurting Juveniles

The movement to decriminalize sex work has been pushed by sex workers for decades and has gained national popularity in criminal justice discussions. Decriminalizing sex work would halt arrests and charges for prostitution. While this may not seem like a juvenile justice issue, there is a small but significant group who have been impacted by anti sex work laws: juveniles arrested for prostitution.

The Trafficking Victims Protection Act defines sex trafficking as recruiting, patronizing, or otherwise causing a person under 18 years old to participate in a commercial sex act.[1] Most states have statutory rape laws which state a person under a certain age cannot consent to sex with an adult. In Texas, for example, an adult cannot engage in sexual contact with a person under 17 years old.[2] These laws indicate a general consensus that minors cannot consent to sex work or sex with adults. If that is the case, the 290 children aged 0-17 who were arrested in 2019 for prostitution should have been treated as victims instead of criminals.[3]

The interception of child trafficking victims and criminal prostitution laws can be seen in the 2010 Texas case In re B.W. This case involved a 13 year old girl who was arrested for prostitution in Texas.[4] The offense was filed in adult criminal court, where it was discovered the arrestee was a child. [5] The prostitution charge was then dismissed, but B.W.’s involvement with the justice system was not over. The charges were transferred to juvenile court, where B.W. pleaded true to the allegation, which is the equivalent of pleading guilty in adult court, and was sentenced to 18 months probation.[6]

On appeal, the Supreme Court of Texas ruled that because the legislature has determined children under 14 do not have the mental capacity to consent to sex with anyone, they are exempt from prostitution charges. [7] This was a win for B.W. and child sex trafficking victims all over Texas, but the impact of criminalization was already felt. B.W. had already been subjected to arrest and booking in adult court. In re B.W. protects juveniles who are 14 or younger, but leaves other teenagers in Texas age 15-16 vulnerable to prostitution charges and arrests. There is not clear data on how many 15 and 16 year olds have been arrested for prostitution in Texas since In re B.W., but Texas makes up part of the 290 total arrests, indicating there have been some. Not all arrests lead to charges, but all arrests traumatize the children who are subject to them.

The effects of arrest on juveniles cannot be taken lightly. Youth who have been arrested are much less likely than their peers to graduate high school or enroll in college.[8] A child who is arrested and is then confined at a juvenile detention facility is virtually guaranteed to not finish their high school education.[9] Young people without a high school degree will face more difficulties finding stability and employment.[10] High school dropouts may face an increased risk of grooming by sex traffickers because they are not around teachers who recognize the signs and can refer the student to school counseling or other services.

Criminalization of sex work is causing lifelong effects in vulnerable juveniles. While full decriminalization of sex work may not be popular in every state, laws preventing minors from being charged with prostitution would go a long way in protecting the country’s youth.

[1] 18 U.S.C. § 1591
[2] Tex. Penal Code §21.11
[3] Office of Juvenile Justice and Delinquency Prevention, https://www.ojjdp.gov/ojstatbb/crime/ucr.asp?table_in=1
[4] In re B.W., 313 S.W.3d 818
[6] ​​Id.
[7] Id.
[8] David S. Kirk & Robert J. Sampson, Juvenile Arrest and Collateral Education Damage in the Transition to Adulthood, 36, 47 (American Psychological Association 2013).
[9] Id at 55
[10] Id.

Texas Tops the Nation in Teen Births

Texas ranks #9 in states with the highest teenage birth rate.[1] A whopping 1 in 6 of Texas teens who gave birth in Texas in 2020 had already given birth before.[2] This comes after Texas passed the controversial Senate Bill 8 which greatly reduced abortion access in Texas.[3]Access to abortion is only half the battle for those trying to reduce unplanned pregnancy in teenagers. Birth control also plays a critical role in protecting teens from unplanned pregnancies.

Birth control options are extremely limited for Texas teens. Texas is one of the states where teens under 18 need parental consent to go on contraception.[4] A teen living independently with their own child needs a parent’s permission to go on contraception. Birth control is a taboo subject between many teens and parents, leaving some teens to wait until it’s too late. Teens who bring up contraception with their parents can be shut down. Parental permission is an even bigger hurdle for teens not living with their parents and teens in foster care who can not procure a parent’s consent.       

Contraception is not covered for teens on CHIP, the state’s health insurance program, and they must instead seek coverage by the state funded Family Planning Program. Parental permission is also required under the Family Planning Program.[5] CHIP covers teens through their 19th birthday. [6] An 18 year old still enrolled in CHIP will not have birth control covered by their insurance and must use the Family Planning Program. The FPP’s opt-in style contraception coverage creates a gap between a teen needing birth control and having that need met. This gap leaves teens vulnerable to unplanned pregnancy while they are trying to be responsible with their sexual health.

Texas attorney general Ken Paxton wrote an opinion targeting families who seek gender-affirming healthcare, particularly hormone blockers, for their transgender child. [7] This spells bad news for birth control, which usually blocks certain pregnancy-inducing hormones. The opinion encourages family services to investigate families suspected of providing gender-affirming care to their child, and is supported by a letter to Texas family services from Governor Greg Abott.[8] The opinion does not outlaw hormone blocking medications for teens. It’s aim is to scare families away from certain healthcare for teenagers. The opinion targets puberty blocking drugs, but it may discourage transgender teens and their parents from going to birth control appointments out of fear of being reported by their doctor. As a result, trans youth face a new barrier to contraception. The attack on hormonal medications for teens leaves some contraceptives vulnerable to similar arguments, as they both use hormones that affect the reproductive system. If the government is successful with this intrusion into family healthcare, birth control could be next. 

If Texas wants to reduce the number of teens giving birth, it must recognize a teen’s right to make their own reproductive health choices. The state can start by ensuring contraception is covered by CHIP, which would allow teens to get a birth control prescription filled soon after visiting their primary care doctor.  Eliminating parental consent to birth control might be a long shot in the lone star state, but drastic action may be the answer to a drastic problem. It’s clear that Texas’ current approach to contraception is failing its children.

[1] https://www.cdc.gov/nchs/pressroom/sosmap/teen-births/teenbirths.htm

[2] https://www.texastribune.org/2022/02/21/texas-teenage-pregnancy-abortion/

[3] https://www.texastribune.org/2022/02/21/texas-teenage-pregnancy-abortion/

[4] https://www.texastribune.org/2022/02/21/texas-teenage-pregnancy-abortion/

[5] https://www.texastribune.org/2022/02/21/texas-teenage-pregnancy-abortion/

[6] https://www.texastribune.org/2022/02/21/texas-teenage-pregnancy-abortion/

[7] https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/2022/kp-0401.pdf

[8] https://gov.texas.gov/uploads/files/press/O-MastersJaime202202221358.pdf