AUSTIN – Texas, a leader in teen pregnancy and the state where more teens give birth to subsequent children than in any other, maintains one of the most restrictive policies in the nation for minors to obtain prescription birth control.

Not even young parents in Texas can get birth control without their own parents' permission at nearly a third of the family planning clinics on contract with the state health department.

While most privately and publicly funded clinics in North Texas prescribe contraceptives without insisting that parents be notified, all 10 school-based clinics run by Parkland Health & Hospital System in Dallas must have a parent's signed consent. One in Carrollton-Farmers Branch, at the school district's insistence, can't prescribe any birth control.

And many doctors in private practice in Dallas-Fort Worth also won't prescribe birth control confidentially. Public health officials and women's health advocates say some doctors aren't aware that Texas laws are silent on whether a minor may independently obtain contraceptives.

As a new report last week showed, Dallas leads all U.S. cities in the percentage of teen births that weren't the mother's first delivery. Critics of state policies said they are idealistic, ideologically driven and woefully out of touch.

"We're in denial that our teens are sexually active," said Janet Realini, a doctor and former Bexar County health department leader seeking to reduce teen pregnancy. "Parents think they've talked to their kids about sex but if you talk to their kids, at least half the time, the kids don't remember that."

She cited the latest federal survey of teenagers' risky behavior, which showed that 53 percent of Texas high school students said in 2007 they'd had sexual intercourse.

While some social conservatives blame the state's high teen pregnancy and birth rates on immigration and cultural decline, others said they struggle to find solutions that don't impinge on parental rights.

Sen. Dan Patrick, R-Houston, acknowledged that teen pregnancy is a "serious problem," but said he felt compelled to oppose a bill last spring that would have let unmarried 16- and 17-year-old mothers give "medical consent" to obtain contraceptives, without involving their parents.

"I supported the general concept [but] the majority of the Senate agreed with me that a doctor should not prescribe contraceptives to minors without giving the parents notice," he said. "The problem is not that we need more contraceptives but more parenting."

Patrick won approval for the parental-notification provision. But the bill's author, Leticia Van de Putte, D-San Antonio, let it die rather than see Patrick's provision become law.

Van de Putte said it's ironic that under existing law, a young mother calls the shots on her child's medical care but isn't trusted to do things to prevent a quick second pregnancy, which for teens carries high risk of a premature baby.

"Until we can as legislators look at common sense rather than trying to win the next primary, we're not going to be courageous enough" to help teens, Van de Putte said.

Texas carefully controls what public schools tell youngsters about sex and how health care providers dispense birth control. A recent study showed only 4 percent of Texas schools teach about potential benefits, as well as risks, of contraception. Abstinence-only instruction focuses on different methods' failure rates.

With the power change in Washington this year, federal funding for abstinence-only education appears to be dying. And in the Legislature, resurgent Democrats tried but failed to soften laws that make it hard for minors to be taught about contraceptives, obtain them and avoid "coverage gaps" in various health programs.

Texas is one of four states that doesn't let its Children's Health Insurance Program for low-income youngsters provide contraceptives. Though it spends $1.2 billion for Medicaid to cover 228,000 births each year, it doesn't automatically enroll those women in a 3-year-old offshoot of Medicaid that covers family planning services for a year at a time, as some states do. And minors aren't allowed in anyway.

Only Texas and Utah forbid giving teens birth control without a parent's consent at state-funded clinics.

"Texas is kind of on its own," said Elizabeth Nash, who tracks state policies for the Guttmacher Institute, a nonpartisan health research center that supports abortion rights.

She said Utah is "more straightforward" because it tells youths on a state health department Web site that they'll have to go to Planned Parenthood clinics if they want birth control and are unwilling to involve their parents.

Gov. Rick Perry, a Republican seeking re-election, "continues to support a focus on abstinence education, and he has advocated strongly for a number of initiatives that protect marriage, strengthen parental rights and provide children the best opportunity to succeed in life," said spokeswoman Katherine Cesinger.

Perry believes "the state should not usurp the role" of parents, but should try to empower them to discuss sex and its consequences with their children, Cesinger said.

Doctors who work with teens say that while some who are sexually active can navigate through a confusing state system of care, others lack street smarts – and transportation.

"The trend is the teens seem to be knowing less," said Celia Neavel, an Austin doctor who runs an adolescent health center at People's Community Clinic, a nonprofit that serves the working poor. "We certainly see some that don't know their own body at all. Or they'll come in pregnant and not even understand their own anatomy. It's really frustrating."

Kathryn Allen, vice president for community relations at Planned Parenthood of North Texas, said local doctors are "very mixed" in responses to minors' requests for birth control pills, implants or shots.

"A lot of young people switch to us when they're 16 and 17 because they're unsure whether the family doctor will immediately turn and walk out of the room and tell the parents in the waiting room," she said.

But minors generally have to have a car and $100 to get on birth control on their own at a clinic, she said. The clinics encourage young women to consult their parents, but many feel they can't, Allen said.

Van de Putte, the Democrats' leader in the Senate, said state officials need a new approach to reduce teen births.

"I've been a pharmacist for over 30 years," she said. "And I can tell you, once they start having sex, they ain't going to stop."