Relating to the required inclusion of a person's sex on a birth certificate and prohibited change of sex on the birth certificate of certain persons.

HB 2291 requires Texas birth certificates to list a child's biological sex (determined by sex organs, chromosomes, or endogenous profile) at birth, with limited exceptions. It prohibits changing this information on birth certificates except in three specific cases: correcting clerical errors, completing missing biological sex details from the original certificate, or updating for individuals born with atypical sex characteristics whose sex is later determined. The bill directly affects all newborns in Texas and individuals seeking to amend birth certificates. It does not allow changes to biological sex information for any other reason, including gender identity. This policy standardizes birth certificate documentation based on biological factors at birth.