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fant health outcomes, as well as reduced educational and employment opportunities for young mothers.2 Teenage pregnancy, early childbearing and adverse infant health outcomes are most likely to occur among disadvantaged women with restricted access to health services, but the social and economic pathways to these outcomes are not well understood.3 A great deal of attention has been focused on the racial gap in teenage parenthood. Black women are much more likely than whites to begin childbearing in their teenage years.4 According to Furstenberg, “both normative and socioeconomic differences may account for these demographic patterns.”5 He and others attribute the variation in teenage birthrates to social inequalities rather than to race per se.6 The social disadvantage of rural populations has been largely neglected in the development of policies and interventions related to adolescent pregnancy, despite the high-risk profile of rural teenagers.7 Rural youth are 22% more likely than urban youth to be living in poverty, but are 20% less likely to be covered by public assistance.8 Because predominantly rural states have had lower participation rates in Aid to Families with Dependent Children, residents of these areas have been less likely to be covered by Medicaid. Historically, rural women have been more likely than their urban counterparts to lack both pubTrude Bennett is assistant professor, Department of Maternal and Child Health, School of Public Health; Julia DeClerque Skatrud is research fellow, and Priscilla Guild is deputy director and senior fellow, Cecil G. Sheps Center for Health Services Research; and Frank Loda is professor, Department of Pediatrics, School of Medicine—all at The University of North Carolina, Chapel Hill. Lorraine V. Klerman is professor and chair, Department of Maternal and Child Health, School of Public Health, University of Alabama, Birmingham. The research on which this article is based was funded by Agency for Health Care Policy and Research (AHCPR) contract 282-93-0038, delivery order 1, as part of the AHCPR Rural Centers–Region IV program. The authors acknowledge the contributions of Jean Carmody, Thomas Ricketts, Robin Schectman, Hilda Ann Howard, AnnaRhesa Versola, Kerry Martin, Nanci Pedulla and Stanley K. Henshaw. Pierre Buekens, Anita Farel and J. Richard Udry provided helpful comments on an earlier version of the manuscript. Rural Adolescent Pregnancy: A View from the South