BACKGROUND: Adolescent pregnancy and birth rates in the United States have declined dramatically from their peaks in 1991, but remain much higher than those seen in most other developed countries. METHODS: Recent results from relevant clinical trials, periodic surveys of reproductive age women, and focus group work as well as professional group recommendations in the United States are presented to provide insights into the problem of unintended teen pregnancy and suggest potential solutions. RESULTS: Dramatic changes in contraceptive technologies and practices have been implemented in the past several years to reduce the barriers young women have in accessing the most effective methods of contraception. However, new reports about how young women view their risks suggest that new strategies will be needed to motivate more sexually active young women to prevent pregnancy. CONCLUSIONS: The safety and efficacy of modern methods of contraceptives are the highest they have ever been, but if unintended pregnancy rates among teens in the United States are to be more significantly reduced, young women's attitudes about contraception and pregnancy prevention need to be better understood and remaining barriers to its access need to be reduced.