Teenage childbearing has never been prevalent in most nations, even when fertility in the Western world was much higher than it is today. However, for reasons still incompletely understood, early family formation was more frequent in many parts of Eastern Europe and some Anglo-speaking countries. In these nations, early marriage was a distinct pattern, and it was not uncommon for teenagers to wed following a premarital pregnancy. Although early marriage has all but disappeared in most industrialized countries, early childbearing continues to occur in high levels in many Eastern European and Anglo-speaking countries. The United States, in particular, has long been an outlier in this trend among high-income nations. Its rate of teenage childbearing is more than four times that of many European nations and more than twice that of Canada and Australia (Singh and Darroch 2000). Despite these consistent distinctions, the rate of fertility among women aged 15-19 dropped rapidly during the past several decades, albeit more slowly in some countries than others, as the demographic transitions associated with adulthood have been delayed in virtually all industrialized nations. This chapter explores some of the reasons for the anomalous pattern in the United States, examines the consequences of early childbearing for teen mothers and their children, and discusses the efficacy of alternative policy approaches to lower early childbearing and lessen its adverse effects.