The USA has the highest rate of teen pregnancy and births in the western industrialized world with 34% of young women becoming pregnant at least once before the age of 20. Eighty percent of these are unintended and to unmarried teens. Despite advances in contraception, there remain three million unintended pregnancies each year in the USA with about half of them ending in planned terminations. Adolescents usually approach providers about 1 year after initiation of sexual activity to seek contraception. Barriers to care include lack of knowledge, confidentiality concerns, and fear of a pelvic examination. Preventive visits prior to initiation should address these issues and open up the conversation about sexual activity and contraception.