This article reviews the literature on health consequences of adolescent sexual behavior and child-bearing in sub-Saharan Africa, and the social and cultural context in which they occur. It suggests that, in addressing the most serious health sequelae, sexual intercourse that occurs in early marriage and premaritally must both be considered. Some limitations of the data are noted. Despite the excess risk to which adolescents are exposed, due both to custom and age-related vulnerability, differences between health effects among adult and adolescent women are often differences in degree. They are attributable to behavioral, social, and biological causes, exist in traditional and nontraditional settings, in union and out of union, and are exacerbated by declining ages at menarche, pressures of HIV/AIDS and STDs, and a dearth of appropriate services-especially for young people. Some current interventions are discussed, and the need for policy as well as medical intervention is stressed.