Published by the Alan Guttmacher Institute (AGI), this article focuses on socio-economic factors influencing reproductive health needs and service use among young women in 12 developing countries. Findings showed that, in most countries, young women from the poorest households were more likely than those from the richest to be married and have at least one child by the age of 18, and to lack financial independence. They were also less likely to know how to prevent sexual transmission of HIV, to use modern methods of contraception, to have given birth with a skilled attendant present, or to use maternal health services. Poor adolescent women were also less likely to be enrolled in school than their wealthy counterparts, and reported less exposure to mass media. The authors conclude that current methods of service delivery that rely on mass media, clinics or schools, may not be reaching the poorest adolescents. Key barriers to accessing care include financial constraints, geographical distance from clinic sites, and social prejudices from health care providers. The authors advocate alternative strategies, including the implementation of community-based outreach programmes, to ensure that the reproductive health needs of poor young women are met.