Purpose: To assess potential impact of programs to prevent adolescent pregnancy on infant mortality. Methods: Infants (n = 247,503) born alive to Alabama residents from 1991 to 1994 were identified from birth cohort files and linked to infant death records. Deliveries funded by Medicaid, private insurance, and self-payers were studied separately. Relative risks (RR) and population attributable risks were calculated. The latter provided estimated percentages by which infant (<1 year) death risks would have decreased if adolescent (≤19 years) pregnancies had been prevented. Results: Infants of mothers <16 years of age were at higher risk of death than were infants of mothers aged 20 to 34 years (adults): the RRs were 4.1, 3.4, and 1.4 for self-payers, private insurance, and Medicaid groups, respectively. In the self-payer and private insurance groups, but not the Medicaid group, infants of mothers aged 17 to 19 years were more likely to die than were infants of adults. Infants from repeat adolescent pregnancies comprised nearly one-third of all infants born to adolescents, and in each payer-group were more likely to die than were infants of adults: The RRs were 4.9, 2.5, and 1.3 for self-payers, private-insurance, and Medicaid groups, respectively. Theoretically, preventing all adolescent pregnancies and preventing only repeat adolescent pregnancies would have reduced infant mortality in the total population by 8% and 4%, respectively. Conclusions: Programs to prevent first and subsequent adolescent pregnancies probably have little effect on infant mortality. Efforts to prevent adolescent pregnancies should not have a short-term goal of notably reducing infant mortality. Copyright © 2001 Society for Adolescent Medicine.