Existing data on American Indians and Alaska Natives (AI/ANs) has indicated high rates of unintended pregnancy, high-risk sexual behavior, and experiences of sexual violence. This study from the first analysis to examine AI/ANs and the urban AI/AN subgroup in the National Survey of Family Growth (NSFG) reports new findings of reproductive health and sexual violence among urban AI/AN young women. We examined 2002 NSFG data on urban AI/AN women ages 15-24 years for pregnancies/births, unintended pregnancy, sexual initiation and contraceptive use. We also examined non-voluntary first sexual intercourse among urban AI/AN women ages 18-44 years. Prevalence estimates and 95 % confidence intervals were calculated. Findings include prevalence rates of risk factors among urban AI/AN women ages 15-24 years including unprotected first sex (38 %), first sex with much older partners (36 %), three or more pregnancies (13 %) and births (5 %) and unintended pregnancies (26 %). Seventeen percent of urban AI/ANs ages 18-44 years reported experiencing non-voluntary first sex. Sixty-one percent of urban AI/AN women ages 15-24 years were not using any method of contraception. Current contraceptive methods among those using a method included: injections/implants (23 %), contraceptive pills (32 %) and condoms (25 %). Findings describe reproductive health risk factors among young urban AI/AN women and highlight the need for enhanced surveillance on these issues. Those working to improve AI/AN health need these data to guide programming and identify resources for implementing and evaluating strategies that address risk factors for this overlooked population.