This project uses discursive, visual, and ethnographic approaches situated in a critical feminist methodology to understand how ways of knowing about youth sexuality and reproduction influence community health work. I understand the “problem” in this inquiry as the discursive contexts that limit critical ways of knowing about young people’s sexual subjectivities and practices and about the design of policies and programs. Although race, class, gender, and sexuality are understood in the public health literature as important social determinants of health, there is a lack of research that applies a critical, feminist lens to these constructs. I draw on three years of ethnographic research in a small, northeastern city with a large Puerto Rican population and high rates of teen pregnancy to illustrate how community health workers take up and transform discourses of race, science, and sexuality as well as how teen parents situate their embodied experiences within these discourses. I combine interviews with key informants, participant observation at coalition meetings and community events, and visual analysis of stories produced by pregnant and parenting young women to argue that the production of authoritative racialized, sexual scientific knowledge both obscures and contributes to health and social inequalities. The politics of youth sexuality and reproduction easily reify what everyone “knows to be true” and enable community health workers to naturalize claims about race, culture, sexual health, and causality. I argue that a reproductive justice framework can shift the discursive context of youth sexuality and reproduction in the city to promote racial, economic, and sexual justice.