The Old Order Amish are a distinct ethnic group with a very high birth rate and patterns of perinatal risk factors quite different from those of the general population. This study reports marital fertility and perinatal, infant, and child death rates for an entire Amish settlement of approximately 10,000 individuals, centered around Geauga County, Ohio. All 6,623 births from 1948 to 1988 listed in a directory of Geauga Settlement Amish households were studied. The childbearing experience of all 475 married women over the age of 44 years was also described. Women aged > 44 years had a median of 8.3 births; 24% of the births were to women aged > 34 years. Despite a higher prevalence of several risk factors for perinatal and infant death among the Amish, neonatal and infant death rates for Geauga Settlement Amish have been very similar to the corresponding rates for white children in rural Ohio and the state as a whole. The beneficial aspects of Amish society that may lessen the impact of perinatal risk factors on mortality merit further study.