A child born in Japan, Finland, Hong Kong, Ireland, Australia, Canada, Singapore, or any of 12 other industrialized nations has a better chance of surviving his or her first year than does a child born in the United States. This is because too many babies are born too small, too many are born too soon, and too many mothers never get decent care and guidance during their pregnancy. In 1985, 9.5 million women of childbearing age had no health insurance. Medicaid now assists less than 40 percent of America's poor and only half of America's poor children. The costs of prenatal care can be as little as $400 per mother; the lifetime costs of caring for a low birthweight infant can reach $400,000. The following recommendations are offered: (1) universal access to early maternal and pediatric care; all workplace health insurance coverage that includes maternity and infant care; government responsibility for those who lack insurance or are unable to pay; and (2) a sustained, broadbased effort to make the health and well-being of mothers and infants a national priority. Strategies for the public and private sectors, communities, and the government are offered. Illustrations accompany the text; a list of references is included. The appendix to this report contains: (1) results of a survey designed to elicit priority recommendations from recognized experts for reducing infant mortality in the U.S.; (2) a paper entitled "A History of Federal Initiatives To Reduce Infant Mortality"; and (3) a series of issue briefs on such topics as: low birthweight; postneonatal mortality; prenatal care; the financing of maternal and infant care; the Special Supplemental Food Program for Women, Infants, and Children (WIC); minority populations; and adolescent pregnancy. The second attachment to the document consists of testomonies on the role of government in reducing infant mortality. Two separate panels were heard. On panel 1, "Setting a National Policy Agenda for Mothers and Infants," the witnesses, all highly placed government officials, described why and how they made infant mortality and maternal and child health policy priorities and offered recommendations for a national policy. On panel 2, "Federal, State, and Local Leadership in Reducing Infant Mortality," administrators from all three governmental levels as well as other expert witnesses discussed issues of intergovernmental and interagency relationships regarding health and education programs and suggested possible solutions. (AA)