Less than 2 years after the Omnibus Budget Reconciliation Act (OBRA) of 1981 mandated the reorganization of long-established maternal and child health services and substantially reduced funding of programs, a rise in the incidence of unfavorable maternal and child outcomes was detected in national health data. Data suggest at least an inferential correlation between the effects of OBRA and health outcomes. This discussion examines the impact of OBRA on the occurrence of infant deaths in three Boston neighborhoods. Using extant data sources and drawing on prior research, the discussion: (1) frames the background and policy context of OBRA; (2) describes national population dynamics and trends, their influence and implications for infant mortality in Massachusetts, in Boston, and in the predominantly black neighborhoods of Roxbury, Dorchester, and Mattapan; (3) reviews relevant research, reports, and supporting documents on the problem; and (4) updates institutional and programatic efforts designed to respond to effects of the OBRA. It is concluded that since the implementation of the budget cuts, there has been an erosion in health status, particularly among mothers and children, and that infant deaths have dramatically increased. (RH)