F ~OR DECADES, infant mortality has been recognized as a key indicator of a society's health status. Since the founding of the Children's Bureau in 1912, a reoccurring focus of the federal government has been infant mortality. The federal government was forced to reexamine its approach to the issue in the late 1980s when the US ranked 21st among industrialized nations in infant mortality. As a result of this, a White House Task Force to Reduce Infant Mortality was convened in 1989. In 1990, recommendations from this task force began to be operationalized into a targeted approach to high-risk, vulnerable communities. In 1991, the Healthy Start Initiative (HSI) was launched under the direction of the Health Resources and Services Administration (HRSA), US Department of Health and Human Services. Administered by HRSA's Maternal and Child Health Bureau (MCHB), the Healthy Start Initiative was founded on the premise that the communities themselves could best develop the strategies necessary to attack the causes of infant mortality and low birth weight, especially among high-risk populations. Healthy Start promotes communitybased, culturally competent, family-centered, comprehensive perinatal care and other facilitating services to women, infants, and their families. These services are integrated into existing systems of perinatal care. For the HSI, perinatal is defined as the 21-month period from conception to the infant's first birthday. For fiscal year 1999 (FY99) the Initiative was appropriated $105 million by Congress (Federal Interagency Forum, 1999). Healthy Start empowers communities to fully address the medical, behavioral, cultural, and social service needs of women and their infants in 3 key ways: increasing community and personal awareness of what the contributing factors are to infant mortality and how to prevent it; streamlining and coordinating services between public and private agencies; and building partnerships and commitment among families, volunteers, businesses, and health care and social service providers. Baseline data indicate that the current Healthy Start communities have infant mortality rates greater than one and one half times the national average, with African-American infant mortality rates 2 to 4 times the white infant mortality rate, and low birth-weight rates typically one and one half times the national average. Significantly for pediatric nurses, the postneonatal infant mortality rate (infants aged 28 days to 364 days) typically is twice the national average. From 1991 to 1997, Healthy Start supported demonstration projects in 22 communities to learn what works best in reducing infant deaths in diverse settings (i.e., 15 projects were funded in 1991, and 7 additional ones in 1994). The national evaluation, an extensive outcomes and processoriented study, of the 15 original HSI demonstration sites will conclude early next year with the final report due in the spring of 2000. The preliminary findings from 10 of the 15 original Healthy Start communities funded in 1991 for the period through 1995 indicate that one community had a statistically significant reduction in infant mortality, 2 had significantly reduced low birth weights, and 4 had significant reductions in preterm births. For African Americans, who represented more than 88% of the women participating, the infant mortality rate was reduced from 19.1 (1989-1991) to 14.4