Help for infants and pregnant women.

Each year, 39,000 American infants die before their first birthdays, giving the U.S. one of the highest infant mortality rates among industrialized countries. Contributing to these deaths is the fact that many children and pregnant women fail to receive basic health services. Yet, according to Joshua Wiener, a senior fellow in the Brookings Economic Studies Program, and Jeannie Engel, a consultant with the Management Assistance Group, authors of Improving Access to Health Services for Children and Pregnant Women, "Where there is agreement that action is necessary, there is not a clear consensus on what should be done."

The national rate of low birth weight, the factor most associated with infant mortality, has remained virtually unchanged over the last decade. Though the death rate of infants has declined in recent years, that is largely the result of high-technology medicine. Little progress was made in the 1980s in getting women into prenatal care in the earliest stages of pregnancy, which can reduce incidence of low birth weights.

Despite the availability of a myriad of services, poor women and children may face obstacles to health care. The AIDS epidemic, drug abuse, homelessness, and other social problems have made these barriers even more complicated than in the past.

Smoking and drug abuse lower infants' birth weights. Large numbers of unintended pregnancies--79% of births to young mothers aged 15-19--also affect the survival of babies. In inner cities, food from chain restaurants and convenience stores must substitute for healthier goods available in suburban grocery stores. At the same time, more demands have been placed on government budgets. General disagreement prevails over whether the role for Federal, state, or local authorities in providing health care should be increased.

Much of the current debate revolves around financing approaches, such as Medicaid and private insurance. Eligibility requirements for Medicaid could be lowered in order to cover more of the poor. Or individuals who might not otherwise be eligible for it could pay for part of their coverage in order to provide more of the needy with health services.

Changes in financing approaches, however, may not resolve some obstacles to health care. Many inner...