In the 20th century, infant and maternal mortality declined dramatically and the life span and quality of life for women and infants increased. At the end of the century, the rate of decline slowed and policy makers began to look for new ways to address the problem. A significant challenge now is to eliminate the persistent disparities in maternal and infant health among various racial and ethnic groups, particularly between black and white women and infants. To improve perinatal outcomes, programs are needed that focus on community-based interventions that reduce infant mortality across all racial and ethnic groups. Two promising programs that are expected to receive additional federal funding through the Children's Health Act are the Fetal and Infant Mortality Review Program and home visiting programs. Expansion of these programs may provide the vehicle to reduce disparities in maternal and infant mortality and morbidity. New programs are needed to meet the ambitious goals of Healthy People 2010.