Western European countries achieve more favorable infant mortality than the United States. Most of the excess U.S. mortality occurs in the first week of life, largely associated with very low birthweight. European countries provide extensive social and financial support for pregnant women and families with young children. Prenatal and obstetric care in Europe is more social in orientation and less interventional than in the U.S. Attention to the social and economic needs of women may more effectively reduce U.S. infant mortality than additional medical care.