Summary: A review was conducted of the District of Columbia's (D.C.'s) progress in improving pregnancy outcome. The District's infant mortality rate declined from 35.3 per 1,000 live births in 1966 to 24.9 per 1,000 live births in 1976. However, the District's 1976 infant mortality rate is substantially higher than the U.S. rate (15.2 per 1,000 live births) and ranks among the highest of all the States and large cities. Substantial differences also exist in the infant mortality rate among the District's nine health service areas. No organization has effectively assumed overall responsibility for seeing that the District has a concerted, systematic approach for improving pregnancy outcome. Planning responsibility is fragmented; better collection and use of data are needed; service delivery and financing need to be coordinated; resources are unevenly distributed; and many physicians are reluctant to accept medicaid patients. More concerted and coordinated efforts are needed to deal with adolescent pregnancy, and more concerted community outreach efforts are needed. The Director of the D.C. Department of Human Resources should: exert more leadership and concerted action to address adverse pregnancy outcome in the District by seeing that responsibilities among agencies for planning, financing, delivering, coordinating, and evaluating services for mothers and infants are clearly defined, understood, and carried out. He should also hasten the development and implementation of a District-wide plan for attacking this problem, work more closely with the Board of Education to pinpoint responsibilities and coordinate efforts to prevent adolescent pregnancy, assess the feasibility of increasing medicaid reimbursement rates, take other action to encourage private physicians to accept medicaid patients, and expand the use of nurse-midwifery services.
