In the last several decades there have been major improvements in the ability to control fertility, treat infertility, and reduce maternal, fetal, and infant mortality. However, neither the preterm birth rate nor the rate of long-term neurologic disabilities associated with preterm birth has declined. Increasing knowledge of the events leading to preterm birth and the pathophysiology of neonatal brain and lung injury suggests that the mortality and long-term impairments associated with these conditions will decrease. The large disparities in reproductive health and birth outcomes between industrialized and developing countries and between most other ethnic groups and blacks in the United States could be reduced by better access to already existing effective interventions.