In 1991, HHS funded entities in 15 rural and urban project areas which had infant mortality rates 1.5 to 2.5 times the national average. These projects are developing coordinated, comprehensive, and culturally responsive models for providing health and other support services. The goal of the Healthy Start Initiative is to reduce infant mortality by 50 percent in the 15 project areas. The initiative is based on innovation in service delivery, community commitment, personal responsibility by expectant parents, increased access to services and resources, integration of health and social services, and multiagency participation. Factors affecting the development of collaborative efforts under the Healthy Start Initiative are examined. Challenges to collaboration are identified, including community involvement, race and class, and economic development issues. Visits made to five Healthy Start sites are described in an appendix. 13 references, 10 photographs, and 1 figure