The most disheartening aspect of a recent report on infant mortality in the United States was not the statistic that once again shows this country an embarrassing 20th in the infant-death rate, but that the answers to reducing the mortality rate have been known — and ignored — for so long.

The report by the National Commission to Prevent Infant Mortality details how the United States went from two decades of steadily reducing the mortality rate throughout the 1960s and 1970s to the early 1980s, when improvement stagnated. The infant-death rate for the United States in 1987 was 10.1 deaths per 1,000 live births. Japan’s mortality rate, for comparison, was half that. Cities such as Washington, D.C., Detroit and Philadelphia have infant-mortality rates that are more than twice the national averages of Jamaica and Costa Rica.

The commission’s findings are supported by recent studies by the Children’s Defense Fund and the Center for the Study of Social Policy, both of which concluded that the federal government isn’t providing adequate programs to reduce the infant-mortality rate in the United States. Even the earlier improvements in the infant mortality rate might be misleading. Dr. Carol Hogue of the Centers for Disease Control attributes the reductions to improved

means of keeping premature babies alive, and not to the improved health of infants.

Why does the United States have such a disappointing record? The commission’s report cites as causes crack use, AIDS, syphilis and birth to unmarried mothers, saying that “these threats have contributed to a `new morbidity’ or sickness among American infants.” It justifiably highlighted some “old morbidities,” however, such as the lack of prenatal care and a decade-long erosion of social programs.

Nutrition and education programs specifically designed to help the mothers, and prenatal and postnatal care have proven effective in reducing the number of low-birthweight babies and increasing the chances of a baby surviving the first year. Federal programs that could help pregnant women have been cut or shelved, though their costs shouldn’t be an impediment to their operation; preventative care costs a minuscule fraction of caring for low-birthweight babies.

Increasing the weight of one low-birthweight baby from 2 pounds to 2 1/2 pounds would save nearly $17,000 in acute inpatient costs alone. Improving the condition of all low birthweight babies could save more than $95 million in short-term care.

By denigrating the importance of programs that care for and educate pregnant women, the federal government has ensured that the nation’s poor have a less than equal chance of giving birth to healthy babies. The commission has clearly outlined the source of the country’s high infant-mortality rate, and has made cogent suggestions for reducing it. The government’s next step will say much about its concerns for those who most need its help.